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

描述(由调查人员提供)：面对联邦医疗保险支付削减、支持老年团队护理的不利医疗保险报销、老年医生供应减少、人口老龄化以及医疗保健提供系统支离破碎，医疗保健组织必须找到创造性的方法，为他们的老年患者实现最佳的综合质量初级保健。本论文的研究是对埃利奥特医生网络(EPN)的个案研究，该网络是总部设在新罕布夏州的埃利奥特卫生系统(EHS)的初级保健实体。EHS是一个有组织的交付系统，目前正在经历一场文化变革。它正在将其核心业务过渡到初级保健，而不是住院急性护理，并将其临床护理服务整合到不同的EHS实体中。为了支持文化变革并重塑其初级保健网络，以最好地服务于不断增长的老龄化人口，EHS实施了EpicCare电子病历，并在曼彻斯特市投资了20,000平方英尺的一站式多服务老年健康中心(SHC)，该中心基于跨学科的老年病团队护理模式。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地点，因为它是美国为数不多的一站式为老年人提供广泛服务的地点之一。具体地说，本论文的研究有四个目的。为了：1)测量每年接受体检访问和医生推荐循证预防服务之间的关系；2)评估曼彻斯特老年保健中心跨学科老年保健模式和传统初级保健模式在接受转介方面是否存在显著差异：A)对被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，以及B)对被诊断为记忆力丧失、痴呆或抑郁症的患者进行老年精神护理；3)确定提供者和患者何时讨论两种护理模式中的预防性服务，他们如何评估老年患者的风险、制定治疗计划和监测患者的进展，以及他们如何协调对跨护理环境需要多种服务的患者的护理；以及4)衡量团队护理模式对患者使用EHS提供的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，以及对选定的PC提供商及其支持人员的面对面访谈。定量数据分析将使用固定效应和差值模型进行。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策略，为老年人提供持续、有效和循证的预防服务。

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.