在退伍军人卫生管理局实施一个多学科复杂的疼痛诊所的实施,干预和下游成本
Sarah I Daniels1, Shayna Cave1, Todd H Wagner2,3
1Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Menlo Park, California, USA.
实施多学科复杂疼痛诊所 (MCPC) 需要为退伍军人卫生管理局的复杂慢性疼痛和物质使用障碍患者进行大量的预先投资. 初始成本较高,但对计划扩展决策而言,全面预算影响分析至关重要.
科学领域:
- 卫生经济学 卫生经济学
- 疼痛管理 疼痛管理
- 药物使用障碍治疗 药物使用障碍治疗
背景情况:
- 退伍军人卫生管理局 (VA) 患有复杂慢性疼痛和物质使用障碍 (SUD) 的患者通常在危险的阿片类药物治疗方案下接受治疗.
- 多学科复杂疼痛诊所 (MCPC) 提供了一种结构化的方法来管理这些复杂的患者需求.
研究的目的:
- 确定在VA系统中实施MCPC的预算影响.
- 分析与高风险患者的MCPC相关的实施,干预和下游成本.
主要方法:
- 微成本计算方法被用来衡量三个VAMCPC的两年实施成本.
- 准实验设计与倾向分数加权差异分析对MCPC患者与对照组进行了比较.
- 用VA行政数据和基于活动的成本计算来提取成本.
主要成果:
- 平均实施便利化成本在每个网站每月从380美元到640美元不等.
- 与对照组相比,每位患者的干预成本在三个MCPC站点中的两个站点显著更高.
- 下游成本在一个地点显著更高,因住院费用和潜在的COVID-19流行病混而导致的变化.
结论:
- 实施MCPC需要大量的启动投资,以支付实施,干预和下游成本.
- 包括所有成本类别在内的全面预算影响分析对于关于MCPC计划扩展的决策至关重要.
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