Association Between Mental Health Conditions and Outpatient Care Fragmentation: a National Study of Older High-Risk Veterans.
Association Between Mental Health Conditions and Outpatient Care Fragmentation: a National Study of Older High-Risk Veterans.
复制标题
心理健康状况与门诊护理分散之间的关联：一项针对老年高风险退伍军人的全国研究。
DOI：
10.1007/s11606-022-07705-z
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发表时间：
2022
影响因子：
5.7
通讯作者：
Zulman,DonnaM
中科院分区：
文献类型：
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作者：
Trivedi,RanakB;Rossi,FernandaS;Javier,SarahJ;Greene,Liberty;Singer,SaraJ;Vanneman,MeganE;Goldstein,Mary;Zulman,DonnaM
目的确定患有精神疾病(MH)的老年退伍军人是否有更多的支离破碎的门诊非MH医疗服务，与没有MH疾病的老年退伍军人相比。设计使用与医疗保险数据相关的2014财年退伍军人健康管理局(VHA)管理数据进行的回顾队列研究。参与者125,481名VHA患者≥65岁，他们连续参加联邦医疗保险A部分和B部分的服务收费，住院风险较高。主要结果和衡量标准主要结果是非MH护理分散，通过(1)非MH提供者计数和(2)通常护理提供者(UPC)，即最常见的非MH提供者的护理比例来衡量。我们分别使用泊松回归和带Logit链接的分数回归检验了NO与任何MH条件和结果之间的关联。我们还比较了没有MH病症的退伍军人与每种MH病症和MH病症的组合，调整了社会人口学、合并症和到VHA专科护理的开车时间。与没有MH条件的退伍军人相比，有MH条件的退伍军人在调整后的模型中有更少的零散护理，更少的非MH提供者(IRR=0.96；95%CI：0.96-0.96)，以及与他们通常的提供者更集中的护理(对于更高的UPC，OR=1.08；95%CI：1.07，1.09)。二次分析显示，有个别MH疾病(如抑郁症)的患者中，非MH提供者(IRR范围：0.86-0.98)较少，护理更集中(OR范围：1.04-1.20)。在检查MH条件的组合时也观察到了类似的模式(IRR范围：0.80-0.90；OR范围：1.16-1.30)。结论与预期相反，在老年、高危退伍军人中，MH条件与较少分散的非MH护理相关。进一步的研究将确定这是由于不同的需求、使用不足还是适当使用医疗保健。
BackgroundHealthcare fragmentation may lead to adverse consequences and may be amplified among older, sicker patients with mental health (MH) conditions.ObjectiveTo determine whether older Veterans with MH conditions have more fragmented outpatient non-MH care, compared with older Veterans with no MH conditions.DesignRetrospective cohort study using FY2014 Veterans Health Administration (VHA) administrative data linked to Medicare data.Participants125,481 VHA patients ≥ 65 years old who were continuously enrolled in Medicare Fee-for-Service Parts A and B and were at high risk for hospitalization.Main Outcome and MeasuresThe main outcome was non-MH care fragmentation as measured by (1) non-MH provider count and (2) Usual Provider of Care (UPC), the proportion of care with the most frequently seen non-MH provider. We tested the association between no vs. any MH conditions and outcomes using Poisson regression and fractional regression with logit link, respectively. We also compared Veterans with no MH condition with each MH condition and combinations of MH conditions, adjusting for sociodemographics, comorbidities, and drive-time to VHA specialty care.Key ResultsIn total, 47.3% had at least one MH condition. Compared to those without MH conditions, Veterans with MH conditions had less fragmented care, with fewer non-MH providers (IRR = 0.96; 95% CI: 0.96–0.96) and more concentrated care with their usual provider (OR = 1.08 for a higher UPC; 95% CI: 1.07, 1.09) in adjusted models. Secondary analyses showed that those with individual MH conditions (e.g., depression) had fewer non-MH providers (IRR range: 0.86–0.98) and more concentrated care (OR range: 1.04–1.20). A similar pattern was observed when examining combinations of MH conditions (IRR range: 0.80–0.90; OR range: 1.16–1.30).ConclusionsContrary to expectations, having a MH condition was associated with less fragmented non-MH care among older, high-risk Veterans. Further research will determine if this is due to different needs, underuse, or appropriate use of healthcare.