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The Participant-Reported Implementation Update and Score PRIUS: A Novel Method for Capturing Implementation-Related Data Over Time
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在医疗保险ACO人群中实施退院后干预计划的实施和结果

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  • 1Mass General Brigham Population Health Services Organization, Somerville, Massachusetts, USA.

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一个新的标准化退院后计划减少了医疗保险患者在负责任的护理组织 (ACO) 中的30天再入院. 这种全系统的干预改善了后续预约率,证明了基于价值的护理模式的价值.

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医疗保险的共享储蓄计划负责任的护理组织后释放计划 后释放计划可以避免的重收.过渡期护理管理管理

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科学领域:

  • 医疗保健服务研究 医疗服务研究
  • 改善医疗保健的质量
  • 基于价值的护理模式

背景情况:

  • 可预防的医院再入院显著增加了医疗保健成本,大约26%的医疗保险药物再入院被认为是可预防的.
  • 在多种不同的卫生系统中大规模实施有效的后释放干预措施存在挑战,证据仍然混杂.
  • 负责任的护理组织 (ACOs) 旨在提高护理质量和降低成本,使再接收减少成为一个关键目标.

研究的目的:

  • 评估一种全新的,多学科的,全系统的解药后干预措施,旨在减少医疗保险共享储蓄计划 (MSSP) 中的30天再入院.
  • 为了测试这样的假设,即通过高真实性工作流程标准化干预交付将降低再接收率.
  • 评估干预对30天再接收率和急诊室 (ED) 报告的影响.

主要方法:

  • 一项前性队列研究比较了试点干预场所患者和倾向匹配的对照组之间的结果.
  • 该干预涉及标准化,多学科的工作流程:病历审查,药剂协调由药剂师,并通过注册护士的退院后评估.
  • 数据收集的重点是30天的再接收率,30天的ED演示和14天的后续预约率.

主要成果:

  • 与匹配的对照组相比,干预队列显示30天再入院率 (13.5%与16.3%,P = 0.07) 的方向性降低.
  • 干预组和对照组之间的30天急诊室表现没有显著差异.
  • 干预组的14天随访预约率显著更高 (70.0%对65.3%,P=0.025).

结论:

  • 一个集中的,标准化的放弃后干预策略可以有效地减少ACO环境中的再接收.
  • 在以价值为基础的护理模式中,结构化,系统级干预对于改善护理过渡和患者结果至关重要.
  • 这种方法突显了可扩展,基于证据的干预措施的潜力,以提高医疗保健的质量和效率.