Burns L R, Lamb G S, Wholey D R
Department of Health Care Systems, Wharton School, University of Pennsylvania, Philadelphia 19104, USA.
Inquiry. 1996 Spring;33(1):30-41.
This study measures the impact of integrated community nursing services on hospital use and costs for elderly people in a health maintenance organization (HMO). We tracked 4,943 HMO patients over three consecutive five-month periods (one preintervention and two postintervention). We compared 326 patients who entered a program of integrated services during period 2 with 301 patients who entered during period 3 and 4,316 nonprogram patients in respect to their utilization and costs during periods 2 and 3. Regression results reveal that patients receiving integrated services had significantly higher utilization and costs during the period of enrollment and significantly lower utilization and costs during the period following enrollment, compared to nonprogram patients. These results were replicated when considering only patients with observed episodes of care in these periods, when controlling for hospital use and costs in the prior period, and when controlling for the risk of selection into the program. The findings suggest that integrating services at the community level may achieve substantial cost savings.
本研究衡量了社区综合护理服务对健康维护组织（HMO）中老年人住院使用情况及费用的影响。我们在连续三个五个月的时间段内（一个干预前阶段和两个干预后阶段）跟踪了4943名HMO患者。我们将在第二阶段进入综合服务项目的326名患者与在第三阶段和第四阶段进入该项目的301名患者以及4316名未参与项目的患者在第二阶段和第三阶段的使用情况及费用进行了比较。回归结果显示，与未参与项目的患者相比，接受综合服务的患者在入组期间的使用率和费用显著更高，而在入组后的时间段内使用率和费用则显著更低。当仅考虑在这些时间段内有观察到护理事件的患者、控制前期的住院使用情况及费用以及控制进入该项目的选择风险时，这些结果得到了重复验证。研究结果表明，在社区层面整合服务可能会实现大幅成本节约。
