慢性病自我管理项目的影响：基于社区干预的医疗保健节省。
The impact of chronic disease self-management programs: healthcare savings through a community-based intervention.
机构信息
School of Public Health, Division of Health Systems Management and Policy, The University of Memphis, Memphis, TN, USA.
出版信息
BMC Public Health. 2013 Dec 6;13:1141. doi: 10.1186/1471-2458-13-1141.
BACKGROUND
Among the most studied evidence-based programs, the Chronic Disease Self-Management Program (CDSMP) has been shown to help participants improve their health behaviors, health outcomes, and reduce healthcare utilization. However, there is a lack of information on how CDSMP, when nationally disseminated, impacts healthcare utilization and averts healthcare costs. The purposes of this study were to: 1) document reductions in healthcare utilization among national CDSMP participants; 2) calculate potential cost savings associated with emergency room (ER) visits and hospitalizations; and 3) extrapolate the cost savings estimation to the American adults.
METHODS
The national study of CDSMP surveyed 1,170 community-dwelling CDSMP participants at baseline, 6 months, and 12 months from 22 organizations in 17 states. The procedure used to estimate potential cost savings included: 1) examining the pattern of healthcare utilization among CDSMP participants from self-reported healthcare utilization assessed at baseline, 6 months, and 12 months; 2) calculating age-adjusted average costs for persons using the 2010 Medical Expenditure Panel Survey; 3) calculating costs saved from reductions in healthcare utilization; 4) estimating per participant program costs; 5) computing potential cost savings by deducting program costs from estimated healthcare savings; and 6) extrapolating savings to national populations using Census data combined with national health statistics.
RESULTS
Findings from analyses showed significant reductions in ER visits (5%) at both the 6-month and 12-month assessments as well as hospitalizations (3%) at 6 months among national CDSMP participants. This equates to potential net savings of $364 per participant and a national savings of $3.3 billion if 5% of adults with one or more chronic conditions were reached.
CONCLUSIONS
Findings emphasize the value of public health tertiary prevention interventions and the need for policies to support widespread adoption of CDSMP.
背景
在最具研究价值的循证项目中，慢性病自我管理计划（CDSMP）已被证明有助于参与者改善健康行为、健康结果，并减少医疗保健的利用。然而，关于 CDSMP 在全国推广时如何影响医疗保健的利用和节省医疗保健成本的信息还很缺乏。本研究的目的是：1）记录全国 CDSMP 参与者的医疗保健利用减少情况；2）计算与急诊室（ER）就诊和住院相关的潜在成本节约；3）将成本节约估计外推到美国成年人。
方法
这项针对 CDSMP 的全国性研究调查了来自 17 个州的 22 个组织的 1170 名社区居住的 CDSMP 参与者，分别在基线、6 个月和 12 个月时进行。估计潜在成本节约的程序包括：1）检查 CDSMP 参与者的医疗保健利用模式，根据基线、6 个月和 12 个月时的自我报告医疗保健利用情况进行评估；2）使用 2010 年医疗支出调查计算年龄调整后的人均费用；3）计算医疗保健利用减少带来的成本节约；4）估算每位参与者的项目成本；5）从估计的医疗保健节省中扣除项目成本来计算潜在的成本节省；6）使用人口普查数据结合国家卫生统计数据，将节省额外推到全国人口。
结果
分析结果表明，全国 CDSMP 参与者在 6 个月和 12 个月评估时急诊就诊（5%）和 6 个月时住院治疗（3%）显著减少。这相当于每位参与者 364 美元的潜在净节省，如果 5%的患有一种或多种慢性病的成年人能够接受 CDSMP，全国的节省额将达到 33 亿美元。
结论
研究结果强调了公共卫生三级预防干预的价值，以及支持广泛采用 CDSMP 的政策的必要性。
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