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糖尿病患者的非面对面护理管理和服务利用情况
Charles Stoecker1, Elizabeth Nauman, Alessandra N Bazzano
1Department of Health Policy and Management, Tulane University School of Public Health and Tropical Medicine, 1440 Canal St #8346, New Orleans, LA 70118.
The American journal of managed care
|August 24, 2023
概括
非面对面的慢性护理管理 (NFFCCM) 增加了门诊访问,但降低了糖尿病医疗保险受益人住院和急诊室的使用. 这种转变表明,人们正在转向低成本的护理环境.
科学领域:
- 医疗保健服务研究 医疗服务研究
- 卫生经济学 卫生经济学
- 老年医学 老年医学
背景情况:
- 在2015年,医疗保险和医疗补助服务中心 (CMS) 引入了非面对面的慢性护理管理 (NFFCCM) 的报销.
- 该政策旨在通过促进远程护理协调,支持患有多种慢性疾病 (包括糖尿病) 的受益人.
- 了解NFFCCM对医疗保健利用的影响对于评估其有效性和成本效益至关重要.
研究的目的:
- 估计NFFCCM利用率与住院,门诊和急救服务的使用率之间的关联.
- 分析NFFCCM的采用如何影响糖尿病老年患者的医疗保健资源分配.
主要方法:
- 使用具有倾向分数匹配的双倍强大的估计器,将NFFCCM用户 (n=282) 与非用户 (n=26,759) 进行比较.
- 测试了NFFCCM治疗强度的四个定义 (任何遭遇,1/月,1/2月,1/3月).
- 分析了来自路易斯安那州四个卫生系统 (2013-2018) 的电子健康记录的数据,这些数据是针对65岁以上的糖尿病患者.
主要成果:
- NFFCCM与门诊诊次数显著增加 (0.056次/月) 有关.
- 相反,NFFCCM显示住院患者 (-0.024次/月) 和急诊室 (-0.017次/月) 使用率显著下降.
- 对NFFCCM强度的替代定义产生了类似的利用模式.
结论:
- CMS对NFFCCM补偿的实施及其随后的卫生系统的采用与患者护理的转变有关.
- 这一转变将利用率从高成本的住院和急诊机构转移到低成本的门诊机构.
- NFFCCM似乎促进了更具成本效益的医疗保健资源分配,用于管理慢性疾病.
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