美国安全网诊所的护理管理服务
Joseph H Joo1,2, Anna M Morenz3, Michael D Dang1
1Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, United States.
Frontiers in health services
|October 9, 2025
概括
在安全网诊所中,利用医疗保险护理管理服务的比例有所增加,但拒绝率也大幅上升. 过渡期护理管理服务的采用率非常低,这表明潜在的障碍或替代偏好.
科学领域:
- 医疗保健服务研究 医疗服务研究
- 卫生政策 卫生政策
- 健行护理服务提供者
背景情况:
- 联邦合格卫生中心 (FQHC) 和农村卫生中心 (RHC) 是美国门诊安全网护理系统的重要组成部分.
- 医疗保险补偿临床医生的护理管理服务,以促进这些安全网诊所的护理协调.
研究的目的:
- 分析与非安全网设施相比,FQHC和RHC中的Medicare患者使用护理管理服务的长期趋势.
- 评估这些环境中一般护理管理和过渡护理管理服务的普及情况.
主要方法:
- 对医疗保险医生费用表数据的回顾性分析.
- 在六年期间,FQHC/RHC和非FQHC/非RHC之间的服务利用率和拒绝率的比较.
主要成果:
- 一般护理管理服务的利用率升了207%,到2023年将达到2,251个服务.
- 一般护理管理服务的拒绝率从2018年的42%增加到2023年的64%.
- 过渡期护理管理服务在FQHC/RHC中很少被使用 (在六年内提供了237项服务),79%的费用被退还.
结论:
- 尽管在安全网诊所关键需要护理协调,但医疗保险患者使用医疗保险管理服务仍然很低.
- 低吸收率可能表明他们更喜欢医疗保险医生费用表之外的护理管理模式,特别是在过渡性护理方面.
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