高需要,高成本的患者在急诊室访问后使用服务的情况
Nadereh Pourat1, Connie Lu, Menbere Haile
1UCLA Center for Health Policy Research, 10960 Wilshire Blvd, Ste 1550, Los Angeles, CA 90024.
The American journal of managed care
|November 25, 2025
概括
卫生中心有效地将急需患者连接到初级保健和心理健康服务,减少重复的急诊和住院治疗. 然而,改善专科护理联系对于所有初级保健提供者来说至关重要.
科学领域:
- 医疗保健服务研究 医疗服务研究
- 初级医疗保健医学 一级医疗保健医学
- 卫生经济学 卫生经济学
背景情况:
- 高需求和高成本 (HNHC) 的患者经常经历分散的护理和高医疗利用率.
- 了解初级保健提供者 (PCP) 类型差异对于优化HNHC人群的护理提供至关重要.
研究的目的:
- 在四种PCP类型中比较HNHC患者及时门诊随访护理和重复急诊室 (ED) 访问和住院的可能性.
- 确定哪些PCP模型在管理HNHC患者和减少昂贵的医疗保健利用方面最有效.
主要方法:
- 一项横截面研究分析了2018年加利福尼亚医疗补助管理护理数据 (N=164,543) 对于HNHC患者.
- 结果包括门诊随访 (初级护理,专科护理,心理健康,物质使用障碍) 在7天内和ED再入院或住院在指数ED访问后30天内.
- 多变量后勤回归模型比较了PCP类型的利用率:HRSA资助的卫生中心,小组实践,个人实践和其他社区诊所.
主要成果:
- 三分之一的指数ED访问在7天内得到初级护理 (30.3%) 或专科护理 (31.8%).
- 在30天内,22%的患者重复了急救诊所,6%的患者住院治疗.
- 与其他PCP类型相比,卫生中心患者的初级护理,心理健康和SUD随访率较高,但专科护理随访率,ED再入院率和住院率较低.
结论:
- 卫生中心擅长将HNHC患者与基本门诊服务联系起来,可能减少住院治疗和重复ED访问.
- 有机会改善医疗中心内的专科护理联系.
- 加强所有PCP类型的护理流程对于减少经常性急救诊所和住院治疗至关重要.
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