Golinelli Davide, Pecoraro Valentina, Tedesco Dario, Negro Antonella, Berti Elena, Camerlingo Maria Domenica, Alberghini Lucia, Lippi Bruni Matteo, Rolli Maurizia, Grilli Roberto
Health Services Research, Evaluation and Policy Unit, Local Health Authority of Romagna, Ravenna, Italy.
Department of Innovation in Healthcare and Social Services, Emilia-Romagna Region, Bologna, Italy.
BMC Health Serv Res. 2025 Apr 10;25(1):526. doi: 10.1186/s12913-025-12690-0.
Population risk stratification (RS) tools have been proposed to tailor interventions, prioritize resources, and proactively manage high-risk individuals with chronic diseases in primary care settings. This study aims to explore the available evidence on the use of population RS tools in primary care settings, specifically evaluating the impact of targeted interventions based on RS tools on selected chronic patients and healthcare utilization outcomes.
A systematic literature review was conducted across multiple electronic databases to identify relevant articles assessing the impact of targeted interventions based on RS tools in the management of chronic disease patients within primary care settings. We included studies meeting the following inclusion criteria: randomized controlled trials (RCTs), controlled clinical trials (CCTs) or before-after studies (BAs); adults with heart failure, chronic kidney disease, type 2 diabetes mellitus, chronic obstructive pulmonary disease, or dementia; interventions relying on RS tools; comparators with or without RS tools; and outcomes including Emergency Department (ED) visits, outpatient visits, hospitalizations, mortality, and costs.
A total of seven studies met the inclusion criteria, comprising one RCT, two CCTs, and four controlled BAs. The findings revealed mixed effects of interventions on patients identified using RS tools. Among the included studies, four reported significant reductions in ED visits. Two studies reported an increase in outpatient visits. Hospitalization rates were reduced in three studies, and two studies reported significant reductions in overall mortality. However, the impact on healthcare costs was inconclusive.
The evidence on the effectiveness of RS tools for chronic disease management in primary care settings remains limited. While some studies demonstrated positive outcomes in reducing hospitalizations, ED visits, and mortality, the overall impact on outpatient service use and healthcare costs varied. Further high-quality studies are needed to evaluate the long-term benefits and cost-effectiveness of RS tools in chronic disease management within primary care.
已提出人群风险分层（RS）工具，以便在初级保健环境中调整干预措施、合理分配资源并积极管理患有慢性病的高危个体。本研究旨在探索在初级保健环境中使用人群RS工具的现有证据，特别评估基于RS工具的针对性干预措施对选定慢性病患者和医疗保健利用结果的影响。
在多个电子数据库中进行了系统的文献综述，以识别评估基于RS工具的针对性干预措施对初级保健环境中慢性病患者管理影响的相关文章。我们纳入了符合以下纳入标准的研究：随机对照试验（RCT）、对照临床试验（CCT）或前后对照研究（BA）；患有心力衰竭、慢性肾病、2型糖尿病、慢性阻塞性肺疾病或痴呆症的成年人；依赖RS工具的干预措施；使用或不使用RS工具的对照；以及包括急诊就诊、门诊就诊、住院、死亡率和费用在内的结果。
共有七项研究符合纳入标准，包括一项RCT、两项CCT和四项对照BA。研究结果显示，干预措施对使用RS工具识别出的患者有不同的影响。在所纳入的研究中，四项报告急诊就诊次数显著减少。两项研究报告门诊就诊次数增加。三项研究报告住院率降低，两项研究报告总体死亡率显著降低。然而，对医疗费用的影响尚无定论。
关于RS工具在初级保健环境中管理慢性病有效性的证据仍然有限。虽然一些研究表明在降低住院率、急诊就诊次数和死亡率方面有积极结果，但对门诊服务使用和医疗费用的总体影响各不相同。需要进一步的高质量研究来评估RS工具在初级保健中慢性病管理的长期效益和成本效益。
