Teo W-S Kelvin, Raj Anusha Govinda, Tan Woan Shin, Ng Charis Wei Ling, Heng Bee Hoon, Leong Ian Yi-Onn
1Health Services & Outcomes Research, National Healthcare Group, Singapore.
Palliat Med. 2014 May;28(5):430-7. doi: 10.1177/0269216314526270. Epub 2014 Mar 20.
Due to limited end-of-life discussions and the absence of palliative care, hospitalisations are frequent at the end of life among nursing home residents in Singapore, resulting in high health-care costs.
Our objective was to evaluate the economic impact of Project Care at the End-of-Life for Residents in homes for the Elderly (CARE) programme on nursing home residents compared to usual end-of-life care. DESIGN AND SETTINGS/PARTICIPANTS: Project CARE was introduced in seven nursing homes to provide advance care planning and palliative care for residents identified to be at risk of dying within 1 year. The cases consisted of nursing home residents enrolled in the Project CARE programme for at least 3 months. A historical group of nursing home residents not in any end-of-life care programme was chosen as the matched controls. Cost differences between the two groups were analysed over the last 3 months and final month of life.
The final sample comprised 48 Project CARE cases and 197 controls. Compared to the controls, the cases were older with more comorbidities and higher nursing needs. After risk adjustment, Project CARE cases demonstrated per-resident cost savings of SGD$7129 (confidence interval: SGD$4544-SGD$9714) over the last 3 months of life and SGD$3703 (confidence interval: SGD$1848-SGD$5557) over the last month of life (US$1 = SGD$1.3).
This study demonstrated substantial savings associated with an end-of-life programme. With a significant proportion of the population in Singapore requiring nursing home care in the near future, these results could assist policymakers and health-care providers in decision-making on allocation of health-care resources.
由于临终讨论有限且缺乏姑息治疗，新加坡养老院居民临终时频繁住院，导致医疗费用高昂。
我们的目标是评估老年人临终关怀项目（CARE）对养老院居民的经济影响，并与常规临终关怀进行比较。
设计与设置/参与者：CARE项目在七家养老院推行，为确定在1年内有死亡风险的居民提供预先护理计划和姑息治疗。病例包括参加CARE项目至少3个月的养老院居民。选择一组未参加任何临终关怀项目的养老院居民作为匹配对照组。分析两组在生命最后3个月和最后1个月的费用差异。
最终样本包括48例CARE项目病例和197例对照。与对照组相比，病例年龄更大，合并症更多，护理需求更高。经过风险调整后，CARE项目病例在生命的最后3个月每位居民节省成本7129新元（置信区间：4544新元 - 9714新元），在生命的最后1个月节省成本3703新元（置信区间：1848新元 - 5557新元）（1美元 = 1.3新元）。
本研究表明临终关怀项目可节省大量费用。鉴于新加坡近期有很大一部分人口需要养老院护理，这些结果可协助政策制定者和医疗服务提供者在医疗资源分配方面做出决策。
