Association Between Care Fragmentation and Total Spending After Durable Left Ventricular Device Implant: A Mediation Analysis of Health Care-Associated Infections Within a National Medicare-Society of Thoracic Surgeons Intermacs Linked Dataset.
Association Between Care Fragmentation and Total Spending After Durable Left Ventricular Device Implant: A Mediation Analysis of Health Care-Associated Infections Within a National Medicare-Society of Thoracic Surgeons Intermacs Linked Dataset.
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耐用左心室装置植入后护理碎片化与总支出之间的关联：国家医疗保险-胸外科医生协会 Intermacs 关联数据集中医疗保健相关感染的中介分析。
DOI：
10.1161/circoutcomes.121.008592
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发表时间：
2022
期刊：
影响因子：
--
通讯作者：
MichiganCongestiveHeartFailu
中科院分区：
文献类型：
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作者：
Kim,KDennie;Funk,RussellJ;Hou,Hechuan;Airhart,Austin;Nassar,Khalil;Pagani,FrancisD;Zhang,Min;Chandanabhumma,PPaul;Aaronson,KeithD;Chenoweth,CarolE;Hider,Ahmad;Cabrera,Lourdes;Likosky,DonaldS;MichiganCongestiveHeartFailu
背景护理碎片与持久性左心室辅助装置（LVAD）植入后的较高感染率相关。鲜为人知的是，护理碎片和总支出之间的关系，以及这种关系是否是介导的infections.MethodsTotal付款被捕获从入院到出院后180天。利用网络理论，基于2009年7月至2017年4月期间接受LVAD植入的4，987名医疗保险受益人的提供者（即麻醉师，心脏外科医生，心脏病学家，重症监护专家，护士执业者，医生助理）之间的共享患者数量，制定了护理碎片化的衡量标准。使用平均路径长度来测量护理碎片化，平均路径长度描述了网络成员之间信息流动的效率;路径长度越长，碎片化程度越大。Terciles的基础上的护理碎片化和多变量回归水平被用来分析护理碎片化和LVAD付款和调解分析之间的关系被用来评估植入后infections.ResultsThe患者队列的作用是81%的男性，73%白色，11%Intermacs配置文件1的平均（SD）年龄为63.1岁（11.1）。提供者网络中的平均（SD）护理碎片化水平为1.7（0.2），从入院到出院后180天的平均（SD）支付为246，905（109，872）。平均（SD）总支付在低，中，高三分位数的护理碎片分别为250，135（111，924），243，288（109，376）和247，290（108，241）。在中介分析中，通过感染，护理碎片化对总支付额的间接影响是积极的，具有统计学意义（β= 16032.5，p= 0.008）。减少护理碎片化的干预措施可能会降低感染的发生率，从而提高对接受持久LVAD植入术患者的护理价值。
BackgroundCare fragmentation is associated with higher rates of infection after durable left ventricular assist device (LVAD) implant. Less is known about the relationship between care fragmentation and total spending, and whether this relationship is mediated by infections.MethodsTotal payments were captured from admission to 180 days post-discharge. Drawing on network theory, a measure of care fragmentation was developed based on the number of shared patients among providers (ie, anesthesiologists, cardiac surgeons, cardiologists, critical care specialists, nurse practitioners, physician assistants) caring for 4,987 Medicare beneficiaries undergoing LVAD implantation between July 2009-April 2017. Care fragmentation was measured using average path length, which describes how efficiently information flows among network members; longer path length indicates greater fragmentation. Terciles based on the level of care fragmentation and multivariable regression were used to analyze the relationship between care fragmentation and LVAD payments and mediation analysis was used to evaluate the role of post-implant infections.ResultsThe patient cohort was 81% male, 73% white, 11% Intermacs Profile 1 with mean (SD) age of 63.1 years (11.1). The mean (SD) level of care fragmentation in provider networks was 1.7 (0.2) and mean (SD) payment from admission to 180 days post-discharge was 246,905( 109,872). Mean (SD) total payments at the lower, middle, and upper terciles of care fragmentation were 250,135( 111,924), 243,288( 109,376), and 247,290( 108,241), respectively. In mediation analysis, the indirect effect of care fragmentation on total payments, through infections, was positive and statistically significant (β= 16032.5, p= 0.008).ConclusionsGreater care fragmentation in the delivery of care surrounding durable LVAD implantation is associated with a higher incidence of infections, and consequently, higher payments for Medicare beneficiaries. Interventions to reduce care fragmentation may reduce the incidence of infections and in turn enhance the value of care for patients undergoing durable LVAD implantation.