Department of Public Health Sciences, Clemson University, Clemson, SC 29634, USA.
Department of Industrial Engineering, Clemson University, Clemson, SC 29634, USA.
Int J Environ Res Public Health. 2023 Dec 2;20(23):7136. doi: 10.3390/ijerph20237136.
Transitional care programs (TCPs), where hospital care team members repeatedly follow up with discharged patients, aim to reduce post-discharge hospital or emergency department (ED) utilization and healthcare costs. We examined the effectiveness of TCPs at reducing healthcare costs, hospital readmissions, and ED visits. Centers for Medicare and Medicaid Services Bundled Payments for Care Improvement (BPCI) program adjudicated claims files and electronic health records from Greenville Memorial Hospital, Greenville, SC, were accessed. Data on post-discharge 30- and 90-day ED visits and readmissions, total costs, and episodes with costs over BPCI target prices were extracted from November 2017 to July 2020 and compared between the "TCP-Graduates" (N = 85) and "Did Not Graduate" (DNG) (N = 1310) groups. As compared to the DNG group, the TCP-Graduates group had significantly fewer 30-day (7.1% vs. 14.9%, = 0.046) and 90-day (15.5% vs. 26.3%, = 0.025) readmissions, episodes with total costs over target prices (25.9% vs. 36.6%, = 0.031), and lower total cost/episode (USD 22,439 vs. USD 28,633, = 0.018), but differences in 30-day (9.4% vs. 11.2%, = 0.607) and 90-day (20.0% vs. 21.9%, = 0.680) ED visits were not significant. TCP was associated with reduced post-discharge hospital readmissions, total care costs, and episodes exceeding target prices. Further studies with rigorous designs and individual-level data should test these findings.
过渡护理计划（TCP），即医院护理团队成员反复跟进出院患者，旨在降低出院后医院或急诊部（ED）的利用和医疗成本。我们研究了 TCP 降低医疗成本、医院再入院和 ED 就诊的效果。我们访问了南卡罗来纳州格林维尔纪念医院的医疗保险和医疗补助服务中心捆绑支付改善护理（BPCI）计划的裁定索赔文件和电子健康记录。从 2017 年 11 月到 2020 年 7 月，从电子健康记录中提取了出院后 30 天和 90 天的 ED 就诊和再入院、总费用以及费用超过 BPCI 目标价格的病例，并将其与“TCP 毕业生”（N=85）和“未毕业”（DNG）（N=1310）组进行比较。与 DNG 组相比，TCP 毕业生组的 30 天（7.1% vs. 14.9%，=0.046）和 90 天（15.5% vs. 26.3%，=0.025）再入院率、总费用超过目标价格的病例（25.9% vs. 36.6%，=0.031）和每例总费用（USD22439 与 USD28633，=0.018）显著更低，但 30 天（9.4% vs. 11.2%，=0.607）和 90 天（20.0% vs. 21.9%，=0.680）ED 就诊率的差异无统计学意义。TCP 与降低出院后医院再入院率、总护理成本和超过目标价格的病例相关。具有严格设计和个体水平数据的进一步研究应检验这些发现。
