Does Greater Continuity of Veterans Administration Primary Care Reduce Emergency Department Visits and Hospitalization in Older Veterans?
Does Greater Continuity of Veterans Administration Primary Care Reduce Emergency Department Visits and Hospitalization in Older Veterans?
复制标题
退伍军人管理初级保健的更大连续性是否会减少老年退伍军人的急诊就诊和住院治疗？
DOI：
10.1111/jgs.13841
复制
发表时间：
2015-12
影响因子：
6.3
通讯作者：
Vaughan-Sarrazin MS
中科院分区：
文献类型：
--
作者：
Katz DA;McCoy KD;Vaughan-Sarrazin MS
评估老年退伍军人初级保健的纵向连续性与急诊室 (ED) 和住院护理的使用之间的关联。回顾性队列研究。退伍军人事务部 (VA) 15 个地区卫生网络的初级保健诊所、急诊室和住院设施。符合 Medicare 资格的 65 岁及以上退伍军人，在 2007-08 财年（基准期）期间接受过 3 次或以上 VA 初级保健护理（N = 243,881）。使用合并的 VA-医疗保险和医疗补助服务中心管理数据估计了两种纵向连续性指标：通常连续性提供者 (UPC) 和修改后的连续性指数 (MMCI)。使用负二项式和多变量逻辑回归模型来预测 2009 财年的急诊室使用情况和住院情况，并控制了社会人口特征、医疗和精神合并症以及卫生服务的基线使用情况。高（IRR=1.05，95%置信区间（CI）=1.02-1.07）、中（IRR=1.04，95%CI=1.02-1.07）和低（IRR=1.06，95%CI=1.03-1.09）UPC患者的急诊就诊发生率（IRR）高于UPC患者那些 UPC 非常高 (0.9–1.0) 的人。高 UPC（比值比 (OR) = 1.04，95% CI = 1.01–1.07）、中度（OR = 1.03，95% CI = 1.00–1.06）和低 UPC（OR = 1.04，95% CI = 1.01–1.07）UPC 患者在随访期间住院的可能性也更大。 MMCI 连续性评分的结果相似。即使初级保健提供者（PCP）连续性稍低，也与老年退伍军人适度增加急诊室使用和住院治疗有关。应尽可能为老年人安排指定的 PCP。
To evaluate the association between longitudinal continuity of primary care and use of emergency department (ED) and inpatient care in older veterans. Retrospective cohort study. Department of Veterans Affairs (VA) primary care clinics in 15 regional health networks, ED and inpatient facilities. Medicare‐eligible veterans aged 65 and older with three or more VA primary care visits during fiscal year 2007–08 (baseline period) (N = 243,881). Two measures of longitudinal continuity were estimated using merged VA–Centers for Medicare and Medicaid Services administrative data: Usual Provider of Continuity (UPC) and Modified Modified Continuity Index (MMCI). Negative binomial and multivariable logistic regression models were used to predict ED use and inpatient hospitalization during fiscal year 2009, controlling for sociodemographic characteristics, medical and psychiatric comorbidity, and baseline use of health services. The incidence rate ratio (IRR) of ED visits was greater in patients with high (IRR = 1.05, 95% confidence interval (CI) = 1.02–1.07), intermediate (IRR = 1.04, 95% CI = 1.02–1.07), and low (IRR = 1.06, 95% CI = 1.03–1.09) UPC than in those with very high UPC (0.9–1.0). Patients with high (odds ratio (OR) = 1.04, 95% CI = 1.01–1.07), intermediate (OR = 1.03, 95% CI = 1.00–1.06), and low (OR = 1.04, 95% CI = 1.01–1.07) UPC were also more likely to be hospitalized during follow‐up. Results were similar for MMCI continuity scores. Even slightly lower primary care provider (PCP) continuity was associated with modestly greater ED use and inpatient hospitalization in older veterans. Additional efforts should be made to schedule older adults with their assigned PCP whenever possible.