Quality and Experience of Outpatient Care in the United States for Adults With or Without Primary Care
Quality and Experience of Outpatient Care in the United States for Adults With or Without Primary Care
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DOI：
10.1001/jamainternmed.2018.6716
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发表时间：
2019-03-01
影响因子：
39
通讯作者：
Linder, Jeffrey A.
中科院分区：
文献类型：
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作者：
Levine, David M.;Landon, Bruce E.;Linder, Jeffrey A.
美国的医疗保健系统通常是围绕医院和专科护理组织的。初级保健的价值仍然不清楚和debented.Objective要确定是否存在一个协会之间接收初级保健和高价值的服务，低价值的服务，和patient experience.DESIGN，SETTING，和PARTICIPANTS这是一个具有全国代表性的分析noninstitutionalized美国成年人18岁或以上谁参加了医疗支出小组调查。从2012年到2014年，我们比较了49286名美国成年人和21133名没有初级保健的成年人的倾向评分加权质量和护理经验。还分析了2002年至2014年的时间趋势。暴露患者报告的初级保健接受情况，由初级保健的4个“C”确定：第一次接触护理是全面的，连续的，协调的。主要结果和措施39个临床质量指标和7个患者体验指标汇总为10个临床质量复合指标（6个高价值和4个低价值服务）、整体患者体验评级和2个体验复合物。结果从2002年到2014年，平均年度调查响应率为58%（范围，49%-65%）。2012年至2014年间，与没有初级保健的受访者相比，（调整前），那些有初级保健的人年龄较大，（50 [95% CI，50-51] vs 38 [95% CI，38-39]岁），女性更常见（55%[95% CI，54%-55%] vs 42%[95% CI，41%-43%]），主要为白色个体（50% [95% CI，49%-52%] vs 43%[95% CI，41%-45%]）。在倾向评分加权后，有或没有初级保健的美国成年人的门诊平均人数相同，（6.7 vs 5.9;差异，0.8 [95% CI，-0.2至1.8]; P = 0.11），急诊科（两者均为0.2;差异为0.0 [95% CI，-0.1至0.0]; P = 0.17），住院患者（两者均为0.1;差异为0.0 [95% CI，0.0-0.0]; P = 0.92），但那些接受初级保健的人每年开更多的处方（平均值，14.1 vs 10.7;差异，3.4 [95% CI，2.0-4.7]; P
IMPORTANCE The US health care system is typically organized around hospitals and specialty care. The value of primary care remains unclear and debated.OBJECTIVE To determine whether an association exists between receipt of primary care and high-value services, low-value services, and patient experience.DESIGN, SETTING, AND PARTICIPANTS This is a nationally representative analysis of noninstitutionalized US adults 18 years or older who participated in the Medical Expenditure Panel Survey. Propensity score-weighted quality and experience of care were compared between 49 286 US adults with and 21 133 adults without primary care from 2012 to 2014. Temporal trends were also analyzed from 2002 to 2014.EXPOSURES Patient-reported receipt of primary care, determined by the 4 "Cs" of primary care: first-contact care that is comprehensive, continuous, and coordinated.MAIN OUTCOMES AND MEASURES Thirty-nine clinical quality measures and 7 patient experience measures aggregated into 10 clinical quality composites (6 high-value and 4 low-value services), an overall patient experience rating, and 2 experience composites.RESULTS From 2002 to 2014, the mean annual survey response rate was 58%(range, 49%-65%). Between 2012 and 2014, compared with respondents without primary care (before adjustment), those with primary care were older (50 [95% CI, 50-51] vs 38 [95% CI, 38-39] years old), more often female (55%[95% CI, 54%-55%] vs 42%[95% CI, 41%-43%]), and predominately white individuals (50% [95% CI, 49%-52%] vs 43%[95% CI, 41%-45%]). After propensity score weighting, US adults with or without primary care had the same mean numbers of outpatient (6.7 vs 5.9; difference, 0.8 [95% CI, -0.2 to 1.8]; P =.11), emergency department (0.2 for both; difference, 0.0 [95% CI, -0.1 to 0.0]; P =.17), and inpatient (0.1 for both; difference, 0.0 [95% CI, 0.0-0.0]; P =.92) encounters annually, but those with primary care filled more prescriptions (mean, 14.1 vs 10.7; difference, 3.4 [95% CI, 2.0-4.7]; P