Hansson Elisabeth, Ekman Inger, Swedberg Karl, Wolf Axel, Dudas Kerstin, Ehlers Lars, Olsson Lars-Eric
Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden Centre for Person-Centred Care (GPCC), University of Gothenburg, Sweden
Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden Centre for Person-Centred Care (GPCC), University of Gothenburg, Sweden.
Eur J Cardiovasc Nurs. 2016 Jun;15(4):276-84. doi: 10.1177/1474515114567035. Epub 2015 Jan 16.
Costs of care for patients with chronic heart failure have been estimated at between 1% and 2% of the total health care expenditure in Europe and North America. Two-thirds are for inpatient care. Person-centred care (PCC) asserts that patients are persons and should not be reduced to their diseases alone.
The aim of this study was to estimate the cost-utility of PCC when compared with conventional care in patients hospitalized for worsening chronic heart failure.
Data for the cost-utility analysis were collected alongside a prospective clinical intervention study with a controlled before and after design from 2008 to 2010. Patient-specific resources used and preference-based health status data were collected at an individual level.Only 63% received PCC as intended illustrating the difficulties of introducing new methods in established organizations. The group intended to have PCC yielded higher costs in comparison with the conventional care group. The incremental cost was estimated as €98. The costs for those who actually received PCC, per protocol (PP) (63%) were significantly (p=0.026) lower than for those in the conventional care group, with an incremental cost-saving of €863. For the first three months, patients in the conventional care group showed decreasing health-related quality of life, with a corresponding improvement in the PCC(PP) group.
It must be emphasized, however, that these positive effects, both cheaper and somewhat better, were obtained only among those receiving the PCC intervention in its intended form, PCC(PP).
据估计，欧洲和北美的慢性心力衰竭患者的护理费用占医疗总支出的1%至2%。其中三分之二用于住院护理。以患者为中心的护理（PCC）认为患者是完整的个体，不应仅仅被视为患有疾病。
本研究旨在评估与传统护理相比，针对因慢性心力衰竭病情恶化而住院的患者实施以患者为中心的护理的成本效益。
成本效益分析的数据是在2008年至2010年进行的一项具有前后对照设计的前瞻性临床干预研究过程中收集的。在个体层面收集了患者使用的特定资源以及基于偏好的健康状况数据。只有63%的患者按预期接受了以患者为中心的护理，这表明在现有组织中引入新方法存在困难。与传统护理组相比，预期接受以患者为中心的护理的组产生了更高的成本。增量成本估计为98欧元。实际接受按方案（PP）实施的以患者为中心的护理（63%）的患者的成本显著低于传统护理组（p = 0.026），成本节约了863欧元。在最初的三个月里，传统护理组患者的健康相关生活质量下降，而以患者为中心的护理（PP）组则相应改善。
然而，必须强调的是，这些既更便宜又稍好一些的积极效果仅在那些以预期形式接受以患者为中心的护理干预（PCC(PP)）的患者中获得。
