BACKGROUND The impact of social determinants of health in allogeneic transplant recipients in low-and middle-income countries is poorly described.This observational study analyzes the impact of place of residence,refe...BACKGROUND The impact of social determinants of health in allogeneic transplant recipients in low-and middle-income countries is poorly described.This observational study analyzes the impact of place of residence,referring institution,and transplant cost coverage(out-of-pocket vs government-funded vs private insurance)on outcomes after allogeneic hematopoietic stem cell transplantation(alloHSCT)in two of Mexico's largest public and private institutions.AIM To evaluate the impact of social determinants of health and their relationship with outcomes among allogeneic transplant recipients in Mexico.METHODS In this retrospective cohort study,we included adolescents and adults≥16 years who received a matched sibling or haploidentical transplant from 2015-2022.Participants were selected without regard to their diagnosis and were sourced from both a private clinic and a public University Hospital in Mexico.Three payment groups were compared:Out-of-pocket(OOP),private insurance,and a federal Universal healthcare program“Seguro Popular”.Outcomes were compared between referred and institution-diagnosed patients,and between residents of Nuevo Leon and out-of-state.Primary outcomes included overall survival(OS),categorized by residence,referral,and payment source.Secondary outcomes encompassed early mortality,event-free-survival,graft-versus-host-relapse-free survival,and non-relapse-mortality(NRM).Statistical analyses employed appropriate tests,Kaplan-Meier method,and Cox proportional hazard regression modeling.Statistical software included SPSS and R with tidycmprsk library.RESULTS Our primary outcome was overall survival.We included 287 patients,n=164 who lived out of state(57.1%),and n=129 referred from another institution(44.9%).The most frequent payment source was OOP(n=139,48.4%),followed by private insurance(n=75,26.1%)and universal coverage(n=73,25.4%).No differences in OS,event-free-survival,NRM,or graft-versus-host-relapse-free survival were observed for patients diagnosed locally vs in another institution,nor patients who lived in-state vs out-of-state.Patients who covered transplant costs through private insurance had the best outcomes with improved OS(median not reached)and 2-year cumulative incidence of NRM of 14%than patients who covered costs OOP(Median OS and 2-year NRM of 32%)or through a universal healthcare program active during the study period(OS and 2-year NRM of 19%)(P=0.024 and P=0.002,respectively).In a multivariate analysis,payment source and disease risk index were the only factors associated with overall survival.CONCLUSION In this Latin-American multicenter study,the site of residence or referral for alloHSCT did not impact outcomes.However,access to healthcare coverage for alloHSCT was associated with improved OS and reduced NRM.展开更多
“十四五”期间,我国公立医院进入高质量发展阶段,医保支付方式改革成为促进公立医院高质量发展的关键举措。然而,从目前情况来看,尽管疾病诊断相关分组(diagnosis related group,DRG)支付方式改革在缩短平均住院日、提高难度系数、降...“十四五”期间,我国公立医院进入高质量发展阶段,医保支付方式改革成为促进公立医院高质量发展的关键举措。然而,从目前情况来看,尽管疾病诊断相关分组(diagnosis related group,DRG)支付方式改革在缩短平均住院日、提高难度系数、降低中低风险病组死亡率方面取得了一定成绩,但也存在着配套政策不完善、分类系统需更新、病案首页质量参差不齐、编码质量急需提高,以及如何处理新技术的使用等诸多问题与挑战。因此,重新审视DRG支付方式对公立医院高质量发展的影响,不仅有助于更加清晰地认识当前所面临的困境,还能为未来进一步完善和优化医保支付方式提供重要参考依据。展开更多
目的分析2022年疾病诊断相关分组(diagnosis related group,DRG)改革效果及其对不同科室的影响,为DRG实施创造有利的政策环境。方法本研究数据来源于北京市二级、三级医院住院病案首页数据库,共纳入北京市城镇职工医疗保险住院患者的住...目的分析2022年疾病诊断相关分组(diagnosis related group,DRG)改革效果及其对不同科室的影响,为DRG实施创造有利的政策环境。方法本研究数据来源于北京市二级、三级医院住院病案首页数据库,共纳入北京市城镇职工医疗保险住院患者的住院病案记录1603989条。构建双重差分模型,采用事件研究法进行平行趋势检验,应用医院月度汇总数据分析2022年DRG改革对城镇职工医疗保险住院患者次均住院费用、平均住院日、30 d再入院患者比例、60 d再入院患者比例和经门诊入院患者比例的影响;在此基础上,选取内科、外科、妇产科和肿瘤科的月度汇总数据进一步分析DRG改革对不同科室住院服务利用的影响。结果相较于非DRG医院,DRG改革使住院患者的次均住院费用下降约9.79%,平均住院日下降约5.35%,而对再入院风险和经门诊入院患者比例无显著影响;DRG改革降低了内科、外科和妇产科的次均住院费用,降低了内科和外科的平均住院日,对所选4个科室的再入院风险和经门诊入院患者比例均无显著影响。结论北京市DRG改革降低了住院患者的次均住院费用,但应注意对医疗行为的持续监督,同时发挥其他支付方式在弥补DRG缺陷方面的作用;DRG改革对不同科室的影响存在差异,需制订适当的支持性政策以维持其良性发展。展开更多
文摘BACKGROUND The impact of social determinants of health in allogeneic transplant recipients in low-and middle-income countries is poorly described.This observational study analyzes the impact of place of residence,referring institution,and transplant cost coverage(out-of-pocket vs government-funded vs private insurance)on outcomes after allogeneic hematopoietic stem cell transplantation(alloHSCT)in two of Mexico's largest public and private institutions.AIM To evaluate the impact of social determinants of health and their relationship with outcomes among allogeneic transplant recipients in Mexico.METHODS In this retrospective cohort study,we included adolescents and adults≥16 years who received a matched sibling or haploidentical transplant from 2015-2022.Participants were selected without regard to their diagnosis and were sourced from both a private clinic and a public University Hospital in Mexico.Three payment groups were compared:Out-of-pocket(OOP),private insurance,and a federal Universal healthcare program“Seguro Popular”.Outcomes were compared between referred and institution-diagnosed patients,and between residents of Nuevo Leon and out-of-state.Primary outcomes included overall survival(OS),categorized by residence,referral,and payment source.Secondary outcomes encompassed early mortality,event-free-survival,graft-versus-host-relapse-free survival,and non-relapse-mortality(NRM).Statistical analyses employed appropriate tests,Kaplan-Meier method,and Cox proportional hazard regression modeling.Statistical software included SPSS and R with tidycmprsk library.RESULTS Our primary outcome was overall survival.We included 287 patients,n=164 who lived out of state(57.1%),and n=129 referred from another institution(44.9%).The most frequent payment source was OOP(n=139,48.4%),followed by private insurance(n=75,26.1%)and universal coverage(n=73,25.4%).No differences in OS,event-free-survival,NRM,or graft-versus-host-relapse-free survival were observed for patients diagnosed locally vs in another institution,nor patients who lived in-state vs out-of-state.Patients who covered transplant costs through private insurance had the best outcomes with improved OS(median not reached)and 2-year cumulative incidence of NRM of 14%than patients who covered costs OOP(Median OS and 2-year NRM of 32%)or through a universal healthcare program active during the study period(OS and 2-year NRM of 19%)(P=0.024 and P=0.002,respectively).In a multivariate analysis,payment source and disease risk index were the only factors associated with overall survival.CONCLUSION In this Latin-American multicenter study,the site of residence or referral for alloHSCT did not impact outcomes.However,access to healthcare coverage for alloHSCT was associated with improved OS and reduced NRM.
文摘“十四五”期间,我国公立医院进入高质量发展阶段,医保支付方式改革成为促进公立医院高质量发展的关键举措。然而,从目前情况来看,尽管疾病诊断相关分组(diagnosis related group,DRG)支付方式改革在缩短平均住院日、提高难度系数、降低中低风险病组死亡率方面取得了一定成绩,但也存在着配套政策不完善、分类系统需更新、病案首页质量参差不齐、编码质量急需提高,以及如何处理新技术的使用等诸多问题与挑战。因此,重新审视DRG支付方式对公立医院高质量发展的影响,不仅有助于更加清晰地认识当前所面临的困境,还能为未来进一步完善和优化医保支付方式提供重要参考依据。
文摘目的分析2022年疾病诊断相关分组(diagnosis related group,DRG)改革效果及其对不同科室的影响,为DRG实施创造有利的政策环境。方法本研究数据来源于北京市二级、三级医院住院病案首页数据库,共纳入北京市城镇职工医疗保险住院患者的住院病案记录1603989条。构建双重差分模型,采用事件研究法进行平行趋势检验,应用医院月度汇总数据分析2022年DRG改革对城镇职工医疗保险住院患者次均住院费用、平均住院日、30 d再入院患者比例、60 d再入院患者比例和经门诊入院患者比例的影响;在此基础上,选取内科、外科、妇产科和肿瘤科的月度汇总数据进一步分析DRG改革对不同科室住院服务利用的影响。结果相较于非DRG医院,DRG改革使住院患者的次均住院费用下降约9.79%,平均住院日下降约5.35%,而对再入院风险和经门诊入院患者比例无显著影响;DRG改革降低了内科、外科和妇产科的次均住院费用,降低了内科和外科的平均住院日,对所选4个科室的再入院风险和经门诊入院患者比例均无显著影响。结论北京市DRG改革降低了住院患者的次均住院费用,但应注意对医疗行为的持续监督,同时发挥其他支付方式在弥补DRG缺陷方面的作用;DRG改革对不同科室的影响存在差异,需制订适当的支持性政策以维持其良性发展。
