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社区护理对脊柱外科复杂性和退伍军人卫生管理局结果的影响
Allison Dorneo1,2, Yi-Jung Shen1,2, Aigerim Kabdiyeva2
1Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, Massachusetts, USA.
Health services research
|October 17, 2025
概括
退伍军人的社区护理 (CC) 脊柱手术更复杂,但与退伍军人卫生管理局 (VHA) 护理相比没有改善结果. 这表明VHA可能会为更密集的程序提供资金,而不会带来质量效益.
科学领域:
- 医疗保健服务研究 医疗服务研究
- 脊柱外科手术的结果
- 退伍军人卫生管理局退伍军人卫生管理局
背景情况:
- 社区护理 (CC) 是退伍军人卫生管理局 (VHA) 为退伍军人提供护理的替代方案.
- 了解CC与VHA在脊椎手术中的比较有效性对于资源配置和患者的治疗结果至关重要.
研究的目的:
- 调查社区护理 (CC) 治疗,手术复杂性和退伍军人脊柱手术中术后手术结果之间的关系.
- 评估VHA和CC脊椎手术复杂性和结果的差异.
主要方法:
- 使用了来自企业数据仓库的退伍军人健康管理局 (VHA) 数据和诊断为腰椎缩 (LSS) 的退伍军人的CC索赔.
- 使用后勤回归和仪器变量分析 (纽威校正) 来评估CC对手术复杂性,30天再入院,30天并发症和1年的重新手术的影响.
- 分析了2019年1月1日至2022年12月31日期间进行的脊柱手术的数据,对于距离VHA设施80英里的LSS患者.
主要成果:
- 在41,726名LSS患者中,7,496人 (18.0%) 接受了脊椎手术;在VHA中为39.0%,在CC中为61.0%.
- 原始模型表明,CC手术与复杂手术,再入院和重新手术的可能性增加有关.
- 经过对混因素进行调整后,只有CC使用与复杂手术增加概率之间的关联仍然显著 (36.48个百分点).
结论:
- 在VHA和CC中接受脊椎手术的退伍军人之间没有观察到术后外科结果的显著差异.
- 接受CC脊椎手术的退伍军人更有可能接受复杂的手术.
- VHA可能在社区中资助更昂贵,资源密集的脊柱手术,而没有相应的质量或结果改善.
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