服务费支付是否增加了心脏衰竭退伍军人的访问量和质量? 一个追溯的队列分析
Yi-Jung Shen1,2, Rebecca Thorsness3, Steven D Pizer4,5
1Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA, USA. yjshen@bu.edu.
Journal of general internal medicine
|December 16, 2025
概括
社区护理 (CC) 心脏病服务的服务费 (FFS) 支付显著增加了心力衰竭患者的门诊访问利用率. 然而,这种增加的利用率并没有导致测量质量的有意义的改善或可预防的入院.
科学领域:
- 医疗保健服务研究 医疗服务研究
- 心脏病学 心脏病学
- 卫生经济学 卫生经济学
背景情况:
- 退伍军人卫生管理局 (VHA) 使用有薪工作人员的直接护理 (DC) 和社区护理 (CC) 门诊服务的收费服务 (FFS).
- 越来越多的CC使用率引发了关于FFS激励措施推动使用率和影响护理质量的问题.
研究的目的:
- 评估FFS支付模式对VHA内心力衰竭患者门诊心脏病护理利用率和质量的影响.
主要方法:
- 对70,841名新诊断为心力衰竭的退伍军人的回顾性队列分析 (2021年7月至2023年12月).
- 使用两阶段的仪器变量模型来评估CC心脏病诊所与心脏病诊所总数的比例.
- 结果包括180天的心脏病门诊,潜在可预防的心力衰竭入院和所有原因的入院.
主要成果:
- 与仅使用DC (3.18) 的退伍军人相比,仅使用CC的退伍军人进行了更多的心脏病检查 (5.39).
- 增加的心电比与更高的心脏病诊所利用率相关 (IRR=2.09).
- 没有观察到可预防住院病例的显著改善 (OR=0.92) 和所有原因住院病例的边际改善 (OR=0.93).
结论:
- FFS支付显著增加了心脏衰竭患者的心脏病门诊利用率.
- 这种增加的利用率并没有转化为衡量质量结果的有意义的改善.
- 需要进一步的研究来探索增加利用的潜在好处.
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