基于团队的辅导与监测的成本效益,用于预防急性损伤
David Xiao1, Sharon E Davis2, Caroline M Godfrey1
1Department of General Surgery, Vanderbilt University Medical Center, Nashville, Tennessee.
JAMA network open
|April 2, 2025
概括
实施自动监控的协作方法可显著减少心脏导管术后与对比相关的急性损伤 (AKI),并证明具有成本效益. 这一策略降低了AKI的可能性,永久性病和相关的医疗保健费用.
科学领域:
- 腎臟病學 (nephrology) 是一種醫學專業.
- 卫生经济学 卫生经济学
- 医疗保健服务研究 医疗服务研究
背景情况:
- 与对比相关的急性损伤 (AKI) 影响超过10%的美国患者接受内血管手术,增加成本和发病率.
- 现有的AKI预防协议显示了可变的吸收和坚持,成本效益不明.
- 心脏导管是常见的内血管手术,在此情况下,预防AKI至关重要.
研究的目的:
- 评估四种不同的实施干预措施的成本效益,以预防心脏导管治疗患者的AKI.
- 确定在这个患者群体中预防AKI的最经济可行的策略.
主要方法:
- 一个具有三年视野的马尔科夫决策模型模拟了质量调整的寿命年 (QALY) 和成本.
- 来自IMPROVE AKI试验 (20个美国VA医疗中心,2019-2021) 的数据提供了模型概率的信息.
- 进行比较的干预措施包括援助,协助监督,协作和与监督合作.
主要成果:
- "与监督合作"的干预表明了经济的主导地位,每人节省了742.75美元,与基本援助相比,成本效益提高了0.02个QALY.
- 在"与监测合作"组 (7.9%) 中,AKI发病率最低.
- 艾基风险和随后的永久性病的成本是干预总成本的关键驱动因素.
结论:
- 与自动监控报告合作的虚拟学习是心脏导管治疗中最经济的AKI预防策略.
- 据估计,这种干预措施可以减少AKI,永久性病以及相关成本.
- 结果可能可以将其推广到其他内血管程序和实施努力中.
相关概念视频
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