Department of Medicine, Philadelphia Veterans Affairs Medical Center, PA, USA.
Health Aff (Millwood). 2013 Jul;32(7):1196-203. doi: 10.1377/hlthaff.2012.0825.
Patients with low socioeconomic status (SES) use more acute hospital care and less primary care than patients with high socioeconomic status. This low-value pattern of care use is harmful to these patients' health and costly to the health care system. Many current policy initiatives, such as the creation of accountable care organizations, aim to improve both health outcomes and the cost-effectiveness of health services. Achieving those goals requires understanding what drives low-value health care use. We conducted qualitative interviews with forty urban low-SES patients to explore why they prefer to use hospital care. They perceive it as less expensive, more accessible, and of higher quality than ambulatory care. Efforts that focus solely on improving the quality of hospital care to reduce readmissions could, paradoxically, increase hospital use. Two different profile types emerged from our research. Patients in Profile A (five or more acute care episodes in six months) reported social dysfunction and disability. Those in Profile B (fewer than five acute care episodes in six months) reported social stability but found accessing ambulatory care to be difficult. Interventions to improve outcomes and values need to take these differences into account.
社会经济地位较低（SES）的患者比社会经济地位较高的患者使用更多的急性医院护理，而使用初级保健的比例较低。这种低价值的护理使用模式对这些患者的健康有害，并使医疗保健系统成本高昂。许多当前的政策举措，如创建问责制医疗组织，旨在改善健康结果和医疗服务的成本效益。要实现这些目标，就需要了解是什么驱动了低价值的医疗保健使用。我们对 40 名城市低收入患者进行了定性访谈，以探讨他们为何更喜欢使用医院护理。他们认为医院护理的费用更低、更方便、质量更高。为了减少再入院而仅仅专注于提高医院护理质量的努力，可能会适得其反地增加医院的使用。我们的研究中出现了两种不同的患者类型。在 Profile A（六个月内有五次或更多次急性护理发作）的患者报告存在社交功能障碍和残疾。在 Profile B（六个月内急性护理发作少于五次）的患者报告社交稳定，但发现获得门诊护理很困难。改善结果和价值的干预措施需要考虑到这些差异。
