Reducing emergency hospital admissions: a population health complex intervention of an enhanced model of primary care and compassionate communities
Reducing emergency hospital admissions: a population health complex intervention of an enhanced model of primary care and compassionate communities
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DOI：
10.3399/bjgp18x699437
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发表时间：
2018-11-01
影响因子：
5.9
通讯作者：
Kellehear, Allan
中科院分区：
文献类型：
--
作者：
Abel, Julian;Kingston, Helen;Kellehear, Allan
背景：减少急诊住院人数一直是医疗保健政策的基石。几乎没有证据表明，在人群中进行系统干预已经实现了这一目标。作者报告了在萨默塞特郡弗罗姆进行的为期44个月的复杂干预对意外入院的影响。目的评价加强初级保健和爱心社区模式的人口健康综合干预对改善人口健康和减少急诊住院率的影响。2013年4月至2017年12月，对萨默塞特郡Frome Medical Practice所有急诊入院患者进行复杂干预的队列回顾性研究，并与萨默塞特郡其他地区进行比较。方法采用广泛的标准确定患者，包括任何引起关注的人。以患者为中心的目标设定和护理计划与富有同情心的社区社会方法相结合，在弗罗姆的人口中广泛实施。结果在2013年4月至2017年12月的研究期间，弗罗姆整个人群的计划外住院人数逐步减少，每季度减少7.9例（95%置信区间[CI] = 2.8至13.1,P = 0.006），减少了14.0%。与此同时，萨默塞特地区每季度的入学人数增加了28.5%，计划外入学人数每季度增加236人（95% CI = 152至320，P < 0.001）。结论：弗罗姆的综合干预措施与非计划住院率的显著降低有关，并降低了弗罗姆整个人口的医疗费用。
BackgroundReducing emergency admissions to hospital has been a cornerstone of healthcare policy. Little evidence exists to show that systematic interventions across a population have achieved this aim. The authors report the impact of a complex intervention over a 44-month period in Frome, Somerset, on unplanned admissions to hospital.AimTo evaluate a population health complex intervention of an enhanced model of primary care and compassionate communities on population health improvement and reduction of emergency admissions to hospital.Design and settingA cohort retrospective study of a complex intervention on all emergency admissions in Frome Medical Practice, Somerset, compared with the remainder of Somerset, from April 2013 to December 2017.MethodPatients were identified using broad criteria, including anyone giving cause for concern. Patient-centred goal setting and care planning combined with a compassionate community social approach was implemented broadly across the population of Frome.ResultsThere was a progressive reduction, by 7.9 cases per quarter (95% confidence interval [CI] = 2.8 to 13.1, P = 0.006), in unplanned hospital admissions across the whole population of Frome during the study period from April 2013 to December 2017, a decrease of 14.0%. At the same time, there was a 28.5% increase in admissions per quarter within Somerset, with a rise in the number of unplanned admissions of 236 per quarter (95% CI = 152 to 320, P < 0.001).ConclusionThe complex intervention in Frome was associated with highly significant reductions in unplanned admissions to hospital, with a decrease in healthcare costs across the whole population of Frome.