Specialty Care and the Patient-Centered Medical Home
Specialty Care and the Patient-Centered Medical Home
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DOI：
10.1097/mlr.0b013e3181f537b0
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发表时间：
2011-01-01
期刊：
影响因子：
3
通讯作者：
Miller, David C.
中科院分区：
文献类型：
--
作者：
Hollingsworth, John M.;Saint, Sanjay;Miller, David C.
背景资料：医疗之家的成功在一定程度上取决于初级保健医生（PCP）和专家合作创建基于集体责任的“医疗社区”的程度。这种合作可能需要一个新的平衡，在慢性病护理，与一些常规的后续行动，目前提供的专家重新分配到PCP和他们的医疗家庭teams.Objectives：要衡量的护理提供的专家为7慢性病，并估计与重新分配一半之间的PCP劳动力的影响。主题：来自2007年全国门诊医疗保健调查的医生。测量：我们确定了慢性阻塞性肺疾病/哮喘、腰痛、糖尿病、冠状动脉疾病/充血性心力衰竭、慢性肾脏疾病和抑郁症的成人门诊就诊。我们计算了专家在直接和间接护理患有这些疾病的患者所花费的时间。我们汇总了各专科医生的个人估计，并将总数转换为年度工作周。在将这个数字减半后，我们除以活跃的PCPs.Results的数量：大多数专业访问（76.8%; 95%置信区间[CI]：73.6%-79.7%）是由既定的患者。专科医生分别花费了552，844（95% CI：454，660 - 651，029）和108，113（95% CI：86，103 - 130，122）累积工作周提供直接和间接随访护理。重新分配一半的这种护理将产生3.2（95%CI：2.6 - 3.8）额外的工作周为每个PCP.Conclusions：专家在常规慢性病随访所花费的累计时间是不平凡的。将这种护理重新分配给PCP指导的医疗之家可能需要多方面的努力来扩大初级保健工作队伍。
Background: The medical home's success depends, in part, on the degree to which primary care physicians (PCPs) and specialists collaborate to create "medical neighborhoods" based on collective accountability. Such collaboration may require a new equilibrium in chronic disease care, with some of the routine follow-up currently provided by specialists reallocated to PCPs and their medical home teams.Objectives: To measure the care delivered by specialists for 7 chronic conditions, and to estimate the implications associated with reallocating half among the PCP workforce.Research Design: Cross-sectional. Subjects: Physicians from the 2007 National Ambulatory Medical Care Survey.Measures: We identified adult ambulatory visits for chronic obstructive pulmonary disease/asthma, low back pain, diabetes mellitus, coronary artery disease/congestive heart failure, chronic kidney disease, and depression. We calculated the time spent by specialists in direct and indirect care for established patients with these conditions. We summed individual physician estimates across specialists and converted the total into annual work weeks. After reducing this figure by half, we divided by the number of active PCPs.Results: Most specialty visits (76.8%; 95% confidence interval [CI] : 73.6%-79.7%) were made by established patients. Specialists spent 552,844 (95% CI: 454,660-651,029) and 108,113 (95% CI: 86,103-130,122) cumulative work weeks providing direct and indirect follow-up care, respectively. Reallocating half of this care would generate 3.2 (95% CI: 2.6 -3.8) additional work weeks for each PCP.Conclusions: The cumulative time spent by specialists in routine chronic disease follow-up is nontrivial. Reallocation of this care to PCP-directed medical homes may require multidimensional efforts to expand the primary care workforce.