加拿大安大略省的初级保健支付模式和可避免的住院治疗:多价值治疗效应分析
Nibene Habib Somé1,2,3,4,5, Rose Anne Devlin6, Nirav Mehta7
1Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada.
Health economics
|June 20, 2024
概括
初级保健支付模式影响住院. 与收费服务相比,资本化模式可能会增加患心痛和心力衰竭等疾病的可避免住院治疗,但以团队为基础的护理可以减轻这种情况,改善慢性疾病管理.
科学领域:
- 医疗保健服务研究 医疗服务研究
- 主要护理政策 基本护理政策
- 卫生经济学 卫生经济学
背景情况:
- 改善初级保健的准入可以减少出院护理敏感条件 (ACSCs) 的住院治疗.
- 安大略省引入了混合医生支付模式 (服务费,资本,团队支付),以提高初级保健和慢性疾病管理的机会.
研究的目的:
- 评估不同初级保健医生支付模式对因激励性 (糖尿病,充血性心力衰竭) 和非激励性 (胸痛,喘) ACSCs而导致的可避免住院治疗的影响.
主要方法:
- 利用了来自安大略省3710名初级保健医生 (2006-2015) 的卫生行政数据.
- 采用了两阶段的估计:通用倾向得分匹配 (多项逻辑),然后使用分数回归模型来估计治疗对可避免住院的平均影响.
主要成果:
- 混合资本化模型与混合费用服务模型相比,与心肌痛和充血性心力衰竭相关的可避免住院病例增加.
- 转向跨专业团队实践的资本医生减少了因充血性心力衰竭而可避免的住院治疗.
结论:
- 初级保健支付结构显著影响可避免的住院率.
- 基于跨专业团队的模型显示了改善慢性疾病管理和减少住院治疗的潜力,而不是单独使用 capitation 模型.
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