在COVID-19大流行后,安全网初级保健能力
Karen E Schifferdecker1,2, Ching-Wen W Yang1, Matthew B Mackwood1,2
1Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire.
JAMA health forum
|August 16, 2024
概括
与其他实践类型相比,联邦合格卫生中心 (FQHC) 在关键护理过程中表现优越,特别是在为服务不足的人群提供服务. 建议增加FQHC的资金,并支持非FQHC安全网的做法,以提高初级保健的准入.
科学领域:
- 医疗保健服务研究 医疗服务研究
- 主要护理是指初级护理.
- 健康 公平 卫生 公平
背景情况:
- 联邦合格医疗中心 (FQHCs) 服务于3000万美国患者,表现出比其他实践类型更好的结果.
- 与其他实践相比,对COVID-19大流行对FQHC能力的影响的理解有限.
研究的目的:
- 为了比较FQHCs的流行后的操作特征和能力与非FQHC安全网和非FQHC,非安全网实践.
- 评估初级保健能力的差异,包括获取和综合措施.
主要方法:
- 一项针对1245家美国实践 (221家FQHC,1024家非FQHC) 的全国代表性调查,从2022年6月到2023年2月进行.
- 实践是通过基于FQHC状态,区域贫困指数和所有权类型的分层随机抽样来选择的.
- 主要结果包括2项获取措施和11项初级保健能力综合措施.
主要成果:
- FQHC更有可能独立拥有并获得COVID-19资金;FQHC和非FQHC安全网的做法在农村地区更为普遍.
- 在行为健康提供,文化知情服务,对社会需求的查/转诊以及共享决策/激励面试培训方面,FQHC显著超过非FQHC.
- 在行为/物质使用查,复杂的护理流程,患者报告的结果措施,决策辅助使用或下班时间访问方面没有观察到显著差异;所有实践中的大多数能力都需要改进.
结论:
- FQHC在为服务不足的人群提供关键护理过程中表现出色,尽管他们为收入较低,医疗服务不足的患者提供服务.
- 扩大FQHC资金和支持非FQHC安全网实践可以改善弱势群体的服务.
- 针对这些实践的有针对性的支持对于加强初级保健至关重要,尤其是在农村地区.
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