Learning From England's Best Practice Tariff: Process Measure Pay-for-Performance Can Improve Hip Fracture Outcomes.
Learning From England's Best Practice Tariff: Process Measure Pay-for-Performance Can Improve Hip Fracture Outcomes.
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DOI：
10.1097/sla.0000000000004305
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发表时间：
2022-03-01
影响因子：
9
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这项研究的目的是评估英国的最佳实践关税（BPT），并考虑医疗保险患者的潜在影响，如果美国采取类似的计划。自《平价医疗法案》开始实施以来，医疗保险通过引入一套不断扩大的替代支付模式，重新努力改善老年人的结果。在创伤患者中，考虑到创伤患者的异质性和由此产生的结局差异，推荐的安排取得了喜忧参半的成功。在英国，一种治疗髋部骨折的新方法可以提供一种可行的替代方案。使用2000年至2016年Medicare（美国）、HES-APC（英格兰）死亡证明相关索赔（≥65岁）的线性回归、中断时间序列、差异中的差异和反事实模型：跟踪美国髋部骨折趋势，观察BPT实施前后英国髋部骨折趋势的变化，比较美国与英国死亡率的变化，并估计总/理论挽救生命。共纳入806，036例英国和3，221，109例美国住院患者。实施BPT后，英格兰的30天死亡率较基线9.9%（相对降低26.3%）降低了2.6个百分点（95%CI：1.7-3.5）。90-365天死亡率分别降低5.6和5.4个死亡点。30/90/365天再入院率也随着住院时间的缩短而下降。从2000年到2016年，美国的结果停滞不前（P > 0.05），导致各国的死亡率倒置，美国每年挽救的潜在生命超过38，000人。过程测量按绩效付费导致英国髋部骨折结局的显著改善。随着改善美国老年人健康的努力不断增加，从BPT这样的成功举措中可以学到重要的经验教训。
The objective of this study was to evaluate England’s Best Practice Tariff (BPT) and consider potential implications for Medicare patients should the US adopt a similar plan. Since the beginning of the Affordable Care Act, Medicare has renewed efforts to improve the outcomes of older adults through introduction of an expanding set of alternative-payment models. Among trauma patients, recommended arrangements met with mixed success given concerns about the heterogeneous nature of trauma patients and resulting outcome variation. A novel approach taken for hip fractures in England could offer a viable alternative. Linear regression, interrupted time-series, difference-in-difference, and counterfactual models of 2000 to 2016 Medicare (US), HES-APC (England) death certificate-linked claims (≥65 years) were used to: track US hip fracture trends, look at changes in English hip fracture trends before-and-after BPT implementation, compare changes in US-versus-English mortality, and estimate total/theoretical lives saved. A total of 806,036 English and 3,221,109 US hospitalizations were included. After BPT implementation, England’s 30-day mortality decreased by 2.6 percentage-points (95%CI: 1.7–3.5) from a baseline of 9.9% (relative reduction 26.3%). 90- and 365-day mortality decreased by 5.6 and 5.4 percentage-points. 30/90/365-day readmissions also declined with a concurrent shortening of hospital length-of-stay. From 2000 to 2016, US outcomes were stagnant (P > 0.05), resulting in an inversion of the countries’ mortality and >38,000 potential annual US lives saved. Process measure pay-for-performance led to significant improvements in English hip fracture outcomes. As efforts to improve US older adult health continue to increase, there are important lessons to be learned from a successful initiative like the BPT.