Joseph Tanenbaum (
Randall D. Cebul is emeritus professor of medicine and of population and quantitative health sciences in the School of Medicine, Case Western Reserve University, and senior scholar in the Center for Health Care Research and Policy, Case Western Reserve University at MetroHealth Medical Center, in Cleveland.
Health Aff (Millwood). 2018 Feb;37(2):266-274. doi: 10.1377/hlthaff.2017.1209.
Although regional health improvement collaboratives have been adopted nationwide to improve primary care quality, their effects on avoidable hospitalizations and costs remain unclear. We quantified the association of the Better Health Partnership, a primary care-led regional health improvement collaborative operating in Cuyahoga County, Ohio (Cleveland and surrounding suburbs), with hospitalization rates for ambulatory care-sensitive conditions. The partnership uses a positive deviance approach to identify, disseminate publicly, and accelerate adoption of best practices for care of patients with diabetes, heart failure, and hypertension. Using a difference-in-differences approach, we compared rates of hospitalizations for ambulatory care-sensitive conditions in six Ohio counties before (2003-08) and after (2009-14) the establishment of the partnership. Age- and sex-adjusted hospitalization rates for targeted ambulatory care-sensitive conditions in Cuyahoga County declined significantly more than the rates in the comparator counties in 2009-11 (106 fewer hospitalizations per 100,000 adult residents) and 2012-14 (91 fewer hospitalizations). We estimated that 5,746 hospitalizations for ambulatory care-sensitive conditions were averted in 2009-14, leading to cost savings of nearly $40 million.
虽然区域卫生改善合作组织已在全国范围内采用，以提高初级保健质量，但它们对可避免住院和成本的影响仍不清楚。我们量化了“更好的健康伙伴关系”（Better Health Partnership）的关联，这是一个在俄亥俄州凯霍加县（克利夫兰及其周边郊区）开展的以初级保健为主导的区域卫生改善合作组织。该伙伴关系采用积极偏差方法，确定、公开传播和加速采用治疗糖尿病、心力衰竭和高血压患者的最佳实践。我们使用差异中的差异方法，比较了在该伙伴关系建立之前（2003-08 年）和之后（2009-14 年），俄亥俄州六个县的门诊保健敏感条件的住院率。2009-11 年（每 10 万成年居民减少 106 例住院）和 2012-14 年（每 10 万成年居民减少 91 例住院），凯霍加县针对目标门诊保健敏感条件的年龄和性别调整后住院率明显下降。我们估计，2009-14 年避免了 5746 例门诊保健敏感条件住院治疗，节省了近 4000 万美元的成本。
