丹麦为无家可归者提供的医院后医疗暂息护理：一项随机对照试验和成本效用分析。
Post-hospital medical respite care for homeless people in Denmark: a randomized controlled trial and cost-utility analysis.
机构信息
Clinical Research Centre, Copenhagen University Hospital Amager and Hvidovre, Kettegaard Alle 30, 2650, Hvidovre, Denmark.
Danish Centre for Health Economics, University of Southern Denmark, Odense, Denmark.
出版信息
BMC Health Serv Res. 2020 Jun 5;20(1):508. doi: 10.1186/s12913-020-05358-4.
BACKGROUND
Being homeless entails higher mortality, morbidity, and prevalence of psychiatric diseases. This leads to more frequent and expensive use of health care services. Medical respite care enables an opportunity to recuperate after a hospitalization and has shown a positive effect on readmissions, but little is known about the cost-effectiveness of medical respite care for homeless people discharged from acute hospitalization. Therefore, the aim of the present study was to investigate the cost-effectiveness of a 2-week stay in post-hospital medical respite care.
METHODS
A randomized controlled trial and cost-utility analysis, from a societal perspective, was conducted between April 2014 and March 2016. Homeless people aged > 18 years with an acute admission were included from 10 different hospitals in the Capital Region of Denmark. The intervention group (n = 53) was offered a 2-week medical respite care stay at a Red Cross facility and the control group (n = 43) was discharged without any extra help (usual care), but with the opportunity to seek help in shelters and from street nurses and doctors in the municipalities. The primary outcome was the difference in health care costs 3 months following inclusion in the study. Secondary outcomes were change in health-related quality of life and health care costs 6 months following inclusion in the study. Data were collected through Danish registries, financial management systems in the municipalities and at the Red Cross, and by using the EQ-5D questionnaire.
RESULTS
After 3 and 6 months, the intervention group had €4761 (p = 0.10) and €8515 (p = 0.04) lower costs than the control group, respectively. Crude costs at 3 months were €8448 and €13,553 for the intervention and control group respectively. The higher costs in the control group were mainly related to acute admissions. Both groups had minor quality-adjusted life year gains.
CONCLUSIONS
This is the first randomized controlled trial to investigate the cost-effectiveness of a 2-week medical respite care stay for homeless people after hospitalization. The study showed that the intervention is cost-effective. Furthermore, this study illustrates that it is possible to perform research with satisfying follow-up with a target group that is hard to reach.
TRIAL REGISTRATION
ClinicalTrials.gov Identifier: NCT02649595.
背景
无家可归会导致更高的死亡率、发病率和精神疾病患病率。这会导致更频繁和昂贵的医疗保健服务使用。医疗暂息护理为住院后康复提供了机会，并已显示出对再入院的积极影响，但对于从急性住院中出院的无家可归者的医疗暂息护理的成本效益知之甚少。因此，本研究旨在调查为期两周的住院后医疗暂息护理的成本效益。
方法
这是一项从 2014 年 4 月至 2016 年 3 月进行的随机对照试验和成本效用分析，从社会角度出发。从丹麦首都地区的 10 家不同医院纳入年龄>18 岁的急性入院的无家可归者。干预组（n=53）接受红十字会设施为期两周的医疗暂息护理，对照组（n=43）在没有任何额外帮助（常规护理）的情况下出院，但有机会在避难所和市政当局的街头护士和医生那里寻求帮助。主要结果是研究纳入后 3 个月的医疗保健成本差异。次要结果是纳入研究后 6 个月的健康相关生活质量和医疗保健成本变化。数据通过丹麦登记处、市政当局和红十字会的财务管理系统以及使用 EQ-5D 问卷收集。
结果
在 3 个月和 6 个月后，干预组的费用分别比对照组低 4761 欧元（p=0.10）和 8515 欧元（p=0.04）。干预组在 3 个月时的未经调整的费用为 8448 欧元，对照组为 13553 欧元。对照组较高的成本主要与急性入院有关。两组的生活质量调整后均有轻微改善。
结论
这是第一项针对住院后无家可归者进行为期两周的医疗暂息护理的成本效益的随机对照试验。研究表明该干预措施具有成本效益。此外，本研究表明，对于难以接触到的目标群体，进行研究并进行令人满意的随访是可能的。
试验注册
ClinicalTrials.gov 标识符：NCT02649595。
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