Guertin Jason R, Bowen James M, Gosse Carolyn, Blackhouse Gord, O'Reilly Daria J, Baltaga Emanuel, Cox Gerard, Johnson Donna, Le Blanc Brandi, Loncke Jane, Pugsley Stewart, Sivakumaran Ravi, Wheatley Laura, Smith Kevin, Tarride Jean-Eric
Programs for Assessment of Technology in Health, The Research Institute of St. Joe's Hamilton, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada.
Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.
Can Respir J. 2017;2017:7049483. doi: 10.1155/2017/7049483. Epub 2017 Aug 7.
St. Joseph's Health System has implemented an integrated comprehensive care bundle care (ICC) program with the hopes that it would improve patients' care while reducing overall costs. The aim of this analysis was to evaluate the performance of the ICC program within patients admitted with chronic pulmonary obstructive disease (COPD).
We conducted a retrospective observational cohort study comparing ICC patients to non-ICC patients admitted to St. Joseph's Healthcare Hamilton for COPD being discharged with support services between June 2012 and March 2015, using administrative data. Confounding adjustment was achieved through the use of propensity score matching. Medical resource utilizations during the initial hospitalization and within the 60 days following discharge were compared using regression models.
All 76 patients who entered the ICC program (100.0%) were matched 1 : 1 to 76 eligible non-ICC patients (28.4%). Length of stay (6.47 [7.29] versus 9.55 [10.21] days) and resource intensity weights (1.16 [0.80] versus 1.64 [1.69]) were lower in the ICC group within the initial hospitalization but, while favoring the ICC program, healthcare resource use tended not to differ statistically following discharge.
The ICC program was able to reduce initial medical resource utilization without increasing subsequent medical resource use.
圣约瑟夫医疗系统实施了一项综合全面护理包计划(ICC),希望能改善患者护理,同时降低总体成本。本分析的目的是评估ICC计划在慢性阻塞性肺疾病(COPD)住院患者中的实施效果。
我们进行了一项回顾性观察队列研究,利用行政数据,将入住圣约瑟夫医疗汉密尔顿分院且在2012年6月至2015年3月期间因COPD出院并接受支持服务的ICC患者与非ICC患者进行比较。通过倾向得分匹配实现混杂因素调整。使用回归模型比较初始住院期间及出院后60天内的医疗资源利用情况。
所有76名进入ICC计划的患者(100.0%)与76名符合条件的非ICC患者(28.4%)进行了1:1匹配。ICC组在初始住院期间的住院时间(6.47[7.29]天对9.55[10.21]天)和资源强度权重(1.16[0.80]对1.64[1.69])较低,虽然有利于ICC计划,但出院后的医疗资源使用在统计学上没有差异。
ICC计划能够降低初始医疗资源利用,而不增加后续医疗资源使用。