Centers of Excellence in Substance Addiction Treatment and Education, Veterans Affairs (VA) Puget Sound Health Care System, Seattle, and Corporal Michael J. Crescenz VA Medical Center, Philadelphia (Browne); Center of Innovation for Veteran-Centered and Value-Driven Care, Health Services Research and Development, VA Puget Sound Health Care System (Hoerster, Fortney, Nelson); Department of Psychiatry and Behavioral Sciences (Browne, Hoerster, Fortney) and School of Medicine (Nelson, Fihn), University of Washington, Seattle; Office of Clinical Systems Development and Evaluation, Veterans Health Administration (VHA), Washington, D.C. (Piegari); VA Ann Arbor Health Care System, Ann Arbor, Michigan (Post); VHA Office of Primary Care, Primary Care Analytics Team (PCAT), Seattle (Mori); Center for Innovation to Implementation, Palo Alto Health Care System, Palo Alto, California, and Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California (Trivedi).
Psychiatr Serv. 2019 Sep 1;70(9):816-823. doi: 10.1176/appi.ps.201800474. Epub 2019 Jul 16.
This study sought to compare quality of care following medical home implementation among Veterans Health Administration (VHA) primary care patients with and without mental illness.
VHA primary care patients seen between April 2010 and March 2013 whose medical records were reviewed by the VHA External Peer Review Program were identified. The proportion of patients meeting quality indicators in each mental illness group (depression, posttraumatic stress disorder, anxiety disorder, substance use disorder, serious mental illness, and any mental illness) was compared with the proportion of patients without mental illness. Sample sizes ranged from 210,864 to 236,421. Differences of 5.0% or greater were deemed clinically important, and higher proportions indicated higher quality of care across 33 clinical indicators.
The proportion of veterans meeting clinical quality indicators ranged from 64.7% to 99.6%. Differences of ≥5.0% between veterans with and without mental illness were detected in six of 33 indicators. A greater proportion of veterans with mental illness received influenza immunizations (age 50-64) and had documented left ventricular functioning (among veterans with chronic heart failure) compared with veterans without mental illness. A lower proportion of veterans with substance use disorders or severe mental illness received colorectal cancer screening or met indicators related to recommended medications if diagnosed as having diabetes or ischemic heart disease.
Contrary to earlier reports of lower-quality care, patients with and without mental illness had similar preventive and chronic disease management care quality following medical home implementation.
本研究旨在比较医疗之家实施后，退伍军人健康管理局（VHA）初级保健患者有无精神疾病的护理质量。
确定了 2010 年 4 月至 2013 年 3 月期间接受 VHA 外部同行审查计划审查其病历的 VHA 初级保健患者。在每个精神疾病组（抑郁症、创伤后应激障碍、焦虑症、物质使用障碍、严重精神疾病和任何精神疾病）中，符合质量指标的患者比例与无精神疾病的患者比例进行了比较。样本量范围从 210864 到 236421。差异 5.0%或更大被认为具有临床意义，较高的比例表示在 33 个临床指标中护理质量更高。
符合临床质量指标的退伍军人比例为 64.7%至 99.6%。在 33 个指标中的 6 个指标中，发现有精神疾病的退伍军人与无精神疾病的退伍军人之间存在≥5.0%的差异。与无精神疾病的退伍军人相比，更多患有精神疾病的退伍军人接受了流感免疫接种（50-64 岁），并记录了左心室功能（在患有慢性心力衰竭的退伍军人中）。患有物质使用障碍或严重精神疾病的退伍军人接受结直肠癌筛查或符合建议药物治疗的指标的比例较低，如果被诊断患有糖尿病或缺血性心脏病。
与早期报告的护理质量较低相反，在医疗之家实施后，有和没有精神疾病的患者具有相似的预防和慢性疾病管理护理质量。
