Delanois Ronald E, Wilkie Wayne A, Mohamed Nequesha S, Remily Ethan A, Pollak Andrew N, Mont Michael A
Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland.
Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland.
J Knee Surg. 2021 Nov;34(13):1421-1428. doi: 10.1055/s-0040-1709677. Epub 2020 May 5.
In 2014, Maryland implemented the Global Budget Revenue (GBR) model for cost reduction and quality improvement. This study evaluated GBR's effect on demographics and outcomes for patients who underwent primary total knee arthroplasty (TKA) by comparing Maryland to the United States (U.S.). We identified primary TKA patients in Maryland's State Inpatient Database ( = 71,022) and the National Inpatient Sample ( = 4,045,245) between 2011 and 2016 utilizing International Classification of Disease (ICD)-9 and ICD-10 diagnosis codes. Multiple regression was used for difference-in-difference (DID) analyses to compare the intervention cohort (Maryland) to the nonintervention cohort (U.S.) between the pre-GBR (2011-2013) and post-GBR (2014-2016) periods. After GBR implementation, there were proportionally less white, obese, morbidly obese, Medicare, and Medicaid patients with proportionally more routine discharge patients in Maryland and the U.S. (all < 0.001). There were proportionally less home health care (HHC) patients in Maryland, but more in the U.S. (both < 0.001). The mean lengths of stay (LOS), costs, and complications decreased for both cohorts, while charges increased for the U.S. (all < 0.001). The DID analysis suggested Maryland saw more Asian and Medicaid patients and less obese and morbidly obese patients under GBR. The DID assessments also found decreased LOS, costs, and charges ( < 0.001 for all) for patients under GBR. As other states such as Pennsylvania and Vermont explore hospital budgets, Maryland may provide a more viable model for future health care policies that incorporate global budgets.
2014年，马里兰州实施了全球预算收入（GBR）模式，以降低成本并提高质量。本研究通过将马里兰州与美国进行比较，评估了GBR对接受初次全膝关节置换术（TKA）患者的人口统计学特征和治疗结果的影响。我们利用国际疾病分类（ICD）-9和ICD-10诊断代码，在2011年至2016年间确定了马里兰州住院患者数据库（n = 71,022）和国家住院患者样本（n = 4,045,245）中的初次TKA患者。采用多元回归进行差异-差异（DID）分析，以比较GBR实施前（2011-2013年）和GBR实施后（2014-2016年）干预队列（马里兰州）与非干预队列（美国）。GBR实施后，马里兰州和美国白人、肥胖、病态肥胖、医疗保险和医疗补助患者的比例相应减少，常规出院患者的比例相应增加（均P < 0.001）。马里兰州接受家庭医疗保健（HHC）的患者比例相应减少，但美国的比例更高（均P < 0.001）。两个队列的平均住院时间（LOS）、成本和并发症均有所下降，而美国的费用有所增加（均P < 0.001）。DID分析表明，在GBR模式下，马里兰州的亚洲人和医疗补助患者增多，肥胖和病态肥胖患者减少。DID评估还发现，GBR模式下患者的LOS、成本和费用均有所降低（均P < 0.001）。由于宾夕法尼亚州和佛蒙特州等其他州正在探索医院预算，马里兰州可能为未来纳入全球预算的医疗保健政策提供更可行的模式。
