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Journal of General Internal Medicine

Erschienen in:

19.03.2021 | Original Research

Comparative Effectiveness of a Complex Care Program for High-Cost/High-Need Patients: a Retrospective Cohort Study

verfasst von: Douglas W. Roblin, PhD, Joel E. Segel, PhD, Richard J. McCarthy, MD, Neeraj Mendiratta, MD

Erschienen in: Journal of General Internal Medicine | Ausgabe 7/2021

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Abstract

Background

High-cost/high-need (HCHN) adults and the healthcare systems that provide their care may benefit from a new patient-centered model of care involving a dedicated physician and nurse team who coordinate both clinical and social services for a small patient panel.

Objective

Evaluate the impact of a Complex Care Program (CCP) on likelihood of patient survival and hospital admission in 180 days following empanelment to the CCP.

Design

Retrospective cohort study using a quasi-experimental design with CCP patients propensity score matched to a concurrent control group of eligible but unempaneled patients.

Setting

Kaiser Permanente Mid-Atlantic States (KPMAS) during 2017–2018.

Participants

Nine hundred twenty-nine CCP patients empaneled January 2017–June 2018, 929 matched control patients for the same period.

Interventions

The KPMAS CCP is a new program consisting of 8 teams each staffed by a physician and nurse who coordinate care across a continuum of specialty care, tertiary care, and community services for a panel of 200 patients with advanced clinical disease and recent hospitalizations.

Main Outcomes

Time to death and time to first hospital admission in the 180 days following empanelment or eligibility.

Results

Compared to matched control patients, CCP patients had prolonged time to death (hazard ratio [HR]: 0.577, 95% CI: 0.474, 0.704), and CCP decedents had longer survival (median days 69.5 vs. 53.0, p=0.03). CCP patients had similar time to hospital admission (HR: 1.081, 95% CI: 0.930, 1.258), with similar results when adjusting for competing risk of death (HR: 1.062, 95% CI: 0.914, 1.084).

Limitations

Non-randomized intervention; single healthcare system; patient eligibility limited to specific conditions.

Conclusion

The KPMAS CCP was associated with significantly reduced short-term mortality risk for eligible patients who volunteered to participate in this intervention.

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Titel: Comparative Effectiveness of a Complex Care Program for High-Cost/High-Need Patients: a Retrospective Cohort Study
verfasst von: Douglas W. Roblin, PhD
Joel E. Segel, PhD
Richard J. McCarthy, MD
Neeraj Mendiratta, MD
Publikationsdatum: 19.03.2021
Verlag: Springer International Publishing
Erschienen in: Journal of General Internal Medicine / Ausgabe 7/2021
Print ISSN: 0884-8734
Elektronische ISSN: 1525-1497
DOI: https://doi.org/10.1007/s11606-021-06676-x

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Abstract

Background

Objective

Design

Setting

Participants

Interventions

Main Outcomes

Results

Limitations

Conclusion

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