Postacute Care Utilization and Episode of Care Payments Following Common Elective Operations.
Postacute Care Utilization and Episode of Care Payments Following Common Elective Operations.
复制标题
常见选择性手术后的急性期护理利用和护理付款情况。
DOI：
10.1097/sla.0000000000004814
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发表时间：
2023
影响因子：
9
通讯作者：
Telem,DanaA
中科院分区：
文献类型：
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作者：
Ehlers,AnneP;Howard,Ryan;Lai,Yen-Ling;Waljee,JenniferF;Delaney,LiaD;Nathan,Hari;Dimick,JustinB;Telem,DanaA
目的：描述PAC的使用和相关支付的病人接受常见的选择性手术。背景资料摘要：PAC的使用和成本在基准条件和操作中有很好的描述，但在普通选择程序中仍未得到充分研究。方法：对2012年至2019年在全州行政索赔数据库中接受选择性胆囊切除术、腹侧或切口疝修补术（VIHR）和腹股沟疝修补术的成年患者进行横断面研究。我们使用多变量逻辑回归来估计PAC使用的几率，并使用多变量线性回归来确定90天护理支付与PAC使用的关系。结果：在34,717名接受择期胆囊切除术的患者中，0.7%使用PAC，导致支付显著增加（19,047美元对7830美元，P< 0.001）。在29,826名接受VIHR的患者中，1.7%使用PAC，导致支付明显更高（19,766美元对9439美元，P< 0.001）。在37,006名接受腹股沟疝修补术的患者中，0.3%的患者使用PAC服务，导致支付的费用显著增加（14,886美元对8062美元，P< 0.001）。我们发现可改变的和不可改变的风险因素都与PAC的使用有关。病态肥胖与VIHR后PAC使用相关[优势比（OR） 1.61, 95%可信区间（CI） 1.29-2.02， P< 0.001]。男性在VIHR （OR 0.43, 95% CI 0.35-0.51， P< 0.001）和腹股沟疝修补中使用PAC的几率较低（OR 0.62, 95% CI 0.39-0.98， P= 0.039）。结论：我们发现了与PAC相关的可改变因素（如肥胖）和不可改变因素（如女性）。优化患者以减少PAC的使用需要了解患者的风险因素以及解决这些因素的系统和流程。
Objective:To describe PAC utilization and associated payments for patients undergoing common elective procedures.Summary of Background Data:Utilization and costs of PAC are well described for benchmarked conditions and operations but remain understudied for common elective procedures.Methods:Cross-sectional study of adult patients in a statewide administrative claims database undergoing elective cholecystectomy, ventral or incisional hernia repair (VIHR), and groin hernia repair from 2012 to 2019. We used multivariable logistic regression to estimate the odds of PAC utilization, and multivariable linear regression to determine the association of 90-day episode of care payments and PAC utilization.Results:Among 34,717 patients undergoing elective cholecystectomy, 0.7% utilized PAC resulting in significantly higher payments ($19,047 vs $7830, P< 0.001). Among 29,826 patients undergoing VIHR, 1.7% utilized PAC resulting in significantly higher payments ($19,766 vs $9439, P< 0.001). Among 37,006 patients undergoing groin hernia repair, 0.3% utilized PAC services resulting in significantly higher payments ($14,886 vs $8062, P< 0.001). We found both modifiable and non-modifiable risk factors associated with PAC utilization. Morbid obesity was associated with PAC utilization following VIHR [odds ratio (OR) 1.61, 95% confidence interval (CI) 1.29–2.02, P< 0.001]. Male sex was associated with lower odds of PAC utilization for VIHR (OR 0.43, 95% CI 0.35–0.51, P< 0.001) and groin hernia repair (OR 0.62, 95% CI 0.39–0.98, P= 0.039).Conclusions:We found both modifiable (eg, obesity) and nonmodifiable (eg, female sex) patient factors that were associated with PAC. Optimizing patients to reduce PAC utilization requires an understanding of patient risk factors and systems and processes to address these factors.