The effects of an innovative integrated care intervention in Brazil on local health service use by dependent older people.
The effects of an innovative integrated care intervention in Brazil on local health service use by dependent older people.
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巴西创新性综合护理干预措施对依赖性老年人使用当地卫生服务的影响。
DOI：
10.1186/s12913-022-07552-y
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发表时间：
2022-02-11
影响因子：
2.8
通讯作者：
Sempé L
中科院分区：
文献类型：
--
作者：
Lloyd-Sherlock P;Giacomin K;Sempé L
自2011年以来，巴西贝洛奥里藏特市一直在实施一项创新计划，以支持弱势社区依赖护理的老年人：老年人护理方案。本文探讨了两个潜在的关联列入PMC类型的门诊卫生服务利用依赖老年人。第一个是，在PMC与更高的频率门诊访问的身体康复。第二，PMC与计划外门诊就诊频率较高相关。我们应用一个准实验设计，一套独特的卫生行政数据记录访问门诊卫生服务。我们专注于访问的宇宙的比较，转化为计划/计划外的访问和康复/其他原因访问门诊服务的比率。首先，我们通过不同的匹配技术，如“粗化精确匹配”（CEM），“最近邻”的基础上logit分数（NN），“最优对”（OP）和“最优充分”（OF）的方法预处理我们的样本。其次，我们估计PMC对我们感兴趣的结果的边际影响。我们使用Poisson回归控制个人和社区因素，并使用稳健的标准误。我们的研究结果以康复和计划访视时PMC的相对发病率为依据。我们发现，在所有匹配的规范下，属于PMC的两个结果的利益显着的阳性发生率。使用CEM的泊松模型显示，PMC患者与非PMC对照组相比，计划访视的发生率高于计划外访视，为1.3（95% CI 1.1-1.4），康复访视的比例更高，为3.4（95% CI 1.7-6.8）。在其他匹配方法和模型中也发现了类似的积极结果。我们的分析显示，老年人之间的显着正相关，包括在PMC和一组匹配的控制更大的比例，使门诊就诊计划，而不是计划外。我们发现，与其他原因相比，康复访问的比例也存在类似的关联。这些研究结果表明，PMC影响门诊卫生服务利用的依赖老年人的一些元素。在线版本包含补充材料，可通过10.1186/s12913-022-07552-y获得。
Since 2011, the Brazilian city of Belo Horizonte has been operating an innovative scheme to support care-dependent older people in disadvantaged communities: Programa Maior Cuidado (PMC – Older Person’s Care Program). This paper examines two potential associations between inclusion in PMC on types of outpatient health service utilization by dependent older people. The first is that being in PMC is associated with a higher frequency of outpatient visits for physical rehabilitation. The second is that being in PMC is associated with a higher frequency of planned versus unplanned outpatient visits. We apply a quasi-experimental design to a unique set of health administrative data recording visits to outpatient health services. We focus on comparisons of the universe of visits, transformed to ratios of planned/unplanned visits and rehabilitation/other reasons for visiting the outpatient service. First, we preprocess our sample through different matching techniques such as ‘coarsened exact matching’ (CEM), ‘nearest neighbor’ based on logit scores (NN), ‘optimal pair’ (OP) and ‘optimal full’ (OF) methods. Second, we estimate marginal effects of being in PMC on our outcomes of interest. We use Poisson regressions controlling for individual and community factors and use robust standard errors. Our results are presented as the comparative incidence ratio of PMC on rehabilitation and planned visits. We find significant positive incidence rates for belonging to PMC for both outcomes of interest under all matching specifications. Poisson models using CEM shows a higher incidence rate for planned visits in comparison to unplanned visits, 1.3 (95% CI 1.1–1.4), by PMC patients compared to the non-PMC controls, and a higher proportion of visits for rehabilitation, 3.4 (95% CI 1.7–6.8). Similar positive results are found across other matching methods and models. Our analysis reveals significant positive associations between older people included in PMC and a matched set of controls for a greater ratio of making outpatient visits that were planned, rather than unplanned. We find similar associations for the proportion of visits made for rehabilitation, as opposed to other reasons. These findings indicate that PMC influences some elements of outpatient health service utilization by dependent older people. The online version contains supplementary material available at 10.1186/s12913-022-07552-y.
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DOI：
10.1590/s1518-8787.2017051000243
发表时间：
2017-01-01
期刊：
Revista de Saúde Pública
影响因子：
--
作者：
Silva, Alexandre Moreira de Melo;Mambrini, Juliana Vaz de Melo;Lima-Costa, Maria Fernanda
通讯作者：
Lima-Costa, Maria Fernanda
影响因子：
7.2
作者：
Petticrew, Mark;Anderson, Laurie;Welch, Vivian
通讯作者：
Welch, Vivian
影响因子：
120.7
作者：
Latham, Nancy K.;Harris, Bette Ann;Bean, Jonathan F.;Heeren, Timothy;Goodyear, Christine;Zawacki, Stacey;Heislein, Diane M.;Mustafa, Jabed;Pardasaney, Poonam;Giorgetti, Marie;Holt, Nicole;Goehring, Lori;Jette, Alan M.
通讯作者：
Jette, Alan M.
影响因子：
2.8
作者：
Finlayson, Kathleen;Chang, Anne M.;O'Brien, Jane
通讯作者：
O'Brien, Jane
影响因子：
4.5
作者：
Carvalho, M. L.;Freitas, C. M.;Miranda, E. S.
通讯作者：
Miranda, E. S.