Department of Medicine, Perelman School of Medicine, Pulmonary, Allergy, and Critical Care Division, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
J Hosp Med. 2023 Nov;18(11):1004-1007. doi: 10.1002/jhm.13215. Epub 2023 Oct 10.
We sought to explore the heterogeneity among patients hospitalized with pneumonia, a condition targeted in payment reform. In a retrospective cohort study of Medicare beneficiaries hospitalized for pneumonia, we compared postacute care utilization and costs of 90-day episodes of care among patients with and without comorbidities of chronic obstructive pulmonary disease (COPD) and/or heart failure. Of the 1,926,674 discharges, 28.1% had COPD, 14.3% had heart failure, and 14.6% carried both diagnoses. Patients with pneumonia were more likely to be discharged to a facility than those with pneumonia and COPD with or without heart failure, though less likely than those with pneumonia and heart failure only. Compared to patients with pneumonia only, patients with COPD and/or heart failure had higher episode payments. Acute conditions such as pneumonia may hold promise for episode-based care payment reform; however, the heterogeneity within this diagnosis indicates the need to consider other patient characteristics in interventions to improve value-based care.
我们试图探讨因支付方式改革而成为目标的肺炎住院患者之间的异质性。在对因肺炎住院的 Medicare 受益人的回顾性队列研究中，我们比较了有无慢性阻塞性肺疾病 (COPD) 和/或心力衰竭合并症的患者的急性后护理利用情况和 90 天护理期的成本。在 1,926,674 例出院患者中，28.1%患有 COPD，14.3%患有心力衰竭，14.6%同时患有这两种疾病。患有肺炎的患者比患有肺炎合并 COPD 和/或心力衰竭（无论有无心力衰竭）的患者更有可能被送往医疗机构，但比仅患有肺炎和心力衰竭的患者更不可能。与仅患有肺炎的患者相比，患有 COPD 和/或心力衰竭的患者的医疗费用更高。肺炎等急性病症可能为基于疾病的护理支付改革带来希望；然而，该诊断内的异质性表明，在改善基于价值的护理的干预措施中需要考虑其他患者特征。
