ImportanceThe Centers for Medicare & Medicaid Services (CMS) Bundled Payments for Care Improvement (BPCI) program was launched in 2013 with a goal to improve care quality while lowering costs to Medicare.ObjectiveTo compare changes in the quality and outcomes of care for patients hospitalized with heart failure according to hospital participation in the BPCI program.Design, Setting, and ParticipantsThis cross-sectional study used a difference-in-difference approach to evaluate the BPCI program in 18 BPCI hospitals vs 211 same-state non-BPCI hospitals for various process-of-care measures and outcomes using American Heart Association Get With The Guidelines–Heart Failure registry and CMS Medicare claims data from November 1, 2008, to August 31, 2018. Data were analyzed from May 2022 to May 2023.ExposuresHospital participation in CMS BPCI Model 2 Heart Failure, which paid hospitals in a fee-for-service process and then shared savings or required reimbursement depending on how the total cost of an episode of care compared with a target price.Main Outcomes and MeasuresPrimary end points included 7 quality-of-care measures. Secondary end points included 9 outcome measures, including in-hospital mortality and hospital-level risk-adjusted 30-day and 90-day all-cause readmission rate and mortality rate.ResultsDuring the study period, 8721 patients were hospitalized in the 23 BPCI hospitals and 94 530 patients were hospitalized in the 224 same-state non-BPCI hospitals. Less than a third of patients (30 723 patients, 29.8%) were 75 years or younger; 54 629 (52.9%) were female, and 48 622 (47.1%) were male. Hospital participation in BPCI Model 2 was not associated with significant differential changes in the odds of various process-of-care measures, except for a decreased odds of evidence-based β-blocker at discharge (adjusted odds ratio [aOR], 0.63; 95% CI, 0.41-0.98; P = .04). Participation in the BPCI was not associated with a significant differential change in the odds of receiving angiotensin-converting enzyme inhibitors/angiotensin receptor blockers or angiotensin receptor-neprilysin inhibitors at discharge, receiving an aldosterone antagonist at discharge, having a cardiac resynchronization therapy (CRT)–defibrillator or CRT pacemaker placed or prescribed at discharge, having implantable cardioverter-defibrillator (ICD) counseling or an ICD placed or prescribed at discharge, heart failure education being provided among eligible patients, or having a follow-up visit within 7 days or less. Participation in the BPCI was associated with a significant decrease in odds of in-hospital mortality (aOR, 0.67; 95% CI, 0.51-0.86; P = .002). Participation was not associated with a significant differential change in hospital-level risk-adjusted 30-day or 90-day all-cause readmission rate and 30-day or 90-day all-cause mortality rate.Conclusion and RelevanceIn this study, hospital participation in the BPCI Model 2 Heart Failure program was not associated with improvement in process-of-care quality measures or 30-day or 90-day risk-adjusted all-cause mortality and readmission rates.

中文翻译：

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用于心力衰竭护理改善、护理质量和结果的捆绑付款


重要性医疗保险中心医疗补助服务 (CMS) 护理改善捆绑支付 (BPCI) 计划于 2013 年启动，旨在提高护理质量，同时降低医疗保险成本。目的比较不同医院的心力衰竭住院患者的护理质量和结果的变化设计、设置和参与者这项横断面研究使用双重差分法来评估 18 家 BPCI 医院与 211 家同州非 BPCI 医院的 BPCI 计划的各种护理流程措施和结果使用美国心脏协会获取指南 - 心力衰竭登记和 CMS 医疗保险索赔数据，数据为 2008 年 11 月 1 日至 2018 年 8 月 31 日。数据分析时间为 2022 年 5 月至 2023 年 5 月。暴露医院参与 CMS BPCI 模型 2 心力衰竭，它以按服务收费的方式向医院付费，然后根据每次护理的总成本与目标价格的比较来分享节省的费用或要求报销。主要结果和措施主要终点包括 7 项护理质量措施。次要终点包括9项结局指标，包括院内死亡率以及医院级别风险调整后的30天和90天全因再入院率和死亡率。 结果研究期间，23家BPCI医院有8721名患者住院。 224 家同州非 BPCI 医院有 94 530 名患者住院。不到三分之一的患者（30 723 名患者，29.8%）年龄在 75 岁或以下；女性 54 629 人（52.9%），男性 48 622 人（47.1%）。 医院参与 BPCI 模型 2 与各种护理过程措施的几率的显着差异变化无关，除了出院时基于证据的 β 受体阻滞剂的几率降低（调整后的比值比 [aOR]，0.63；95 % CI，0.41-0.98；磷= .04)。参与 BPCI 与出院时接受血管紧张素转换酶抑制剂/血管紧张素受体阻滞剂或血管紧张素受体脑啡肽酶抑制剂、出院时接受醛固酮拮抗剂、接受心脏再同步治疗 (CRT) 的几率的显着差异变化无关– 出院时放置或处方除颤器或 CRT 起搏器、出院时进行植入式心律转复除颤器 (ICD) 咨询或放置或处方 ICD、在符合条件的患者中提供心力衰竭教育，或在 7 天内或更短的时间内进行随访。参与 BPCI 与院内死亡率显着降低相关（aOR，0.67；95% CI，0.51-0.86；磷= .002)。参与与医院级别风险调整后的 30 天或 90 天全因再入院率以及 30 天或 90 天全因死亡率的显着差异变化无关。结论和相关性在本研究中，医院参与BPCI 模型 2 心力衰竭计划中的改善与护理过程质量措施或 30 天或 90 天风险调整全因死亡率和再入院率的改善无关。