Melnick Glenn A, Green Lois, Rich Jeremy
Glenn A. Melnick (
Lois Green is an affiliated researcher in the USC Center for Health Financing, Policy, and Management.
Health Aff (Millwood). 2016 Jan;35(1):28-35. doi: 10.1377/hlthaff.2015.0253.
In 2009 HealthCare Partners Affiliates Medical Group, based in Southern California, launched House Calls, an in-home program that provides, coordinates, and manages care primarily for recently discharged high-risk, frail, and psychosocially compromised patients. Its purpose is to reduce preventable emergency department visits and hospital readmissions. We present data over time from this well-established program to provide an example for other new programs that are being established across the United States to serve this population with complex needs. The findings show that the initial House Calls structure, staffing patterns, and processes differed across the geographic areas that it served, and that they also evolved over time in different ways. In the same time period, all areas experienced a reduction in operating costs per patient and showed substantial reductions in monthly per patient health care spending and hospital utilization after enrollment in the House Calls program, compared to the period before enrollment. Despite more than five years of experience, the program structure continues to evolve and adjust staffing and other features to accommodate the dynamic nature of this complex patient population.
2009年，总部位于南加州的医疗保健合作伙伴附属医疗集团推出了“上门医疗服务”项目，这是一项居家护理项目，主要为近期出院的高危、体弱以及存在社会心理问题的患者提供、协调和管理护理服务。其目的是减少可预防的急诊就诊和住院再入院情况。我们展示了这个成熟项目随时间推移的数据，为美国各地正在设立的其他新项目提供一个范例，这些新项目旨在为有复杂需求的人群提供服务。研究结果表明，“上门医疗服务”最初的项目结构、人员配置模式和流程在其服务的不同地理区域存在差异，并且随着时间的推移也以不同方式演变。在同一时期，与加入“上门医疗服务”项目之前相比，所有地区每位患者的运营成本都有所降低，并且在加入该项目后，每位患者每月的医疗保健支出和医院利用率大幅下降。尽管有五年多的经验，但该项目结构仍在不断演变，并调整人员配置和其他特征，以适应这一复杂患者群体的动态特性。
