参与多层医疗家庭干预与护理质量,利用率和成本的变化之间的关联
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
概括
这项研究发现,大型医疗家庭试点改善了糖尿病护理质量,但没有降低医疗保健利用率或成本. 对于医疗家庭干预,可能需要进一步的细化.
科学领域:
- 医疗保健服务研究 医疗服务研究
- 初级医疗保健医学 一级医疗保健医学
- 提高质量 提高质量
背景情况:
- 医疗家庭干预旨在加强初级保健提供.
- 它们在提高质量和控制成本方面的有效性仍然不确定.
- 宾夕法尼亚州东南部慢性护理倡议是一个大型的,多层医疗家庭试点项目.
研究的目的:
- 评估宾夕法尼亚州东南部慢性护理计划对护理质量,利用率和成本的影响.
- 测量试点参与与医疗保健提供变化之间的关联.
主要方法:
- 使用差异差异设计,将32个试点实践与29个类似的比较实践进行比较.
- 分析了试点实践中的64,243名患者和比较实践中的55,959名患者的索赔数据.
- 结构能力,质量指标,利用率和成本在3年的时间内进行了评估.
主要成果:
- 试点实践获得了国家质量保证委员会 (NCQA) 的认可,并采用了新的能力.
- 在一个质量指标中观察到统计学上显著的改善:糖尿病查 (82.7% vs 71.7%).
- 与试点参与相关的医疗保健利用或成本没有显著变化.
结论:
- 多层医疗家庭试点显示质量改善有限,并且在三年内没有降低利用率或成本.
- 参与实践采用了新的结构能力,并获得NCQA认证.
- 研究结果表明,目前的医疗家庭干预措施可能需要进一步改进,以实现更广泛的质量和成本效益.
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