Variation in Risk-Standardized Acute Admission Rates Among Patients With Heart Failure in Accountable Care Organizations: Implications for Quality Measurement.
Variation in Risk-Standardized Acute Admission Rates Among Patients With Heart Failure in Accountable Care Organizations: Implications for Quality Measurement.
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DOI：
10.1161/jaha.122.029758
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发表时间：
2023-07-04
影响因子：
5.4
通讯作者：
Lagu, Tara
中科院分区：
文献类型：
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作者：
Chuzi, Sarah;Lindenauer, Peter K.;Faridi, Kamal;Priya, Aruna;Pekow, Penelope S.;D'Aunno, Thomas;Mazor, Kathleen M.;Stefan, Mihaela S.;Spatz, Erica S.;Gilstrap, Lauren;Werner, Rachel M.;Lagu, Tara
关键词：
责任医疗组织 (ACO) 旨在提高医疗保健质量并降低成本，包括心力衰竭 (HF) 患者的医疗保健质量。然而，不同 ACO 心衰患者入院率的差异以及相关因素尚未得到很好的描述。我们确定了心力衰竭的医疗保险按服务收费受益人，他们在 2017 年被分配到医疗保险共享储蓄计划 ACO，并在 2018 年生存了 ≥30 天。我们计算了 ACO 的风险标准化急性入院率，将 ACO 分配到 3 个表现类别中的一个，并检查了 ACO 特征和表现类别之间的关联。在 1 232 222 名心力衰竭受益人中，283 795 人（平均年龄 81 岁；54% 女性；86% 白人；78% 城市）被分配到 467 个医疗保险共享储蓄计划 ACO 中的 1 个。在 ACO 中，中位风险标准化急性入院率为每 100 人 87 例入院，范围为每 100 名受益人 61 例（最低）到 109 例（最高）入院。与总体平均水平相比，13% 的 ACO 在风险标准化急性入院率方面表现较好，72% 没有差异，14% 表现较差。大多数绩效较好的 ACO 的黑人受益人较少，并且不隶属于医院。大多数表现低于平均水平的 ACO 规模较大，位于东北部，有医院附属机构，并且初级保健提供者的比例较低。 ACO 中患有心衰的受益人入院很常见，并且各个 ACO 的风险标准化急性入院率存在差异。 ACO 性能与某些 ACO 特征相关。未来的研究应尝试阐明 ACO 结构和特征与入院风险之间的关系。
Accountable care organizations (ACOs) aim to improve health care quality and reduce costs, including among patients with heart failure (HF). However, variation across ACOs in admission rates for patients with HF and associated factors are not well described. We identified Medicare fee‐for‐service beneficiaries with HF who were assigned to a Medicare Shared Savings Program ACO in 2017 and survived ≥30 days into 2018. We calculated risk‐standardized acute admission rates across ACOs, assigned ACOs to 1 of 3 performance categories, and examined associations between ACO characteristics and performance categories. Among 1 232 222 beneficiaries with HF, 283 795 (mean age, 81 years; 54% women; 86% White; 78% urban) were assigned to 1 of 467 Medicare Shared Savings Program ACOs. Across ACOs, the median risk‐standardized acute admission rate was 87 admissions per 100 people, ranging from 61 (minimum) to 109 (maximum) admissions per 100 beneficiaries. Compared to the overall average, 13% of ACOs performed better on risk‐standardized acute admission rates, 72% were no different, and 14% performed worse. Most ACOs with better performance had fewer Black beneficiaries and were not hospital affiliated. Most ACOs that performed worse than average were large, located in the Northeast, had a hospital affiliation, and had a lower proportion of primary care providers. Admissions are common among beneficiaries with HF in ACOs, and there is variation in risk‐standardized acute admission rates across ACOs. ACO performance was associated with certain ACO characteristics. Future studies should attempt to elucidate the relationship between ACO structure and characteristics and admission risk.