Impact of illness management and recovery programs on hospital and emergency room use by Medicaid enrollees.
Impact of illness management and recovery programs on hospital and emergency room use by Medicaid enrollees.
复制标题
疾病管理和康复计划对医疗补助参与者使用医院和急诊室的影响。
DOI：
10.1176/ps.62.5.pss6205_0509
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发表时间：
2011
期刊：
影响因子：
--
通讯作者：
Kim,Edward
中科院分区：
文献类型：
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作者：
Salyers,MichelleP;Rollins,AngelaL;Clendenning,Daniel;McGuire,AlanB;Kim,Edward
疾病管理和康复是一个结构化的项目，帮助患有严重精神疾病的消费者学习有效的方法来管理疾病和追求康复目标。本研究考察了该计划对卫生服务利用的影响。方法：本研究是对印第安纳州实施疾病管理和康复的五个自信社区治疗（ACT）团队进行回顾性队列研究。利用2003年7月1日至2008年6月30日的医疗补助索赔数据，以人月为分析水平创建了面板数据，共对498个独特个体进行了14,261次观察。采用零膨胀负二项回归模型预测住院天数和急诊室就诊次数，包括人口统计学特征、就业状况、精神病学诊断和并发物质使用障碍等协变量。感兴趣的主要预测变量是接受疾病管理和康复服务，退出计划和计划毕业状态。结果接受一些疾病管理和康复服务的消费者比只接受ACT的消费者住院天数少。毕业生的急诊就诊次数比act消费者少。结论本研究首次探讨了疾病管理和康复对服务利用的影响。控制了一些背景变量，该研究表明，疾病管理和康复计划与减少住院病人住院和急诊室使用相关，超过ACT。（精神科服务62:509 - 515,2011）
ObjectiveIllness management and recovery is a structured program that helps consumers with severe mental illness learn effective ways to manage illness and pursue recovery goals. This study examined the impact of the program on health service utilization.MethodsThis was a retrospective cohort study of five assertive community treatment (ACT) teams in Indiana that implemented illness management and recovery. With Medicaid claims data from July 1, 2003, to June 30, 2008, panel data were created with person-months as the level of analysis, resulting in 14,261 observations for a total of 498 unique individuals. Zero-inflated negative binomial regression models were used to predict hospitalization days and emergency room visits, including covariates of demographic characteristics, employment status, psychiatric diagnosis, and concurrent substance use disorder. The main predictor variables of interest were receipt of illness management and recovery services, dropout from the program, and program graduation status.ResultsConsumers who received some illness management and recovery services had fewer hospitalization days than those receiving only ACT. Graduates had fewer emergency room visits than did ACT-only consumers.ConclusionsThis is the first study to examine the impact of illness management and recovery on service utilization. Controlling for a number of background variables, the study showed that illness management and recovery programs were associated with reduced inpatient hospitalization and emergency room use over and above ACT. (Psychiatric Services62:509–515, 2011)