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医疗保健热点项目不能降低再住院率
作者:小柯机器人 发布时间:2020/1/13 14:31:16

美国麻省理工学院Amy Finkelstein研究组取得一项新突破。他们对医疗保健热点项目进行了一项随机对照试验。 2020年1月9日,国际知名学术期刊《新英格兰医学杂志》发表了这一成果。

人们普遍对旨在减少“高需求者”开支和提高医疗保健质量的项目感兴趣,因为这类患者对医疗保健服务的使用率很高。

由卡姆登医疗保健提供者联盟创建的“热点”计划作为一类颇有前景的高需求者干预措施,已引起全美关注,并扩展到全美各个城市。

在出院后的几个月里,一个由护士、社会工作者和社区卫生工作者组成的团队会登门拜访已注册的患者,协调门诊治疗并将其与社会服务联系起来。

研究组随机分配了800名医疗和社会状况复杂的住院患者,所有患者在过去6个月内至少有一次额外住院治疗,分别接受联盟的治疗-过渡计划干预或常规护理。最终干预组180天内的再住院率为62.3%,对照组为61.7%,组间差异不显著。干预组入组后6个月内的再住院率比入组前下降了38个百分点,但该结论有所误导,因为对照组也出现了类似下降。

总之,对于那些卫生保健服务使用率很高的患者,参与联盟项目后的再住院率并不低于接受常规治疗。

附:英文原文

Title: Health Care Hotspotting — A Randomized, Controlled Trial

Author: Amy Finkelstein, Ph.D.,, Annetta Zhou, Ph.D.,, Sarah Taubman, Sc.D.,, and Joseph Doyle, Ph.D.

Issue&Volume: 2020-01-08

Abstract: 

BACKGROUND
There is widespread interest in programs aiming to reduce spending and improve health care quality among “superutilizers,” patients with very high use of health care services. The “hotspotting” program created by the Camden Coalition of Healthcare Providers (hereafter, the Coalition) has received national attention as a promising superutilizer intervention and has been expanded to cities around the country. In the months after hospital discharge, a team of nurses, social workers, and community health workers visits enrolled patients to coordinate outpatient care and link them with social services.

METHODS
We randomly assigned 800 hospitalized patients with medically and socially complex conditions, all with at least one additional hospitalization in the preceding 6 months, to the Coalition’s care-transition program or to usual care. The primary outcome was hospital readmission within 180 days after discharge.

RESULTS
The 180-day readmission rate was 62.3% in the intervention group and 61.7% in the control group. The adjusted between-group difference was not significant (0.82 percentage points; 95% confidence interval, −5.97 to 7.61). In contrast, a comparison of the intervention-group admissions during the 6 months before and after enrollment misleadingly suggested a 38-percentage-point decline in admissions related to the intervention because the comparison did not account for the similar decline in the control group.

CONCLUSIONS
In this randomized, controlled trial involving patients with very high use of health care services, readmission rates were not lower among patients randomly assigned to the Coalition’s program than among those who received usual care. 

DOI: 10.1056/NEJMsa1906848

Source: https://www.nejm.org/doi/full/10.1056/NEJMsa1906848

 

期刊信息

The New England Journal of Medicine:《新英格兰医学杂志》,创刊于1812年。隶属于美国麻省医学协会,最新IF:70.67
官方网址:http://www.nejm.org/
投稿链接:http://www.nejm.org/page/author-center/home