一项全国性护理协调项目对降低高成本、高需求糖尿病医疗补助受益人的医疗服务利用率的评估。
Evaluation of a National Care Coordination Program to Reduce Utilization Among High-cost, High-need Medicaid Beneficiaries With Diabetes.
作者信息
Duru O Kenrik, Harwood Jessica, Moin Tannaz, Jackson Nicholas J, Ettner Susan L, Vasilyev Arseniy, Mosley David G, O'Shea Donna L, Ho Sam, Mangione Carol M
机构信息
David Geffen School of Medicine, UCLA.
VA Greater Los Angeles Healthcare System.
出版信息
Med Care. 2020 Jun;58 Suppl 6 Suppl 1(Suppl 6 1):S14-S21. doi: 10.1097/MLR.0000000000001315.
BACKGROUND
Medical, behavioral, and social determinants of health are each associated with high levels of emergency department (ED) visits and hospitalizations.
OBJECTIVE
The objective of this study was to evaluate a care coordination program designed to provide combined "whole-person care," integrating medical, behavioral, and social support for high-cost, high-need Medicaid beneficiaries by targeting access barriers and social determinants.
RESEARCH DESIGN
Individual-level interrupted time series with a comparator group, using person-month as the unit of analysis.
SUBJECTS
A total of 42,214 UnitedHealthcare Medicaid beneficiaries (194,834 person-months) age 21 years or above with diabetes, with Temporary Assistance to Needy Families, Medicaid expansion, Supplemental Security Income without Medicare, or dual Medicaid/Medicare.
MEASURES
Our outcome measures were any hospitalizations and any ED visits in a given month. Covariates of interest included an indicator for intervention versus comparator group and indicator and spline variables measuring changes in an outcome's time trend after program enrollment.
RESULTS
Overall, 6 of the 8 examined comparisons were not statistically significant. Among Supplemental Security Income beneficiaries, we observed a larger projected decrease in ED visit risk among the intervention sample versus the comparator sample at 12 months postenrollment (difference-in-difference: -6.6%; 95% confidence interval: -11.2%, -2.1%). Among expansion beneficiaries, we observed a greater decrease in hospitalization risk among the intervention sample versus the comparator sample at 12 months postenrollment (difference-in-difference: -5.8%; 95% confidence interval: -11.4%, -0.2%).
CONCLUSION
A care coordination program designed to reduce utilization among high-cost, high-need Medicaid beneficiaries was associated with fewer ED visits and hospitalizations for patients with diabetes in selected Medicaid programs but not others.
背景
健康的医学、行为和社会决定因素均与急诊就诊和住院的高发生率相关。
目的
本研究的目的是评估一项护理协调项目，该项目旨在通过针对获取障碍和社会决定因素，为高成本、高需求的医疗补助受益人群提供综合的“全人护理”，整合医学、行为和社会支持。
研究设计
采用个体水平的间断时间序列设计，并设置一个对照组，以人月作为分析单位。
研究对象
共有42214名联合健康医疗补助计划的受益人群（194834人月），年龄在21岁及以上，患有糖尿病，领取临时援助家庭补助、符合医疗补助扩展计划、领取无医疗保险的补充保障收入，或同时享有医疗补助和医疗保险。
测量指标
我们的结局指标是特定月份内的任何住院情况和任何急诊就诊情况。感兴趣的协变量包括干预组与对照组的指标，以及测量项目入组后结局时间趋势变化的指标和样条变量。
结果
总体而言，8项检验比较中的6项无统计学意义。在领取补充保障收入的受益人群中，我们观察到干预组样本在入组后12个月时的急诊就诊风险预计比对照组样本有更大幅度的下降（差值：-6.6%；95%置信区间：-11.2%，-2.1%）。在符合医疗补助扩展计划的受益人群中，我们观察到干预组样本在入组后12个月时的住院风险比对照组样本有更大幅度的下降（差值：-5.8%；95%置信区间：-11.4%，-0.2%）。
结论
一项旨在降低高成本、高需求医疗补助受益人群医疗服务利用率的护理协调项目，在部分医疗补助计划中与糖尿病患者的急诊就诊和住院次数减少有关，但在其他计划中并非如此。
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