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目的本项准实验研究在俄克拉何马州一个农业县进行,旨在建立一种长期可行的乡村社区预防保健服务提醒模式,方便患者获得预防保健服务,改善基层医疗机构在此方面的不足。本研究设置的健康协调员与基层医疗卫生机构、县卫生部门、县医院、健康信息交流组织同时为使县城居民享受到循证预防保健服务而工作。方法根据基层医疗卫生机构为患者制定的个性化重点推荐服务协议内容,由健康协调员在每年的出生月份对县区患者进行电话随访,提醒其该年度需接受的预防保健服务。登记患者信息可以明确患者所需的预防保健服务,保证社区预防保健服务的后续进行,并且可以记录整个社区的预防保健服务开展情况。社区提供重点预防保健服务的投资回报率由参与组织机构评估。结果该县7个基层医疗卫生机构中有6个对此项目感兴趣,3个在2015年6月此项目开展时完全实施了第一年规划。当地健康信息交流组织为健康协调员提供了9 138例该县居民最新病历信息。第一年健康协调员与5 034例居民进行了电话沟通,向其推荐了所需的7 776项预防保健服务。其中1 146例(22%)患者及时接受了推荐的所有服务,3 888例(78%)至少有一项推荐的服务未及时接受。该县卫生机构在提供选择性预防保健服务方面有明显改善(10项服务的改善率为3%~215%,平均改善率为35%,P=0.004);服务带来的投资回报率为32%~122%,平均80%。设置健康协调员的卫生体系获得预期收入为$52 000,实现了投资回报率为40%的目标。结论建立一个新型县级患者拓展服务项目是可行的,有助于改善乡村地区的预防保健服务且能够带来成本效益,但效果仍待于进一步证实。
Purpose This pilot study was conducted in an agricultural county in Oklahoma to establish a long-term reminder of prevention and care services for rural communities to facilitate access to preventive health care services and to improve primary health care institutions’ inadequacies in this regard. The health coordinators set up in this study work with primary health care institutions, county health departments, county hospitals and health information exchange organizations in order to enable county residents to enjoy evidence-based preventive health care services. Methods According to the personalized recommendation service agreement for primary care patients, health coordinators conducted telephone interviews with patients in the county during the month of birth to remind them of the preventive health care services to be accepted in this year. Registering patient information identifies the patient’s need for preventive care, ensures follow-up to community preventive health care services, and documents the prevention of health-care services throughout the community. The rate of return on investment by communities in providing key preventive care services is assessed by the participating organizations. Results Six of the seven primary health care facilities in the county were interested in the project, and three fully implemented the first year plan when the project was launched in June 2015. The local health information exchange provided the health coordinator with information on the latest medical records of 9 138 residents of the county. The first year of health coordinators conducted telephone communications with 5 034 residents, recommending the required 7 776 preventive health services. Among them, 1 146 (22%) patients received all the recommended services in time, and at least 3,888 (78%) of the recommended services were not accepted in time. There was a significant improvement in the provision of selective preventive health services (3% ~ 215% for 10 services, with an average improvement rate of 35%, P = 0.004) for health facilities in the county; the return on investment from services was 32 % ~ 122%, an average of 80%. The health coordinator’s health system was set at an expected revenue of $ 52,000 and achieved a target of 40% return on investment. Conclusion It is feasible to establish a new county-level patient extension service project, which will help to improve preventive health care services in rural areas and bring cost-effectiveness, but the effect needs to be further confirmed.