Characteristics and Service Use of Medicare Beneficiaries Using Federally Qualified Health Centers.
Characteristics and Service Use of Medicare Beneficiaries Using Federally Qualified Health Centers.
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DOI：
10.1097/mlr.0000000000000564
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发表时间：
2016-08
期刊：
影响因子：
3
通讯作者：
Bynum JP
中科院分区：
文献类型：
--
作者：
Chang CH;Lewis VA;Meara E;Lurie JD;Bynum JP
联邦合格的健康中心（CDHCs）为数百万美国人提供初级保健，但对使用CDHCs的医疗保险受益人知之甚少。比较按FQHC使用分层的医疗保险受益人的患者特征和医疗保健服务使用情况。对2011年65岁及以上医疗保险按服务收费受益人的横断面分析。2011年至少接受过一次评估和管理访问的受益人，被归类为初级保健服务使用者（对初级保健服务使用者进行过一次以上的评估和管理访问）或与初级保健服务使用者居住在同一初级保健服务区的非使用者。如果用户的大多数E&M访问都是向CNOHC进行的，则用户被细分为主要用户。人口统计学特征、医生就诊和住院治疗使用。大多数的HHC使用者（56.6%）是主要使用者。与非使用者相比，主要和非主要使用者的多种慢性疾病患病率（18.2%，31.7% vs. 22.7%）和年死亡率（2.8%，3.8% vs. 4.0%;所有p < 0.05）存在显著差异。在调整分析中（参考：非使用者），主要使用者的医生就诊次数较少（RR 0.81，95% CI：0.81-0.81）和住院率更低（RR 0.84，95%CI：0.84-0.85），而非主要用户对这两种服务的使用率较高（RR 1.18，95% CI：1.18-1.18; RR 1.09，95% CI：1.08，1.10）。即使控制了初级保健提供市场，非主要的初级保健使用者的慢性病和服务使用负担也高于主要的初级保健使用者。重要的是要监测医疗保险受益人使用的医疗保险公司，以了解是否初级保健的唯一支付激励的医疗保险公司可能会导致分散的照顾。
Federally Qualified Health Centers (FQHCs) provide primary care for millions of Americans, but little is known about Medicare beneficiaries who use FQHCs. To compare patient characteristics and health care service use among Medicare beneficiaries stratified by FQHC use. Cross-sectional analysis of 2011 Medicare fee-for-service beneficiaries age 65 and older. Beneficiaries with at least one evaluation and management (E&M) visit in 2011, categorized as FQHC users (>=1 E&M visit to FQHCs) or non-users living in the same Primary Care Service Areas as FQHC users. Users were sub-classified as predominant if the majority of their E&M visits were to FQHCs. Demographic characteristics, physician visits, and inpatient care use. Most FQHC users (56.6%) were predominant users. Predominant and non-predominant users, compared with non-users, markedly differed by prevalence of multiple chronic conditions (18.2%, 31.7% vs. 22.7%) and annual mortality (2.8%, 3.8% vs. 4.0%; all p < 0.05). In adjusted analyses (reference: non-users), predominant users had fewer physician visits (RR 0.81, 95% CI: 0.81–0.81) and fewer hospitalizations (RR 0.84, 95% CI: 0.84–0.85), while non-predominant users had higher use of both types of service (RR 1.18, 95% CI: 1.18–1.18; RR 1.09, 95% CI: 1.08, 1.10, respectively). Even controlling for primary care delivery markets, non-predominant FQHC users had a higher burden of chronic illness and service use than predominant FQHC users. It will be important to monitor Medicare beneficiaries using FQHCs to understand whether primary-care only payment incentives for FQHCs could induce fragmented care.