参与以儿科为重点的医疗之家学习协作项目与马萨诸塞州公共保险儿童可预防的急诊科就诊次数减少之间的关联。
Association between Practice Participation in a Pediatric-focused Medical Home Learning Collaborative and Reduction of Preventable Emergency Department Visits by Publicly-insured Children in Massachusetts.
作者信息
Kirby Paul B, Christensen Anna L, Bannister Louise, Konar Valerie
机构信息
Commonwealth Medicine Center for Health Policy and Research, University of Massachusetts Medical School, Quincy, Mass.
Mathematica Policy Research, Washington, D.C.
出版信息
Pediatr Qual Saf. 2018 Aug 10;3(5):e097. doi: 10.1097/pq9.0000000000000097. eCollection 2018 Sep-Oct.
INTRODUCTION
This study evaluates the impact of practice participation in a pediatric patient-centered medical home learning collaborative on preventable emergency department (ED) visits among children in MassHealth (Massachusetts Medicaid/Children's Health Insurance Program).
METHODS
Claims and enrollment data were extracted for child MassHealth members (aged 3-18) comprising 2 groups: members enrolled in a group of 13 child-serving practices that participated in an intensive, 29-month long patient-centered medical home learning collaborative (intervention group), and members enrolled in a group of 12 comparison practices with roughly similar panel size, type, and geographic location (comparison group). Preventable ED visits were identified using a modified version of the New York University ED algorithm. Two analyses were then conducted: (1) a repeat cross-sectional analysis among children enrolled in intervention or comparison group practices during baseline (first half of 2011) and follow-up (second half of 2013) periods; and (2) a longitudinal analysis among a subset of children enrolled for the full study period (2011-2013). Both analyses tested whether the effect of the intervention differed for children with versus without chronic conditions (effect modification).
RESULTS
Preventable ED visits declined from baseline to follow-up among children in both intervention and comparison practices. In the cross-sectional analysis, the decrease was the same in both practice groups, and for children with versus without chronic conditions. The longitudinal analysis shows a statistically significantly greater decrease among children with chronic conditions enrolled in the intervention practices ( = 0.02).
CONCLUSION
Children with chronic conditions might receive the greatest benefit from receiving care in a medical home setting.
引言
本研究评估了参与以儿科患者为中心的医疗之家学习协作项目对马萨诸塞医疗补助计划（马萨诸塞州医疗补助/儿童健康保险计划）覆盖儿童中可预防的急诊就诊情况的影响。
方法
提取了儿童马萨诸塞医疗补助计划参保者（3至18岁）的理赔和参保数据，这些参保者分为两组：一组是13家为儿童服务的医疗机构的参保者，这些机构参与了为期29个月的强化型以患者为中心的医疗之家学习协作项目（干预组）；另一组是12家对照医疗机构的参保者，这些对照医疗机构在规模、类型和地理位置上大致相似（对照组）。使用纽约大学急诊算法的修改版来确定可预防的急诊就诊情况。然后进行了两项分析：（1）对在基线期（2011年上半年）和随访期（2013年下半年）参与干预组或对照组医疗机构的儿童进行重复横断面分析；（2）对在整个研究期（2011 - 2013年）内入组的部分儿童进行纵向分析。两项分析均检验了干预效果在有慢性疾病和无慢性疾病儿童之间是否存在差异（效应修正）。
结果
干预组和对照组医疗机构的儿童中，可预防的急诊就诊情况从基线期到随访期均有所下降。在横断面分析中，两个医疗机构组以及有慢性疾病和无慢性疾病的儿童中下降情况相同。纵向分析显示，参与干预性医疗机构的有慢性疾病儿童的下降幅度在统计学上显著更大（P = 0.02）。
结论
患有慢性疾病的儿童可能从在医疗之家环境中接受护理中获益最大。
Zotero 插件