Soto-Gordoa Myriam, Arrospide Arantzazu, Merino Hernández Marisa, Mora Amengual Joana, Fullaondo Zabala Ane, Larrañaga Igor, de Manuel Esteban, Mar Javier
AP-OSI Research Unit, Alto Deba Integrated Health Care Organization, Mondragon, Spain; Kronikgune, Barakaldo, Spain.
AP-OSI Research Unit, Alto Deba Integrated Health Care Organization, Mondragon, Spain; Health Services Research on Chronic Patients Network (REDISSEC), Kronikgune Group, Barakaldo, Spain; Biodonostia Health Research Institute, San Sebastian-Donostia, Spain.
Value Health. 2017 Jan;20(1):100-106. doi: 10.1016/j.jval.2016.08.002. Epub 2016 Oct 10.
To develop a framework for the management of complex health care interventions within the Deming continuous improvement cycle and to test the framework in the case of an integrated intervention for multimorbid patients in the Basque Country within the CareWell project.
Statistical analysis alone, although necessary, may not always represent the practical significance of the intervention. Thus, to ascertain the true economic impact of the intervention, the statistical results can be integrated into the budget impact analysis. The intervention of the case study consisted of a comprehensive approach that integrated new provider roles and new technological infrastructure for multimorbid patients, with the aim of reducing patient decompensations by 10% over 5 years. The study period was 2012 to 2020.
Given the aging of the general population, the conventional scenario predicts an increase of 21% in the health care budget for care of multimorbid patients during the study period. With a successful intervention, this figure should drop to 18%. The statistical analysis, however, showed no significant differences in costs either in primary care or in hospital care between 2012 and 2014. The real costs in 2014 were by far closer to those in the conventional scenario than to the reductions expected in the objective scenario. The present implementation should be reappraised, because the present expenditure did not move closer to the objective budget.
This work demonstrates the capacity of budget impact analysis to enhance the implementation of complex interventions. Its integration in the context of the continuous improvement cycle is transferable to other contexts in which implementation depth and time are important.
制定一个在戴明持续改进周期内管理复杂医疗保健干预措施的框架，并在CareWell项目中针对巴斯克地区的多病患者综合干预案例对该框架进行测试。
仅进行统计分析虽然有必要，但可能并不总能体现干预措施的实际意义。因此，为确定干预措施的真正经济影响，可将统计结果纳入预算影响分析。案例研究的干预措施包括一种综合方法，该方法整合了针对多病患者的新的提供者角色和新的技术基础设施，目标是在5年内将患者失代偿情况减少10%。研究期为2012年至2020年。
鉴于总人口老龄化，传统情景预测在研究期间，用于多病患者护理的医疗保健预算将增加21%。若干预成功，这一数字应降至18%。然而，统计分析表明，2012年至2014年期间，初级保健和医院护理的成本均无显著差异。2014年的实际成本与传统情景下的成本相比，远比与目标情景下预期的成本降低更为接近。当前的实施情况应重新评估，因为目前的支出并未更接近目标预算。
这项工作证明了预算影响分析在加强复杂干预措施实施方面的能力。将其整合到持续改进周期的背景下可推广到其他实施深度和时间很重要的情况。
