Rodriguez Hector P, McClellan Sean R, Bibi Salma, Casalino Lawrence P, Ramsay Patricia P, Shortell Stephen M
University of California, Berkeley, CA, USA
American Institutes for Research, Foster City, CA, USA.
Med Care Res Rev. 2016 Jun;73(3):308-28. doi: 10.1177/1077558715613233. Epub 2015 Nov 16.
Practice ownership and Medicaid revenue may affect the use of care management processes (CMPs) for chronic conditions and expansion of health information technology (HIT). Using a national cohort of medical practices, we compared the use of CMPs and HIT from 2006/2008 to 2013 by practice ownership and level of Medicaid revenue. Poisson regression models estimated changes in CMP use, and linear regression estimated changes in HIT, by practice ownership and Medicaid patient revenue, controlling for other practice characteristics. Compared with physician-owned practices, system-owned practices adopted a greater number of CMPs and HIT functions over time (p < .001). High Medicaid revenue (≥30.0%) was associated with less adoption of CMPs (p < .001) and HIT (p < .01). System-owned practices (p < .001) and community health centers (p < .001) with high Medicaid revenue were more likely than physician-owned practices with high Medicaid revenue to adopt CMPs over time. System and community health center ownership appear to help high Medicaid practices overcome CMP adoption constraints.
医疗机构所有权和医疗补助收入可能会影响慢性病护理管理流程(CMPs)的使用以及健康信息技术(HIT)的推广。我们利用一个全国性的医疗实践队列,比较了2006/2008年至2013年不同医疗机构所有权和医疗补助收入水平下CMPs和HIT的使用情况。泊松回归模型估计了CMP使用情况的变化,线性回归估计了HIT的变化,分析了医疗机构所有权和医疗补助患者收入情况,并控制了其他医疗机构特征。随着时间的推移,与医生所有的医疗机构相比,系统所有的医疗机构采用了更多的CMPs和HIT功能(p < .001)。高医疗补助收入(≥30.0%)与较少采用CMPs(p < .001)和HIT(p < .01)相关。随着时间的推移,高医疗补助收入的系统所有的医疗机构(p < .001)和社区卫生中心(p < .001)比高医疗补助收入的医生所有的医疗机构更有可能采用CMPs。系统和社区卫生中心的所有权似乎有助于高医疗补助的医疗机构克服CMP采用方面的限制。