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JAMA子刊:与综合医院相比,儿科专科医院在常规外科手术方面是否提供了更高的价值?

2022-06-29 liangying MedSci原创

接受普通外科手术的儿童在CH和NCH具有相同的临床结果,但这些手术与较高的费用相关,因此,整体护理价值较低。

虽然儿童医院(CH)占美国医院的比例不到5%,但占儿科住院天数的40%,护理费用的50%。2009年,40家独立的CH占美国年度医疗保健支出的100多亿美元,前10家CH的利润超过8亿美元。在过去十年中,当代儿科护理经历了实质性的区域化,目前正在努力将儿童外科护理集中提供给专业中心。

虽然儿童医院(CH)在美国提供了相当一部分高度专业化的儿科护理,但与非儿童医院(NCH)相比,在常规外科手术方面,CH的价值尚不清楚。本研究的目的是通过评估临床结果和支付数据来检验CH在常规手术中的价值。

这项回顾性队列研究利用医疗成本研究所的管理数据,对2010年至2015年间接受13种常用外科手术中的1种手术的儿科患者进行了90天的随访。数据分析时间为2019年7月至2021年12月。主要结果为从私人保险公司支付的普通外科手术费用以及30、60和90天的总体并发症和再入院率。

共有368220名儿童患者接受了其中一种手术,其中男性220899例(60.0%),118977人(32.3%)在独立式CH(CH-A)进行了手术,75256人(20.4%)在成人医院附属CH(CH-B)进行了手术,173987人(47.3%)在NCH进行了手术。CH-A所有程序的平均(SD)付款为6533.56美元(6399.97美元),CH-B为5847.50美元(4947.47美元),NCH为5034.25美元(4787.07美元)。

CH-A、CH-B和NCH的平均(SD)总并发症发生率分别为0.004、0.01和0.003。在所有医院类型中,30天、60天和90天的再入院率相似。在调整邮政编码、年份、手术、手术设置以及可观察到的患者、医院和县特征后,CH-A住院患者普通程序的估计付款比NCH高出39%。CH-A的门诊普通程序费用比NCH高34%。

手术并发症和再入院率

总之,在这项队列研究中,接受普通外科手术的儿童在CH和NCH具有相同的临床结果,但这些手术与较高的费用相关,因此,整体护理价值较低。为了确保向患者和支付者提供最佳价值,需要进行更多的研究,以评估CH和NCH确保获取、降低成本和提高价值的机制。

参考文献:Raval MV, Reiter AJ, McCarthy IM. Association of Children’s Hospital Status With Value for Common Surgical Conditions. JAMA Netw Open. 2022;5(6):e2218348. doi:10.1001/jamanetworkopen.2022.18348

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    不错的文章

    0

  5. [GetPortalCommentsPageByObjectIdResponse(id=1715416, encodeId=49db1e154167a, content=<a href='/topic/show?id=235220e0106' target=_blank style='color:#2F92EE;'>#专科#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=60, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=20701, encryptionId=235220e0106, topicName=专科)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=894231925290, createdName=12498ebem29暂无昵称, createdTime=Sun May 14 12:41:44 CST 2023, time=2023-05-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1695570, encodeId=d42416955e04f, content=<a href='/topic/show?id=3c9ce911681' target=_blank style='color:#2F92EE;'>#综合医院#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=64, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79116, encryptionId=3c9ce911681, topicName=综合医院)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=7a1429829192, createdName=amyloid, createdTime=Tue Dec 20 12:41:44 CST 2022, time=2022-12-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1229441, encodeId=a6e712294412c, content=<a href='/topic/show?id=8f275032126' target=_blank style='color:#2F92EE;'>#期刊论坛#</a><a href='/topic/show?id=23e3454e353' target=_blank style='color:#2F92EE;'>#学习#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=66, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=50321, encryptionId=8f275032126, topicName=期刊论坛), TopicDto(id=45473, encryptionId=23e3454e353, topicName=学习)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=b0825417521, createdName=ms6000000960504356, createdTime=Wed Jun 29 12:59:50 CST 2022, time=2022-06-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1229440, encodeId=b2b91229440c2, content=不错的文章, beContent=null, objectType=article, channel=null, level=null, likeNumber=64, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=b0825417521, createdName=ms6000000960504356, createdTime=Wed Jun 29 12:59:43 CST 2022, time=2022-06-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1343402, encodeId=f3fa1343402f8, content=<a href='/topic/show?id=d3ea4293676' target=_blank style='color:#2F92EE;'>#外科手术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=68, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=42936, encryptionId=d3ea4293676, topicName=外科手术)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTLGtr9t89oicQdQSIeKmOQic1weIWfibJ7H24XnT8ic9wiaUMTnXByenuwicOj8Jib42ibHXNptnuiaKthhiaVw/132, createdBy=ac342500190, createdName=ms7524819409032184, createdTime=Mon Jun 27 01:41:44 CST 2022, time=2022-06-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1243579, encodeId=c1e612435e9c8, content=JAMA上文章都是顶级的,谢谢梅斯及时上新, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=肿瘤克星, createdTime=Sat Jun 25 13:41:44 CST 2022, time=2022-06-25, status=1, ipAttribution=)]
  6. [GetPortalCommentsPageByObjectIdResponse(id=1715416, encodeId=49db1e154167a, content=<a href='/topic/show?id=235220e0106' target=_blank style='color:#2F92EE;'>#专科#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=60, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=20701, encryptionId=235220e0106, topicName=专科)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=894231925290, createdName=12498ebem29暂无昵称, createdTime=Sun May 14 12:41:44 CST 2023, time=2023-05-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1695570, encodeId=d42416955e04f, content=<a href='/topic/show?id=3c9ce911681' target=_blank style='color:#2F92EE;'>#综合医院#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=64, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79116, encryptionId=3c9ce911681, topicName=综合医院)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=7a1429829192, createdName=amyloid, createdTime=Tue Dec 20 12:41:44 CST 2022, time=2022-12-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1229441, encodeId=a6e712294412c, content=<a href='/topic/show?id=8f275032126' target=_blank style='color:#2F92EE;'>#期刊论坛#</a><a href='/topic/show?id=23e3454e353' target=_blank style='color:#2F92EE;'>#学习#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=66, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=50321, encryptionId=8f275032126, topicName=期刊论坛), TopicDto(id=45473, encryptionId=23e3454e353, topicName=学习)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=b0825417521, createdName=ms6000000960504356, createdTime=Wed Jun 29 12:59:50 CST 2022, time=2022-06-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1229440, encodeId=b2b91229440c2, content=不错的文章, beContent=null, objectType=article, channel=null, level=null, likeNumber=64, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=b0825417521, createdName=ms6000000960504356, createdTime=Wed Jun 29 12:59:43 CST 2022, time=2022-06-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1343402, encodeId=f3fa1343402f8, content=<a href='/topic/show?id=d3ea4293676' target=_blank style='color:#2F92EE;'>#外科手术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=68, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=42936, encryptionId=d3ea4293676, topicName=外科手术)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTLGtr9t89oicQdQSIeKmOQic1weIWfibJ7H24XnT8ic9wiaUMTnXByenuwicOj8Jib42ibHXNptnuiaKthhiaVw/132, createdBy=ac342500190, createdName=ms7524819409032184, createdTime=Mon Jun 27 01:41:44 CST 2022, time=2022-06-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1243579, encodeId=c1e612435e9c8, content=JAMA上文章都是顶级的,谢谢梅斯及时上新, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=肿瘤克星, createdTime=Sat Jun 25 13:41:44 CST 2022, time=2022-06-25, status=1, ipAttribution=)]
    2022-06-25 肿瘤克星

    JAMA上文章都是顶级的,谢谢梅斯及时上新

    0

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