The Effect of CMS's Comprehensive Care for Joint Replacement Bundled Payment Model on Trajectories of Post-acute Rehabilitation Care After Total Hip Arthroplasty.
The Effect of CMS's Comprehensive Care for Joint Replacement Bundled Payment Model on Trajectories of Post-acute Rehabilitation Care After Total Hip Arthroplasty.
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DOI：
10.1016/j.apmr.2022.05.018
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发表时间：
2022-12
影响因子：
4.3
通讯作者：
Pezzin, Liliana E.
中科院分区：
文献类型：
--
作者：
Kallies, Kara;Dillingham, Timothy R.;Edelstein, Adam;Hume, Eric;Polsky, Daniel;Schwartz, Roy;McGinley, Emily L.;Pezzin, Liliana E.
评估 CJR 政策对全髋关节置换术 (THA) 后 90 天急性后护理轨迹的影响。多变量双重差分模型适用于在受政策影响或豁免的地区在 CJR 实施之前（2014-2015 年）和 CJR 实施之后（2017 年）接受 THA 的 Medicare 受益人。标准大都市统计区 (SMSA) 的医院。全国有 357,844 名老年医疗保险患者接受 THA。无 对于最初出院到社区的患者，在出院后 90 天内将护理升级至机构化（即入住住院康复 (IRF) 或专业护理机构 (SNF)），并在最初出院到机构环境的患者中，在护理结束时返回社区。研究期间，全国 357,844 名接受 THA 的老年医疗保险患者中，47.6% 直接出院到社区，52.4% 在机构接受急性后护理。在 90 天的护理结束后，在 CJR 地区保单后出院到机构的患者返回社区的可能性比在保单豁免地区接受治疗的患者要低约 10%（OR=0.91；95%CI=0.84 – 0.98；p=0.02）。尽管幅度很大，但 CJR 实施后在捆绑区域接受治疗的患者护理升级的估计并不具有统计学意义。我们的研究结果支持进一步探索强制捆绑支付政策对结果的意外影响，以及进一步检查美国接受髋关节置换术的政策相关患者亚组的结果。
To evaluate the impact of the CJR policy on the 90-day trajectory of post-acute care following a total hip arthroplasty (THA). Multivariable difference-in-difference models applied to Medicare beneficiaries undergoing a THA prior to (2014–2015) and post-CJR implementation (2017) in areas subjected to or exempt from the policy. Hospitals in Standard Metropolitan Statistical Areas (SMSAs). 357,844 elderly Medicare patients nationwide undergoing THA. None Escalation in care to institutionalization (i.e., admission to an inpatient rehabilitation (IRF) or skilled nursing facility (SNF)) during 90-days post-discharge for those initially discharged to the community and return to the community at the end of the episode of care among those initially discharged to an institutional setting. Of the 357,844 elderly Medicare patients nationwide undergoing THA during the study period, 47.6% were discharged directly to the community while 52.4% received post-acute care in an institution. Patients discharged to an institution post-policy in a CJR area were about 10% less likely to return to the community (OR=0.91; 95 %CI=0.84 – 0.98; p=0.02) at the end of the 90-day episode of care than those treated in policy exempt areas. Despite large in magnitude, estimates of escalation in care among patients treated in bundling areas post-CJR implementation were not statistically significant. Our findings support further exploration of unanticipated effects of mandatory bundled payment policies on outcomes, as well as further examination of outcomes among policy-relevant sub-groups of patients undergoing hip replacement in the U.S.
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影响因子：
3.9
作者：
Singh, Jasvinder A.;Yu, Shaohua;Cleveland, John D.
通讯作者：
Cleveland, John D.
影响因子：
3
作者：
Elixhauser, A;Steiner, C;Coffey, RN
通讯作者：
Coffey, RN
影响因子：
6.1
作者：
Athey, S;Imbens, GW
通讯作者：
Imbens, GW
影响因子：
158.5
作者：
Barnett, Michael L.;Wilcock, Andrew;Mehrotra, Ateev
通讯作者：
Mehrotra, Ateev
Medicare和Medicaid双重合格患者之间的强制性捆绑付款协会与急性护理后的关节替代付款协会。
影响因子：
3
作者：
Li Y;Ying M;Cai X;Thirukumaran CP
通讯作者：
Thirukumaran CP