Does managed care affect quality? Appropriateness, referral patterns, and outcomes of carotid endarterectomy.
Does managed care affect quality? Appropriateness, referral patterns, and outcomes of carotid endarterectomy.
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DOI：
10.1177/1062860608323926
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发表时间：
2008-11
期刊：
影响因子：
--
通讯作者：
Chassin MR
中科院分区：
文献类型：
--
作者：
Halm EA;Press MJ;Tuhrim S;Wang J;Rojas M;Chassin MR
评估管理式护理(MC)对接受颈动脉内膜切除术(CEA)的联邦医疗保险受益人的外科护理质量的多个维度的影响。这是一项对纽约所有CEA(N=9308)进行的基于人群的观察性研究。临床数据从医疗图表中提取，以评估手术后30天内的适当性和死亡/中风情况。使用卡方检验比较患者之间的差异、适宜性和结果，并使用回归分析比较风险调整后的结果。按服务收费(FFS，N=8691)和MC(N=897)CEA患者在手术指征、围手术期风险和大多数合并症方面相似。FFS组和MC组的不适性差异无统计学意义(8.6%比8.4%)。MC患者不太可能有高容量的外科医生(20.1%比13.5%)或医院(20.5%比13.0%；p<；0.05)。风险调整后的死亡/卒中比率无差异(OR=0.97；95%CI，0.69-1.37)。医疗保险MC计划对CEA的不适当性、转诊模式或结果没有积极影响。
To assess the impact of managed care(MC) on several dimensions of quality of surgical care among Medicare beneficiaries undergoing carotid endarterectomy(CEA). This was a population-based, observational study of all CEAs(N=9308) in NY. Clinical data were abstracted from medical charts to assess appropriateness and deaths/strokes within 30 days of surgery. Differences in patients, appropriateness, and outcomes were compared using chi square tests and risk-adjusted outcomes compared using regression. Fee-For-Service(FFS, N=8691) and MC(N=897) CEA patients were similar in indications for surgery, perioperative risk, and most comorbidities. There were no differences in inappropriateness between FFS and MC(8.6% v. 8.4%). MC patients were less likely to have a high volume surgeon(20.1% v. 13.5%) or hospital(20.5% v. 13.0%;p<.05). There were no differences in risk-adjusted rates of death/stroke(OR=0.97;95% CI, 0.69–1.37). Medicare MC plans did not have a positive impact on inappropriateness, referral patterns or outcomes of CEA.
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影响因子：
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