Rodriguez Hector P, Rubio Karl, Miller-Rosales Chris, Wood Andrew J
Division of Health Policy and Management, School of Public Health, University of California, Berkeley, 2121 Berkeley Way West #5427, Berkeley, CA 94704, United States.
Department of Health Care Policy, Harvard Medical School, 180 Longwood Ave, Boston, MA 02115, United States.
Health Aff Sch. 2023 Jun 20;1(1):qxad021. doi: 10.1093/haschl/qxad021. eCollection 2023 Jul.
Patient-engagement strategies are being encouraged by payers and governments, but with limited evidence about whether practice adoption of these strategies impacts utilization and spending. We examine the association of physician practice adoption of patient-engagement strategies (low vs moderate vs high) with potentially preventable utilization and total spending for patients with type 2 diabetes and/or cardiovascular disease using US physician practice survey (n = 2086) and Medicare fee-for-service (n = 736 269) data. In adjusted analyses, there were no differences in potentially preventable utilization associated with practice adoption of patient-engagement strategies. Compared with patients attributed to practices with moderate adoption, patients attributed to practices with high adoption had higher total spending ($26 364 vs $25 991; < .05) driven by spending for long-term services and supports, including home health agency, long-term care, skilled nursing facilities, and hospice payments. In contrast, patients attributed to practices with low adoption had higher total spending ($26 481 vs $25 991; < .01) driven by spending for tests and acute care and clinical access spending. The results highlight that stakeholders that encourage the use of patient-engagement strategies should not necessarily expect reduced spending.
支付方和政府都在鼓励采用患者参与策略，但关于这些策略在实际应用中是否会影响医疗服务利用率和支出的证据有限。我们利用美国医生执业调查（n = 2086）和医疗保险按服务付费（n = 736269）数据，研究了医生执业机构采用患者参与策略的程度（低、中、高）与2型糖尿病和/或心血管疾病患者潜在可预防的医疗服务利用率及总支出之间的关联。在调整分析中，采用患者参与策略的执业机构在潜在可预防的医疗服务利用率方面没有差异。与中等采用程度的执业机构的患者相比，高采用程度的执业机构的患者总支出更高（26364美元对25991美元；P<0.05），这是由长期服务和支持方面的支出推动的，包括家庭健康机构、长期护理、专业护理机构和临终关怀支付。相比之下，低采用程度的执业机构的患者总支出更高（26481美元对25991美元；P<0.01），这是由检查、急性护理和临床就诊支出推动的。研究结果表明，鼓励使用患者参与策略的利益相关者不一定能预期支出会减少。
