プライマリケア医師の労働力とメディケア受給者の健康成果
Chiang-Hua Chang1, Therese A Stukel, Ann Barry Flood
1Center for Health Policy Research, Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth Medical School, Lebanon, NH 03766, USA. chiang-hua.chang@dartmouth.edu
JAMA
|May 26, 2011
まとめ
医療従事者の人数が多くなるということは,患者さんの健康状態が改善され,外来医療に敏感な疾患の入院が少なくなり,死亡率も低下するとの関連がある. この関連性は,プライマリーケアクリニックの全日制相当 (FTE) の測定値を使用する際に特に顕著です.
科学分野:
- 医療サービス 研究 医療サービス
- プライマリーケア医療 プライマリーケア医療
- ヘルスケア・ワーカーフォース・スタディズ・ヘルスケア・ワーカーフォース・スタディズ
背景:
- プライマリケア医の供給と患者のアウトカムとの関係は,プライマリケア労働力の拡大への関心にもかかわらず,よく理解されていません.
- プライマリケアへのアクセスを改善することは,医療の質を向上させ,費用を管理するための目標です.
研究 の 目的:
- 大人のプライマリケア医の可用性と個々の患者の健康結果との関連を定量化するために.
- プライマリーケア医師の労働力のさまざまな指標が患者の健康と医療費にどのように影響するか調査する.
主な方法:
- 2007年メディケアサービス料金受給者 (65歳以上) の横断分析.
- メディケア受給者あたり,アメリカン・メディカル・アソシエーション (AMA) のマスターファイル数とメディケア受給者の1人当たりのプライマリケア臨床フルタイム相当数 (FTEs) の2つのプライマリケア医師人材の測定値を利用した.
- 死亡率, ambulatory care sensitive condition (ACSC) の入院,およびメディケア支出を含む個々の患者のアウトカムを調べました.
主要な成果:
- 特にFTEsで測定されたプライマリケア医師の労働力の増加は,ACSCC入院の減少と死亡率の低下と相関しています.
- AMAマスターファイルの測定では,最も高いクインティルの受給者は,最も低いクインティルと比較して,ACSCの入院数が少なく (RR 0.94),死亡率が低い (RR 0.98).
- FTEの測定では,最も高いクインティルの受給者には死亡率が低く (RR 0.95),ACSCCの入院数が少なく (RR 0.91),メディケア支出がわずかに高かった (RR 1.01) ことが示された.
結論:
- 医療従事者の人数が増加することは,一般的に患者の治療成果の改善と関連しています.
- フルタイム相当 (FTE) の測定は, ambulatory primary careの容量と患者の健康への影響をより正確に反映することができます.
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