Center for the Study of Healthcare Innovation, Implementation & Policy (CSHIIP), VA Greater Los Angeles HSR&D, Los Angeles, CA, USA.
Covenant Health Network, Phoenix, AZ, USA.
J Gen Intern Med. 2021 Nov;36(11):3366-3372. doi: 10.1007/s11606-021-06869-4. Epub 2021 May 13.
Quantitative evaluations of the effectiveness of intensive primary care (IPC) programs for high-needs patients have yielded mixed results for improving healthcare utilization, cost, and mortality. However, IPC programs may provide other value.
To understand the perspectives of high-needs patients and primary care facility leaders on the effects of a Veterans Affairs (VA) IPC program on patients.
A total of 66 semi-structured telephone interviews with high-needs VA patients and primary care facility leaders were conducted as part of the IPC program evaluation.
High-needs patients (n = 51) and primary care facility leaders (n = 15) at 5 VA pilot sites.
We used content analysis to examine interview transcripts for both a priori and emergent themes about perceived IPC program effects.
Patients enrolled in VA IPCs reported improvements in their experience of VA care (e.g., patient-provider relationship, access to their team). Both patients and leaders reported improvements in patient motivation to engage with self-care and with their IPC team, and behaviors, especially diet, exercise, and medication management. Patients also perceived improvements in health and described receiving assistance with social needs. Despite this, patients and leaders also outlined patient health characteristics and contextual factors (e.g., chronic health conditions, housing insecurity) that may have limited the effectiveness of the program on healthcare cost and utilization.
Patients and primary care facility leaders report benefits for high-needs patients from IPC interventions that translated into perceived improvements in healthcare, health behaviors, and physical and mental health status. Most program evaluations focus on cost and utilization, which may be less amenable to change given this cohort's numerous comorbid health conditions and complex social circumstances. Future IPC program evaluations should additionally examine IPC's effects on quality of care, patient satisfaction, quality of life, and patient health behaviors other than utilization (e.g., engagement, self-efficacy).
对强化初级保健（IPC）计划对高需求患者的有效性进行定量评估，其改善医疗保健利用、成本和死亡率的结果喜忧参半。然而，IPC 计划可能会提供其他价值。
了解高需求患者和初级保健机构领导对退伍军人事务部（VA）IPC 计划对患者影响的看法。
作为 IPC 计划评估的一部分，共对 5 个 VA 试点的 51 名高需求 VA 患者和 15 名初级保健机构领导进行了 66 次半结构式电话访谈。
高需求 VA 患者（n=51）和初级保健机构领导（n=15）在 5 个 VA 试点。
我们使用内容分析法检查访谈记录中关于感知 IPC 计划效果的预设和新兴主题。
参加 VA IPC 的患者报告称他们对 VA 护理的体验有所改善（例如，医患关系、获得团队支持）。患者和领导者都报告称患者参与自我保健和 IPC 团队的积极性以及行为（尤其是饮食、锻炼和药物管理）有所改善。患者还认为他们的健康状况有所改善，并表示得到了社会需求方面的帮助。尽管如此，患者和领导者还概述了患者的健康特征和背景因素（例如，慢性健康状况、住房不安全），这些因素可能限制了该计划对医疗保健成本和利用率的有效性。
患者和初级保健机构领导报告称，IPC 干预措施对高需求患者有益，这转化为医疗保健、健康行为以及身体和心理健康状况的感知改善。大多数计划评估都侧重于成本和利用率，鉴于这一人群存在许多合并健康状况和复杂的社会环境，这些因素可能更难改变。未来的 IPC 计划评估还应额外检查 IPC 对护理质量、患者满意度、生活质量和患者健康行为（例如参与度、自我效能感）的影响，而不仅仅是利用率。
