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

老年人的最佳初级护理：年度体检与综合护理系统

• 批准号: 7672937
• 负责人: Phuong Hoang
• 金额: $ 3.7万
• 依托单位: BRANDEIS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-09-30 至 2011-09-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7672937
• 关键词: Optimal; Primary; Care; Elders; Annual

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.

描述（由研究者提供）：面对医疗保险支付削减，不利的医疗保险报销，以支持老年团队护理，老年医生的供应萎缩，人口老龄化不断增长，以及分散的医疗保健提供系统，医疗保健组织必须找到创造性的方法，以实现最佳的综合质量的初级保健为他们的老年患者。本论文的研究是埃利奥特医生网络（EPN），这是埃利奥特卫生系统（EHS），总部设在新罕布什尔州的初级保健实体的案例研究。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，而不是住院医院急症护理，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病团队护理模式。环境卫生服务中心的曼彻斯特SHC是研究老年人初级保健和临床整合协调的理想场所，因为它是美国少数几个提供一站式老年人服务的场所之一。具体而言，本论文的研究有四个目的。收件人：1）测量每年接受体检与医生推荐循证预防服务之间的关系; 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之间是否存在显著差异：A）为诊断患有退行性关节病的患者提供物理治疗（骨关节炎）或脑血管疾病（中风）和B）诊断为记忆丧失、痴呆或抑郁的患者的老年精神病护理; 3）确定提供者和患者何时讨论两种护理模式中的预防服务，他们如何评估老年患者的风险，制定治疗计划，并监测患者的进展，以及他们如何协调对需要多种护理服务的患者的护理;以及4）测量团队护理模式对患者使用EHS提供的门诊服务和住院服务的影响。数据将来自EPN 2001-06小组管理数据、Elliot医院数据以及与选定PC提供商及其支持人员的面对面访谈。将使用固定效应和差异中差异模型进行定量数据分析。定性数据将用于解释定量分析。研究结果将有助制订策略，为长者提供持续、有效及以实证为本的预防服务。