农村县预防性服务的可持续模式：健康在一起研究。

A Sustainable Model for Preventive Services in Rural Counties: The Healthier Together Study.

机构信息

From the College of Medicine, Department of Family and Preventive Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK (ZN, DS); College of Public Health, Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK (YDZ); Institute of Public Policy, Harry S. Truman School of Public Affairs, University of Missouri, Columbia, MO (BM); School of Medicine, Center for Health Policy, University of Missouri, Columbia, MO (TGR).

出版信息

J Am Board Fam Med. 2020 Sep-Oct;33(5):698-706. doi: 10.3122/jabfm.2020.05.190357.

DOI:10.3122/jabfm.2020.05.190357

PMID:32989064

Abstract

OBJECTIVE

The Healthier Together study aimed to implement and evaluate a sustainable, rural community-based patient outreach model for preventive care provided through primary care practices located in 3 rural counties in Oklahoma. Community-based wellness coordinators (WCs) working with primary care practitioners, county health departments, local hospitals, and health information exchange (HIE) networks helped residents receive high-priority evidence-based preventive services.

METHODS

The WCs used a wellness registry connected to electronic medical records and HIEs and called patients at the county level, based on primary care practitioner-preferred protocols. The registry flagged patient-level preventive care gaps, tracked outreach efforts, and documented the delivery of services throughout the community. Return on investment (ROI) in participating organizations was estimated by the study team.

RESULTS

Forty-four of the 59 eligible clinician practices participated in the study. Two regional HIEs supplied periodic health data updates for 71,989 patients seen in the 3 implementation counties. A total of 45,862 outreach calls were made by 6 WCs, 100,896 high-priority recommendations were offered to patients based on care gaps and 14,043 additional services were delivered. Of all the patients reached, only 1917 (4.2%) were up to date on all prioritized services. Participating primary care practices significantly improved the delivery of preventive services (mean increase: 20.2% across 12 services; < .001; range: 7% to 43%) and realized a mean ROI of 68%. Health systems that employed the WCs earned a mean revenue of $175,000, realizing a 75% ROI for the outreach program.

CONCLUSIONS

Although health care is under-resourced and segmented in many rural counties, when stakeholder partnerships are established, they may be able to achieve and economically sustain community-wide health improvement by creating a win-win situation for all partners.

摘要

目的

“Healthier Together”研究旨在实施和评估一种可持续的、以农村社区为基础的患者外展模式，为位于俄克拉荷马州 3 个农村县的基层医疗实践提供预防保健。与基层医疗从业者、县卫生部门、当地医院和健康信息交换（HIE）网络合作的社区健康协调员（WC）帮助居民获得高优先级的基于证据的预防服务。

方法

WC 使用与电子病历和 HIE 连接的健康注册系统，并根据基层医疗从业者首选的方案，按县一级呼叫患者。该注册系统标记患者层面的预防保健差距，跟踪外展工作，并记录整个社区的服务提供情况。参与组织的投资回报率（ROI）由研究小组估计。

结果

59 家符合条件的临床医生实践中有 44 家参与了研究。两个区域 HIE 为 3 个实施县的 71989 名患者提供定期健康数据更新。6 名 WC 共拨打了 45862 个外呼电话，根据护理差距向 100896 名患者提供了 14043 项高优先级建议，并提供了 14043 项额外服务。在所接触到的所有患者中，只有 1917 名（4.2%）患者接受了所有优先服务。参与的基层医疗实践显著提高了预防服务的提供（12 项服务的平均增长率为 20.2%；<0.001；范围为 7%至 43%），实现了 68%的平均投资回报率。使用 WC 的卫生系统获得了 17.5 万美元的平均收入，为外展项目实现了 75%的投资回报率。