Impact of territorial case management on hospital admissions for complex chronic patients in Catalonia (Spain)

IF 3.6 3区医学 Q1 HEALTH CARE SCIENCES & SERVICES

Health Policy Pub Date : 2025-06-25 DOI:10.1016/j.healthpol.2025.105384

Jesús Antonio Vaquero Cruzado , Nuria Gutiérrez Jiménez , Laura Carrillo Ciércoles , Eva García Tarrida , María Jesús Megido Badía , Nuria Fabrellas Padrés

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引用次数: 0

Abstract

Background

Chronic diseases are the most frequent health problem in the population. The development of case management, as an advanced care practice, is a basic strategy in the care of complex chronicity. The Catalan Health Plan establishes general guidelines for chronic care, linked to the role of the nurse case management.

Objective

The objective is to analyse the impact on the health system of shared monitoring, by the chronicity care team and its primary care reference team, in patients identified as complex chronic diseases (CCP) or with advanced disease (MACA), in regarding hospital admissions.

Methods

Retrospective quasi-experimental intervention study, with pre-post analysis, comparing each patient one year before and one year after being incorporated into the case management portfolio of a team made up of 14 nurses, 2 family medicine specialists and one social worker, with attention 365 days a year, 24 h a day.

Results

Regarding the decrease in hospital admissions, an average decrease (2013–2021) of 56 % was observed for MACA and 53 % in CCP. Statistical analysis based on a Poisson regression model with offset demonstrates that the intervention program had a significant effect on reducing hospital admissions, from a team formed from primary care itself.

Conclusions

The organization and structure of a chronic care team such as the one described, in an integrated manner with other levels of care, allows for a significant reduction in hospital admissions.

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加泰罗尼亚（西班牙）地区病例管理对复杂慢性患者入院的影响

背景慢性病是人群中最常见的健康问题。发展病例管理作为一种先进的护理实践，是复杂慢性疾病护理的基本策略。《加泰罗尼亚健康计划》规定了慢性病护理的一般准则，并与护士病例管理的作用相联系。目的分析慢性病护理团队及其初级保健参考团队在确定为复杂慢性病（CCP）或晚期疾病（MACA）的患者入院时对卫生系统进行共享监测的影响。方法回顾性准实验干预研究，采用前后分析的方法，比较每例患者纳入由14名护士、2名家庭医学专家和1名社工组成的一年365天，每天24小时的病例管理组合的一年前和一年后的情况。结果关于住院率的下降，2013-2021年MACA平均下降56%，CCP平均下降53%。基于偏移量的泊松回归模型的统计分析表明，干预方案对减少住院率有显著影响，这是由初级保健本身组成的团队。如上所述的慢性护理团队的组织和结构，与其他级别的护理相结合，可以显著减少住院率。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Health Policy 医学-卫生保健

CiteScore

6.40

自引率

6.10%

发文量

157

审稿时长

3-8 weeks

期刊介绍： Health Policy is intended to be a vehicle for the exploration and discussion of health policy and health system issues and is aimed in particular at enhancing communication between health policy and system researchers, legislators, decision-makers and professionals concerned with developing, implementing, and analysing health policy, health systems and health care reforms, primarily in high-income countries outside the U.S.A.