Department of Biostatistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China.
School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia.
PLoS One. 2018 Jul 3;13(7):e0199879. doi: 10.1371/journal.pone.0199879. eCollection 2018.
This study aims to examine the costs associated with a Hospital in the Nursing Home (HiNH) program in Queensland Australia directed at patients from residential aged care facilities (RACFs) with emergency care needs.
A cost analysis was undertaken comparing the costs under the HiNH program and the current practice, in parallel with a pre-post controlled study design. The study was conducted in two Queensland public hospitals: the Royal Brisbane and Women's Hospital (intervention hospital) and the Logan Hospital (control hospital). Main outcome measures were the associated incremental costs or savings concerning the HiNH program provision and the acute hospital care utilisation over one year after intervention.
The initial deterministic analysis calculated the total induced mean costs associated with providing the HiNH program over one year as AU$488,116, and the total induced savings relating to acute hospital care service utilisation of AU$8,659,788. The total net costs to the health service providers were thus calculated at -AU$8,171,671 per annum. Results from the probabilistic sensitivity analysis (based on 10,000 simulations) showed the mean and median annual net costs associated with the HiNH program implementation were -AU$8,444,512 and-AU$8,202,676, and a standard deviation of 2,955,346. There was 95% certainty that the values of net costs would fall within the range from -AU$15,018,055 to -AU$3,358,820.
The costs relating to implementing the HiNH program appear to be much less than the savings in terms of associated decreases in acute hospital service utilisation. The HiNH service model is likely to have the cost-saving potential while improving the emergency care provision for RACF residents.
本研究旨在考察澳大利亚昆士兰州一家养老院医院（HiNH）计划的相关成本，该计划面向有紧急护理需求的养老院居民。
采用成本分析方法，对 HiNH 计划和现行做法的成本进行比较，并采用前后对照控制设计。该研究在昆士兰州的两家公立医院进行：皇家布里斯班妇女医院（干预医院）和洛根医院（对照医院）。主要观察指标是 HiNH 计划提供的相关增量成本或节省，以及干预后一年急性医院护理利用情况。
初始确定性分析计算出提供 HiNH 计划一年的总诱导平均成本为 488116 澳元，与急性医院护理服务利用相关的总诱导节省为 8659788 澳元。因此，卫生服务提供者的总净成本为每年-8171671 澳元。基于 10000 次模拟的概率敏感性分析结果显示，HiNH 计划实施的年均净成本平均值和中位数分别为-8444512 澳元和-8202676 澳元，标准差为 2955346 澳元。有 95%的把握认为净成本值将在-15018055 澳元至-3358820 澳元的范围内。
实施 HiNH 计划的相关成本似乎明显低于与急性医院服务利用减少相关的节省。HiNH 服务模式可能具有成本节约潜力，同时改善养老院居民的紧急护理服务。
