High rate of fistula placement in a cohort of dialysis patients in a single payer system.
High rate of fistula placement in a cohort of dialysis patients in a single payer system.
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在单一支付系统中的一组透析患者中，瘘管放置率很高。
DOI：
10.1111/j.1542-4758.2010.00479.x
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发表时间：
2010
期刊：
影响因子：
--
通讯作者：
Lipschutz,JoshuaH
中科院分区：
文献类型：
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作者：
Blosser,ChristopherD;Ayehu,Gashu;Wu,Sam;Lomagro,RuthM;Malone,Ellen;Brunelli,StevenM;Itkin,Max;Golden,Michael;McCombs,Peter;Lipschutz,JoshuaH
动静脉瘘（AVF）被认为优于动静脉移植物和导管。尽管如此，美国的 AVF 患病率仍低于既定目标。血管通路的并发症发生率和财务成本持续上升，并且不成比例地导致医疗保健成本迅速增长。对某种血管通路的经济激励与通路放置率之间的关系尚不清楚。截至 2008 年 8 月 1 日，所有在费城退伍军人事务医疗中心接受护理的慢性血液透析患者 (n=99) 均为参与者。将人口统计学特征、血管通路类型和非相对价值单位补偿作为预测因子进行评估，并分析血管通路患病率、手术时间和通路干预频率。在这组患有 51.5% 糖尿病的患者中，AVF 发生率为 73.7%。随着时间的推移，每位患者每年接受的手术次数保持不变。费城退伍军人事务医疗中心采用单一支付系统，实现了较高的 AVF 患病率，并超过了国家 AVF 目标。美国目前存在对动静脉移植物放置的经济激励，因为尽管贵要静脉转位的手术时间较长，但动静脉移植物和贵要静脉转位也有类似的医疗保险报销。费城退伍军人事务医疗中心 AVF 患病率高可能是由于 VA 非相对价值单位驱动系统允许跨学科护理、优先考虑 AVF 以及在适当时频繁使用贵要静脉转位手术。我们已经确定了一个重要的、假设生成的例子，即基于非相对价值单位的血管通路方法在患者护理和成本方面产生了优异的结果。
Arteriovenous fistulas (AVFs) are considered superior to arteriovenous grafts and catheters. Nevertheless, AVF prevalence in the United States remains under the established target. The complication rates and financial cost of vascular access continue to rise and disproportionately contribute to the burgeoning health care costs. The relationship between financial incentives for a type of vascular access and rate of access placement is unclear. All chronic hemodialysis patients (n=99) receiving care at Philadelphia Veterans Affairs Medical Center as of August 1, 2008 were participants. Demographic characteristics, vascular access type, and nonrelative value unit compensation were assessed as predictors, and the vascular access prevalence rate, operative times, and frequency of access interventions were analyzed. A 73.7% AVF rate was achieved in this cohort of patients with 51.5% diabetes mellitus. The number of access procedures per patient per year remained constant over time. The Philadelphia Veterans Affairs Medical Center, a single payer system, achieved superior AVF prevalence and exceeded the national AVF target. Financial incentives for arteriovenous graft placement currently exist in the United States, as there is similar Medicare reimbursement for arteriovenous graft and basilic vein transposition, despite longer operative times for basilic vein transpositions. The high AVF prevalence at the Philadelphia Veterans Affairs Medical Center may be due to the VA nonrelative value unit‐driven system that allows for interdisciplinary care, priority of AVFs, and frequent use of basilic vein transposition surgery, when appropriate. We have identified an important, hypothesis‐generating example of a nonrelative value unit‐based approach to vascular access yielding superior results with respect to patient care and cost.