The relationship between managed care insurance and use of lower-mortality hospitals for CABG surgery
The relationship between managed care insurance and use of lower-mortality hospitals for CABG surgery
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DOI：
10.1001/jama.283.15.1976
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发表时间：
2000-04-19
影响因子：
120.7
通讯作者：
Hannan, EL
中科院分区：
文献类型：
--
作者：
Erickson, LC;Torchiana, DF;Hannan, EL
在纽约州，关于冠状动脉旁路移植术（CABG）质量的明确信息已经有近十年的历史了;但是，在此情况下，目的比较管理式医疗保险和按服务收费（FFS）保险在低死亡率条件下接受CABG手术的患者比例，并分析其与死亡率最低的CABG手术医院的关系。死亡率医院。设计一项回顾性队列研究，对1993年至1996年的冠状动脉旁路移植术出院情况进行研究，使用纽约卫生部数据库和多变量分析，估计不同类型健康保险患者对低死亡率医院的使用情况。设置纽约的心脏外科中心，其中14家被列为低死亡率医院（平均死亡率为2.1%），17家医院被列为死亡率较高的医院（平均死亡率为3.2%）。患者共58902例年龄大于17岁的住院接受CABG手术的成年人。如果CABG手术与任何瓣膜手术或左心室动脉瘤切除术相结合，或者如果患者年龄小于65岁并参加了Medicare FFS或Medicare管理式护理，则将其排除在外。主要结果测量患者在较低的手术时间接受CABG手术的概率。结果与私人FFS保险的患者相比，（n = 18905），拥有私人管理式医疗保险的病人（n = 7169）和医疗保险管理式医疗保险（n = 880）在低死亡率医院接受CABG手术的可能性较小（相对风险[RR]在死亡率较低的医院手术的患者与私人FFS保险的患者相比，0.77; 95%置信区间[CI]，0.74-0.81; P
Context Explicit information about the quality of coronary artery bypass graft (CABG) surgery has been available for nearly a decade in New York State; however, the extent to which managed care insurance plans direct enrollees to the lowest-mortality CABG surgery hospitals remains unknown.Objective To compare the proportion of patients with managed care insurance and fee-for-service (FFS) insurance who undergo CABG surgery at lower-mortality hospitals.Design A retrospective cohort study of CABG surgery discharges from 1993 to 1996, using New York Department of Health databases and multivariate analysis to estimate the use of lower-mortality hospitals by patients with different types of health Insurance.Setting Cardiac surgical centers in New York, of which 14 were classified as lower-mortality hospitals (mean rate, 2.1%) and 17 were classified as higher-mortality hospitals (mean rate, 3.2%). Patients A total of 58 902 adults older than 17 years who were hospitalized for CABG surgery.Patients were excluded if their CABG surgery was combined with any valve procedure or left ventricular aneurysm resection or if they were younger than 65 years and enrolled in Medicare FFS or Medicare managed care.Main Outcome Measure Probability of a patient receiving CABG surgery at a lower-mortality hospital.Results Compared with patients with private FFS insurance (n = 18 905), patients with private managed care insurance (n = 7169) and Medicare managed care insurance (n = 880) were less likely to receive CABG surgery at a lower-mortality hospital (relative risk [RR] of surgery at a lower-mortality hospital compared with patients with private FFS insurance, 0.77; 95% confidence interval [CI], 0.74-0.81; P