Guided Care: Cost and utilization outcomes in a pilot study
Guided Care: Cost and utilization outcomes in a pilot study
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DOI：
10.1089/dis.2008.111723
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发表时间：
2008-02-01
期刊：
影响因子：
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通讯作者：
Boult, Chad
中科院分区：
文献类型：
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作者：
Sylvia, Martha L.;Griswold, Michael;Boult, Chad
引导式护理（GC）是对初级护理的增强，它结合了疾病管理和慢性病护理创新的操作原则。在一项为期6个月的准实验性研究中，我们比较了分配到GC和UC的患者的成本和利用模式。该设置是一个以社区为基础的普通内科实践。研究对象为4名普通内科医师的患者。他们是老年人，慢性病患者，居住在社区，是一个资本健康计划的成员，并被确定为高风险。使用调整后的临床群体预测模型（R）（ACG-PM），我们确定了未来医疗保健利用风险最高的人群。我们选择了75名最高风险的老年患者的2名内科医生在初级保健实践中接受GC和75名最高风险的老年患者的2名内科医生在同一实践中接受UC。保险数据被用来描述群体的人口统计学、慢性病、保险支出和利用。在我们的研究结果中，在基线时，GC（所有目标患者）和UC组在人口统计学和慢性疾病患病率方面相似，但GC组的平均ACG-PM风险评分较高（0.34 vs. 0.20，p < 0.0001）。在接下来的6个月里，GC组有较低的未经调整的平均保险费用，住院，住院日，急诊科就诊（p > 0.05）。在较低风险水平下，GC和UC组之间的保险支出差异较大（ACG-PM = 0.10，平均差异= 4340美元; ACG-PM = 0.6，平均差异= 1304美元）。分配接受GC的75例患者中有31例实际入组了干预。这些结果表明，GC可能会减少高风险老年人的保险支出。如果这些结果在更大规模的随机研究中得到证实，GC可能有助于提高美国老龄人口的医疗保健效率。
Guided Care (GC) is an enhancement to primary care that incorporates the operative principles of disease management and chronic care innovations. In a 6-month quasi-experimental study, we compared the cost and utilization patterns of patients assigned to GC and Usual Care (UC). The setting was a community-based general internal medicine practice. The participants were patients of 4 general internists. They were older, chronically ill, community-dwelling patients, members of a capitated health plan, and identified as high risk. Using the Adjusted Clinical Groups Predictive Model (R) (ACG-PM), we identified those at highest risk of future health care utilization. We selected the 75 highest-risk older patients of 2 internists at a primary care practice to receive GC and the 75 highest-risk older patients of 2 other internists in the same practice to receive UC. Insurance data were used to describe the groups' demographics, chronic conditions, insurance expenditures, and utilization. Among our results, at baseline, the GC (all targeted patients) and UC groups were similar in demographics and prevalence of chronic conditions, but the GC group had a higher mean ACG-PM risk score (0.34 vs. 0.20, p < 0.0001). During the following 6 months, the GC group had lower unadjusted mean insurance expenditures, hospital admissions, hospital days, and emergency department visits (p > 0.05). There were larger differences in insurance expenditures between the GC and UC groups at lower risk levels (at ACG-PM = 0.10, mean difference = $4340; at ACG-PM = 0.6, mean difference = $1304). Thirty-one of the 75 patients assigned to receive GC actually enrolled in the intervention. These results suggest that GC may reduce insurance expenditures for high-risk older adults. If these results are confirmed in larger, randomized studies, GC may help to increase the efficiency of health care for the aging American population.