在高需求,高成本的医疗保险人群中,高性能初级保健诊所
Adam L Beckman1, Maike Tietschert2, Andrew Old3
1Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.
BMJ open quality
|July 25, 2023
概括
对于高需要,高成本 (HNHC) 医疗保险受益人的高性能初级保健诊所很少见. 没有一家诊所获得"明亮点"的地位,这表明需要为这些患者群体提供更好的支持.
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
- 卫生经济学 卫生经济学
背景情况:
- 初级保健诊所正在专注于高需要,高成本 (HNHC) 医疗保险受益者,以减少支出和提高质量.
- HNHC的受益者包括有虚弱的老年人,65岁以下残疾的成年人以及患有复杂慢性疾病的人.
- 对于这些HNHC亚群的高性能初级保健诊所的流行率,称为"明亮点",是未知的.
研究的目的:
- 为了确定初级保健诊所在HNHC子群体的成本或质量指标上表现出色的流行率.
- 确定在HNHC组中以更低的成本实现有利结果的"明亮点"诊所.
主要方法:
- 使用2014-2015年医疗保险索赔数据进行的横截面研究.
- 根据年度支出,可避免的住院,急救诊所,再入院率和在家度过的健康日子来评估诊所.
- 高绩效定义为在HNHC子群的≥4个指标上排名在最高四分位数中;在所有子群中"明亮点"的排名很高.
主要成果:
- 分析了2770家服务于HNHC亚群体的初级保健诊所.
- 不到4%的诊所是个别HNHC亚群的高绩效诊所.
- <0.5%的诊所在给定的子群体的五个措施中都表现出色.
- 没有一家初级保健诊所符合"明亮点"的定义.
结论:
- 对于HNHC医疗保险受益人来说,高绩效的初级保健诊所很少见.
- 需要大量的努力来支持初级保健,为这些复杂的患者群体提供最佳的护理.
相关概念视频
01:30Primary Healthcare Services
1.4K
Primary care promotes wellness and prevents disease. This care includes health promotion, education, protection (such as immunizations), early disease screening, and environmental considerations. Settings providing this type of healthcare include physician offices, public health clinics, school nursing, and community health nursing.
In 1978, international leaders convened in Alma-Ata, Kazakhstan, for what would be a pivotal event in global health. The Alma-Ata Declaration was the first to call...
In 1978, international leaders convened in Alma-Ata, Kazakhstan, for what would be a pivotal event in global health. The Alma-Ata Declaration was the first to call...
1.4K
01:30Specialized Care Centers and Settings-II
756
Rural Health Centers
Rural health centers are specialized care facilities in remote locations with very few medical personnel. The primary care providers who run the centers are mostly Registered Nurse Practitioners. Here, emergency treatment is provided to critically ill or injured patients before they are transferred to the closest hospital. Fortunately, due to advancement in technology, many rural healthcare facilities and professionals have easy access to diagnostic and treatment...
Rural health centers are specialized care facilities in remote locations with very few medical personnel. The primary care providers who run the centers are mostly Registered Nurse Practitioners. Here, emergency treatment is provided to critically ill or injured patients before they are transferred to the closest hospital. Fortunately, due to advancement in technology, many rural healthcare facilities and professionals have easy access to diagnostic and treatment...
756
01:26Methods Of Healthcare Delivery System
3.3K
At the different levels of the healthcare system, we see varying methods of healthcare used. These methods include managed care systems, case management, and primary healthcare.
Managed Care System:
The managed care system is designed to control the cost while maintaining the quality of care. The patient's care from admission to discharge is planned by the primary care provider or the case manager, also known as the gatekeeper. In a managed care system, the number of care providers is...
Managed Care System:
The managed care system is designed to control the cost while maintaining the quality of care. The patient's care from admission to discharge is planned by the primary care provider or the case manager, also known as the gatekeeper. In a managed care system, the number of care providers is...
3.3K
01:11Secondary Healthcare System
1.5K
Secondary healthcare is offered by a specialist, generally in hospitals or clinics for patients referred by primary healthcare providers. It occurs when a person has an illness or injury that requires specific medical care. Secondary care is often referred to as acute care. Secondary care can range from uncomplicated care to repair a minor laceration or treat a strep throat infection to more complicated emergent care, such as treating a head injury sustained in an automobile accident. Whatever...
1.5K
01:18Introduction To Health Care Delivery System
2.8K
The healthcare system is constantly changing and complex. Various services are available from different healthcare providers, but gaining access to these services has become challenging for people with limited healthcare insurance. Uninsured people present a challenge to healthcare because they frequently postpone or forego treatment.
The Institute of Medicine (IOM) advocates for a patient-centered, effective, safe, timely, equitable, and effective healthcare system. The National Priorities...
The Institute of Medicine (IOM) advocates for a patient-centered, effective, safe, timely, equitable, and effective healthcare system. The National Priorities...
2.8K
01:30Specialized Care Centers and Settings-I
972
Specialized care settings or centers are situated in convenient locations within the community and offer care to a specific group or population. They consist of daycare facilities, mental health facilities, rural health facilities, educational institutions, industries, shelters for the homeless, and rehabilitation facilities.
Daycare centers
They provide several functions. Some facilities care for healthy newborns and children whose parents work, while others are medically focused and care for...
Daycare centers
They provide several functions. Some facilities care for healthy newborns and children whose parents work, while others are medically focused and care for...
972