大量脊柱手术中心的成本和资源利用情况:2019年对142,617个医疗保险索赔的数据库研究
Jerry Y Du1, Rujvee P Patel2, Mitchell A Johnson2
13Center for Neuroscience and Spine, Virginia Mason Franciscan Health, Seattle, Washington.
Journal of neurosurgery. Spine
|January 22, 2026
概括
脊柱手术中医院体积较高与成本较低,住院时间较短 (LOS) 和非家庭出院率较低相关. 这表明,在以价值为基础的护理的大量中心中,从规模经济中获益.
科学领域:
- 卫生经济学 卫生经济学
- 脊柱外科手术的结果
- 基于价值的医疗保健
背景情况:
- 捆绑支付越来越关注脊柱手术中的基于价值的护理.
- 与关节关节整形相比,脊柱手术的规模经济存在有限的研究.
- 评估医院体积的影响对于优化脊柱外科手术护理的提供至关重要.
研究的目的:
- 评估医院体积对选择性住院脊柱手术的成本,住院时间 (LOS) 和出院目的地的影响.
- 分析医疗保险人口中的这些结果,以告知基于价值的护理策略.
- 识别潜在的差异和改善脊柱手术成本效益的机会.
主要方法:
- 使用的2019年医疗保险数据 (提供者分析和审查有限数据集,影响文件).
- 确定了5个脊椎手术队伍 (非融合,宫融合等). 从与诊断相关的组代码.
- 将142,617名选择性非医疗保险优势患者分为低,中,高医院体积类别.
- 采用多变量模型来评估体积和成本/LOS/放电之间的关联,控制混因素.
主要成果:
- 单变量分析显示,高数量与更高的成本和更长的LOS有关;中等数量与较低的非家庭排放有关.
- 多变量分析显示,增加的量与成本下降相关 (中等 -882美元,高 -1764美元) 和LOS (中等 -0.066天,高 -0.132天).
- 较高的医院体积显著降低了非家庭出院的风险 (调整的OR为中等的0.809,高体积的0.746).
结论:
- 在选择性脊柱手术中,增加的医院体积独立地与更低的成本,更短的LOS和减少非家庭出院风险有关.
- 大批量中心可能通过规模经济和精益实践实现效率提升,这需要进一步研究.
- 调查结果表明,对较小的医院有潜在的财务影响,需要通过捆绑支付进行公平的报销调整.
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