Cov Nqi Them Nqi Tshaj Lij Rau Raum Hloov Kev Ntsuam Xyuas Thiab Tos Cov Kev Tswj Xyuas Hauv Tebchaws Meskas, 2012-2017
Jun 12, 2024
Cov txiaj ntsig
Peb qhov kev tshawb fawb zaum kawg yog 1335 xyoo tsev kho mob los ntawm 2012 txog 2017, ntawm 930 xyoo tsev kho mob los ntawm 2013 txog 2017 tau txuas nrog OPO cov ntaub ntawv nqi. Table 1 qhia cov yam ntxwv hauv paus. Thaum lub sijhawm kawm, cov tsev kho mob hloov pauv tau nce hauv nruab nrab (IQR) raum tos cov npe ntim (2012-2013: 273 [110-569] cov neeg mob; 2016-2017: 281 [128-599] cov neeg mob ; P < .001), nruab nrab (IQR) lub raum tos daim ntawv teev lub cev muaj zog (2012-2013: 167 [65-346] cov neeg mob; 2016-2017: 172 [74-369] cov neeg mob; P <.001), thiab nruab nrab (IQR)Hloov lub raum ntim(2012-2013: 52 [24-94]; 2016-2017: 60 [28-117]; P < .001). Qhov nce ntawm kev hloov pauv ntim feem ntau cuam tshuam nrog kev nce hauv cov neeg tuaghloov pauv hloovntim ( nruab nrab [IQR] cov neeg tuag pub dawb, {{0}}: 35 [15-65]; 2016- 2017, 44 [18-83]; P < .001). Qhov nce ntawm kev hloov pauv tau pom nyob rau hauv txhua cheeb tsam United Network of Organ Sharing (UNOS) tshwj tsis yog Cheeb Tsam 10 (Midwest), qhov uas nws tseem nyob sib nrug (eAppendix 2 hauv Kev Ntxiv). Comorbidities, raws li kev kwv yees los ntawm EPTS, kuj nce ntxiv thaum lub sijhawm kawm, hauv ob tus neeg mob ntawm daim ntawv tos thiab cov neeg mob tau txais kev hloov pauv, nrog rau kev hloov pauv ntawm cov neeg mob uas muaj lub nra hnyav tshaj plaws (EPTS 0-20) rau cov neeg mob. hnyav dua comorbidity. Medicare piv tau nyob tas li ntawm 0.72 thoob plaws lub sijhawm kawm, txhais tau hais tias Medicare tau lav kwv yees li 72% ntawm tag nrho cov nqi OACC thoob plaws lub sijhawm kawm. Tus qauv tau txais tus nqi ib lub raum kuj tau nce ntxiv nyob rau lub sijhawm kawm los ntawm kwv yees li $ 1000, lossis 3%, ib xyoos (los ntawm qhov nruab nrab [IQR] ntawm $33 000 [$30 000-$35 000] hauv 2012-2013 rau $35 000 [$32 000-$38 000] hauv 2016-2017), thiab tau pab txhawb rau 36% ntawm qhov nruab nrab OACC tus nqi ibhloov raumthoob plaws lub sijhawm kawm.
Medicare qhov feem ntawm OACC cov nqi tau nce los ntawm $0.95 billion hauv 2012 txog $1.32 billion hauv 2017 (Daim duab 1). Tus nqi nruab nrab (IQR) OACC ib lub raum hloov pauv tau nce los ntawm $ 81,000 ($ 66,{10}} $ 103,000) ib lub raum hloov pauv hauv xyoo 2012 txog $ 100,{{15} } ($ 82,000-$ 125,{19}}) ib lub raum hloov pauv hauv xyoo 2017. Tus nqi nruab nrab (IQR) OACC tus nqi yog los ntawm cov nqi uas tsis yog kev yuav khoom hauv nruab nrog cev (OACC tsawg SAC) nce los ntawm ${{21} } ($36 000-$81 000) ib lub raum hloov hauv 2013 rau $62 000 ($46 000-$86 000) ib lub raum hloov hauv 2017. OACC ibhloov raumsib txawv los ntawm UNOS cheeb tsam, nrog cov nqi siab tshaj plaws hauv cheeb tsam 9 (New York, Vermont), 4 (Texas), thiab 5 (Southwest). Kev kwv yees rau feem ntau thaj tsam tsis ua tiav qhov tseem ceeb (Tshooj 2 hauv Cov Khoom Ntxiv). Tag nrho cov nqi OACC (nyob rau theem kev kawm-xyoo) tau muaj txiaj ntsig zoo nrog ob qho tib si hloov pauv thiab cov npe tos ntim (Daim duab 2). Qhov qis tshaj tertile ranged ntawm $0 mus rau $3 600 000; nruab nrab tertile, $3 700 000 rau $8 300 000; siab tshaj tertile, $8 300 000 rau $39 000 000.
Peb xaiv cov qauv uas hloov pauv thiab tos cov npe ntim tau sawv cev los ntawm cov ntsiab lus linear. eAppendix 3 hauv Cov Khoom Ntxiv nthuav qhia qhov sib piv ntawm cov qauv nrog cov qauv sib txawv. Lub ntsiab lus OACC tus nqi ib lub raum hloov pauv tau cuam tshuam nrog kev txo qis vim tias cov kev hloov pauv hloov pauv tau hloov pauv ntau dua thiab nce xyoo, qhov ntsuas tus nqi hauv zos, ntau tus neeg mob tau teev npe nyob rau hauv daim ntawv tos, thiab ntau tus neeg mob ntawm daim ntawv tos nrog EPTS ntawm 81 txog 100 ( denoting ntau comorbidity ntawm daim ntawv tos) (Table 2). Tus qauv zoo ib yam thaum peb tshuaj xyuas OACC cov nqi uas yog tus nqi uas tsis yog kev yuav khoom hauv nruab nrog cev (OACC tsawg SAC) (Table 2). Hloov mus rau qhov kev hloov pauv hauv xyoo 2017 nrog qhov nruab nrab nqi hauv zos qhov ntsuas, hloov pauv thiab tos cov npe ntim, thiab lub nra hnyav, txhais tau tias OACC tus nqi ibhloov raumtau cuam tshuam nrog kev txo qis ntawm $3500 (95% CI, $2700-$4300) rau 10 kev hloov pauv tau ua (P < .001) thiab nce nrog xyoo ($4400 [95% CI, $3500-$5300]] ib xyoos twg; ntawm daim ntawv tos ($ 3200 [95% CI, $1700-$ 4600] rau 100 tus neeg mob; P < .001), thiab ntau tus neeg mob ntawm daim ntawv tos uas muaj kev sib txuam siab ($ 1500 [95% CI, ${{26] }}$ 2500] rau 1% nce hauv feem ntawm cov neeg mob tos nrog cov qhab nia siab tshaj plaws P=.002) (Daim duab 3).
Hauv kev txheeb xyuas tus khub, peb tau saib ntawm daim ntawv teev npe tos-cov npe-rau-hloov piv, lossis qhov piv ntawm cov neeg mob ntawm cov npe tos rau cov neeg mob tau txais kev hloov pauv hauv txhua xyoo, thiab nws lub koom haum nrog tus nqi OACC. rau lub raum transplantation. Qhov nruab nrab tos daim ntawv teev-rau-hloov piv yog 4.7 (IQR, 3.0-7.1; ntau yam, 0-97). Qhov sib piv ntau dua, qhov siab dua qhov txhais tau tias OACC nqi ib lub raum hloov pauv (eAppendix 4 hauv Kev Ntxiv). Kev nce ntawm cov npe tos - qhov piv rau hloov pauv ntawm 1 (los ntawm qhov nruab nrab ntawm 5 mus rau 6 tus neeg mob ntawm daim ntawv tos rau ib tus neeg mob tau txais kev hloov pauv) tau cuam tshuam nrog qhov nce ntawm $ 6930 (tom qab hloov kho rau ib xyoos, qhov ntsuas tus nqi, thiab tos. npe comorbidity) txhais tau tias OACC nqi ibhloov raum(Daim duab 3).
