覆盖缺口对慢性阻塞性肺疾病医疗保险受益人的医疗利用的影响。
Effect of coverage gap on healthcare utilization among Medicare beneficiaries with chronic obstructive pulmonary disorder.
机构信息
a University of Houston College of Pharmacy , Houston , TX , USA.
b Cigna-HealthSpring , Houston , TX , USA.
出版信息
Curr Med Res Opin. 2019 Feb;35(2):321-328. doi: 10.1080/03007995.2018.1495622. Epub 2018 Jul 31.
OBJECTIVE
To evaluate the association between the Medicare coverage gap with hospitalization, emergency room (ER) visits, and time to hospitalization in chronic obstructive pulmonary disease (COPD) patients.
METHODS
Retrospective cohort study using data from a Medicare Advantage (MA) plan. Patients with ≥1 claim for COPD at baseline, ≥65 years, continuous 24-months enrollment and without any cancer/end stage renal disease diagnosis were eligible. Patients not reaching the coverage gap (no coverage gap) were matched and compared to those reaching the coverage gap and those reaching catastrophic coverage in separate analyses. Chi-square tests and Cox proportional hazards model were used to compare outcomes across matched cohorts.
RESULTS
In total, 3142 COPD patients were identified (79% no coverage gap, 10% coverage gap, and 11% catastrophic coverage). Compared to the no coverage gap group, a larger number of beneficiaries in the coverage gap group had ≥1 hospitalization (26% vs 32%, p < .05), ≥ 1 ER visits (43% vs 49%, p < .05), and ≥1 hospitalization/ER (total visit) (47% vs 54%, p < .05), respectively. Compared to the no coverage gap group, a greater number of beneficiaries in catastrophic coverage had ≥1 ER visit (45% vs 53%, p < .05) or ≥1 total visits (48% vs 56%, p < .05), respectively. Time to hospitalization was shorter among those entering the coverage gap as compared to the no coverage gap [Hazards Ratio (HR) = 1.5; p = .040].
CONCLUSIONS
COPD patients entering the coverage gap and catastrophic coverage were associated with increased utilization of healthcare services. Entering the coverage gap was also associated with shorter time to hospitalization as compared to the no coverage gap.
目的
评估医疗保险覆盖缺口与慢性阻塞性肺疾病（COPD）患者住院、急诊就诊和住院时间之间的关联。
方法
这是一项使用医疗保险优势（MA）计划数据的回顾性队列研究。符合条件的患者为在基线时有≥1 次 COPD 就诊记录、≥65 岁、连续 24 个月参保且无癌症/终末期肾病诊断的患者。未达到覆盖缺口（无覆盖缺口）的患者与达到覆盖缺口和达到灾难性覆盖的患者分别进行匹配，并在单独的分析中进行比较。卡方检验和 Cox 比例风险模型用于比较匹配队列的结果。
结果
总共确定了 3142 名 COPD 患者（79%无覆盖缺口，10%覆盖缺口，11%灾难性覆盖）。与无覆盖缺口组相比，覆盖缺口组有更多的患者有≥1 次住院（26% vs. 32%，p<0.05）、≥1 次急诊就诊（43% vs. 49%，p<0.05）和≥1 次住院/急诊就诊（总就诊次数）（47% vs. 54%，p<0.05）。与无覆盖缺口组相比，灾难性覆盖组有更多的患者有≥1 次急诊就诊（45% vs. 53%，p<0.05）或≥1 次总就诊次数（48% vs. 56%，p<0.05）。与无覆盖缺口组相比，进入覆盖缺口组的患者住院时间更短[风险比（HR）=1.5；p=0.040]。
结论
进入覆盖缺口和灾难性覆盖的 COPD 患者与医疗服务利用的增加有关。与无覆盖缺口相比，进入覆盖缺口也与住院时间更短有关。
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