O'Sullivan M J, Volicer B
Department of Health and Clinical Sciences, University of Massachusetts, Lowell, USA.
Home Health Care Serv Q. 1997;16(3):21-34. doi: 10.1300/J027v16n03_03.
With the introduction of Medicare's Prospective Payment System (PPS) and DRGs, the economic value of home health care services lies in its ability to reduce total patient care costs by the substitution of outpatient home care for inpatient hospital care. Analysis of service delivery patterns utilized by home health agencies in meeting goals for patient care will be an important ingredient in meeting these objectives. The purpose of this study was to determine if important patient characteristics known at the onset of home health care are predictive of utilization of home health services and/or the likelihood of meeting goals for home care established at the time of certification of care. Multivariate models were developed which predicted the odds of terminating with goals met based upon age, intensity of utilization, functional limitations, prognosis, presence of a caregiver, and type of patient condition. Results indicated that variability in likelihood of meeting goals for care is much better predicted by patient characteristics than by utilization of home care services.
随着医疗保险的预期支付系统（PPS）和诊断相关分组（DRGs）的引入，家庭医疗服务的经济价值在于其能够通过用门诊家庭护理替代住院医院护理来降低患者的总体护理成本。分析家庭健康机构为实现患者护理目标所采用的服务提供模式将是实现这些目标的重要因素。本研究的目的是确定在家庭医疗护理开始时已知的重要患者特征是否能预测家庭医疗服务的使用情况和/或在护理认证时实现家庭护理目标的可能性。开发了多变量模型，该模型根据年龄、使用强度、功能限制、预后、是否有护理人员以及患者病情类型来预测达到目标后终止治疗的几率。结果表明，与家庭护理服务的使用情况相比，患者特征能更好地预测实现护理目标可能性的差异。
