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首页> 美国卫生研究院文献>Journal of Primary Care Community Health >Primary Care Comprehensiveness and Care Coordination in Robust Specialist Networks Results in Lower Emergency Department Utilization: A Network Analysis of Medicaid Physician Networks
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Primary Care Comprehensiveness and Care Coordination in Robust Specialist Networks Results in Lower Emergency Department Utilization: A Network Analysis of Medicaid Physician Networks

机译：强大的专业网络中的初级保健综合性和关心协调导致较低的急诊部门利用率：Medicatods医师网络的网络分析

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Background: Care coordination is an essential and difficult to measure function of primary care. Objective: Our objective was to assess the impact of network characteristics in primary/specialty physician networks on emergency department (ED) visits for patients with chronic ambulatory care sensitive conditions (ACSCs). Subjects and Measures: This cross-sectional social network analysis of primary care and specialty physicians caring for adult Medicaid beneficiaries with ACSCs was conducted using 2009 Texas Medicaid Analytic eXtract (MAX) files. Network characteristic measures were the main exposure variables. A negative binomial regression model analyzed the impact of network characteristics on the ED visits per patient in the panel. Results: There were 42 493 ACSC patients assigned to 5687 primary care physicians (PCPs) connected to 11 660 specialist physicians. PCPs whose continuity patients did not visit a specialist had 86% fewer ED visits per patient in their panel, compared with PCPs whose patients saw specialists. Among PCPs connected to specialists in the network, those with a higher number of specialist collaborators and those with a high degree of centrality had lower patient panel ED rates. Conclusions: PCPs providing comprehensive care (ie, without specialist consultation) for their patients with chronic ACSCs had lower ED utilization rates than those coordinating care with specialists. PCPs with robust specialty networks and a high degree of centrality in the network also had lower ED utilization. The right fit between comprehensiveness of primary care, care coordination, and adequate capacity of specialty availability in physician networks is needed to drive outcomes.
机译：背景：护理协调是一个必不可少的且难以测量初级保健功能。目的：我们的目的是评估慢性门诊敏感条件（ACSCs）患者对急诊部门（ED）访问的主要/特种医师网络中网络特征的影响。主题与措施：使用2009德克萨斯医疗补助分析提取物（MAX）文件进行了对初级保健和专业医生照顾ACSCS的初级保健和专业医师的横断面社会网络分析。网络特征措施是主要的曝光变量。负二项式回归模型分析了网络特征对面板中每位患者的ED访问的影响。结果：42个493名ACSC患者分配到5687名初级保健医生（PCP），连接到11 660名专业医师。与患者看到专家的PCP相比，PCP在他们的小组中，他们的连续性患者没有参观专家的患者每位患者的次数减少86％。在连接到网络专家的PCP中，具有较多专科合作者的人和具有高中心性的人具有较低的患者面板ED率。结论：PCP为其慢性ACSCS患者提供全面的护理（即没有专业咨询）的ED利用率比与专家的协调护理更低。具有强大的专业网络和网络中高度中心的PCP也具有较低的ID利用率。需要在初级保健，护理协调和实际可用性的全面性之间施加综合性之间的权利，以推动结果。

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