Almalki Ziyad S, Alotaibi Abrar A, Alzaidi Wejdan S, Alghamdi Afnan A, Bahowirth Abdulrahman M, Alsalamah Noura M
Department of Clinical Pharmacy, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Al-Kharj, Riyadh, Saudi Arabia,
Department of Clinical Pharmacy, College of Pharmacy, Taif University, Taif, Mecca, Saudi Arabia.
Clinicoecon Outcomes Res. 2018 Oct 31;10:665-673. doi: 10.2147/CEOR.S179337. eCollection 2018.
Despite the strong evidence of an association between adoption of the patient-centered medical home (PCMH) and improved clinical outcomes among patients with hypertension, evidence for associations between the PCMH and health care utilization and cost reduction within the general adult population with hypertension is less developed.
This study was designed to examine the effect of PCMH on health service expenditures and utilization in a national sample of the US adult population who were diagnosed with hypertension.
The 2010-2015 Medical Expenditure Panel Survey data were used. The study sample was limited to adults (≥18 years) diagnosed with essential hypertension. We investigated the impact of PCMH on the direct hypertension-related total and on the costs of inpatient stays, prescription medications, outpatient visits, emergency room visits, office-based services, and other medical expenditures by using log-transformed multiple linear regression models and the propensity score method.
Of the 18,630 adults identified with hypertension, 19.2% (n=3,583) of them had received PCMH care from 2010 to 2015. After matching, the no PCMH group showed greater mean in all hypertension-related health service costs and utilization. After adjusting for the remaining con-founders, the PCMH group showed a significant association with lower total costs, office-based services, number of office-based visits, and outpatient visits compared with the control group.
A significant relationship between experiencing PCMH care and a lower total health care expenditure was found in patients with hypertension.
尽管有充分证据表明采用以患者为中心的医疗之家（PCMH）与高血压患者临床结局改善之间存在关联，但关于PCMH与普通成年高血压患者医疗保健利用及成本降低之间关联的证据尚不充分。
本研究旨在调查PCMH对美国成年高血压患者全国样本的医疗服务支出和利用情况的影响。
使用2010 - 2015年医疗支出面板调查数据。研究样本限于诊断为原发性高血压的成年人（≥18岁）。我们通过使用对数转换的多元线性回归模型和倾向得分法，研究了PCMH对直接高血压相关总费用以及住院、处方药、门诊就诊、急诊就诊、门诊服务和其他医疗支出费用的影响。
在18,630名确诊为高血压的成年人中，19.2%（n = 3,583）在2010年至2015年期间接受了PCMH护理。匹配后，非PCMH组在所有高血压相关医疗服务成本和利用方面的均值更高。在对其余混杂因素进行调整后，与对照组相比，PCMH组在总费用、门诊服务、门诊就诊次数和门诊就诊方面显示出显著较低的关联。
在高血压患者中发现接受PCMH护理与较低的总医疗保健支出之间存在显著关系。
