基于家庭的初级保健对医疗保健患者的医院使用的影响:一项观察性研究
Laura Kimmey1, Andrea Wysocki2, Lauren Vollmer Forrow3
1Mathematica, Washington, DC, USA. lkimmey@mathematica-mpr.com.
Journal of general internal medicine
|August 1, 2023
概括
对高需要,高成本患者的家庭初级保健 (HBPC) 并没有显著减少住院总数或医疗保险支出. 然而,HBPC在两年后显示出降低潜在可避免住院率的潜力.
科学领域:
- 老年医学 老年医学
- 医疗保健服务研究 医疗服务研究
- 主要护理是指初级护理.
背景情况:
- 高需求,高成本的医疗保险患者面临的挑战是获得传统的办公室基础初级保健.
- 基于家庭的初级保健 (HBPC) 通过减少接入障碍,并使全面的患者评估提供了一个解决方案.
- 在脆弱患者群体中,HBPC可能会降低医院利用率.
研究的目的:
- 评估HBPC对高需要,高成本患者的住院和医疗保险住院费用的影响.
- 确定HBPC服务是否可以减轻高风险医疗保险人口的医疗保健利用率和成本.
主要方法:
- 采用了一种匹配的回顾性队列研究设计,利用差异分析.
- 这项研究包括55,303名新的HBPC接受者和156,142名来自费用服务医疗保险的匹配比较患者.
- 在开始HBPC治疗前两年和开始HBPC治疗后两年,分析了患者数据.
主要成果:
- 在启动后的第一年或第二年,HBPC并没有导致住院总数的统计显著减少.
- 在HBPC的第二年观察到可能可以避免的住院病例的显著减少 (每1000名患者减少11人).
- 在第一年,住院费用略有下降,但在第二年没有明显的变化.
结论:
- 虽然HBPC并没有显著减少对高需要,高成本患者的整体住院治疗或医疗保险支出,但它在减少可能可避免的住院治疗方面显示出了潜在的益处.
- 这些发现表明,HBPC可能为高风险医疗保险受益人特定类型的住院提供有针对性的好处.
- 可能需要进一步的研究来优化HBPC干预措施,以最大限度地影响医疗保健利用率和成本.
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