Center for Management of Complex Chronic Care, Edward Hines, Jr. Veterans Affairs (VA) Hospital, Chicago, IL, USA.
Med Care. 2012 Feb;50(2):161-70. doi: 10.1097/MLR.0b013e31822dcf15.
Healthcare for end-stage renal disease (ESRD) is intensive, expensive, and provided in both the public and private sector. Using a societal perspective, we examined healthcare costs and health outcomes for Department of Veterans Affairs (VA) ESRD patients comparing those who received hemodialysis care at VA versus private sector facilities.
Dialysis patients were recruited from 8 VA medical centers from 2001 through 2003 and followed for 12 months in a prospective cohort study. Patient demographics, clinical characteristics, quality of life, healthcare use, and cost data were collected. Healthcare data included utilization (VA), claims (Medicare), and patient self-report. Costs included VA calculated costs, Medicare dialysis facility reports and reimbursement rates, and patient self-report. Multivariable regression was used to compare costs between patients receiving dialysis at VA versus private sector facilities.
The cohort comprised 334 patients: 170 patients in the VA dialysis group and 164 patients in the private sector group. The VA dialysis group had more comorbidities at baseline, outpatient and emergency visits, prescriptions, and longer hospital stays; they also had more conservative anemia management and lower baseline urea reduction ratio (67% vs. 72%; P<0.001), although levels were consistent with guidelines (Kt/V≥1.2). In adjusted analysis, the VA dialysis group had $36,431 higher costs than those in the private sector dialysis group (P<0.001).
Continued research addressing costs and effectiveness of care across public and private sector settings is critical in informing health policy options for patients with complex chronic illnesses such as ESRD.
终末期肾病（ESRD）的医疗保健需要密集、昂贵，并在公共和私营部门提供。从社会角度出发，我们比较了退伍军人事务部（VA）ESRD 患者在 VA 和私营部门设施接受血液透析治疗的医疗保健成本和健康结果。
从 2001 年至 2003 年，从 8 个 VA 医疗中心招募透析患者，并在前瞻性队列研究中进行了 12 个月的随访。收集患者的人口统计学、临床特征、生活质量、医疗保健使用和成本数据。医疗保健数据包括利用（VA）、索赔（医疗保险）和患者自我报告。成本包括 VA 计算的成本、医疗保险透析机构报告和报销率以及患者自我报告。使用多变量回归比较在 VA 和私营部门接受透析治疗的患者之间的成本。
该队列包括 334 名患者：VA 透析组 170 名，私营部门透析组 164 名。VA 透析组基线时合并症更多，门诊和急诊就诊、处方和住院时间更长；他们的贫血管理也更保守，基线尿素降低率较低（67%比 72%；P<0.001），尽管水平符合指南（Kt/V≥1.2）。在调整分析中，VA 透析组的成本比私营部门透析组高 36,431 美元（P<0.001）。
在为患有复杂慢性疾病（如 ESRD）的患者提供医疗保健时，继续研究公共和私营部门的成本和效果至关重要，这为卫生政策选择提供了信息。
