Carey Iain M, Hosking Fay J, Harris Tess, DeWilde Stephen, Beighton Carole, Shah Sunil M, Cook Derek G
Population Health Research Institute, St George's University of London, London, UK.
J Epidemiol Community Health. 2017 Jan;71(1):52-58. doi: 10.1136/jech-2016-207557. Epub 2016 Jun 16.
Annual health checks for adults with intellectual disability (ID) have been incentivised by National Health Service (NHS) England since 2009, but it is unclear what impact they have had on important health outcomes such as emergency hospitalisation.
An evaluation of a 'natural experiment', incorporating practice and individual-level designs, to assess the effectiveness of health checks for adults with ID in reducing emergency hospital admissions using a large English primary care database. For practices, changes in admission rates for adults with ID between 2009-2010 and 2011-2012 were compared in 126 fully participating versus 68 non-participating practices. For individuals, changes in admission rates before and after the first health check for 7487 adults with ID were compared with 46 408 age-sex-practice matched controls. Incident rate ratios (IRRs) comparing changes in admission rates are presented for: all emergency, preventable emergency (for ambulatory care sensitive conditions (ACSCs)) and elective emergency.
Practices with high health check participation showed no change in emergency admission rate among patients with ID over time compared with non-participating practices (IRR=0.97, 95% CI 0.78 to 1.19), but emergency admissions for ACSCs did fall (IRR=0.74, 0.58 to 0.95). Among individuals with ID, health checks had no effect on overall emergency admissions compared with controls (IRR=0.96, 0.87 to 1.07), although there was a relative reduction in emergency admissions for ACSCs (IRR=0.82, 0.69 to 0.99). Elective admissions showed no change with health checks in either analysis.
Annual health checks in primary care for adults with ID did not alter overall emergency admissions, but they appeared influential in reducing preventable emergency admissions.
自2009年以来，英国国家医疗服务体系（NHS）一直在鼓励为成年智障人士进行年度健康检查，但目前尚不清楚这些检查对诸如急诊住院等重要健康结果产生了何种影响。
对一项“自然实验”进行评估，该实验结合了实践和个体层面的设计，以使用一个大型英国初级医疗数据库来评估针对成年智障人士的健康检查在减少急诊住院方面的有效性。对于医疗机构，比较了2009 - 2010年和2011 - 2012年期间126家完全参与的医疗机构与68家未参与的医疗机构中成年智障患者的住院率变化。对于个体，比较了7487名成年智障患者首次健康检查前后的住院率变化与46408名年龄、性别和医疗机构匹配的对照者。给出了比较住院率变化的发病率比（IRR），用于：所有急诊、可预防急诊（针对非卧床护理敏感病症（ACSCs））和择期急诊。
与未参与的医疗机构相比，健康检查参与度高的医疗机构中，智障患者的急诊住院率随时间没有变化（IRR = 0.97，95%CI 0.78至1.19），但ACSCs的急诊住院率确实有所下降（IRR = 0.74，0.58至0.95）。在智障个体中，与对照者相比，健康检查对总体急诊住院没有影响（IRR = 0.96，0.87至1.07），尽管ACSCs的急诊住院有相对减少（IRR = 0.82，0.69至0.99）。在两项分析中，择期住院率在健康检查后均无变化。
针对成年智障人士的初级医疗年度健康检查并未改变总体急诊住院情况，但在减少可预防的急诊住院方面似乎有影响。
