Heinrich S, Weigelt I, Rapp K, Becker C, Rissmann U, König H-H
Institut für Medizinische Soziologie, Sozialmedizin und Gesundheitsökonomie, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland.
Z Gerontol Geriatr. 2012 Feb;45(2):128-37. doi: 10.1007/s00391-011-0243-9.
A National Expert Standard for Fall and Fracture Prevention ("Expertenstandard Sturzprophylaxe") was established a few years ago in Germany. The purpose of this study was to determine for the first time the implementation and costs of fall and fracture prevention measures based on this National Expert Standard in German nursing homes in a real world setting.
This before/after study is based on an un-blinded, controlled translational study focussing on the primary prevention of fall-related hip fractures in nursing homes in Bavaria. 274 nursing homes were included in this study in 2008. The intervention aimed at implementing fall and fracture prevention measures based on the National Expert Standard. A random sample of 79 nursing homes was assessed via telephone at baseline and two follow ups. Costs were determined from a societal perspective, based on a questionnaire covering use and costs of fall and fracture prevention measures. Costs were analysed using paired t-tests and non-parametric bootstrapping techniques.
The implementation of this program led to an increase in fall and fracture prevention activities and to additional mean costs of 6,248 EUR (± SD 7,340 EUR; pricing year 2008) per nursing home over 18 months. Costs varied widely between nursing homes. The majority of additional costs occurred for the implementation of strength and balance training. Depending on type and costs of staff conducting the training, total costs varied between 4,347 EUR (± SD 7,167 EUR) and 7,024 EUR (± SD 7,439 EUR).
The implementation of fall and fracture prevention measures based on the National Expert Standard led to additional costs. Cost figures can be used by decision-makers with respect to decisions on resource allocation for different prevention programs (e.g., different National Expert Standards), to determine the main cost components, and finally for model-based cost-effectiveness analyses of fall-prevention programs in nursing homes.
几年前德国制定了《跌倒与骨折预防国家专家标准》（“Expertenstandard Sturzprophylaxe”）。本研究的目的是首次在现实环境中确定德国养老院基于该国家专家标准的跌倒与骨折预防措施的实施情况及成本。
这项前后对照研究基于一项非盲、对照的转化研究，重点是巴伐利亚州养老院与跌倒相关髋部骨折的一级预防。2008年，本研究纳入了274家养老院。干预旨在实施基于国家专家标准的跌倒与骨折预防措施。通过电话对79家养老院的随机样本在基线和两次随访时进行评估。从社会角度确定成本，基于一份涵盖跌倒与骨折预防措施使用情况和成本的问卷。使用配对t检验和非参数自抽样技术分析成本。
该项目的实施导致跌倒与骨折预防活动增加，每家养老院在18个月内平均额外成本为6248欧元（±标准差7340欧元；定价年份2008）。各养老院成本差异很大。大部分额外成本用于实施力量和平衡训练。根据进行训练的工作人员类型和成本，总成本在4347欧元（±标准差7167欧元）至7024欧元（±标准差7439欧元）之间。
基于国家专家标准实施跌倒与骨折预防措施会产生额外成本。成本数据可供决策者用于不同预防项目（如不同国家专家标准）资源分配决策，以确定主要成本组成部分，最终用于养老院跌倒预防项目基于模型的成本效益分析。
