临床医生在养老院护理方面的专业化与养老院临床质量评分之间的关联。
Association Between Clinician Specialization in Nursing Home Care and Nursing Home Clinical Quality Scores.
机构信息
Division of General Internal Medicine, University of Pennsylvania, Philadelphia, PA; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA.
Division of General Internal Medicine, University of Pennsylvania, Philadelphia, PA.
出版信息
J Am Med Dir Assoc. 2019 Aug;20(8):1007-1012.e2. doi: 10.1016/j.jamda.2018.12.017. Epub 2019 Feb 7.
IMPORTANCE
While the number of prescribing clinicians (physicians and nurse practitioners) who provide any nursing home care remained stable over the past decade, the number of clinicians who focus their practice exclusively on nursing home care has increased by over 30%.
OBJECTIVES
To measure the association between regional trends in clinician specialization in nursing home care and nursing home quality.
DESIGN
Retrospective cross-sectional study.
SETTING AND PARTICIPANTS
Patients treated in 15,636 nursing homes in 305 US hospital referral regions between 2013 and 2016.
MEASURES
Clinician specialization in nursing home care for 2012-2015 was measured using Medicare fee-for-service billings. Nursing home specialists were defined as generalist physicians (internal medicine, family medicine, geriatrics, and general practice) or advanced practitioners (nurse practitioners and physician assistants) with at least 90% of their billings for care in nursing homes. The number of clinicians was aggregated at the hospital referral region level and divided by the number of occupied Medicare-certified nursing home beds. Nursing Home Compare quality measure scores for 2013-2016 were aggregated at the HHR level, weighted by occupied beds in each nursing home in the hospital referral region. We measured the association between the number of nursing home specialists per 1000 beds and the clinical quality measure scores in the subsequent year using linear regression.
RESULTS
An increase in nursing home specialists per 1000 occupied beds in a region was associated with lower use of long-stay antipsychotic medications and indwelling bladder catheters, higher prevalence of depressive symptoms, and was not associated with urinary tract infections, use of restraints, or short-stay antipsychotic use.
CONCLUSIONS AND IMPLICATIONS
Higher prevalence of nursing home specialists was associated with regional improvements in 2 of 6 quality measures. Future studies should evaluate whether concentrating patient care among clinicians who specialize in nursing home practice improves outcomes for individual patients. The current findings suggest that prescribing clinicians play an important role in nursing home care quality.
重要性
尽管过去十年为所有养老院提供护理的开处方临床医生（医生和执业护士）人数保持稳定，但专门从事养老院护理的临床医生人数增加了 30%以上。
目的
衡量临床医生在养老院护理方面的专业化区域趋势与养老院质量之间的关联。
设计
回顾性横截面研究。
地点和参与者
2013 年至 2016 年间，在 305 个美国医院转诊区域的 15636 家养老院接受治疗的患者。
措施
使用医疗保险按服务收费计费来衡量 2012-2015 年养老院护理的临床医生专业化程度。养老院专家被定义为普通医生（内科、家庭医学、老年医学和全科医学）或高级从业人员（执业护士和医师助理），其至少 90%的计费用于养老院护理。临床医生人数按医院转诊区域级别汇总，并按医院转诊区域内每个养老院的入住床位数进行划分。2013-2016 年的疗养院比较质量测量分数在 HHR 级别进行汇总，按每个医院转诊区域内的疗养院入住床位加权。我们使用线性回归衡量每千张床位的养老院专家人数与下一年临床质量测量得分之间的关联。
结果
一个地区每千张床位养老院专家人数的增加与长期使用抗精神病药物和留置导尿管的减少、抑郁症状的患病率增加有关，与尿路感染、使用约束带或短期使用抗精神病药物无关。
结论和意义
养老院专家人数的增加与 6 项质量指标中的 2 项区域改善有关。未来的研究应评估是否将患者护理集中在专门从事养老院实践的临床医生中，是否可以改善个体患者的结果。目前的研究结果表明，开处方的临床医生在养老院护理质量中发挥着重要作用。
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