Pearson Sue, Inglis Sally C, McLennan Skye N, Brennan Lucy, Russell Mary, Wilkinson David, Thompson David R, Stewart Simon
Division of Health Sciences, University of South Australia, Adelaide, Australia.
Arch Intern Med. 2006 Mar 27;166(6):645-50. doi: 10.1001/archinte.166.6.645.
Data on the long-term benefits of nonspecific disease management programs are limited. We performed a long-term follow-up of a previously published randomized trial.
We compared all-cause mortality and recurrent hospitalization during median follow-up of 7.5 years in a heterogeneous cohort of patients with chronic illness initially exposed to a multidisciplinary, home-based intervention (HBI) (n = 260) or to usual postdischarge care (n = 268).
During follow-up, HBI had no impact on all-cause mortality (relative risk, 1.04; 95% confidence interval, 0.80-1.35) or event-free survival from death or unplanned hospitalization (relative risk, 1.03; 95% confidence interval, 0.86-1.24). Initial analysis suggested that HBI had only a marginal impact in reducing unplanned hospitalization, with 677 readmissions vs 824 for the usual care group (mean +/- SD rate, 0.72 +/- 0.96 vs 0.84 +/- 1.20 readmissions/patient per year; P = .08). When accounting for increased hospital activity in HBI patients with chronic obstructive pulmonary disease during follow-up for 2 years, post hoc analyses showed that HBI reduced readmissions by 14% within 2 years in patients without this condition (mean +/- SD rate, 0.54 +/- 0.72 vs 0.63 +/- 0.88 readmission/patient per year; P = .04) and by 21% in all surviving patients within 3 to 8 years (mean +/- SD rate, 0.64 +/- 1.26 vs 0.81 +/- 1.61 readmissions/patient per year; P = .03). Overall, recurrent hospital costs were significantly lower (14%) in the HBI group (mean +/- SD, 823 dollars +/- 1642 dollars vs 960 dollars +/- 1376 dollars per patient per year; P = .045).
This unique study suggests that a nonspecific HBI provides long-term cost benefits in a range of chronic illnesses, except for chronic obstructive pulmonary disease.
关于非特异性疾病管理项目长期益处的数据有限。我们对之前发表的一项随机试验进行了长期随访。
我们比较了在中位随访7.5年期间，一组患有慢性疾病的异质性患者的全因死亡率和再次住院情况。这些患者最初接受了多学科居家干预（HBI）（n = 260）或常规出院后护理（n = 268）。
在随访期间，HBI对全因死亡率（相对风险，1.04；95%置信区间，0.80 - 1.35）或免于死亡或非计划住院的无事件生存期（相对风险，1.03；95%置信区间，0.86 - 1.24）没有影响。初步分析表明，HBI在减少非计划住院方面仅有微小影响，HBI组有677次再入院，常规护理组有824次（平均±标准差率，每年每位患者0.72±0.96次再入院 vs 0.84±1.20次；P = 0.08）。当考虑到随访2年期间HBI组慢性阻塞性肺疾病患者的医院活动增加时，事后分析显示，在无此疾病的患者中，HBI在2年内使再入院率降低了14%（平均±标准差率，每年每位患者0.54±0.72次再入院 vs 0.63±0.88次；P = 0.04），在所有存活患者中，3至8年内再入院率降低了21%（平均±标准差率，每年每位患者0.64±1.26次再入院 vs 0.81±1.61次；P = 0.03）。总体而言，HBI组再次住院费用显著更低（低14%）（平均±标准差，每年每位患者823美元±1642美元 vs 960美元±1376美元；P = 0.045）。
这项独特的研究表明，除慢性阻塞性肺疾病外，非特异性居家干预在一系列慢性疾病中具有长期成本效益。
