Physician Participation in Meaningful Use and Quality of Care for Medicare Fee-for-Service Enrollees
Physician Participation in Meaningful Use and Quality of Care for Medicare Fee-for-Service Enrollees
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DOI：
10.1111/jgs.14704
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发表时间：
2017-03-01
影响因子：
6.3
通讯作者：
Kaushal, Rainu
中科院分区：
文献类型：
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作者：
Jung, Hye-Young;Unruh, Mark Aaron;Kaushal, Rainu
目标有意义的使用计划已通过激励计划提供近300亿美元，以鼓励提供者采用和使用电子健康记录。本研究的目的是评估门诊医生参与有意义的使用对向Medicare按服务收费（FFS）登记者提供的护理质量的影响。设计回顾性队列研究。设置涵盖2010年1月至2012年12月期间的100%住院和门诊Medicare FFS索赔。来自纽约州的110名Medicare FFS入组者。测量住院和急诊科（艾德）就诊，用于门诊护理敏感性疾病（ACSC）、糖尿病视网膜病变筛查、糖尿病肾病筛查、结直肠癌筛查，结果医生参与有意义使用倡议与ACSC相关住院率的降低无关（0.0个百分点，95%置信区间（CI）：0.0-0.1）或艾德访视（0.0个百分点，95% CI：0.0-0.1）。有意义的使用参与与结直肠癌筛查的更高几率相关（比值比（OR）：1.2，95% CI：1.1-1.4），但不适用于糖尿病视网膜病变筛查（OR：1.1，95% CI：1.0-1.2）、糖尿病肾病筛查（OR：1.0，95% CI：0.8-1.2）或流感疫苗接种（OR：1.1，95% CI：1.0-1.2）。在二次分析中发现了类似的结果，双重资格的受益人参加医疗保险和Medicaid.ConclusionPhysician参与有意义的使用是不相关的六个质量措施的实质性改善。
ObjectivesThe Meaningful Use initiative has made nearly $30 billion available through incentive programs to encourage provider adoption and use of electronic health records. The objective of this study was to evaluate the impact of outpatient physicians' participation in Meaningful Use on the quality of care provided to Medicare fee-for-service (FFS) enrollees.DesignRetrospective cohort study.SettingOne hundred percent inpatient and outpatient Medicare FFS claims covering the period January 2010 through December 2012.Participants303,110 Medicare FFS enrollees from New York State.MeasurementsHospitalizations and emergency department (ED) visits for ambulatory care sensitive conditions (ACSCs), diabetic retinopathy screening, diabetic nephropathy screening, colorectal cancer screening, and influenza vaccinations.ResultsPhysician participation in the Meaningful Use initiative was not associated with reductions in ACSC-related hospitalizations (0.0 percentage points, 95% confidence interval (CI): 0.0-0.1) or ED visits (0.0 percentage points, 95% CI: 0.0-0.1) relative to the comparison group. Meaningful Use participation was associated with higher odds of colorectal cancer screening (odds ratio (OR): 1.2, 95% CI: 1.1-1.4) relative to the comparison group, but not for diabetic retinopathy screening (OR: 1.1, 95% CI: 1.0-1.2), diabetic nephropathy screening (OR: 1.0, 95% CI: 0.8-1.2), or influenza vaccinations (OR: 1.1, 95% CI: 1.0-1.2). Similar results were found in secondary analyses of dually-eligible beneficiaries participating in both Medicare and Medicaid.ConclusionPhysician participation in Meaningful Use was not associated with substantial improvements on six quality measures.