用风险减轻措施重新设计以人为中心的捆绑支付模式,描述异质的慢性患者群体
Sterre S Bour1, Lucas M A Goossens2, Maureen P M H Rutten-van Mölken2,3
1Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, Netherlands. bour@eshpm.eur.nl.
概括
这项研究使综合护理的新支付模式投入使用,降低了初级保健合作社 (PCC) 管理2型糖尿病 (DM2),心血管疾病 (CVR) 和慢性阻塞性肺病 (COPD) 患者的财务风险. 风险调整和成本上限措施将PCC的财务不确定性降至最低.
科学领域:
- 医疗保健服务研究 医疗服务研究
- 初级保健管理管理初级保健管理
- 卫生经济学 卫生经济学
背景情况:
- 荷兰的初级保健合作社 (PCC) 目前正在为2型糖尿病 (DM2),心血管疾病 (CVR) 和慢性阻塞性肺病 (COPD) 的患者使用单一疾病管理计划 (SDMP).
- 现有由捆绑支付资助的SDMP面临着由于患者多病症增加的挑战,突出需要更多以人为中心的护理模式.
- 之前提出的替代支付模式旨在将以人为中心的方法整合到护理中.
研究的目的:
- 为了使荷兰初级保健中的综合,以人为中心的护理变得可操作,并展示一种替代的支付模式.
- 分析与PCC不同的护理包设计相关的患者子组和财务风险.
- 评估风险减轻措施在减少PCC的财务不确定性方面的有效性.
主要方法:
- 对索赔数据的集群分析,以确定患者子组.
- 使用全科医生可访问的数据预测集群概率.
- 根据患者子组量身定制的多样化护理套餐的设计.
- 对不同规模的PCC进行财务风险评估,包括风险调整和成本上限.
主要成果:
- PCC的大小和护理包的内容显著影响了预测的财务结果 (损失或利).
- 拟议的支付模式的实施证明了可行性.
- 风险调整和成本限制措施有效地降低了预测的财务损失或利,使它们接近零.
结论:
- 操作化的支付模式为初级机构的综合,以人为中心的护理提供了一个可行的框架.
- 通过战略设计护理套餐和实施风险减轻策略,可以有效地管理PCC的财务风险.
- 这种方法支持为复杂的患者群体提供更可持续和以患者为中心的护理.
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