Division of Cardiology, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California; Division of Cardiology, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California.
Division of Cardiology, Veterans Affairs Palo Alto Healthcare System, Palo Alto, California.
JACC Heart Fail. 2018 May;6(5):388-397. doi: 10.1016/j.jchf.2017.12.007. Epub 2018 Apr 11.
The purpose of this study was to analyze cumulative Medicare expenditures at index admission and after discharge by race or ethnicity.
Heart failure with preserved ejection fraction (HFpEF) is a growing proportion of heart failure (HF) admissions. Research on health care expenditures for patients with HFpEF is limited.
Records of patients discharged from the Get With The Guidelines-Heart Failure registry between 2006 and 2014 were linked to Medicare data. The primary outcome was unadjusted payments for acute care services. Comparisons between race/ethnic groups were made using generalized linear mixed models. Cost ratios were reported by race/ethnicity, and adjustments were made sequentially for patient characteristics, hospital factors, and regional socioeconomic status.
Median Medicare costs for index hospitalizations were $7,241 for the entire cohort, $7,049 for whites, $8,269 for blacks, $8,808 for Hispanics, $8,477 for Asians, and $8,963 for other races. Median costs at 30 days for readmitted patients were $9,803 and $17,456 for the entire cohort at 1-year. No significant differences were seen in index admission cost ratios by race/ethnicity. At 30 days among readmitted patients, costs were 9% higher (95% confidence interval [CI]: 1% to 17%; p = 0.020) for blacks in the fully adjusted model than whites. At 1 year, costs were 14% higher (95% CI: 9% to 18%; p < 0.001) for blacks, 7% higher (95% CI: 0% to 14%; p = 0.041) for Hispanics, and 24% higher (95% CI: 8% to 42%; p = 0.003) for patients of other races. No significant differences between white and Asian expenditures were noted.
Minority patients with HFpEF have greater acute care service costs. Further research of improving care delivery is needed to reduce acute care use for vulnerable populations.
本研究旨在分析按种族或族裔划分的索引入院和出院后的医疗保险支出累计情况。
射血分数保留型心力衰竭（HFpEF）在心衰（HF）入院患者中占比不断增加。关于 HFpEF 患者医疗保健支出的研究有限。
将 2006 年至 2014 年间从 Get With The Guidelines-Heart Failure 注册中心出院的患者记录与医疗保险数据相关联。主要结局为急性护理服务的未经调整支付额。使用广义线性混合模型比较不同种族/族裔群体之间的差异。按种族/族裔报告成本比，并按患者特征、医院因素和区域社会经济状况顺序进行调整。
整个队列的索引住院医疗保险费用中位数为 7241 美元，白人 7049 美元，黑人 8269 美元，西班牙裔 8808 美元，亚裔 8477 美元，其他种族 8963 美元。再入院患者 30 天的中位费用为 9803 美元，整个队列在 1 年时为 17456 美元。按种族/族裔划分，索引入院费用比无显著差异。在再入院患者中，在完全调整模型中，黑人 30 天的费用比白人高 9%（95%置信区间：1%至 17%；p=0.020）。在 1 年时，黑人的费用高 14%（95%置信区间：9%至 18%；p<0.001），西班牙裔高 7%（95%置信区间：0%至 14%；p=0.041），其他种族高 24%（95%置信区间：8%至 42%；p=0.003）。白人支出与亚裔支出之间无显著差异。
HFpEF 少数族裔患者的急性护理服务费用更高。需要进一步研究改善护理服务，以减少弱势群体的急性护理使用。
