综合团队护理与医疗保健质量,利用和成本的关联
Brenda Reiss-Brennan1, Kimberly D Brunisholz1, Carter Dredge1
1Intermountain Healthcare, Salt Lake City, Utah.
JAMA
|August 24, 2016
概括
与传统实践管理相比,集成团队护理 (TBC) 模式提高了质量,减少了医疗保健利用率. 结核病实践显示出更好的抑郁症查和糖尿病护理,急诊次数更少,总体成本更低.
科学领域:
- 医疗服务研究
- 主要护理医学
- 健康经济学
背景情况:
- 医疗保健中的综合团队交付模式的价值尚未得到确立.
- 评估基于团队的护理 (TBC) 与传统的实践管理 (TPM) 对于优化患者结果和资源配置至关重要.
研究的目的:
- 评估TBC实践与TPM实践中接受初级保健和患者结果,医疗保健利用和成本之间的关联.
- 在TBC模型中比较综合体和精神健康服务与标准护理的有效性.
主要方法:
- 使用了追溯的纵向队列研究设计.
- 从2003年至2013年分析了来自113个初级保健机构的成年患者 (≥18岁),比较了TBC和TPM设置.
- 主要结果包括质量指标,医疗保健利用率,提供系统支付和计划投资成本.
主要成果:
- 在TBC实践中,抑郁症查率更高,糖尿病护理包的遵守率更高,自我护理计划的文件也更高.
- 与TPM相比,TBC诊所患者的急诊室访问,住院和门诊护理敏感的住院率较低.
- 对于TBC集团来说,医疗保健系统的总体支付较低,成本低于该计划的投资.
结论:
- 在TBC实践中接受初级保健与改善护理质量和减少急性护理使用有关.
- 在综合医疗保健系统中,TBC模型显示了节省成本的潜力.
- 这些发现支持在初级保健机构更广泛地实施综合团队式护理模式.
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