The Effects of Global Budgeting on Emergency Department Admission Rates in Maryland
The Effects of Global Budgeting on Emergency Department Admission Rates in Maryland
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DOI：
10.1016/j.annemergmed.2019.06.009
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发表时间：
2020-03-01
影响因子：
6.2
通讯作者：
Pines, Jesse M.
中科院分区：
文献类型：
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作者：
Galarraga, Jessica E.;Black, Bernard;Pines, Jesse M.
研究目标：2014年，马里兰州推出了一种基于人口的支付模式，用全球预算取代了按服务收费的所有基于医院的服务。这一全球预算收入计划为医院提供了强大的激励措施，以严格控制病人数量并实现预算目标。我们检验了全球预算收入模式对急诊科入院率的影响。方法：我们使用医疗记录和账单数据来检查从2012年1月1日到2015年12月31日在25家以医院为基础的急诊科，包括10家马里兰州全球预算收入医院，10家匹配的非马里兰州医院(一级对照)和5家马里兰州患者总收入医院(二级对照)的成人急诊科就诊情况。2010年，根据马里兰州一项针对乡村医院的试点计划，患者总收入医院采用了全球预算。结果：在3,175,210次急诊就诊中，马里兰州全球预算收入医院的急诊住院率比非马里兰州对照医院下降了0.6%(95%可信区间-0.8%至-0.4%)，相对下降3.0%。与病人总收入医院相比，下降1.9%(95%可信区间-2.2%至-1.7%)，相对下降9.5%。在门诊护理敏感和非门诊护理敏感的情况下，急诊入院率的相对下降是相似的。不同临床条件下的入院率下降情况不同。结论：全球预算收入模型的实施导致急诊入院率在前两年有统计学意义上的显著下降，尽管幅度不大，其中急诊入院人数的下降在某些临床情况下最为明显。
Study objective: In 2014, Maryland launched a population-based payment model that replaced fee-for-service payments with global budgets for all hospital-based services. This global budget revenue program gives hospitals strong incentives to tightly control patient volume and meet budget targets. We examine the effects of the global budget revenue model on rates of admission to the hospital from emergency departments (EDs).Methods: We used medical record and billing data to examine adult ED encounters from January 1, 2012, to December 31, 2015, in 25 hospital-based EDs, including 10 Maryland global budget revenue hospitals, 10 matched non-Maryland hospitals (primary control), and 5 Maryland Total Patient Revenue hospitals (secondary control). Total Patient Revenue hospitals adopted global budgeting in 2010 under a pilot Maryland program targeting rural hospitals. We conducted difference-in-differences analyses for overall ED admission rates, ED admission rates for ambulatory-care-sensitive conditions and non-ambulatory-care-sensitive conditions, and for clinical conditions that commonly lead to admission.Results: In 3,175,210 ED encounters, the ED admission rate for Maryland global budget revenue hospitals decreased by 0.6% (95% confidence interval -0.8% to -0.4%) compared with that for non-Maryland controls after global budget revenue implementation, a 3.0% relative decline, and decreased by 1.9% (95% confidence interval -2.2% to -1.7%) compared with that for Total Patient Revenue hospitals, a 9.5% relative decline. Relative declines in ED admission rates were similar for ambulatory-care-sensitive-condition and non-ambulatory-care-sensitive-condition encounters. Admission rate declines varied across clinical conditions.Conclusion: Implementation of the global budget revenue model led to statistically significant although modest declines in ED admission rates within its first 2 years, with declines in ED admissions most pronounced among certain clinical conditions.