A Comparison of Health Plan- and Provider-Delivered Chronic Care Management Models on Patient Clinical Outcomes.
A Comparison of Health Plan- and Provider-Delivered Chronic Care Management Models on Patient Clinical Outcomes.
复制标题
健康计划和提供者提供的慢性病护理管理模式对患者临床结果的比较。
DOI：
10.1007/s11606-016-3617-2
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发表时间：
2016
影响因子：
5.7
通讯作者：
Holtrop,JodiSummers
中科院分区：
文献类型：
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作者：
Luo,Zhehui;Chen,Qiaoling;Annis,AnnM;Piatt,Gretchen;Green,LeeA;Tao,Min;Holtrop,JodiSummers
背景：现实世界中实施的慢性护理管理模式千差万别。这种变化的一个方面是交付模式。两种截然不同的策略包括提供者提供的护理管理(PDCM)和健康计划提供的护理管理(HPDCM)。目的我们的目的是比较PDCM和HPDCM在改善慢性病患者临床结果方面的有效性。设计采用差异法进行准试验性两组前组设计。PATIENTS商业保险的患者，具有五种慢性疾病-充血性心力衰竭、慢性阻塞性肺疾病、冠心病、糖尿病或哮喘中的任何一种，被外包到PDCM或HPDCM并参与研究。MAIN MEASURE被纳入的患者是那些尝试或实际接触过护理管理的人；而积极参与的患者是那些与护理经理进行了一次或多次护理管理会议/会面的患者。有效性测量包括血压、低密度脂蛋白(LDL)、体重减轻和血红蛋白A1c(仅适用于糖尿病患者)。在第一年的随访中对主要终点进行了评估。KEY结果总共有4,000名患者被聚集在165个实践中(PDCM组31个，HPDCM组134个)。低密度脂蛋白得到控制的患者比例在统计学上有显著改善：低密度脂蛋白 和 100g/dL的患者比例在低密度脂蛋白胆固醇组增加了3%(95%可信区间：1%至6%)，高密度脂蛋白胆固醇组增加了1%(95%可信区间：−2%至5%)。然而，这些改善中的2%的差异在统计学上并不显著(95%的CI：−2%对6%)。HPDCM方法显示外展患者的整体糖尿病护理改善了3%[95%CI：2%至6%]，肥胖率较PDCM显著降低(4%，95%CI：0.3%至8%)。结论这两种护理管理交付模式都可能是改善慢性病患者护理的可行选择。在这些有商业保险的人群中，PDCM和HPDCM在第一年都没有导致患者临床指标的显著改善。提供者提供的计划中不同的护理管理策略需要进一步调查。
BACKGROUNDThe real world implementation of chronic care management model varies greatly. One aspect of this variation is the delivery mode. Two contrasting strategies include provider-delivered care management (PDCM) and health plan-delivered care management (HPDCM).OBJECTIVEWe aimed to compare the effectiveness of PDCM vs. HPDCM on improving clinical outcomes for patients with chronic diseases.DESIGNWe used a quasi-experimental two-group pre-post design using the difference-in-differences method.PATIENTSCommercially insured patients, with any of the five chronic diseases—congestive heart failure, chronic obstructive pulmonary disease, coronary heart disease, diabetes, or asthma, who were outreached to and engaged in either PDCM or HPDCM were included in the study.MAIN MEASURESOutreached patients were those who received an attempted or actual contact for enrollment in care management; and engaged patients were those who had one or more care management sessions/encounters with a care manager. Effectiveness measures included blood pressure, low density lipoprotein (LDL), weight loss, and hemoglobin A1c (for diabetic patients only). Primary endpoints were evaluated in the first year of follow-up.KEY RESULTSA total of 4,000 patients were clustered in 165 practices (31 in PDCM and 134 in HPDCM). The PDCM approach demonstrated a statistically significant improvement in the proportion of outreached patients whose LDL was under control: the proportion of patients with LDL < 100 mg/dL increased by 3 % for the PDCM group (95 % CI: 1 % to 6 %) and 1 % for the HPDCM group (95 % CI: −2 % to 5 %). However, the 2 % difference in these improvements was not statistically significant (95 % CI: −2 % to 6 %). The HPDCM approach showed 3 % [95 % CI: 2 % to 6 %] improvement in overall diabetes care among outreached patients and significant reduction in obesity rates compared to PDCM (4 %, 95 % CI: 0.3 % to 8 %).CONCLUSIONSBoth care management delivery modes may be viable options for improving care for patients with chronic diseases. In this commercially insured population, neither PDCM nor HPDCM resulted in substantial improvement in patients’ clinical indicators in the first year. Different care management strategies within the provider-delivered programs need further investigation.