system dynamics to model the unintended consequences of denying payment for venous thromboembolism after total knee arthroplasty系统动力学模型的意想不到的后果,拒绝支付全膝关节置换术后静脉血栓栓塞.pdf

System Dynamics to Model the Unintended Consequences of Denying Payment for Venous Thromboembolism after Total Knee Arthroplasty 1,2 1,2 1,3 1 6 Mathias Worni , Ricardo Pietrobon , Guilherme Roberto Zammar , Jatin Shah , Bryan Yoo , 1,7 4,5 5 Mauro Maldonato , Steven Takemoto , Thomas P. Vail * 1 Research on Research Group, Department of Surgery, Duke University, Durham, North Carolina, United States of America, 2 Department of Surgery, Duke University ´ ´ ´ ´ Medical Center, Durham, North Carolina, United States of America, 3 Pontifıcia Universidade Catolica do Parana, Curitiba - Parana, Brazil, 4 Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, California, United States of America, 5 Philip R. Lee Institute for Health Policy Studies, San Francisco, California, United States of America, 6 Stanford University, Palo Alto, California, United States of America, 7 Department of Storic, Linguistic and Antropologic Sciences, University of Basilicata, Potenza, Italy Abstract Background: The Hospital Acquired Condition Strategy (HACS) denies payment for venous thromboembolism (VTE) after total knee arthroplasty (TKA). The intention is to reduce complications and associated costs, while improving the quality of care by mandating VTE prophylaxis. We applied a system dynamics model to estimate the impact of HACS on VTE rates, and potential unintended consequences such as increased rates of bleeding and infection and decreased access for patients who might