University of California, Berkeley, 50 University Hall, MC7360, Berkeley, CA 94720. E-mail:
Am J Manag Care. 2017 Oct;23(10):596-603.
In 2011, the California Right Care Initiative implemented a countywide physician organization learning collaborative called University of Best Practices (UBP) in San Diego County for major healthcare systems and physician organizations to share best practices in managing cardiovascular and cerebrovascular risk factors. Our objective was to examine whether UBP was associated with fewer hospitalizations for heart attacks and strokes.
A quasi-experimental design was used to compare age-adjusted adult hospitalization rates before UBP initiation (2007-2010) against rates after UBP initiation (2011-2014) in San Diego County versus the rest of California.
Difference-in-differences (DID) logistic regression models were estimated using hospitalization data from the California Office of Statewide Health Planning and Development for 2007 to 2014, including 372,205 and 642,455 hospitalizations for heart attacks and strokes, respectively.
In the UBP versus pre-UBP period, the odds of adults being hospitalized for a heart attack in San Diego County decreased (odds ratio [OR], 0.84), whereas the odds stayed the same for adults in the rest of California (OR, 1.00): DID ratio of OR, 0.84 (P <.001). This relative decrease was equivalent to 2735 (or 16.5%) fewer hospitalizations, totaling $61 million (2014 dollars). No robust association was found between UBP implementation and hospitalizations for strokes.
A countywide physician organization learning collaborative was associated with fewer hospitalizations for heart attacks, but not for strokes. Healthcare systems and physician organizations should consider forming collaboratives to share best practices to manage patients' cardiovascular and cerebrovascular risk factors, which may lead to fewer hospitalizations and reduced healthcare costs.
2011 年，加利福尼亚州“正确护理倡议”（California Right Care Initiative）在圣地亚哥县实施了一项名为“最佳实践大学”（University of Best Practices，UBP）的全县医师组织学习合作项目，旨在让各大医疗保健系统和医师组织分享管理心血管和脑血管风险因素的最佳实践。我们的目标是检验 UBP 是否与心脏病发作和中风的住院人数减少有关。
采用准实验设计，比较圣地亚哥县 UBP 启动前（2007-2010 年）和启动后（2011-2014 年）的成人住院率，与加利福尼亚州其他地区进行对比。
使用加利福尼亚州全州卫生规划与发展办公室 2007 年至 2014 年的住院数据，采用差异中的差异（Difference-in-differences，DID）逻辑回归模型进行分析，包括心脏病发作和中风分别为 372205 例和 642455 例的住院数据。
在 UBP 与 UBP 前时期，圣地亚哥县成年人因心脏病发作住院的几率下降（比值比[odds ratio，OR]为 0.84），而加利福尼亚州其他地区的成年人几率保持不变（OR 为 1.00）：OR 的 DID 比值为 0.84（P<0.001）。这种相对下降相当于 2735 例（或 16.5%）住院人数减少，总计节省 6100 万美元（2014 年美元）。未发现 UBP 实施与中风住院之间存在明显关联。
全县医师组织学习合作与心脏病发作住院人数减少有关，但与中风无关。医疗保健系统和医师组织应考虑建立合作关系，分享管理患者心血管和脑血管风险因素的最佳实践，这可能会减少住院人数并降低医疗保健成本。
