Lown Institute, Needham, Massachusetts.
Menzies Centre for Health Policy, Sydney School of Public Health, University of Sydney, Australia, NSW.
JAMA Health Forum. 2021 Jul 23;2(7):e211719. doi: 10.1001/jamahealthforum.2021.1719. eCollection 2021 Jul.
There has been insufficient research on the patient harms and costs associated with potential low-value procedures in the US Medicare population.
To report the prevalence of adverse events associated with potential low-value procedures and the additional hospital length of stay (LOS) and costs.
This is a retrospective cohort study using Medicare fee-for-service claims between January 2016 to December 2018. Participants were aged 65 years or older. Procedures were selected if they had previously published indicators of low-value care, including knee arthroscopy, spinal fusion, vertebroplasty, percutaneous coronary intervention (PCI), carotid endarterectomy, renal stenting, and hysterectomy for benign conditions. Analysis was conducted from July to December, 2020.
For inpatient procedures, the number and rate of admissions with a hospital-acquired condition (HAC) or patient safety indicator event (PSIs), as well as the unadjusted and adjusted difference in mean LOS and Medicare costs between admissions with and without a HAC/PSI. For outpatient procedures, we report the number of claims where the beneficiary had an unplanned hospital admission within seven days and the number of these admissions with a HAC/PSI.
There were 573 351 patients included in the study, with 617 264 procedures; the mean (SD) age was 74.2 (6.7) years, with 320 637 women (55.9%), and mostly White patients (520 735; 90.8%). Among the 197 755 claims for the inpatient procedures, 231 had an HAC and 1764 had a PSI. Spinal fusion was associated with the most HACs (123 admissions) and PSIs (1015 admissions). Overall, HACs during a PCI admission were associated with the highest adjusted additional mean LOS (17.5 days; 95% CI, 10.3-23.6), with also the highest adjusted additional mean cost ($22 000; 95% CI, $9100-$32 600). There were 419 509 included outpatient procedures, and 7514 (1.8%) had an unplanned admission within 7 days. A total of 17 HACs and PSIs occurred in these admissions.
In this cross-sectional cohort study of Medicare fee-for-service claims, patients receiving potential low-value care were exposed to risk of unnecessary harm associated with higher cost and LOS.
美国医疗保险人群中，针对潜在低价值治疗的患者危害和成本的研究还不够充分。
报告与潜在低价值治疗相关的不良事件发生率，以及由此导致的额外住院时间（LOS）和费用。
设计、地点和参与者：这是一项回顾性队列研究，使用了 2016 年 1 月至 2018 年 12 月期间的医疗保险费用服务索赔数据。参与者年龄在 65 岁或以上。如果手术有先前发表的低价值护理指标，包括膝关节镜检查、脊柱融合术、椎体成形术、经皮冠状动脉介入治疗（PCI）、颈动脉内膜切除术、肾支架置入术和良性疾病的子宫切除术，则选择这些手术。分析于 2020 年 7 月至 12 月进行。
对于住院治疗，记录出现医院获得性疾病（HAC）或患者安全指标事件（PSI）的住院人数和比率，以及 HAC/PSI 与无 HAC/PSI 的住院治疗之间 LOS 和医疗保险费用的未调整和调整后差异。对于门诊治疗，我们报告了在 7 天内有计划外住院的受益人的索赔数量，以及这些住院中出现 HAC/PSI 的数量。
研究纳入了 573351 名患者，共进行了 617264 次手术；平均（SD）年龄为 74.2（6.7）岁，其中 320637 名女性（55.9%），大多数为白人患者（520735 名；90.8%）。在 197755 份住院治疗的索赔中，有 231 份发生了 HAC，有 1764 份发生了 PSI。脊柱融合术与最多的 HAC（123 例入院）和 PSI（1015 例入院）相关。总体而言，PCI 治疗期间的 HAC 与最高的调整后平均 LOS 增加（17.5 天；95%CI，10.3-23.6）相关，与最高的调整后平均费用增加（22000 美元；95%CI，9100-32600 美元）相关。纳入了 419509 例门诊手术，其中有 7514 例（1.8%）在 7 天内有计划外住院。这些住院中有 7514 例（1.8%）发生了 419509 例，共发生了 7514 例（1.8%）。共有 17 例 HAC 和 PSI。
在这项针对医疗保险费用服务索赔的横断面队列研究中，接受潜在低价值治疗的患者面临与更高成本和 LOS 相关的不必要伤害的风险。
