The role of provider continuity in preventing hospitalizations
The role of provider continuity in preventing hospitalizations
复制标题
DOI：
10.1001/archfami.7.4.352
复制
发表时间：
1998-07-01
期刊：
影响因子：
--
通讯作者：
Mainous, AG
中科院分区：
文献类型：
--
作者：
Gill, JM;Mainous, AG
目的：为了研究供应商的连续性和未来住院治疗的医疗补助人口之间的关联，并确定这种关联是否是更大的门诊护理敏感conditions.Design：分析支付索赔的特拉华州医疗补助计划在2年期间（1993年7月1日至1995年6月30日）。计算每个参与者在研究第1年期间与单一提供者的连续性。参与者：共有13495名年龄在0至64岁之间的按服务收费的医疗补助患者连续入组，他们在研究的第一年至少进行了3次门诊医生就诊。结果：第1年平均连续性评分为0.50，11.9%的患者在第2年住院。在控制了人口统计学、门诊就诊次数和病例组合后，较高的提供者连续性与因任何疾病住院的可能性较低相关（比值比[OR] = 0.56，95%置信区间[CI]，0.46-0.69）。对于慢性非卧床护理敏感性疾病，提供者连续性和住院之间存在类似的相关性（OR = 0.54; 95%CI，0.34-0.88），但对于急性非卧床护理敏感性疾病，结论：在特拉华州医疗补助人群中，与提供者的连续性护理与未来住院可能性降低相关。这表明，鼓励患者将其护理集中在单一提供者身上的政策可能会降低住院率，并可能降低医疗保健成本。这项研究并不支持这样的假设，即某些条件是特别敏感的门诊护理。
Objectives: To examine the association between provider continuity and future hospitalization in a Medicaid population, and to determine if this association is greater for ambulatory care-sensitive conditions.Design: Analysis of paid claims to the Delaware Medicaid program during a 2-year period (July 1, 1993, to June 30, 1995). Continuity with a single provider during year 1 of the study was computed for each participant.Participants: A total of 13 495 continuously enrolled fee-for-service Medicaid patients aged 0 to 64 years who had made at least 3 ambulatory physician visits during the first year of the study.Main Outcome Measurer Likelihood of hospitalization in year 2 of the study for all conditions and for ambulatory care-sensitive conditions.Results: The mean continuity score was 0.50 in year 1 and 11.9% of patients were hospitalized in year 2. After controlling for demographics, number of ambulatory visits, and case mix, higher provider continuity was associated with a lower likelihood of hospitalization for any condition (odds ratio [OR] = 0.56, 95% confidence interval [CI], 0.46-0.69). For chronic ambulatory care-sensitive conditions there was a similar association between provider continuity and hospitalization (OR = 0.54; 95% CI, 0.34-0.88), but for acute ambulatory care-sensitive conditions there was no significant association (OR = 0.80; 95% CI, 0.48-1.34).Conclusions: Continuity of care with a provider is associated with a decreased future likelihood of hospitalization in the Delaware Medicaid population. This suggests that policies that encourage patients to concentrate their care with a single provider may lead to lower hospitalization rates and possibly lower health care costs. This study does not support the hypothesis that a certain set of conditions are particularly ambulatory care sensitive.