Agana Denny Fe G, Salemi Jason L, Striley Catherine W
Baylor College of Medicine, Department of Family and Community Medicine, 3701 Kirby Drive, Suite 600, Mailstop: BCM700, Houston, TX 77098, United States of America.
University of Florida, Department of Epidemiology, 2004 Mowry Road, PO Box 100231, Gainesville, FL 32610, United States of America.
Prev Med Rep. 2019 Mar 15;14:100848. doi: 10.1016/j.pmedr.2019.100848. eCollection 2019 Jun.
The high-risk strategy in prevention has remained the preferred approach in health care. High-profile research predominantly emphasizes specific high-risk subgroups such as those who have extremely high cholesterol and super-utilizers of emergency departments. Dr. Geoffrey Rose's alternative population approach, though well established in principle, has failed to come to fruition in primary care research, aside from a few exceptions. The population approach extends intervention efforts to more moderate-risk people, attempting to shift the overall distribution in a positive direction, effecting change in more of the population. Despite requiring more initial investment due to the larger target group, the health-related gains and downstream cost savings through a population strategy may yield greater long-term cost-effectiveness than the high-risk strategy. We describe the example of extending prevention efforts from super-utilizers (e.g. those with ≥3 readmissions per year) to include those who readmit in moderate frequency (1-2 per year) in terms of potential hospital days and associated medical costs averted.
预防中的高风险策略一直是医疗保健领域的首选方法。备受瞩目的研究主要强调特定的高风险亚组，如那些胆固醇极高的人群以及急诊部门的超级使用者。杰弗里·罗斯博士的另一种人群方法，尽管在原则上已确立，但除了少数例外情况，在初级保健研究中尚未取得成果。人群方法将干预努力扩展到风险程度更为中等的人群，试图朝着积极方向改变总体分布，从而使更多人群发生改变。尽管由于目标群体较大，人群策略需要更多的初始投资，但通过该策略获得的与健康相关的收益以及下游成本节省，可能会比高风险策略产生更高的长期成本效益。我们以将预防努力从超级使用者（例如每年住院≥3次的人群）扩展到中等频率住院者（每年1 - 2次）为例，阐述其在潜在住院天数和避免的相关医疗成本方面的情况。
