Outcomes after carotid endarterectomy among elderly dual Medicare-Medicaid-eligible patients
Outcomes after carotid endarterectomy among elderly dual Medicare-Medicaid-eligible patients
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DOI：
10.1212/wnl.0000000000006380
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发表时间：
2018-10-23
期刊：
影响因子：
9.9
通讯作者：
Lichtman, Judith H.
中科院分区：
文献类型：
--
作者：
Leifheit, Erica C.;Wang, Yun;Lichtman, Judith H.
目的 确定同时符合 Medicare 和 Medicaid 福利资格的患者在颈动脉内膜切除术 (CEA) 后的结果是否与符合仅 Medicare 资格的患者的结果相当。 方法 研究队列包括 2003 年至 2010 年间接受 CEA（ICD-9-CM 代码 38.12）的按服务付费 Medicare 受益人（ICD-9-CM 代码 38.12）。医疗补助保险被视为双重资格。我们拟合混合模型来评估覆盖范围（双重资格与仅医疗保险）和调整人口和临床特征后随时间变化的结果之间的关系。结果有 53,773 名双重资格受益人和 452,182 名仅医疗保险受益人因 CEA 住院。接受CEA的双重资格患者的比例从2003年的10.1%增加到2010年的11.5%，全国范围内的地理分布没有变化。在调整分析中，双重资格受益人与仅 Medicare 受益人相比，30 天缺血性中风或死亡的发生率更高；院内、30 天和 1 年全因死亡率较高；以及更高的 30 天全因再入院率。 2003 年至 2010 年期间，结果每年相对减少 2% 至 5%，但双重资格状态和时间之间没有显着的交互作用。 结论 双重资格受益人的结果比仅符合 Medicare 资格的受益人更差。需要进行额外的工作才能了解造成这种差异的原因。
ObjectiveTo determine whether patients who are dual eligible for Medicare and Medicaid benefits have outcomes after carotid endarterectomy (CEA) that are comparable to the outcomes of those eligible for Medicare alone.MethodsThe study cohort included fee-for-service Medicare beneficiaries >= 65 years of age who underwent CEA (ICD-9-CM code 38.12) between 2003 and 2010. Beneficiaries with >= 1 month of Medicaid coverage were considered dual eligible. We fit mixed models to assess the relationship between coverage (dual eligible vs Medicare only) and outcomes over time after adjustment for demographic and clinical characteristics.ResultsThere were 53,773 dual-eligible and 452,182 Medicare-only beneficiaries hospitalized for CEA. The percentage of dual-eligible patients receiving CEA increased from 10.1% in 2003 to 11.5% in 2010, with no change in geographic distribution across the country. In adjusted analyses, dual-eligible vs Medicare-only beneficiaries had a higher rate of 30-day ischemic stroke or death; higher in-hospital, 30-day, and 1-year all-cause mortality; and higher 30-day all-cause readmission. Relative annual reductions in outcomes from 2003 to 2010 ranged from 2% to 5%, but there was no significant interaction between dual-eligible status and time.ConclusionsDual-eligible beneficiaries had worse outcomes than those eligible for Medicare alone. Additional work is necessary to understand the reasons for this difference.