Optimal Primary Care for Elders: Annual Physicals vs. Comprehensive Care Systems

描述（由研究者提供）：面对医疗保险支付的削减，不利的医疗保险报销来支持老年团队护理，老年医生的供应减少，人口老龄化的增长，以及分散的卫生保健提供系统，卫生保健组织必须找到创造性的方法来实现老年患者的最佳综合质量初级保健。本文以艾略特医生网络（EPN）为研究对象，该网络是位于新罕布什尔州的艾略特卫生系统（EHS）的初级保健实体。EHS是一个有组织的交付系统，目前正在经历文化变革。它正在将其核心业务转变为初级保健，而不是住院医院急性护理，并在不同的EHS实体中整合其临床护理服务。为了支持文化变革和重塑其初级保健网络，以最好地服务于日益增长的老龄化人口，EHS实施了EpicCare电子病历，并在曼彻斯特市投资了一个20,000平方英尺的一站式多服务高级健康中心（SHC），该中心基于跨学科的老年医学团队护理模式。EHS的曼彻斯特shc是研究老年人初级保健和临床整合协调的绝佳场所，因为它是美国为数不多的为老年人提供一站式广泛服务的场所之一。特别地，本文的研究有四个目的。目的：1)测量年度体检次数与循证预防服务医师推荐的关系；2)评估跨学科老年医学曼彻斯特高级健康中心护理模式与传统初级保健模式在接诊方面是否存在显著差异：a)对诊断为退行性关节疾病（骨关节炎）或脑血管疾病（中风）的患者进行物理治疗；B)对诊断为记忆丧失、痴呆或抑郁症的患者进行老年精神病学护理；3)确定提供者和患者在两种护理模式中讨论预防服务的时间，他们如何评估老年患者的风险，制定治疗计划，监测患者的进展，以及他们如何协调需要多种服务的患者的护理；4)测量团队护理模式对患者使用EHS门诊和住院服务的影响。数据将来自EPN 2001-06年度的小组管理数据、埃利奥特医院的数据，以及与选定的个人电脑供应商及其支持人员的面对面访谈。定量数据分析将采用固定效应模型和差中差模型。定性数据将用于定量分析的解释。这项研究的结果将有助于制定战略，为老年人提供持续、有效、循证的预防服务。

DESCRIPTION (provided by the investigator): Faced with Medicare payment cuts, unfavorable Medicare reimbursement to support geriatric team care, a shrinking supply of geriatricians, a growing aging population, and a fragmented health care delivery system, health care organizations have to find creative ways to achieve optimal integrated quality primary care for their elderly patients. This dissertation research is a case study of the Elliot Physician Network (EPN), which is the primary care entity of the Elliot Health System (EHS), based in New Hampshire. The EHS is an organized delivery system that is currently undergoing a culture change. It is transitioning its core business to primary care instead of inpatient hospital acute care and integrating its clinical care services across the different EHS entities. To support the culture change and to reshape its primary care network to best serve its growing aging population, the EHS has implemented an EpicCare electronic medical record and has invested in a 20,000 square foot, one-stop, multi-services Senior Health Center (SHC) in the city of Manchester that is based on an interdisciplinary geriatrics team care model. The Manchester-SHC of the EHS serves as an excellent site to study coordination of elderly primary care and clinical integration because it is one of a few sites in the US offering a wide range of services catered to elders in one stop. In particular, this dissertation research has four aims. To: 1) Measure the relationship between receipt of an annual physical exam visit and physician recommendation of evidence-based preventive services; 2) Evaluate whether there is a significant difference between the interdisciplinary geriatrics Manchester Senior Health Center care model and the traditional primary care model in the receipt of referrals for: A) physical therapy for patients diagnosed with degenerative joint disease (osteoarthritis) or cerebrovascular disease (stroke) and B) geropsychiatric care for patients diagnosed with memory loss, dementia, or depression; 3) Identify when providers and patients discuss preventive services in the two models of care, how they assess risks for an elderly patient, develop a treatment plan, and monitor patients' progress, and how they coordinate care for patients needing multiple services across care settings; and 4) Measure the impact of the team care model on patients' use of outpatient services and inpatient services offered at the EHS. Data will be drawn from EPN 2001-06 panel administrative data, Elliot Hospital data, and face-to-face interviews with selected PC providers and their support staff members. Quantitative data analyses will be conducted using fixed-effect and difference-in-difference models. Qualitative data will be used to inform interpretation of quantitative analyses. Results of this study will help to develop strategies for delivering continuous, effective, evidence-based preventive services to elders.