Continuity of Care and the Risk of Preventable Hospitalization in Older Adults
Continuity of Care and the Risk of Preventable Hospitalization in Older Adults
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DOI：
10.1001/jamainternmed.2013.10059
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发表时间：
2013-11-11
影响因子：
39
通讯作者：
Fisher, Elliott S.
中科院分区：
文献类型：
--
作者：
Nyweide, David J.;Anthony, Denise L.;Fisher, Elliott S.
重要性可预防住院在老年人中很常见，其原因尚不清楚。目的确定具有较高护理连续性的门诊就诊模式的联邦医疗保险患者是否有较低的可预防住院风险。设计回溯性队列研究。设置门诊就诊和住院入院情况。PARTICIPANT在2008年连续招募65岁以上的按服务收费的医疗保险受益人，至少有4次门诊就诊。示例：使用护理连续性分数和通常提供者的连续性分数来衡量长达24个月的患者与医生的就诊集中度。MAIN结果和衡量指标13个可预防的住院人数中的任何一个的发生情况、发生情况和衡量标准在24个月的随访期结束时，如果没有发生可预防的入院病例，或者如果患者死亡，则对患者进行审查。结果在3276635例符合条件的患者中，12.6%的患者在2年观察期内有可预防的住院，最常见的原因是充血性心力衰竭(25%)、细菌性肺炎(22.7%)、尿路感染(14.9%)或慢性阻塞性肺疾病(12.5%)。在对患者基线特征和市场水平因素进行调整后，根据任一连续性指标，护理连续性增加0.1%与可预防住院率降低约2%相关(护理连续性评分风险比[HR]，0.98[95%CI，0.98-0.99；通常提供者连续性评分HR，0.98[95%CI，0.98-0.98])。护理的连续性与死亡率无关。结论在65岁以上的按服务收费的医疗保险受益人中，门诊护理的连续性越高，可预防住院率越低。
IMPORTANCE Preventable hospitalizations are common among older adults for reasons that are not well understood.OBJECTIVE To determine whether Medicare patients with ambulatory visit patterns indicating higher continuity of care have a lower risk of preventable hospitalization.DESIGN Retrospective cohort study.SETTING Ambulatory visits and hospital admissions.PARTICIPANTS Continuously enrolled fee-for-service Medicare beneficiaries older than 65 years with at least 4 ambulatory visits in 2008.EXPOSURES The concentration of patient visits with physicians measured for up to 24 months using the continuity of care score and usual provider continuity score on a scale from 0 to 1.MAIN OUTCOMES AND MEASURES Index occurrence of any 1 of 13 preventable hospital admissions, censoring patients at the end of their 24-month follow-up period if no preventable hospital admissions occurred, or if they died. RESULTS Of the 3 276 635 eligible patients, 12.6% had a preventable hospitalization during their 2-year observation period, most commonly for congestive heart failure (25%), bacterial pneumonia (22.7%), urinary infection (14.9%), or chronic obstructive pulmonary disease (12.5%). After adjustment for patient baseline characteristics and market-level factors, a 0.1 increase in continuity of care according to either continuitymetric was associated with about a 2% lower rate of preventable hospitalization (continuity of care score hazard ratio [HR], 0.98 [95% CI, 0.98-0.99; usual provider continuity score HR, 0.98 [95% CI, 0.98-0.98). Continuity of care was not related to mortality rates.CONCLUSIONS AND RELEVANCE Among fee-for-service Medicare beneficiaries older than 65 years, higher continuity of ambulatory care is associated with a lower rate of preventable hospitalization.