McGuire James, Rosenheck Robert
Veterans Affairs Northeast Program Evaluation Center (NEPEC) Project CHALENG Evaluation, Los Angeles, CA, USA.
J Healthc Qual. 2005 Nov-Dec;27(6):26-32. doi: 10.1111/j.1945-1474.2005.tb00586.x.
The 2003 National Healthcare Disparities Report underscored the need for performance measurement of evidence-based preventive services for at-risk populations. This study compares receipt of primary care prevention services among homeless and nonhomeless veteran patients who received Veterans Affairs (VA) medical care services. The study used chart review data on a national sample of 94,932 veterans with chronic medical conditions whose care was reviewed through the VA External Peer Review Program during 1998 and 1999. Receipt of eight preventive services was examined: two measures of immunization, four of cancer screening, and two of tobacco use and counseling. In risk-adjusted models, recently homeless veterans received 9% fewer prevention services for which they were eligible. Modest differences in receiving prevention services between domiciled and recently homeless veterans suggest that targeted efforts are needed to facilitate access to needed medical services in this population.
《2003年国家医疗保健差异报告》强调了对高危人群循证预防服务进行绩效评估的必要性。本研究比较了接受退伍军人事务部（VA）医疗服务的无家可归退伍军人患者和非无家可归退伍军人患者接受初级保健预防服务的情况。该研究使用了1998年和1999年通过VA外部同行评审计划对94932名患有慢性疾病的退伍军人进行全国抽样的病历审查数据。研究考察了八项预防服务的接受情况：两项免疫措施、四项癌症筛查措施以及两项烟草使用与咨询措施。在风险调整模型中，近期无家可归的退伍军人接受符合条件的预防服务的比例要低9%。在有住所的退伍军人和近期无家可归的退伍军人之间，接受预防服务存在适度差异，这表明需要有针对性的努力来促进这一人群获得所需的医疗服务。
