Features of Patient-Centered Primary Care and the Use of Ambulatory Care.
Features of Patient-Centered Primary Care and the Use of Ambulatory Care.
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以患者为中心的初级保健的特点和门诊护理的使用。
DOI：
10.1089/pop.2016.0079
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发表时间：
2017
影响因子：
2.5
通讯作者：
Tai-Seale,Ming
中科院分区：
文献类型：
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作者：
Wong,Paul;Panattoni,Laura;Tai-Seale,Ming
本研究探讨了患者使用门诊护理资源与以患者为中心的初级护理（PCPC）特征之间的关系，特别是临床级国家质量保证委员会（NCQA）对PCPC的认可，护理的连续性和护理团队沟通。本研究的数据来自加州一家大型多专业团体诊所的电子健康记录，涵盖了2009年至2010年期间37，042名非老年患者的资本管理式护理计划。使用广义线性模型对这些数据进行回归分析，比较患者水平年度资源使用指标（总相对值单位[tRVU]）与临床和患者水平PCPC指标以及患者水平风险（例如，年龄、合并症）。与NCQA认可三级诊所相比，二级诊所的患者使用的门诊护理tRVU减少了4.8%（P< 0.001）。初级护理连续性增加1个标准差的患者使用的门诊护理tRVU减少3.9%（P< 0.001）。更换初级保健医生的患者使用的门诊护理tRVU增加了17.4%（P< 0.001）。这些结果表明，PCPC与诊所和患者级别功能相关的资源使用减少相关。患者水平的相关性记录了PCPC的临床内异质性。基于这些发现，可以鼓励实践与NCQA的高度认可保持一致，促进初级保健的连续性，并注意个体患者水平的差异。
This study explores the association between patients’ use of ambulatory care resources and features of patient-centered primary care (PCPC), specifically clinic-level National Committee for Quality Assurance (NCQA) recognition of PCPC, continuity of care, and care team communication. Data for this study were compiled from the electronic health records of a large multispecialty group practice in California, covering the period between 2009 and 2010 for 37,042 nonelderly patients under capitated managed care plans. Regression analysis of these data was performed using a generalized linear model, comparing measures of patient-level annual resource use (in total relative value units [tRVUs]) against measures of both clinic- and patient-level PCPC, and patient-level risk (eg, age, comorbidities). Patients linked to NCQA Recognition Level III versus Level II clinics used 4.8% (P< 0.001) fewer ambulatory care tRVUs. Patients with a 1 standard deviation increase in primary care continuity used 3.9% (P< 0.001) fewer ambulatory care tRVUs. Patients who switched primary care physicians used 17.4% (P< 0.001) more ambulatory care tRVUs. These results indicate that PCPC is associated with reductions in resource use related to both clinic- and patient-level features. The patient-level associations document within-clinic heterogeneity in PCPC. Based on these findings, practices can be encouraged to perform consistent with high NCQA recognition, promote primary care continuity, and be mindful of differences at an individual patient level.