Better Access, Quality, and Cost for Clinically Complex Veterans with Home-Based Primary Care
Better Access, Quality, and Cost for Clinically Complex Veterans with Home-Based Primary Care
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DOI：
10.1111/jgs.13030
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发表时间：
2014-10-01
影响因子：
6.3
通讯作者：
Hossain, Monir
中科院分区：
文献类型：
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作者：
Edes, Thomas;Kinosian, Bruce;Hossain, Monir
在成功降低医疗保健支出时，必须满足患者的目标，并将节省与成本转移区分开来。尽管退伍军人事务部（VA）针对慢性病患者的家庭初级保健（HBPC）计划已导致VA的成本降低，但尚不清楚成本降低是否是由于限制服务或将成本转移到医疗保险以及HBPC是否符合患者目标。使用适应VA的分层条件类别（HCC）模型进行成本预测，以确定9，425名新入组的HBPC接受者的VA加医疗保险预计成本。预测的年度成本与HBPC之前和期间观察到的年度成本进行了比较。为了评估病人的护理观点，31退伍军人和照顾者进行了采访，从三个代表性的节目。在HBPC期间，医疗保险费用比预期低10.8%，VA加医疗保险费用比预期低11.7%，合并住院比没有HBPC期间低25.5%。患者对HBPC团队的访问，教育和护理的连续性表示高度满意，他们认为这有助于减少病情加重，急诊和住院。HBPC改善了访问，同时减少住院和总成本。医疗保险目前正在通过家庭独立示范测试HBPC方法。
In successfully reducing healthcare expenditures, patient goals must be met and savings differentiated from cost shifting. Although the Department of Veterans Affairs (VA) Home Based Primary Care (HBPC) program for chronically ill individuals has resulted in cost reduction for the VA, it is unknown whether cost reduction results from restricting services or shifting costs to Medicare and whether HBPC meets patient goals. Cost projection using a hierarchical condition category (HCC) model adapted to the VA was used to determine VA plus Medicare projected costs for 9,425 newly enrolled HBPC recipients. Projected annual costs were compared with observed annualized costs before and during HBPC. To assess patient perspectives of care, 31 veterans and caregivers were interviewed from three representative programs. During HBPC, Medicare costs were 10.8% lower than projected, VA plus Medicare costs were 11.7% lower than projected, and combined hospitalizations were 25.5% lower than during the period without HBPC. Patients reported high satisfaction with HBPC team access, education, and continuity of care, which they felt contributed to fewer exacerbations, emergency visits, and hospitalizations. HBPC improves access while reducing hospitalizations and total cost. Medicare is currently testing the HBPC approach through the Independence at Home demonstration.