Boockvar Kenneth S, Gruber-Baldini Ann L, Stuart Bruce, Zimmerman Sheryl, Magaziner Jay
Geriatric Research, Education, and Clinical Center, JJ Peters Veterans Affairs Medical Center, Bronx, New York 10468, USA.
J Am Geriatr Soc. 2008 Jul;56(7):1206-12. doi: 10.1111/j.1532-5415.2008.01748.x. Epub 2008 May 12.
To compare Medicare payments of nursing home residents triaged to nursing home with those of nursing home residents triaged to the hospital for acute infection care.
Observational study with propensity score matching.
Fifty-nine nursing homes in Maryland.
Two thousand two hundred eighty-five individuals admitted to the 59 nursing homes and followed between 1992 and 1997.
Demographic and clinical data were obtained from interviews and medical record review and linked to Medicare payment records. Incident infection was ascertained according to medical record review for new infectious diagnoses or prescription of antibiotics. Hospital triage was defined as hospital transfer within 3 days of infection onset. Hospital triage patients were paired with similar nursing home triage patients using propensity score matching. Medicare expenditures for triage groups were compared in 1997 dollars.
Of 3,618 infection cases, 28% were genitourinary infections, 20% skin, 14% upper respiratory, 12% lower respiratory, 4% gastrointestinal, and 2% bloodstream. Two hundred fifty-six pairs of hospital and nursing home triage cases fulfilled matching criteria. Mean Medicare payments+/-standard deviation were $5,202+/-7,310 and $996+/-2,475 per case in the hospital and nursing home triage groups, respectively, for a mean difference of $4,206 (95% confidence interval=$3,260-5,151). Mean payments per case in the hospital triage group were $3,628 higher in inpatient expenditures, $482 higher in physician visit expenditures, $161 higher in emergency department expenditures, and $147 higher in skilled nursing day expenditures.
Per-case Medicare expenditures are higher with hospital triage than for nursing home triage for nursing home residents with acute infection. This result may be used to estimate cost savings to Medicare of interventions designed to reduce hospital use by nursing home residents.
比较被分诊到疗养院的养老院居民与被分诊到医院接受急性感染治疗的养老院居民的医疗保险支付情况。
倾向得分匹配的观察性研究。
马里兰州的59家养老院。
入住这59家养老院并在1992年至1997年期间接受随访的2285名个体。
通过访谈和病历审查获取人口统计学和临床数据，并与医疗保险支付记录相关联。根据新的感染诊断或抗生素处方的病历审查确定感染事件。医院分诊定义为感染发作后3天内转院。使用倾向得分匹配将医院分诊患者与类似的疗养院分诊患者配对。以1997年美元计算比较分诊组的医疗保险支出。
在3618例感染病例中，28%为泌尿生殖系统感染，20%为皮肤感染，14%为上呼吸道感染，12%为下呼吸道感染，4%为胃肠道感染，2%为血流感染。256对医院和疗养院分诊病例符合匹配标准。医院分诊组和疗养院分诊组每例的平均医疗保险支付分别为5202美元±7310美元和996美元±2475美元，平均差异为4206美元（95%置信区间=3260 - 5151美元）。医院分诊组每例的住院支出平均高出3628美元，医生诊疗支出高出482美元，急诊科支出高出161美元，熟练护理日支出高出147美元。
对于患有急性感染的养老院居民，医院分诊的每例医疗保险支出高于疗养院分诊。这一结果可用于估计旨在减少养老院居民住院率的干预措施为医疗保险节省的成本。
