Veterans Health Administration Investments In Primary Care And Mental Health Integration Improved Care Access
Veterans Health Administration Investments In Primary Care And Mental Health Integration Improved Care Access
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DOI：
10.1377/hlthaff.2019.00270
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发表时间：
2019-08-01
期刊：
影响因子：
9.7
通讯作者：
Trivedi, Ranak B.
中科院分区：
文献类型：
--
作者：
Leung, Lucinda B.;Rubenstein, Lisa, V;Trivedi, Ranak B.
为了增加获得护理的机会，退伍军人健康管理局（VHA）的国家初级保健-心理健康一体化（PC-MHI）倡议在初级保健诊所中嵌入专家，护理经理或两者，以合作照顾患有精神疾病的退伍军人。2013-16年，在396个VHA诊所的540万初级保健患者中检查了该倡议对医疗保健使用和成本模式的影响。看过PC-MHI提供者的患者的中位数为6.3%。这些提供者看到的诊所患者比例的每一个百分点的增加与11%的心理健康和40%的初级保健访问有关，但也与每年每位患者平均总成本增加9%有关。平均而言，2.5次综合护理访问取代了没有发生的每一次基于专业的心理健康访问。PC-MHI与改善门诊治疗相关，尽管增加了VHA的总成本。要成功实施综合护理，就必须在保健系统内进行大量投资并建立多学科伙伴关系。
Aiming to increase care access, the national Primary Care-Mental Health Integration (PC-MHI) initiative of the Veterans Health Administration (VHA) embedded specialists, care managers, or both in primary care clinics to collaboratively care for veterans with psychiatric illness. The initiative's effects on health care use and cost patterns were examined among 5.4 million primary care patients in 396 VHA clinics in 2013-16. The median rate of patients who saw a PC-MHI provider was 6.3 percent. Each percentage-point increase in the proportion of clinic patients seen by these providers was associated with 11 percent more mental health and 40 percent more primary care visits but also with 9 percent higher average total costs per patient per year. At the mean, 2.5 integrated care visits substituted for each specialty-based mental health visit that did not occur. PC-MHI was associated with improved access to outpatient care, albeit at increased total cost to the VHA. Successful implementation of integrated care necessitates significant investment and multidisciplinary partnership within health systems.