Kasteridis Panagiotis, Mason Anne, Street Andrew
Research Fellow, Centre for Health Economics, University of York, UK.
Senior Research Fellow, Centre for Health Economics, University of York, UK.
J Health Serv Res Policy. 2021 Jan;26(1):46-53. doi: 10.1177/1355819620931872. Epub 2020 Jul 1.
As part of the Vanguard programme, two integrated care models were introduced in South Somerset for people with complex care needs: the Complex Care Team and Enhanced Primary Care. We assessed their impact on a range of utilization measures and mortality.
We used monthly individual-level linked primary and secondary care data from April 2014 to March 2018 to assess outcomes before and after the introduction of the care models. The analysis sample included 564 Complex Care Team and 841 Enhanced Primary Care cases that met specific criteria. We employed propensity score methods to identify out-of-area control patients and difference-in-differences analysis to isolate the care models' impact.
We found no evidence of significantly reduced utilization in any of the Complex Care Team or Enhanced Primary Care cohorts. The death rate was significantly lower only for those in the first Enhanced Primary Care cohort.
The integrated care models did not significantly reduce utilization nor consistently reduce mortality. Future research should test longer-term outcomes associated with the new models of care and quantify their contribution in the context of broader initiatives.
作为先锋计划的一部分，在南萨默塞特郡为有复杂护理需求的人群引入了两种综合护理模式：复杂护理团队模式和强化初级护理模式。我们评估了它们对一系列使用指标和死亡率的影响。
我们使用了2014年4月至2018年3月每月的个人层面的初级和二级护理关联数据，以评估护理模式引入前后的结果。分析样本包括564例符合特定标准的复杂护理团队模式案例和841例强化初级护理模式案例。我们采用倾向得分法来确定区域外对照患者，并采用差分分析来分离护理模式的影响。
我们没有发现任何证据表明复杂护理团队模式或强化初级护理模式队列中的使用量有显著减少。仅第一个强化初级护理模式队列中的患者死亡率显著较低。
综合护理模式并没有显著降低使用量，也没有持续降低死亡率。未来的研究应该测试与新护理模式相关的长期结果，并在更广泛的举措背景下量化它们的贡献。
