高需要,高成本商业保险患者的护理协调:一项随机临床试验
O Kenrik Duru1, Jessica Harwood1, Tannaz Moin1,2
1Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, Los Angeles, California.
JAMA network open
|June 24, 2025
概括
国家护理协调并没有降低医疗保健成本或为高需要,高成本的患者的紧急访问. 这项研究强调了改善这种复杂人群的护理效率的挑战.
科学领域:
- 医疗保健服务研究 医疗服务研究
- 医疗保健管理的管理
- 人口健康 人口健康
背景情况:
- 高需要,高成本 (HNHC) 患者占美国人口的5%,但几乎占所有医疗保健支出的一半.
- 确定针对这一群体的有效干预措施对于控制不断上升的医疗保健成本至关重要.
研究的目的:
- 评估国家电话护理协调计划对商业保险HNHC患者医疗保健成本和利用的影响.
- 确定护理协调是否可以减少急诊室的访问,住院和整体医疗保健支出.
主要方法:
- 一个全国性的,双臂随机临床试验,涉及93,379名HNHC患者.
- 干预组接受了注册护士的电话护理协调;对照组接受了通常的护理.
- 在12个月的随访期间进行了治疗意图和仪器变量分析.
主要成果:
- 干预组和对照组之间没有观察到统计学上显著的差异,即平均每月访问急诊室,住院住院,或总医疗费用.
- 包括糖尿病患者在内的子组分析也显示,利用率或成本没有显著降低.
- 仪器变量分析没有显示出护理协调干预改善结果的证据.
结论:
- 国家护理协调干预措施没有导致HNHC患者医疗成本或急性护理利用率下降.
- 这些发现强调了提高HNHC人口面临不断上升的成本的护理效率的复杂性和挑战.
- 需要进一步的研究来确定有效的策略来管理这个高成本的患者群体.
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