Clinical Excellence Research Center (NTB, CCS, DY, SP, BB, SP, RMK, TP, AM), Stanford University School of Medicine, Stanford University, Stanford, CA.
Clinical Excellence Research Center (NTB, CCS, DY, SP, BB, SP, RMK, TP, AM), Stanford University School of Medicine, Stanford University, Stanford, CA.
Am J Geriatr Psychiatry. 2019 Feb;27(2):149-161. doi: 10.1016/j.jagp.2018.09.015. Epub 2018 Sep 28.
The authors describe a comprehensive care model for Alzheimer disease (AD) that improves value within 1-3 years after implementation by leveraging targeted outpatient chronic care management, cognitively protective acute care, and timely caregiver support.
Using current best evidence, expert opinion, and macroeconomic modeling, the authors designed a comprehensive care model for AD that improves the quality of care while reducing total per capita healthcare spending by more than 15%. Cost savings were measured as reduced spending by payers. Cost estimates were derived from medical literature and national databases, including both public and private U.S. payers. All estimates reflect the value in 2015 dollars using a consumer price index inflation calculator. Outcome estimates were determined at year 2, accounting for implementation and steady-state intervention costs.
After accounting for implementation and recurring operating costs of approximately $9.5 billion, estimated net cost savings of between $13 and $41 billion can be accomplished concurrently with improvements in quality and experience of coordinated chronic care ($0.01-$6.8 billion), cognitively protective acute care ($8.7-$26.6 billion), timely caregiver support ($4.3-$7.5 billion), and caregiver efficiency ($4.1-$7.2 billion).
A high-value care model for AD may improve the experience of patients with AD while significantly lowering costs.
作者描述了一种全面的阿尔茨海默病(AD)护理模式,通过有针对性的门诊慢性护理管理、认知保护急性护理和及时的护理人员支持,在实施后 1-3 年内提高价值。
作者使用当前最佳证据、专家意见和宏观经济模型,设计了一种全面的 AD 护理模式,在提高护理质量的同时,将人均医疗保健总支出降低 15%以上。节省的成本是指支付方减少的支出。成本估算来自医学文献和国家数据库,包括美国公共和私人支付者。所有估算均使用消费者价格指数通胀计算器反映 2015 年的价值。结果估计在第 2 年确定,考虑到实施和稳定状态干预成本。
在考虑到大约 95 亿美元的实施和经常性运营成本后,通过改善协调慢性护理的质量和体验(0.01 亿至 68 亿美元)、认知保护急性护理(87 亿至 266 亿美元)、及时的护理人员支持(43 亿至 75 亿美元)和护理人员效率(41 亿至 72 亿美元),可以同时实现 130 亿至 410 亿美元的净成本节省。
AD 的高价值护理模式可以改善 AD 患者的体验,同时显著降低成本。