Back to basics: A mediation analysis approach to addressing the fundamental questions of integrated care evaluations
Back to basics: A mediation analysis approach to addressing the fundamental questions of integrated care evaluations
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回到基础：解决综合护理评估基本问题的中介分析方法
DOI：
10.1002/hec.4713
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发表时间：
2023
期刊：
影响因子：
2.1
通讯作者：
Lugo-Palacios D
中科院分区：
文献类型：
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作者：
Lugo-Palacios D
世界各地的卫生系统都致力于改善卫生和社会护理服务的整合，以便为患者提供更好的护理。现有的评价只侧重于护理一体化对健康结果的影响，几乎没有发现任何效果。这表明有必要后退一步，问一问综合保健方案是否实际上导致了更大程度的临床综合保健，以及更大程度的综合是否与改善健康结果有关。我们提出了一种调解分析的方法，以解决这两个基本问题时，评估综合护理计划。我们通过重新检查英语综合护理计划对临床整合的影响，并评估更大程度的整合是否与更少的门诊敏感疾病入院人数之间存在因果关系来说明我们的方法。我们使用全科医生层面的门诊转诊的集中指数来衡量临床整合。虽然我们发现该计划增加了初级和二级护理的整合，但临床整合并没有调节非计划入院人数的减少。我们的分析强调需要更好地理解整合对健康结果的假设因果影响，并展示中介分析如何为未来的评估和方案设计提供信息。
Health systems around the world are aiming to improve the integration of health and social care services to deliver better care for patients. Existing evaluations have focused exclusively on the impact of care integration on health outcomes and found little effect. That suggests the need to take a step back and ask whether integrated care programmes actually lead to greater clinical integration of care and indeed whether greater integration is associated with improved health outcomes. We propose a mediation analysis approach to address these two fundamental questions when evaluating integrated care programmes. We illustrate our approach by re‐examining the impact of an English integrated care program on clinical integration and assessing whether greater integration is causally associated with fewer admissions for ambulatory care sensitive conditions. We measure clinical integration using a concentration index of outpatient referrals at the general practice level. While we find that the scheme increased integration of primary and secondary care, clinical integration did not mediate a decrease in unplanned hospital admissions. Our analysis emphasizes the need to better understand the hypothesized causal impact of integration on health outcomes and demonstrates how mediation analysis can inform future evaluations and program design.