Patient-Centered Medical Home Membership Is Associated with Decreased Hospital Admissions for Emergency Department Behavioral Health Patients
Patient-Centered Medical Home Membership Is Associated with Decreased Hospital Admissions for Emergency Department Behavioral Health Patients
复制标题
DOI：
10.1089/pop.2016.0189
复制
发表时间：
2018-06-01
影响因子：
2.5
通讯作者：
Katzelnick, David J.
中科院分区：
文献类型：
--
作者：
Adaji, Akuh;Melin, Gabrielle J.;Katzelnick, David J.
该研究的目的是考察多付费以患者为中心的医疗之家(PCMH)对在三级急诊科(ED)就诊的行为健康患者的卫生保健利用的影响。对在明尼苏达州罗切斯特市梅奥诊所医院急诊室接受精神科咨询的PCMH患者和非PCMH患者进行了回顾性的健康记录回顾。使用Logistic回归模型评估单变量和多变量与72小时内入院和复诊结果的关系，并用优势比(OR)和95%可信区间(CI)进行总结。在研究期间，3815名患者共进行了5398次访问。其中，PCMH患者就诊2440人次(45%)。总共有2983例(55%)患者就诊后入院。在单变量模型中，PCMH患者(53%)较非PCMH患者(57%)较少(OR0.84；95%CI0.76~0.94；P=0.002)，经多因素校正后仍有统计学意义(OR0.83；95%CI0.74~0.93；P=0.001)。在2415例非入院患者中，PCMH患者与非PCMH患者72小时内复发率差异无统计学意义(OR1.12；95%CI 0.83~1.43；P=0.36)。PCMH会员资格与急诊科住院的可能性较低有关。PCMH干预可能与降低卫生保健利用率有关。
The objective was to examine the impact of a multipayer patient-centered medical home (PCMH) on health care utilization for behavioral health patients seen at a tertiary care emergency department (ED). A retrospective health records review was performed for PCMH and non-PCMH patients who presented and received a psychiatric consultation during a 2-year period in the ED of the Mayo Clinic Hospital in Rochester, Minnesota. Univariable and multivariable associations with the outcomes of admission and return visits within 72 hours were evaluated using logistic regression models and summarized with odds ratios (ORs) and 95% confidence intervals (CIs). There were 5398 visits among 3815 patients during the study period. Among these, there were 2440 (45%) PCMH patient visits. There were 2983 (55%) total patient visits resulting in an admission. In a univariable model, PCMH patients (53%) were less likely to be admitted from the ED compared with non-PCMH patients (57%) (OR 0.84; 95% CI 0.76-0.94; P=0.002) and this remained statistically significant (OR 0.83; 95% CI 0.74-0.93; P=0.001) after multivariable adjustment. Among the 2415 non-admitted patients, there was no significant difference in returns within 72 hours between PCMH patients (13%) and non-PCMH patients (12%) (OR 1.12; 95% CI 0.83-1.43; P=0.36). PCMH membership was associated with a lower probability of inpatient hospitalization from the ED. PCMH interventions may be associated with a reduction in health care utilization.