Gidwani-Marszowski Risha, Faricy-Anderson Katherine, Asch Steven M, Illarmo Samantha, Ananth Lakshmi, Patel Manali I
Health Economics Resource Center, VA Palo Alto Health Care System, Menlo Park, California.
Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, California.
Cancer. 2020 Jul 15;126(14):3297-3302. doi: 10.1002/cncr.32896. Epub 2020 May 13.
The Centers for Medicare and Medicaid Services (CMS) has released quality measures regarding potentially avoidable hospitalizations visits in the 30 days after receipt of outpatient chemotherapy. This study evaluated the proportions of patients treated by Medicare-reimbursed clinicians and Veterans Health Administration (VA) clinicians who experienced avoidable acute care in order to evaluate differences in health system performance.
This retrospective evaluation of Medicare and VA administrative data used a cohort of cancer decedents (fiscal years 2010-2014). Cohort members were veterans aged 66 years or older at death who were dually enrolled in Medicare and the VA. Chemotherapy was identified through International Classification of Diseases, Ninth Revision and Current Procedural Terminology (ICD-9) codes. CMS defines avoidable hospitalizations as those related to anemia, dehydration, diarrhea, emesis, fever, nausea, neutropenia, pain, pneumonia, or sepsis in the 30 days after chemotherapy. Following CMS guidance, this study compared the proportions of patients with potentially avoidable hospitalizations, using hierarchical generalized estimating equations.
There were 27,443 patients who received outpatient chemotherapy. Patients receiving Medicare chemotherapy were significantly more likely to have potentially avoidable hospitalizations than patients receiving VA chemotherapy (adjusted odds ratio, 1.58; 95% confidence interval, 1.41-1.78; P < .001). In predicted estimates, 7.1% of Medicare-treated veterans had potentially avoidable hospitalizations in the 30 days after chemotherapy, compared with 4.6% of VA-treated veterans.
Results indicate veterans with cancer receiving chemotherapy in the VA have higher quality care with respect to avoidable hospitalizations than veterans receiving chemotherapy through Medicare. As more veterans seek care in the private sector under the Maintaining Internal Systems and Strengthening Integrated Outside Networks (MISSION) Act, concerted efforts may be warranted to ensure that veterans do not experience a decline in care quality.
医疗保险和医疗补助服务中心（CMS）发布了关于门诊化疗后30天内潜在可避免住院就诊的质量指标。本研究评估了接受医疗保险报销的临床医生和退伍军人健康管理局（VA）临床医生治疗的患者中经历可避免急性护理的比例，以评估卫生系统绩效的差异。
这项对医疗保险和VA行政数据的回顾性评估使用了一组癌症死者（2010 - 2014财年）。队列成员为死亡时年龄在66岁及以上、同时参加医疗保险和VA的退伍军人。通过国际疾病分类第九版和当前程序术语（ICD - 9）编码确定化疗情况。CMS将可避免住院定义为化疗后30天内与贫血、脱水、腹泻、呕吐、发热、恶心、中性粒细胞减少、疼痛、肺炎或败血症相关的住院。按照CMS指南，本研究使用分层广义估计方程比较了潜在可避免住院患者的比例。
有27443名患者接受了门诊化疗。接受医疗保险化疗的患者比接受VA化疗的患者更有可能出现潜在可避免住院（调整后的优势比为1.58；95%置信区间为1.41 - 1.78；P <.001）。在预测估计中，7.1%接受医疗保险治疗的退伍军人在化疗后30天内有潜在可避免住院，而接受VA治疗的退伍军人为4.6%。
结果表明，在可避免住院方面，在VA接受化疗的癌症退伍军人比通过医疗保险接受化疗的退伍军人获得了更高质量的护理。随着越来越多的退伍军人根据《维持内部系统和加强外部综合网络法案》（MISSION）在私营部门寻求护理，可能需要共同努力以确保退伍军人的护理质量不会下降。
