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医院之间IBD护理结果和成本的差异:IBD价值研究结果
Reinier C A van Linschoten1,2, C Janneke van der Woude2, Elyke Visser1,2
1Department of Gastroenterology and Hepatology, Franciscus Gasthuis and Vlietland, Rotterdam, the Netherlands.
Inflammatory bowel diseases
|April 26, 2024
概括
在炎症性肠病 (IBD) 护理中,医院的变化是最小的. 患者因素,而不是医院,驱动IBD结果和成本的差异,需要患者层面的干预来提高质量.
科学领域:
- 胃肠病学 胃肠病学
- 医疗保健服务研究 医疗服务研究
- 改善临床质量 改善临床质量
背景情况:
- 医疗保健结果和成本的变化为改善和公平护理提供了机会.
- 了解炎症性肠病 (IBD) 治疗的医院级差异对于提高质量和降低成本至关重要.
- 以前的研究强调需要评估各医疗机构的IBD护理差异.
研究的目的:
- 评估不同医院之间与炎症性肠病 (IBD) 护理相关的结果和成本的变化程度.
- 确定归因于治疗医院的结果和成本变化的比例与患者特定因素的比例.
- 为提高IBD管理质量的战略提供信息.
主要方法:
- 一项为期12个月的队列研究,涉及1010名IBD患者,在8家荷兰医院接受生物药物或新的小分子治疗.
- 从一般化的线性混合模型中得出的类内相关系数 (ICC) 用于分析结果和成本的情况混合调整的变化.
- 结果使用国际健康成果测量联盟 (ICHOM) 标准集进行评估,成本包括门诊,住院和药物费用.
主要成果:
- 在IBD结局 (缓解率:临床医生报告的83%与患者报告的40%) 和成本 (平均每6个月8323欧元,主要是由于先进疗法) 中,大多数变化都不能归因于医院 (ICCs 0-2%).
- 患者层面的特征是变化的主要驱动因素,占结果和成本差异的50%以上.
- 临床医生报告了高缓解率,但患者报告的结果明显较低,这表明在感知治疗有效性的潜在差距.
结论:
- 观察到的IBD结果和成本的变化主要是由患者因素驱动的,而不是医院的表现,这限制了这些指标用于医院质量比较的使用.
- 未来的质量改进举措应侧重于护理的结构和流程措施.
- 实施针对性患者层面的干预措施对于改善炎症性肠病护理的整体质量至关重要.
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