Carrier Emily, Reschovsky James
Issue Brief Cent Stud Health Syst Change. 2009 Dec(129):1-4.
Use of care management tools--such as group visits or patient registries--varies widely among primary care physicians whose practices care for patients with four common chronic conditions--asthma, diabetes, congestive heart failure and depression--according to a new national study by the Center for Studying Health System Change (HSC). For example, less than a third of these primary care physicians in 2008 reported their practices use nurse managers to coordinate care, and only four in 10 were in practices using registries to keep track of patients with chronic conditions. Physicians also used care management tools for patients with some chronic conditions but not others. Practice size and setting were strongly related to the likelihood that physicians used care management tools, with solo and smaller group practices least likely to use care management tools. The findings suggest that, along with experimenting with financial incentives for primary care physicians to adopt care management tools, policy makers might consider developing community-level care management resources, such as nurse managers, that could be shared among smaller physician practices.
根据卫生系统变革研究中心（HSC）的一项新的全国性研究，在为患有哮喘、糖尿病、充血性心力衰竭和抑郁症这四种常见慢性病患者提供诊疗服务的初级保健医生中，护理管理工具（如小组问诊或患者登记）的使用情况差异很大。例如，2008年这些初级保健医生中不到三分之一的人报告称其诊所使用护士经理来协调护理，十分之四的人所在诊所使用登记系统来跟踪慢性病患者。医生也会针对某些慢性病患者使用护理管理工具，而对其他患者则不然。诊所规模和环境与医生使用护理管理工具的可能性密切相关，单人诊所和规模较小的团体诊所使用护理管理工具的可能性最小。研究结果表明，除了尝试对初级保健医生采用护理管理工具给予经济激励外，政策制定者可能还应考虑开发社区层面的护理管理资源，如护士经理，以便较小规模的医生诊所能够共享。
