全关节整形手术捆绑支付计划对外科手术期间吸烟和肥胖的影响
Matthew S Galetta1, Mackenzie A Roof, Shengnan Huang
1Department of Orthopedic Surgery, NYU Langone Health, New York, New York.
Bulletin of the Hospital for Joint Disease (2013)
|February 4, 2026
概括
医疗保险提供者在捆绑支付后看到活跃吸烟者的减少. 然而,有商业保险的肥胖患者增加了,这表明在基于价值的护理模式中对高风险个体进行手术的潜在阻碍.
科学领域:
- 整形外科手术 整形外科手术
- 卫生政策 卫生政策
- 以价值为基础的护理
背景情况:
- 医疗保险 (Medicare) 的"护理费用捆绑支付"倡议鼓励以价值为基础的护理.
- 提供者面临着糟糕结果的财务风险,可能会阻止对高风险患者的护理.
- 本研究研究了可修改的风险因素 (肥胖,吸烟) 在倡议后的变化.
研究的目的:
- 描述医疗保险,医疗补助和商业保险患者吸烟状况和肥胖症的变化.
- 评估"护理捆绑支付计划"对患者风险因素的影响.
- 探索基于价值的护理模式中的潜在提供者阻碍因素.
主要方法:
- 对11,790名关节整形术患者 (2013-2019) 的回顾性观察分析.
- 根据吸烟情况 (目前,以前,从未吸烟) 和BMI (肥胖,严重肥胖,超肥胖) 分类的患者.
- 评估了不同风险类别患者的年均比例之间的相关性.
主要成果:
- 在医疗保险患者中,活跃吸烟者的统计显著下降 (7.91%至5.99%).
- 在商业保险人群中,BMI>40kg/m2的患者显著增加 (3.64%至6.65%).
- 与其他保险组相比,医疗补助患者的活跃吸烟率更高.
结论:
- 医疗保险患者在倡议后经历了活跃吸烟的显著减少.
- 肥胖症在商业保险患者中增加,但不是医疗保险患者.
- 研究结果表明,在风险共享计划中,对肥胖和吸烟患者进行手术可能有潜在的阻碍;肥胖可能比吸烟更难改变.
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