Impact of the Medicare Short Stay Transfer Policy on patients undergoing major orthopedic surgery.
Impact of the Medicare Short Stay Transfer Policy on patients undergoing major orthopedic surgery.
复制标题
医疗保险短期转院政策对接受大型骨科手术的患者的影响。
DOI：
10.1111/j.1475-6773.2006.00606.x
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发表时间：
2007
影响因子：
3.4
通讯作者：
Ettner,SusanL
中科院分区：
文献类型：
--
作者：
FitzGerald,JohnD;Boscardin,WJohn;Hahn,BevraH;Ettner,SusanL
目的：研究短期住院转移政策（SSTP）对实践模式的影响。数据来源：本研究使用的数据来自医疗保险和医疗补助服务中心医疗保险提供者分析和审查（MEDPAR）文件，家庭健康标准分析文件，1999年服务提供者文件，研究设计：采用中断的时间序列分析来检查住院时间（LOS）和“早期”的概率。出院后急诊护理（PAC）。数据收集。选择1996年1月1日至2000年12月31日期间接受择期关节置换（JR）手术或髋关节骨折（FX）手术治疗的所有按服务付费医疗保险接受者的100%样本。主要发现。在实施SSTP之前。JR和FX患者的LOS每年分别下降0.37和0.30天。在实施SSTP后，服务水平分别立即增加了0.20和0.17天。此后，服务水平一直保持平稳。JR和FX患者中“提前”出院接受PAC的患者比例分别以每年4.4和2.6个百分点的速度上升，1998年9月达到高峰，分别为28.8%和20.4%。在实施SSTP之后，“早期”PAC的使用率下降了4.3和3.0个百分点。此后，早期PAC的利用率以慢得多的速度增长（JR）或保持平稳（FX）。有显着的区域变化的幅度响应policy.Conclusion。SSTP的实施减少了财政激励出院患者早期PAC。这主要是通过延长服务时间来实现的，而PAC的利用率没有发生有意义的变化。随着最近SSTP扩展到29个DRG（占所有出院人数的34%），这些发现对患者护理具有重要意义。
Objective.To examine the impact of the Short Stay Transfer Policy (SSTP) on practice patterns.Data Sources.This study uses data from the Centers for Medicare and Medicaid Services Medicare Provider Analysis and Review (MEDPAR) file, Home Health Standard Analytical File, 1999 Provider of Service file, and data from the 2000 United States Census.Study Design.An interrupted time‐series analysis was used to examine the length of stay (LOS) and probability of “early” discharge to post acute care (PAC).Data Collection.Separate 100percent samples of all fee‐for‐service Medicare recipients undergoing either elective joint replacement (JR) surgery or surgical management of hip fracture (FX) between January 1, 1996 and December 31, 2000 were selected.Principal Findings.Prior to implementation of the SSTP. LOS had been falling by 0.37 and 0.30 days per year for JR and FX patients respectively. After implementation of the SSTP, there was an immediate increase in LOS by 0.20 and 0.17 days, respectively. Thereafter, LOS remained flat. The proportion of patients discharged “early” to PAC had been rising by 4.4 and 2.6 percentage points per year for JR and FX patients respectively, to a peak of 28.8percent and 20.4percent early PAC utilization in September 1998. Immediately after implementation of the SSTP, there was a 4.3 and 3.0 percentage point drop in utilization of “early” PAC. Thereafter utilization of early PAC increased at a much slower rate (for JR) or remained flat (for FX). There was significant regional variation in the magnitude of response to the policy.Conclusion.Implementation of the SSTP reduced the financial incentive to discharge patients early to PAC. This was accomplished primarily through longer LOS without meaningful change in PAC utilization. With the recent expansion of the SSTP to 29 DRGs (representing 34percent of all discharges), these findings have important implications regarding patient care.