与医疗保险和医疗补助综合相关的护理变化,适用于双重资格的个人
Eric T Roberts1, Lingshu Xue2, John Lovelace3
1Division of General Internal Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia.
JAMA health forum
|December 21, 2023
概括
整合医疗保险和医疗补助通过完全整合的双重符合条件的特殊需求计划 (FIDE-SNPs) 增加了家庭和社区服务 (HCBS) 的使用. 然而,这种整合并没有显著改变双重符合条件的个人其他护理模式.
科学领域:
- 医疗保健服务研究 医疗服务研究
- 卫生政策 卫生政策
- 老年学是一门学科.
背景情况:
- 综合护理模式旨在为双重资格的个人简化医疗保险和医疗补助服务.
- 完全集成的双重符合条件的特殊需求计划 (FIDE-SNP) 是一个重要的集成模型,但业绩数据仍然有限.
- 了解FIDE-SNP对护理提供的影响对于优化为这一群体提供服务至关重要.
研究的目的:
- 评估将医疗保险和医疗补助覆盖范围纳入FIDE-SNP对宾夕法尼亚州护理利用和模式的影响.
- 评估在家庭和社区服务 (HCBS),护理协调,住院和养老院住宿的整合后的变化.
主要方法:
- 采用差异差异分析,比较两个双重合格个体的队列.
- 整合队列包括受2018年国家改革影响的FIDE-SNP入学者,该改革要求医疗补助管理护理.
- 用非综合覆盖的对比队列来建立护理变化的反事实.
主要成果:
- 整合与使用家庭和社区服务 (HCBS) 显著增加,增加了0.61天/人/月.
- 在护理管理,治疗慢性病的药物使用或住院后门诊随访方面没有观察到显著的差异性变化.
- 综合和非综合群体之间的住院时间没有差异,由于死亡率,长期养老院住院的变化无法可靠地确定.
结论:
- 通过FIDE-SNPs实现医疗保险和医疗补助的整合,有望提高双重符合条件的个人获得HCBS的机会.
- 该研究表明,需要完善综合护理策略,以影响更广泛的护理协调和急性后护理结果.
- 进一步的研究是有必要的,以充分了解长期影响,并优化综合护理模型的性能.
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