Department of Emergency Medicine University of Michigan, Robert Wood Johnson Foundation Clinical Scholar, Ann Arbor, MI.
Acad Emerg Med. 2013 Sep;20(9):961-4. doi: 10.1111/acem.12205.
The objective was to identify the effect of the Alternative Quality Contract (AQC), a global payment system implemented by Blue Cross Blue Shield (BCBS) of Massachusetts in 2009, on emergency department (ED) presentations.
Blue Cross Blue Shield of Massachusetts claims from 2006 through 2009 for 332,624 enrollees whose primary care physicians (PCPs) enrolled in the AQC, and 1,296,399 whose PCPs were not enrolled in the AQC, were evaluated. A pre-post, intervention-control, propensity-scored difference-in-difference approach was used to isolate the AQC effect on ED visits. The analysis adjusted for age, sex, health status, and secular trends to compare ED use between the treatment and control groups.
Overall, secular trends showed that the number of ED visits decreased slightly for both treatment and control groups. The adjusted analysis of the AQC group showed decreases from 0.131 to 0.127 visits per member/quarter, and the control group decreased from 0.157 to 0.152 visits per member/quarter. The difference-in-difference analysis showed the AQC had no statistically significant effect on total ED use compared to the control group.
In the first year of this AQC, we did not find evidence of change in aggregate ED use. Similar global budget programs may not alter ED use in the initial implementation period.
本研究旨在确定 2009 年马萨诸塞州蓝十字蓝盾（BCBS）实施的全球支付系统——替代质量合同（AQC）对急诊就诊的影响。
对 2006 年至 2009 年期间参加 AQC 的 332624 名参保者和未参加 AQC 的 1296399 名参保者的 BCBS 马萨诸塞州理赔记录进行评估。采用前后干预对照倾向评分差值法，以隔离 AQC 对急诊就诊的影响。分析调整了年龄、性别、健康状况和季节性趋势，以比较治疗组和对照组之间的急诊就诊情况。
总体而言，季节性趋势显示，治疗组和对照组的急诊就诊人数均略有下降。对 AQC 组的调整分析显示，每成员/季度就诊次数从 0.131 次降至 0.127 次，对照组从 0.157 次降至 0.152 次。差异分析显示，与对照组相比，AQC 对总急诊就诊次数没有统计学上的显著影响。
在 AQC 的第一年，我们没有发现总体急诊就诊量变化的证据。类似的全球预算计划在初始实施阶段可能不会改变急诊就诊量。
