Kinchin Irina, Russell Alex M T, Tsey Komla, Jago Jon, Wintzloff Thomas, Meurk Carla, Doran Christopher M
a Centre for Indigenous Health Equity Research and School of Health, Medical and Applied Sciences, Psychology and Public Health Department , CQUniversity , Brisbane , Australia.
b The Cairns Institute , James Cook University , Cairns , Australia.
J Med Econ. 2019 May;22(5):491-498. doi: 10.1080/13696998.2019.1588126. Epub 2019 Mar 15.
Residential step-up/step-down services provide transitional care and reintegration into the community for individuals experiencing episodes of subacute mental illness. This study aims to examine psychiatric inpatient admissions, length of stay, and per capita cost of care following the establishment of a step-up/step-down Prevention And Recovery Care (PARC) facility in regional Australia.
This was a pragmatic before and after study set within a participatory action research methodology. The target sample comprised patients at a PARC facility over 15 months. Six-month individual level data prior to study entry, during, and over 6-months from study exit were examined using patient activity records. Costs were expressed in 2015-2016AU$.
An audit included 192 people experiencing 243 episodes of care represented by males (58%), mean age = 39.3 years (SD = 12.7), primarily diagnosed with schizophrenia (48%) or mood disorders (30%). The cost of 1 day in a psychiatric inpatient unit was found to be comparable to an average of 5 treatment days in PARC; the mean cost difference per-bed day (AU$1,167) was associated with fewer and shorter inpatient stays. Reduced use of inpatient facility translated into an opportunity cost of improved patient flow equivalent to AU$12,555 per resident (bootstrapped 95% CI = $5,680-$19,280). More noticeable outcomes were observed among those who stayed in PARC for longer during index admission (r = 0.16, p = 0.024), who have had more and lengthy inpatient stays (r = 0.52, p < 0.001 and r = 0.69, p < 0.001), and those who stepped-down from the hospital (p < 0.001). This information could be proactively used within step-up/step-down services to target care to patients most likely to benefit. Despite early evidence of positive association, the results warrant further investigation using an experimental study design with alongside economic evaluation.
Efforts should be directed toward the adoption of cost-effective alternatives to psychiatric inpatient facilities that provide comparable or improved patient outcomes.
住院式逐步升级/逐步降级服务为经历亚急性精神疾病发作的个体提供过渡性护理并使其重新融入社区。本研究旨在考察在澳大利亚地区设立一个逐步升级/逐步降级的预防与康复护理（PARC）设施后，精神科住院患者的入院情况、住院时长及人均护理成本。
这是一项采用参与式行动研究方法的实用前后对照研究。目标样本包括PARC设施在15个月期间的患者。利用患者活动记录，对研究入组前6个月、研究期间以及研究结束后6个月的个体层面数据进行了考察。成本以2015 - 2016澳元表示。
一项审计纳入了192人，他们经历了243次护理事件，其中男性占58%，平均年龄为39.3岁（标准差 = 12.7），主要诊断为精神分裂症（48%）或情绪障碍（30%）。发现精神科住院单元1天的成本与PARC平均5天的治疗成本相当；每张床位日的平均成本差异（1167澳元）与住院次数减少和住院时长缩短相关。住院设施使用的减少转化为患者流量改善的机会成本，相当于每位居民12555澳元（自助抽样95%置信区间 = 5680 - 19280美元）。在指数住院期间在PARC停留时间更长的患者（r = 0.16，p = 0.024）、有更多且更长住院经历的患者（r = 0.52，p < 0.001和r = 0.69，p < 0.001）以及从医院逐步降级的患者（p < 0.001）中观察到更显著的结果。这些信息可在逐步升级/逐步降级服务中积极用于针对最可能受益的患者提供护理。尽管有早期证据表明存在正相关，但结果仍需使用实验研究设计并结合经济评估进行进一步调查。
应努力采用具有成本效益的替代方案来替代精神科住院设施，以提供可比或更好的患者治疗效果。
