在预付费护理的随机试验中使用医院
A L Siu1, A Leibowitz, R H Brook
1Health Sciences Program, Rand Corporation, Santa Monica, Calif. 90406-2138.
JAMA
|March 4, 1988
概括
卫生维护组织 (HMO) 通过选择性地避免自由裁量程序来减少住院. 这项研究发现,在HMO中,任意手术和医疗住院的比例较低,没有对健康造成不良影响,这表明有针对性的成本节约.
科学领域:
- 医疗保健服务研究 医疗服务研究
- 医疗保健管理的管理
- 相对的有效性比较
背景情况:
- 卫生维护组织 (HMO) 以节省成本而闻名,主要是通过降低住院率.
- 目前尚不清楚是否通过选择性地避免不必要的住院治疗来实现这些节约.
研究的目的:
- 调查HMO是否选择性地减少与免费服务 (FFS) 护理相比的自由裁量入院.
- 评估不同住院率对患者健康结果的影响.
主要方法:
- 一项随机试验将家庭分配给HMO或FFS护理.
- 医生们对医疗保健系统视而不见,审查了244份医疗记录.
- 评估了医院住院的适宜性和医疗指示.
主要成果:
- 在HMO组中,自由裁量手术的发生率明显较低.
- 在HMO中,自由裁量和非自由裁量医疗住院的比例较低.
- 在HMO和FFS系统中,非选择性手术的发生率与HMO和FFS系统相同.
结论:
- 通过选择性避免任意手术,特别是手术,HMO实现了较低的住院率.
- 尽管减少了非选择性住院治疗,但没有观察到任何不良健康影响,这表明有效的门诊护理替代或对健康的影响最小.
- 医疗卫生组织的成本节约不是统一的,而是针对特定的,可以避免的住院治疗.
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