Quality of Care in the United States Territories, 1999-2012.
Quality of Care in the United States Territories, 1999-2012.
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美国领土的护理质量，1999 - 2012年。
DOI：
10.1097/mlr.0000000000000797
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发表时间：
2017-10
期刊：
影响因子：
3
通讯作者：
Krumholz HM
中科院分区：
文献类型：
--
作者：
Nuti SV;Wang Y;Masoudi FA;Nunez-Smith M;Normand ST;Murugiah K;Rodríguez-Vilá O;Ross JS;Krumholz HM
数以百万计的美国人生活在美国领土上，但这些领土上的医疗保险受益人的健康状况和支付情况尚未得到很好的描述。在 1999 年至 2012 年间因急性心肌梗死 (AMI)、心力衰竭 (HF) 和肺炎住院的年龄≥65 岁的按服务收费医疗保险受益人中，我们比较了各领地和州的住院率、患者结果和住院费用。 14 年来，各地区有 4,350,813 名独特受益人，各州有 402,902,615 名独特受益人。 AMI、心力衰竭和肺炎的住院率总体下降，并且没有显着差异。然而，这些地区的所有 3 种情况的 30 天死亡率均较高：在最近一段时间（2008 年至 2012 年），30 天死亡率的调整后赔率分别为 1.34（95% CI，1.21 至 1.48）、1.24（95% CI，1.12 至 1.37）和 1.85（95% CI，1.71 至 1.37）。 2.00) 分别适用于 AMI、HF 和肺炎；调整后的一年死亡率几率也较高。在最近的研究期间，按照 2012 年美元计算，各地区的通货膨胀调整后医疗保险住院费用低于各州，AMI、心力衰竭和肺炎住院费用分别少 9234 美元（比各州低 61%）、4479 美元（低 50%）和 4403 美元（低 39%）（全部 p<0.001）。在医疗保险按服务收费受益人中，2008 年至 2012 年，各地区因 AMI、心力衰竭和肺炎住院的患者死亡率较高，或没有显着差异，而医院报销较低。改善这些地区的医疗保健和政策对于确保所有美国人的健康公平至关重要。
Millions of Americans live in United States territories, but health outcomes and payments among Medicare beneficiaries in these territories are not well characterized. Among Fee-for-Service Medicare beneficiaries aged ≥65 years hospitalized between 1999 and 2012 for acute myocardial infarction (AMI), heart failure (HF), and pneumonia, we compared hospitalization rates, patient outcomes, and inpatient payments in the territories and states. Over 14 years, there were 4,350,813 unique beneficiaries in the territories and 402,902,615 in the states. Hospitalization rates for AMI, HF, and pneumonia declined overall and did not differ significantly. However, 30-day mortality rates were higher in the territories for all 3 conditions: in the most recent time period (2008–2012), the adjusted odds of 30-day mortality were 1.34 (95% CI, 1.21 to 1.48), 1.24 (95% CI, 1.12 to 1.37), and 1.85 (95% CI, 1.71 to 2.00) for AMI, HF, and pneumonia, respectively; adjusted odds of 1-year mortality were also higher. In the most recent study period, inflation-adjusted Medicare in-patient payments, in 2012 dollars, were lower in the territories than the states, at $9234 less (61% lower than states), $4479 less (50% lower), and $4403 less (39% lower) for AMI, HF, and pneumonia hospitalizations, respectively (p<0.001 for all). Among Medicare Fee-for-Service beneficiaries, in 2008–2012 mortality rates were higher, or not significantly different, and hospital reimbursements were lower for patients hospitalized with AMI, HF, and pneumonia in the territories. Improvement of health care and policies in the territories is critical to ensure health equity for all Americans.