Effect of managed care on preventable hospitalization rates in California
Effect of managed care on preventable hospitalization rates in California
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DOI：
10.1097/00005650-200204000-00007
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发表时间：
2002-04-01
期刊：
影响因子：
3
通讯作者：
Bindman, AB
中科院分区：
文献类型：
--
作者：
Backus, L;Moron, M;Bindman, AB
背景。门诊护理敏感 (ACS) 疾病的住院率已成为医疗保健可及性和质量的潜在指标。管理式护理对于减少这些可能可预防的住院治疗的效果尚不清楚。 目的。确定管理式医疗普及率的增加是否与 ACS 病症住院率的变化相关。设计和环境。对 1990 年至 1997 年间所有加州因 ACS 病症住院的纵向分析总计为 394 个小区域。 ACS 住院率变化与管理式医疗普及率变化之间的关联。结果。在未经调整的分析中，随着时间的推移，管理式医疗普及率的变化与 ACS 病症住院率的变化之间没有关联。然而，在控制了地区人口统计数据和标记条件住院率变化（假设随着时间的推移保持稳定）的多变量模型中，管理式医疗普及率的变化与 ACS 住院率的微小但具有统计显着性的变化呈负相关。私人管理式医疗普及率每增加 10 个百分点，ACS 住院率就会下降 3.1%（95% CI，-5.4% 至 -0.8%）。总体而言，在加利福尼亚州，社区私人管理式医疗渗透率的提高与 ACS 入院率的下降相关。需要进行更多研究来确定观察到的关联是否存在因果关系、影响机制以及它是否代表患者健康结果的改善。
BACKGROUND. Hospitalization rates for ambulatory care-sensitive (ACS) conditions have emerged as a potential indicator of health care access and quality. The effect of managed care on reducing these potentially preventable hospitalizations is unknown.OBJECTIVE. To ascertain whether increases in managed care penetration were associated with changes in hospitalization rates for ACS conditions.DESIGN AND SETTING. Longitudinal analysis between 1990 and 1997 of all California hospitalizations for ACS conditions aggregated to 394 small areas.MEASURES. Association of change in ACS hospitalization rate with change in managed care penetration.RESULTS. in unadjusted analysis there was no association between the change in managed care penetration and the change in hospitalization rates for ACS conditions over time. However, in a multivariate model that controlled for changes in area demographics and hospitalization rates for marker conditions that were assumed to be stable over time, the change in managed care penetration was negatively associated with a small but statistically significant change in the ACS hospitalization rate. Each 10-point increase in percentage private managed care penetration was associated with a 3.1% decrease in the ACS hospitalization rate (95% Cl, -5.4% to -0.8%)CONCLUSIONS. Overall, in California, an increase in the penetration of private managed care in a community was associated with a decrease in ACS admission rates. Additional research is needed to determine if the observed association is causal, the mechanism of the effect and whether it represents an improvement in patients' health outcomes.