Medicare expenditures for nursing home residents triaged to nursing home or hospital for acute infection
Medicare expenditures for nursing home residents triaged to nursing home or hospital for acute infection
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DOI：
10.1111/j.1532-5415.2008.01748.x
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发表时间：
2008-07-01
影响因子：
6.3
通讯作者：
Magaziner, Jay
中科院分区：
文献类型：
--
作者：
Boockvar, Kenneth S.;Gruber-Baldini, Ann L.;Magaziner, Jay
目的：比较分流到疗养院的疗养院居民与分流到医院进行急性感染护理的疗养院居民的医疗保险支付情况。设计：采用倾向评分匹配的观察性研究。地点：马里兰州的 59 家疗养院。参与者：1992 年至 1997 年间，2285 名入住 59 家疗养院并进行随访的人。测量：人口统计和临床数据是通过访谈和医疗记录审查获得的，并与医疗保险付款记录相关联。事件感染是根据新感染诊断的病历审查或抗生素处方确定的。医院分诊定义为感染发生后 3 天内转院。使用倾向评分匹配将医院分诊患者与类似的疗养院分诊患者配对。分诊组的医疗保险支出按 1997 年美元进行比较。 结果：在 3,618 例感染病例中，28% 为泌尿生殖系统感染，20% 为皮肤感染，14% 为上呼吸道感染，12% 为下呼吸道感染，4% 为胃肠道感染，2% 为血液感染。 256 对医院和疗养院分诊病例符合匹配标准。医院和疗养院分诊组的平均医疗保险支付+/-标准差分别为每例5,202 +/- 7,310美元和996 +/- 2,475美元，平均差异为4,206美元（95%置信区间=3,260-5,151美元）。医院分诊组中每个病例的平均住院费用高出 3,628 美元，就诊费用高出 482 美元，急诊室费用高出 161 美元，熟练护理日间费用高出 147 美元。结论：对于患有急性感染的疗养院居民，医院分诊组的每例医疗保险支出高于疗养院分诊的费用。该结果可用于估计旨在减少疗养院居民使用医院的干预措施为医疗保险节省的成本。
OBJECTIVES: To compare Medicare payments of nursing home residents triaged to nursing home with those of nursing home residents triaged to the hospital for acute infection care.DESIGN: Observational study with propensity score matching.SETTING: Fifty-nine nursing homes in Maryland.PARTICIPANTS: Two thousand two hundred eighty-five individuals admitted to the 59 nursing homes and followed between 1992 and 1997.MEASUREMENTS: Demographic and clinical data were obtained from interviews and medical record review and linked to Medicare payment records. Incident infection was ascertained according to medical record review for new infectious diagnoses or prescription of antibiotics. Hospital triage was defined as hospital transfer within 3 days of infection onset. Hospital triage patients were paired with similar nursing home triage patients using propensity score matching. Medicare expenditures for triage groups were compared in 1997 dollars.RESULTS: Of 3,618 infection cases, 28% were genitourinary infections, 20% skin, 14% upper respiratory, 12% lower respiratory, 4% gastrointestinal, and 2% bloodstream. Two hundred fifty-six pairs of hospital and nursing home triage cases fulfilled matching criteria. Mean Medicare payments +/- standard deviation were $5,202 +/- 7,310 and $996 +/- 2,475 per case in the hospital and nursing home triage groups, respectively, for a mean difference of $4,206 (95% confidence interval=$3,260-5,151). Mean payments per case in the hospital triage group were $3,628 higher in inpatient expenditures, $482 higher in physician visit expenditures, $161 higher in emergency department expenditures, and $147 higher in skilled nursing day expenditures.CONCLUSION: Per-case Medicare expenditures are higher with hospital triage than for nursing home triage for nursing home residents with acute infection. This result may be used to estimate cost savings to Medicare of interventions designed to reduce hospital use by nursing home residents.