Optimal Primary Care for Elders: Annual Physicals vs. Comprehensive Care Systems

老年人的最佳初级护理：年度体检与综合护理系统

• 批准号: 7672937
• 负责人: Phuong Hoang
• 金额: $ 3.7万
• 依托单位: BRANDEIS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-09-30 至 2011-09-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7672937
• 关键词: Optimal; Primary; Care; Elders; Annual

DESCRIPTION (provided by the investigator): Faced with Medicare payment cuts, unfavorable Medicare reimbursement to support geriatric team care, a shrinking supply of geriatricians, a growing aging population, and a fragmented health care delivery system, health care organizations have to find creative ways to achieve optimal integrated quality primary care for their elderly patients. This dissertation research is a case study of the Elliot Physician Network (EPN), which is the primary care entity of the Elliot Health System (EHS), based in New Hampshire. The EHS is an organized delivery system that is currently undergoing a culture change. It is transitioning its core business to primary care instead of inpatient hospital acute care and integrating its clinical care services across the different EHS entities. To support the culture change and to reshape its primary care network to best serve its growing aging population, the EHS has implemented an EpicCare electronic medical record and has invested in a 20,000 square foot, one-stop, multi-services Senior Health Center (SHC) in the city of Manchester that is based on an interdisciplinary geriatrics team care model. The Manchester-SHC of the EHS serves as an excellent site to study coordination of elderly primary care and clinical integration because it is one of a few sites in the US offering a wide range of services catered to elders in one stop. In particular, this dissertation research has four aims. To: 1) Measure the relationship between receipt of an annual physical exam visit and physician recommendation of evidence-based preventive services; 2) Evaluate whether there is a significant difference between the interdisciplinary geriatrics Manchester Senior Health Center care model and the traditional primary care model in the receipt of referrals for: A) physical therapy for patients diagnosed with degenerative joint disease (osteoarthritis) or cerebrovascular disease (stroke) and B) geropsychiatric care for patients diagnosed with memory loss, dementia, or depression; 3) Identify when providers and patients discuss preventive services in the two models of care, how they assess risks for an elderly patient, develop a treatment plan, and monitor patients' progress, and how they coordinate care for patients needing multiple services across care settings; and 4) Measure the impact of the team care model on patients' use of outpatient services and inpatient services offered at the EHS. Data will be drawn from EPN 2001-06 panel administrative data, Elliot Hospital data, and face-to-face interviews with selected PC providers and their support staff members. Quantitative data analyses will be conducted using fixed-effect and difference-in-difference models. Qualitative data will be used to inform interpretation of quantitative analyses. Results of this study will help to develop strategies for delivering continuous, effective, evidence-based preventive services to elders.

描述（由研究者提供）：面对医疗保险付款削减、支持老年团队护理的医疗保险报销不利、老年科医生供应量减少、人口老龄化不断增长以及医疗保健服务体系分散等问题，医疗保健组织必须找到创造性的方法为老年患者提供最佳的综合优质初级护理。本论文研究是艾略特医生网络 (EPN) 的案例研究，该网络是艾略特医疗系统 (EHS) 的初级保健实体，总部位于新罕布什尔州。 EHS 是一个有组织的交付系统，目前正在经历文化变革。该公司正在将其核心业务从住院急症护理转向初级护理，并将其临床护理服务整合到不同的 EHS 实体中。为了支持文化变革并重塑其初级保健网络，以最好地服务于日益增长的老龄化人口，EHS 实施了 EpicCare 电子病历，并投资建设了 20,000 平方英尺的一站式多功能服务高级健康中心 (SHC) ）位于曼彻斯特市，基于跨学科老年病学团队护理模式。 EHS 的曼彻斯特 SHC 是研究老年人初级保健和临床整合协调的绝佳场所，因为它是美国为数不多的为老年人提供一站式广泛服务的少数场所之一。具体来说，本论文的研究有四个目的。目的： 1) 衡量接受年度体检与医生推荐循证预防服务之间的关系； 2) 评估曼彻斯特高级健康中心跨学科老年医学护理模式与传统初级护理模式在接受转诊方面是否存在显着差异： A) 对诊断为退行性关节病（骨关节炎）或脑血管疾病的患者进行物理治疗（中风）和 B）诊断患有记忆丧失、痴呆或抑郁症的患者的老年精神护理； 3) 确定提供者和患者何时讨论两种护理模式中的预防性服务，他们如何评估老年患者的风险，制定治疗计划和监测患者的进展，以及他们如何在护理环境中协调对需要多种服务的患者的护理; 4) 衡量团队护理模式对患者使用 EHS 提供的门诊服务和住院服务的影响。数据将取自 EPN 2001-06 小组管理数据、埃利奥特医院数据以及与选定的 PC 提供商及其支持人员的面对面访谈。将使用固定效应和双重差分模型进行定量数据分析。定性数据将用于解释定量分析。这项研究的结果将有助于制定战略，为老年人提供持续、有效、循证的预防服务。