College of Nursing.
Hollings Cancer Center.
Med Care. 2018 Oct;56(10):883-889. doi: 10.1097/MLR.0000000000000979.
In 2014, the Medical University of South Carolina (MUSC) implemented a Tobacco Dependence Treatment Service (TDTS) consistent with the Joint Commission (JC) standards recommending that hospitals screen patients for smoking, provide cessation support, and follow-up contact for relapse prevention within 1 month of discharge. We previously demonstrated that patients exposed to the MUSC TDTS were approximately half as likely to be smoking one month after discharge and 23% less likely to have a 30-day hospital readmission. This paper examines whether exposure to the TDTS influenced downstream health care charges 12 months after patients were discharged from the hospital.
Data from MUSC's electronic health records, the TDTS, and statewide health care utilization datasets (eg, hospitalization, emergency department, and ambulatory surgery visits) were linked to assess how exposure to the MUSC TDTS impacted health care charges. Total health care charges were compared for patients with and without TDTS exposure. To reduce potential TDTS exposure selection bias, propensity score weighting was used to balance baseline characteristics between groups. The cost of delivering the MUSC TDTS intervention was calculated, along with cost per smoker.
The overall adjusted mean health care charges for smokers exposed to the TDTS were $7299 lower than for those who did not receive TDTS services (P=0.047). The TDTS cost per smoker was modest by comparison at $34.21 per smoker eligible for the service.
Results suggest that implementation of a TDTS consistent with JC standards for smoking cessation can be affordably implemented and yield substantial health care savings that would benefit patients, hospitals, and insurers.
2014 年，南卡罗来纳医科大学（MUSC）实施了一项符合联合委员会（JC）标准的烟草依赖治疗服务（TDTS），该标准建议医院在出院后 1 个月内对患者进行吸烟筛查、提供戒烟支持和随访以预防复发。我们之前的研究表明，接触 MUSC TDTS 的患者在出院后一个月内吸烟的可能性降低了一半，30 天内再次住院的可能性降低了 23%。本文研究了接触 TDTS 是否会影响患者出院后 12 个月的下游医疗费用。
将 MUSC 的电子健康记录、TDTS 以及全州医疗保健利用数据集（如住院、急诊和门诊手术就诊）的数据进行链接，以评估接触 MUSC TDTS 对医疗费用的影响。比较了接触和未接触 TDTS 的患者的总医疗费用。为了减少潜在的 TDTS 暴露选择偏差，使用倾向评分加权来平衡组间的基线特征。计算了提供 MUSC TDTS 干预措施的成本，以及每位吸烟者的成本。
接触 TDTS 的吸烟者的总体调整后平均医疗费用比未接受 TDTS 服务的吸烟者低 7299 美元（P=0.047）。相比之下，TDTS 每例吸烟者的成本相对较低，为符合服务条件的每位吸烟者 34.21 美元。
结果表明，实施符合 JC 标准的 TDTS 以进行戒烟可以负担得起，并且可以产生大量的医疗保健节省，使患者、医院和保险公司受益。
