The Association Between Continuity of Care and the Overuse of Medical Procedures.
The Association Between Continuity of Care and the Overuse of Medical Procedures.
复制标题
护理连续性与医疗程序过度使用之间的关联。
DOI：
10.1001/jamainternmed.2015.1340
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发表时间：
2015-07
影响因子：
39
通讯作者：
Pollack CE
中科院分区：
文献类型：
--
作者：
Romano MJ;Segal JB;Pollack CE
过度使用不必要的医疗程序和护理连续性差都被认为是导致医疗保健支出高和患者预后差的原因。调查护理连续性与使用可能不必要的程序之间的关系。观察性回顾性队列（n = 1 208 250例年龄在65岁以下的患者），使用2008年以来5%的医疗保险按服务收费索赔。我们使用Bice-Boxerman护理连续性指数评估连续性。我们使用一组先前经过验证的19个可能被过度使用的程序来测量过度使用。总的来说，14.7%的患者在日历年内至少接受了一次可能被过度使用的手术。连续性评分（0.4 SDs）每增加0.1，患者接受过度使用手术的几率是评分较低患者的0.93倍（95% CI, 0.93 - 0.94）。较高的连续性与较低的9项手术的几率显著相关（Holm-Bonferroni校正P < 0.02显著性：13项诊断试验中有6项[or为0.84-0.99;P < 0.001]和3项治疗试验[or为0.81-0.87;P < 0.001]）。相反，较高的连续性与3项检查（1项诊断试验[OR， 1.06; P < .001]， 2项筛查试验中的1项[OR， 1.05; P < .001]和单次监测试验[OR， 1.03; P < .01]）的过度使用显著相关。连续性的增加与过度使用的总体减少有关，表明高连续性护理的潜在益处；然而，这种关联的强度和方向根据具体的程序而有所不同。
Both the overuse of unnecessary medical procedures and poor continuity of care are thought to contribute to high health care spending and poor patient outcomes. To investigate the association between care continuity and use of potentially unnecessary procedures. Observational retrospective cohort (n = 1 208 250 patients > 65 years) using 5% Medicare fee-for-service claims from 2008. We evaluated continuity using the Bice-Boxerman continuity of care index. We measured overuse using a previously validated set of 19 potentially overused procedures. Altogether, 14.7% of patients received at least 1 potentially overused procedure during the calendar year. For each 0.1 increase in the continuity score (0.4 SDs), patients had 0.93 times the odds of receiving overused procedures than those with lower scores (95% CI, 0.93–0.94). Higher continuity was significantly associated with lower odds of 9 procedures (Holm-Bonferroni corrected P < .02 was significant: 6 of 13 diagnostic tests [with ORs, 0.84–0.99; P < .001] and 3 therapeutic procedures [with ORs 0.81–0.87; P <.001]). Conversely, higher continuity was significantly associated with increased overuse for 3 procedures (1 diagnostic test [OR, 1.06; P < .001], 1 of 2 screening tests [OR, 1.05; P < .001], and the single monitoring test [OR, 1.03; P < .01]). Increased continuity was associated with an overall decrease in overuse, suggesting a potential benefit of high-continuity care; however, the strength and direction of the association varied according to the specific procedure.
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影响因子：
5
作者：
BRESLAU, N;HAUG, MR
通讯作者：
HAUG, MR
影响因子：
39
作者：
Nyweide, David J.;Anthony, Denise L.;Fisher, Elliott S.
通讯作者：
Fisher, Elliott S.
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作者：
Segal, Jodi B.;Bridges, John F. P.;Chan, Kitty S.
通讯作者：
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作者：
STEINWACHS, DM
通讯作者：
STEINWACHS, DM
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作者：
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通讯作者：
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