Medicaid beneficiaries undergoing complex surgery at quality care centers: insights into the Affordable Care Act
Medicaid beneficiaries undergoing complex surgery at quality care centers: insights into the Affordable Care Act
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DOI：
10.1016/j.amjsurg.2015.11.026
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发表时间：
2016-04-01
影响因子：
3
通讯作者：
Al-Refaie, Waddah B.
中科院分区：
文献类型：
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作者：
Hall, Erin C.;Zheng, Chaoyi;Al-Refaie, Waddah B.
背景：医疗补助受益人没有平等的机会进入大容量中心进行复杂的外科手术。我们假设在同一家医院接受紧急普通手术和复杂手术的患者之间存在很大的医疗补助差距。方法：使用1998年至2010年全国住院患者样本，我们确定了大容量胰腺切除术医院。然后，我们比较了在这些医院接受阑尾切除术和胰腺切除术的医疗补助患者的百分比。使用广义估计方程模型评估与医疗补助差距增加相关的医院特征。结果：共纳入289家大容量胰腺切除术医院602医院年的数据。医疗补助阑尾切除术和胰腺切除术的中位数百分比分别为12.1%（四分位数范围：5.8%至19.8%）和6.7%（四分位数范围：0%至15.4%）。每年进行大于或等于40例胰腺切除术的医院存在显著的医疗补助差距的几率更高（优势比为2.3,95%置信区间为1.1至5.0）。结论：在同一家医院接受紧急普通外科手术的医疗补助患者与接受更复杂外科护理的患者之间存在差距，并且在复杂选择性手术量非常大的医院中，这种差距可能会被夸大。(C) 2016 Elsevier Inc.版权所有。
BACKGROUND: Medicaid beneficiaries do not have equal access to high-volume centers for complex surgical procedures. We hypothesize there is a large Medicaid Gap between those receiving emergency general vs complex surgery at the same hospital.METHODS: Using the Nationwide Inpatient Sample, 1998 to 2010, we identified high-volume pancreatectomy hospitals. We then compared the percentage of Medicaid patients receiving appendectomies vs pancreatectomies at these hospitals. Hospital characteristics associated with increased Medicaid Gap were evaluated using generalized estimating equation models.RESULTS: A total of 602 hospital-years of data from 289 high-volume pancreatectomy hospitals were included. Median percentages of Medicaid appendectomies and pancreatectomies were 12.1% (interquartile range: 5.8% to 19.8%) and 6.7% (interquartile range: 0% to 15.4%), respectively. Hospitals that performed greater than or equal to 40 pancreatic resections per year had higher odds of having significant Medicaid Gap (odds ratio 2.3, 95% confidence interval 1.1 to 5.0).CONCLUSIONS: Gaps exist between the percentages of Medicaid patients receiving emergency general surgery vs more complex surgical care at the same hospital and may be exaggerated in hospitals with very high volume of complex elective surgeries. (C) 2016 Elsevier Inc. All rights reserved.