Denver/Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, VA Eastern Colorado Health Care System, Aurora, CO, USA.
Health Systems, Management and Policy, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
J Gen Intern Med. 2022 Nov;37(14):3529-3534. doi: 10.1007/s11606-022-07401-y. Epub 2022 Aug 30.
The Veterans Affairs (VA) Healthcare System Rural Transitions Nurse Program (TNP) addresses barriers veterans face when transitioning from urban tertiary VA hospitals to home. Previous clinical evaluations of TNP have shown that enrolled veterans were more likely to follow up with their primary care provider within 14 days of discharge and experience a significant reduction in mortality within 30 days compared to propensity-score matched controls.
Examine changes from pre- to post-hospitalization in total, inpatient, and outpatient 30-day healthcare utilization costs for TNP enrollees compared to controls.
Quantitative analyses modeling the changes in cost via multivariable linear mixed-effects models to determine the association between TNP enrollment and changes in these costs.
Veterans meeting TNP eligibility criteria who were discharged home following an inpatient hospitalization at one of the 11 implementation sites from April 2017 to September 2019.
The four-step TNP transitional care intervention.
Changes in 30-day total, inpatient, and outpatient healthcare utilization costs were calculated for TNP enrollees and controls.
Among 3001 TNP enrollees and 6002 controls, no statistically significant difference in the change in total costs (p = 0.65, 95% CI: (- $675, $350)) was identified. However, on average, the increase in inpatient costs from pre- to post-hospitalization was approximately $549 less for TNP enrollees (p = 0.02, 95% CI: (- $856, - $246)). The average increase in outpatient costs from pre- to post-hospitalization was approximately $421 more for TNP enrollees compared to controls (p = 0.003, 95% CI: ($109, $671)).
Although we found no difference in change in total costs between veterans enrolled in TNP and controls, TNP was associated with a smaller increase in direct inpatient medical costs and a larger increase in direct outpatient medical costs. This suggests a shifting of costs from the inpatient to outpatient setting.
退伍军人事务部（VA）医疗保健系统农村过渡护士计划（TNP）旨在解决退伍军人从城市三级 VA 医院过渡到家庭时所面临的障碍。之前对 TNP 的临床评估表明，与倾向得分匹配的对照组相比，参加 TNP 的退伍军人在出院后 14 天内更有可能与初级保健提供者跟进，并且在 30 天内的死亡率显著降低。
与对照组相比，检查 TNP 参与者在住院前和住院后 30 天内的总、住院和门诊医疗保健利用成本的变化。
通过多变量线性混合效应模型对成本变化进行定量分析，以确定 TNP 参与与这些成本变化之间的关联。
符合 TNP 资格标准的退伍军人，他们在 2017 年 4 月至 2019 年 9 月期间的 11 个实施地点之一接受住院治疗后出院回家。
四步 TNP 过渡性护理干预措施。
为 TNP 参与者和对照组计算了 30 天内总、住院和门诊医疗保健利用成本的变化。
在 3001 名 TNP 参与者和 6002 名对照组中，总费用变化没有统计学差异（p = 0.65，95%CI：（-675 美元，350 美元））。然而，平均而言，TNP 参与者的住院费用从住院前到住院后的增加减少了大约 549 美元（p = 0.02，95%CI：（-856 美元，-246 美元））。与对照组相比，TNP 参与者的门诊费用从住院前到住院后的增加平均增加了约 421 美元（p = 0.003，95%CI：（109 美元，671 美元））。
尽管我们发现 TNP 参与者与对照组在总费用变化方面没有差异，但 TNP 与直接住院医疗费用增加幅度较小和直接门诊医疗费用增加幅度较大相关。这表明成本从住院向门诊转移。
