Results of a Medicare Bundled Payments for Care Improvement Initiative for Chronic Obstructive Pulmonary Disease Readmissions
Results of a Medicare Bundled Payments for Care Improvement Initiative for Chronic Obstructive Pulmonary Disease Readmissions
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DOI：
10.1513/annalsats.201610-775bc
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发表时间：
2017-05-01
影响因子：
8.3
通讯作者：
Dransfield, Mark T.
中科院分区：
文献类型：
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作者：
Bhatt, Surya P.;Wells, J. Michael;Dransfield, Mark T.
理由：大约20%因慢性阻塞性肺疾病(COPD)急性加重而住院的医疗保险受益人在出院后30天内再次入院。除了对过度再入院实施惩罚外，美国医疗保险和医疗补助服务中心还制定了捆绑的护理改善付款(BPCI)计划，以改善结果和控制成本。目的：评估作为我们机构参与BPCI的一部分，以住院、过渡和门诊护理为重点的综合性COPD多学科干预是否可以降低COPD急性加重的30天全原因再住院率和总体成本。方法：我们进行了干预前的一项研究，比较了仅限Medicare的COPD急性加重患者的全原因再入院和指数住院后的成本。主要结果是30天全原因再住院率与历史对照对象的差异；次要结果包括90天全原因再住院率以及与BPCI目标价格相比的医疗费用。结果：2014年，78名连续的联邦医疗保险患者前瞻性地参加了BPCI干预，而历史组自2012年以来只有109名患者。BPCI患者更有可能接受定期随访电话、肺炎球菌和流感疫苗、家庭保健、耐用医疗设备和肺部康复，并前往肺部诊所就诊。30天和90天的全原因再住院率没有差异(12例冠状动脉介入治疗，12例(15.4%)与非冠状动脉介入治疗19例(17.4%)；P=0.711)，90天(21例[26.9%]对37例[33.9%]；P=0.306)。与BPCI目标价格相比，我们产生的90天成本降低了4.3%，这是医疗系统的重大投资。结论：Medicare BPCI干预没有降低COPD急性加重住院后30天的全原因再住院率或总成本。尽管在多个中心招募更多患者的其他研究可能会证明我们的BPCI倡议对COPD再入院的有效性，但这在任何一个中心都不太可能具有成本效益。
Rationale: Approximately 20% of Medicare beneficiaries hospitalized for acute exacerbations of chronic obstructive pulmonary disease (COPD) are readmitted within 30 days of discharge. In addition to implementing penalties for excess readmissions, the U.S. Centers for Medicare and Medicaid Services has developed Bundled Payments for Care Improvement (BPCI) initiatives to improve outcomes and control costs.Objectives: To evaluate whether a comprehensive COPD multidisciplinary intervention focusing on inpatient, transitional, and outpatient care as part of our institution's BPCI participation would reduce 30-day all-cause readmission rates for COPD exacerbations and reduce overall costs.Methods: We performed a pre-postintervention study comparing all-cause readmissions and costs after index hospitalization for Medicare-only patients with acute exacerbation of COPD. The primary outcome was the difference in 30-day all-cause readmission rate compared with historical control subjects; secondary outcomes included the 90-day all-cause readmission rate and also health care costs compared with BPCI target prices.Results: Seventy-eight consecutive Medicare patients were prospectively enrolled in the BPCI intervention in 2014 and compared with 109 patients in the historical group from 2012. Patients in BPCI were more likely to receive regular follow-up phone calls, pneumococcal and influenza vaccines, home health care, durable medical equipment, and pulmonary rehabilitation, and to attend pulmonary clinic. There was no difference in all-cause readmission rates at 30 days (BPCI, 12 events [15.4%] vs. non-BPCI, 19 events [17.4%]; P = 0.711), and 90 days (21 [26.9%] vs. 37 [33.9%]; P = 0.306). Compared with BPCI target prices, we incurred 4.3% lower 90-day costs before accounting for significant investment from the health system.Conclusions: A Medicare BPCI intervention did not reduce 30-day all-cause readmission rates or overall costs after hospitalization for acute exacerbation of COPD. Although additional studies enrolling larger numbers of patients at multiple centers may demonstrate the efficacy of our BPCI initiative for COPD readmissions, this is unlikely to be cost effective at any single center.