Boise VAMC Center of Excellence in Primary Care Education,, Medical Service, Boise, ID, USA.
University of Washington School of Medicine, Department of Medicine, Seattle, WA, USA.
Transl Behav Med. 2018 May 23;8(3):366-374. doi: 10.1093/tbm/ibx082.
There is need for effective venues to allow teams to coordinate care for high-risk or high-need patients. In addition, health systems need to assess the impact of such approaches on outcomes related to chronic health conditions and patient utilization. We evaluate the clinical impact of a novel case conference involving colocated trainees and supervisors in an interprofessional academic primary care clinic. The study utilized a prospective cohort with control group. Intervention patients (N = 104) were matched with controls (N = 104) from the same provider's panel using propensity scores based on age, gender, risk predictors, and prior utilization patterns. Clinical outcomes and subsequent utilization patterns were compared prior to and up to 6 months following the conference. In terms of utilization, intervention patients demonstrated increased visits with primary care team members (p = .0002) compared with controls, without a corresponding increase in the number of primary care providers' visits. There was a trend towards decreased urgent care and emergency visits (p = .07) and a significant decrease in the rate of hospitalizations (p = .04). Patients with poorly-controlled hypertension saw significant decreases in mean systolic blood pressure from 167 to 146 mm Hg. However, there were no differences between the intervention and control groups. Intervention patients with diabetes demonstrated a nonsignificant trend towards decreased hemoglobin A1c from 9.8 to 9.4, when compared with controls. Interprofessional case conferences have potential to improve care coordination and may be associated with improved disease management, decreased unplanned care, and overall reduced hospitalizations.
需要有效的场所，让团队能够协调高风险或高需求患者的护理。此外，卫生系统需要评估这些方法对与慢性健康状况和患者利用相关的结果的影响。我们评估了一种新型病例会议对跨专业学术初级保健诊所中合作培训生和主管的临床影响。该研究采用了前瞻性队列研究，对照组。干预组患者（N=104）与同一提供者小组中的对照组患者（N=104）进行了匹配，匹配的依据是年龄、性别、风险预测因素和先前的利用模式的倾向得分。在会议前和会议后 6 个月内比较了临床结果和随后的利用模式。在利用方面，与对照组相比，干预组患者与初级保健团队成员的就诊次数增加（p=0.0002），而初级保健提供者的就诊次数没有相应增加。急诊就诊和急诊就诊的趋势减少（p=0.07），住院率显著降低（p=0.04）。血压控制不佳的高血压患者的平均收缩压从 167 毫米汞柱降至 146 毫米汞柱，有显著下降。然而，干预组和对照组之间没有差异。与对照组相比，患有糖尿病的干预组患者的血红蛋白 A1c 从 9.8 降至 9.4，呈下降趋势，但无统计学意义。跨专业病例会议有可能改善护理协调，并可能与改善疾病管理、减少非计划性护理以及总体减少住院治疗有关。
