Improving Population Health Management Strategies: Identifying Patients Who Are More Likely to Be Users of Avoidable Costly Care and Those More Likely to Develop a New Chronic Disease
Improving Population Health Management Strategies: Identifying Patients Who Are More Likely to Be Users of Avoidable Costly Care and Those More Likely to Develop a New Chronic Disease
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DOI：
10.1111/1475-6773.12545
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发表时间：
2017-08-01
影响因子：
3.4
通讯作者：
Parrotta, Carmen
中科院分区：
文献类型：
--
作者：
Hibbard, Judith H.;Greene, Jessica;Parrotta, Carmen
Objective.探索使用患者激活测量（PAM）来识别更有可能使用非卧床护理敏感（ACS）的患者以及未来慢性疾病的增加。次要数据是从一个大型的责任医疗机构的电子健康记录中提取的。这是一项回顾性队列设计。2011年测量了关键预测变量PAM评分，并用于预测2012-2014年的结果。结果包括ACS的使用和新的慢性疾病的可能性。我们从初级保健诊所用户中抽取了98，142名成年患者的样本。要纳入研究，患者必须在2011年进行PAM评分，并在随后的三年中每年至少进行一次门诊访视。PAM水平是ACS利用率的重要预测因子。与PAM评分高的患者相比，低活化患者ACS利用的几率显著更高。同样，PAM评分低的患者在观察的每一年中更有可能有新的慢性病诊断。评估患者激活可能有助于识别可以从更多支持中受益的患者。这种方法可以帮助ACO实现人口健康管理目标。
Objective. To explore using the Patient Activation Measure (PAM) for identifying patients more likely to have ambulatory care-sensitive (ACS) utilization and future increases in chronic disease.Data Sources. Secondary data are extracted from the electronic health record of a large accountable care organization.Study Design. This is a retrospective cohort design. The key predictor variable, PAM score, is measured in 2011, and is used to predict outcomes in 2012-2014. Outcomes include ACS utilization and the likelihood of a new chronic disease.Data. Our sample of 98,142 adult patients was drawn from primary care clinic users. To be included, patients had to have a PAM score in 2011 and at least one clinic visit in each of the three subsequent years.Principal Findings. PAM level is a significant predictor of ACS utilization. Less activated patients had significantly higher odds of ACS utilization compared to those with high PAM scores. Similarly, patients with low PAM scores were more likely to have a new chronic disease diagnosis over each of the years of observation.Conclusions. Assessing patient activation may help to identify patients who could benefit from greater support. Such an approach may help ACOs reach population health management goals.