Rhee Hyekyun, Pesis-Katz Irena, Xing Jingping
School of Nursing, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY 14642, USA.
J Asthma. 2012 Aug;49(6):606-13. doi: 10.3109/02770903.2012.694540. Epub 2012 Jul 4.
Frequent use of health-care services associated with pediatric asthma places substantial economic burden on families and society. The purpose of this study is to examine the cost-saving effects of a peer-led program through reduction in health-care utilization in comparison to an adult-led program.
Randomly assigned adolescents (13-17 years) participated in either peer-led (n = 59) or adult-led (n = 53) asthma self-management program. Health-care utilization data were collected at baseline and at 3-, 6-, and 9-months post-intervention. Negative binomial regression models were conducted to examine the effects of the peer-led program on health-care utilization. Net cost savings were estimated based on the differences in program costs and health-care utilization costs between groups.
Significant group differences were found in acute office visits and school clinic visits after controlling for race and socioeconomic status. The incidence rate of acute office visits was 80-82% less for the peer-led group during follow-ups. The peer-led group was four to five times more likely to use school clinics due to asthma than the adult-led group during follow-ups. The non-research cost of peer-led program per participant was lower than the adult-led program, $64 versus $99, respectively. The net cost saving from the reduction in acute office visits and the lower program costs of the peer-led program was estimated $51.8 per person for a 3-month period.
An asthma self-management program using peer leaders can potentially yield health-care cost savings through the reduction in acute office visits in comparison to a traditional program led by health-care professionals.
与小儿哮喘相关的医疗服务频繁使用给家庭和社会带来了巨大的经济负担。本研究的目的是通过与成人主导的项目相比,减少医疗服务利用,来检验同伴主导项目的成本节约效果。
随机分配的青少年(13 - 17岁)参加同伴主导(n = 59)或成人主导(n = 53)的哮喘自我管理项目。在基线以及干预后3个月、6个月和9个月收集医疗服务利用数据。进行负二项回归模型以检验同伴主导项目对医疗服务利用的影响。基于两组项目成本和医疗服务利用成本的差异估计净成本节约。
在控制种族和社会经济地位后,急性门诊就诊和学校诊所就诊方面发现了显著的组间差异。在随访期间,同伴主导组的急性门诊就诊发生率降低了80 - 82%。在随访期间,同伴主导组因哮喘使用学校诊所的可能性是成人主导组的四到五倍。同伴主导项目每位参与者的非研究成本低于成人主导项目,分别为64美元和99美元。估计在3个月期间,同伴主导项目因急性门诊就诊减少和项目成本较低而带来的净成本节约为每人51.8美元。
与由医疗保健专业人员主导的传统项目相比,使用同伴领导者的哮喘自我管理项目有可能通过减少急性门诊就诊来节约医疗成本。