捆绑支付计划和实践模式的变化以及主要胃肠道外科手术中的插曲支出
Cody Lendon Mullens1,2,3, David Schwartzman4, Samantha L Savitch1,2
1Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA.
Health services research
|September 15, 2025
概括
护理改善 - 先进 (BPCI-A) 计划的捆绑支付并没有显著改变微创手术的使用或主要胃肠道手术的90天支出. 这项研究没有发现对事件成本或外科手术方法趋势的影响.
科学领域:
- 卫生经济学 卫生经济学
- 外科手术的结果
- 医疗保健政策 医疗保健政策
背景情况:
- 医疗保健改善捆绑支付 - 先进 (BPCI-A) 旨在降低医疗保健成本并提高质量.
- 大型胃肠道手术在医疗保险计划中占据了重要的成本中心.
- 最少侵入性手术 (MIS) 往往与降低成本和改善患者结果有关.
研究的目的:
- 评估BPCI-A计划的招生与微创手术利用率的变化之间的关联.
- 评估BPCI-A参与对主要胃肠道手术90天病例支出的影响.
主要方法:
- 使用医疗保险索赔和美国医院协会数据 (2013-2021) 的比较研究.
- 参与BPCI-A的医院与不参与的对照医院进行了比较.
- 使用平衡和差异差异分析来控制混因素.
主要成果:
- 在BPCI-A和对照医院之间的90天病例支付没有显著差异 (-$172;95%CI: -$1104至$760).
- 在BPCI-A和对照医院之间,微创手术方法的利用趋势没有显著差异 (RR差异: -0.003;95%CI: -0.10至0.04).
- 在研究期间,MIS的总体使用量增加了,不管BPCI-A参与.
结论:
- 参与BPCI-A的大肠外科手术病例的医院在病例支出方面没有显著差异.
- 参与BPCI-A并没有导致微创手术方法的使用发生重大变化.
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