短期入住专业护理机构患者的推荐护士人员配备水平的成本效益
Cost-effectiveness of recommended nurse staffing levels for short-stay skilled nursing facility patients.
作者信息
Ganz David A, Simmons Sandra F, Schnelle John F
机构信息
Robert Wood Johnson Clinical Scholars Program, Veterans Affairs Greater Los Angeles Health Care System and University of California, Los Angeles, 911 Broxton Plaza, Los Angeles, CA 90024, USA.
出版信息
BMC Health Serv Res. 2005 May 10;5:35. doi: 10.1186/1472-6963-5-35.
BACKGROUND
Among patients in skilled nursing facilities for post-acute care, increased registered nurse, total licensed staff, and nurse assistant staffing is associated with a decreased rate of hospital transfer for selected diagnoses. However, the cost-effectiveness of increasing staffing to recommended levels is unknown.
METHODS
Using a Markov cohort simulation, we estimated the incremental cost-effectiveness of recommended staffing versus median staffing in patients admitted to skilled nursing facilities for post-acute care. The outcomes of interest were life expectancy, quality-adjusted life expectancy, and incremental cost-effectiveness.
RESULTS
The incremental cost-effectiveness of recommended staffing versus median staffing was $321,000 per discounted quality-adjusted life year gained. One-way sensitivity analyses demonstrated that the cost-effectiveness ratio was most sensitive to the likelihood of acute hospitalization from the nursing home. The cost-effectiveness ratio was also sensitive to the rapidity with which patients in the recommended staffing scenario recovered health-related quality of life as compared to the median staffing scenario. The cost-effectiveness ratio was not sensitive to other parameters.
CONCLUSION
Adopting recommended nurse staffing for short-stay nursing home patients cannot be justified on the basis of decreased hospital transfer rates alone, except in facilities with high baseline hospital transfer rates. Increasing nurse staffing would be justified if health-related quality of life of nursing home patients improved substantially from greater nurse and nurse assistant presence.
背景
在接受急性后期护理的专业护理机构患者中，注册护士、持证工作人员总数和护士助理人员配备的增加与特定诊断的医院转诊率降低相关。然而，将人员配备增加到推荐水平的成本效益尚不清楚。
方法
我们使用马尔可夫队列模拟，估计了在接受急性后期护理的专业护理机构患者中，推荐人员配备与中等人员配备相比的增量成本效益。感兴趣的结果是预期寿命、质量调整预期寿命和增量成本效益。
结果
推荐人员配备与中等人员配备相比的增量成本效益为每获得一个贴现质量调整生命年321,000美元。单向敏感性分析表明，成本效益比最敏感于从疗养院急性住院的可能性。与中等人员配备情况相比，成本效益比也对推荐人员配备情况下患者恢复健康相关生活质量的速度敏感。成本效益比对其他参数不敏感。
结论
仅基于降低医院转诊率，不能证明为短期疗养院患者采用推荐的护士人员配备是合理的，除非在基线医院转诊率高的机构。如果疗养院患者的健康相关生活质量因更多护士和护士助理的存在而大幅改善，增加护士人员配备将是合理的。
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