Outcomes in Older Adults with Multimorbidity Associated with Predominant Provider of Care Specialty.
Outcomes in Older Adults with Multimorbidity Associated with Predominant Provider of Care Specialty.
复制标题
DOI：
10.1111/jgs.14882
复制
发表时间：
2017-09
影响因子：
6.3
通讯作者：
Meara E
中科院分区：
文献类型：
--
作者：
Bynum JPW;Chang CH;Austin A;Carmichael D;Meara E
大多数老年人有多种慢性病，导致昂贵的护理，需要跨专业的协调。然而，在美国，许多人使用专科医生而不是初级保健作为他们主要的门诊服务提供者（PPC）。由于新的医生支付模式是根据《医疗保险和芯片再授权法》（MACRA）设计的，因此需要了解专家是否能像初级保健那样有效地为这一高成本、高需求的人群提供护理。我们测试了初级保健与专业PPC是否与老年多发病患者的更好结局相关。使用倾向评分匹配的观察性研究。2011 - 2012年按服务收费的医疗保险。65岁以上的多子女受益人。自变量是一个指标，有一个专业（与初级）护理PPC。主要结果为一年死亡率、住院率、标准化费用、门诊就诊模式。在3，934，942名患有多项疾病的受益人中，三分之二的人有初级保健提供者作为他们的PPC。与初级保健PPC相比，专科PPC患者的住院率更高（每1,000人多40.3人），支出更高（每位受益人多1，781美元），但死亡率（高0.2%）或可预防的住院率差异不大。支出差异源于专业费用（每位受益人高出769美元）、住院费用（每位受益人高出572美元）和门诊费用（每位受益人高出510美元）。所有p值<.001。此外，与初级保健PPC相比，专家PPC的患者的护理连续性较低，并且有更多的提供者。老年人与多morphine与专家作为他们的主要门诊护理提供者有较高的支出和较低的连续性的护理，但类似的临床结果的患者的PPC是在初级保健。
Most older adults have multiple chronic conditions which lead to costly care that requires coordination across specialties. Yet many in the U.S. use a specialist physician rather than primary care as their predominant provider of ambulatory visits (PPC). As new physician payment models are designed under the Medicare and Chip Reauthorization Act (MACRA), information on whether specialists deliver care as efficiently as primary care to this high cost, high need population is needed. We test whether primary care versus specialty PPC is associated with better outcomes for older adults with multimorbidity. Observational study using propensity-score matching. Fee-for-service Medicare, 2011–2012. Beneficiaries over age 65 with multimorbidity. The independent variable was an indicator for having a specialty (versus primary) care PPC. Main outcomes were one-year mortality, hospitalization, and standardized expenditures, ambulatory visit patterns. In 3,934,942 beneficiaries with multimorbidity, two-thirds had a primary care provider as their PPC. Patients with a specialty PPC compared to primary care PPC had higher hospitalizations (40.3 more per 1,000) and higher spending ($1,781 more per beneficiary) but little meaningful difference in mortality (0.2% higher) or preventable hospitalizations. Spending differences stemmed from professional fees ($769 higher per beneficiary), inpatient stays ($572 higher per beneficiary) and outpatient facilities ($510 higher per beneficiary). All p-values <.001. In addition, people with a specialist versus primary care PPC had lower continuity of care and saw a greater number of providers. Older adults with multimorbidity with a specialist as their main ambulatory care provider had higher spending and lower continuity of care but similar clinical outcomes as patients whose PPC was in primary care.
登录
查看更多内容
影响因子：
39.2
作者：
Greenfield, S;Kaplan, SH;Griffith, JL
通讯作者：
Griffith, JL
影响因子：
120.7
作者：
Boyd, CM;Darer, J;Wu, AW
通讯作者：
Wu, AW
影响因子：
39
作者：
Nyweide, David J.;Anthony, Denise L.;Fisher, Elliott S.
通讯作者：
Fisher, Elliott S.
影响因子：
2
作者：
Austin, Peter C.
通讯作者：
Austin, Peter C.
影响因子：
7.2
作者：
Lewis, Beth G.;Halm, Ethan A.;Federman, Alex D.
通讯作者：
Federman, Alex D.