Department of Health Systems and Population Health, University of Washington, Seattle, Washington, USA.
Noridian Healthcare Solutions, LLC, Fargo, North Dakota, USA.
Clin Cardiol. 2024 Nov;47(11):e70030. doi: 10.1002/clc.70030.
Since 2010, all non-VA hospitals performing cardiac surgeries and percutaneous interventions in Washington State have participated in the Cardiac Care Outcomes Assessment Program (COAP), a data-driven, physician-led collaborative quality improvement (QI) collaborative. Prior literature has demonstrated QI programs such as COAP can avert avoidable utilization such as hospital readmissions. However, it is unknown whether such improvements translate into economic benefits.
This study compared downstream healthcare costs between patients undergoing cardiac interventions for coronary artery disease (CAD) at hospitals that were and were not participating in COAP.
Post hoc analysis of Medicare administrative and claims data examined 2.5 million randomly selected deidentified beneficiaries receiving a percutaneous coronary intervention or coronary artery bypass grafting between 2013 and 2020. Total costs were defined as all reimbursements paid by Medicare for up to 5 years following cardiac intervention. Because all non-VA hospitals in Washington State participated in COAP, we compared respective groups of patients receiving intervention in Washington State with all non-Washington states, adjusting for patient demographics and comorbidity. To model costs, we applied a multipart estimator, which distinguishes the impact of QI program participation due to survival and utilization while accounting for censoring.
Total 5-year downstream costs were $3861 lower (95% confidence interval [CI] = $1794 to $5741) among patients receiving cardiac intervention at COAP-exposed hospitals. Lower costs were largely driven by lower utilization during calendar quarters where death was not observed.
Participation in this state-wide cardiac quality improvement program was associated with economic benefits in patients receiving intervention for CAD.
自 2010 年以来，华盛顿州所有进行心脏手术和经皮介入治疗的非退伍军人事务部医院都参与了心脏护理结果评估计划（COAP），这是一个数据驱动、由医生领导的合作质量改进（QI）合作。先前的文献表明，COAP 等 QI 计划可以避免不必要的利用，如医院再入院。然而，尚不清楚这些改进是否转化为经济效益。
本研究比较了在参与和不参与 COAP 的医院接受冠状动脉疾病（CAD）心脏介入治疗的患者之间的下游医疗保健成本。
对 Medicare 管理和索赔数据进行事后分析，检查了 250 万名随机选择的接受经皮冠状动脉介入治疗或冠状动脉旁路移植术的匿名受益人的数据，这些患者在 2013 年至 2020 年间接受治疗。总费用定义为 Medicare 在心脏介入后 5 年内支付的所有报销费用。由于华盛顿州的所有非退伍军人事务部医院都参与了 COAP，我们将在华盛顿州接受介入治疗的患者与所有非华盛顿州的患者进行了比较，同时调整了患者的人口统计学和合并症。为了对成本进行建模，我们应用了一个多部分估计器，该估计器区分了由于生存和利用而导致的 QI 计划参与的影响，同时考虑了删失。
在接受 COAP 暴露医院心脏介入治疗的患者中，5 年内的总下游成本降低了 3861 美元（95%置信区间 [CI] = 1794 美元至 5741 美元）。较低的成本主要是由于在没有观察到死亡的日历季度中利用降低所致。
参与这项全州范围的心脏质量改进计划与接受 CAD 介入治疗的患者的经济效益相关。
