研究表明，對患者進(jìn)行強(qiáng)化治療并不會減少他們的再發(fā)病次數(shù)

研究表明，對患者進(jìn)行強(qiáng)化治療并不會減少他們的再發(fā)病次數(shù)

Improving health and lowering costs for the sickest and most expensive patients in America is a dream harder to realize than many health care leaders had hoped, according to a study published Wednesday in the New England Journal of Medicine.

周三發(fā)表在《新英格蘭醫(yī)學(xué)雜志》上的一項研究顯示，為美國病情最重、費(fèi)用最高的患者改善健康、降低費(fèi)用，是一個比許多醫(yī)療保健領(lǐng)導(dǎo)人所希望的更難實現(xiàn)的夢想。

Researchers tested whether pairing frequently hospitalized patients in Camden, N.J., with nurses and social workers could stop that costly cycle of readmissions. The study found no effect: Patients receiving extra support were just as likely to return to the hospital within 180 days as those not receiving that help.

研究人員測試了新澤西州卡姆登經(jīng)常住院的患者與護(hù)士和社會工作者配對是否可以阻止代價高昂的再次住院周期。研究發(fā)現(xiàn)沒有任何影響：接受額外照顧的患者與沒有接受照顧的患者在180天內(nèi)返回醫(yī)院的可能性一樣大。

The results are a blow to Dr. Jeffrey Brenner and the Camden Coalition of Healthcare Providers, the organization he founded nearly 20 years ago.

這一結(jié)果對杰弗里·布倫納博士和他在近20年前創(chuàng)建的醫(yī)療服務(wù)提供者卡姆登聯(lián)盟是一個打擊。

"It's my life's work. So, of course, you're upset and sad," says Brenner, who now does similar work with health insurance giant UnitedHealthcare.

“這是我畢生的工作。所以，當(dāng)然，你會感到沮喪和悲傷，”布倫納說，他現(xiàn)在醫(yī)療保險巨頭聯(lián)合醫(yī)療集團(tuán)也做著類似的工作。

The model of care, pioneered in part by Brenner and profiled in a widely read 2011 article in The New Yorker, has inspired dozens of similar projects across the country and attracted millions in philanthropic funding.

這種護(hù)理模式在一定程度上是由布倫納首創(chuàng)的，并在2011年《紐約客》的一篇廣為流傳的文章中進(jìn)行了介紹。這種模式已經(jīng)激勵了全國數(shù)十個類似的項目，并吸引了數(shù)百萬美元的慈善資金。

"This is the messy thing about science," says Brenner, who won a MacArthur Foundation "Genius Grant" for his efforts. "Sometimes things work the way you want them to work and sometimes they don't."

“這就是科學(xué)的混亂之處，”布倫納說，他因自己的努力獲得了麥克阿瑟基金會的“天才獎”。“有時事情會按照你希望的方式進(jìn)行，有時又不會。”

Many hospital and insurance executives have pinned their hopes on this research because it promised to solve a common problem: when patients' lives are so complicated by social factors like poverty and addiction that their manageable medical conditions, like diabetes and asthma, lead to expensive, recurring hospital stays.

許多醫(yī)院和保險業(yè)高管將希望寄托在這項研究上，因為它有望解決一個普遍的問題：當(dāng)患者的生活因貧困和成癮等社會因素而變得如此復(fù)雜時，他們的糖尿病和哮喘等可控的醫(yī)療狀況會導(dǎo)致昂貴的反復(fù)住院費(fèi)用。

Brenner's prescription: Pair these patients with front-line care workers who would shepherd them to the social and medical services they needed. Brenner boiled the model's potential down to eight words: better care, lower costs.

布倫納的處方：將這些患者與一線護(hù)理人員配對，后者將引導(dǎo)他們獲得所需的社會和醫(yī)療服務(wù)。布倫納將該模式的潛力歸結(jié)為八個字：護(hù)理越好，成本越低。

As word spread, breathless headlines popped up like "Health Care's Best Hope," and "Could Camden Coalition Save U.S. Health Care?"

隨著消息的傳播，像“醫(yī)療保健的最大希望”和“卡姆登聯(lián)盟能拯救美國醫(yī)療保健嗎?”這樣令人屏息的頭條新聞層出不窮。

"Lots of organizations make claims that their programs work and they've never been rigorously tested," Brenner says.

布倫納說:“許多組織聲稱他們的程序是有效的，但他們從來沒有經(jīng)過嚴(yán)格的測試。”

Instead, Brenner took the unusual step of inviting the scrutiny of respected researchers.

相反，布倫納采取了不同尋常的步驟，邀請受人尊敬的研究人員進(jìn)行詳細(xì)審查。

And the result: The 400 patients who received the intensive help were just as likely to return to the hospital as the patients who didn't. In both groups, nearly two-thirds of people were readmitted within 180 days.

結(jié)果是:接受強(qiáng)化治療的400名患者和沒有接受強(qiáng)化治療的患者一樣有可能返回醫(yī)院。在兩組中，近三分之二的人在180天內(nèi)再次入院。