高成本/高需求患者复杂护理方案的疗效比较：一项回顾性队列研究。

Comparative Effectiveness of a Complex Care Program for High-Cost/High-Need Patients: a Retrospective Cohort Study.

机构信息

Mid-Atlantic Permanente Research Institute, Kaiser Permanente Mid-Atlantic States, Rockville, MD, USA.

The Pennsylvania State University, University Park, PA, USA.

出版信息

J Gen Intern Med. 2021 Jul;36(7):2021-2029. doi: 10.1007/s11606-021-06676-x. Epub 2021 Mar 19.

DOI:10.1007/s11606-021-06676-x

PMID:33742306

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8298622/

Abstract

BACKGROUND

High-cost/high-need (HCHN) adults and the healthcare systems that provide their care may benefit from a new patient-centered model of care involving a dedicated physician and nurse team who coordinate both clinical and social services for a small patient panel.

OBJECTIVE

Evaluate the impact of a Complex Care Program (CCP) on likelihood of patient survival and hospital admission in 180 days following empanelment to the CCP.

DESIGN

Retrospective cohort study using a quasi-experimental design with CCP patients propensity score matched to a concurrent control group of eligible but unempaneled patients.

SETTING

Kaiser Permanente Mid-Atlantic States (KPMAS) during 2017-2018.

PARTICIPANTS

Nine hundred twenty-nine CCP patients empaneled January 2017-June 2018, 929 matched control patients for the same period.

INTERVENTIONS

The KPMAS CCP is a new program consisting of 8 teams each staffed by a physician and nurse who coordinate care across a continuum of specialty care, tertiary care, and community services for a panel of 200 patients with advanced clinical disease and recent hospitalizations.

MAIN OUTCOMES

Time to death and time to first hospital admission in the 180 days following empanelment or eligibility.

RESULTS

Compared to matched control patients, CCP patients had prolonged time to death (hazard ratio [HR]: 0.577, 95% CI: 0.474, 0.704), and CCP decedents had longer survival (median days 69.5 vs. 53.0, p=0.03). CCP patients had similar time to hospital admission (HR: 1.081, 95% CI: 0.930, 1.258), with similar results when adjusting for competing risk of death (HR: 1.062, 95% CI: 0.914, 1.084).

LIMITATIONS

Non-randomized intervention; single healthcare system; patient eligibility limited to specific conditions.

CONCLUSION

The KPMAS CCP was associated with significantly reduced short-term mortality risk for eligible patients who volunteered to participate in this intervention.

摘要

背景

高成本/高需求（HCHN）成年人及其医疗保健系统可能受益于一种新的以患者为中心的护理模式，该模式涉及一个专门的医生和护士团队，为一个小患者群体协调临床和社会服务。

目的

评估 180 天内参与复杂护理计划（CCP）对患者生存和住院的影响。

设计

使用准实验设计的回顾性队列研究，将 CCP 患者的倾向评分与同期符合条件但未入选的患者进行匹配。

地点

2017-2018 年期间的 Kaiser Permanente Mid-Atlantic States（KPMAS）。

参与者

2017 年 1 月至 2018 年 6 月入选的 929 名 CCP 患者，同期为同一时期的 929 名匹配对照患者。

干预措施

KPMAS CCP 是一个新计划，由 8 个团队组成，每个团队都由一名医生和一名护士组成，他们在专科护理、三级护理和社区服务的连续体上为一组 200 名患有晚期临床疾病和近期住院的患者协调护理。

主要结果

入选或符合条件后 180 天内的死亡时间和首次住院时间。

结果

与匹配的对照患者相比，CCP 患者的死亡时间延长（风险比 [HR]：0.577，95%CI：0.474，0.704），CCP 患者的生存期更长（中位天数 69.5 天与 53.0 天，p=0.03）。CCP 患者的住院时间相似（HR：1.081，95%CI：0.930，1.258），在调整死亡竞争风险后结果相似（HR：1.062，95%CI：0.914，1.084）。