Abstract：
BACKGROUND: Many healthcare systems have implemented intensive outpatient primary care programs with the hopes of reducing healthcare costs.
OBJECTIVE: The Veterans Health Administration (VHA) piloted primary care intensive management (PIM) for patients at high risk for hospitalization or death, or \"high-risk.\" We evaluated whether a referral model would decrease high-risk patient costs.
METHODS: Retrospective cohort study using a quasi-experimental design comparing 456 high-risk patients referred to PIM from October 2017 to September 2018 to 415 high-risk patients matched on propensity score.
METHODS: Veterans in the top 10th percentile of risk for 90-day hospitalization or death and recent hospitalization or emergency department (ED) visit.
METHODS: PIM consisted of interdisciplinary teams that performed comprehensive assessments, intensive case management, and care coordination services.
METHODS: Change in VHA and non-VHA outpatient utilization, inpatient admissions, and costs 12 months pre- and post-index date.
RESULTS: Of the 456 patients referred to PIM, 301 (66%) enrolled. High-risk patients referred to PIM had a marginal reduction in ED visits (- 0.7; [95% CI - 1.50 to 0.08]; p = 0.08) compared to propensity-matched high-risk patients; overall outpatient costs were similar. High-risk patients referred to PIM had similar number of medical/surgical hospitalizations (- 0.2; [95% CI, - 0.6 to 0.16]; p = 0.2), significant increases in length of stay (6.36; [CI, - 0.01 to 12.72]; p = 0.05), and higher inpatient costs ($22,628, [CI, $3587 to $41,669]; p = 0.02) than those not referred to PIM.
CONCLUSIONS: VHA intensive outpatient primary care was associated with higher costs. Referral to intensive case management programs targets the most complex patients and may lead to increased utilization and costs, particularly in an integrated healthcare setting with robust patient-centered medical homes.
BACKGROUND: PIM 2.0: Patient Aligned Care Team (PACT) Intensive Management (PIM) Project (PIM2). NCT04521816. https://clinicaltrials.gov/study/NCT04521816.
OBJECTIVE: The Veterans Health Administration (VHA) piloted primary care intensive management (PIM) for patients at high risk for hospitalization or death, or \"high-risk.\" We evaluated whether a referral model would decrease high-risk patient costs.
METHODS: Retrospective cohort study using a quasi-experimental design comparing 456 high-risk patients referred to PIM from October 2017 to September 2018 to 415 high-risk patients matched on propensity score.
METHODS: Veterans in the top 10th percentile of risk for 90-day hospitalization or death and recent hospitalization or emergency department (ED) visit.
METHODS: PIM consisted of interdisciplinary teams that performed comprehensive assessments, intensive case management, and care coordination services.
METHODS: Change in VHA and non-VHA outpatient utilization, inpatient admissions, and costs 12 months pre- and post-index date.
RESULTS: Of the 456 patients referred to PIM, 301 (66%) enrolled. High-risk patients referred to PIM had a marginal reduction in ED visits (- 0.7; [95% CI - 1.50 to 0.08]; p = 0.08) compared to propensity-matched high-risk patients; overall outpatient costs were similar. High-risk patients referred to PIM had similar number of medical/surgical hospitalizations (- 0.2; [95% CI, - 0.6 to 0.16]; p = 0.2), significant increases in length of stay (6.36; [CI, - 0.01 to 12.72]; p = 0.05), and higher inpatient costs ($22,628, [CI, $3587 to $41,669]; p = 0.02) than those not referred to PIM.
CONCLUSIONS: VHA intensive outpatient primary care was associated with higher costs. Referral to intensive case management programs targets the most complex patients and may lead to increased utilization and costs, particularly in an integrated healthcare setting with robust patient-centered medical homes.
BACKGROUND: PIM 2.0: Patient Aligned Care Team (PACT) Intensive Management (PIM) Project (PIM2). NCT04521816. https://clinicaltrials.gov/study/NCT04521816.
摘要：
背景：许多医疗保健系统都实施了强化的门诊初级保健计划，以期降低医疗保健成本。
目标：退伍军人健康管理局（VHA）为住院或死亡高危患者试行初级护理强化管理（PIM），或“高风险”。“我们评估了转诊模式是否会降低高风险患者的成本。
方法：采用准实验设计的回顾性队列研究，比较了2017年10月至2018年9月456名PIM高危患者与415名倾向评分匹配的高危患者。
方法：在90天住院或死亡和最近住院或急诊（ED）就诊的前10百分位的退伍军人。
方法：PIM由跨学科团队组成，进行全面评估，强化病例管理，护理协调服务。
方法：VHA和非VHA门诊使用率的变化，住院,以及索引日期前后12个月的费用。
结果：在456名患者中，301（66%）注册。与倾向匹配的高危患者相比，PIM高危患者的ED就诊次数略有减少（-0.7；[95％CI-1.50至0.08]；p=0.08）；总体门诊费用相似。转诊为PIM的高危患者的内科/外科住院次数相似（-0.2；[95％CI，-0.6至0.16]；p=0.2），住院时间显着增加（6.36；[CI，-0.01至12.72]；p=0.05），住院费用（22,628美元，[CI，3587美元至41,669美元]；p=0.02）高于未提及PIM的费用。
结论：VHA强化门诊初级保健与较高的费用相关。转诊强化病例管理计划针对最复杂的患者，并可能导致利用率和成本的提高。特别是在具有强大的以患者为中心的医疗家庭的综合医疗保健环境中。
背景：PIM2.0：患者对齐护理团队（PACT）强化管理（PIM）项目（PIM2）。NCT04521816。https://clinicaltrials.gov/study/NCT04521816.
目标：退伍军人健康管理局（VHA）为住院或死亡高危患者试行初级护理强化管理（PIM），或“高风险”。“我们评估了转诊模式是否会降低高风险患者的成本。
方法：采用准实验设计的回顾性队列研究，比较了2017年10月至2018年9月456名PIM高危患者与415名倾向评分匹配的高危患者。
方法：在90天住院或死亡和最近住院或急诊（ED）就诊的前10百分位的退伍军人。
方法：PIM由跨学科团队组成，进行全面评估，强化病例管理，护理协调服务。
方法：VHA和非VHA门诊使用率的变化，住院,以及索引日期前后12个月的费用。
结果：在456名患者中，301（66%）注册。与倾向匹配的高危患者相比，PIM高危患者的ED就诊次数略有减少（-0.7；[95％CI-1.50至0.08]；p=0.08）；总体门诊费用相似。转诊为PIM的高危患者的内科/外科住院次数相似（-0.2；[95％CI，-0.6至0.16]；p=0.2），住院时间显着增加（6.36；[CI，-0.01至12.72]；p=0.05），住院费用（22,628美元，[CI，3587美元至41,669美元]；p=0.02）高于未提及PIM的费用。
结论：VHA强化门诊初级保健与较高的费用相关。转诊强化病例管理计划针对最复杂的患者，并可能导致利用率和成本的提高。特别是在具有强大的以患者为中心的医疗家庭的综合医疗保健环境中。
背景：PIM2.0：患者对齐护理团队（PACT）强化管理（PIM）项目（PIM2）。NCT04521816。https://clinicaltrials.gov/study/NCT04521816.
