推出了麻醉学绩效改进与报告交流（ASPIRE）合作质量改进（CQI）计划，旨在建立一种医院间的合作伙伴关系，以衡量质量、审查基于证据的实践，并改善与麻醉相关的结果。开展手术CQI参与与成本节约和患者结果的改善相关，但麻醉CQI对医疗成本的影响尚未得到彻底评估。在本研究中，我们评估了参与麻醉CQI是否能够实现医疗成本节约。我们假设ASPIRE参与与减少支付医保费用和密歇根价值合作伙伴（MVC）登记的包括重大和高容量手术在内的主要手术之间存在关联。在这项回顾性观察研究中，我们比较了MVC的支付数据，其中Group 1 ASPIRE医院于2015年1月加入ASPIRE，与非ASPIRE的匹配对照医院进行比较。MVC根据Blue Cross Blue Shield of Michigan首选提供者组织、Blue Care Network健康维护组织和Medicare费用支付计划的被保险患者计算价格标准化、风险调整支付。2014年的片段是ASPIRE之前的时间段，2016年6月至2017年7月的片段是ASPIRE之后的时间段。我们进行了差异性分析，评估ASPIRE实施是否与总体片段支付的减少程度更大相比于同一时间段内对照医院的变化。在与数控匹配的8个ASPIRE医院（N = 17,852例）中，我们发现总片段支付有统计学显著减少（-719美元；95% CI[-1340到-97]；P = .023），相比之下，8个非ASPIRE匹配对照医院（N = 12,987例）总片段支付的变化。对包括结肠切除术、结直肠癌切除术、胃切除术、食管切除术、胰腺切除术、子宫切除术、关节置换术（膝关节和髋关节）和髋骨骨折修复的重大和高容量手术而言。在辅助分析中，ASPIRE医院30天出院后的支付（-354美元；95% CI[-582到-126]；P = .002）也有显著减少，与非ASPIRE对照组相比。亚组分析显示，ASPIRE参与医院的关节置换术片段支付显著减少（-860美元；95% CI[-1222到-499]；P < .001）。包含患者层面协变量的敏感性分析也显示了一致的结果。参与麻醉学CQI，ASPIRE，与所选重大和高容量手术的总体片段支付较低有关。这项分析支持参与麻醉CQI可以降低医疗费用的观点。版权所有©2023国际麻醉研究学会。

The Anesthesiology Performance Improvement and Reporting Exchange (ASPIRE) Collaborative Quality Initiative (CQI) was launched as a partnership among hospitals to measure quality, review evidence-based practices, and improve anesthesia-related outcomes. Cost savings and improved patient outcomes have been associated with surgical CQI participation, but the impact of an anesthesia CQI on health care cost has not been thoroughly assessed. In this study, we evaluated whether participation in an anesthesia CQI led to health care savings. We hypothesized that ASPIRE participation is associated with reduced total episode payments for payers and major, high-volume procedures included in the Michigan Value Collaborative (MVC) registry.In this retrospective observational study, we compared MVC episode payment data from Group 1 ASPIRE hospitals, the first cluster of 8 Michigan hospitals to join ASPIRE in January 2015, to non-ASPIRE matched control hospitals. MVC computes price-standardized, risk-adjusted payments for patients insured by Blue Cross Blue Shield of Michigan Preferred Provider Organization, Blue Care Network Health Maintenance Organization, and Medicare Fee-for-Service plans. Episodes from 2014 comprised the pre-ASPIRE time period, and episodes from June 2016 to July 2017 constituted the post-ASPIRE time period. We performed a difference-in-differences analysis to evaluate whether ASPIRE implementation was associated with greater reduction in total episode payments compared to the change in the control hospitals during the same time periods.We found a statistically significant reduction in total episode (-$719; 95% CI [-$1340 to -$97]; P = .023) payments at the 8 ASPIRE hospitals (N = 17,852 cases) compared to the change observed in 8 matched non-ASPIRE hospitals (N = 12,987 cases) for major, high-volume surgeries, including colectomy, colorectal cancer resection, gastrectomy, esophagectomy, pancreatectomy, hysterectomy, joint replacement (knee and hip), and hip fracture repair. In secondary analyses, 30-day postdischarge (-$354; 95% CI [-$582 to -$126]; P = .002) payments were also significantly reduced in ASPIRE hospitals compared to non-ASPIRE controls. Subgroup analyses revealed a significant reduction in total episode payments for joint replacements (-$860; 95% CI [-$1222 to -$499]; P < .001) at ASPIRE-participating hospitals. Sensitivity analyses including patient-level covariates also showed consistent results.Participation in an anesthesiology CQI, ASPIRE, is associated with lower total episode payments for selected major, high-volume procedures. This analysis supports that participation in an anesthesia CQI can lead to reduced health care payments.Copyright © 2023 International Anesthesia Research Society.