Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 10.052
Filtrar
4.
J Surg Oncol ; 121(8): 1175-1178, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32207151

RESUMO

BACKGROUND AND OBJECTIVES: Prophylactic lymphovenous anastomosis (LVA) has been shown to decrease the incidence of postoperative lymphedema among patients receiving mastectomy with axillary lymph node dissection (ALND). However, the economic impact of this intervention on overall healthcare costs has not been adequately studied and insurance reimbursement for lymphedema treatment is limited resulting in substantial out-of-pocket patient expenses. METHODS: We performed a cost-minimization decision analysis from the societal perspective to assess two different patient scenarios: (a) mastectomy with ALND alone, (b) mastectomy with ALND and prophylactic LVA. RESULTS: The annual cost of lymphedema-related care is estimated to be $5,691.88 ($3,160.52 direct, $2,531.36 indirect). If all patients undergoing mastectomy with ALND undergo prophylactic LVA, the average expected lifetime cost per patient in the entire population (whether or not they develop lymphedema) is approximately $6,295.61, compared to $13,942.26 if no patients in the same population receive prophylactic LVA. CONCLUSIONS: Prophylactic LVA is economically preferred over mastectomy and ALND alone from a cost minimization perspective, and results in an average of $7,646.65 (45.2%) cost saving per patient over the course of their lifetime.


Assuntos
Anastomose Cirúrgica/economia , Linfedema Relacionado a Câncer de Mama/prevenção & controle , Neoplasias da Mama/economia , Neoplasias da Mama/cirurgia , Anastomose Cirúrgica/métodos , Linfedema Relacionado a Câncer de Mama/economia , Controle de Custos , Tomada de Decisões , Árvores de Decisões , Feminino , Custos de Cuidados de Saúde , Humanos , Reembolso de Seguro de Saúde , Excisão de Linfonodo/economia , Vasos Linfáticos/cirurgia , Mastectomia/efeitos adversos , Mastectomia/economia , Microcirurgia/economia , Microcirurgia/métodos , Complicações Pós-Operatórias/economia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Programa de SEER , Estados Unidos
5.
Value Health ; 23(2): 154-156, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-32113619

RESUMO

Value-based pharmaceutical contracts (VBPCs) are performance-based reimbursement agreements between healthcare payers and pharmaceutical manufacturers in which the price, amount, or nature of reimbursement is tied to value-based outcomes. VBPCs are often complex, and the nature of who benefits and in what ways can be unclear. We discuss how VBPCs compare with value-based payer-provider arrangements in terms of performance-based reimbursements and alignment of incentives. In addition, we examine how VBPCs can affect costs, clinical outcomes, and access to medications. Because these contracts are unlikely to reduce costs in isolation, we recommend taking a patient-centered approach when developing VBPCs and tying VBPCs to more overarching payer drug cost reduction strategies.


Assuntos
Contratos/economia , Custos de Medicamentos , Indústria Farmacêutica/economia , Alocação de Recursos para a Atenção à Saúde/economia , Reembolso de Seguro de Saúde/economia , Seguro de Saúde Baseado em Valor/economia , Aquisição Baseada em Valor/economia , Redução de Custos , Análise Custo-Benefício , Gastos em Saúde , Acesso aos Serviços de Saúde/economia , Humanos , Formulação de Políticas
6.
Plast Reconstr Surg ; 145(4): 865-876, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32221191

RESUMO

BACKGROUND: Within the multidisciplinary management of breast cancer, variations exist in the reconstructive options offered and care provided. The authors evaluated plastic surgeon perspectives on important issues related to breast cancer management and reconstruction and provide some insight into factors that influence these perspectives. METHODS: Women diagnosed with early-stage breast cancer (stages 0 to II) between July of 2013 and September of 2014 were identified through the Georgia and Los Angeles Surveillance, Epidemiology, and End Results registries. These women were surveyed and identified their treating plastic surgeons. Surveys were sent to the identified plastic surgeons to collect data on specific reconstruction practices. RESULTS: Responses from 134 plastic surgeons (74.4 percent response rate) were received. Immediate reconstruction (79.7 percent) was the most common approach to timing, and expander/implant reconstruction (72.6 percent) was the most common technique reported. Nearly one-third of respondents (32.1 percent) reported that reimbursement influenced the proportion of autologous reconstructions performed. Most (82.8 percent) reported that discussions about contralateral prophylactic mastectomy were initiated by patients. Most surgeons (81.3 to 84.3 percent) felt that good symmetry is achieved with unilateral autologous reconstruction with contralateral symmetry procedures in patients with small or large breasts; a less pronounced majority (62.7 percent) favored unilateral implant reconstructions in patients with large breasts. In patients requiring postmastectomy radiation therapy, one-fourth of the surgeons (27.6 percent) reported that they seldom recommend delayed reconstruction, and 64.9 percent reported recommending immediate expander/implant reconstruction. CONCLUSIONS: Reconstructive practices in a modern cohort of plastic surgeons suggest that immediate and implant reconstructions are performed preferentially. Respondents perceived a number of factors, including surgeon training, time spent in the operating room, and insurance reimbursement, to negatively influence the performance of autologous reconstruction.


Assuntos
Neoplasias da Mama/cirurgia , Mamoplastia/estatística & dados numéricos , Mastectomia/efeitos adversos , Padrões de Prática Médica/estatística & dados numéricos , Retalhos Cirúrgicos/estatística & dados numéricos , Adulto , Idoso , Implantes de Mama/estatística & dados numéricos , Feminino , Georgia , Humanos , Reembolso de Seguro de Saúde/estatística & dados numéricos , Los Angeles , Mamoplastia/economia , Mamoplastia/instrumentação , Mamoplastia/métodos , Pessoa de Meia-Idade , Mastectomia Profilática/estatística & dados numéricos , Programa de SEER/estatística & dados numéricos , Cirurgiões/estatística & dados numéricos , Retalhos Cirúrgicos/economia , Retalhos Cirúrgicos/transplante , Inquéritos e Questionários/estatística & dados numéricos , Tempo para o Tratamento , Dispositivos para Expansão de Tecidos/estatística & dados numéricos
7.
Value Health ; 23(2): 139-150, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-32113617

RESUMO

Healthcare resource allocation decisions made under conditions of uncertainty may turn out to be suboptimal. In a resource constrained system in which there is a fixed budget, these suboptimal decisions will result in health loss. Consequently, there may be value in reducing uncertainty, through the collection of new evidence, to make better resource allocation decisions. This value can be quantified using a value of information (VOI) analysis. This report, from the ISPOR VOI Task Force, introduces VOI analysis, defines key concepts and terminology, and outlines the role of VOI for supporting decision making, including the steps involved in undertaking and interpreting VOI analyses. The report is specifically aimed at those tasked with making decisions about the adoption of healthcare or the funding of healthcare research. The report provides a number of recommendations for good practice when planning, undertaking, or reviewing the results of VOI analyses.


Assuntos
Orçamentos , Tomada de Decisões , Técnicas de Apoio para a Decisão , Custos de Medicamentos , Desenvolvimento de Medicamentos/economia , Alocação de Recursos para a Atenção à Saúde/economia , Pesquisa sobre Serviços de Saúde/economia , Avaliação da Tecnologia Biomédica/economia , Redução de Custos , Análise Custo-Benefício , Humanos , Reembolso de Seguro de Saúde/economia , Modelos Econômicos , Modelos Estatísticos , Formulação de Políticas , Seguro de Saúde Baseado em Valor/economia , Aquisição Baseada em Valor/economia
8.
Am Surg ; 86(2): 140-145, 2020 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-32167057

RESUMO

Perception of physician reimbursement for surgical procedures is not well studied. The few existing studies illustrate that patients believe compensation to be higher than in reality. These studies focus on patient perceptions and have not assessed health-care workers' views. Our study examined health-care workers' perception of reimbursement for complex surgical oncology procedures. An anonymous online survey was distributed to employees at our cancer center with descriptions and illustrations of three oncology procedures-hepatectomy, gastrectomy, and pancreaticoduodenectomy. Participants estimated the Medicare fee and gave their perceived value of each procedure. Participants recorded their perception of surgeon compensation overall, both before and after revealing the Medicare fee schedule. Most of the 113 participants were physicians (33.6%) and nurses (28.3%). When blinded to the Medicare fee schedules, most felt that reimbursements were too low for all procedures (60-64%) and that surgeons were overall undercompensated (57%). Value predictions for each procedure were discordant from actual Medicare fee schedules, with overestimates up to 374 per cent. After revealing the Medicare fee schedules, 55 per cent of respondents felt that surgeons were undercompensated. Even among health-care workers, a large discrepancy exists between perceived and actual reimbursement. Revealing actual reimbursements did not alter perception on overall surgeon compensation.


Assuntos
Gastrectomia/economia , Pessoal de Saúde/psicologia , Hepatectomia/economia , Reembolso de Seguro de Saúde/economia , Medicare/economia , Pancreaticoduodenectomia/economia , Institutos de Câncer , Honorários e Preços , Feminino , Pessoal de Saúde/estatística & dados numéricos , Humanos , Masculino , Corpo Clínico/economia , Corpo Clínico/estatística & dados numéricos , Pessoa de Meia-Idade , Recursos Humanos de Enfermagem/economia , Recursos Humanos de Enfermagem/estatística & dados numéricos , Estados Unidos
11.
Value Health ; 23(1): 25-31, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31952669

RESUMO

BACKGROUND: The economic evaluation of healthcare technologies has become in many countries a basic tool for reimbursement, pricing and purchasing decisions. OBJECTIVE: The objective of this article is to examine the institutional, legal, and political factors that have impeded the application of economic evaluation and the criterion of efficiency in the process of pricing and reimbursement of new medicines in Spain. METHODS: Narrative description of the current institutional framework for the use of economic evaluation in pricing and reimbursement in Spain, legal and policy framework in the field of evaluation of new medicines, and stakeholder initiatives and policies related to the use of economic evaluation outside of the pricing and reimbursement process. RESULTS: Spain has an institutional framework created and established over the last years that could have facilitated a formal use of economic evaluation in the process of pricing and reimbursement. Nevertheless, the real use of economic evaluation at the central or regional level is still unknown, although application of the efficiency criterion, linking to cost-effectiveness, has been clearly required by Spanish laws and regulations at the national level. We highlight a certain degree of moral hazard from the central government that is not directly responsible for the budget impact of reimbursement and pricing decisions. There are currently a number of ongoing initiatives in the field of economic evaluation by various agents, but they remain uncoordinated. CONCLUSIONS: Poor governance at the highest level of decision making is the main reason for the lack of interest in economic evaluation. A profound political change, supported by transparency and accountability, is required before the criterion of efficiency can be fully considered in the process of pricing and reimbursement of new medicines in Spain.


Assuntos
Custos de Medicamentos , Alocação de Recursos para a Atenção à Saúde/economia , Política de Saúde/economia , Reembolso de Seguro de Saúde/economia , Avaliação da Tecnologia Biomédica/economia , Análise Custo-Benefício , Regulamentação Governamental , Disparidades em Assistência à Saúde/economia , Humanos , Formulação de Políticas , Política , Espanha , Participação dos Interessados
12.
Value Health ; 23(1): 32-38, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31952671

RESUMO

BACKGROUND: Some studies in the Netherlands have gauged public views on principles for healthcare priority setting, but they fall short of comprehensively explaining the public disapproval of several recent reimbursement decisions. OBJECTIVE: To obtain insight into citizens' preferences and identify the criteria they would propose for decisions pertaining to the benefits package of basic health insurance. METHODS: Twenty-four Dutch citizens were selected for participation in a Citizen Forum, which involved 3 weekends. Deliberations took place in small groups and in plenary, guided by 2 moderators, on the basis of 8 preselected case studies, which participants later compared and prioritized under the premise that not all treatments can or need to be reimbursed. Participants received opportunities to inform themselves through written brochures and live interactions with 3 experts. RESULTS: The Citizen Forum identified 16 criteria for inclusion or exclusion of treatments in the benefits package; they relate to the condition (2 criteria), treatment (11 criteria), and individual characteristics of those affected by the condition (3 criteria). In most case studies, it was a combination of criteria that determined whether or not participants favored inclusion of the treatment under consideration in the benefits package. Participants differed in their opinion about the relative importance of criteria, and they had difficulty in operationalizing and trading off criteria to provide a recommendation. CONCLUSIONS: Informed citizens are prepared to make and, to a certain extent, capable of making reasoned choices about the reimbursement of health services. They realize that choices are both necessary and possible. Broad public support and understanding for making tough choices regarding the benefits package of basic health insurance is not automatic: it requires an investment.


Assuntos
Custos de Medicamentos , Alocação de Recursos para a Atenção à Saúde/economia , Política de Saúde/economia , Reembolso de Seguro de Saúde/economia , Opinião Pública , Avaliação da Tecnologia Biomédica/economia , Assistência de Saúde Universal , Cobertura Universal do Seguro de Saúde/economia , Análise Custo-Benefício , Regulamentação Governamental , Alocação de Recursos para a Atenção à Saúde/organização & administração , Disparidades em Assistência à Saúde/economia , Humanos , Países Baixos , Preferência do Paciente , Formulação de Políticas , Política , Participação dos Interessados , Avaliação da Tecnologia Biomédica/organização & administração , Cobertura Universal do Seguro de Saúde/organização & administração
13.
Value Health ; 23(1): 43-51, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31952673

RESUMO

In April 2019, Japan formally introduced health technology assessment (HTA) and, more specifically, a cost-effectiveness analysis, to inform healthcare decision making, mainly when it comes to the pricing of new technologies. This article provides an overview of this new policy, which was implemented formally after a pilot program. In the fiscal year (FY) 2012, discussions on cost-effectiveness assessments were initiated in Japan. After 7 years of deliberations, a cost-effectiveness assessment was implemented formally in April 2019. In Japan, the cost-effectiveness analysis has been used to inform price adjustments of healthcare technologies, although it has not yet been used for decision making on insurance coverage. Selection criteria were established because not all drugs and medical devices could be evaluated owing to a shortage of experts. Exclusion criteria have also been applied to prevent access restriction. The scope of the evaluation's price adjustment target is limited to part of the product price. If the cost per quality-adjusted life-year (QALY) threshold falls below ¥5 million per QALY, the price adjustment rate changes stepwise according to the cost per QALY. In addition to price reduction, a price-raising scheme has also been implemented for scenarios where products are evaluated to be highly cost-effective and innovative. This article describes the first formally implemented HTA system in Japan. Although it is too early to make any conclusions about its effect, the Japan-specific context makes this system unique. To fully understand the opportunities and challenges of the new system, it is vital that Japan accumulates experience with this system and develops human resources in health economic evaluation.


Assuntos
Custos de Cuidados de Saúde , Alocação de Recursos para a Atenção à Saúde/economia , Política de Saúde/economia , Reembolso de Seguro de Saúde/economia , Avaliação da Tecnologia Biomédica/economia , Análise Custo-Benefício , Regulamentação Governamental , Disparidades em Assistência à Saúde/economia , Humanos , Japão , Formulação de Políticas , Qualidade de Vida , Anos de Vida Ajustados por Qualidade de Vida , Valores Sociais , Participação dos Interessados
14.
Am J Ophthalmol ; 214: 32-39, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-31926887

RESUMO

PURPOSE: To assess the factors influencing the Medicare collections disparity between male and female ophthalmologists. DESIGN: Retrospective cohort study. METHODS: The Medicare Provider Utilization and Payment Data from 2012-2015 were combined with the 2015 Physician Compare National Downloadable file and US Census data. Three complementary regression models were generated for number of patients seen, number of services performed per patient, and the amount collected per service. Predictor variables included gender, calendar year, geography, years since medical school graduation, and subspecialty. RESULTS: After adjusting for age, geography, and subspecialty, women ophthalmologists collected 42% less as compared to male ophthalmologists, with the median male ophthalmologist out-earning the 75th-percentile female ophthalmologist across almost all age groups, practice categories, and geographic regions. Although women are entering more lucrative subspecialties (cataract and retina) at a higher rate than before, the percentage of women pursuing these subspecialties remains lower than that of men. CONCLUSIONS: Compared with men, women ophthalmologists see fewer patients and have lower Medicare collections. The observed gender gap in collections was highly persistent across years in practice, subspecialty, and geographic region. Future studies are warranted to examine whether the observed gender collections gap results from structural inequities, social circumstances, or personal choices.


Assuntos
Reembolso de Seguro de Saúde/economia , Medicare/economia , Oftalmologistas/tendências , Oftalmologia/economia , Médicas/tendências , Padrões de Prática Médica/economia , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Padrões de Prática Médica/estatística & dados numéricos , Estudos Retrospectivos , Estados Unidos
15.
Plast Reconstr Surg ; 145(2): 333-339, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31985616

RESUMO

BACKGROUND: Rates of autologous breast reconstruction are stagnant compared with prosthetic techniques. Insufficient physician payment for microsurgical autologous breast reconstruction is one possible explanation. The payment difference between governmental and commercial payers creates a natural experiment to evaluate its impact on method of reconstruction. This study assessed the influence of physician payment differences for microsurgical autologous breast reconstruction and implants by insurance type on the likelihood of undergoing microsurgical reconstruction. METHODS: The Massachusetts All-Payer Claims Database was queried for women undergoing immediate autologous or implant breast reconstruction from 2010 to 2014. Univariate analyses compared demographic and clinical characteristics between different reconstructive approaches. Logistic regression explored the relative impact of insurance type and physician payments on breast reconstruction modality. RESULTS: Of the women in this study, 82.7 percent had commercial and 17.3 percent had governmental insurance. Implants were performed in 80 percent of women, whereas 20 percent underwent microsurgical autologous reconstruction. Women with Medicaid versus commercial insurance were less likely to undergo microsurgical reconstruction (16.4 percent versus 20.3 percent; p = 0.063). Commercial insurance, older age, and obesity independently increased the odds of microsurgical reconstruction (p < 0.01). When comparing median physician payments, governmental payers reimbursed 78 percent and 63 percent less than commercial payers for microsurgical reconstruction ($1831 versus $8435) and implants ($1249 versus $3359, respectively). Stratified analysis demonstrated that as physician payment increased, the likelihood of undergoing microsurgical reconstruction increased, independent of insurance type (p < 0.001). CONCLUSIONS: Women with governmental insurance had lower odds of undergoing microsurgical autologous breast reconstruction compared with commercial payers. Regardless of payer, greater reimbursement for microsurgical reconstruction increased the likelihood of microsurgical reconstruction. Current microsurgical autologous breast reconstruction reimbursements may not be commensurate with physician effort when compared to prosthetic techniques. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, II.


Assuntos
Reembolso de Seguro de Saúde/economia , Mamoplastia/economia , Microcirurgia/economia , Adulto , Implante Mamário/economia , Implante Mamário/estatística & dados numéricos , Implantes de Mama/economia , Implantes de Mama/estatística & dados numéricos , Neoplasias da Mama/economia , Neoplasias da Mama/cirurgia , Feminino , Retalhos de Tecido Biológico/economia , Humanos , Mamoplastia/estatística & dados numéricos , Massachusetts , Mastectomia/economia , Mastectomia/métodos , Medicaid/economia , Medicaid/estatística & dados numéricos , Microcirurgia/estatística & dados numéricos , Microvasos , Pessoa de Meia-Idade , Reoperação/economia , Reoperação/estatística & dados numéricos , Transplante Autólogo/economia , Estados Unidos
16.
Ann Surg ; 271(1): 17-22, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-30921048

RESUMO

OBJECTIVE: The purpose of this study is to evaluate monetary trends from 2000 to 2018 in Medicare reimbursement rates for the most common general surgery procedures. SUMMARY BACKGROUND DATA: A complete understanding of financial trends in general surgery in the United States is lacking. As such, an evaluation of trends in reimbursement rates in general surgery is important for defining the specialty's current and future financial health. METHODS: The Physician Fee Schedule Look-Up Tool from the Centers for Medicare and Medicaid Services was queried for each of the 20 top codes top in general surgery. The total raw percent change in Medicare reimbursement rate for each procedure from 2000 to 2018 was calculated and averaged. All data was corrected for inflation. Both average annual and total percentage change were calculated based on these adjusted trends. Compound annual growth rate was calculated using the adjusted data. RESULTS: After adjusting all data for inflation, the reimbursement rate for all included procedures decreased by an average of 24.4% throughout the study period. During this time, the adjusted reimbursement rate decreased by an average of 1.4% each year with an average compound annual growth rate of -1.6%. CONCLUSION: After adjusting for inflation, Medicare reimbursement rates in general surgery have steadily decreased from 2000 to 2018. It is important that these trends are understood and considered by surgeons, healthcare administrators, and policy-makers in order to develop and implement agreeable models of reimbursement while ensuring access to quality general surgery care in the United States.


Assuntos
Reembolso de Seguro de Saúde/economia , Medicare/economia , Qualidade da Assistência à Saúde/tendências , Mecanismo de Reembolso , Procedimentos Cirúrgicos Operatórios/economia , Humanos , Estudos Retrospectivos , Estados Unidos
17.
Am J Obstet Gynecol ; 222(4): 348.e1-348.e9, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-31629727

RESUMO

BACKGROUND: Several states require that abortions be provided in ambulatory surgery centers. Supporters of such laws argue that they make abortions safer, yet previous studies have found no differences in abortion-related morbidities or adverse events for abortions performed in ambulatory surgery centers versus office-based settings. However, little is known about how costs of abortions provided in ambulatory surgery centers differ from those provided in office-based settings. OBJECTIVE: To compare healthcare expenditures for abortions performed in ambulatory surgery centers versus office-based settings using a large national private insurance claims database. MATERIALS AND METHODS: A retrospective cohort study compared expenditures for abortions performed in ambulatory surgery centers versus office-based settings. Data on women who had abortions in an ambulatory surgery center or office-based setting between January 1, 2011, and December 31, 2014 were obtained from the MarketScan Commercial Claims and Encounters database. The sample was limited to women who were continuously enrolled in their insurance plans for at least 1 year before and at least 6 weeks after the abortion. Healthcare expenditures were assessed separately for the index abortion and the 6-week period after the abortion. Costs were measured from the perspective of the healthcare system and included all payments to the provider, including insurance company payments and any patient out-of-pocket payments. RESULTS: Overall, 49,287 beneficiaries who had 50,311 abortions met inclusion criteria. Of the included abortions, 47% were first-trimester aspiration, 27% first-trimester medication, and 26% second-trimester or later abortions. Most abortions (89%) were provided in office-based settings, with 11% provided in ambulatory surgery centers. Unadjusted mean index abortion costs were higher in ambulatory surgery centers than in office-based settings ($1704 versus $810; P < .001). After adjusting for patient clinical and demographic characteristics, costs of index abortions were $772 higher (95% confidence interval, $746-$797), total follow-up costs for abortions that had any follow-up care were $1099 higher (95% confidence interval, $1004-$1,195), and total follow-up costs for abortions that had an abortion-related morbidity or adverse event were not significantly different in ambulatory surgery centers compared to office-based settings. There were also no significant differences in the likelihood of having any follow-up care or abortion-related event follow-up care. CONCLUSION: Abortions performed at ambulatory surgery centers are significantly more costly than those performed in office-based settings, with no difference in the likelihood of receiving follow-up care. Laws requiring that abortions be provided in ambulatory surgery centers may only result in increased costs for abortions, with no effect on abortion safety.


Assuntos
Aborto Induzido/economia , Procedimentos Cirúrgicos Ambulatórios/economia , Custos de Cuidados de Saúde/estatística & dados numéricos , Consultórios Médicos/economia , Centros Cirúrgicos/economia , Aborto Induzido/efeitos adversos , Aborto Induzido/estatística & dados numéricos , Demandas Administrativas em Assistência à Saúde/estatística & dados numéricos , Adulto , Procedimentos Cirúrgicos Ambulatórios/estatística & dados numéricos , Bases de Dados Factuais , Feminino , Gastos em Saúde/estatística & dados numéricos , Humanos , Reembolso de Seguro de Saúde/estatística & dados numéricos , Consultórios Médicos/estatística & dados numéricos , Complicações Pós-Operatórias/economia , Gravidez , Primeiro Trimestre da Gravidez , Segundo Trimestre da Gravidez , Estudos Retrospectivos , Centros Cirúrgicos/estatística & dados numéricos , Adulto Jovem
19.
Ann Allergy Asthma Immunol ; 124(2): 150-155, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31785369

RESUMO

OBJECTIVE: The identification of anaphylaxis cases is imperative for optimal clinicalprovider knowledge deficiencies in diagnosis and treatment and the efficacy of reimbursement codes, such as International Classification of Diseases (ICD) and current procedural terminology (CPT) codes, in detecting anaphylaxis. DATA SOURCES: Pubmed. STUDY SELECTIONS: Recent and clinically relevant literature on anaphylaxis and provider knowledge, ICD, CPT, Healthcare Common Procedural Coding System (HCPCS), and E-codes were selected and reviewed. RESULTS: Reimbursement codes are used to detect anaphylaxis in administrative claims databases. Inaccurate recognition of the diagnosis by providers, underreporting, and cause identification are challenges faced by health researchers using reimbursement codes for anaphylaxis case identification. Anaphylactic shock-specific ICD codes were noted to have a positive predictive value (PPV) of 52% to 53% of anaphylaxis events compared with physician chart review, which was improved to 63% to 67.3% when used in conjunction with anaphylaxis symptom-specific ICD, CPT, HCPCS, and E-codes 31, 34, and 35. CONCLUSION: Education of providers to properly diagnose and treat anaphylaxis requires systematic and educational investments. The ICD codes specific to anaphylactic shock have suboptimal PPV to identify anaphylaxis in administrative claims databases. Use of algorithms incorporating other reimbursement codes improve the PPV, but they are limited by inaccurate diagnoses and underreporting of anaphylaxis. Future ICD-11 reclassification may improve anaphylaxis detection by reimbursement codes.


Assuntos
Anafilaxia/diagnóstico , Anafilaxia/epidemiologia , Registros Médicos , Current Procedural Terminology , Bases de Dados Factuais , Humanos , Revisão da Utilização de Seguros , Reembolso de Seguro de Saúde , Classificação Internacional de Doenças , Vigilância em Saúde Pública
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA