Malcolm L, Wright L, Carson S
Aotearoa Health, Lyttelton RD 1.
N Z Med J. 2000 Dec 8;113(1123):514-7.
To study health services utilisation linkages and methodological issues in integrating primary and secondary care services for a defined general practice population (Christchurch South Health Centre, CSHC).
The Centre supplied national health index (NHI) linked data on date of birth, gender and community services card (CSC) status for 10,174 patients, and data on primary care. Secondary care providers supplied NHI linked data on specialist outpatients, emergency department usage for 1996 to 1998, and waiting lists. The Health Funding Authority (HFA) supplied NHI linked data on inpatient/daypatients for 1996 and 1997. Data were also obtained relating to community support services and long-term care. Rates of hospital utilisation for the Centre's population were standardised for comparison with national and Christchurch figures using age, gender and CSCs. Overall per capita expenditure was calculated for this population.
Patients with CSCs constituted 31.2% of the practice population, but generated 60.8% of bed-days. Patients with high use health cards (HUHCs) constituted 8.6% of the population, but generated 42.4% of bed-days. This group was at high risk of hospitalisation over a wide range of disease categories. Standardised rates of hospital utilisation were significantly lower for the Centre's older patients, especially for bed-days, than both national and Christchurch figures. Only a small proportion of referrals to specialist outpatients, 28.2% in 1998, was from the Centre's general practitioners (GPs), the remainder being generated internally within the specialist services. The overall expenditure per capita on the Centre's population was $1012, which was substantially less than expected in comparison with national figures.
The study demonstrates the importance of primary care factors in the utilisation of secondary care, especially acute hospitalisation in older patients. This needs further study as it could provide important insights into ways of reducing acute admissions. If there is to be more effective management of the primary/secondary care interface, more research and development effort is needed into the characteristics of patients at high risk of referral and admission, and how inappropriate secondary care can be averted.
研究针对特定全科医疗人群（克赖斯特彻奇南部健康中心，CSHC）整合初级和二级医疗服务时的卫生服务利用联系及方法学问题。
该中心提供了10174名患者的与国家健康指数（NHI）相关联的出生日期、性别及社区服务卡（CSC）状态数据，以及初级医疗数据。二级医疗服务提供者提供了与NHI相关联的专科门诊患者数据、1996年至1998年急诊科使用情况数据及候诊名单。卫生基金管理局（HFA）提供了1996年和1997年与NHI相关联的住院/日间患者数据。还获取了与社区支持服务和长期护理相关的数据。该中心人群的医院利用率通过年龄、性别和CSC进行标准化，以便与全国和克赖斯特彻奇的数据进行比较。计算了该人群的人均总支出。
持有CSC的患者占执业人群的31.2%，但产生了60.8%的住院日。持有高使用健康卡（HUHC）的患者占人群的8.6%，但产生了42.4%的住院日。该组在多种疾病类别中住院风险较高。该中心老年患者的标准化医院利用率，尤其是住院日利用率，显著低于全国和克赖斯特彻奇的数据。1998年转诊至专科门诊的患者中，只有一小部分（28.2%）来自该中心的全科医生（GP），其余由专科服务内部产生。该中心人群的人均总支出为1012美元，与全国数据相比大幅低于预期。
该研究表明初级医疗因素在二级医疗利用中的重要性，尤其是老年患者的急性住院情况。这需要进一步研究，因为它可能为减少急性入院的方法提供重要见解。如果要更有效地管理初级/二级医疗接口，则需要对转诊和入院高风险患者的特征以及如何避免不适当的二级医疗进行更多的研发工作。
