Solberg Leif I, Ohnsorg Kris A, Parker Emily D, Ferguson Robert, Magnan Sanne, Whitebird Robin R, Neely Claire, Brandenfels Emily, Williams Mark D, Dreskin Mark, Hinnenkamp Todd, Ziegenfuss Jeanette Y
Director for Care Improvement Research for the HealthPartners Institute in Minneapolis, MN.
Project Manager for the HealthPartners Institute in Minneapolis, MN.
Perm J. 2018;22:17-102. doi: 10.7812/TPP/17-102.
There are few proven strategies to reduce the frequency of potentially preventable hospitalizations and Emergency Department (ED) visits. To facilitate strategy development, we documented these events among complex patients and the factors that contribute to them in a large care-improvement initiative.
Observational study with retrospective audits and selective interviews by the patients' care managers among 12 diverse medical groups in California, Minnesota, Pennsylvania, and Washington that participated in an initiative to implement collaborative care for patients with both depression and either uncontrolled diabetes, uncontrolled hypertension, or both. We reviewed information about 373 adult patients with the required conditions who belonged to these medical groups and had experienced 389 hospitalizations or ED visits during the 12-month study period from March 30, 2014, through March 29, 2015. The main outcome measures were potentially preventable hospitalizations or ED visit events.
Of the studied events, 28% were considered to be potentially preventable (39% of ED visits and 14% of hospitalizations) and 4.6% of patients had 40% of events. Only type of insurance coverage; patient lack of resources, caretakers, or understanding of care; and inability to access clinic care were more frequent in those with potentially preventable events. Neither disease control nor ambulatory care-sensitive conditions were associated with potentially preventable events.
Among these complex patients, patient characteristics, disease control, and the presence of ambulatory care-sensitive conditions were not associated with likelihood of ED visits or hospital admissions, including those considered to be potentially preventable. The current focus on using ambulatory care-sensitive conditions as a proxy for potentially preventable events needs further evaluation.
几乎没有经过验证的策略可降低潜在可预防的住院频率和急诊就诊次数。为推动策略制定，我们在一项大型改善护理计划中记录了复杂患者中的这些事件以及导致这些事件的因素。
进行观察性研究，由患者的护理经理对加利福尼亚州、明尼苏达州、宾夕法尼亚州和华盛顿州的12个不同医疗组进行回顾性审计和选择性访谈，这些医疗组参与了一项为患有抑郁症且患有未控制的糖尿病、未控制的高血压或两者兼有的患者实施协作护理的计划。我们审查了属于这些医疗组且在2014年3月30日至2015年3月29日的12个月研究期间经历了389次住院或急诊就诊的373名成年患者的信息。主要结局指标为潜在可预防的住院或急诊就诊事件。
在研究的事件中，28%被认为是潜在可预防的（急诊就诊的39%和住院的14%），4.6%的患者发生了40%的事件。在发生潜在可预防事件的患者中，仅保险类型、患者缺乏资源、护理人员或对护理的理解以及无法获得门诊护理的情况更为常见。疾病控制和非卧床护理敏感状况均与潜在可预防事件无关。
在这些复杂患者中，患者特征、疾病控制和非卧床护理敏感状况的存在与急诊就诊或住院的可能性无关，包括那些被认为是潜在可预防的情况。目前将非卧床护理敏感状况用作潜在可预防事件替代指标的做法需要进一步评估。
