Division of Health Services Research, Department of Urology, University of Michigan, 2800 Plymouth Rd, Bldg 16, Ann Arbor, MI 48109-2800. Email:
Am J Manag Care. 2023 Jul;29(7):349-355. doi: 10.37765/ajmc.2023.89395.
To understand the effects of accountable care organizations (ACOs) on use of surgery in patients with Alzheimer disease and related dementias (ADRD).
Retrospective national cohort study of all Medicare beneficiaries identified in a 20% sample between 2010 and 2017. The primary exposure was participation in ACOs. The primary outcome was use of 1 of 6 common surgical procedures (aortic valve replacement [AVR], abdominal aortic aneurysm [AAA] repair, colectomy, carotid artery repair, major joint repair, and prostatectomy).
Multivariable logistic regression models were fit using beneficiary-year as the unit of analysis to estimate the likelihood of undergoing each procedure among patients with ADRD and without ADRD, stratified by ACO participation. Additional models were fit to determine how the relationship between ACO participation and surgery was altered based on procedure urgency and the availability of minimally invasive technology.
Adjusted odds for use of surgery were lower among patients with ADRD compared with patients without ADRD for all procedures. ACO participation had varying impact on patients with ADRD, with higher odds of AVR and major joint surgery and lower odds of carotid artery repair. Availability of minimally invasive technology increased the likelihood of AVR and AAA repair among patients with ADRD; however, ACO participation reduced these effects. The effect of ACO participation on the likelihood of undergoing surgery did not vary by urgency of the procedure.
The likelihood of undergoing surgery is overall lower among patients with ADRD and may vary by ACO participation for specific procedures.
了解责任医疗组织（ACO）对阿尔茨海默病和相关痴呆症（ADRD）患者手术使用的影响。
这是一项回顾性全国队列研究，纳入了 2010 年至 2017 年期间 20%的样本中所有的 Medicare 受益人的数据。主要暴露因素为参与 ACO。主要结局是使用 6 种常见手术之一（主动脉瓣置换术[AVR]、腹主动脉瘤[AAA]修复术、结肠切除术、颈动脉修复术、大关节修复术和前列腺切除术）。
使用受益年度作为分析单位，使用多变量逻辑回归模型来估计 ADRD 患者和非 ADRD 患者接受每种手术的可能性，同时根据 ACO 参与情况进行分层。另外还拟合了一些模型，以确定 ACO 参与与手术之间的关系如何根据手术紧急程度和微创手术技术的可用性而改变。
与非 ADRD 患者相比，ADRD 患者接受所有手术的调整后手术可能性均较低。ACO 参与对 ADRD 患者的影响不同，AVR 和大关节手术的可能性更高，而颈动脉修复术的可能性更低。微创手术技术的可用性增加了 ADRD 患者接受 AVR 和 AAA 修复术的可能性；然而，ACO 参与降低了这些效果。ACO 参与对手术可能性的影响不因手术的紧急程度而有所不同。
ADRD 患者总体上手术可能性较低，并且特定手术的 ACO 参与可能会有所不同。
