Effect of an innovative Medicare managed care program on the quality of care for nursing home residents
Effect of an innovative Medicare managed care program on the quality of care for nursing home residents
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DOI：
10.1093/geront/44.1.95
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发表时间：
2004-02-01
期刊：
影响因子：
5.7
通讯作者：
Keckhafer, G
中科院分区：
文献类型：
--
作者：
Kane, RL;Flood, S;Keckhafer, G
目的：我们试图评估创新的Medicare+Choice HMO提供的护理质量，该HMO专门针对养老院居民，并雇用执业护士提供额外的初级护理，超过医生提供的初级护理。Evercare方法的基本前提是，额外的初级保健将降低不良事件的发生率，并减少医院的使用。四个方面的质量进行了评估：死亡率，可预防的住院治疗，质量指标来自最低限度的数据集，并在功能的变化。设计和方法：将Evercare提供的护理与两个对照组进行比较：（a）同一家庭中未参加Evercare的其他居民和（B）同一地理区域中未参加Evercare的家庭居民。数据来自各种来源，包括最低数据集。利用率基于对照组的医疗保险数据和Evercare居民的联合医疗保健数据。生存分析用于估计死亡率。对质量指标采用了各种风险调整方法。结果：Evercare居民的死亡风险率显着低于同一养老院的其他居民。Evercare居民可预防的住院次数较少;一个对照组的差异显著。的.质量指标和功能变化率相当。含义：Evercare通过使用执业护士，代表了一种模式，可以提供更有效的护理，至少具有可比的质量。
Purpose: We sought to assess the quality of care provided by an innovative Medicare+Choice HMO targeted specifically at nursing home residents and employing nurse practitioners to provide additional primary care over and above that provided by physicians. The underlying premise of the Evercare approach is that the additional primary care will reduce the rate of untoward events and reduce the use of hospitals. Four aspects of quality were assessed: mortality, preventable hospitalizations, quality indicators derived from the Minimum Data Set, and change in functioning. Design and Methods: The care provided by Evercare was compared with that for two control groups: (a) other residents in the same homes not enrolled in Evercare and (b) residents in homes in the same geographic area that did not participate in Evercare. Data came from various sources, including the Minimum Data Set. Utilization was based on Medicare data for controls and United Healthcare data for Evercare residents. Survival analysis was used to estimate mortality rates. Various risk adjustment methods were applied to the quality indicators. Results: The hazard rates of mortality were significantly lower for Evercare residents than for other residents in the same nursing homes. Evercare residents had fewer preventable hospitalizations; the difference was significant for one control group. The. rates of quality indicators and functional change were equivalent. Implications: Evercare, with its use of nurse practitioners, represents a model that can provide more efficient care that is of at least comparable quality.