Assessment of Rheumatoid Arthritis Quality Process Measures and Associated Costs
Assessment of Rheumatoid Arthritis Quality Process Measures and Associated Costs
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DOI：
10.1089/pop.2015.0133
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发表时间：
2017-02-01
影响因子：
2.5
通讯作者：
Ruetsch, Charles
中科院分区：
文献类型：
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作者：
Brady, Brenna L.;Tkacz, Joseph;Ruetsch, Charles
目的是研究类风湿关节炎（RA）的医疗保健成本和质量之间的关系。使用管理索赔计算8个治疗RA的过程措施。计算了实现或未实现每项措施的成员的相关医疗保健费用。从Optum Clinformatics Datamart数据库中提取2011年RA患者的医疗、药房和实验室声明（国际疾病分类，第九版，临床修订版714.x）。其中绝大多数是50多岁的女性。措施实现率范围为55.9%至80.8%。符合措施的成员的平均护理费用为18，644美元;不符合措施的成员的平均费用为14，973美元。主要成本驱动因素是药房和办公费用，分别占总成本的42.4%和26.3%。回归分析显示，生物制品使用（在获得措施的群体中更为普遍）与所有措施的总支出之间存在统计学显著相关（P < 0.001）。两组的药物费用相似。符合措施的个人在门诊费用中所占比例较高;不符合措施的个人在住院和门诊费用中所占比例较高。这些研究结果表明，提高质量可能会导致降低住院和门诊费用。然而，由于强化药物治疗方案，RA护理的总成本可能仍然很高。
The objective was to examine the relationship between health care costs and quality in rheumatoid arthritis (RA). Administrative claims were used to calculate 8 process measures for the treatment of RA. Associated health care costs were calculated for members who achieved or did not achieve each of the measures. Medical, pharmacy, and laboratory claims for RA patients (International Classification of Diseases, Ninth Revision, Clinical Modification 714.x) were extracted from the Optum Clinformatics Datamart database for 2011. Individuals were predominately female and in their mid-fifties. Measure achievement ranged from 55.9% to 80.8%. The mean cost of care for members meeting the measure was $18,644; members who did not meet the measures had a mean cost of $14,973. Primary cost drivers were pharmacy and office expenses, accounting for 42.4% and 26.3% of total costs, respectively. Regression analyses revealed statistically significant associations between biologic usage, which was more prevalent in groups attaining measures, and total expenditure across all measures (Ps < 0.001). Pharmacy costs were similar between both groups. Individuals meeting the measures had a higher proportion of costs accounted for by office visits; those not meeting the measures had a higher proportion of costs from inpatient and outpatient visits. These findings suggest that increased quality may lead to lower inpatient and outpatient hospital costs. Yet, the overall cost of RA care is likely to remain high because of intensive pharmacotherapy regimens.