医疗保险责任制医疗组织：泌尿外科癌症手术的康复期护理使用和术后结果。
Medicare Accountable Care Organizations: Post-acute Care Use and Post-surgical Outcomes in Urologic Cancer Surgery.
机构信息
Division of Health Policy and Outcomes Research, Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY.
Division of Hematology, Oncology, Department of Medicine, University of Rochester Medical Center, Rochester, NY; James P. Wilmot Cancer Institute, Rochester, NY; Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY.
出版信息
Urology. 2022 Sep;167:102-108. doi: 10.1016/j.urology.2022.06.018. Epub 2022 Jun 28.
OBJECTIVE
To evaluate association between Medicare accountable care organizations (ACOs) participation of hospitals on post-acute care (PAC) use and spending, and post-surgical outcomes in Medicare beneficiaries undergoing urologic cancer surgeries. Despite increasing prevalence of urologic cancer and surgical care contributing to a large proportion of total health care costs, and recent Medicare payment reforms such as accountable care organizations, the role of ACOs in urologic cancer care has been unexplored.
METHODS
We conducted a longitudinal analysis of 2011-2017 Medicare claims data to compare post-surgical outcomes between Medicare ACO and non-ACO patients before and after implementation of Medicare shared savings program (MSSP). Our outcomes of interest were Post-acute care (PAC) use (overall, institutional, and home health), Skilled Nursing Facility (SNF) length of stay and Medicare spending for SNF patients, 30-day and 90-day unplanned readmissions and complications after index procedure.
RESULTS
Study sample included a total of 334,514 Medicare patients undergoing bladder, prostate, kidney cancer surgeries at 524 Medicare ACO and 2066 non-ACO hospitals. For bladder cancer surgery, Medicare ACO participation was associated with significantly reduced overall post-acute care use, but not with changes in readmission or complication rate. For prostate cancer and kidney cancer surgery, we found no significant association between hospital participation in Medicare ACOs and PAC use or post-surgical outcomes.
CONCLUSION
Hospital participation in MSSP ACOs leads to lower post-acute care use without compromising patient outcomes for Medicare beneficiaries undergoing bladder cancer surgery. Future research is needed to understand longer-term impact of ACO participation on urologic cancer surgery outcomes.
目的
评估医院参与医疗保险责任制医疗组织（ACO）对接受泌尿科癌症手术的 Medicare 受益人的术后康复护理（PAC）使用和支出以及术后结果的影响。尽管泌尿科癌症的发病率不断上升，且手术治疗占总医疗费用的很大一部分，再加上最近医疗保险的支付改革（如责任制医疗组织），但责任制医疗组织在泌尿科癌症护理中的作用仍未得到探索。
方法
我们对 2011 年至 2017 年 Medicare 索赔数据进行了纵向分析，以比较 Medicare 共享储蓄计划（MSSP）实施前后 Medicare ACO 和非 ACO 患者的术后结果。我们感兴趣的结果是术后康复护理（整体、机构和家庭健康）的使用、康复护理设施（SNF）的住院时间和 Medicare 对 SNF 患者的支出、30 天和 90 天的非计划性再入院和指数手术后 90 天内的并发症。
结果
研究样本包括总共 334514 名接受膀胱癌、前列腺癌、肾癌手术的 Medicare 患者，这些患者在 524 家 Medicare ACO 和 2066 家非 ACO 医院接受治疗。对于膀胱癌手术，Medicare ACO 的参与与整体术后康复护理使用显著减少相关，但与再入院或并发症发生率的变化无关。对于前列腺癌和肾癌手术，我们发现医院参与 Medicare ACO 与 PAC 使用或术后结果之间没有显著关联。
结论
医院参与 MSSP ACO 可降低 Medicare 膀胱癌手术受益人的术后康复护理使用量，而不会影响患者的结果。需要进一步研究以了解 ACO 参与对泌尿科癌症手术结果的长期影响。
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