在VHA购买与提供护理:精神病医院住院后随访的质量差异
Kenneth J Nieser1,2, Cheng Chen1, Alex H S Harris1,2
1Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, CA.
Medical care
|December 8, 2025
概括
与VHA提供的护理相比,退伍军人卫生管理局 (VHA) 购买的精神病治疗的门诊随访率明显较低. 这突显了退伍军人利用社区提供者的心理健康护理连续性的潜在差异.
科学领域:
- 医疗保健服务研究 医疗服务研究
- 心理健康服务 心理健康服务
- 医疗保健的质量 医疗保健的质量
背景情况:
- 退伍军人卫生管理局 (VHA) 在医疗保健服务方面越来越依赖社区提供者.
- 这种转变可能会影响护理质量,并导致分散,特别是在住院和门诊精神卫生保健之间的连续性方面.
研究的目的:
- 为了比较VHA提供的精神病医院住院的门诊随访率与VHA从社区提供者购买的门诊随访率.
- 分析这些费率的整体情况,并按个别VHA设施分层分析.
主要方法:
- 利用VHA电子医疗记录和社区护理索赔数据进行分析.
- 对VHA购买和VHA交付精神病医院住院的7天和30天门诊随访率进行比较.
- 在四个诊断组和个别VHA设施中检查了率.
主要成果:
- 在研究的64,784例住院病例中,超过30%是VHA购买的.
- 在VHA购买的住院患者的随访率显著下降:在7天后下降30.1个百分点,在30天后下降22.5个百分点.
- 对神经认知障碍出院的随访率较低;在128个购买护理的VHA设施中的121个,30天的随访率较低.
结论:
- 关于VHA和社区精神病治疗之间的质量差异的数据对VHA入学者和项目经理有价值.
- 将门诊随访措施纳入VHA购买的护理质量报告和基于价值的合同中,可以激励改善护理质量.
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