Seow H, Pataky R, Lawson B, O'Leary E M, Sutradhar R, Fassbender K, McGrail K, Barbera L, Mpa M D, Burge F, Peacock S J, Hoch J S
Department of Oncology, McMaster University, Hamilton, ON;
Canadian Centre for Applied Research in Cancer Control, Vancouver, BC;
Curr Oncol. 2016 Feb;23(Suppl 1):S42-51. doi: 10.3747/co.23.2971. Epub 2016 Feb 29.
Research has demonstrated that increases in palliative homecare nursing are associated with a reduction in the rate of subsequent hospitalizations. However, little evidence is available about the cost-savings potential of palliative nursing when accounting for both increased nursing costs and potentially reduced hospital costs.
Our retrospective cohort study included cancer decedents from British Columbia, Ontario, and Nova Scotia who received any palliative nursing in the last 6 months of life. A Poisson regression analysis was used to determine the association of increased nursing costs (in 2-week blocks) on the relative average hospital costs in the subsequent 2-week block and on the overall total cost (hospital costs plus nursing costs in the preceding 2-week block).
The cohort included 58,022 cancer decedents. Results of the analysis for the last month of life showed an association between increased nursing costs and decreased relative hospital costs in comparisons with a reference group (>0 to 1 hour nursing in the block): the maximum decrease was 55% for Ontario, 31% for British Columbia, and 38% for Nova Scotia. Also, increased nursing costs in the last month were almost always associated with lower total costs in comparison with the reference. For example, cost savings per person-block ranged from $376 (>10 nursing hours) to $1,124 (>4 to 6 nursing hours) in British Columbia.
In the last month of life, increased palliative nursing costs (compared with costs for >0 to 1 hour of nursing in the block) were associated with lower relative hospital costs and a lower total cost in a subsequent block. Our research suggests a cost-savings potential associated with increased community-based palliative nursing.
研究表明，姑息性家庭护理的增加与随后住院率的降低有关。然而，在考虑增加的护理成本和可能降低的医院成本时，关于姑息护理节省成本潜力的证据很少。
我们的回顾性队列研究纳入了来自不列颠哥伦比亚省、安大略省和新斯科舍省的癌症死者，他们在生命的最后6个月接受了任何姑息护理。采用泊松回归分析来确定护理成本增加（以2周为单位）与随后2周相对平均医院成本以及总体总成本（医院成本加上前2周的护理成本）之间的关联。
该队列包括58,022名癌症死者。生命最后一个月的分析结果显示，与参照组（该时间段内护理时长>0至1小时）相比，护理成本增加与相对医院成本降低之间存在关联：安大略省最大降幅为55%，不列颠哥伦比亚省为31%，新斯科舍省为38%。此外，与参照组相比，生命最后一个月护理成本增加几乎总是与总成本降低相关。例如，在不列颠哥伦比亚省，每人时间段的成本节省范围从376美元（护理时长>10小时）到1,124美元（护理时长>4至6小时）。
在生命的最后一个月，姑息护理成本增加（与该时间段内护理时长>0至1小时的成本相比）与随后时间段内相对医院成本降低和总成本降低相关。我们的研究表明，增加社区姑息护理具有节省成本的潜力。
