Does a Large-Scale Organizational Transformation Toward Patient-Centered Access Change the Utilization and Costs of Care for Patients With Diabetes?
Does a Large-Scale Organizational Transformation Toward Patient-Centered Access Change the Utilization and Costs of Care for Patients With Diabetes?
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DOI：
10.1177/1077558712446705
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发表时间：
2012-10-01
影响因子：
2.5
通讯作者：
Reid, Robert
中科院分区：
文献类型：
--
作者：
Grembowski, David;Anderson, Melissa L.;Reid, Robert
作者检查了团体健康的访问倡议是否改变了糖尿病登记者的利用和护理费用。使用单个（单组）间断时间序列设计，重复测量的广义估计方程模型被用来估计在该倡议推出期间利用率和成本的变化（2002-2003年），并比较（年变化率）（1998-2002年），以斜坡全面实施（2003-2006年）在9,871名成员中连续登记1997年至2006年与1型或2型糖尿病。在全面实施期间，总成本增加，但总成本的年度变化没有变化。初级保健就诊次数减少，但初级保健联系人增加，这主要是由于该倡议采用了安全信息。专业访问没有改变;但是，该倡议可能增加了紧急访问。为了减少急诊就诊，未来的访问倡议应包括积极和全面的门诊护理糖尿病患者。
The authors examined whether Group Health's Access Initiative changed the utilization and costs of care among enrollees with diabetes. Using a single (one-group) interrupted time series design, repeated-measures generalized estimating equation models were used to estimate changes in utilization and costs during the Initiative rollout (2002-2003) and to compare the slopes (annual rates of change) for utilization and costs during the Pre-Initiative period (1998-2002) to the slopes during Full-Implementation (2003-2006) among 9,871 members continuously enrolled from 1997 to 2006 with type 1 or 2 diabetes. Total costs increased in Full-Implementation, but the annual change in total costs did not change. Primary care visits declined, but primary care contacts grew, largely from the Initiative's introduction of secure messaging. Specialty visits did not change; however, the Initiative may have increased emergency visits. To reduce emergency visits, future access initiatives should include proactive and comprehensive outpatient care for patients with diabetes.