本文由小咖机器人翻译整理

期刊来源：Ann Intern Med

原文链接：https://doi.org/10.7326/M23-2331

摘要内容如下：

背景

在家庭以外获得医疗保健的天数不仅代表了获得所需护理的机会，还代表了大量的时间、精力和成本，特别是对老年人及其护理伙伴而言。然而，这些“卫生保健接触日”并没有被定性。

客观

评估老年人接触日的构成、变化和模式以及相关因素。

设计

横断面研究。

设置

具有全国代表性的2019年医疗保险当前受益人调查数据与索赔相关。

参与者

传统医疗保险中65岁及以上的社区居住成年人。

测量

门诊联系天数（初级护理或专科护理诊所就诊、测试、成像、程序或治疗的天数）和总联系天数（门诊天数加上医院、急诊科、专业护理机构或临终关怀机构的住院天数）；多变量混合效应泊松回归，以确定与接触天数相关的患者因素。

结果

在加权结果中，6619名老年人（加权:29694084）在一年中平均有17.3个走动接触日（SD，22.1）和20.7个总接触日（SD，27.5）；11.1%有50天或以上的总接触天数。老年人在门诊护理上花费的接触日最多，包括初级保健就诊（平均值[SD]，3.5[5.0]）、专科护理就诊（5.7[9.6]）、测试（5.3[7.2]）、成像（2.6[3.9]）、程序（2.5[6.4]）和治疗（5.7[13.3]）。一半的检测和成像日与门诊就诊不在同一天（分别为48.6%和50.1%）。与更多的门诊接触天数相关的因素包括较年轻的年龄、女性、白种人、非西班牙裔、较高的收入、较高的教育程度、城市居民、更多的慢性病和寻求护理的行为（例如，去看医生…一旦（I）…感觉不好）。

局限性

研究人群仅限于传统医疗保险人群。

结论

平均而言，老年人一年中有3周的时间在家庭之外接受护理。这些接触日大多是非卧床的，不仅因慢性病的数量，而且因社会人口因素、地理因素和寻求护理的行为而有很大差异。这些结果显示了临床需求以外的因素，这些因素可能会导致接触日的过度使用和使用不足，以及优化这一以人为中心的措施以减轻患者负担的机会，例如，通过护理协调。

主要资金来源

国家老龄化研究所。

英文原文如下：

Abstracts

BACKGROUND  Days spent obtaining health care outside the home can represent not only access to needed care but also substantial time, effort, and cost, especially for older adults and their care partners. Yet, these "health care contact days" have not been characterized.

OBJECTIVE  To assess composition of, variation and patterns in, and factors associated with contact days among older adults.

DESIGN  Cross-sectional study.

SETTING  Nationally representative 2019 Medicare Current Beneficiary Survey data linked to claims.

PARTICIPANTS  Community-dwelling adults aged 65 years and older in traditional Medicare.

MEASUREMENTS  Ambulatory contact days (days with a primary care or specialty care office visit, test, imaging, procedure, or treatment) and total contact days (ambulatory days plus institutional days in a hospital, emergency department, skilled-nursing facility, or hospice facility); multivariable mixed-effects Poisson regression to identify patient factors associated with contact days.

RESULTS  In weighted results, 6619 older adults (weighted: 29 694 084) had means of 17.3 ambulatory contact days (SD, 22.1) and 20.7 total contact days (SD, 27.5) in the year; 11.1% had 50 or more total contact days. Older adults spent most contact days on ambulatory care, including primary care visits (mean [SD], 3.5 [5.0]), specialty care visits (5.7 [9.6]), tests (5.3 [7.2]), imaging (2.6 [3.9]), procedures (2.5 [6.4]), and treatments (5.7 [13.3]). Half of the test and imaging days were not on the same days as office visits (48.6% and 50.1%, respectively). Factors associated with more ambulatory contact days included younger age, female sex, White race, non-Hispanic ethnicity, higher income, higher educational attainment, urban residence, more chronic conditions, and care-seeking behaviors (for example, "go to the doctor…as soon as (I)…feel bad").

LIMITATION  Study population limited to those in traditional Medicare.

CONCLUSION  On average, older adults spent 3 weeks in the year getting care outside the home. These contact days were mostly ambulatory and varied widely not only by number of chronic conditions but also by sociodemographic factors, geography, and care-seeking behaviors. These results show factors beyond clinical need that may drive overuse and underuse of contact days and opportunities to optimize this person-centered measure to reduce patient burdens, for example, via care coordination.

PRIMARY FUNDING SOURCE  National Institute on Aging.

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