Department of Health Services, School of Public Health, University of Washington, 1959 NE Pacific Street, Box 357660, Seattle, WA 98195-7475, USA.
Med Care Res Rev. 2012 Oct;69(5):519-39. doi: 10.1177/1077558712446705. Epub 2012 May 31.
The authors examined whether Group Health's Access Initiative changed the utilization and costs of care among enrollees with diabetes. Using a single (one-group) interrupted time series design, repeated-measures generalized estimating equation models were used to estimate changes in utilization and costs during the Initiative rollout (2002-2003) and to compare the slopes (annual rates of change) for utilization and costs during the Pre-Initiative period (1998-2002) to the slopes during Full-Implementation (2003-2006) among 9,871 members continuously enrolled from 1997 to 2006 with type 1 or 2 diabetes. Total costs increased in Full-Implementation, but the annual change in total costs did not change. Primary care visits declined, but primary care contacts grew, largely from the Initiative's introduction of secure messaging. Specialty visits did not change; however, the Initiative may have increased emergency visits. To reduce emergency visits, future access initiatives should include proactive and comprehensive outpatient care for patients with diabetes.
作者研究了 Group Health 的 Access Initiative 是否改变了糖尿病患者的医疗服务利用和成本。采用单组（one-group）中断时间序列设计，重复测量广义估计方程模型用于估计倡议实施期间（2002-2003 年）的利用和成本变化，并比较倡议前期间（1998-2002 年）和完全实施期间（2003-2006 年）的利用和成本斜率（年变化率），在 1997 年至 2006 年间持续入组的 9871 名 1 型或 2 型糖尿病患者中。在完全实施期间，总费用增加，但总费用的年变化没有改变。初级保健就诊减少，但初级保健接触增加，主要是由于倡议引入了安全信息传递。专科就诊没有变化；然而，该倡议可能增加了急诊就诊。为了减少急诊就诊，未来的访问计划应包括对糖尿病患者进行积极主动和全面的门诊护理。
