Enriched Medical Home Intervention Using Community Health Worker Home Visitation and ED Use
Enriched Medical Home Intervention Using Community Health Worker Home Visitation and ED Use
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DOI：
10.1542/peds.2016-1849
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发表时间：
2017-05-01
期刊：
影响因子：
8
通讯作者：
Pati, Susmita
中科院分区：
文献类型：
--
作者：
Anugu, Meghana;Braksmajer, Amy;Pati, Susmita
背景和目标：社区卫生工作者 (CEIW) 在扩大医疗家庭服务和减少紧急医疗保健使用方面具有巨大潜力，但儿科方面的证据很少。我们评估了现有的丰富医疗家庭干预 (EMHI) 的影响，该干预直接将 CHW 纳入急诊科 (ED) 就诊和儿科门诊护理敏感病症 (ACSC) 住院治疗。方法：这项前瞻性队列研究中的 EMHI 组接受了经过培训的 CHW 的家访，以支持遵守推荐的护理；对照组接受常规护理（UC）。社会人口学特征是根据 EMHI 数据库编制的，研究参与者的急诊和住院信息是从全州数据库中提取的。使用倾向评分匹配法调整组间不同特征后，采用 Wilcoxon 符号秩检验比较 ED 数据，采用 Wald 检验比较干预组和 UC 组 ACSC 的住院使用情况。 结果：研究样本包括 922 名儿童（干预组 225 名，UC 697 名）。经过倾向评分匹配后，分析样本包括 450 名儿童（225 名干预儿童，225 名 UC 儿童）。倾向评分匹配后，干预组前往急诊科接受 ACSC 的可能性显着低于 UC 组（18.2% vs 35.1%；P =.004）。我们发现两组之间的 ACSC 住院率没有差异。结论：我们的研究结果表明，使用经过培训的社区卫生工作者进行 EMHI 可能是一种具有成本效益的模式，可以减少可预防的急诊室使用率，尤其是在弱势儿童中。
BACKGROUND AND OBJECTIVES: Community health workers (CEIWs) have great potential to extend medical home services and reduce emergent health care use, but evidence in pediatrics is scarce. We evaluated the impact of an existing enriched medical home intervention (EMHI) that directly integrates CHWs into emergency department (ED) visits and hospitalizations for pediatric ambulatory care-sensitive conditions (ACSCs).METHODS: The EMHI group in this prospective cohort study received home visits from trained CHWs to support adherence to recommended care; the comparison group received usual care (UC). Sociodemographic characteristics were compiled from the EMHI database, and ED and hospitalization information was extracted for study participants from a statewide database. The Wilcoxon signed rank test was used to compare ED data and the Wald test was used to compare hospitalization use for ACSCs between the intervention and UC groups after adjusting for different characteristics between groups by using propensity score matching method.RESULTS: The study sample included 922 children (225 intervention, 697 UC). After propensity score matching, the analytic sample included 450 children (225 intervention, 225 UC). After propensity score matching, the intervention group was significantly less likely than the UC group to visit the ED for an ACSC (18.2% vs 35.1%; P =.004). We found no differences in ACSC hospitalizations between the 2 groups.CONCLUSIONS: Our findings suggest that EMHIs using trained CHWs may be a cost-effective model to reduce preventable ED utilization, especially among vulnerable children.