Columbia University School of Nursing, New York, New York, USA.
Nurs Forum. 2021 Jan;56(1):127-133. doi: 10.1111/nuf.12500. Epub 2020 Aug 26.
High-need high-cost (HNHC) patients are variously defined in the literature as the small subset of the population who account for the majority of US health care costs. Lack of consensus on the defining attributes of HNHC patients has challenged the effectiveness of interventions aimed to improve disease management and reduce costs. Guided by the Walker and Avant method of concept analysis, a literature review of 2 databases (PubMed and CINAHL) was conducted. Three main subgroups of HNHC patients were identified: adults with multiple chronic conditions and functional disability, the frail elderly, and patients under 65 years old with a disability or behavioral health condition. HNHC patients are categorized by a feedback loop of acute-on-chronic health conditions, preventable health service utilization, and fragmented care. Antecedents that predispose becoming a HNHC patient include challenges accessing timely care, low socioeconomic status, unmet support, and social factors such as isolation and inadequate.
高需求高花费（HNHC）患者在文献中有多种定义，他们是指占美国医疗保健费用大部分的一小部分人群。由于缺乏对 HNHC 患者定义属性的共识，旨在改善疾病管理和降低成本的干预措施的有效性受到了挑战。本研究以沃克和阿凡特的概念分析方法为指导，对 2 个数据库（PubMed 和 CINAHL）进行了文献回顾。确定了 HNHC 患者的 3 个主要亚组：患有多种慢性疾病和功能障碍的成年人、体弱的老年人以及 65 岁以下患有残疾或行为健康状况的患者。HNHC 患者的分类是基于慢性健康状况的急性加重、可预防的卫生服务利用和分散的护理的反馈循环。导致成为 HNHC 患者的前因包括难以获得及时的护理、低社会经济地位、未得到满足的支持以及孤立和不足等社会因素。
