Is Implementation of the Care Transitions Intervention Associated with Cost Avoidance After Hospital Discharge?
Is Implementation of the Care Transitions Intervention Associated with Cost Avoidance After Hospital Discharge?
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DOI：
10.1007/s11606-014-2814-0
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发表时间：
2014-06-01
影响因子：
5.7
通讯作者：
Gravenstein, Stefan
中科院分区：
文献类型：
--
作者：
Gardner, Rebekah;Li, Qijuan;Gravenstein, Stefan
背景：执行不佳的出院过渡给医疗保健系统带来了巨大的成本。几种循证干预可以减少出院后的利用。目的：评估与实施护理过渡干预(CTI)相关的成本避免。设计：一项使用连续便利抽样的准实验性队列研究。PATIENTS：2009年1月1日至2011年5月31日在罗德岛六家医院住院的按服务收费的医疗保险受益人。干预：CTI是一种以患者为中心的教练干预措施，旨在使个人能够更好地管理他们的健康。它从医院内开始，持续30天，包括一次家庭访问和一到两个电话。MAIN措施：我们检查了接受指导(干预组)、拒绝或失去随访(内部控制组)、符合条件但没有接触(外部控制组)的患者出院后的总利用率和成本，使用倾向评分匹配来控制基线差异。KEY结果：与匹配的内部对照组(N=321)相比，干预组在出院后6个月内的利用率显著低于匹配的内部对照组(N=321)，平均总医疗费用(14,729美元对18,779美元，P=0.03)。与内部对照相比，每个接受干预的患者避免的成本为3752美元。外对照组的结果与此相似。没有观察到成本转移到其他利用类型。结论：这项分析表明，CTI在住院后至少6个月内产生了有意义的成本避免，并提供了有用的指标来评估医院再入院减少计划的影响和成本避免。(C)2014年全科内科医学会
BACKGROUND: Poorly-executed transitions out of the hospital contribute significant costs to the healthcare system. Several evidence-based interventions can reduce post-discharge utilization.OBJECTIVE: To evaluate the cost avoidance associated with implementation of the Care Transitions Intervention (CTI).DESIGN: A quasi-experimental cohort study using consecutive convenience sampling.PATIENTS: Fee-for-service Medicare beneficiaries hospitalized from 1 January 2009 to 31 May 2011 in six Rhode Island hospitals.INTERVENTION: The CTI is a patient-centered coaching intervention to empower individuals to better manage their health. It begins in-hospital and continues for 30 days, including one home visit and one to two phone calls.MAIN MEASURES: We examined post-discharge total utilization and costs for patients who received coaching (intervention group), who declined or were lost to follow-up (internal control group), and who were eligible, but not approached (external control group), using propensity score matching to control for baseline differences.KEY RESULTS: Compared to matched internal controls (N=321), the intervention group had significantly lower utilization in the 6 months after discharge and lower mean total health care costs ($14,729 vs. $18,779, P=0.03). The cost avoided per patient receiving the intervention was $3,752, compared to internal controls. Results for the external control group were similar. Shifting of costs to other utilization types was not observed.CONCLUSIONS: This analysis demonstrates that the CTI generates meaningful cost avoidance for at least 6 months post-hospitalization, and also provides useful metrics to evaluate the impact and cost avoidance of hospital readmission reduction programs. (C) Society of General Internal Medicine 2014