Health Services Utilization of a Care Coordination/Home-Telehealth Program for Veterans With Diabetes A Matched-cohort Study
Health Services Utilization of a Care Coordination/Home-Telehealth Program for Veterans With Diabetes A Matched-cohort Study
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DOI：
10.1097/00004479-200507000-00006
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发表时间：
2005-07-01
影响因子：
2.3
通讯作者：
Ryan, Patricia
中科院分区：
文献类型：
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作者：
Chumbler, Neale R.;Vogel, W. Bruce;Ryan, Patricia
本研究考察了退伍军人事务（VA）以患者为中心的护理协调/家庭远程医疗（CC/HT）项目作为退伍军人糖尿病治疗的辅助手段的有效性。使用慢性护理模型的改编版本，我们分析了400名参加VA CC/HT项目的糖尿病退伍军人和400名没有接受CC/HT干预的糖尿病退伍军人在医疗保健服务使用方面的差异。倾向评分用于改善治疗组和对照组之间的平衡。在入组前后12个月评估服务使用结果。在多变量模型中使用差异中的差异方法来评估CC/HT项目患者的治疗效果。入组12个月后，治疗组和对照组之间在基于需求的初级保健就诊（新安排的就诊使退伍军人能够“及时”看到健康状况，在健康恶化之前监测和满足健康状况）方面存在显著差异，治疗组增加，对照组减少（P < 0.01）。在亚组分析中，我们能够控制患者的Hb a （1c）值，我们发现治疗组比对照组患者住院1次或更多次的可能性更低。我们的研究结果对管理具有启示意义，因为CC/HT计划似乎提高了老年糖尿病退伍军人接受适当、及时护理的能力，从而提高了对他们的护理质量，并更有效地利用了VA医疗保健资源。
This study examined the effectiveness of a veterans affairs (VA) patient-centered care coordination/home-telehealth (CC/HT) program as an adjunct to treatment for veterans with diabetes. Using an adapted version of the Chronic Care Model, we analyzed the differences in healthcare service use between a cohort of 400 veterans with diabetes who were enrolled in a VA CC/HT program and a matched comparison cohort of 400 veterans with diabetes who received no CC/HT intervention. Propensity scores were used to improve the balance between the treatment and comparison groups. Service use outcomes were assessed at 12 months before and after enrollment. A difference-in-differences approach was used in the multivariate models to assess the treatment effect for patients in the CC/HT programs. Twelve months after enrollment, there was a significant difference between the treatment and comparison groups in terms of need-based primary care visits (newly scheduled visits that enable the veteran to be seen "just in time," where the health status is monitored and met before health deteriorates), increasing in the treatment group and decreasing in the comparison group (P < .01). In a subgroup analysis, where we were able to control for the patients' Hb A(1c) values, we found that the treatment group had a lower likelihood of having 1 or more hospitalizations than patients in the comparison group. Our findings have implications for management in that the CC/HT program appears to improve the ability of older veterans with diabetes to receive appropriate, timely care, thereby improving the quality of care for them and making more efficient use of VA healthcare resources.