Bergmo Trine S, Berntsen Gro K, Dalbakk Monika, Rumpsfeld Markus
Norwegian Centre for Integrated Care and Telemedicine, University Hospital of North Norway, 9038, Tromsø, Norway.
Division of Internal Medicine, University Hospital of North Norway, Tromsø, Norway.
BMC Geriatr. 2015 Oct 23;15:133. doi: 10.1186/s12877-015-0133-x.
The present study protocol describes the evaluation of a comprehensive integrated care model implemented at two hospital sites at the University Hospital of North Norway (UNN). The PAtient Centred Team (PACT) model includes proactive, patient-centred interdisciplinary teams that aim to improve the continuum and quality of care of frail elderly patients and reduce health care costs. The main objectives of the evaluation are to analyse the effectiveness and cost effectiveness of using patient-centred teams as part of routine service provision for this patient group. The evaluation will analyse the effect on patient health and functional status, patient experiences and hospital utilisation, and it will conduct an economic evaluation. This paper describes the PACT model and the rationale for and design of the planned effectiveness and cost-effectiveness study.
METHODS/DESIGN: This is a prospective, non-randomised matched control before-and-after intervention study. Patients in the intervention group will be recruited from the hospital sites that have implemented the PACT model. The controls will be recruited from two hospitals without the model. The control patients and the index patients will be matched according to sex, age and number of long-term conditions. The study aims to include 600 patients in each group, which will provide sufficient power to detect a clinical change in the primary outcome. The primary outcome is the physical dimension of the Short Form Health Survey (SF-36). Secondary outcomes are the Patient Generated Index (PGI), the Patient Activation Measure (PAM), the Patient Assessment of Chronic Illness Care (PACIC), hospitalisation and length of stay. The cost-effectiveness study takes a health provider perspective and calculates the cost per quality-adjusted life-years (QALYs) gained. The data will be collected at baseline, 6 and 12 months. The data will be analysed using techniques and models that recognise the lack of randomisation and the correlation of cost and effect data.
The study results will provide knowledge about whether the integrated care model implemented at UNN improves the quality of care for the frail elderly with multiple conditions. The study will establish whether the PAC. T model improves health and functional status and is cost effective compared to the usual care for this patient group.
ClinicalTrials.gov: NCT02541474.
本研究方案描述了对挪威北部大学医院（UNN）两个院区实施的综合整合照护模式的评估。以患者为中心的团队（PACT）模式包括积极主动、以患者为中心的跨学科团队，旨在改善体弱老年患者的照护连续性和质量，并降低医疗保健成本。评估的主要目标是分析将以患者为中心的团队作为该患者群体常规服务一部分的有效性和成本效益。该评估将分析对患者健康和功能状态、患者体验及医院利用情况的影响，并将进行经济评估。本文描述了PACT模式以及计划中的有效性和成本效益研究的基本原理与设计。
方法/设计：这是一项前瞻性、非随机配对对照干预前后研究。干预组患者将从已实施PACT模式的院区招募。对照组将从两所未采用该模式的医院招募。对照患者和索引患者将根据性别、年龄和长期病症数量进行匹配。该研究旨在每组纳入600名患者，这将为检测主要结局的临床变化提供足够的效力。主要结局是简短健康调查问卷（SF - 36）的身体维度。次要结局包括患者生成指数（PGI）、患者激活度量表（PAM）、慢性病照护患者评估（PACIC）、住院情况和住院时长。成本效益研究从医疗服务提供者的角度出发，计算每获得一个质量调整生命年（QALY）的成本。数据将在基线、6个月和12个月时收集。将使用认识到缺乏随机化以及成本和效果数据相关性的技术和模型对数据进行分析。
研究结果将提供有关UNN实施的整合照护模式是否改善了患有多种病症的体弱老年人的照护质量的知识。该研究将确定PACT模式是否改善了健康和功能状态，以及与该患者群体的常规照护相比是否具有成本效益。
ClinicalTrials.gov：NCT02541474。
