Talley Michele H, Polancich Shea, Williamson Jason B, Frank Jennifer S, Curry William, Russell John F, Selleck Cynthia
1 Department of Adult/Acute Health, Chronic Care and Foundations, University of Alabama at Birmingham School of Nursing , Birmingham, Alabama.
2 Improvement, Innovation and Analytics and Nursing Administration, University of Alabama at Birmingham Hospital , Birmingham, Alabama.
Popul Health Manag. 2018 Oct;21(5):373-377. doi: 10.1089/pop.2017.0170. Epub 2018 Feb 13.
Diabetes is a leading cause of morbidity and mortality; prevalence of diabetes is especially high in the southeastern United States among minority populations and those from lower socioeconomic sectors without access to health care services. The purpose of this project was to evaluate the clinical and financial outcomes of a nurse-led, interprofessional collaborative practice model that provides care coordination and transitional care for uninsured patients with diabetes. Data for this study were collected and evaluated from medical records of patients seen at the Providing Access to Health Care (PATH) Clinic between August 1, 2015, through May 30, 2017. Clinical outcomes were evaluated by comparing hemoglobin A1c (HbA1c) values before and after referral to the PATH Clinic. Cost savings to the academic medical center were evaluated by comparing costs associated with inpatient or emergency department encounters before and after referral to the PATH Clinic. A significant decrease in HbA1c (P < .0005) was noted for patients attending the PATH Clinic. In addition, financial analyses revealed a 55% decrease in pre to post PATH Clinic patients' direct costs. Similarly, a 42% decrease in the pre to post PATH Clinic patients' direct cost per encounter was noted. Average length of stay also was reduced when these patients were readmitted to the academic medical center. Results from this study support the effectiveness of the PATH Clinic model in caring for uninsured patients with clinically complex medical and social needs, often with behavioral health problems, who incur high health care spending and are often readmitted.
糖尿病是发病和死亡的主要原因；在美国东南部，少数族裔以及社会经济地位较低且无法获得医疗服务的人群中，糖尿病的患病率尤其高。本项目的目的是评估一种由护士主导的跨专业协作实践模式的临床和财务成果，该模式为未参保的糖尿病患者提供护理协调和过渡性护理。本研究的数据收集自2015年8月1日至2017年5月30日期间在“提供医疗服务途径”（PATH）诊所就诊的患者的病历，并进行了评估。通过比较转诊至PATH诊所前后的糖化血红蛋白（HbA1c）值来评估临床结果。通过比较转诊至PATH诊所前后与住院或急诊科就诊相关的费用，评估学术医疗中心的成本节约情况。在PATH诊所就诊的患者的HbA1c显著下降（P < 0.0005）。此外，财务分析显示，PATH诊所患者转诊前后的直接成本下降了55%。同样，PATH诊所患者每次就诊的直接成本在转诊前后下降了42%。当这些患者再次入住学术医疗中心时，平均住院时间也缩短了。本研究结果支持了PATH诊所模式在照顾未参保的、临床医疗和社会需求复杂（通常伴有行为健康问题）、医疗保健支出高且经常再次入院的患者方面的有效性。
