Surgical Procedures at Critical Access Hospitals Within Hospital Networks.
Surgical Procedures at Critical Access Hospitals Within Hospital Networks.
复制标题
医院网络内关键医院的手术程序。
DOI：
10.1097/sla.0000000000005772
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发表时间：
2023
影响因子：
9
通讯作者：
Ibrahim,AndrewM
中科院分区：
文献类型：
--
作者：
Mullens,CodyL;Scott,JohnW;Mead,Mitchell;Kunnath,Nicholas;Dimick,JustinB;Ibrahim,AndrewM
目的：比较医疗保险受益者中有无参加医院网络的关键准入医院的手术结果和支出。背景：关键准入医院为8000多万美国人提供基本护理。这些医院通常是乡村医院，距离另一家医院超过35英里，并被要求与其他能够提供更高水平护理的机构保持患者转移协议。一些关键通路医院进一步正式加入了医院网络。方法：这是一项从2014年到2018年的横断面回顾研究，比较了关键通路医院中有无参与医院网络的16,128名接受医疗保险受益人的阑尾切除、胆囊切除、结肠切除或疝气修补。使用考虑患者和医院因素的多变量Logistic回归对30天死亡率和再入院进行了风险调整。结果：在医院网络内的危重医院获得护理的受益人(平均年龄=75.70岁，SD=7.4%)更有可能携带≥2 Elixhauser合并症(68.7%vs.62.8%，P<；0.001)。在医院网络中的关键准入医院，30天死亡率更高(4.30%vs.3.81%，OR=1.11P<；0.001)。同样，在医院网络中的关键准入医院的再住院率更高(15.13%比14.34%，OR=1.06，P<；0.001)。此外，在医院网络中的关键通道医院，每个患者的总病程费用高出960美元(23,878美元对22,918美元，P<；0.001)。结论：医院网络内的关键通道医院为更复杂的医疗患者提供护理，并与接受普通普通手术的联邦医疗保险受益人的临床结果较差和费用较高相关。背景关键通道医院(CAH)在为8000万美国人提供医疗保健服务方面起着关键作用。1设立这一医院是为了减少这些小医院的财务脆弱性，从而改善获得护理的机会，进而维持农村社区的重要卫生保健资源。2、3 CAH条款为25家床位医院提供联邦补贴，这些医院距离附近的另一家医院35英里。4如果病人需要更高水平的护理，CAH需要提供24小时急救服务，并维持附近的转院关系。3、4一些CAH通过成为附近医院网络的正式参与者，进一步发展了这种关系。
Objective:To compare surgical outcomes and expenditures at critical access hospitals that do versus do not participate in a hospital network among Medicare beneficiaries.Background:Critical access hospitals provide essential care to more than 80 million Americans. These hospitals, often rural, are located more than 35 miles away from another hospital and are required to maintain patient transfer agreements with other facilities capable of providing higher levels of care. Some critical access hospitals have gone further to formally participate in a hospital network.Methods:This was a cross-sectional retrospective study from 2014 to 2018 comparing 16,128 Medicare beneficiary admissions for appendectomy, cholecystectomy, colectomy, or hernia repair at critical access hospitals that do versus do not participate in a hospital network. Thirty-day mortality and readmissions were risk adjusted using multivariable logistic regression accounting for patient and hospital factors. Price-standardized, risk-adjusted Medicare expenditures were compared for the 30-day total episode payments consisting of index hospitalization, physician services, readmissions, and postacute care payments.Results:Beneficiaries (average age= 75.7 years, SD= 7.4) who obtained care at critical access hospitals in a hospital network were more likely to carry≥ 2 Elixhauser comorbidities (68.7% vs. 62.8%, P< 0.001). Rates of 30-day mortality were higher at critical access hospitals in a hospital network (4.30% vs. 3.81%, OR= 1.11, P< 0.001). Similarly, readmission rates were higher at critical access hospitals that were in a hospital network (15.13% vs. 14.34%, OR= 1.06, P< 0.001). Additionally, total episode payments were found to be $960 higher per patient at critical access hospitals that were in a hospital network ($23,878 vs. $22,918, P< 0.001).Conclusions:Critical access hospitals within hospital networks provided care to more medically complex patients and were associated with worse clinical outcomes and higher costs among Medicare beneficiaries undergoing common general surgery operations.BACKGROUNDCritical access hospitals (CAHs) are pivotal in providing health care services to> 80 million Americans. 1 This hospital designation was created to improve access to care by reducing financial vulnerability of these small hospitals and, in turn, maintain vital health care resources in rural communities. 2, 3 The CAH provision provides federal subsidies to 25 bed hospitals located> 35 miles from another nearby facility. 4 CAHs are required to provide 24 hour a day emergency services and to maintain nearby transfer relationships should a patient need a higher level of care. 3, 4 Some CAHs have taken this relationship further by becoming formal participants within nearby hospital networks.