目的:人际连续性已被证明在初级保健的有益效果中起着至关重要的作用。在医疗支付模式快速演变的20年里,我们试图总结与医疗保健成本和使用的连续性相关的同行评审文献的范围,对于评估基于价值的支付设计中连续性测量的必要性至关重要的信息。
方法:在全面回顾之前的连续性文献后,我们使用已建立的医学主题词(MeSH)和关键词的组合来搜索PubMed,Embase,和Scopus在2002年至2022年之间发表的关于“护理的连续性”和“患者护理的连续性”的文章,“和付款人相关的结果,包括护理费用,医疗费用,医疗保健费用,护理总费用,利用率,门诊护理敏感状况,以及这些疾病的住院治疗。我们只搜索初级保健关键词,MeSH术语,和其他受控词汇,包括初级保健,初级卫生保健,家庭医学,家庭实践,儿科,和内科。
结果:我们的搜索产生了83篇文章,描述了2002年至2022年之间发表的研究。其中,18项研究共有18项独特结果,研究了连续性与医疗保健成本之间的关系,79项研究共142项独特结局,评估了连续性与医疗保健使用之间的关联.人际连续性与160个结果中的109个显著降低的成本或更有利的使用相关。
结论:今天的人际连续性仍然与更低的医疗保健成本和更适当的使用显著相关。需要进一步的研究来在临床医生处分解这些关联,团队,实践,和系统级别,但是连续性评估对于设计基于价值的初级保健支付显然很重要。
Interpersonal continuity has been shown to play an essential role in primary care\'s salutary effects. Amid 2 decades of rapid evolution in the health care payment model, we sought to summarize the range of peer-reviewed literature relating continuity to health care costs and use, information critical to assessing the need for continuity measurement in value-based payment design.
After comprehensively reviewing prior continuity literature, we used a combination of established medical subject headings (MeSH) and key words to search PubMed, Embase, and Scopus for articles published between 2002 and 2022 on \"continuity of care\" and \"continuity of patient care,\" and payor-relevant outcomes, including cost of care, health care costs, cost of health care, total cost of care, utilization, ambulatory care-sensitive conditions, and hospitalizations for these conditions. We limited our search to primary care key words, MeSH terms, and other controlled vocabulary, including primary care, primary health care, family medicine, family practice, pediatrics, and internal medicine.
Our search yielded 83 articles describing studies that were published between 2002 and 2022. Of these, 18 studies having a total of 18 unique outcomes examined the association between continuity and health care costs, and 79 studies having a total of 142 unique outcomes assessed the association between continuity and health care use. Interpersonal continuity was associated with significantly lower costs or more favorable use for 109 of the 160 outcomes.
Interpersonal continuity today remains significantly associated with lower health care costs and more appropriate use. Further research is needed to disaggregate these associations at the clinician, team, practice, and system levels, but continuity assessment is clearly important to designing value-based payment for primary care.