کد مقاله | کد نشریه | سال انتشار | مقاله انگلیسی | نسخه تمام متن |
---|---|---|---|---|
10047373 | 1598398 | 2005 | 7 صفحه PDF | دانلود رایگان |
عنوان انگلیسی مقاله ISI
Changes in Medicare Reimbursement and Patient-Nephrologist Visits, Quality of Care, and Health-Related Quality of Life
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کلمات کلیدی
quality improvement - بهبود کیفیتend-stage renal disease (ESRD) - بیماری کلیوی مرحله پایانی (ESRD)Adherence - تبعیتvascular access - دسترسی عروقیMedicare - مدیکر Patient outcomes - نتایج بیمارControl chart - نمودار کنترلیHemodialysis (HD) - همودیالیز (HD)Dialysis adequacy - کفایت دیالیزAnemia - کم خونیHealth-related quality of life - کیفیت زندگی مرتبط با سلامت
موضوعات مرتبط
علوم پزشکی و سلامت
پزشکی و دندانپزشکی
بیماریهای کلیوی
پیش نمایش صفحه اول مقاله
![عکس صفحه اول مقاله: Changes in Medicare Reimbursement and Patient-Nephrologist Visits, Quality of Care, and Health-Related Quality of Life Changes in Medicare Reimbursement and Patient-Nephrologist Visits, Quality of Care, and Health-Related Quality of Life](/preview/png/10047373.png)
چکیده انگلیسی
Background: Medicare's reimbursement system was changed in January 2004 to encourage more frequent visits between dialysis patients and nephrologists. We sought to determine the impact of this policy change on patient-nephrologist visits, quality of care, and health-related quality of life. Methods: We examined visits and outcomes for 2,043 patients at 12 hemodialysis facilities in northeast Ohio for 12 months before and 7 months after the reimbursement change. For comparison of outcomes, we used linear, logistic, or negative binomial regression models (for continuous, binary, and rate outcomes, respectively) to assess the significance of changes across the 2 periods. Results: For patients seen before and after the reimbursement change for at least 6 months, the number of visits per patient-month increased from 1.52 before to 3.14 after (P < 0.001). The percentage of patients with no nephrologist visits per patient-month decreased from 16.6% before to 4.6% after (P < 0.001). However, there were no clinically important changes in Kt/V, albumin level, hemoglobin level, phosphorus level, calcium level, hemodialysis catheter use, ultrafiltration volume, shortened or skipped treatments, hospital admissions, hospitalization days, or health-related quality of life, including patient satisfaction. Conclusion: Despite a marked increase in visits between patients and nephrologists, there was no clinically important impact on parameters related to quality of care or health-related quality of life. Additional work is needed to determine effective payment strategies to improve dialysis patient outcomes.
ناشر
Database: Elsevier - ScienceDirect (ساینس دایرکت)
Journal: American Journal of Kidney Diseases - Volume 46, Issue 4, October 2005, Pages 621-627
Journal: American Journal of Kidney Diseases - Volume 46, Issue 4, October 2005, Pages 621-627
نویسندگان
Evelyn K. MD, Peter B. MD, Andrew S. DO, Thomas E. PhD, Edmond S. MD, Ashwini R. MD,