一种基于社区的创新模式，用于改善农村县的预防保健服务。
An Innovative Community-based Model for Improving Preventive Care in Rural Counties.
作者信息
Nagykaldi Zsolt J, Scheid Dewey, Zhao Daniel, Mishra Bhawani, Greever-Rice Tracy
机构信息
From the College of Medicine, Department of Family and Preventive Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK (ZJN, DS); College of Public Health, Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, Oklahoma City (DZ); Division of Applied Social Sciences, Office of Social and Economic Data Analysis, University of Missouri, Columbia, MO (BM, TGR)
From the College of Medicine, Department of Family and Preventive Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK (ZJN, DS); College of Public Health, Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, Oklahoma City (DZ); Division of Applied Social Sciences, Office of Social and Economic Data Analysis, University of Missouri, Columbia, MO (BM, TGR).
出版信息
J Am Board Fam Med. 2017 Sep-Oct;30(5):583-591. doi: 10.3122/jabfm.2017.05.170035.
OBJECTIVE
This quasi-experimental pilot study aimed to implement and evaluate a sustainable, rural community-based patient outreach model for preventive care provided through primary care practices (PCPs) located in a rural county in Oklahoma. A Wellness Coordinator (WC) working with PCPs, the county health department, the county hospital, and a health information exchange (HIE) organization helped county residents receive evidence-based preventive services.
METHODS
The WC used a community wellness registry connected to electronic medical records via HIE and called patients at the county level based on PCP-prioritized and tailored protocols. The registry flagged patient-level preventive care gaps, tracked outreach efforts, and documented the delivery of preventive services throughout the community. Return on investment (ROI) for prioritized preventive services was estimated in participating organizations.
RESULTS
Six of the 7 PCPs in the county expressed interest in the project. Three of these practices fully implemented the 1-year outreach program starting in mid 2015. The regional HIE supplied periodic data updates for 9138 county residents to help the coordinators address care gaps using the community registry. A total of 5034 outreach calls were made by the WC in the first year and 7776 prioritized recommendations were offered when care gaps were detected. Of the 5034 distinct patients who received a call, 1146 (22%) were up to date on all prioritized services, whereas 3888 (78%) were due for at least 1 of the selected services. Health care organizations in the county significantly improved the delivery of selected preventive services (mean increase, 35% across 10 services; = .004; range, 3% to 215%) and realized a mean ROI of 80% for these services (range, 32% to 122%). The health system that employed the WC earned an estimated revenue of $52,000 realizing a 40% ROI for the coordinator position.
CONCLUSIONS
Although more research is needed, our pilot study suggests that it may be feasible and cost effective to implement an innovative, county-level patient outreach program for improving preventive care in rural settings.
目的
本准实验性试点研究旨在实施并评估一种可持续的、基于农村社区的患者外展模式，该模式通过位于俄克拉荷马州一个农村县的基层医疗实践（PCP）提供预防性护理。一名健康协调员（WC）与基层医疗医生、县卫生部门、县医院以及一个健康信息交换（HIE）组织合作，帮助该县居民获得循证预防性服务。
方法
WC使用通过HIE与电子病历相连的社区健康登记册，并根据基层医疗医生优先排序和量身定制的方案在县级层面给患者打电话。该登记册标记出患者层面的预防性护理缺口，跟踪外展工作，并记录整个社区预防性服务的提供情况。对参与组织中优先预防性服务的投资回报率（ROI）进行了估算。
结果
该县7名基层医疗医生中有6名对该项目表示感兴趣。其中3家医疗机构从2015年年中开始全面实施了为期1年的外展项目。地区HIE为9138名县居民提供定期数据更新，以帮助协调员利用社区登记册解决护理缺口。WC在第一年共拨打了5034次外展电话，在发现护理缺口时提供了7776条优先建议。在接到电话的5034名不同患者中，1146名（22%）所有优先服务均已完成，而3888名（78%）至少有一项选定服务到期。该县的医疗保健组织显著改善了选定预防性服务的提供情况（10项服务的平均增幅为35%；P = .004；范围为3%至215%），这些服务的平均投资回报率为80%（范围为从32%至122%）。雇佣WC的卫生系统获得了约52,000美元的收入，协调员职位的投资回报率为40%。
结论
尽管还需要更多研究，但我们的试点研究表明，实施一项创新的县级患者外展项目以改善农村地区的预防性护理可能是可行且具有成本效益的。
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