生命末期的成本节约. 数据显示了什么?
1Center for Outcomes and Policy Research, Division of Cancer Epidemiology and Control, Dana-Farber Cancer Institute, Boston, MA 02115, USA.
JAMA
|June 26, 1996
概括
临终关怀和预先指示为终身护理提供了显著的成本节约,尽管比预期的要少. 这些干预措施赋予患者自主权,并应因其价值和潜在的财务利益而受到鼓励.
科学领域:
- 卫生经济学 卫生经济学
- 抚慰性护理是一种缓解性护理.
- 医学伦理 医学伦理
背景情况:
- 生命末期的医疗保健占医疗保健预算的很大一部分.
- 通过临终关怀和预先指示节省成本的潜力被广泛讨论,但缺乏明确的证据.
- 现有研究存在方法学上的挑战,包括选择偏差和各种各样的成本评估.
研究的目的:
- 评估与宿舍和预先指令相关的最终成本节省.
- 解决以前关于终身护理成本的研究方法的局限性.
- 为政策和实践提供有关鼓励这些以患者为中心的干预措施的信息.
主要方法:
- 对临终关怀和预先指令的随机和非随机试验的审查和分析.
- 识别和讨论影响成本节约评估的方法问题.
- 综合现有数据以估计不同时间段的潜在成本降低.
主要成果:
- 随机试验没有显示出显著的节约,通常是由于样本规模小或方法有缺陷.
- 非随机试验报告了广泛的节约 (0%至68%).
- 估计的储蓄在生命的最后一个月从25-40%不等,在过去的12个月下降到0-10%.
结论:
- 虽然成本节约低于人们普遍认为的,但临终关怀和预先指示是具有成本效益的.
- 这些干预措施有助于患者在终身决策中的自主性.
- 建议鼓励临终关怀和预先指示,因为它们的价值和潜在的经济效益.
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