University of Michigan School of Nursing, 400 N. Ingalls, Ann Arbor, MI 48109, USA.
Heart Lung. 2013 Sep-Oct;42(5):332-8. doi: 10.1016/j.hrtlng.2013.05.001. Epub 2013 Jul 1.
To compare healthcare resource use of patients with heart failure (HF) randomized to the cognitive training intervention and to the health education active control intervention in a randomized controlled pilot study.
Cognitive training interventions may be efficacious and improve patients' memory and abilities to perform instrumental activities of daily living and self-care behaviors that may, in turn, lower healthcare resource use, but the influence of these interventions on healthcare resource use is unknown.
Thirty-four HF patients were randomized to the computerized plasticity-based cognitive training intervention called Brain Fitness and to the health education active control intervention and completed the study. The primary outcome variable for the study was memory (recall and delayed recall). The secondary purpose of the study that is the focus of this paper was to compare healthcare resource use between the two groups using the third-party payer perspective. Data were collected at baseline and at 8 and 12 weeks after baseline. Healthcare resources were priced at Medicare payment levels for services and average wholesale price for medications.
Average costs of visits, procedures, and medications were similar between groups. Average costs of hospitalizations and tests, and therefore total costs, were half as much in the Brain Fitness group as compared to the active control group, but this difference was not significantly different from zero (p = 0.24).
Larger randomized controlled trials are needed that include analyses of program costs and costs associated with medical and non-medical services in order to fully evaluate efficacy of this intervention.
在一项随机对照试点研究中，比较随机分配至认知训练干预组和健康教育主动对照组的心力衰竭（HF）患者的医疗资源使用情况。
认知训练干预可能有效，可改善患者的记忆力，并提高其进行日常活动工具性能力和自我护理行为的能力，而这些能力反过来又可能降低医疗资源的使用，但这些干预对医疗资源使用的影响尚不清楚。
34 名 HF 患者被随机分配至名为“大脑健身”的基于可塑性的计算机认知训练干预组和健康教育主动对照组，并完成了研究。研究的主要结局变量是记忆力（回忆和延迟回忆）。本研究的次要目的（也是本文的重点）是从第三方付款人角度比较两组之间的医疗资源使用情况。数据在基线和基线后 8 周和 12 周收集。医疗资源的价格按照服务的医疗保险支付水平和药物的平均批发价计算。
两组的就诊、检查和药物费用平均水平相似。住院和检查的平均费用，以及因此的总费用，在大脑健身组是主动对照组的一半，但这一差异与零没有显著差异（p = 0.24）。
需要开展更大规模的随机对照试验，包括对该干预措施的项目成本以及医疗和非医疗服务相关成本的分析，以充分评估该干预的疗效。
