在COVID-19疫情期间医疗保险的护理质量指标
Jeanette Thornton, Mark Hamelburg, Lynn Nonnemaker
1AHIP, 601 Pennsylvania Ave NW, South Building, Ste 500, Washington, DC 20004.
The American journal of managed care
|August 20, 2025
概括
医疗保险优势 (MA) 计划在COVID-19大流行期间保持了比传统医疗保险 (TM) 更高的临床质量. 虽然面对面的查减少了,但药物坚持改善了,特别是在MA注册者中.
科学领域:
- 医疗服务研究
- 公共卫生
- 流行病学
背景情况:
- 随着COVID-19大流行,医疗保健提供和质量监测受到严重影响.
- 了解医疗保险优势 (MA) 和传统医疗保险 (TM) 在此期间的比较表现对于政策和患者护理至关重要.
- 评估了包括查和药物管理在内的护理质量指标,以评估计划的性能.
研究的目的:
- 为了比较COVID-19大流行对医疗保险优势 (MA) 计划和传统医疗保险 (TM) 计划中受益人提供的护理质量的影响.
- 分析在疫情前 (2019年) 和疫情 (2021年) 期间对MA和TM注册者的特定临床质量措施的变化.
- 识别疫情对各种类型的质量措施的差异性影响,例如亲自查和药物遵守.
主要方法:
- 使用了回顾性队列研究设计.
- 分析了2017年至2021年期间注册的医疗保险受益人,形成了2019年 (流行病前) 和2021年 (流行病) 的队列.
- 评估了12项临床质量措施,包括4项查措施和8项药物管理/坚持措施.
主要成果:
- 超过319万受益者被纳入分析.
- 在2019年和2021年,医疗保险优势计划在所有12项质量措施中表现明显好于传统医疗保险.
- 在疫情期间,MA和TM的个人查率均有所下降,MA的下降幅度略大. 然而,药物管理和遵守措施都得到了改善,特别是在MA计划中.
结论:
- 在COVID-19大流行期间,医疗保险优势计划在临床质量方面始终超过传统医疗保险.
- 尽管与大流行相关的挑战影响了临床护理,但药物管理计划显示出耐药性和与药物相关的质量指标的改善.
- 这些发现表明,即使在公共卫生危机中,药物管理计划也可能提供更强大的护理质量框架.
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