与使用美国退伍军人预防性健康库存相关的因素
Chelle L Wheat1, Edwin S Wong1,2, Kristen E Gray1,2
1Center for Veteran-Centered and Value-Driven Care, Veterans Affairs (VA) Puget Sound Health Care System, Seattle, Washington.
JAMA network open
|March 18, 2024
概括
退伍军人有更高的医疗保健需求 (更高的护理评估需求得分) 和更多的先前门诊访问更有可能接受预防性健康清单 (PHI) 干预. 这有助于确定改善退伍军人护理协调的机会.
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
- 退伍军人卫生管理局退伍军人卫生管理局
背景情况:
- 随着COVID-19大流行,预防性和慢性病护理受到破坏,导致质量大幅下降.
- 退伍军人卫生管理局 (VHA) 实施了预防性健康清单 (PHI),这是一个护理管理干预措施,以解决与流行病相关的护理缺口.
研究的目的:
- 确定与退伍军人使用PHI干预相关的关键患者,从业者和临床因素.
- 了解PHI接收的模式,以改善护理协调.
主要方法:
- 一项队列研究分析了2021年2月1日至2022年2月1日之间的VHA初级保健诊所的行政数据.
- 使用具有固定的临床效应的二项通用线性模型和最小绝对缩小和选择操作员 (LASSO) 程序来识别与PHI接收相关的因素.
- 这项研究包括超过430万名退伍军人,检查了患者,从业者和诊所的特点.
主要成果:
- 接受PHI的退伍军人有更高的护理评估需求 (CAN) 评分,表明更大的医疗保健需求.
- 获得PHI的患者更有可能居住在城市地区,并且前往初级保健的距离更短.
- 增加先前门诊利用率和较高的初级保健医生病例负载与更高的PHI收款有关.
- 最后的模型表明先前的门诊使用和CAN得分是PHI接收的重要预测因素.
结论:
- 退伍军人有更高的CAN分数和更大的先前门诊使用更有可能获得PHI.
- 这些发现突出了在VHA系统内加强护理协调的潜在干预点.
- 了解与PHI接收相关的因素可以帮助优化向需要综合护理的退伍军人提供服务.
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