MacIntyre C Raina, Ruth Denise, Ansari Zahid
National Centre for Immunisation Research & Surveillance of Vaccine Preventable Diseases, Children's Hospital at Westmead, Westmead, NSW 2145, Australia.
Int J Qual Health Care. 2002 Aug;14(4):285-93. doi: 10.1093/intqhc/14.4.285.
As the cost of acute care in hospitals increases, there is an increasing need to find alternative means of providing acute care. Hospital in the home (HITH) has developed in response to this challenge. Current evidence is conflicting as to whether HITH provides cost savings compared with in-hospital care (IHC). The heterogeneous nature of HITH and the clinical complexity of patients is the greatest obstacle to making valid comparisons between the two modes of care.
To compare costs and outcomes of HITH to IHC in hospitals in Victoria, Australia.
DATA SOURCES/STUDY SETTING: Hospital morbidity data and medical records from Victoria, Australia.
A costing study of 924 randomly selected episodes of HITH care, individually matched to 924 comparable IHC episodes.
Unadjusted total episode costs (TEC) and averaged daily costs for HITH and IHC were calculated. Mortality and length of stay (LOS) were compared for HITH and IHC episodes. Simple linear and multiple regression were used to analyse costing data, while logistic regression was used to compare in-hospital mortality and LOS in HITH versus IHC episodes.
The 1848 episodes of care in the sample represented a heterogeneous range of acute conditions in 31 Victoria hospitals. HITH consisted of two distinct subgroups: pure-HITH (total episode substitution) and mixed-HITH (partial episode substitution). The cost of episodes of acute care containing a HITH component were overall 9% less expensive than IHC (P = 0.04), while pure-HITH was 38% cheaper than matched IHC (P < 0.001). The variable HITH, along with LOS and chemotherapy, explained the 60% variation in TEC. The mean cost of pure-HITH episodes was 22% lower compared to mixed-HITH (P = 0.004). The in-hospital mortality rate in HITH (3.8%) and IHC (5.2%) was not significantly different. Pure-HITH was associated with shorter LOS, while mixed HITH was strongly associated with longer LOS.
In our study the adjusted cost of HITH was significantly cheaper than IHC, particularly as total episode substitution. The cost needs to be adjusted because many factors other than HITH or IHC can influence crude costs. There may be potential for wider use of HITH for appropriately selected patients.
随着医院急性护理成本的增加，寻找提供急性护理的替代方式的需求日益增长。居家医院（HITH）应运而生以应对这一挑战。关于HITH与住院护理（IHC）相比是否能节省成本，目前的证据存在矛盾。HITH的异质性以及患者的临床复杂性是对这两种护理模式进行有效比较的最大障碍。
比较澳大利亚维多利亚州医院中HITH与IHC的成本和结局。
数据来源/研究背景：来自澳大利亚维多利亚州的医院发病数据和医疗记录。
一项成本核算研究，对924例随机选取的HITH护理病例进行单独匹配，与924例可比的IHC病例进行对比。
计算HITH和IHC未经调整的总病例成本（TEC）和日均成本。比较HITH和IHC病例的死亡率和住院时间（LOS）。使用简单线性回归和多元回归分析成本核算数据，同时使用逻辑回归比较HITH与IHC病例的院内死亡率和LOS。
样本中的1848例护理病例代表了维多利亚州31家医院中一系列不同的急性病症。HITH由两个不同的亚组组成：纯HITH（总病例替代）和混合HITH（部分病例替代）。包含HITH成分的急性护理病例的成本总体上比IHC低9%（P = 0.04），而纯HITH比匹配的IHC便宜38%（P < 0.001）。变量HITH、LOS和化疗解释了TEC中60%的变异。纯HITH病例的平均成本比混合HITH低22%（P = 0.004）。HITH（3.8%）和IHC（5.2%）的院内死亡率无显著差异。纯HITH与较短的LOS相关，而混合HITH与较长的LOS密切相关。
在我们的研究中，调整后的HITH成本明显低于IHC，特别是作为总病例替代时。成本需要进行调整，因为除了HITH或IHC之外，许多因素都会影响原始成本。对于适当选择的患者，HITH可能有更广泛应用的潜力。
