Impact of Referring High-Risk Patients to Intensive Outpatient Primary Care Services: A Propensity Score-Matched Analysis.

Autor: Chang ET; VHA Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), Los Angeles, CA, USA. Evelyn.Chang@va.gov.; Department of Medicine, VHA Greater Los Angeles Healthcare System, Los Angeles, CA, USA. Evelyn.Chang@va.gov.; Department of Medicine, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA, USA. Evelyn.Chang@va.gov., Huynh A; VHA Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), Los Angeles, CA, USA., Yoo C; VHA Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), Los Angeles, CA, USA., Yoon J; VHA Health Economics Resource Center (HERC), Menlo Park, CA, USA.; Department of General Internal Medicine, UCSF School of Medicine, San Francisco, CA, USA., Zulman DM; VHA HSR Center for Innovation to Implementation, Menlo Park, CA, USA.; Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA, USA., Ong MK; VHA Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), Los Angeles, CA, USA.; Department of Medicine, VHA Greater Los Angeles Healthcare System, Los Angeles, CA, USA.; Department of Medicine, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA, USA.; Department of Health Policy and Management, Fielding School of Public Health, University of California at Los Angeles, Los Angeles, CA, USA., Klein M; Department of Medicine, VHA Northeast Ohio Healthcare System, Cleveland, OH, USA., Eng J; On Lok Program of All-Inclusive Care for the Elderly (PACE), San Francisco, CA, USA.; Division of Geriatrics, University of California, San Francisco, CA, USA., Roy S; VHA Salisbury Healthcare System, Salisbury, NC, USA., Stockdale SE; VHA Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), Los Angeles, CA, USA.; Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, USA., Jimenez EE; VHA Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), Los Angeles, CA, USA.; Behavioral Neurology, Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA, USA., Denietolis A; VHA Office of Primary Care, 810 Vermont Ave, Washington, DC, 20420, USA., Needleman J; Department of Health Policy and Management, Fielding School of Public Health, University of California at Los Angeles, Los Angeles, CA, USA., Asch SM; VHA HSR Center for Innovation to Implementation, Menlo Park, CA, USA.; Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA, USA.
Jazyk: angličtina
Zdroj: Journal of general internal medicine [J Gen Intern Med] 2024 Jul 29. Date of Electronic Publication: 2024 Jul 29.
DOI: 10.1007/s11606-024-08923-3
Abstrakt: 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.
Design: 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.
Participants: Veterans in the top 10th percentile of risk for 90-day hospitalization or death and recent hospitalization or emergency department (ED) visit.
Intervention: PIM consisted of interdisciplinary teams that performed comprehensive assessments, intensive case management, and care coordination services.
Main Outcomes and Measures: Change in VHA and non-VHA outpatient utilization, inpatient admissions, and costs 12 months pre- and post-index date.
Key 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 and Relevance: 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.
Trial Registration: PIM 2.0: Patient Aligned Care Team (PACT) Intensive Management (PIM) Project (PIM2). NCT04521816. https://clinicaltrials.gov/study/NCT04521816.
(© 2024. This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply.)
Databáze: MEDLINE
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