Une \u00e9tude publi\u00e9e dans le cadre de la s\u00e9rie de publications externes de la RAND Corporation analyse l\u2019impact de l\u2019affiliation d\u2019organisations de m\u00e9decins g\u00e9n\u00e9ralistes ind\u00e9pendants (Primary Care Physician Organizations, POs) \u00e0 des syst\u00e8mes de sant\u00e9 int\u00e9gr\u00e9s verticalement sur la qualit\u00e9 des soins et l\u2019utilisation des services pour les b\u00e9n\u00e9ficiaires du r\u00e9gime Original Medicare aux \u00c9tats-Unis. L\u2019objectif est d\u2019\u00e9valuer si cette int\u00e9gration organisationnelle am\u00e9liore les performances, y compris pour certains sous-groupes de POs suppos\u00e9s en tirer davantage de b\u00e9n\u00e9fices.<\/p>\n
L\u2019analyse repose sur des donn\u00e9es nationales am\u00e9ricaines couvrant la p\u00e9riode 2013-2019, issues des bases de remboursements Medicare, du syst\u00e8me d\u2019enregistrement des prestataires et structures (Provider Enrollment, Chain, and Ownership System \u2013 PECOS) et des d\u00e9clarations fiscales des organisations \u00e0 but non lucratif (formulaire IRS 990). Treize indicateurs de qualit\u00e9 et d\u2019utilisation des soins ont \u00e9t\u00e9 examin\u00e9s, portant notamment sur la pr\u00e9vention, la prise en charge des maladies chroniques, la continuit\u00e9 des soins et le recours aux consultations de soins primaires et de sp\u00e9cialistes.<\/p>\n
Les r\u00e9sultats ne montrent pas de lien syst\u00e9matique entre affiliation \u00e0 un syst\u00e8me de sant\u00e9 int\u00e9gr\u00e9 et am\u00e9lioration significative des soins pr\u00e9ventifs, de la gestion des maladies chroniques ou de l\u2019utilisation globale des services. Quelques progr\u00e8s limit\u00e9s sont observ\u00e9s sur certains indicateurs pr\u00e9cis, en particulier une am\u00e9lioration des examens ophtalmologiques chez les patients diab\u00e9tiques et de la continuit\u00e9 des soins au niveau de l\u2019organisation. En parall\u00e8le, une baisse des consultations de soins primaires et des consultations de sp\u00e9cialistes est constat\u00e9e apr\u00e8s affiliation.<\/p>\n
Des effets diff\u00e9renci\u00e9s apparaissent selon le type d\u2019organisation. Les petites POs obtiennent des gains suppl\u00e9mentaires en mati\u00e8re de d\u00e9pistage du cancer du sein par rapport aux grandes POs. En revanche, les POs initialement de faible qualit\u00e9 et les POs situ\u00e9es en zone rurale pr\u00e9sentent des performances relativement inf\u00e9rieures sur au moins un autre indicateur apr\u00e8s l\u2019affiliation. L\u2019\u00e9tude souligne ainsi que l\u2019appartenance \u00e0 un syst\u00e8me de sant\u00e9 int\u00e9gr\u00e9, \u00e0 elle seule, ne se traduit pas par une am\u00e9lioration g\u00e9n\u00e9ralis\u00e9e de la qualit\u00e9 des soins pour les diff\u00e9rents profils d\u2019organisations de soins primaires.<\/p>\n
La RAND Corporation, institution de recherche \u00e0 but non lucratif sp\u00e9cialis\u00e9e dans l\u2019appui \u00e0 la d\u00e9cision publique par la recherche et l\u2019analyse, pr\u00e9cise que les publications de l\u2019institution ne refl\u00e8tent pas n\u00e9cessairement les opinions de ses clients ou financeurs. L\u2019\u00e9tude met en avant des r\u00e9sultats nuanc\u00e9s et souligne les limites d\u2019une approche reposant uniquement sur l\u2019int\u00e9gration verticale pour am\u00e9liorer la qualit\u00e9 des soins dans le cadre de Medicare, sans pour autant proposer de recommandations normatives explicites pour les politiques publiques.(contenu r\u00e9sum\u00e9 en fran\u00e7ais par l’IA)\u00a0Lire la Suite<\/a><\/p>","protected":false},"excerpt":{"rendered":" Une \u00e9tude publi\u00e9e dans le cadre de la s\u00e9rie de publications externes de la RAND Corporation analyse l\u2019impact de l\u2019affiliation d\u2019organisations de m\u00e9decins g\u00e9n\u00e9ralistes ind\u00e9pendants (Primary Care Physician Organizations, POs) […]<\/p>\n","protected":false},"author":1,"featured_media":10675,"comment_status":"","ping_status":"","sticky":false,"template":"","format":"standard","meta":{"site-sidebar-layout":"default","site-content-layout":"","ast-site-content-layout":"default","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","ast-disable-related-posts":"","theme-transparent-header-meta":"","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"default","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center 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