预先护理规划计费代码的实用性:对美国医院医生文件的横截面分析
Eleni Fanouraki1, Meredith A MacMartin1,2, Amber E Barnato3,4
1The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, One Medical Center Drive, Williamson Translational Research Building, 5 Th Floor, Lebanon, NH, 03756, USA.
BMC research notes
|July 2, 2025
概括
预先护理计划 (ACP) 计费代码99497和99498的敏感度不足以准确测量所有在医院中的ACP事件. 索赔数据可能低估了临床医生ACP实践的真实流行率.
科学领域:
- 医疗保健管理的管理
- 老年医学 老年医学
- 医疗账单计费 医疗账单计费
背景情况:
- 提前护理计划 (ACP) 对于将患者的偏好与医疗治疗结合起来至关重要.
- 准确测量ACP对于质量改善和研究至关重要.
- 现有的账单代码可能无法完全捕捉到ACP讨论的范围.
研究的目的:
- 为了验证ACP计费代码99497和99498的准确性,用于测量住院患者中ACP发生的情况.
- 在现实世界的医院环境中评估这些代码的敏感性和特异性.
主要方法:
- 对434次住院病人的医生笔记进行了回顾性图表审查.
- 与Medicare索赔数据相比,ACP的图表文件对计费代码99497和99498.8的数据进行了比较.
- 对文档内容的定性分析.
主要成果:
- 只有19.6%的审查图表记录了ACP.
- 非洲和非洲国家发票代码显示57.6%的敏感度和100%的特异性.
- 几乎一半 (46%) 的经过记录的非洲国家和地区对话集中在当前住院治疗上,而不是未来的偏好.
结论:
- 非洲和中东的发票代码99497和99498是特定的,但对于衡量非洲和中东的发生而言并不敏感.
- 使用这些代码的索赔数据可能低估了ACP临床实践.
- 据报道,很大一部分的ACP对话涉及到即时的护理需求,而不是长期的未来偏好.
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