基于社区的综合护理模式的成本效益与对有复杂需求的老年人通常的护理相比:一个阶段式结集群随机试验
Irina Kinchin1,2, Sean Kelley3, Elena Meshcheriakova4
1Centre for Health Policy and Management, Trinity College Dublin, the University of Dublin, Dublin, Ireland.
与通常的初级保健相比,OPEN ARCH综合护理模型改善了功能独立性,并减少了老年人住院的时间. 这种以社区为基础的方法在澳大利亚表现出了有利的成本效益.
科学领域:
- 医疗保健服务研究 医疗服务研究
- 老年学是一门学科.
- 卫生经济学 卫生经济学
背景情况:
- 综合护理模式对于管理社区老年人的复杂需求至关重要.
- 评估这种模型与通常的初级保健相比的成本效益 (CE) 对于资源分配至关重要.
- 开放的弧形模型是一个旗舰计划,旨在提供全面的社区护理.
研究的目的:
- 评估OPEN ARCH综合护理模式的实施,交付和成本效益.
- 为了将OPEN ARCH模型与慢性疾病的老年人通常的初级保健进行比较.
- 从医疗保健系统和患者的角度分析成本和结果.
主要方法:
- 一个为期9个月的阶梯结集群随机试验,涉及澳大利亚远北昆士兰州的14家普通医院.
- 招募具有慢性疾病和复杂护理需求的社区老年人.
- 贝叶斯成本效益分析使用1万个蒙特卡洛模拟,测量功能状态 (FIM) 和生活质量 (EQ-5D-3L,AQoL-8D).
主要成果:
- 开放的弧形模型的成本约为每位参与者A1354美元.
- 在分析视角上,在OPEN ARCH和常规护理之间没有发现成本或资源使用的显著差异.
- OPEN ARCH显示了提高功能独立性和减少住院时间的潜力,并确定了特定的支付意愿门.
结论:
- 与澳大利亚通常的初级保健相比,OPEN ARCH模型显示了有利的贝叶斯成本效益概况.
- 它有效地改善了老年人的功能状态和依赖程度.
- 该模型显示出避免或减少住院住院的可能性,为社区医疗提供了可行的替代方案.
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