主要护理医生工作人员和医疗保险受益人的健康结果
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
概括
更多的初级保健医生员工与更好的患者健康结果有关,包括 ambulatory care 敏感疾病的住院减少和较低的死亡率. 这种关联在使用全职等效 (FTE) 衡量初级保健临床医生时尤其明显.
科学领域:
- 医疗保健服务研究 医疗服务研究
- 主要护理医学 医疗保健
- 医疗保健劳动力研究 劳动力研究
背景情况:
- 尽管人们对扩大初级保健工作人员的兴趣,但初级保健医生供应和患者结果之间的关系尚未得到充分理解.
- 改善初级保健准入是提高医疗保健质量和管理成本的目标.
研究的目的:
- 量化成人初级保健医生的可用性与个体患者健康结果之间的关联.
- 调查初级保健医生劳动力的不同措施如何影响患者健康和医疗保健支出.
主要方法:
- 2007年医疗保险服务费受益者 (65岁以上) 的横截面分析.
- 利用了两个初级保健医生劳动力指标:美国医学协会 (AMA) 主档计数和初级保健临床全职等效 (FTEs) 每个医疗保险受益人.
- 检查了个体患者的结果,包括死亡率,门诊护理敏感条件 (ACSC) 住院治疗和医疗保险支出.
主要成果:
- 较高的初级保健医生劳动力,特别是以FTEs来衡量,与减少ACSC住院和较低的死亡率相关.
- 美国医疗药物管理协会 (AMA) 主档测量显示,与最低五分位数相比,最高五分位数的受益人患上ACSCC住院病例较少 (RR 0.94) 和死亡率较低 (RR 0.98).
- 全日制医疗补助措施表明,最高五分位数的受益人死亡率较低 (RR 0.95),ACSCC住院次较少 (RR 0.91),医疗保险支出略高 (RR 1.01).
结论:
- 增加初级保健医生的员工总体上与改善的患者结果有关.
- 全职等效 (FTE) 可以更准确地反映出门诊初级保健能力及其对患者健康的影响.
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