家庭医生系统对具有独特服务利用模式的糖尿病患者的影响:基于基于组的轨迹建模的差异分析
Xinyi Liu1,2, Luying Zhang1, Xianqun Fan3
1School of Public Health, Fudan University, Shanghai, China.
BMJ global health
|September 23, 2024
概括
中国的家庭医生系统 (FDS) 提高了糖尿病患者的初级保健使用和成本,同时降低了医院访问和费用. 这种系统对先前在医院使用量较高的患者特别有效,改善了慢性疾病的整体管理.
科学领域:
- 医疗保健服务研究 医疗服务研究
- 公共卫生政策 公共卫生政策
- 慢性疾病管理 慢性疾病管理
背景情况:
- 中国实施家庭医生制度 (FDS) 旨在重塑医疗保健的提供.
- 了解FDS对不同患者群体,特别是糖尿病患者和不同服务利用模式的影响至关重要.
研究的目的:
- 评估中国FDS对糖尿病患者医疗利用和医疗成本的影响.
- 分析不同长期服务利用轨迹的这些影响.
主要方法:
- 在中国A市 (2014-2019) 进行的回顾性队列研究,使用卫生系统和保险数据.
- 基于组的轨迹建模,将糖尿病患者 (N=17,232) 分类为四种服务利用模式 (2014-2017).
- 倾向性得分匹配和差异分析以比较FDS注册 (干预) 与未注册 (控制) 患者 (2018-2019).
主要成果:
- FDS在高二级/高三级医院访问组 (增加6.265) 和高整体利用组 (增加4.642) 中显著增加了社区卫生中心 (CHC) 访问量.
- 相反,FDS导致这些群体的二级/三级住院次数大幅减少 (55.5%的高住院次数组的成本减少).
- 所有FDS注册的糖尿病患者的自付费用显著下降.
结论:
- 中国的FDS有效地将医疗保健利用转向初级保健 (CHC) 并减少糖尿病患者对医院的依赖.
- 该系统对具有高历史医院利用率的患者具有特别的好处,降低了访问和相关成本.
- 建议对FDS进行改进,以进一步优化初级保健参与和慢性疾病管理.
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