建立电话护理对医疗保健利用影响的模型。

Modeling the effects of telephone nursing on healthcare utilization.

机构信息

Department of Engineering Sciences and Mathematics, Luleå University of Technology, Sweden.

Department of Health Sciences, Luleå University of Technology, Sweden.

出版信息

Int J Med Inform. 2018 May;113:98-105. doi: 10.1016/j.ijmedinf.2018.02.004. Epub 2018 Feb 10.

DOI:10.1016/j.ijmedinf.2018.02.004

PMID:29976474

Abstract

BACKGROUND

Telephone nursing is the first line of contact for many care-seekers and aims at optimizing the performance of the healthcare system by supporting and guiding patients to the correct level of care and reduce the amount of unscheduled visits. Good statistical models that describe the effects of telephone nursing are important in order to study its impact on healthcare resources and evaluate changes in telephone nursing procedures.

OBJECTIVE

To develop a valid model that captures the complex relationships between the nurse's recommendations, the patients' intended actions and the patients' health seeking behavior. Using the model to estimate the effects of telephone nursing on patient behavior, healthcare utilization, and infer potential cost savings.

METHODS

Bayesian ordinal regression modeling of data from randomly selected patients that received telephone nursing. Inference is based on Markov Chain Monte Carlo (MCMC) methods, model selection using the Watanabe-Akaike Information Criteria (WAIC), and model validation using posterior predictive checks on standard discrepancy measures.

RESULTS AND CONCLUSIONS

We present a robust Bayesian ordinal regression model that predicts three-quarters of the patients' healthcare utilization after telephone nursing and we found no evidence of model deficiencies. A patient's compliance to the nurse's recommendation varies and depends on the recommended level of care, its agreement with and level of the patient's prior intention, and the availability of different care options at the time. The model reveals a risk reducing behavior among patients and the effect of the telephone nursing recommendation is 7 times higher than the effect of the patient's intended action prior to consultation if the recommendation is the highest level of care. But the effect of the nurse's recommendation is lower, or even non-existing, if the recommendation is self-care. Telephone nursing was found to have a constricting effect on healthcare utilization, however, the compliance to nurse's recommendation is closely tied to perceptions of risk, emphasizing the importance to address caller's needs of reassurance.

摘要

背景

电话护理是许多寻求护理者的第一联系点，旨在通过支持和指导患者获得正确的护理水平，减少非计划性就诊次数，从而优化医疗体系的运行。描述电话护理效果的良好统计模型对于研究其对医疗资源的影响以及评估电话护理程序的变化非常重要。

目的

开发一个有效的模型，捕捉护士建议、患者预期行动和患者寻求医疗行为之间的复杂关系。利用该模型来估计电话护理对患者行为、医疗保健利用的影响，并推断潜在的成本节约。

方法

对随机选择接受电话护理的患者数据进行贝叶斯有序回归建模。推理基于马尔可夫链蒙特卡罗（MCMC）方法，使用 Watanabe-Akaike 信息准则（WAIC）进行模型选择，并使用标准差异度量的后验预测检查进行模型验证。

结果和结论

我们提出了一个稳健的贝叶斯有序回归模型，该模型可以预测接受电话护理后四分之三的患者的医疗保健利用情况，且没有发现模型缺陷的证据。患者对护士建议的依从性各不相同，这取决于建议的护理水平、与患者先前意图的一致性及其水平，以及当时可用的不同护理选择。该模型揭示了患者的风险降低行为，如果建议是最高级别护理，那么电话护理建议的效果是患者咨询前预期行动的 7 倍。但如果建议是自我护理，那么建议的效果较低，甚至不存在。电话护理被发现对医疗保健利用有收缩作用，但对护士建议的依从性与对风险的认知密切相关，这强调了满足来电者的安心需求的重要性。