Department of Emergency Medicine, University of Michigan, TC B1-220 1500 E Medical Center Dr, Ann Arbor, MI, 48109, USA.
Acute Care Research Unit, Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA.
BMC Health Serv Res. 2023 Nov 1;23(1):1190. doi: 10.1186/s12913-023-10214-2.
Patients presenting to academic medical centers (AMC) typically receive primary care, specialty care, or both. Resources needed for each type of care vary, requiring different levels of care coordination. We propose a novel method to determine whether a patient primarily receives primary or specialty care to allow for optimization of care coordination.
We aimed to define the concepts of a Lifer Patient and Destination Patient and analyze the current state of care utilization in those groups to inform opportunities for improving care coordination.
Using AMC data for a 36-month study period (FY17-19), we evaluated the number of unique patients by residence zip code. Patients with at least one primary care visit and patients without a primary care visit were classified as Lifer and Destination patients, respectively. Cohen's effect sizes were used to evaluate differences in mean utilization of different care delivery settings.
The AMC saw 35,909 Lifer patients and 744,037 Destination patients during the study period. Most patients were white, non-Hispanic females; however, the average age of a Lifer was seventy-two years whereas that of a Destination patient was thirty-eight. On average, a Lifer had three times more ambulatory care visits than a Destination patient. The proportion of Inpatient encounters is similar between the groups. Mean Inpatient length of stay (LOS) is similar between the groups, but Destination patients have more variance in LOS. The rate of admission from the emergency department (ED) for Destination patients is nearly double Lifers'.
There were differences in ED, ambulatory care, and inpatient utilization between the Lifer and Destination patients. Furthermore, there were incongruities between rate of hospital admissions and LOS between two groups. The Lifer and Destination patient definitions allow for identification of opportunities to tailor care coordination to these unique groups and to allocate resources more efficiently.
就诊于学术医疗中心（AMC）的患者通常会接受初级保健、专科保健或两者兼有。每种类型的护理所需的资源不同，需要不同程度的护理协调。我们提出了一种新的方法来确定患者主要接受初级保健还是专科保健，以便优化护理协调。
我们旨在定义常住患者和目的地患者的概念，并分析这两组患者的当前护理利用情况，为改善护理协调提供机会。
使用 AMC 在 36 个月的研究期间（FY17-19）的数据，我们根据居住邮政编码评估了独特患者的数量。至少有一次初级保健就诊的患者和没有初级保健就诊的患者分别被归类为常住患者和目的地患者。我们使用 Cohen 的效应大小来评估不同护理提供环境下的利用差异。
在研究期间，AMC 共接待了 35909 名常住患者和 744037 名目的地患者。大多数患者为白人、非西班牙裔女性；然而，常住患者的平均年龄为 72 岁，而目的地患者的平均年龄为 38 岁。平均而言，常住患者的门诊就诊次数是目的地患者的三倍。两组的住院就诊比例相似。两组的平均住院时间（LOS）相似，但目的地患者的 LOS 差异较大。目的地患者从急诊科入院的比例几乎是常住患者的两倍。
常住患者和目的地患者在急诊科、门诊和住院利用方面存在差异。此外，两组的入院率和 LOS 之间存在不一致性。常住患者和目的地患者的定义可以识别机会，为这些独特的群体定制护理协调，并更有效地分配资源。
