基于价值的医疗保健心力衰竭:生活质量和成本分析
Eduarda Chiesa Ghisleni1, Vitória Rech Astolfi2, Larissa Zimmermann3
1Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil; Post-Graduate Program in Cardiology, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil; Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil.
Clinics (Sao Paulo, Brazil)
|November 4, 2024
概括
巴西的心力衰竭患者生活质量不佳,成本高昂,随着疾病的严重程度而增加. 这些发现强调了需要基于价值的医疗保健策略,以改善患者的治疗结果和管理费用.
科学领域:
- 心脏病学 心脏病学
- 卫生经济学 卫生经济学
- 生活质量研究 研究 生命质量研究
背景情况:
- 心力衰竭 (HF) 是一个重要的全球健康问题.
- 了解患者的体验,包括生活质量 (QoL) 和治疗费用,对于有效的医疗管理至关重要.
- 基于价值的医疗保健 (VBHC) 旨在优化患者相对于成本的结果.
研究的目的:
- 测量巴西心力衰竭 (HF) 门诊患者的生活质量 (QoL) 和治疗成本.
- 在巴西HF护理的背景下引入基于价值的医疗保健 (VBHC) 的原则.
- 提供数据,可以为医疗保健策略和补偿模式提供信息.
主要方法:
- 一项涉及巴西三家医院198名HF门诊患者 (射出分数<50%) 的横截面研究.
- 利用36项简短形式调查 (SF-36) 和明尼苏达州生活与心力衰竭问卷 (MLHFQ) 来评估QOL.
- 采用时间驱动活动为基础的成本计算 (TDABC) 方法来计算门诊随访费用,按NYHA功能类别和性别分层.
主要成果:
- 患者报告了不良的QoL,在较高的NYHA功能类别中得分明显恶化.
- 很大一部分患者 (三分之一) 表现出中度至严重的抑郁和焦虑症状,女性报告焦虑水平较高.
- 平均门诊费用从NYHA I的215美元到NYHA III/IV的667美元不等,实验室和检查费用占晚期费用的大部分 (高达74%) .
结论:
- 巴西的心力衰竭患者面临降低QoL和增加治疗成本,这两者都随着NYHA级别的升级而升级.
- 高频频似乎不成比例地影响女性的心理健康.
- 增加的成本主要是由诊断测试和程序驱动的,这强调了需要数据驱动的高质量生活和成本评估来指导基于价值的医疗保健和报销策略.
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