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在省级创伤质量保证计划中实施针对低价值临床实践的审计和反模块:一个成本效益研究
Blanchard Conombo1,2, Jason R Guertin1, Jeffrey S Hoch3
1Department of Social and Preventative Medicine, Université Laval, Québec City, Québec, Canada.
实施审计和反 (A&F) 模块以减少创伤护理中低价值实践 (LVPs) 是更有效和潜在的成本效益. 干预成本为每次LVP160美元,通过促进和频繁的评估提高了价值.
科学领域:
- 医疗保健服务研究 医疗服务研究
- 医学经济学 医学经济学
- 创伤护理系统创伤护理系统
背景情况:
- 审计和反 (A&F) 干预措施提高了对基于证据的护理的坚持,并减少了低价值实践 (LVPs).
- 现有的质量保证计划往往侧重于高价值的护理和风险调整的结果.
- 针对特定于创伤入院的LVP的潜在成本效益需要进行调查.
研究的目的:
- 评估A&F模块的成本效益,该模块旨在减少创伤护理中的LVPs.
- 评估特定的A&F特征对其成本效益的影响.
主要方法:
- 一个概率性的静态决策分析模型被用于成本效益分析.
- 这项研究采用了北克卫生部在北克创伤护理连续性的观点.
- 将A&F模块实施的假设场景与现状场景进行了比较.
主要成果:
- 与现状相比,A&F模块的成本更高 ($1,480,850) 但通过避免更多的LVPs (6,005) 与现状相比 ($1,124,661;避免了8,228 LVPs) 实现了更高的效率.
- 每个避免的LVP的增量成本计算为160.0美元.
- 通过增加便利性,更频繁的评估和专注于大量创伤中心,成本效益得到了改善.
结论:
- 针对LVP的A&F模块在避免每LVP160美元的支付意愿门下显示出更高的有效性和潜在的成本效益.
- 虚拟促进,频繁的评估,以及在高量中心的实施,提高了该模块的成本效益.
- 真正的增量成本效益比率 (ICER) 可能被低估,因为潜在成本被低估或错过的机会成本.
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