Abstract：
OBJECTIVE: To assess the body of literature examining episode-based bundled payment models effect on health care spending, utilization, and quality of care for surgical conditions.
UNASSIGNED: Episode-based bundled payments were developed as a strategy to lower healthcare spending and improve coordination across phases of healthcare. Surgical conditions may be well-suited targets for bundled payments because they often have defined periods of care and widely variable healthcare spending. In bundled payment models, hospitals receive financial incentives to reduce spending on care provided to patients during a predefined clinical episode. Despite the recent proliferation of bundles for surgical conditions, a collective understanding of their effect is not yet clear.
METHODS: A scoping review was conducted, and four databases were queried from inception through September 27, 2021, with search strings for bundled payments and surgery. All studies were screened independently by two authors for inclusion.
RESULTS: Our search strategy yielded a total of 879 unique articles of which 222 underwent a full-text review and 28 met final inclusion criteria. Of these studies, most (23 of 28) evaluated the impact of voluntary bundled payments in orthopedic surgery and found that bundled payments are associated with reduced spending on total care episodes, attributed primarily to decreases in post-acute care spending. Despite reduced spending, clinical outcomes (e.g., readmissions, complications, and mortality) were not worsened by participation. Evidence supporting the effects of bundled payments on cost and clinical outcomes in other non-orthopedic surgical conditions remains limited.
CONCLUSIONS: Present evaluations of bundled payments primarily focus on orthopedic conditions and demonstrate cost savings without compromising clinical outcomes. Evidence for the effect of bundles on other surgical conditions and implications for quality and access to care remain limited.
UNASSIGNED: Episode-based bundled payments were developed as a strategy to lower healthcare spending and improve coordination across phases of healthcare. Surgical conditions may be well-suited targets for bundled payments because they often have defined periods of care and widely variable healthcare spending. In bundled payment models, hospitals receive financial incentives to reduce spending on care provided to patients during a predefined clinical episode. Despite the recent proliferation of bundles for surgical conditions, a collective understanding of their effect is not yet clear.
METHODS: A scoping review was conducted, and four databases were queried from inception through September 27, 2021, with search strings for bundled payments and surgery. All studies were screened independently by two authors for inclusion.
RESULTS: Our search strategy yielded a total of 879 unique articles of which 222 underwent a full-text review and 28 met final inclusion criteria. Of these studies, most (23 of 28) evaluated the impact of voluntary bundled payments in orthopedic surgery and found that bundled payments are associated with reduced spending on total care episodes, attributed primarily to decreases in post-acute care spending. Despite reduced spending, clinical outcomes (e.g., readmissions, complications, and mortality) were not worsened by participation. Evidence supporting the effects of bundled payments on cost and clinical outcomes in other non-orthopedic surgical conditions remains limited.
CONCLUSIONS: Present evaluations of bundled payments primarily focus on orthopedic conditions and demonstrate cost savings without compromising clinical outcomes. Evidence for the effect of bundles on other surgical conditions and implications for quality and access to care remain limited.
摘要：
目的：评估大量文献，研究基于事件的捆绑支付模式对医疗保健支出的影响，利用率，和手术条件的护理质量。
■基于事件的捆绑支付被开发为降低医疗保健支出和改善医疗保健各阶段协调的策略。手术条件可能是捆绑支付的理想目标，因为它们通常具有明确的护理期限和变化很大的医疗保健支出。在捆绑支付模式中，医院获得财政奖励，以减少在预定义的临床发作期间向患者提供的护理支出。尽管最近用于手术条件的束激增，对它们的影响的集体理解尚不清楚。
方法：进行了范围审查，从成立到2021年9月27日，对四个数据库进行了查询，并搜索了捆绑付款和手术的字符串。所有研究均由两位作者独立筛选纳入。
结果：我们的搜索策略共产生了879篇独特文章，其中222篇接受了全文审查，28篇符合最终纳入标准。在这些研究中,大多数（28个中的23个）评估了自愿性捆绑付款在骨科手术中的影响，发现捆绑付款与减少总护理事件的支出有关，主要归因于急性后护理支出的减少。尽管支出减少，临床结果(例如，再入院,并发症,和死亡率）并未因参与而恶化。支持捆绑付款对其他非骨科手术条件的成本和临床结果的影响的证据仍然有限。
结论：目前对捆绑支付的评估主要集中在骨科条件上，并在不影响临床结果的情况下显示出成本节约。捆绑对其他手术条件的影响以及对质量和获得护理的影响的证据仍然有限。
■基于事件的捆绑支付被开发为降低医疗保健支出和改善医疗保健各阶段协调的策略。手术条件可能是捆绑支付的理想目标，因为它们通常具有明确的护理期限和变化很大的医疗保健支出。在捆绑支付模式中，医院获得财政奖励，以减少在预定义的临床发作期间向患者提供的护理支出。尽管最近用于手术条件的束激增，对它们的影响的集体理解尚不清楚。
方法：进行了范围审查，从成立到2021年9月27日，对四个数据库进行了查询，并搜索了捆绑付款和手术的字符串。所有研究均由两位作者独立筛选纳入。
结果：我们的搜索策略共产生了879篇独特文章，其中222篇接受了全文审查，28篇符合最终纳入标准。在这些研究中,大多数（28个中的23个）评估了自愿性捆绑付款在骨科手术中的影响，发现捆绑付款与减少总护理事件的支出有关，主要归因于急性后护理支出的减少。尽管支出减少，临床结果(例如，再入院,并发症,和死亡率）并未因参与而恶化。支持捆绑付款对其他非骨科手术条件的成本和临床结果的影响的证据仍然有限。
结论：目前对捆绑支付的评估主要集中在骨科条件上，并在不影响临床结果的情况下显示出成本节约。捆绑对其他手术条件的影响以及对质量和获得护理的影响的证据仍然有限。
