Research Fellow, Health Organisation, Policy, and Economics, Centre for Primary Care and Health Services Research, University of Manchester, UK.
Research Associate, Health Organisation, Policy, and Economics, Centre for Primary Care and Health Services Research, University of Manchester, UK.
J Health Serv Res Policy. 2021 Apr;26(2):125-132. doi: 10.1177/1355819620963500. Epub 2020 Oct 27.
To examine the effectiveness of two integrated care models ('vanguards') in Salford and South Somerset in England, United Kingdom, in relation to patient experience, health outcomes and costs of care (the 'triple aim').
We used difference-in-differences analysis combined with propensity score weighting to compare the two care model sites with control ('usual care') areas in the rest of England. We estimated combined and separate annual effects in the three years following introduction of the new care model, using the national General Practice Patient Survey (GPPS) to measure patient experience (inter-organisational support with chronic condition management) and generic health status (EQ-5D); and hospital episode statistics (HES) data to measure total costs of secondary care. As secondary outcomes we measured proxies for improved prevention: cost per user of secondary care (severity); avoidable emergency admissions; and primary care utilisation.
Both intervention sites showed an increase in total costs of secondary care (approximately £74 per registered patient per year in Salford, £45 in South Somerset) and cost per user of secondary care (£130-138 per person per year). There were no statistically significant effects on health status or patient experience of care. There was a more apparent short-term negative effect on measured outcomes in South Somerset, in terms of increased costs and avoidable emergency admissions, but these reduced over time.
New care models such as those implemented within the Vanguard programme in England might lead to unintended secondary care cost increases in the short to medium term. Cost increases appeared to be driven by average patient severity increases in hospital. Prevention-focused population health management models of integrated care, like previous more targeted models, do not immediately improve the health system's triple aim.
考察英国英格兰索尔福德和萨默塞特南部两个综合护理模式（“先锋”）在患者体验、健康结果和护理成本（“三重目标”）方面的效果。
我们使用差异中的差异分析结合倾向评分加权，将两个护理模式地点与英格兰其他地区的对照（“常规护理”）区域进行比较。我们使用全国普通实践患者调查（GPPS）来衡量患者体验（慢性病管理的组织间支持）和一般健康状况（EQ-5D），使用医院发病统计数据（HES）来衡量二级护理的总成本，以衡量新护理模式引入后三年的综合和单独年度效果；我们还使用了二级护理用户成本（严重程度）、可避免急诊入院和初级保健利用情况等改善预防措施的代理指标来衡量次要结果。
两个干预地点的二级护理总成本均有所增加（索尔福德约为每位注册患者每年 74 英镑，萨默塞特为 45 英镑），二级护理用户成本也有所增加（每人每年 130-138 英镑）。在健康状况或护理体验方面没有统计学上显著的效果。在萨默塞特，短期来看，干预对测量结果的影响更为明显，即成本增加和可避免的急诊入院，但随着时间的推移，这些影响有所减少。
在英格兰，像先锋计划中实施的那样的新型护理模式可能会导致短期内二级护理成本的意外增加。成本增加似乎是由医院中患者平均严重程度的增加所驱动的。以预防为重点的综合护理人群健康管理模式，与之前更有针对性的模式一样，并没有立即改善卫生系统的三重目标。
