Health Care Hotspotting - A Randomized, Controlled Trial
Health Care Hotspotting - A Randomized, Controlled Trial
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DOI：
10.1056/nejmsa1906848
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发表时间：
2020-01-09
影响因子：
158.5
通讯作者：
Doyle, Joseph
中科院分区：
文献类型：
--
作者：
Finkelstein, Amy;Zhou, Annetta;Doyle, Joseph
背景人们对旨在减少“超级利用者”（即高度利用医疗保健服务的患者）的支出和提高医疗保健质量的计划产生了广泛的兴趣。卡姆登医疗保健提供者联盟（以下简称联盟）创建的“热点”计划作为一种有前途的超级利用者干预措施受到了全国的关注，并已扩展到全国各地的城市。在出院后的几个月里，一个由护士、社会工作者和社区卫生工作者组成的小组访问登记的病人，协调门诊护理，并将他们与社会服务联系起来。方法：我们随机分配了800名住院患者的医疗和社会复杂的条件，所有至少有一个额外的住院在过去6个月，联盟的护理过渡计划或常规护理。主要结局是出院后180天内再次住院。结果干预组180 d再入院率为62.3%，对照组为61.7%。调整后的组间差异不显著（0.82个百分点; 95%置信区间，-5.97至7.61）。相比之下，对干预组在入组前6个月和入组后6个月期间的入院率进行比较，误导性地表明与干预相关的入院率下降了38个百分点，因为该比较没有考虑到对照组的类似下降。结论：在这项随机对照试验中，涉及非常高使用卫生保健服务的患者，随机分配到联盟计划的患者的再入院率并不比接受常规护理的患者低。（由国家老龄化研究所和其他机构资助; ClinicalTrials.gov编号，;美国经济协会注册号，AEARCTR-0000329。
Background There is widespread interest in programs aiming to reduce spending and improve health care quality among "superutilizers," patients with very high use of health care services. The "hotspotting" program created by the Camden Coalition of Healthcare Providers (hereafter, the Coalition) has received national attention as a promising superutilizer intervention and has been expanded to cities around the country. In the months after hospital discharge, a team of nurses, social workers, and community health workers visits enrolled patients to coordinate outpatient care and link them with social services. Methods We randomly assigned 800 hospitalized patients with medically and socially complex conditions, all with at least one additional hospitalization in the preceding 6 months, to the Coalition's care-transition program or to usual care. The primary outcome was hospital readmission within 180 days after discharge. Results The 180-day readmission rate was 62.3% in the intervention group and 61.7% in the control group. The adjusted between-group difference was not significant (0.82 percentage points; 95% confidence interval, -5.97 to 7.61). In contrast, a comparison of the intervention-group admissions during the 6 months before and after enrollment misleadingly suggested a 38-percentage-point decline in admissions related to the intervention because the comparison did not account for the similar decline in the control group. Conclusions In this randomized, controlled trial involving patients with very high use of health care services, readmission rates were not lower among patients randomly assigned to the Coalition's program than among those who received usual care. (Funded by the National Institute on Aging and others; ClinicalTrials.gov number, ; American Economic Association registry number, AEARCTR-0000329.)