在全关节整形术中患者级价值分析:优化护理交付价值
Stephen A Doxey1,2, Fernando A Huyke-Hernández1,2, Samuel Davidson3
1Department of Orthopedic Surgery, TRIA, Bloomington, Minnesota.
患者报告的结果与关节整形术 (THA) 的成本没有相关性. 植入物是主要的成本驱动因素,而手术设置和出院目的地影响了整体价值.
科学领域:
- 整形外科手术 整形外科手术
- 卫生经济学 卫生经济学
- 基于价值的医疗保健
背景情况:
- 医疗保健中的价值被定义为与护理成本相对应的患者结果.
- 患者级价值分析 (PLVA) 是一种评估医疗保健价值的方法.
- 在此之前,PLVA尚未应用于关节全整形术 (THA).
研究的目的:
- 在初级THA患者的1年护理期间进行PLVA.
- 确定影响大都会医疗保健系统内THA值的因素.
主要方法:
- 使用的部残疾和骨关节炎结局得分,关节置换 (HOOS-JR) 用于患者报告的结果.
- 雇员基于时间驱动的基于活动的成本 (TDABC) 为1年的护理费用.
- 计算1年价值系数 (VHOOS) 作为HOOS-JR变化与事件成本的比率.
主要成果:
- 平均HOOS-JR改善为+34.9;平均成本为13,835.5美元.
- 植入物 (39.0%) 和康复后护理 (24.1%) 是最大的成本贡献者.
- 在家庭出院的门诊外科中心 (ASC) 的THAs显示出更高的值 (VHOOS=0.42),而不是在康复中心 (VHOOS=0.15) 的医院THAs.
结论:
- 患者报告的结果与初级THA.的成本没有相关性.
- 手术环境 (ASC与医院) 和出院目的地显著影响了价值.
- PLVA可以优化THA护理交付途径.
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