{"id":24891,"date":"2023-11-29T04:37:00","date_gmt":"2023-11-28T20:37:00","guid":{"rendered":"http:\/\/csccm.org.cn\/?p=24891"},"modified":"2023-11-29T05:41:42","modified_gmt":"2023-11-28T21:41:42","slug":"jama%e5%8f%91%e8%a1%a8%e8%ae%ba%e6%96%87%ef%bc%9a%e7%99%be%e4%b8%87%e5%bf%83%e8%84%8f%e6%a8%a1%e5%9e%8b%e5%af%b9%e5%bf%83%e8%82%8c%e6%a2%97%e5%a1%9e%e3%80%81%e5%8d%92%e4%b8%ad%e5%8f%8amedicare","status":"publish","type":"post","link":"https:\/\/csccm.org.cn\/?p=24891","title":{"rendered":"[JAMA\u53d1\u8868\u8bba\u6587]\uff1a\u767e\u4e07\u5fc3\u810f\u6a21\u578b\u5bf9\u5fc3\u808c\u6897\u585e\u3001\u5352\u4e2d\u53caMedicare\u82b1\u8d39\u7684\u5f71\u54cd"},"content":{"rendered":"\n

Original Investigation <\/p>\n\n\n\n

October 17, 2023<\/p>\n\n\n\n

Effects of the Million Hearts Model on Myocardial Infarctions, Strokes, and Medicare Spending: A Randomized Clinical Trial<\/h1>\n\n\n\n

Laura\u00a0Blue,\u00a0Keith\u00a0Kranker,\u00a0Amanda R.\u00a0Markovitz,\u00a0et al<\/h3>\n\n\n\n

JAMA.\u00a0<\/em>2023;330(15):1437-1447. doi:10.1001\/jama.2023.19597<\/h3>\n\n\n\n

<\/a>Key Points<\/p>\n\n\n\n

Question<\/strong>  Did the Million Hearts Model, which encouraged and paid for cardiovascular risk assessment and reduction, reduce the incidence of first-time myocardial infarctions and strokes or Medicare spending among Medicare beneficiaries aged 40 to 79 years?<\/p>\n\n\n\n

Findings<\/strong>  The model reduced the probability of a first-time myocardial infarction or stroke over 5 years by 0.3 percentage points among people at high or medium risk for these events, without statistically significant changes in Medicare spending.<\/p>\n\n\n\n

Meaning<\/strong>  The commitment of health care organizations to cardiovascular risk assessment and follow-up, coupled with payments for risk assessment and reduction, reduced myocardial infarction and stroke rates. Results support guideline recommendations for cardiovascular risk assessment.<\/a><\/p>\n\n\n\n

Abstract<\/p>\n\n\n\n

Importance<\/strong>  The Million Hearts Model paid health care organizations to assess and reduce cardiovascular disease (CVD) risk. Model effects on long-term outcomes are unknown.<\/p>\n\n\n\n

Objective<\/strong>  To estimate model effects on first-time myocardial infarctions (MIs) and strokes and Medicare spending over a period up to 5 years.<\/p>\n\n\n\n

Design, Setting, and Participants<\/strong>  This pragmatic cluster-randomized trial ran from 2017 to 2021, with organizations assigned to a model intervention group or standard care control group. Randomized organizations included 516 US-based primary care and specialty practices, health centers, and hospital-based outpatient clinics participating voluntarily. Of these organizations, 342 entered patients into the study population, which included Medicare fee-for-service beneficiaries aged 40 to 79 years with no previous MI or stroke and with high or medium CVD risk (a 10-year predicted probability of MI or stroke [ie, CVD risk score] \u226515%) in 2017-2018.<\/p>\n\n\n\n

Intervention<\/strong>  Organizations agreed to perform guideline-concordant care, including routine CVD risk assessment and cardiovascular care management for high-risk patients. The Centers for Medicare & Medicaid Services paid organizations to calculate CVD risk scores for Medicare fee-for-service beneficiaries. CMS further rewarded organizations for reducing risk among high-risk beneficiaries (CVD risk score \u226530%).<\/p>\n\n\n\n

Main Outcomes and Measures<\/strong>  Outcomes included first-time CVD events (MIs, strokes, and transient ischemic attacks) identified in Medicare claims, combined first-time CVD events from claims and CVD deaths (coronary heart disease or cerebrovascular disease deaths) identified using the National Death Index, and Medicare Parts A and B spending for CVD events and overall. Outcomes were measured through 2021.<\/p>\n\n\n\n

Results<\/strong>\u00a0\u00a0High- and medium-risk model intervention beneficiaries (n\u2009=\u2009130\u202f578) and standard care control beneficiaries (n\u2009=\u200988\u202f286) were similar in age (median age, 72-73 y), sex (58%-59% men), race (7%-8% Black), and baseline CVD risk score (median, 24%). The probability of a first-time CVD event within 5 years was 0.3 percentage points lower for intervention beneficiaries than control beneficiaries (3.3% relative effect; adjusted hazard ratio [HR], 0.97 [90% CI, 0.93-1.00];\u00a0P<\/em>\u2009=\u2009.09). The 5-year probability of combined first-time CVD events and CVD deaths was 0.4 percentage points lower in the intervention group (4.2% relative effect; HR, 0.96 [90% CI, 0.93-0.99];\u00a0P<\/em>\u2009=\u2009.02). Medicare spending for CVD events was similar between the groups (effect estimate, \u2212$1.83 per beneficiary per month [90% CI, \u2212$3.97 to \u2212$0.30];\u00a0P<\/em>\u2009=\u2009.16), as was overall Medicare spending including model payments (effect estimate, $2.11 per beneficiary per month [90% CI, \u2212$16.66 to $20.89];\u00a0P<\/em>\u2009=\u2009.85).<\/p>\n\n\n\n

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Conclusions and Relevance<\/strong>  The Million Hearts Model, which encouraged and paid for CVD risk assessment and reduction, reduced first-time MIs and strokes. Results support guidelines to use risk scores for CVD primary prevention.<\/p>\n\n\n\n

Trial Registration<\/strong>  ClinicalTrials.gov Identifier: NCT04047147<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"

Original Investigation  October 17, 2023 […]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":[],"categories":[32,23],"tags":[],"_links":{"self":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/24891"}],"collection":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=24891"}],"version-history":[{"count":1,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/24891\/revisions"}],"predecessor-version":[{"id":24892,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/24891\/revisions\/24892"}],"wp:attachment":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=24891"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=24891"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=24891"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}