住院患儿磺胺嘧啶银与门诊纳米晶银治疗小儿烫伤护理模式的价值分析
Inpatient silver sulphadiazine versus outpatient nanocrystalline silver models of care for pediatric scald burns: A value analysis.
作者信息
Malic Claudia, Verchere Cynthia, Arneja Jugpal S
机构信息
Division of Plastic Surgery, British Columbia Children's Hospital and University of British Columbia, Vancouver, British Columbia.
出版信息
Plast Surg (Oakv). 2014 Summer;22(2):99-102.
BACKGROUND/OBJECTIVE: Scalds represent the most frequent pediatric burn injury. Inpatient nonsurgical wound management of small or medium-size burns (<20% total body surface area) represents a significant proportion of the cost of care, with nanocrystalline silver (NCS) and silver sulphadiazine (SSD) among the most commonly used dressings. Although several articles have described healing outcomes using these dressings, there are few concurrent economic analyses. To analyze overall health care value (outcomes/cost) in burns not requiring surgery, the authors compared management of scald burns with NCS versus SSD from both a quality perspective and using bottom-up microcosting to determine which dressing option optimizes health care value.
METHODS
A value analysis was performed. Published studies investigating NCS and/or SSD in the treatment of pediatric burns over the past 25 years were analyzed. Healing time, hospital duration and frequency of dressings were chosen as quality metrics. A bottom-up microcosting analysis was performed to estimate costs associated with the two dressing options.
RESULTS
Over the 25-year period, 356 studies investigated the use of SSD in burns, while 55 studies evaluated the use of NCS. Mean age and burn size were equivalent. Mean time to healing was 14.9 days for NCS and 17.2 days for SSD. The mean duration of hospital stay was 14.9 days for SSD and 5.9 days for NCS. Dressings were performed twice per week for NCS, and once or twice per day for SSD. The mean total cost per patient to the health care system was estimated to be $61,140 for SSD and $17,220 for NCS.
CONCLUSION
Published outcomes of healing time are equivalent or slightly better using NCS over SSD for pediatric scalds. The financial model illustrated a potential significant cost saving with NCS, primarily as a result of an outpatient model of care. Overall health care value is optimized using NCS for pediatric scalds.
背景/目的：烫伤是儿童最常见的烧伤类型。中小面积烧伤（<20% 体表面积）的住院非手术伤口处理占护理费用的很大一部分，纳米晶银（NCS）和磺胺嘧啶银（SSD）是最常用的敷料。尽管有几篇文章描述了使用这些敷料的愈合结果，但同时进行经济分析的却很少。为了分析非手术烧伤的整体医疗保健价值（结果/成本），作者从质量角度并使用自下而上的微观成本核算方法比较了 NCS 和 SSD 治疗烫伤的情况，以确定哪种敷料选择能优化医疗保健价值。
方法
进行了一项价值分析。分析了过去 25 年中研究 NCS 和/或 SSD 治疗儿童烧伤的已发表研究。选择愈合时间、住院时间和换药频率作为质量指标。进行了自下而上的微观成本核算分析，以估计与两种敷料选择相关的成本。
结果
在这 25 年期间，356 项研究调查了 SSD 在烧伤中的应用，而 55 项研究评估了 NCS 的应用。平均年龄和烧伤面积相当。NCS 的平均愈合时间为 14.9 天，SSD 为 17.2 天。SSD 的平均住院时间为 14.9 天，NCS 为 5.9 天。NCS 每周换药两次，SSD 每天换药一到两次。医疗保健系统每位患者的平均总成本估计 SSD 为 61,140 美元，NCS 为 17,220 美元。
结论
已发表的结果表明，对于儿童烫伤，使用 NCS 的愈合时间与 SSD 相当或略好。财务模型显示使用 NCS 可能会显著节省成本，主要是由于门诊护理模式。使用 NCS 可优化儿童烫伤的整体医疗保健价值。
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