Spending and quality after three years of Medicare's bundled payments for medical conditions: quasi-experimental difference-in-differences study
Spending and quality after three years of Medicare's bundled payments for medical conditions: quasi-experimental difference-in-differences study
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DOI：
10.1136/bmj.m1780
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发表时间：
2020-06-17
影响因子：
105.7
通讯作者：
Navathe, Amol S.
中科院分区：
文献类型：
--
作者：
Rolnick, Joshua A.;Liao, Joshua M.;Navathe, Amol S.
目的评估长期参与美国医疗条件捆绑付费计划(BPCI)的医院是否与支出、死亡率或医疗服务使用的变化有关。该计划要求医院对从入院到出院90天期间的所有护理支出负责。设计准-实验差异分析。设置参与急性心肌梗死、充血性心力衰竭、慢性阻塞性肺疾病(COPD)或肺炎的捆绑付费的医院，以及与未参与的医院的倾向得分匹配。PARTICIPANTS238家参与改善护理捆绑付款的医院和1415家非BPCI医院。226家bpci医院与700家非bpci医院配对。主要结果测量主要结果是出院90天后的总支出和死亡。次要结果包括按急性后护理类型分类的支出和使用。根据患者、医院和医院的市场特征，对BPCI医院和非BPCI医院进行了比较。市场特征包括人口规模、竞争力和急诊后床位供应。结果在226家非急诊介入医院中，基线期间的护理例数为261 163次，治疗期为93 562次，而700家匹配的非急诊介入医院分别为211 208次和78 643次，匹配后医院和市场特征差异不大。一些患者的特征呈现不同的趋势(例如，平均年龄变化--BPCI医院与非BPCI医院的0.3岁，P
OBJECTIVETo evaluate whether longer term participation in the bundled payments for care initiative (BPCI) for medical conditions in the United States, which held hospitals financially accountable for all spending during an episode of care from hospital admission to 90 days after discharge, was associated with changes in spending, mortality, or health service use.DESIGNQuasi-experimental difference-in-differences analysis.SETTINGUS hospitals participating in bundled payments for acute myocardial infarction, congestive heart failure, chronic obstructive pulmonary disease (COPD), or pneumonia, and propensity score matched to non-participating hospitals.PARTICIPANTS238 hospitals participating in the Bundled Payments for Care Improvement initiative (BPCI) and 1415 non-BPCI hospitals. 226 BPCI hospitals were matched to 700 non-BPCI hospitals.MAIN OUTCOME MEASURESPrimary outcomes were total spending on episodes and death 90 days after discharge. Secondary outcomes included spending and use by type of post-acute care. BPCI and non-BPCI hospitals were compared by patient, hospital, and hospital market characteristics. Market characteristics included population size, competitiveness, and post-acute bed supply.RESULTSIn the 226 BPCI hospitals, episodes of care totaled 261 163 in the baseline period and 93 562 in the treatment period compared with 211 208 and 78 643 in the 700 matched non-BPCI hospitals, respectively, with small differences in hospital and market characteristics after matching. Differing trends were seen for some patient characteristics (eg, mean age change -0.3 years at BPCI hospitals v non-BPCI hospitals, P