Bui Alex A T, Taira Ricky K, Goldman Dana, Dionisio John David N, Aberle Denise R, El-Saden Suzie, Sayre James, Rice Thomas, Kangarloo Hooshang
From Medical Informatics Group, Department of Radiology, David Geffen School of Medicine, University of California at Los Angeles, 924 Westwood Blvd., Suite 420, Los Angeles, CA 90024, USA.
Acad Radiol. 2004 Jan;11(1):13-20. doi: 10.1016/s1076-6332(03)00570-1.
A streamlined process of care supported by technology and imaging may be effective in managing the overall healthcare process and costs. This study examined the effect of an imaging-based electronic process of care on costs and rates of hospitalization, emergency room (ER) visits, specialist diagnostic referrals, and patient satisfaction.
A healthcare process was implemented for an employer group, highlighting improved patient access to primary care plus routine use of imaging and teleconsultation with diagnostic specialists. An electronic infrastructure supported patient access to physicians and communication among healthcare providers. The employer group, a self-insured company, manages a healthcare plan for its employees and their dependents: 4,072 employees were enrolled in the test group, and 7,639 in the control group. Outcome measures for expenses and frequency of hospitalizations, ER visits, traditional specialist referrals, primary care visits, and imaging utilization rates were measured using claims data over 1 year. Homogeneity tests of proportions were performed with a chi-square statistic, mean differences were tested by two-sample t-tests. Patient satisfaction with access to healthcare was gauged using results from an independent firm.
Overall per member/per month costs post-implementation were lower in the enrolled population (126 dollars vs 160 dollars), even though occurrence of chronic/expensive diseases was higher in the enrolled group (18.8% vs 12.2%). Lower per member/per month costs were seen for inpatient (33.29 dollars vs 35.59 dollars); specialist referrals (21.36 dollars vs 26.84 dollars); and ER visits (3.68 dollars vs 5.22 dollars). Moreover, the utilization rate for hospital admissions, ER visits, and traditional specialist referrals were significantly lower in the enrolled group, although primary care and imaging utilization were higher. Comparison to similar employer groups showed that the company's costs were lower than national averages (119.24 dollars vs 146.32 dollars), indicating that the observed result was not attributable to normalization effects. Patient satisfaction with access to healthcare ranked in the top 21st percentile.
A streamlined healthcare process supported by technology resulted in higher patient satisfaction and cost savings despite improved access to primary care and higher utilization of imaging.
由技术和影像支持的简化护理流程可能在管理整体医疗过程和成本方面有效。本研究考察了基于影像的电子护理流程对成本、住院率、急诊室就诊率、专科诊断转诊率及患者满意度的影响。
为一个雇主群体实施了一种医疗流程，突出改善患者获得初级护理的机会以及常规使用影像和与诊断专科医生进行远程会诊。一个电子基础设施支持患者与医生的联系以及医疗服务提供者之间的沟通。该雇主群体是一家自我投保的公司，为其员工及其家属管理一项医疗计划：4072名员工被纳入试验组，7639名员工被纳入对照组。使用1年期间的理赔数据来衡量住院费用和住院频率、急诊室就诊、传统专科转诊、初级护理就诊及影像利用率等结果指标。比例的齐性检验使用卡方统计量，均值差异通过两样本t检验进行检验。使用一家独立公司的结果来衡量患者对获得医疗服务的满意度。
尽管纳入组中慢性/昂贵疾病的发生率较高（18.8%对12.2%），但实施后纳入人群的总体人均每月成本较低（分别为126美元和160美元）。住院（分别为33.29美元和35.59美元）、专科转诊（分别为21.36美元和26.84美元）以及急诊室就诊（分别为3.68美元和5.22美元）的人均每月成本较低。此外，纳入组的住院、急诊室就诊和传统专科转诊的利用率显著较低，尽管初级护理和影像利用率较高。与类似雇主群体的比较表明，该公司的成本低于全国平均水平（分别为119.24美元和146.32美元），这表明观察到的结果并非归因于标准化效应。患者对获得医疗服务的满意度排名在前21%。
尽管获得初级护理的机会增加且影像利用率提高，但由技术支持的简化医疗流程提高了患者满意度并节省了成本。
