Impact of Cuts in Reimbursement on Outcome of Acute Myocardial Infarction and Use of Percutaneous Coronary Intervention A Nationwide Population-based Study Over the Period 1997 to 2008
Impact of Cuts in Reimbursement on Outcome of Acute Myocardial Infarction and Use of Percutaneous Coronary Intervention A Nationwide Population-based Study Over the Period 1997 to 2008
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DOI：
10.1097/mlr.0b013e318235382b
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发表时间：
2011-12-01
期刊：
影响因子：
3
通讯作者：
Tung, Yu-Chi
中科院分区：
文献类型：
--
作者：
Chang, Guann-Ming;Cheng, Shou-Hsia;Tung, Yu-Chi
背景资料：削减报销（如美国的平衡预算法案或全球预算）对病人护理质量的影响是医疗保健改革的一个重要问题。关于补偿削减是否与急性心肌梗死（AMI）护理的过程和结果相关的信息有限。目的：我们使用全国纵向人群数据来研究30天死亡率和经皮冠状动脉介入治疗（PCI）自2002年7月以来，AMI患者的使用根据实施医院全球预算引起的财务压力程度而变化Taiwan.Methods:我们分析了台湾1997年至2008年期间所有102，520名在台湾综合急症医院住院的AMI患者，通过台湾全民健康保险研究数据库。多层次逻辑回归分析进行调整后，患者，医生和医院的特点，以测试与30天死亡率和PCI use.Results的补偿削减的关联：支付减少对整体医院收入的平均幅度最高（10.02%）在2004年至2005年期间。大幅削减报销与较高的调整后30天死亡率相关。报销削减和PCI use.Conclusions：AMI患者的死亡率增加下增加的经济压力，从削减报销之间没有统计学显着的相关性。然而，在整个研究期间，PCI的使用不受影响。负边际贡献或高成本服务的数量或质量的降低，如护士配备，可以解释报销削减与AMI结局之间的关联。
Background: The impact of cuts in reimbursement, such as the Balanced Budget Act in the United States or global budgeting, on the quality of patient care is an important issue in health-care reform. Limited information is available regarding whether reimbursement cuts are associated with processes and outcomes of acute myocardial infarction (AMI) care.Objectives: We used nationwide longitudinal population-based data to examine how 30-day mortality and percutaneous coronary intervention (PCI) use for AMI patients changed in accordance with the degree of financial strain induced by the implementation of hospital global budgeting since July 2002 in Taiwan.Methods: We analyzed all 102,520 AMI patients admitted to general acute care hospitals in Taiwan over the period 1997 to 2008 through Taiwan's National Health Insurance Research Database. Multilevel logistic regression analysis was performed after adjustment for patient, physician, and hospital characteristics to test the association of reimbursement cuts with 30-day mortality and PCI use.Results: The mean magnitude of payment reduction on overall hospital revenues was highest (10.02%) during the period 2004 to 2005. Large reimbursement cuts were associated with higher adjusted 30-day mortality. There was no statistically significant correlation between reimbursement cuts and PCI use.Conclusions: The mortality of AMI patients increases under increased financial strain from cuts in reimbursement. Nevertheless, the use of PCI is not affected throughout the study period. Reductions in the quantity or quality of services with a negative contribution margin or high cost, such as nurse staffing, may explain the association between reimbursement cuts and AMI outcome.