通过建立姑息治疗和慢性疾病暂息设施来减少澳大利亚偏远地区的住院人数。
Reducing hospital admissions in remote Australia through the establishment of a palliative and chronic disease respite facility.
机构信息
Centre for Remote Health, a centre of Flinders University, PO Box 4066, Alice Springs, NT, 0871, Australia.
Northern Territory Department of Health, Darwin, Australia.
出版信息
BMC Palliat Care. 2017 Nov 21;16(1):54. doi: 10.1186/s12904-017-0247-3.
BACKGROUND
There are limited respite services for palliative care patients and their families in the Northern Territory (NT). The high prevalence of complex chronic diseases, limited access to primary care services, and the poor living situations of many Aboriginal and Torres Strait Islander Australians result in high hospitalisation rates and pressure on tertiary health services. Palliative Care NT identified a need for a flexible, community based, culturally appropriate respite service in Alice Springs. It was of particular interest to assess the impact of the respite service on the extent to which hospital resources were accessed by this population of patients.
METHODS
Respite service use and hospital use data were collected over two time periods: the 12 months prior to the establishment of the service; and the first 10 months of the operation of the service. The financial implications of the facility were assessed in terms of the National Weighted Activity Unit (NWAU). Of primary interest in this study was the impact of the respite service on admissions to the Emergency Department (ED), to the Wards, and to the Intensive Care Unit (ICU). The amount of ventilator hours consumed was also of interest.
RESULTS
Overall, there was a mean cost saving of $1882.50 per episode for hospital admissions with a reduction in: hospital admissions; mean length of stay; Intensive Care Unit (ICU) hours; and ventilator hours.
CONCLUSIONS
The establishment of the respite service has met an important and unmet need in Alice Springs: provision of respite where none has existed before. The service did assist with savings to the health department which could contribute to the cost of the facility over time. Two features of the respite facility that may have contributed to the savings generated were the enhanced coordination of care for patients with complex chronic diseases, as well as improved medication compliance and symptom management.
背景
北领地（NT）为姑息治疗患者及其家属提供的缓解服务有限。复杂慢性病的高发率、初级保健服务的有限获取途径，以及许多澳大利亚原住民和托雷斯海峡岛民的恶劣生活状况，导致住院率和对三级卫生服务的压力居高不下。姑息治疗 NT 组织认为，爱丽丝泉需要一种灵活、以社区为基础、具有文化适应性的缓解服务。特别值得评估的是，该服务对这部分患者使用医院资源的程度产生了何种影响。
方法
在两个时间段内收集了缓解服务使用和医院使用数据：服务建立前的 12 个月；以及服务运营的前 10 个月。该设施的财务影响根据国家加权活动单位（NWAU）进行评估。在这项研究中，主要关注的是缓解服务对急诊科（ED）、病房和重症监护病房（ICU）入院的影响。呼吸机小时数的消耗也是研究的重点。
结果
总体而言，每次住院的平均费用节省了 1882.50 美元，住院人数、平均住院时间、重症监护病房（ICU）小时数和呼吸机小时数都有所减少。
结论
该缓解服务的建立满足了爱丽丝泉的一项重要和未满足的需求：提供以前不存在的缓解服务。该服务确实有助于节省卫生部门的开支，随着时间的推移，这可能会为设施的成本做出贡献。缓解设施的两个特点可能有助于产生节省：为患有复杂慢性病的患者提供更好的协调护理，以及提高药物依从性和症状管理。
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