Byrne Margaret M, Charns Martin P, Parker Victoria A, Meterko Mark M, Wray Nelda P
Center for Bioethics and Health Law, and Center for Research on Health Care, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
Med Care. 2004 Jan;42(1):28-37. doi: 10.1097/01.mlr.0000102493.28759.71.
To determine whether clinical service lines in primary care and mental health reduces inpatient and urgent care utilization.
All VHA medical centers were surveyed to determine whether service lines had been established in primary care or mental health care prior to the beginning of fiscal year 1997 (FY97). Facility-level data on medical utilization from Veterans Health Affairs (VHA) administrative databases were used for descriptive and multivariate regression analyses of utilization and of changes in measures between FY97 and FY98. Nine primary care-related and 5 mental health-related variables were analyzed.
Primary care and mental health service lines had been established in approximately half of all facilities. Service lines varied in duration and extent of restructuring. Mere presence of a service line had no positive and several negative effects on measured outcome variables. More detailed analyses showed that some types of service lines have statistically significant and mostly negative effects on both mental health and primary care-related measures. Newly implemented service lines had significantly less improvement in measures over time than facilities with no service line.
Health care organizations are implementing innovative organizational structures in hopes of improving quality of care and reducing resource utilization. We found that service lines in primary care and mental health may lead to an initial period of disruption, with little evidence of a beneficial effect on performance for longer duration service lines.
确定初级保健和心理健康领域的临床服务线是否能降低住院和紧急护理的使用率。
对所有退伍军人健康管理局（VHA）医疗中心进行调查，以确定在1997财年（FY97）开始之前，初级保健或心理健康护理领域是否已建立服务线。使用来自退伍军人健康事务（VHA）行政数据库的机构层面医疗利用数据，对利用率以及FY97和FY98之间指标的变化进行描述性和多变量回归分析。分析了九个与初级保健相关的变量和五个与心理健康相关的变量。
约半数机构已建立初级保健和心理健康服务线。服务线在重组的持续时间和范围上存在差异。仅仅设立服务线对所测量的结果变量没有积极影响，反而有一些负面影响。更详细的分析表明，某些类型的服务线对心理健康和初级保健相关指标均具有统计学显著且大多为负面影响。随着时间推移，新实施的服务线在指标改善方面明显不如未设立服务线的机构。
医疗保健组织正在实施创新的组织结构，以期提高护理质量并减少资源利用。我们发现，初级保健和心理健康领域的服务线可能会导致初期的混乱，几乎没有证据表明长期服务线对绩效有有益影响。
