Hanmer Janel, Liu Yushu, Leon-Jhong Anita, Bui Thuy, Meltzer Avery, Kogan Jane, Schuster James, Fischer Gary S, Bryk Jodie
Department of General Internal Medicine, University of Pittsburgh, 230 McKee Place, Suite 600, Pittsburgh, PA, 15213, USA.
UPMC Health Plan, 600 Grant Street, Pittsburgh, PA, 15219, USA.
J Gen Intern Med. 2025 Jun;40(8):1877-1884. doi: 10.1007/s11606-024-09006-z. Epub 2024 Sep 3.
Many interventions implemented for multi-visit patients (MVP) have been developed to address patient-centric needs of these individuals and reduce unplanned care for ambulatory-sensitive conditions. More rigorous research is needed to better understand the impact of these interventions on changes in care utilization including unplanned care.
To evaluate the impact of the Enhanced Care Program (ECP), a payer-provider collaborative model, on unplanned care use and cost of care.
Using propensity methods, a comparison group was constructed using insurer membership files. Comparisons were performed using a difference-in-differences analysis.
Patients enrolled in ECP through December 2019 were considered eligible for the study (n = 357). All patients had five or more ED visits in the past year or two or more inpatient hospitalizations in the past year prior to enrollment.
ECP is a high-intensity outpatient intervention intended to reduce avoidable unplanned care such as ED visits and inpatient hospital stays through home visits, chronic/acute disease management, and intensive care coordination.
The primary outcomes of interest were events per 100 members per year of ED use with return to home, unplanned inpatient and observational status admissions, and unplanned behavioral health inpatient admission, and cost of care per member per month.
Overall total unplanned care encounters were significantly reduced with a difference-in-difference of 320 unplanned care encounters per 100 members per year in the intervention group (p < 0.05). The ECP group showed statistically significant decreases in costs of unplanned ED, unplanned observation admission, and unplanned inpatient behavioral medicine costs, but statistically significant increases in overall pharmacy costs and lab costs. Changes in total costs of care for the ECP group were not statistically different than the control group (p = 0.55).
ECP showed significant reduction of unplanned care for MVP patients.
为多次就诊患者（MVP）实施的许多干预措施旨在满足这些个体以患者为中心的需求，并减少对门诊敏感疾病的非计划性医疗。需要更严格的研究来更好地了解这些干预措施对包括非计划性医疗在内的医疗利用变化的影响。
评估增强护理计划（ECP），一种支付方与医疗机构合作的模式，对非计划性医疗使用和医疗成本的影响。
采用倾向得分法，利用保险公司会员档案构建对照组。使用双重差分分析进行比较。
截至2019年12月参加ECP的患者被认为符合研究条件（n = 357）。所有患者在入组前一年有五次或更多次急诊就诊，或过去一年有两次或更多次住院治疗。
ECP是一种高强度门诊干预措施，旨在通过家访、慢性/急性疾病管理和强化护理协调，减少如急诊就诊和住院等可避免的非计划性医疗。
感兴趣的主要结局是每年每100名成员的急诊使用后回家的事件、非计划性住院和观察状态入院、非计划性行为健康住院入院，以及每月每名成员的医疗成本。
总体非计划性医疗遭遇显著减少，干预组每年每100名成员的非计划性医疗遭遇差异为320次（p < 0.05）。ECP组在非计划性急诊、非计划性观察入院和非计划性住院行为医学成本方面有统计学显著下降，但总体药房成本和实验室成本有统计学显著增加。ECP组的总医疗成本变化与对照组无统计学差异（p = 0.55）。
ECP显示MVP患者的非计划性医疗显著减少。
