本文由小咖机器人翻译整理

期刊来源：JAMA

原文链接：https://doi.org/10.1001/jama.2023.23649

摘要内容如下：

重要性

终末期肾病治疗选择（ETC）模型随机选择了30%的美国透析机构，根据其使用家庭透析、肾移植等待名单或移植收据来获得财政奖励。不成比例地为高社会风险人群提供服务的设施对家庭透析和肾移植的使用率较低，这引起了人们的担忧，即这些设施在支付模式中可能表现不佳。

目的

检查透析机构的第一年ETC模型绩效评分和经济处罚，根据其事件患者的社会风险进行分层。

设计、设置和参与者

从2021年1月1日至12月31日，对参与ETC模式的2191家美国透析机构进行横断面研究。

曝光

事件患者人群的构成，以非西班牙裔黑人、西班牙裔、居住在高度弱势社区、无保险或在透析开始时由医疗补助计划覆盖的患者的比例为特征。设施层面的综合社会风险评分评估每个设施是否属于具有0、1或至少2个这些特征的最高五分位数。

主要成果和措施

使用家庭透析、等待名单或移植；模型性能评分；和经济处罚。

结果

使用125984例事件患者的数据（中位年龄，65岁[IQR，54-74]；女性占41.8%；黑人占28.6%；11.7%为西班牙裔），1071家透析机构（48.9%）没有社会风险特征，491家（22.4%）有2个或2个以上。在ETC模式的第一年，与没有社会风险特征的人相比，有2个或更多的透析设施的平均绩效得分较低（3.4比3.6，P=.002），家庭透析的使用率较低（14.1%比16.0%，P<.001）。这些机构收到的经济处罚较高（18.5%比11.5%，P<0.001），更经常有最高的5%的付款削减（2.4%比0.7%；P=.003），并且不太可能获得4%的最高奖金（0%比2.7%；P<.001）。与所有其他机构相比，治疗无保险患者或医疗补助计划（Medicaid）覆盖的患者的最高五分位数（17.4%vs 12.9%，P=.01）以及黑人患者比例最高的五分位数（18.5%vs 12.6%，P=.001）遭受了更多的经济处罚。

结论

在医疗保险和医疗补助服务中心（Centers for Medicare&Medicaid Services）的ETC模式的第一年，为较高比例的具有社会风险特征的患者提供服务的透析机构的绩效得分较低，受到的经济处罚也明显较高。

英文原文如下：

Abstracts

Importance  The End-Stage Renal Disease Treatment Choices (ETC) model randomly selected 30% of US dialysis facilities to receive financial incentives based on their use of home dialysis, kidney transplant waitlisting, or transplant receipt. Facilities that disproportionately serve populations with high social risk have a lower use of home dialysis and kidney transplant raising concerns that these sites may fare poorly in the payment model.

Objective  To examine first-year ETC model performance scores and financial penalties across dialysis facilities, stratified by their incident patients' social risk.

Design, Setting, and Participants  A cross-sectional study of 2191 US dialysis facilities that participated in the ETC model from January 1 through December 31, 2021.

Exposure  Composition of incident patient population, characterized by the proportion of patients who were non-Hispanic Black, Hispanic, living in a highly disadvantaged neighborhood, uninsured, or covered by Medicaid at dialysis initiation. A facility-level composite social risk score assessed whether each facility was in the highest quintile of having 0, 1, or at least 2 of these characteristics.

Main Outcomes and Measures  Use of home dialysis, waitlisting, or transplant; model performance score; and financial penalization.

Results  Using data from 125 984 incident patients (median age, 65 years [IQR, 54-74]; 41.8% female; 28.6% Black; 11.7% Hispanic), 1071 dialysis facilities (48.9%) had no social risk features, and 491 (22.4%) had 2 or more. In the first year of the ETC model, compared with those with no social risk features, dialysis facilities with 2 or more had lower mean performance scores (3.4 vs 3.6, P = .002) and lower use of home dialysis (14.1% vs 16.0%, P < .001). These facilities had higher receipt of financial penalties (18.5% vs 11.5%, P < .001), more frequently had the highest payment cut of 5% (2.4% vs 0.7%; P = .003), and were less likely to achieve the highest bonus of 4% (0% vs 2.7%; P < .001). Compared with all other facilities, those in the highest quintile of treating uninsured patients or those covered by Medicaid experienced more financial penalties (17.4% vs 12.9%, P = .01) as did those in the highest quintile in the proportion of patients who were Black (18.5% vs 12.6%, P = .001).

Conclusions  In the first year of the Centers for Medicare & Medicaid Services' ETC model, dialysis facilities serving higher proportions of patients with social risk features had lower performance scores and experienced markedly higher receipt of financial penalties.

-----------分割线---------

点击链接：https://www.mediecogroup.com/community/user/vip/categories/ ，成为医咖会员，获取12项专属权益。

现在购买可享受最大优惠（买一年送三个月，买两年送一年），2024年2月10日起将不再享有该优惠。