两项创新癌症护理项目有降低利用率和支出的潜力。
Two Innovative Cancer Care Programs Have Potential to Reduce Utilization and Spending.
作者信息
Colligan Erin M, Ewald Erin, Keating Nancy L, Parashuram Shriram, Spafford Michelle, Ruiz Sarah, Moiduddin Adil
机构信息
*Centers for Medicare and Medicaid Services, Baltimore †NORC at the University of Chicago, Bethesda, MD ‡Department of Health Care Policy, Harvard Medical School §Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA ∥Administration for Community Living, Washington, DC.
出版信息
Med Care. 2017 Oct;55(10):873-878. doi: 10.1097/MLR.0000000000000795.
BACKGROUND
Cancer patients often present to the emergency department (ED) and hospital for symptom management, but many of these visits are avoidable and costly.
OBJECTIVE
We assessed the impact of 2 Health Care Innovation Awards that used an oncology medical home model [Community Oncology Medical Home (COME HOME)] or patient navigation model [Patient Care Connect Program (PCCP)] on utilization and spending.
METHODS
Participants in COME HOME and PCCP models were matched to similar comparators using propensity scores. We analyzed utilization and spending outcomes using Medicare fee-for-service claims with unadjusted and adjusted difference-in-differences models.
RESULTS
In the adjusted models, both COME HOME and PCCP were associated with fewer ED visits than a comparison group (15 and 22 per 1000 patients/quarter, respectively; P<0.01). In addition, COME HOME had lower spending ($675 per patient/quarter; P<0.01), and PCCP had fewer hospitalizations (11 per 1000 patients/quarter; P<0.05), relative to the comparison group. Among patients undergoing chemotherapy, fewer COME HOME and PCCP patients had ED visits (18 and 28 per 1000 patients/quarter, respectively; P<0.01) and fewer PCCP patients had hospitalizations (13 per 1000 patients/quarter; P<0.05), than comparison patients.
CONCLUSIONS
The oncology medical home and patient navigator programs both showed reductions in spending or utilization. Adoption of such programs holds promise for improving cancer care.
背景
癌症患者常因症状管理前往急诊科（ED）和医院就诊，但其中许多就诊是可以避免的且成本高昂。
目的
我们评估了两项医疗保健创新奖的影响，这两项奖分别采用了肿瘤医疗之家模式[社区肿瘤医疗之家（COME HOME）]或患者导航模式[患者护理连接计划（PCCP）]对医疗服务利用和费用支出的影响。
方法
使用倾向得分将COME HOME和PCCP模式的参与者与类似的对照者进行匹配。我们使用医疗保险按服务收费索赔数据，通过未调整和调整后的差异-差异模型分析医疗服务利用和费用支出结果。
结果
在调整后的模型中，COME HOME和PCCP与对照组相比，急诊就诊次数均减少（分别为每1000名患者/季度15次和22次；P<0.01）。此外，与对照组相比，COME HOME的费用支出更低（每位患者/季度675美元；P<0.01），PCCP的住院次数更少（每1000名患者/季度11次；P<0.05）。在接受化疗的患者中，与对照患者相比，COME HOME和PCCP患者的急诊就诊次数更少（分别为每1000名患者/季度18次和28次；P<0.01），PCCP患者的住院次数更少（每1000名患者/季度13次；P<0.05）。
结论
肿瘤医疗之家和患者导航计划均显示出费用支出或医疗服务利用的减少。采用此类计划有望改善癌症护理。
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