Center for Health Systems Effectiveness, Oregon Health & Science University, Portland.
JAMA Health Forum. 2022 Jun 17;3(6):e221657. doi: 10.1001/jamahealthforum.2022.1657. eCollection 2022 Jun.
Prior research concluded that institutional postacute care spending decreased under the Comprehensive Care for Joint Replacement (CJR) model. Less is known about how changes in institutional postacute care spending varied across different types of hospitals.
To measure hospital-level heterogeneity in the association of the CJR model with changes in institutional postacute care spending and to identify hospital characteristics associated with this variation.
Using 100% Medicare claims data, this cross-sectional study assessed institutional postacute care spending from 2016 to 2017 among US hospitals randomly selected to participate in the CJR model and control group hospitals that were eligible but not selected for the participation in the CJR model. A causal forest was used to estimate the treatment effect of the CJR model conditional on hospital characteristics. Analysis was conducted between October 2019 and October 2021.
The unit of analysis was each hospital; the outcome was the average per-episode Medicare spending for institutional postacute care within 90 days after hospital discharge for hip or knee joint replacement.
This study included 531 CJR participating hospitals and 658 control group hospitals from 2016 to 2017. The CJR model was associated with a $761 reduction in institutional postacute care spending (95% CI, -$1172 to -$351). The reduction in spending under the CJR model did not vary across conditional on hospital characteristics. Limited evidence was found for greater savings among hospitals with higher pre-CJR spending. However, this finding did not hold for hospitals in the highest quintile of pre-CJR spending.
In this cross-sectional study of 1189 hospitals, findings did not show strong evidence for significant heterogeneity in how the CJR model was associated with reductions in institutional postacute care spending across a range of hospital characteristics. Savings were not concentrated in hospitals with specific characteristics, such as hospitals with high-volume joint replacement or hospitals serving less medically or socially complex patients. Findings suggest that the CJR model created opportunities for savings across a spectrum of different hospitals.
先前的研究得出结论，机构康复护理支出在综合关节置换护理（CJR）模式下有所减少。对于机构康复护理支出的变化如何因不同类型的医院而异，了解得较少。
衡量 CJR 模式与机构康复护理支出变化之间关联的医院层面异质性，并确定与这种变化相关的医院特征。
设计、设置和参与者：本横断面研究使用 100%的医疗保险索赔数据，评估了 2016 年至 2017 年期间美国随机选择参与 CJR 模式的医院和有资格但未被选择参与 CJR 模式的对照组医院的机构康复护理支出。使用因果森林估计 CJR 模型对医院特征的条件处理效果。分析于 2019 年 10 月至 2021 年 10 月进行。
分析单位为每家医院；结果是髋关节或膝关节置换后 90 天内机构康复护理的每例 Medicare 支出平均值。
本研究包括 2016 年至 2017 年的 531 家 CJR 参与医院和 658 家对照组医院。CJR 模式与机构康复护理支出减少 761 美元相关（95%CI，-1172 美元至-351 美元）。在考虑到医院特征的情况下，CJR 模型下的支出减少没有差异。在 CJR 前支出较高的医院中，有证据表明节省更多。然而，这一发现不适用于 CJR 前支出最高五分位数的医院。
在这项对 1189 家医院的横断面研究中，没有发现强有力的证据表明，CJR 模式与机构康复护理支出减少之间的关联在一系列医院特征方面存在显著异质性。节省并未集中在具有特定特征的医院，例如关节置换量较大的医院或服务于医疗或社会复杂程度较低的患者的医院。研究结果表明，CJR 模式为各种不同的医院创造了节省机会。
