Kiani Sara N, Maron Samuel Z, Rosenzweig Shoshana, Zubizarreta Nicole, Poeran Jashvant, Moucha Calin S
Leni and Peter W. May Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Institute for Healthcare Delivery Science, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
HSS J. 2024 May;20(2):261-267. doi: 10.1177/15563316231155387. Epub 2023 Feb 24.
While the comprehensive care for joint replacement (CJR) bundled payment program for total joint replacement (TJR) emphasizes value, concerns persist regarding unintended consequences, primarily hospital selection of healthier, younger patients. : We sought to assess changes in patient characteristics and outcomes after CJR implementation in New York State. : This retrospective cohort study included primary total hip and total knee arthroplasties from the New York Statewide Planning and Research Cooperative System (SPARCS) database. Procedures performed before (July 2014 to March 2016; n = 58,610) and after (April 2016 to December 2017; n = 78,728) CJR implementation were compared. Primary outcomes were patient characteristics: Deyo-Comorbidity Index and age. Secondary outcomes were increased hospitalization cost, discharge to institutional post-acute care, and prolonged length of stay. A difference-in-differences analysis estimated changes after CJR implementation, comparing CJR to non-CJR hospitals. : We found that CJR implementation (in 49 of 144 New York State hospitals) coincided with slightly older and more comorbid TJR recipients. The CJR program coincided with significantly reduced hospitalization cost and discharge to institutional post-acute care but not length of stay. Some CJR effects appear to have affected non-Medicare patients, as well. : This retrospective analysis suggests that in New York State, the CJR bundled payment program did not result in hospitals selecting younger and healthier TJR recipients and coincided with decreased costs and fewer discharges to institutional postacute care.
虽然全关节置换（TJR）的关节置换综合护理（CJR）捆绑支付计划强调价值，但对于意外后果的担忧依然存在，主要是医院选择更健康、更年轻的患者。我们试图评估纽约州实施CJR后患者特征和结局的变化。这项回顾性队列研究纳入了纽约州全州规划与研究合作系统（SPARCS）数据库中的初次全髋关节置换术和全膝关节置换术。比较了CJR实施前（2014年7月至2016年3月；n = 58,610）和实施后（2016年4月至2017年12月；n = 78,728）进行的手术。主要结局是患者特征：Deyo合并症指数和年龄。次要结局是住院费用增加、出院后转至机构接受急性后护理以及住院时间延长。采用差异分析估计CJR实施后的变化，将实施CJR的医院与未实施CJR的医院进行比较。我们发现，CJR的实施（在纽约州144家医院中的49家）与年龄稍大、合并症更多的TJR接受者相符。CJR计划与住院费用显著降低以及出院后转至机构接受急性后护理的情况减少相关，但与住院时间无关。一些CJR的影响似乎也波及了非医疗保险患者。这项回顾性分析表明，在纽约州，CJR捆绑支付计划并未导致医院选择更年轻、更健康的TJR接受者，而是与成本降低以及出院后转至机构接受急性后护理的情况减少相关。
