养老院痴呆症护理规划的经济学：一项整群随机对照试验。
The economics of dementia-care mapping in nursing homes: a cluster-randomised controlled trial.
作者信息
van de Ven Geertje, Draskovic Irena, van Herpen Elke, Koopmans Raymond T C M, Donders Rogier, Zuidema Sytse U, Adang Eddy M M, Vernooij-Dassen Myrra J F J
机构信息
Department of Primary and Community Care, Radboud University Nijmegen Medical Centre, Nijmegen, Gelderland, The Netherlands ; Radboud Alzheimer Centre, Radboud University Nijmegen Medical Centre, Nijmegen, Gelderland, The Netherlands.
Department of Primary and Community Care, Radboud University Nijmegen Medical Centre, Nijmegen, Gelderland, The Netherlands.
出版信息
PLoS One. 2014 Jan 28;9(1):e86662. doi: 10.1371/journal.pone.0086662. eCollection 2014.
BACKGROUND
Dementia-care mapping (DCM) is a cyclic intervention aiming at reducing neuropsychiatric symptoms in people with dementia in nursing homes. Alongside an 18-month cluster-randomized controlled trial in which we studied the effectiveness of DCM on residents and staff outcomes, we investigated differences in costs of care between DCM and usual care in nursing homes.
METHODS
Dementia special care units were randomly assigned to DCM or usual care. Nurses from the intervention care homes received DCM training, a DCM organizational briefing day and conducted the 4-months DCM-intervention twice during the study. A single DCM cycle consists of observation, feedback to the staff, and action plans for the residents. We measured costs related to health care consumption, falls and psychotropic drug use at the resident level and absenteeism at the staff level. Data were extracted from resident files and the nursing home records. Prizes were determined using the Dutch manual of health care cost and the cost prices delivered by a pharmacy and a nursing home. Total costs were evaluated by means of linear mixed-effect models for longitudinal data, with the unit as a random effect to correct for dependencies within units.
RESULTS
34 units from 11 nursing homes, including 318 residents and 376 nursing staff members participated in the cost analyses. Analyses showed no difference in total costs. However certain changes within costs could be noticed. The intervention group showed lower costs associated with outpatient hospital appointments over time (p = 0.05) than the control group. In both groups, the number of falls, costs associated with the elderly-care physician and nurse practitioner increased equally during the study (p<0.02).
CONCLUSIONS
DCM is a cost-neutral intervention. It effectively reduces outpatient hospital appointments compared to usual care. Other considerations than costs, such as nursing homes' preferences, may determine whether they adopt the DCM method.
TRIAL REGISTRATION
Dutch Trials Registry NTR2314.
背景
痴呆症护理图谱（DCM）是一种循环干预措施，旨在减少养老院中痴呆症患者的神经精神症状。在一项为期18个月的整群随机对照试验中，我们研究了DCM对居民和工作人员结局的有效性，同时我们调查了养老院中DCM护理成本与常规护理成本之间的差异。
方法
痴呆症特殊护理单元被随机分配接受DCM或常规护理。干预护理院的护士接受了DCM培训、一次DCM组织简报日，并在研究期间两次进行为期4个月的DCM干预。一个DCM周期包括观察、向工作人员反馈以及为居民制定行动计划。我们在居民层面测量了与医疗保健消费、跌倒和使用精神药物相关的成本，在工作人员层面测量了旷工成本。数据从居民档案和养老院记录中提取。费用使用荷兰医疗保健成本手册以及药房和养老院提供的成本价格来确定。通过纵向数据的线性混合效应模型评估总成本，将单元作为随机效应以校正单元内的相关性。
结果
来自11家养老院的34个单元，包括318名居民和376名护理人员参与了成本分析。分析显示总成本没有差异。然而，可以注意到成本内部的某些变化。随着时间的推移，干预组与门诊预约相关费用低于对照组（p = 0.05）。在两组中，跌倒次数、与老年护理医生和执业护士相关的费用在研究期间均同等增加（p<0.02）。
结论
DCM是一种成本中性的干预措施。与常规护理相比，它能有效减少门诊预约。除成本外的其他因素，如养老院的偏好，可能决定它们是否采用DCM方法。
试验注册
荷兰试验注册中心NTR2314。
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