Two-Year Impact of the Alternative Quality Contract on Pediatric Health Care Quality and Spending
Two-Year Impact of the Alternative Quality Contract on Pediatric Health Care Quality and Spending
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DOI：
10.1542/peds.2012-3440
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发表时间：
2014-01-01
期刊：
影响因子：
8
通讯作者：
Schuster, Mark A.
中科院分区：
文献类型：
--
作者：
Chien, Alyna T.;Song, Zirui;Schuster, Mark A.
目的：研究马萨诸塞州的蓝十字蓝盾全球预算安排，替代质量合同（AQC）对儿科质量和特殊卫生保健需要（CSHCN）和非CSHCN儿童的支出的2年影响。使用差异中的差异方法，我们比较了126975名接受AQC组护理的0至21岁患者与415331名接受非AQC组护理的倾向匹配患者的质量和支出趋势; 23%的参与者是CSHCN。我们比较了2006-2008年和2009-2010年AQC实施前后的质量和支出，调整了年龄，性别，健康风险评分和长期趋势的分析。儿科结局指标包括与按绩效付费（P4P）相关的4项预防措施和2项急性护理措施、与P4P无关的3项哮喘和2项注意力缺陷/多动障碍质量指标以及平均年医疗总支出。在AQC的前两年，CSHCN与P4P相关的儿科护理质量提高了1.8% AQC组与非AQC组相比，非CSHCN组为+ 1.2%（P < .001）;与P4P无关的质量指标显示无显著变化。平均每年的医疗总支出是类似的5倍以上的CSHCN比非CSHCN;有没有显着影响的AQC的支出趋势为children.CONCLUSIONS：在第一个2年的合同，AQC有一个小的，但显着的积极影响，儿科预防保健质量与P4P;这种效果是更大的CSHCN比非CSHCN。然而，它并没有显着影响（积极或消极）CSHCN措施不绑定到P4P或影响人均支出的任何一组。
OBJECTIVE: To examine the 2-year effect of Blue Cross Blue Shield of Massachusetts' global budget arrangement, the Alternative Quality Contract (AQC), on pediatric quality and spending for children with special health care needs (CSHCN) and non-CSHCN.METHODS: Using a difference-in-differences approach, we compared quality and spending trends for 126 975 unique 0-to 21-year-olds receiving care from AQC groups with 415 331 propensity-matched patients receiving care from non-AQC groups; 23% of enrollees were CSHCN. We compared quality and spending pre (2006-2008) and post (2009-2010) AQC implementation, adjusting analyses for age, gender, health risk score, and secular trends. Pediatric outcome measures included 4 preventive and 2 acute care measures tied to pay-for-performance (P4P), 3 asthma and 2 attention-deficit/hyperactivity disorder quality measures not tied to P4P, and average total annual medical spending.RESULTS: During the first 2 years of the AQC, pediatric care quality tied to P4P increased by + 1.8% for CSHCN (P < .001) and + 1.2% for non-CSHCN (P < .001) for AQC versus non-AQC groups; quality measures not tied to P4P showed no significant changes. Average total annual medical spending was similar to 5 times greater for CSHCN than non-CSHCN; there was no significant impact of the AQC on spending trends for children.CONCLUSIONS: During the first 2 years of the contract, the AQC had a small but significant positive effect on pediatric preventive care quality tied to P4P; this effect was greater for CSHCN than non-CSHCN. However, it did not significantly influence (positively or negatively) CSHCN measures not tied to P4P or affect per capita spending for either group.