社区卫生工作者标准化干预对医疗保健利用在综合医疗系统中的影响
Aditi Vasan1,2,3, Molly Knowles4,5, Shaun Flerchinger6,7
1Division of General Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA. vasana@chop.edu.
Journal of general internal medicine
|April 11, 2025
概括
社区卫生工作者 (CHW) 的干预减少了低收入患者的住院时间,增加了初级保健访问. 这种标准化的方法,即以患者为中心的个性化管理 (IMPaCT),在综合卫生系统中显示出前景.
科学领域:
- 公共卫生 公共卫生
- 医疗保健服务研究 医疗服务研究
- 健康 公平 卫生 公平
背景情况:
- 众所周知,社区卫生工作者 (CHW) 的干预可以改善健康结果并减少急性护理的使用.
- 关于CHW干预措施在综合卫生系统中的影响的研究有限.
研究的目的:
- 为了评估以患者为中心的目标 (IMPaCT) 的个性化管理,CHW干预.
- 评估IMPaCT在综合卫生系统内对低收入患者急性护理利用率和初级护理参与度的影响.
主要方法:
- 具有调整差异回归的前性随机分析.
- 在低收入地区的1230名成年人被随机分配到IMPACT (n=820) 或常规护理 (n=410).
- IMPACT涉及3个月的每周远程指导,支持和导航,根据患者的目标量身定制.
主要成果:
- 在IMPaCT患者中,住院日数显著减少 (每1000名成员/月172.3天,p=0.022).
- 在IMPaCT患者中,更高比例的患者参加了初级保健访问 (85.7%与79.5%,p=0.006).
- 两组之间没有观察到急诊室使用率的显著差异.
结论:
- 标准化CHW干预 (IMPaCT) 的远程交付减少了医院利用率.
- 该干预措施在COVID-19大流行期间改善了低收入患者在综合卫生系统中的初级保健参与.
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