Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI.
Department of Physical Medicine and Rehabilitation, University of Pennsylvania, Philadelphia, PA.
Arch Phys Med Rehabil. 2022 Dec;103(12):2398-2403. doi: 10.1016/j.apmr.2022.05.018. Epub 2022 Jun 26.
To evaluate the effect of the Comprehensive Care for Joint Replacement (CJR) policy on the 90-day trajectory of post-acute care after a total hip arthroplasty (THA).
Multivariable difference-in-difference models applied to Medicare beneficiaries undergoing a THA prior to (2014-2015) and post-CJR implementation (2017) in areas subjected to or exempt from the policy.
Hospitals in standard metropolitan statistical areas.
357,844 elderly Medicare patients nationwide undergoing THA (N=357,844).
None.
Escalation in care to institutionalization (ie, admission to an inpatient rehabilitation or skilled nursing facility during 90-days postdischarge for those initially discharged to the community and return to the community at the end of the episode of care among those initially discharged to an institutional setting).
Of the 357,844 elderly Medicare patients nationwide undergoing THA during the study period, 47.6% were discharged directly to the community and 52.4% received post-acute care in an institution. Patients discharged to an institution post-policy in a CJR area were about 10% less likely to return to the community (odds ratio=0.91; 95% confidence interval, 0.84-0.98; P=.02) at the end of the 90-day episode of care than those treated in policy-exempt areas. Despite the large magnitude, estimates of escalation in care among patients treated in bundling areas post-CJR implementation were not statistically significant.
Our findings support further exploration of unanticipated effects of mandatory bundled payment policies on outcomes, as well as further examination of outcomes among policy-relevant subgroups of patients undergoing hip replacement in the United States.
评估综合关节置换护理（CJR）政策对全髋关节置换术（THA）后急性后期护理 90 天轨迹的影响。
多变量差异差异模型应用于 Medicare 受益人在 CJR 实施之前（2014-2015 年）和之后（2017 年）在接受或豁免政策的标准大都市统计区的医院进行 THA。
标准大都市统计区的医院。
全国范围内接受 THA 的 357844 名老年 Medicare 患者（N=357844）。
无。
护理升级为住院治疗（即对于最初出院到社区的患者，在出院后 90 天内入住住院康复或熟练护理设施，而对于最初出院到机构环境的患者，在治疗结束时返回社区）。
在研究期间，全国范围内接受 THA 的 357844 名老年 Medicare 患者中，47.6%直接出院到社区，52.4%在机构接受急性后期护理。政策后在 CJR 地区出院到机构的患者在 90 天治疗结束时返回社区的可能性降低约 10%（优势比=0.91；95%置信区间，0.84-0.98；P=.02），而在政策豁免地区接受治疗的患者则降低了 10%。尽管幅度很大，但在 CJR 实施后接受捆绑治疗的患者中，护理升级的估计值在统计学上没有显著意义。
我们的研究结果支持进一步探讨强制性捆绑支付政策对结果的意外影响，以及进一步研究美国接受髋关节置换术的政策相关患者亚组的结果。
