多層医療家庭介入への参加と,医療の質,利用,費用の変化との関連
Mark W Friedberg1, Eric C Schneider2, Meredith B Rosenthal3
1RAND Corporation, Boston, Massachusetts2Division of General Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts3Department of Medicine, Harvard Medical School, Boston, Massachusetts.
JAMA
|February 27, 2014
まとめ
この研究では,大規模な医療ホームのパイロットが糖尿病の治療の質を向上させましたが,医療の利用やコストを削減することはありませんでした. 医療家庭での介入については,さらなる精細化が必要になる可能性があります.
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
- 品質の向上 品質の向上
背景:
- メディカルホームの介入は,初等医療の提供を強化することを目的としています.
- 品質を向上させ,コストを抑えることに有効性は依然として不確実である.
- ペンシルベニア州南東部の慢性ケアイニシアチブは,大規模な,複数層の医療ホームパイロットでした.
研究 の 目的:
- 南東ペンシルベニアの慢性ケアイニシアチブのケア品質,利用,費用への影響を評価する.
- パイロット参加と医療提供の変化との関連を測定する.
主な方法:
- 32のパイロット・プラクティスを,29の同様の比較プラクティスと比較した.
- パイロット・プラクティスの患者64,243人,比較プラクティスの患者55,959人のクレームデータを分析した.
- 構造能力,品質測定,利用,コストの評価は3年間にわたって行われました.
主要な成果:
- パイロットプラクティスは,国家品質保証委員会 (NCQA) の承認を得て,新しい能力を採用しました.
- 統計的に有意な改善は,糖尿病における腎不全のスクリーニング (82.7%対71.7%) の1つの品質測定で観察されました.
- 医療利用や費用の有意な変化は,パイロット参加と関連付けられませんでした.
結論:
- マルチレイヤーメディカルホームのパイロット試験は,限られた品質改善を示し,3年間で利用率やコストを削減しなかった.
- 参加した診療所は,新しい構造的能力を採用し,NCQA認証を取得しました.
- 研究結果は,現在の医療家庭での介入は,より広範な品質とコストの利益を達成するためにさらなる精錬を必要とする可能性があることを示唆しています.
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