HealthHelp, Houston, TX, USA.
5167Humana Inc., Louisville, KY, USA.
Vasc Endovascular Surg. 2022 May;56(4):393-400. doi: 10.1177/15385744211055911. Epub 2022 Feb 27.
After a nondenial prior authorization program evaluates orders for peripheral artery revascularization (PAR), ordering physicians sometimes withdraw their orders based upon program recommendations. Some patients with withdrawn orders receive PAR if claudication does not resolve. To characterize patient outcomes under this program, we evaluated whether associations existed between the withdrawal of patients' initial PAR orders and the presence of claims for PAR and claims mentioning intermittent claudication (IC) in the following 16 weeks.
Orders for PAR placed from 1/1/19 to 9/30/19 for patients with Medicare Advantage health plans were extracted from a national healthcare organization's database. Claims data from 0 to 16 weeks following the order were reviewed to determine if patients had downstream PAR claims, or if they had emergency department or hospital claims mentioning IC. Chi-square tests were used to assess the association between order withdrawal and downstream PAR, as well as claims mentioning IC. Multivariate logistic regressions were run to assess the same, controlling for patient age, sex, urbanicity, local median income, state obesity rate, type of PAR, ordering physician specialty, and whether PAR was ordered in a hospital setting.
Of 1588 orders meeting inclusion criteria, 71.9% (1038/1444) of authorized orders and 61.1% (88/144) of withdrawn orders were followed by PAR within 16 weeks, a significant difference ( < .01). Relatedly, 69.8% (1008/1444) of authorized orders and 70.8% (102/144) of withdrawn orders were followed by IC claims, an insignificant difference. Multivariate logistic regressions showed patients with withdrawn PAR orders had significantly lower adjusted odds of PAR (OR: 0.63; 95% CI: 0.44-0.91), but an insignificant difference in their adjusted odds of IC (OR: 1.10; CI: 0.76-1.64).
Although patients with withdrawn PAR orders were significantly less likely to receive PAR in the subsequent 16 weeks, no association was found between withdrawn PAR orders and subsequent claims mentioning IC.
在非否认性预授权计划评估外周动脉血运重建（PAR）的医嘱后，开具医嘱的医生有时会根据该计划的建议撤回医嘱。一些撤回医嘱的患者如果跛行没有缓解，会接受 PAR。为了描述该计划下患者的结局，我们评估了患者初始 PAR 医嘱撤回与以下 16 周内 PAR 索赔和间歇性跛行（IC）索赔之间是否存在关联。
从一家全国性医疗机构的数据库中提取了 Medicare Advantage 健康计划患者在 19 年 1 月 1 日至 9 月 30 日期间下达的 PAR 医嘱。查看了医嘱下达后 0 至 16 周的理赔数据，以确定患者是否有 PAR 理赔，或是否有急诊或医院理赔提到 IC。使用卡方检验评估了医嘱撤回与 PAR 理赔以及提到 IC 的理赔之间的关联。进行了多变量逻辑回归，以评估在控制了患者年龄、性别、城市状况、当地中位收入、州肥胖率、PAR 类型、开具医嘱的医生专业、以及 PAR 是否在医院环境中下达等因素后，上述两者之间的关联。
在符合纳入标准的 1588 个医嘱中，71.9%（1038/1444）的授权医嘱和 61.1%（88/144）的撤回医嘱在 16 周内接受了 PAR，差异显著（<0.01）。相关地，70.8%（102/144）的授权医嘱和 69.8%（1008/1444）的撤回医嘱出现了提到 IC 的理赔，差异无统计学意义。多变量逻辑回归显示，撤回 PAR 医嘱的患者 PAR 的调整后比值比（OR）显著降低（OR：0.63；95%CI：0.44-0.91），但调整后出现 IC 的比值比（OR：1.10；CI：0.76-1.64）无显著差异。
尽管撤回 PAR 医嘱的患者在随后的 16 周内接受 PAR 的可能性显著降低，但撤回 PAR 医嘱与随后提到 IC 的理赔之间未发现关联。
