Carlson Lucas C, Pu Charles T, Mark Eden, Gao Ya, Nussbaum Lisa, Vogeli Christine
Population Health Management, Mass General Brigham Boston Massachusetts USA.
Department of Emergency Medicine Brigham and Women's Hospital Boston Massachusetts USA.
Health Sci Rep. 2022 Aug 26;5(5):e643. doi: 10.1002/hsr2.643. eCollection 2022 Sep.
In 2014, Mass General Brigham, formerly Partners HealthCare, launched a novel urgent home-based medical care program to provide rapid medical evaluation and treatment to homebound patients and older adults with frailty or limited mobility named the partners mobile observation unit (PMOU) program.
We conducted a pragmatic, embedded evaluation assessing the impact of PMOU on postreferral utilization and total medical expenditure (TME). We used propensity weighting and logistic regression to estimate the 30-day adjusted odds ratios (ORs) of emergency department (ED) utilization and inpatient medical hospitalization for patients enrolled in PMOU (891 episodes of care) relative to those who were referred but not enrolled in the program (57 episodes of care) during the period of April 2017 to June 2018. We additionally conducted a difference-in-differences analysis assessing program impact on TME, comparing claims data 30 days pre/post referral.
Despite positive trends, there were no statistically significant differences between the two groups with regard to postreferral ED visits or hospitalizations, with an OR of 0.83 ( = 0.56) and OR of 0.64 ( = 0.21), respectively. There was no statistically significant difference in pre/post referral TME for intervention relative to control episodes ( = 0.64). In post hoc analysis of control episodes, 75% received care elsewhere within 14 days of referral.
Although the results suggested positive trends, this analysis of this relatively mature program was unable to identify statistically significant reductions in ED visits, hospitalizations, or TME associated with the PMOU program. Future efforts to build home-based urgent care programs or related programs targeting older adults with frailty or limited mobility should aim to improve patient targeting and identify opportunities to improve program operations and generate meaningful reductions in healthcare utilization and spending.
2014年，前身为合作伙伴医疗保健公司的麻省总医院布莱根分院推出了一项新型的基于家庭的紧急医疗护理项目，为居家患者以及体弱或行动不便的老年人提供快速医疗评估和治疗，该项目名为合作伙伴移动观察单元（PMOU）项目。
我们进行了一项务实的嵌入式评估，以评估PMOU对转诊后利用率和总医疗支出（TME）的影响。我们使用倾向加权和逻辑回归来估计2017年4月至2018年6月期间参加PMOU的患者（891次护理事件）相对于被转诊但未参加该项目的患者（57次护理事件）的急诊室（ED）利用率和住院医疗住院的30天调整优势比（OR）。我们还进行了差异分析，评估该项目对TME的影响，比较转诊前/后30天的索赔数据。
尽管有积极趋势，但两组在转诊后急诊就诊或住院方面没有统计学上的显著差异，OR分别为0.83（=0.56）和0.64（=0.21）。干预组与对照组相比，转诊前/后TME没有统计学上的显著差异（=0.64）。在对对照组事件的事后分析中，75%的患者在转诊后14天内在其他地方接受了治疗。
尽管结果显示出积极趋势，但对这个相对成熟项目的分析未能发现与PMOU项目相关的急诊就诊、住院或TME有统计学上的显著减少。未来建立基于家庭的紧急护理项目或针对体弱或行动不便老年人的相关项目的努力，应旨在改善患者定位，并找出改善项目运作的机会，以显著减少医疗保健的使用和支出。
