研究表明，對患者進行強化治療并不會減少他們的再發(fā)病次數

研究表明，對患者進行強化治療并不會減少他們的再發(fā)病次數

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)學雜志》上的一項研究顯示，為美國病情最重、費用最高的患者改善健康、降低費用，是一個比許多醫(yī)療保健領導人所希望的更難實現的夢想。

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常住院的患者與護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，當然，你會感到沮喪和悲傷，”布倫納說，他現在醫(yī)療保險巨頭聯(lián)合醫(yī)療集團也做著類似的工作。

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行了介紹。這種模式已經激勵了全國數十個類似的項目，并吸引了數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：當患者的生活因貧困和成癮等社會因素而變得如此復雜時，他們的糖尿病和哮喘等可控的醫(yī)療狀況會導致昂貴的反復住院費用。

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理人員配對，后者將引導他們獲得所需的社會和醫(yī)療服務。布倫納將該模式的潛力歸結為八個字：護理越好，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，但他們從來沒有經過嚴格的測試。”

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行詳細審查。

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.

結果是:接受強化治療的400名患者和沒有接受強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天內再次入院。