340B 计划对低收入患者的医疗质量的影响。

The impacts of the 340B Program on health care quality for low-income patients.

机构信息

Department of Population Health, New York University Grossman School of Medicine, New York City, New York, USA.

New York University Wagner Graduate School of Public Service, New York City, New York, USA.

出版信息

Health Serv Res. 2023 Oct;58(5):1089-1097. doi: 10.1111/1475-6773.14204. Epub 2023 Jul 20.

DOI:10.1111/1475-6773.14204

PMID:37475113

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10480080/

Abstract

OBJECTIVE

To assess the effects of hospital 340B eligibility on quality of inpatient care provided to Medicaid and uninsured patients and for all patients.

DATA

Agency for Health Care Research and Quality's Healthcare Cost and Utilization Project State Inpatient Data, Hospital Cost Reporting Information System Data, Office of Pharmacy Affairs Information System Data, and American Hospital Association Annual Survey.

DESIGN

Regression discontinuity design comparing hospitals just above the DSH percentage program eligibility threshold to those just below. Quality measures include all-cause mortality and 30-day readmission rates as well as condition-specific measures.

DATA EXTRACTION

Inpatient data from general acute care hospitals from 2008 to 2014 in 15 states. Data linked on hospital 340B eligibility and participation.

PRINCIPAL FINDINGS

We did not find discontinuities in inpatient care quality across the Program eligibility threshold for Medicaid and uninsured patients; specifically, on all-cause mortality (beta = -0.04 percentage points, 95% CI: -0.16, 0.08), 30-day readmission rates (beta = -0.16 percentage points, 95% CI: -0.81, 0.5), or other measures. Among insured and non-Medicaid patients, we found discontinuities for acute myocardial infarction (beta = -0.87 percentage points, 95% CI: -1.55, -0.2) and postoperative sepsis (beta = -0.15 percentage points, 95% CI: -0.23, -0.07) mortality.

CONCLUSIONS

340B Program participation has not demonstrated improved quality of inpatient care among Medicaid or uninsured patients.

摘要

目的

评估医院 340B 资格对向医疗补助和无保险患者以及所有患者提供的住院治疗质量的影响。

数据

医疗保健成本和利用项目州住院数据、医院成本报告信息系统数据、药房事务信息系统数据和美国医院协会年度调查的美国卫生保健研究与质量局。

设计

比较刚好超过 DSH 百分比计划资格门槛的医院和刚好低于门槛的医院的回归不连续性设计。质量衡量标准包括全因死亡率和 30 天再入院率以及特定疾病的衡量标准。

数据提取

来自 2008 年至 2014 年 15 个州的普通急症护理医院的住院数据。数据与医院 340B 资格和参与情况相关联。

主要发现

我们没有发现 Medicaid 和无保险患者计划资格门槛的住院治疗质量存在不连续性；具体来说，在全因死亡率（β=-0.04 个百分点，95%CI：-0.16，0.08）、30 天再入院率（β=-0.16 个百分点，95%CI：-0.81，0.5）或其他衡量标准方面。在有保险和非 Medicaid 患者中，我们发现急性心肌梗死（β=-0.87 个百分点，95%CI：-1.55，-0.2）和术后败血症（β=-0.15 个百分点，95%CI：-0.23，-0.07）死亡率存在不连续性。