Early effect of a financial incentive for surgeries within 48 h after hip fracture on the number of expedited hip fracture surgeries, in-hospital mortality, perioperative morbidity, length of stay and inpatient medical expenses.

IF 2.1 4区 医学 Q3 HEALTH CARE SCIENCES & SERVICES Journal of evaluation in clinical practice Pub Date : 2024-10-16 DOI:10.1111/jep.14189
Kenta Minato, Susumu Kunisawa, Yuichi Imanaka
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Abstract

Objective: To examine the early effects of the financial incentive (FI) implemented in April 2022 in Japan for surgeries within 48 h after hip fracture (HF) in patients aged 75 and older on expedited HF surgery (EHFS), in-hospital mortality, perioperative morbidity, length of stay (LOS) and inpatient medical expenses (IMEs).

Study setting and design: We conducted a quasi-experimental study and constructed segmented regression models for controlled interrupted time-series analyses, assuming a Poisson distribution, to evaluate the slope changes (SCs) in the outcomes of interest before and after the introduction of the FI.

Data sources and analytic sample: We used Diagnosis Procedure Combination data from the Quality Indicator/Improvement Project database between 1 April 2018 and 31 March 2023. Patients aged 50 years or older who were hospitalized with a diagnosis of HF and underwent surgery for HF were included.

Principal findings: A total of 82,163 patients from 183 hospitals were included in the analyses. In the age group of 75 years and older, increasing trends in the number of EHFSs were observed even before the introduction of the FI, while before and after the introduction of the FI, none of the SCs in the monthly number of EHFSs within 2 days, within 1 day, and on the day of admission were statistically significant (incident rate ratio: 1.0043, 95% confidence interval [CI]: [0.9977-1.0111], 1.0068 [0.9987-1.0149], 1.0073 [0.9930-1.0219]). Nor were any of the SCs in in-hospital deaths, perioperative complications, LOS, and IMEs statistically significant. Additionally, there were no statistical differences in the SCs for any of the outcomes between the two age groups.

Conclusion: This study suggested that there was no significant, short-term effect of the FI for surgeries within 48 h after HF on any of the outcomes of interest.

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对髋部骨折后 48 小时内进行手术的经济激励措施对髋部骨折快速手术数量、院内死亡率、围手术期发病率、住院时间和住院医疗费用的早期影响。
目的研究背景与设计:我们进行了一项准实验性研究,并建立了分段回归模型进行控制性间断时间序列分析,以评估髋部骨折(HF)后48小时内手术的早期经济激励(FI)对75岁及以上患者加速HF手术(EHFS)、院内死亡率、围手术期发病率、住院时间(LOS)和住院医疗费用(IMEs)的影响:我们进行了一项准实验性研究,并建立了分段回归模型进行受控间断时间序列分析,假设为泊松分布,以评估引入 FI 前后相关结果的斜率变化(SCs):我们使用了质量指标/改进项目数据库中 2018 年 4 月 1 日至 2023 年 3 月 31 日期间的诊断程序组合数据。纳入的患者年龄在 50 岁或以上,因诊断为心房颤动住院并接受心房颤动手术:共有 183 家医院的 82163 名患者纳入分析。在 75 岁及以上年龄组中,即使在引入 FI 之前,EHFS 的数量也呈上升趋势,而在引入 FI 之前和之后,2 天内、1 天内和入院当天的每月 EHFS 数量的 SCs 均无统计学意义(事故率比:1.0043,95% 置信区间 [CI]:[0.9977-1.0043]):[0.9977-1.0111], 1.0068 [0.9987-1.0149], 1.0073 [0.9930-1.0219]).院内死亡、围手术期并发症、LOS 和 IME 均无统计学意义。此外,两个年龄组之间任何结果的SCs均无统计学差异:本研究表明,高频术后 48 小时内手术的 FI 对任何相关结果都没有明显的短期影响。
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来源期刊
CiteScore
4.80
自引率
4.20%
发文量
143
审稿时长
3-8 weeks
期刊介绍: The Journal of Evaluation in Clinical Practice aims to promote the evaluation and development of clinical practice across medicine, nursing and the allied health professions. All aspects of health services research and public health policy analysis and debate are of interest to the Journal whether studied from a population-based or individual patient-centred perspective. Of particular interest to the Journal are submissions on all aspects of clinical effectiveness and efficiency including evidence-based medicine, clinical practice guidelines, clinical decision making, clinical services organisation, implementation and delivery, health economic evaluation, health process and outcome measurement and new or improved methods (conceptual and statistical) for systematic inquiry into clinical practice. Papers may take a classical quantitative or qualitative approach to investigation (or may utilise both techniques) or may take the form of learned essays, structured/systematic reviews and critiques.
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