医院出院后的过渡性护理管理与替代支付模式之间的重叠
Joseph H Joo1, MacKenzie L Hughes2, Wen Hu2
1Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
在医院后的转换过程中, 关怀协调是至关重要的. 替代性支付模式 (APM) 和过渡性护理管理 (TCM) 服务有很大的重叠,但接受TCM的APM患者不太可能来自服务不足的群体,这引发了健康差异的担忧.
科学领域:
- 医疗服务研究
- 卫生政策
- 健康上的差异
背景情况:
- 有效的护理协调对于成功的医院后过渡至关重要.
- 医疗保险和医疗补助服务中心 (CMS) 通过替代支付模式 (APM) 和过渡性护理管理 (TCM) 服务促进护理协调.
- 关于APM和TCM计划中受益人的重叠和特征的数据有限.
研究的目的:
- 为了比较APM和TCM组中的受益人的特点.
- 量化APM排放和涉及TCM服务的排放之间的重叠.
- 确定与APM和TCM交集相关的潜在健康差异.
主要方法:
- 对超过700万受益者和1100万退院者的2018-2019年医疗保险索赔数据进行分析.
- 通过APM和TCM组对受益人特征进行比较.
- 量化APM排放和TCM利用之间的重叠.
主要成果:
- 41.6%的排放符合APM,14%涉及TCM.
- 在符合APM的排放中,TCM服务占19.7%.
- 与非APM受益者相比,56.7%的TCM服务提供给了APM受益者,这些受益者不太可能来自服务不足的人群.
结论:
- 在医疗保险中,APM和TCM服务存在显著的重叠.
- 接受TCM的APM受益者可能代表较不多样化的群体,这表明潜在的健康差异存在问题.
- 需要进一步研究以了解这种重叠对护理协调和患者结果的影响.
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