论文部分内容阅读
背景 2003年医疗保险现代化行动,国会要求医疗保险和医疗补助服务中心对医疗保险医疗费用项目中的商业化疾病管理模式进行检测。方法医疗保险医疗救助先导项目,针对8个商业化疾病管理项目用于护士电话中心,进行大型随机研究。我们将心力衰竭、糖尿病或并存两种病的病人随机分组,干预组或常规照顾组(对照组),用双差分法,将他们进行比较,以评价商业化项目对临床医疗质量、急诊医疗利用及医疗费用受惠者医疗保险支付的影响。结果研究入选病人242 417例(干预组163 107例,对照组79 310例)。与常规照顾组比较,8个商业化疾病管理项目未能使住院率或急诊室就诊率减少。40项照顾过程测量比较,我们仅发现其中14项有明显改善。这些改善源自医疗保险项目向疾病管理公司支付的成本(4亿美元),并未正式缩减医疗保险支出。结论本大型研究表明,商业化疾病管理项目用于护士电话中心,使医疗质量测量得到适度改善,并未证实急诊医疗利用或医疗成本有所减少。
Background In 2003, the Medicare Modernization Campaign called for the Medicare and Medicaid Services Centers to test the commercialized disease management model in Medicare medical expenses programs. Methods Medicare Medicare Pilot Project, a large randomized study of 8 commercial disease management programs for nurse call centers. We randomized patients with heart failure, diabetes or coexisting disease, intervention group or general care group (control group) and compared them with double difference method to evaluate the impact of commercialization on clinical care quality, emergency medical use And medical expenses beneficiaries of medical insurance payments. Results A total of 242 417 patients were enrolled in the study (163 107 in the intervention group and 79 310 in the control group). Compared with the routine care group, eight commercial disease management programs failed to reduce the hospitalization rate or emergency department visit rate. We compared 40 caregiving measures and found that only 14 of them significantly improved. These improvements stem from the cost of the Medicare program paid to the disease management company ($ 400 million) and have not officially reduced Medicare spending. Conclusions This large study shows that commercial disease management programs are being used in nurse call centers to provide a modest improvement in the measurement of quality of care without any reduction in emergency medical use or medical costs.