在服务点健康计划中自我转介
C B Forrest1, J P Weiner, J Fowles
1Health Services Research and Development Center, Johns Hopkins School of Public Health, 624 N Broadway, Room 689, Baltimore, MD 21205USA. cforrest@jhsph.edu
大多数健康维护组织服务点 (POS) 计划会员不会自行推专业护理. 那些自我推的人报告了更高的满意度,对护理协调的影响有限.
科学领域:
- 医疗保健服务研究 医疗服务研究
- 管理护理管理护理
- 医疗保健政策 医疗保健政策
背景情况:
- 医疗维护组织 (HMO) 越来越多地提供服务点 (POS) 计划,减少对专业护理的限制.
- POS计划允许以更高的自费费用向专家进行自我推,但对其使用和影响的数据有限.
研究的目的:
- 在POS计划中量化自我推率.
- 确定那些自我推的患者的特征.
- 了解自我推的原因,并评估对专业护理的满意度.
主要方法:
- 1996年美国三个地区 (中西部,东北部,大西洋中部) 的行政数据库 (N=345,023) 的回顾性分析.
- 1997年中西部POS计划中的专业护理用户的电话调查 (N=606).
- 检查了自我推的服务使用,收费,理由和满意度.
主要成果:
- 自助推率因地区而异 (8.8%至17.3%).
- 自助推一般医生比推专家更为常见.
- 患有慢性疾病,成本分担较高,医生连续性较少的患者更有可能自我推.
- 自助推的关键原因包括对直接访问的偏好,医生关系问题和现有的专家关系.
- 与医生推的患者相比,自我推的患者对专科护理的满意度更高.
结论:
- 大多数POS注册者 (93-96%) 在一年内没有使用自推选项.
- 由于自我转诊导致的不协调护理的可能性似乎有限.
- 较高的患者对专业服务的满意度可能会抵消自我转诊的潜在缺点.
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