双重参保退伍军人接受低价值宫颈癌筛查后的护理级联。
Care cascades following low-value cervical cancer screening in dually enrolled Veterans.
机构信息
Center for Health Equity Research and Promotion (CHERP), VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA.
Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
出版信息
J Am Geriatr Soc. 2024 Jul;72(7):2091-2099. doi: 10.1111/jgs.18956. Epub 2024 May 9.
BACKGROUND
Veterans dually enrolled in the Veterans Health Administration (VA) and Medicare commonly experience downstream services as part of a care cascade after an initial low-value service. Our objective was to characterize the frequency and cost of low-value cervical cancer screening and subsequent care cascades among Veterans dually enrolled in VA and Medicare.
METHODS
This retrospective cohort study used VA and Medicare administrative data from fiscal years 2015 to 2019. The study cohort was comprised of female Veterans aged >65 years and at low risk of cervical cancer who were dually enrolled in VA and Medicare. Within this cohort, we compared differences in the rates and costs of cascade services related to low-value cervical cancer screening for Veterans who received and did not receive screening in FY2018, adjusting for baseline patient- and facility-level covariates using inverse probability of treatment weighting.
RESULTS
Among 20,972 cohort-eligible Veterans, 494 (2.4%) underwent low-value cervical cancer screening with 301 (60.9%) initial screens occurring in VA and 193 (39%) occurring in Medicare. Veterans who were screened experienced an additional 26.7 (95% CI, 16.4-37.0) cascade services per 100 Veterans compared to those who were not screened, contributing to $2919.4 (95% CI, -265 to 6104.7) per 100 Veterans in excess costs. Care cascades consisted predominantly of subsequent cervical cancer screening procedures and related outpatient visits with low rates of invasive procedures and occurred in both VA and Medicare.
CONCLUSIONS
Veterans dually enrolled in VA and Medicare commonly receive related downstream tests and visits as part of care cascades following low-value cervical cancer screening. Our findings demonstrate that to fully capture the extent to which individuals are subject to low-value care, it is important to examine downstream care stemming from initial low-value services across all systems from which individuals receive care.
背景
在 Veterans Health Administration（VA）和 Medicare 双重注册的退伍军人通常会在初始低价值服务后经历下游服务，这是一个护理级联。我们的目标是描述 Veterans Health Administration（VA）和 Medicare 双重注册的退伍军人中低价值宫颈癌筛查的频率和成本，以及随后的护理级联。
方法
这是一项使用 VA 和 Medicare 行政数据的回顾性队列研究，数据来自 2015 年至 2019 财年。研究队列由年龄>65 岁且宫颈癌风险较低的女性退伍军人组成，他们在 VA 和 Medicare 双重注册。在这个队列中，我们比较了在 2018 财年接受和未接受筛查的退伍军人中，与低价值宫颈癌筛查相关的级联服务的比率和成本差异，使用逆概率治疗加权法，根据基线患者和设施水平的协变量进行调整。
结果
在 20972 名符合条件的队列退伍军人中，有 494 人（2.4%）接受了低价值宫颈癌筛查，其中 301 人（60.9%）初始筛查在 VA 进行，193 人（39%）在 Medicare 进行。与未接受筛查的退伍军人相比，接受筛查的退伍军人每 100 人增加了 26.7（95%CI，16.4-37.0）项级联服务，导致每 100 人额外增加 2919.4 美元（95%CI，-265 至 6104.7）的费用。护理级联主要由随后的宫颈癌筛查程序和相关门诊就诊组成，侵袭性程序的发生率较低，发生在 VA 和 Medicare 中。
结论
在 Veterans Health Administration（VA）和 Medicare 双重注册的退伍军人通常会在接受低价值宫颈癌筛查后接受相关的下游测试和就诊，这是一个护理级联。我们的研究结果表明，为了全面了解个人接受低价值护理的程度，重要的是要检查个人接受护理的所有系统中，源自初始低价值服务的下游护理。
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