在COVID-19大流行期间,美国初级保健准入和能力的变化
Matthew Mackwood1,2, Elliott Fisher1,2,3, Rachel O Schmidt2
1Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire.
在COVID-19大流行期间,初级保健的准入率下降,但实践能力有所改善. 综合所有权和负责任的护理组织 (ACO) 与更好的成绩有关,突出了以价值为基础的护理.
科学领域:
- 初级保健研究研究初级保健研究
- 医疗保健服务研究 医疗服务研究
- 医疗保健管理的管理
背景情况:
- 可访问的,高质量的初级保健能力是必不可少的,但在COVID-19大流行期间他们的实施变化仍然不清楚.
- 了解与增强初级保健能力相关的因素对于改善医疗保健提供至关重要.
研究的目的:
- 描述美国初级保健实践的可访问性和能力.
- 检查从2017-2018年到2022-2023年,包括大流行期间,初级保健可及性和能力的变化.
- 调查实践所有权和负责任的护理组织 (ACO) 参与与这些变化的关联.
主要方法:
- 这是一项回顾性队列研究,分析了两项对美国初级保健实践领导人 (2017-2018年和2022-2023年) 的全国调查数据.
- 基于综合实践所有权 (独立,医生团体,医院/卫生系统) 和ACO参与的差异.
- 通过0-100级标准化的复合分数来衡量获得护理 (延长时间) 和护理能力.
主要成果:
- 在两个调查期间之间,通过延长工作日或周末时间来衡量护理的机会下降了.
- 平均初级保健能力分数从51增加到54.
- 更多的综合实践 (医生集团和医院/医疗系统所有) 和ACO参与者在2022-2023年表现出更高的能力得分和更好地获得延长工作日时间.
结论:
- 尽管获得率下降,但在研究期间,包括COVID-19大流行期间,初级保健能力有所改善.
- 综合实践所有权和ACO参与与更好的访问和能力得分有关,这表明基于价值的护理模式支持更高质量的初级保健.
- 实践中的显著差异突出了改进的机会,以及激励和结构在加强初级保健提供方面的重要性.
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