推荐门诊护理服务的使用情况：退伍军人事务部的质量差距正在缩小吗？

Use of recommended ambulatory care services: is the Veterans Affairs quality gap narrowing?

作者信息

Ross Joseph S, Keyhani Salomeh, Keenan Patricia S, Bernheim Susannah M, Penrod Joan D, Boockvar Kenneth S, Federman Alex D, Krumholz Harlan M, Siu Albert L

机构信息

HSR&D Targeted Research Enhancement Program and Geriatrics Research, Education, and Clinical Center, James J. Peters Veterans Administration Medical Center, Bronx, New York 10025, USA.

出版信息

Arch Intern Med. 2008 May 12;168(9):950-8. doi: 10.1001/archinte.168.9.950.

DOI:10.1001/archinte.168.9.950

PMID:18474759

Abstract

BACKGROUND

Veterans Affairs medical centers (VAMCs) provide better preventive and chronic disease care when compared with other health care organizations, although recent health care quality improvement initiatives outside the VAMC sector may have narrowed quality differences.

METHODS

Using the nationally representative 2000 and 2004 surveys of the Behavior Risk Factor Surveillance System, which included 152,310 community-dwelling insured adults in 2000 and 251,570 in 2004, we compared self-reported use of 17 recommended ambulatory care services for cancer prevention, cardiovascular risk reduction, diabetes mellitus management, and infectious disease prevention among insured adults receiving and not receiving care at VAMCs.

RESULTS

A total of 2852 insured adults (1.9%) received care at VAMCs in 2000 and 7155 (2.4%) received care at VAMCs in 2004. Use of 9 of the 17 services was greater in 2004 when compared with 2000 (P < or = .05). In 2000, receiving VAMC care was associated with greater use of 6 of the 17 services; in 2004, receiving VAMC care was associated with greater use of 12 of the 17 services (P < or = .05). In 2004, greater use among these 12 services ranged from 10% greater use of cholesterol screening to 40% greater use of colorectal cancer screening. For 13 of the 17 services, the likelihood of service use among adults receiving VAMC care when compared with adults not receiving VAMC care was not significantly different in 2004 than in 2000. However, this likelihood was significantly greater (for VAMC vs non-VAMC use) in 2004 than in 2000 for breast cancer screening (relative risk [RR], 1.21 [95% confidence interval {CI}, 1.15-1.25] vs 0.80 [95% CI, 0.58-0.98]; P < .001), dilated eye examination among adults with diabetes (RR, 1.12 [95% CI, 1.07-1.15] vs 1.01 [95% CI, 0.88-1.09]; P = .04), and influenza (RR, 1.30 [95% CI, 1.24-1.36] vs 1.06 [95% CI, 0.89-1.21]; P = .006) and pneumococcal (RR, 1.27 [95% CI, 1.23-1.31] vs 1.04 [95% CI, 0.86-1.21]; P = .005) vaccinations.

CONCLUSION

Despite increasing emphasis on quality of care and improved performance throughout the US health care system, adults receiving VAMC care remain more likely to receive recommended ambulatory care.

摘要

背景

与其他医疗保健机构相比，退伍军人事务医疗中心（VAMC）能提供更好的预防和慢性病护理，尽管VAMC部门以外最近的医疗保健质量改进举措可能缩小了质量差异。

方法

利用具有全国代表性的2000年和2004年行为危险因素监测系统调查，2000年调查包括152310名社区参保成年人，2004年调查包括251570名，我们比较了在VAMC接受护理和未接受护理的参保成年人中，17项推荐的门诊护理服务的自我报告使用情况，这些服务用于癌症预防、心血管风险降低、糖尿病管理和传染病预防。

结果

2000年共有2852名参保成年人（1.9%）在VAMC接受护理，2004年有7155名（2.4%）。与2000年相比，2004年17项服务中有9项的使用增加（P≤0.05）。2000年，接受VAMC护理与17项服务中的6项使用增加相关；2004年，接受VAMC护理与17项服务中的12项使用增加相关（P≤0.05）。2004年，这12项服务中使用增加幅度较大的，从胆固醇筛查使用增加10%到结肠直肠癌筛查使用增加40%不等。对于17项服务中的13项，2004年接受VAMC护理的成年人与未接受VAMC护理的成年人相比，服务使用可能性与2000年相比无显著差异。然而，2004年乳腺癌筛查（相对风险[RR]，1.21[95%置信区间{CI}，1.15 - 1.25]对比0.80[95%CI，0.58 - 0.98]；P < 0.001）、糖尿病成年人的扩瞳眼部检查（RR，1.12[95%CI，1.07 - 1.15]对比1.01[95%CI，0.88 - 1.09]；P = 0.04）、流感（RR, 1.30[95%CI，1.24 - 1.36]对比1.06[95%CI，0.89 - 1.21]；P = 0.006）和肺炎球菌（RR，1.27[95%CI，1.23 - 1.31]对比1.04[95%CI，0.86 - 1.21]；P = 0.005）疫苗接种方面，这种可能性（VAMC与非VAMC使用情况相比）显著高于2000年。