Imperiale T F, Siegal A P, Crede W B, Kamens E A
Department of Internal Medicine, Yale University School of Medicine, New Haven, Conn.
JAMA. 1988 Jun 17;259(23):3418-21.
The clinical impact of a statewide Medicare preadmission certification program was assessed with a retrospective survey of Connecticut physicians. In a three-month period, only 100 (0.37%) of 28,450 Medicare admission requests were disapproved for reimbursement. Following disapproval, 22 patients were admitted immediately, 44 received outpatient care, and eight additional outpatients were not evaluated or treated. The remaining 26 patients subsequently were admitted with preadmission approval due to changed clinical condition or failed outpatient plan. Although some patients had minor problems that their physicians believed would have been avoided by immediate admission, no severe morbidity resulted from admission delay. Many physicians expressed concern about preadmission certification program-related patient anxiety and inconvenience. Although this limited survey provides preliminary evidence that preadmission certification programs can be implemented without major deleterious short-term medical effects, continued monitoring of physicians and patients involved in disapproved admissions is necessary to evaluate potential medical and psychosocial problems.
通过对康涅狄格州医生的回顾性调查，评估了全州范围内医疗保险预认证计划的临床影响。在三个月的时间里，28450份医疗保险入院申请中只有100份（0.37%）因报销问题被驳回。被驳回后，22名患者立即入院，44名接受门诊治疗，另有8名门诊患者未接受评估或治疗。其余26名患者随后因临床状况改变或门诊计划失败而在获得预认证后入院。尽管一些患者有小问题，其医生认为立即入院本可避免这些问题，但入院延迟并未导致严重的发病率。许多医生对预认证计划相关的患者焦虑和不便表示担忧。尽管这项有限的调查提供了初步证据，表明预认证计划可以在不产生重大短期不良医疗影响的情况下实施，但仍有必要持续监测参与被驳回入院的医生和患者，以评估潜在的医疗和社会心理问题。
