Gordon John B, Colby Holly H, Bartelt Tera, Jablonski Debra, Krauthoefer Mary L, Havens Peter
Department of Pediatrics, Medical College of Wisconsin, Children's Research Institute, and Special Needs Program, Children's Hospital of Wisconsin, Mail Stop C350, 9000 W Wisconsin Ave, Milwaukee, WI 53226, USA.
Arch Pediatr Adolesc Med. 2007 Oct;161(10):937-44. doi: 10.1001/archpedi.161.10.937.
To evaluate the impact of a tertiary care center special needs program that partners with families and primary care physicians to ensure seamless inpatient and outpatient care and assist in providing medical homes.
Up to 3 years of preenrollment and postenrollment data were compared for patients in the special needs program from July 1, 2002, through June 30, 2005.
A tertiary care center pediatric hospital and medical school serving urban and rural patients.
A total of 227 of 230 medically complex and fragile children and youth with special needs who had a wide range of chronic disorders and were enrolled in the special needs program.
Care coordination provided by a special needs program pediatric nurse case manager with or without a special needs program physician.
Preenrollment and postenrollment tertiary care center resource utilization, charges, and payments.
A statistically significant decrease was found in the number of hospitalizations, number of hospital days, and tertiary care center charges and payments, and an increase was found in the use of outpatient services. Aggregate data revealed a decrease in hospital days from 7926 to 3831, an increase in clinic visits from 3150 to 5420, and a decrease in tertiary care center payments of $10.7 million. The special needs program budget for fiscal year 2005 had a deficit of $400,000.
This tertiary care-primary care partnership model improved health care and reduced costs with relatively modest institutional support.
评估一个三级医疗中心特殊需求项目的影响，该项目与家庭和初级保健医生合作，以确保住院和门诊护理无缝衔接，并协助提供医疗之家。
对2002年7月1日至2005年6月30日期间参加特殊需求项目的患者，比较了长达3年的入学前和入学后数据。
一家为城乡患者服务的三级医疗中心儿科医院和医学院。
230名有特殊需求、患有多种慢性疾病且参加特殊需求项目的病情复杂且脆弱的儿童和青少年中，共有227名。
由特殊需求项目儿科护士病例经理在有或没有特殊需求项目医生的情况下提供护理协调。
入学前和入学后三级医疗中心的资源利用、费用和支付情况。
发现住院次数、住院天数以及三级医疗中心的费用和支付均有统计学意义的下降，门诊服务使用量增加。汇总数据显示，住院天数从7926天降至3831天，门诊就诊次数从3150次增至5420次，三级医疗中心支付减少1070万美元。2005财年特殊需求项目预算出现40万美元的赤字。
这种三级医疗与初级医疗的合作模式在相对适度的机构支持下改善了医疗保健并降低了成本。
