Ryan Mandy, Major Kirsten, Skåtun Diane
Health Economics Research Unit, University of Aberdeen, Scotland AB25 2QN, UK.
J Eval Clin Pract. 2005 Aug;11(4):328-38. doi: 10.1111/j.1365-2753.2005.00539.x.
This study builds on the results of a randomized controlled trial concerned with examining the effect of reducing waiting times on the health status of patients referred for non-urgent rheumatology opinion. No difference in clinical outcomes was found between a 'fast-track' and 'ordinary' appointment system. This suggests that rationing by waiting times is not detrimental to health. However, such an approach ignores the value patients attach to reducing waiting time.
To estimate the monetary value of reducing waiting time, as well as changes in duration of appointment and the introduction of a pain management service, in the provision of rheumatology services.
Discrete choice experiment (DCE).
The main outpatient clinic of the rheumatology service for the Lothian and Borders region.
262 patients who had received a specialist rheumatology opinion--73 had received fast-track treatment, 65 standard care and 124 were non-trial patients.
A response rate of 71% was achieved. Patients valued a 9-week reduction in waiting time at 131 pounds sterling. However, the introduction of a pain management service was valued at 209 pounds sterling. Thus, the latter is of more value to respondents. Evidence was also found of the internal consistency and theoretical validity of the DCE approach.
The reduction of waiting times is a central plank of NHS policy. Whilst a reduction in waiting time is of value, a pain management service is of more benefit than a 9-week reduction in waiting time. DCE were shown to be a potentially useful technique for valuing different aspects of health care interventions.
本研究基于一项随机对照试验的结果，该试验旨在研究减少等待时间对非紧急转诊至风湿病专科的患者健康状况的影响。在“快速通道”预约系统和“普通”预约系统之间未发现临床结果存在差异。这表明通过等待时间进行资源分配对健康无害。然而，这种方法忽视了患者对减少等待时间的重视程度。
评估在提供风湿病服务过程中，减少等待时间、预约时长变化以及引入疼痛管理服务的货币价值。
离散选择实验（DCE）。
洛锡安和边境地区风湿病服务的主要门诊诊所。
262名接受过风湿病专科意见的患者——73名接受过快速通道治疗，65名接受标准护理，124名是非试验患者。
实现了71%的回复率。患者认为等待时间减少9周的价值为131英镑。然而，引入疼痛管理服务的价值为209英镑。因此，后者对受访者来说更有价值。还发现了DCE方法的内部一致性和理论有效性的证据。
减少等待时间是英国国家医疗服务体系（NHS）政策的核心内容。虽然减少等待时间有价值，但疼痛管理服务比等待时间减少9周更有益。离散选择实验被证明是一种评估医疗保健干预不同方面价值的潜在有用技术。
