RAND Corporation, Boston, MA, USA.
Boston University School of Medicine, Boston, MA, USA.
J Gen Intern Med. 2019 Jan;34(1):82-89. doi: 10.1007/s11606-018-4718-x. Epub 2018 Oct 26.
Regular primary care visits may allow an opportunity to deliver high-value, proactive care. However, no previous study has examined whether more temporally regular primary care visits predict better outcomes.
To examine the relationship between the temporal regularity of primary care (PC) visits and outcomes.
Retrospective cohort study.
We used Medicare claims for 378,862 fee-for-service Medicare beneficiaries, who received PC at 1328 federally qualified health centers from 2010 to 2014.
We created five beneficiary groups based upon their annual number of PC visits. We further subdivided those groups according to whether PC visits occurred with more or less regularity than the median value. We compared these 10 subgroups on three outcomes, adjusting for beneficiary characteristics: emergency department (ED) visits, hospitalizations, and total Medicare expenditures. We also aggregated to the clinic level and divided clinics into tertiles of more, less, and similarly regular to predicted. We compared these three groups of clinics on the same three outcomes of care.
Within each visit frequency group, beneficiaries in the subgroup with fewer regular visits had more ED visits, more hospitalizations, and higher costs. Among beneficiaries with the most frequent PC visits, the less regular subgroup had more ED visits (1.70 vs. 1.31 per person-year), more hospitalizations (0.69 vs. 0.57), and greater Medicare expenditures ($20,731 vs. $17,430, p < 0.001 for all comparisons). Clinics whose PC visits were more regular than predicted also had better outcomes than other clinics, although the effect sizes were smaller.
Temporal patterns of PC visits are correlated with outcomes, even among beneficiaries who appear otherwise similar. Measuring the temporal regularity of PC visits may be useful for identifying beneficiaries at risk for adverse events, and as a barometer for and an impetus to clinic-level quality improvement.
定期的初级保健就诊可能为提供高价值的主动护理提供机会。然而，以前没有研究检验过就诊时间的规律性是否与更好的结果相关。
检验初级保健（PC）就诊时间的规律性与结果之间的关系。
回顾性队列研究。
我们使用了 Medicare 索赔数据，包括 2010 年至 2014 年在 1328 家合格的联邦健康中心接受 PC 的 378862 名付费 Medicare 受益人群。
我们根据患者每年接受 PC 就诊的次数将患者分为 5 组。然后，我们根据就诊时间的规律性，将这些组进一步细分为就诊时间更规律或更不规律的亚组。我们比较了这 10 个亚组在 3 种结果上的差异，调整了受益人的特征：急诊就诊、住院和 Medicare 总支出。我们还将就诊情况汇总到诊所水平，并将诊所分为就诊时间更规律、更不规律和类似规律的 3 个组。我们比较了这 3 组诊所的 3 种医疗结果。
在每个就诊频率组内，就诊时间更不规律的亚组患者的急诊就诊次数更多、住院次数更多、医疗费用更高。在 PC 就诊最频繁的受益人群中，就诊时间更不规律的亚组患者的急诊就诊次数更多（1.70 次/人年比 1.31 次/人年）、住院次数更多（0.69 次比 0.57 次）、 Medicare 支出更高（20731 美元比 17430 美元，所有比较均 P<0.001）。就诊时间比预测的更规律的诊所也比其他诊所的医疗结果更好，尽管效果大小较小。
即使在其他方面相似的受益人群中，PC 就诊的时间模式也与结果相关。测量 PC 就诊时间的规律性可能有助于识别有不良事件风险的患者，并且可以作为诊所层面质量改进的指标和动力。
