Bavle Abhishek, Grimes Amanda, Zhao Sibo, Zinn Daniel, Jackson Andrea, Patel Binita, Porea Timothy, Dutta Ankhi, Russell Heidi, Heczey Andras
Jimmy Everest Section of Pediatric Hematology/Oncology, University of Oklahoma Health Sciences Center, Oklahoma City, OK.
Texas Children's Cancer and Hematology Centers.
J Pediatr Hematol Oncol. 2018 Oct;40(7):e415-e420. doi: 10.1097/MPH.0000000000001084.
On the basis of significant evidence for safety, the international pediatric fever and neutropenia committee recommends the identification and management of patients with "low-risk fever and neutropenia" (LRFN), outpatient with oral antibiotics, instead of traditional inpatient management. The aim of our study was to compare the cost-per-patient with these 2 strategies, and to evaluate parent and provider satisfaction with the outpatient management of LRFN. Between March 2016 and February 2017, 17 LRFN patients (median absolute neutrophil count, 90/μL) were managed at a single institution, per new guidelines. Fifteen patients were discharged on presentation or at 24 to 48 hours postadmission on oral levofloxacin, and 2 were inadvertently admitted off protocol. The mean cost of management for the postimplementation cohort was compared with a historic preimplementation control group. Satisfaction surveys were completed by parents and health care providers of LRFN patients. The mean total cost of an LRFN episode was $12,500 per patient preimplementation and $6168 postimplementation, a decrease of $6332 (51%) per patient. All parents surveyed found outpatient follow-up easy; most (12/14) parents and all (16/16) providers preferred outpatient management. Outpatient management of LRFN patients was less costly, and was preferred by a majority of parents and all health care providers, compared with traditional inpatient management.
基于充分的安全性证据，国际儿科发热与中性粒细胞减少症委员会建议识别和管理“低风险发热与中性粒细胞减少症”（LRFN）患者，采用口服抗生素门诊治疗，而非传统的住院治疗。我们研究的目的是比较这两种策略的人均成本，并评估家长和医疗服务提供者对LRFN门诊治疗的满意度。在2016年3月至2017年2月期间，按照新指南，一家机构对17例LRFN患者（中位绝对中性粒细胞计数为90/μL）进行了治疗。15例患者在就诊时或入院后24至48小时口服左氧氟沙星后出院，2例无意中未按方案收治。将实施后队列的平均管理成本与历史实施前对照组进行比较。对LRFN患者的家长和医疗服务提供者进行了满意度调查。LRFN发作的人均总费用在实施前为每名患者12,500美元，实施后为6168美元，每名患者减少了6332美元（51%）。所有接受调查的家长都觉得门诊随访很轻松；大多数（12/14）家长和所有（16/16）医疗服务提供者更喜欢门诊治疗。与传统住院治疗相比，LRFN患者的门诊治疗成本更低，且受到大多数家长和所有医疗服务提供者的青睐。
