Dávila Castrodad Iciar M, Mohamed Nequesha S, Wilkie Wayne A, Remily Ethan A, Pollak Andrew N, Mont Michael A, Delanois Ronald E
Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Baltimore, MD, USA.
Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA.
Arthroplast Today. 2020 Jan 9;6(1):88-93. doi: 10.1016/j.artd.2019.12.002. eCollection 2020 Mar.
Maryland implemented the Global Budget Revenue (GBR) to reduce hospital costs, improve quality, and decrease readmissions. Studies assessing its impact on inpatient total hip arthroplasty (THA) procedures are lacking. This study compared before and after GBR changes in 1) patient characteristics; 2) discharge dispositions and lengths of stay (LOS); 3) costs and charges of inpatient stays; and 4) 30-day readmission rates (RR) for THA recipients.
The Maryland State Inpatient Database was queried for patients who underwent THA between 2010 and 2016 utilizing the ICD-9 and ICD-10 procedure codes (n = 43,251). Pre- and post-GBR periods were grouped as 2010 to 2013 and 2014 to 2016, respectively. Chi-square analyses were used to analyze patient characteristics. Student's t-tests were utilized to compare ages, LOS, costs, charges, and RR.
There were no differences in the proportion of minorities undergoing THA between the pre- and post-GBR periods (18.3% vs 19.4% African American, 1.2% vs 1.3% Hispanic; = .056). The number of THA patients with Medicaid insurances increased during post-GBR (4.0% vs 6.7%; < .001). There was an increased rate of home discharges during post-GBR (33.1% vs 40.9%; < .001). We found lower LOS (-0.50 days; 95% CI: -0.458 to -0.533; < .001), mean inpatient costs (-$1417.44; 95% CI -$1143.76 to -$1150.32; < .001), and mean inpatient charges (-$2196.50; 95% CI: -$1980.10 to -$2412.90; < .001) during the post-GBR period. There were lower 30-day RR during the post-GBR period (-0.9%; < .001).
Our findings suggest favorable preliminary results for patients undergoing THA under the GBR model.
马里兰州实施全球预算收入（GBR）以降低医院成本、提高质量并减少再入院率。目前缺乏评估其对住院全髋关节置换术（THA）手术影响的研究。本研究比较了GBR实施前后在以下方面的变化：1）患者特征；2）出院处置方式和住院时间（LOS）；3）住院费用和收费；4）THA接受者的30天再入院率（RR）。
利用ICD - 9和ICD - 10手术编码，查询马里兰州住院患者数据库中2010年至2016年期间接受THA手术的患者（n = 43251）。GBR实施前和实施后时期分别分组为2010年至2013年和2014年至2016年。采用卡方分析来分析患者特征。使用学生t检验来比较年龄、LOS、费用、收费和RR。
GBR实施前后接受THA手术的少数族裔比例无差异（非裔美国人分别为18.3%对19.4%，西班牙裔分别为1.2%对1.3%；P = 0.056）。GBR实施后，接受医疗补助保险的THA患者数量增加（4.0%对6.7%；P < 0.001）。GBR实施后，回家出院的比例增加（33.1%对40.9%；P < 0.001）。我们发现GBR实施后住院时间缩短（-0.50天；95%置信区间：-0.458至-0.533；P < 0.001），平均住院费用降低（-1417.44美元；95%置信区间：-1143.76美元至-1150.32美元；P < 0.001），平均住院收费降低（-2196.50美元；95%置信区间：-1980.10美元至-2412.90美元；P < 0.001）以及30天再入院率降低（-0.9%；P < 0.001）。
我们的研究结果表明，在GBR模式下接受THA手术的患者取得了良好的初步效果。
