在医疗补助管理护理中的行为健康整合的获取,利用和质量
K John McConnell1, Sara Edelstein1, Jennifer Hall2
1Center for Health Systems Effectiveness, Oregon Health & Science University, Portland.
JAMA health forum
|December 28, 2023
概括
将行为健康整合到医疗补助管理护理组织 (MCOs) 中并没有显著改变服务使用或结果. 需要额外的支持来改善综合管理护理 (IMC) 中的护理提供和患者结果.
科学领域:
- 医疗保健服务研究 医疗服务研究
- 公共卫生 公共卫生
- 卫生政策 卫生政策
背景情况:
- 许多州正在从医疗补助管理护理组织 (MCO) 转向综合行为健康服务.
- 关于这种转型对医疗保健提供和患者治疗结果的影响的证据有限.
- 了解这些影响对于为政策和实践提供信息至关重要.
研究的目的:
- 评估华盛顿医疗补助计划 (Medicaid) 过渡到综合管理护理 (IMC) 与医疗服务利用,质量,与健康相关的结果和健康的社会决定因素的变化之间的关联.
- 提供关于将行为健康服务整合到MCOs中的有效性的证据.
主要方法:
- 一项队列研究分析了2014-2019年华盛顿医疗补助MCO入学者的索赔数据 (13-64岁),使用差异分析.
- 该研究结合了采访24个关键信息者的定性数据,包括行为健康机构领导人和管理护理管理人员.
- 分析的重点是利用率,质量,健康结果 (例如,自我伤害) 和社会决定因素 (例如,就业,无家可归,逮捕).
主要成果:
- 在MCO内部的金融整合与大多数利用率和质量指标的变化没有显著的关联.
- 大多数与健康相关的结果保持不变;然而,在轻度/中度精神疾病的入学者中观察到心脏事件略有下降.
- 患有严重精神疾病的人员就业率略有下降,逮捕率略有增加.
结论:
- 在MCO中向金融整合过渡并没有在大多数利用,质量,结果和社会决定因素指标上取得显著的改善.
- 定性发现表明,这种变化被认为是行政性的,缺乏实践护理整合指导.
- 建议提供额外的支持,包括监测,培训和资金,以促进交付系统的变化并提高综合护理的有效性.
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