肝移植中的资源利用:患者特征和临床实践的影响. 在NIDDK肝移植数据库组
J Showstack1, P P Katz, J R Lake
1Department of Medicine, University of California, San Francisco 94143-0936, USA. jas1@itsa.ucsf.edu
JAMA
|April 27, 1999
概括
肝移植成本受到患者年龄和疾病严重程度以及临床实践等因素的重大影响. 了解这些驱动因素可以帮助优化资源配置,并可能减少医疗保健费用.
科学领域:
- 移植医学 移植医学
- 卫生经济学 卫生经济学
- 医疗资源管理 医疗资源管理
背景情况:
- 肝移植对医疗保健系统来说是一个巨大的经济负担.
- 关于影响肝移植资源利用的因素的研究有限.
- 确定成本驱动因素对于优化患者护理和资源配置至关重要.
研究的目的:
- 研究移植前患者特征和临床实践与肝移植医院资源利用之间的关联.
- 确定与更高资源消耗相关的特定患者人口统计和临床因素.
主要方法:
- 进行了一项前性队列研究,涉及711名成年患者,他们在1991年1月至1994年7月期间接受单个器官肝移植.
- 资源利用是标准化的,并来自数据库,将服务链接到价格表.
- 从美国三个主要的移植中心收集了数据.
主要成果:
- 更高的资源利用与捐赠者和接受者的年龄 (≥60岁),酒精性肝病,Child-Pugh级C严重程度,移植时入住重症监护室 (ICU),住院死亡和多次移植有关.
- 例如,酒精性肝病的平均资源利用率增加了26% (49,596美元),而Child-Pugh类C的平均资源利用率增加了41% (67,658美元).
- 在移植中心之间观察到停留时间和资源利用率的显著差异.
结论:
- 老年接受者,酒精性肝病患者和重病患者的治疗费用较高,这表明器官分配标准可能会影响移植费用.
- 在移植中心之间,临床实践和资源利用存在相当大的差异.
- 实施标准化临床指导方针可能会降低成本,提高肝移植的护理质量.
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