由初级保健医生为老年人提供预防服务
Hoangmai H Pham1, Deborah Schrag, J Lee Hargraves
1Center for Studying Health System Change, Washington, DC 20024, USA. mpham@hschange.org
JAMA
|July 28, 2005
概括
对于医疗保险受益者的预防性护理往往不够理想. 实践的特点,如收入来源和医生组规模,显著影响提供基本的健康查和疫苗接种.
科学领域:
- 医疗保健服务研究 医疗服务研究
- 预防医学 预防医学
- 卫生政策 卫生政策
背景情况:
- 在医疗保险受益者中,预防性服务的使用率远远低于国家目标.
- 识别影响预防护理质量的因素对于改善人口健康结果至关重要.
研究的目的:
- 确定与医疗保险受益人获得的预防性护理质量相关的医生和实践特征.
- 确定特定的实践环境和与预防性服务提供变化相关的医生属性.
主要方法:
- 对2000-2001年社区追踪研究医生调查数据的横截面分析与医疗保险索赔相关.
- 包括3660名医生和24581名65岁以上的医疗保险受益者.
- 评估了接受六项关键预防服务的受益人比例,并根据患者和社区因素进行调整.
主要成果:
- 总体而言,预防服务的提供低于国家目标.
- 实践类型和医疗补助收入的百分比与服务提供有很强的联系.
- 医疗补助收入较低的诊所的受益者接受了更多的糖尿病眼科检查,A1c监测,乳房影像和疫苗接种.
结论:
- 对医疗保险受益人提供预防性护理是不理想的.
- 特定的实践环境和医生子组与接受低质量的护理的风险更高有关.
- 针对高风险实践的有针对性的干预可以提高预防服务的质量.
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