Post-Acute Care Use Associated with Medicare Shared Savings Program and Disparities.
Post-Acute Care Use Associated with Medicare Shared Savings Program and Disparities.
复制标题
与医疗保险共享储蓄计划和差异相关的急性后护理使用。
DOI：
10.1016/j.jamda.2022.07.024
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发表时间：
2022
影响因子：
7.6
通讯作者：
Li,Yue
中科院分区：
文献类型：
--
作者：
Kim,Yeunkyung;Thirukumaran,Caroline;Temkin-Greener,Helena;Holloway,Robert;Hill,Elaine;Li,Yue
医疗保险共享储蓄计划（MSSP）于2012年实施，但MSSP对机构急性后护理（PAC）使用的影响，以及种族/民族和付款人身份的研究较少。我们研究了医院参与MSSP对机构PAC使用的影响，以及3个医疗保险患者组中种族/民族和付款人身份的变化：缺血性中风、髋部骨折和选择性全关节置换术（TJA）。设计2010-2016年医疗保险提供者分析和审查文件的回顾性分析。设置和参与者最初因缺血性中风、髋部骨折入院的医疗保险按服务收费患者，方法患者水平的线性概率模型与差异中的差异方法被用来比较在机构PAC使用的变化，在MSSP参与医院与非参与医院，以及比较不同的变化，种族/随着时间的推移，机构PAC使用的种族和付款人状态。与非MSSP参与医院相比，缺血性卒中队列的95%可信区间（CI）为0.00- 0.3，P <0.05。关于人种/种族和支付者身份的差异，对于择期TJA患者，在参与MSSP的医院中，少数种族患者在机构PAC使用方面比白色患者高3.8个百分点（95%CI 0.01- 0.06，P <0.01）。此外，对于缺血性卒中队列，在MSSP参与医院的双重合格患者在机构PAC使用方面比仅Medicare患者高2.0个百分点（95%CI 0.00- 0.04，P <0.10）。此外，与非MSSP参与医院相比，MSSP参与医院更有可能将少数种族患者的择期TJA和双重资格的缺血性卒中患者出院至机构PAC。
ObjectivesMedicare Shared Savings Program (MSSP) was implemented in 2012, but the impact of the MSSP on institutional post-acute care (PAC) use, and by race/ethnicity and payer status is less studied. We studied the impact of hospital participation in the MSSP on institutional PAC use and variations by race/ethnicity and payer status among 3 Medicare patient groups: ischemic stroke, hip fracture, and elective total joint arthroplasty (TJA).DesignA retrospective analysis of 2010–2016 Medicare Provider Analysis and Review files.Setting and ParticipantsMedicare fee-for-service patients originally admitted for ischemic stroke, hip fracture, or elective TJA in MSSP-participating hospitals or nonparticipating hospitals.MethodsPatient-level linear probability models with difference-in-differences approach were used to compare the changes in institutional PAC use in MSSP-participating hospitals with nonparticipating hospitals as well as to compare the changes in differences by race/ethnicity and payer status in institutional PAC use over time.ResultsHospital participation in MSSP was significantly associated with increased institutional PAC use for the ischemic stroke cohort by 1.5 percentage points [95% confidence interval (CI) 0.00–0.3,P< .05] compared with non-MSSP participating hospitals. Regarding variations by race/ethnicity and payer status, for the elective TJA patients, racial minority patients in MSSP-participating hospitals had 3.8 percentage points greater (95% CI 0.01–0.06,P< .01) in institutional PAC use than white patients. Also, for ischemic stroke cohort, dual-eligible patients in MSSP-participating hospitals had 2.0 percentage points greater (95% CI 0.00–0.04,P< .10) in institutional PAC use than Medicare-only patients.Conclusions and ImplicationsThis study found that hospital participation in the MSSP was associated with slightly increased institutional PAC use for ischemic stroke Medicare patients. Also, compared to non-MSSP participating hospitals, MSSP-participating hospitals were more likely to discharge racial minority patients for elective TJA and dual-eligible patients for ischemic stroke to institutional PAC.