Freeborn D K, Mullooly J P, Colombo T, Burnham V
J Community Health. 1978 Summer;3(4):306-20. doi: 10.1007/BF01498507.
An original goal of the Kaiser-Permanente Neighborhood Health Center Project was to organize the project so that a medically indigent population would be able to utilize fully and appropriately the services of a complex medical care program. A special program of outreach services was designed as the principal means to achieve this goal. This study was made to determine the effects of these outreach services on (1) the use of or nonuse of ambulatory care services; (2) the volume and type of services used; (3) the patterns of use; and (4) the appointment-keeping behavior of the project population for a 12-month period. Outreach and medical care services were provided to an average of 7,000 persons in 1,500 low-income families who were enrolled as health plan members in the Kaiser-Permanente Medical Care Program. Project participants were randomly divided into two groups, one with and one without services, and utilization data were collected from their medical and administrative records. The findings suggest that outreach intervention had a positive effect on access to care. Persons who received outreach services were more likely to contact the medical care system; these persons also showed a substantial difference in the volume of services they used, when compared to those without outreach services. Outreach workers were less successful in changing utilization patterns, although slight differences were found in the direction of more appropriate use. Persons with outreach services were more likely to have made contacts with their regular physician, to have made a smaller proportion of walk-in contacts, to have had a higher proportion of regularly scheduled contacts, and to have made a higher proportion of continuing visits. Outreach workers also had little or no effect on appointment-keeping behavior.
凯撒-永久医疗集团社区健康中心项目的最初目标是对该项目进行组织安排，以便让医疗贫困人群能够充分且恰当地利用综合医疗护理项目的服务。一项外展服务特别项目被设计为实现这一目标的主要手段。本研究旨在确定这些外展服务对以下方面的影响：（1）门诊护理服务的使用或未使用情况；（2）所使用服务的数量和类型；（3）使用模式；以及（4）项目人群在12个月期间的预约就诊行为。外展服务和医疗护理服务提供给了凯撒-永久医疗护理项目中登记为健康计划成员的1500个低收入家庭中的平均7000人。项目参与者被随机分为两组，一组接受服务，一组不接受服务，并从他们的医疗和行政记录中收集使用数据。研究结果表明，外展干预对获得医疗服务有积极影响。接受外展服务的人更有可能与医疗护理系统联系；与未接受外展服务的人相比，这些人在使用服务的数量上也有显著差异。外展工作人员在改变使用模式方面不太成功，尽管在更合理使用的方向上发现了细微差异。接受外展服务的人更有可能与他们的常规医生联系，非预约就诊的比例更小，定期预约就诊的比例更高，持续就诊的比例也更高。外展工作人员对预约就诊行为也几乎没有影响。
