Division of Health and Environment, Abt Associates, Durham, North Carolina, USA.
Division of Health and Environment, Abt Associates, Rockville, Maryland, USA.
Health Serv Res. 2022 Oct;57(5):1094-1103. doi: 10.1111/1475-6773.13966. Epub 2022 May 4.
To determine whether the Comprehensive Care for Joint Replacement (CJR) model, a mandatory episode-based payment program for knee and hip replacement surgery, affected patient-reported measures of quality.
Surveys of Medicare fee-for-service beneficiaries who had hip or knee replacement surgery, collected between July 2018 and March 2019, secondary Medicare administrative data, the Provider of Services file, CJR and Bundled Payments for Care Improvement participant lists from the Centers for Medicare & Medicaid Services, and the Area Health Resource Files.
In 2018, participation in the CJR model was mandatory for nearly all hospitals in 34 randomly selected, metropolitan statistical areas (MSAs) that had high historical Medicare payments for lower-extremity joint replacements surgery. The control group included 47 high-payment MSAs randomly assigned as controls. We estimated risk-adjusted differences in self-reported measures of functional status and pain, satisfaction with care, and caregiver help between respondents in CJR hospitals and respondents in hospitals located in the control group.
We selected a census of CJR patients and an equal number of control patients to survey. We fielded two waves of surveys using a mail and phone protocol, yielding 8433 CJR and 9014 control respondents.
CJR respondents were slightly more likely to depend on caregivers for certain activities of daily living when they got home (either directly from the hospital or after an institutional post-acute care stay). On a 100-point scale, differences ranged from -2.6 points (p < 0.01) for help needed bathing to -1.7 points (p < 0.05) for help needed using the toilet. However, differences in eight measures of self-reported functional status approximately 90-120 days after hospital discharge were not statistically significant, ranging from -1.1% (p = 0.087) to 0.7% (p = 0.437).
CJR did not harm patient health or affect patient satisfaction on average but did increase reliance on caregivers during recovery.
确定强制性基于疾病的支付计划（CJR）模型（适用于膝关节和髋关节置换手术）是否会影响患者报告的质量指标。
2018 年 7 月至 2019 年 3 月期间，对接受髋关节或膝关节置换手术的 Medicare 按服务收费受益人的调查，其次是 Medicare 管理数据、服务提供者文件、CMS 的 CJR 和捆绑支付改善计划参与者名单，以及区域卫生资源文件。
2018 年，34 个随机选择的大都市统计区（MSA）中几乎所有的医院都必须参与 CJR 模型，这些 MSA 过去对下肢关节置换手术的 Medicare 支付较高。对照组包括随机指定为对照组的 47 个高支付 MSA。我们估计了 CJR 医院的受访者和对照组医院的受访者之间在功能状态和疼痛、护理满意度以及护理人员帮助的自我报告测量值方面的风险调整差异。
我们选择了 CJR 患者的普查和数量相等的对照组患者进行调查。我们使用邮件和电话协议进行了两轮调查，共收到了 8433 名 CJR 和 9014 名对照组受访者。
CJR 受访者在回家后（无论是直接从医院还是在机构康复后），某些日常生活活动可能更依赖护理人员。在 100 分制中，差异范围从洗澡需要帮助的 2.6 分（p<0.01）到使用厕所需要帮助的 1.7 分（p<0.05）。然而，出院后约 90-120 天的八项自我报告功能状态测量值的差异没有统计学意义，范围从 1.1%（p=0.087）到 0.7%（p=0.437）。
CJR 平均不会损害患者健康或影响患者满意度，但确实会增加患者在康复期间对护理人员的依赖。
