Ho Yi-Lwun, Hsu Tse-Pin, Chen Chiou-Ping, Lee Chu-Yuan, Lin Yen-Hung, Hsu Ron-Bin, Wu Yen-Wen, Chou Nai-Kuan, Lee Chi-Ming, Wang Shoei-Shen, Ting Hsiu-Tzu, Chen Ming-Fong
Graduate Institute of Clinical Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan.
J Formos Med Assoc. 2007 Apr;106(4):313-9. doi: 10.1016/S0929-6646(09)60258-8.
BACKGROUND/PURPOSE: The influence of home- and clinic-based caring system on the economic burden of heart failure remains unknown.
Between January 2004 and December 2004, chronic heart failure patients who were followed up by specialist nurse-led telephone visiting regularly were enrolled. Clinical and economic data half a year before enrollment were collected as control.
A total of 247 patients (168 males, 79 females; mean age, 60 +/- 17 years) were enrolled. The mean follow-up period was 139 +/- 96 days. The mean left ventricular ejection fraction was 35%. There were 1618 times of specialist nurse-led telephone visiting (average 8 +/- 6 times/patient). The mortality rate was 5.7%. Before enrollment, the total hospitalization fees were 624,020 US dollars. After enrollment, the cost was reduced to 362,722 US dollars (41.8% reduction). The mean functional class (New York Heart Association) also improved from 2.27 +/- 0.80 to 1.9 6 +/- 0.90 (p < 0.001). The mean duration of hospital stay due to heart failure was reduced by 5.3 days (26.2% decrement). The total numbers of admission were reduced to 36 times (33.0% decrement). The readmission rate due to etiologies other than heart failure (such as infection, gastrointestinal bleeding, etc.) was reduced from 15.9% to 7.7%. The total fees of visiting emergency station were reduced from 6528 US dollars to 6101 US dollars (6.5% decrement). On the other hand, the frequency of visiting the outpatient department (OPD) increased from 5.2 +/- 3.2 to 6.6 +/- 4.1 times/patient (p < 0.001). The total fees of visiting OPD increased from 90,783 US dollars to 94,855 US dollars(4.4% increment).
The home- and clinic-based caring system is capable of decreasing adverse outcomes, most notably hospitalization and length of stay, and could trigger significant cost savings in the management of heart failure.
背景/目的：家庭与门诊相结合的护理体系对心力衰竭经济负担的影响尚不清楚。
选取2004年1月至2004年12月期间，由专科护士定期进行电话随访的慢性心力衰竭患者。收集入组前半年的临床和经济数据作为对照。
共纳入247例患者（男性168例，女性79例；平均年龄60±17岁）。平均随访期为139±96天。平均左心室射血分数为35%。专科护士进行电话随访共1618次（平均每位患者8±6次）。死亡率为5.7%。入组前，总住院费用为624,020美元。入组后，费用降至362,722美元（降低了41.8%）。平均心功能分级（纽约心脏协会）也从2.27±0.80改善至1.96±0.90（p<0.001）。因心力衰竭导致的平均住院天数减少了5.3天（减少了26.2%）。住院总次数降至36次（减少了33.0%）。因心力衰竭以外病因（如感染、胃肠道出血等）导致的再入院率从15.9%降至7.7%。急诊就诊总费用从6528美元降至6101美元（减少了6.5%）。另一方面，门诊就诊频率从每位患者5.2±3.2次增加至6.6±4.1次（p<0.001）。门诊就诊总费用从90,783美元增加至94,855美元（增加了4.4%）。
家庭与门诊相结合的护理体系能够降低不良结局，尤其是住院率和住院时长，并能在心力衰竭管理中显著节省费用。
