Lina Tieu, Nadereh Pourat, Elizabeth Bromley, Rajat Simhan, Weihao Zhou, Xiao Chen, Beth Glenn, Roshan Bastani
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引用次数: 0
摘要
行为健康一体化(BHI)越来越多地得到实施,以扩大在初级保健中处理行为健康状况的能力。来自公立医院重新设计和Medi-Cal计划激励评估的调查和索赔数据被用于检查加州17家公立医院的医疗补助患者的身体健康和酒精相关结果之间的关系。关键信息者调查数据在3个级别(总体组合、基础设施和流程领域,10个主题)测量了医院级别的健康指数。多水平logistic回归模型估计了BHI与结果之间的关系,表明在酒精相关指数遭遇后的一年内接受适当的酒精相关护理(任何初级保健就诊、任何解毒、及时开始、及时参与)和急性护理(任何急诊[ED]就诊或住院,分类为酒精相关或全因)。在6196名患者中,一些人接受了与酒精有关的初级保健访问(33%),戒毒(16%),及时开始(14%)或参与治疗(7%)。急诊科就诊导致出院(40%与酒精有关,64%全因)比住院(15%与酒精有关,26%全因)更常见。在控制患者水平特征的情况下,没有观察到总体身体健康指数与这些结果之间的显著关系。然而,较高的BHI基础设施与酒精相关(比值比[OR] 1.86, 95%可信区间[CI] 1.14-3.05)和全因住院(比值比[OR] 1.25, 95% CI 1.01-1.55)相关。BHI主题(例如,与提供者的支持有关)与酒精相关解毒、初级保健就诊、及时开始和急性护理利用的可能性较大之间存在关联。研究结果表明,实施特定的BHI成分可能会改善酒精相关治疗的接受情况,并为未来对这些关系的研究提供了依据。
Assessing the Relationship Between Behavioral Health Integration and Alcohol-Related Treatment Among Patients with Medicaid.
Behavioral health integration (BHI) is increasingly implemented to expand capacity to address behavioral health conditions within primary care. Survey and claims data from the evaluation of the Public Hospital Redesign and Incentives in Medi-Cal program were used to examine the relationship between BHI and alcohol-related outcomes among Medicaid patients within 17 public hospitals in California. Key informant survey data measured hospital-level BHI at 3 levels (overall composite, infrastructure, and process domains, 10 themes). Multilevel logistic regression models estimated the relationship between BHI and outcomes indicating receipt of appropriate alcohol-related care (any primary care visit, any detoxification, timely initiation, timely engagement) and acute care (any emergency department [ED] visit or hospitalization, classified as alcohol-related or all-cause) in the year following an alcohol-related index encounter. Of 6196 patients, some had an alcohol-related primary care visit (33%), detoxification (16%), timely initiation (14%), or engagement in treatment (7%). ED visits resulting in discharge were more common (40% alcohol-related, 64% all-cause) than hospitalizations (15% alcohol-related, 26% all-cause). Controlling for patient-level characteristics, no significant relationships between overall BHI and these outcomes were observed. However, greater BHI infrastructure was associated with alcohol-related (odds ratio [OR] 1.86, 95% confidence interval [CI] 1.14-3.05) and all-cause hospitalization (OR 1.25, 95% CI 1.01-1.55). Associations emerged between BHI themes (eg, related to support of providers) and greater likelihood of alcohol-related detoxification, primary care visit, timely initiation, and acute care utilization. Findings suggest that implementing specific BHI components may improve receipt of alcohol-related treatment, and warrant future research into these relationships.
期刊介绍:
Population Health Management provides comprehensive, authoritative strategies for improving the systems and policies that affect health care quality, access, and outcomes, ultimately improving the health of an entire population. The Journal delivers essential research on a broad range of topics including the impact of social, cultural, economic, and environmental factors on health care systems and practices.
Population Health Management coverage includes:
Clinical case reports and studies on managing major public health conditions
Compliance programs
Health economics
Outcomes assessment
Provider incentives
Health care reform
Resource management
Return on investment (ROI)
Health care quality
Care coordination.