Song Nancy, Frean Molly, Covington Christian T, Tietschert Maike, Ling Emilia, Bahadurzada Hassina, Kerrissey Michaela, Friedberg Mark, Singer Sara J
Stanford University School of Medicine, CA, USA.
University of Pennsylvania, Philadelphia, USA.
Med Care Res Rev. 2022 Oct;79(5):640-649. doi: 10.1177/10775587211067897. Epub 2022 Jan 10.
Requirements for integrating care across providers, settings, and over time increase with patients' needs. Health care providers' ability to offer care that patients experience as integrated may vary among patients with different levels of need. We explore the variation in patients' perceptions of integrated care among Medicare beneficiaries based on the beneficiary's level of need using ordinary least square regression for each of four high-need groups: beneficiaries (a) with complex chronic conditions, (b) with frailties, (c) below 65 with disability, and (d) with any (of the first three) high needs. We control for beneficiary demographics and other factors affecting integrated care, and we conduct sensitivity analyses controlling for multiple individual chronic conditions. We find significant positive associations with level of need for provider support for self-directed care and medication and home health management. Controlling for multiple individual chronic conditions reduces effect sizes and number of significant relationships.
随着患者需求的增加,跨提供者、环境以及不同时间整合护理的要求也会提高。医疗保健提供者提供患者体验为整合性护理的能力,在需求程度不同的患者中可能会有所差异。我们使用普通最小二乘法回归,针对四个高需求群体中的每一个群体,探讨医疗保险受益人对整合护理的认知差异,这四个群体分别是:(a)患有复杂慢性病的受益人,(b)身体虚弱的受益人,(c)65岁以下残疾受益人,以及(d)有任何(前三项中的)高需求的受益人。我们控制了受益人的人口统计学特征和其他影响整合护理的因素,并进行了敏感性分析,以控制多种个体慢性病。我们发现,提供者对自我护理、药物治疗和家庭健康管理的支持需求程度与需求水平之间存在显著的正相关。控制多种个体慢性病会减小效应大小和显著关系的数量。