Mayo Clinic, Primary Care Internal Medicine, 200 First Street SW, Rochester, MN 55905, USA.
Mayo Clinic, Center for the Science of Health Care Delivery, 200 First Street SW, Rochester, MN 55905, USA.
Healthc (Amst). 2018 Mar;6(1):52-66. doi: 10.1016/j.hjdsi.2017.09.001. Epub 2017 Sep 23.
Co-location of specialists in primary care has been suggested as an approach to reduce care fragmentation, inefficiency, and cost. We conducted a systematic review and meta-analysis evaluating the impact of co-located specialty care models in primary care settings.
Ovid Medline In-Process & Other Non-Indexed Citations, Ovid MEDLINE, Ovid EMBASE, Ovid Cochrane Central Register of Controlled Trials, Ovid Cochrane Database of Systematic Reviews, and Scopus was conducted through February 2015. A manual search of the included studies' bibliographies was conducted. Randomized controlled trials (RCTs) and observational studies reporting physically co-located specialties in primary care on the following outcomes were included: patient satisfaction; provider satisfaction; health care access and utilization; clinical outcomes, and costs.
Of 1620 articles, 22 studies met inclusion criteria, including 9 RCTs and 13 observational studies. Co-located care was observed to be associated with increased patient satisfaction (OR 2.04; 95% CI 1.04-3.98), primary care provider satisfaction (OR 6.49, 95% CI 4.28-9.85), and outpatient visits (OR 1.94; 95% CI 1.13-3.33). Co-located care was associated with reduced appointment wait time (OR 0.20, 95%CI 0.10 - 0.41). Reduced costs and improvement in quality of life and selected diabetes related outcomes were also observed. Evidence quality was limited by few studies, high risk of bias, and heterogeneity.
Co-located specialty care in primary care settings may support the aims of high value care delivery. However, additional studies are needed to further evaluate the value of co-location of specific specialties and stronger data on impact to health outcomes and cost.
将专家集中在初级保健中被认为是一种减少护理碎片化、提高效率和降低成本的方法。我们进行了一项系统评价和荟萃分析，评估了在初级保健环境中集中设置专科护理模式的影响。
通过 2015 年 2 月对 Ovid Medline In-Process & 其他非索引引文、Ovid MEDLINE、Ovid EMBASE、Ovid Cochrane 对照试验中心注册库、Ovid Cochrane 系统评价数据库和 Scopus 进行了检索。对纳入研究的参考文献进行了手工检索。纳入了在以下方面具有物理上集中的专科的随机对照试验（RCTs）和观察性研究：患者满意度；提供者满意度；医疗保健获取和利用；临床结果和成本。
在 1620 篇文章中，有 22 篇研究符合纳入标准，包括 9 项 RCTs 和 13 项观察性研究。集中护理与增加患者满意度（OR 2.04；95%CI 1.04-3.98）、初级保健提供者满意度（OR 6.49，95%CI 4.28-9.85）和门诊就诊次数（OR 1.94；95%CI 1.13-3.33）相关。集中护理与预约等待时间缩短（OR 0.20，95%CI 0.10-0.41）相关。还观察到降低成本以及改善生活质量和某些糖尿病相关结果。证据质量因研究数量较少、高偏倚风险和异质性而受到限制。
在初级保健环境中集中设置专科护理可能支持提供高价值护理的目标。然而，还需要进一步评估集中特定专科护理的价值以及对健康结果和成本的影响的更强数据。
