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科学领域:

  • 医疗保健服务研究 医疗服务研究
  • 健康 结果 研究 研究 结果
  • 卫生政策 卫生政策

背景情况:

  • 准确地将患者分配给初级保健医生 (PCP) 对于有效的医疗保健提供和质量测量至关重要.
  • 了解被分配和既定患者之间的一致性对于评估医疗保健系统绩效至关重要.
  • 转向基于价值的支付需要精确识别医生与患者之间的关系.

研究的目的:

  • 评估一个大型医疗保健系统中患者分配和确立的患者医生关系之间的对齐.
  • 确定患者分配一致性与医疗保健有效性数据和信息集 (HEDIS) 质量性能之间的关联.
  • 在患者分配中识别真阳性,假阳性,真阴性和假阴性分类的程度.

主要方法:

  • 在亚利桑那州城,从2020年1月到2022年2月的Medicaid入学者的回顾性横截面分析.
  • 在一个完全集成的医疗保健提供系统中,包括100,030名被分配到或从PCP获得初级保健服务的Medicaid患者.
  • 使用精度和回忆测量来评估一致性,并分析HEDIS质量指标作为结果测量.

主要成果:

  • 只有15%的患者被一致确定并分配到相同的PCP (真阳性).
  • 总体准确率为21%,回忆率为37%,这表明患者分配中存在重大不一致.
  • 与未建立的患者相比,已建立的患者在6个指标中的5个方面显示出显著更高的HEDIS质量表现.

结论:

  • 大多数被分配的患者没有从他们指定的PCP获得护理,这影响了护理的连续性.
  • 建立的患者与医生的关系与优越的HEDIS质量表现有关.
  • 这些发现强调了需要改进的方法来准确识别医生与患者之间的关系,特别是在基于价值的护理模式的背景下.