人口层面的卫生干预和退伍军人初级保健质量
Chelle L Wheat1, Ashok Reddy1,2,3, Sarah E Shirley1
1Center for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle, Washington.
JAMA network open
|November 18, 2025
概括
退伍军人卫生局的预防性健康清单 (PHI) 改善了糖尿病和高血压护理质量,但没有增加可预防的医疗保健使用. 这一举措为COVID-19流行病后的患者重新参与提供了一个模型.
科学领域:
- 医疗保健服务研究 医疗服务研究
- 慢性疾病管理 慢性疾病管理
- 人口健康 人口健康
背景情况:
- 随着COVID-19大流行,初级保健服务受到干扰,影响了慢性病的管理.
- 退伍军人卫生管理局 (VHA) 推出了预防性健康清单 (PHI),以解决慢性疾病的延迟护理和预防性查问题.
研究的目的:
- 评估VHA的PHI倡议与初级保健质量之间的关联.
- 评估PHI实施对潜在可避免的医疗保健利用的影响.
主要方法:
- 一项队列研究利用了VHA的行政数据,比较了接受PHI护理的糖尿病/高血压退伍军人与没有接受PHI护理的退伍军人.
- 使用倾向得分匹配来创建可比的队列.
- 差异分析评估了临床质量措施 (例如,糖尿病控制) 和可预防的护理使用 (例如,急救诊所,住院).
主要成果:
- 接受PHI护理的退伍军人患糖尿病控制不良的概率较低 (2.9个百分点),血压控制充足的概率较高 (4.0个百分点).
- 在PHI和非PHI组之间,在使用他类药物治疗或使用可预防护理方面没有发现显著差异.
- 使用PHI与门诊护理利用率的增加有关 (1000名退伍军人中有310次).
结论:
- VHA的PHI倡议改善了糖尿病和高血压患者的护理质量.
- PHI的实施并没有导致可预防的医疗保健使用率增加.
- 公共卫生服务作为人口健康策略的潜在模型,旨在重新参与患者,特别是在与流行病相关的干扰之后.
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