医疗保险的医院再接收减少计划减少了与跌倒有关的医疗保健使用量:一个意想不到的好处?
Geoffrey J Hoffman1,2, Neil B Alexander3,4, Jinkyung Ha5
1Department of Systems, Populations and Leadership, University of Michigan School of Nursing, Ann Arbor, Michigan, USA.
Health services research
|October 8, 2023
概括
医院再录取减少计划 (HRRP) 减少了心力衰竭和肺炎的医疗保险患者的严重跌倒相关伤害 (FRIs). 这表明改善过渡期护理和急性后转诊可能是关键因素.
科学领域:
- 医疗保健服务研究 医疗服务研究
- 老年学是一门学科.
- 公共卫生政策 公共卫生政策
背景情况:
- 医院再接收减少计划 (HRRP) 旨在减少医疗保险受益人的医院再接收.
- 严重的落相关伤害 (FRIs) 对老年人,特别是患有慢性疾病的老年人来说,构成了严重的伤害负担.
- 了解像HRRP这样的质量改进举措对患者安全结果的影响至关重要.
研究的目的:
- 确定HRRP是否与医疗保险受益人中严重跌倒相关伤害 (FRI) 的减少有关.
- 与非目标条件相比,检查HRRP针对条件的FRI再录取的变化.
- 探索与HRRP对FRI的影响相关的潜在机制,例如急性后护理转诊的变化.
主要方法:
- 用于65岁及以上的受益人使用的二次医疗保险服务费用数据.
- 在HRRP宣布和实施之前和之后,采用事件研究设计来评估30日和90天FRI再接收的变化.
- 分析了针对目标疾病 (急性心肌梗塞,充血性心力衰竭,肺炎) 和非目标疾病的数据,并通过医院风险水平和潜在的升级编码探索了修改.
主要成果:
- 宣布HRRP与30日和90日FRI再入院患者的12%-20%的减少有关,这些患者患有充血性心力衰竭 (CHF) 和急性心肌梗塞 (AMI).
- 实施后两年,HRRP继续显示与AMI和CHF患者90天FRI再入院减少的关联.
- 在HRRP宣布AMI,CHF和肺炎患者后,观察到家庭健康和熟练护理设施的转诊量显著下降.
结论:
- HRRP与严重跌倒相关伤害的减少有关,特别是在心力衰竭和肺炎患者中.
- 这些发现表明,HRRP可能通过促使更好的过渡期护理和后急性转诊模式间接改善了患者安全.
- 这项研究强调了再入院减少计划有可能带来更广泛的患者安全益处的潜力.
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