社会需要的强度 病例管理服务和医院和急诊室使用的变化 成年医疗补助受益者中的使用情况
Crystal Guo1, Timothy T Brown1, Hector P Rodriguez1
1University of California, Berkeley, School of Public Health, Health Policy and Management, Berkeley, CA.
高强度的社会需求案例管理显著减少了社区连接患者的医院和急诊室的访问. 密集服务可以改善护理过渡,并为有复杂健康需求的个人提供支持.
科学领域:
- 医疗保健服务研究 医疗服务研究
- 健康的社会决定因素
- 卫生经济学 卫生经济学
背景情况:
- 社会需求案例管理计划的强度和结构各不相同.
- 社区连接 (CommunityConnect) 是Contra Costa Health的一项计划,提供社会需求案例管理.
- 了解服务强度对医疗保健利用的影响对于优化资源配置至关重要.
研究的目的:
- 确定高强度和低强度病例管理服务与医疗保健利用之间的关联.
- 评估CommunityConnect病例管理强度对医院和急诊室 (ED) 使用的影响.
- 评估不同级别的社会需求案例管理的有效性.
主要方法:
- 利用仪器变量分析来解决高强度服务的内因性.
- 采用零膨胀负二项式模型来估计医疗保健利用率.
- 分析了2017年8月至2018年12月期间注册的19782名成年医疗补助受益人的数据.
主要成果:
- 高强度病例管理与住院住院患者 (IRR = 0.341) 和急救诊所 (IRR = 0.608) 的发病率降低有关.
- 在高强度服务 (IRR = 0.579) 中也观察到可以避免的ED访问的减少.
- 在服务强度和超额零医疗保健事件的可能性之间没有发现显著的关联.
结论:
- 高强度社会需求的案例管理可能比低强度服务更有效地减少医疗保健使用率.
- 密集病例管理在支持患者出院和护理过渡方面表现有前途.
- 有针对性的,密集的干预措施可能对非零使用医疗保健的个人有益.
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