Center for Medicare & Medicaid Innovation, Centers for Medicare & Medicaid Services, Baltimore, MD, USA.
The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, NH, USA.
J Gen Intern Med. 2022 Feb;37(2):283-289. doi: 10.1007/s11606-021-06710-y. Epub 2021 Apr 1.
It is not uncommon for medical specialists to predominantly care for patients with certain chronic conditions rather than primary care physicians (PCPs), yet the resource implications from such patterns of care are not well understood.
To assess resource use of diabetes patients who predominantly visit a PCP versus a medical specialist.
Retrospective cohort study of diabetes patients aging into the traditional Medicare program. Patients were attributed to a PCP or medical specialist annually based on a preponderance of ambulatory care visits and categorized according to whether attribution changed year to year. Propensity score weighting was used to balance baseline demographic characteristics, diabetes complications, and underlying health conditions between patients attributed to PCPs and to medical specialists. Spending and utilization were measured up to 3 patient-years.
A total of 141,558 patient-years.
Total visits, unique physicians, hospital admissions, emergency department visits, procedures, imaging, and tests.
Each year, roughly 70% of patients maintained attribution to a PCP and 15% to a medical specialist relative to the previous year. After propensity weighting, patients continuously attributed to a PCP versus medical specialist from 1 year to the next had lower average total payer payments ($10,326 [SD $57,386] versus $14,971 [SD $74,112], P<0.0001) and lower total patient out-of-pocket payments ($1,707 [SD $6,020] versus $2,443 [SD $7,984], P<0.0001). Rates of hospitalization, emergency department visits, procedures, imaging, and tests were lower among patients attributed to PCPs as well.
Older adults with diabetes who receive more of their ambulatory care from a PCP instead of a medical specialist show evidence of lower resource use.
医学专家主要照顾某些慢性疾病患者而不是初级保健医生（PCP）的情况并不少见，但这种护理模式的资源影响尚不清楚。
评估主要就诊于 PCP 而非医学专家的糖尿病患者的资源利用情况。
对进入传统医疗保险计划的糖尿病患者进行回顾性队列研究。根据门诊就诊次数的优势，每年将患者分配给 PCP 或医学专家，并根据每年的归属是否发生变化进行分类。采用倾向评分加权法，平衡分配给 PCP 和医学专家的患者的基线人口统计学特征、糖尿病并发症和基础健康状况。测量了患者最长 3 年的就诊次数和使用情况。
共 141558 人年。
总就诊次数、就诊医师人数、住院、急诊就诊、手术、影像和检验。
每年，大约 70%的患者相对于前一年保持与 PCP 的归属，15%的患者保持与医学专家的归属。经过倾向评分加权后，连续 1 年以上从 1 年到下一年一直分配给 PCP 的患者，其平均总支付人付款（$10326 [SD $57386] 与 $14971 [SD $74112]，P<0.0001）和患者自付费用（$1707 [SD $6020] 与 $2443 [SD $7984]，P<0.0001）均较低。分配给 PCP 的患者的住院率、急诊就诊率、手术率、影像率和检验率也较低。
从医学专家处获得的门诊护理较少而从 PCP 处获得的护理较多的老年糖尿病患者表现出资源利用较低的证据。
