HealthCare Partners, Torrance, CA, USA.
Am J Manag Care. 2012 Aug 1;18(8):e269-76.
To assess the efficacy of a home care program designed to improve access to medical care for older adults with multiple chronic conditions who are at risk for hospitalization.
Randomized controlled trial in which participants were assigned to the home care intervention (Choices for Healthy Aging [CHA]) program or usual care.
The intervention group consisted of 298 older adults at risk of hospitalization as determined by a risk stratification tool. Measures included satisfaction with medical care, medical service use, and costs of medical care.
The intervention group reported significantly greater satisfaction with care than usual care recipients (t test = 2.476; P = .014). CHA patients were less likely than usual care patients to be admitted to the hospital (25.6% and 37.1%, respectively; P = .02). There were no differences in terms of costs of care between the home care and usual care groups.
Provision of home care to older adults at high risk of hospitalization may improve satisfaction with care while reducing hospitalizations. Lack of difference in medical costs suggests that managed care organizations need to consider targeting rather than using risk stratification measures when designing programs for high-risk groups.
评估一项旨在改善有多种慢性病且有住院风险的老年人获得医疗服务的家庭护理计划的效果。
这是一项随机对照试验，参与者被分配到家庭护理干预（健康老龄化选择，简称 CHA）组或常规护理组。
干预组由 298 名被风险分层工具确定为有住院风险的老年人组成。措施包括对医疗护理的满意度、医疗服务的使用以及医疗护理的费用。
与常规护理组相比，干预组报告的对护理的满意度显著更高（t 检验=2.476；P=.014）。CHA 患者住院的可能性低于常规护理患者（分别为 25.6%和 37.1%；P=.02）。家庭护理组和常规护理组之间的护理费用没有差异。
为有高住院风险的老年人提供家庭护理可能会提高对护理的满意度，同时减少住院。医疗费用方面没有差异表明，管理式医疗组织在为高风险群体设计项目时，需要考虑目标人群而非使用风险分层措施。
