超越孤岛：针对老年患者居家环境的远程医疗强化综合护理模式——有效性和成本效益评估的前瞻性观察队列研究

BeyondSilos, a Telehealth-Enhanced Integrated Care Model in the Domiciliary Setting for Older Patients: Observational Prospective Cohort Study for Effectiveness and Cost-Effectiveness Assessments.

作者信息

Piera-Jiménez Jordi, Daugbjerg Signe, Stafylas Panagiotis, Meyer Ingo, Müller Sonja, Lewis Leo, da Col Paolo, Folkvord Frans, Lupiáñez-Villanueva Francisco

机构信息

Open Evidence Research Group, Universitat Oberta de Catalunya, Barcelona, Spain.

Department of Research & Development, Badalona Serveis Assistencials, Badalona, Spain.

出版信息

JMIR Med Inform. 2020 Oct 6;8(10):e20938. doi: 10.2196/20938.

DOI:10.2196/20938

PMID:33021490

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7576466/

Abstract

BACKGROUND

Information and communication technology may provide domiciliary care programs with continuity of care. However, evidence about the effectiveness and cost-effectiveness of information and communication technology in the context of integrated care models is relatively scarce.

OBJECTIVE

The objective of our study was to provide evidence on the clinical effectiveness and cost-effectiveness of the BeyondSilos project for patients enrolled in the Badalona city pilot site in Spain.

METHODS

A quasi-experimental study was used to assess the cost-effectiveness of information and communication technology-enhanced integration of health and social care, including the third sector (intervention), compared to basic health and social care coordination (comparator). The study was conducted in Badalona between 2015 and 2016. Participants were followed for 8 months.

RESULTS

The study included 198 patients: 98 in the intervention group and 100 in the comparator group. The mean Barthel index remained unchanged in the intervention group (mean change 0.14, 95% CI -4.51 to 4.78; P=.95) but decreased in the comparator group (mean change -3.23, 95% CI -5.34 to -1.11; P=.003). Instrumental Activities of Daily Living significantly decreased in both groups: mean changes of -0.23 (95% CI -0.44 to -0.02; P=.03) and -0.33 (95% CI -0.46 to -0.20; P<.001) in the intervention and comparator groups, respectively. No differences were found in the Geriatric Depression Scale (intervention: mean change 0.28, 95% CI -0.44 to 1.01, P=.44; comparator: mean change -0.29, 95% CI -0.59 to 0.01, P=.06). The intervention showed cost-effectiveness (incremental cost-effectiveness ratio €6505.52, approximately US $7582).

CONCLUSIONS

The information and communication technology-enhanced integrated domiciliary care program was cost-effective. The beneficial effects of this approach strongly rely upon the commitment of the professional staff involved.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03111004; http://clinicaltrials.gov/ct2/show/ NCT03111004.

摘要

背景

信息通信技术可为家庭护理计划提供持续护理。然而，关于信息通信技术在综合护理模式中的有效性和成本效益的证据相对较少。

目的

我们研究的目的是为西班牙巴达洛纳市试点地区参与BeyondSilos项目的患者提供临床有效性和成本效益的证据。

方法

采用准实验研究来评估信息通信技术增强的健康与社会护理整合（包括第三部门，即干预组）相较于基本健康与社会护理协调（对照组）的成本效益。该研究于2015年至2016年在巴达洛纳进行。对参与者进行了8个月的随访。

结果

该研究纳入了198名患者：干预组98名，对照组100名。干预组的巴氏指数均值保持不变（平均变化0.14，95%置信区间为-4.51至4.78；P = 0.95），而对照组则下降（平均变化-3.23，95%置信区间为-5.34至-1.11；P = 0.003）。两组的日常生活活动能力均显著下降：干预组和对照组的平均变化分别为-0.23（95%置信区间为-0.44至-0.02；P = 0.03）和-0.33（95%置信区间为-0.46至-0.20；P < 0.001）。老年抑郁量表方面未发现差异（干预组：平均变化0.28，95%置信区间为-0.44至1.01，P = 0.44；对照组：平均变化-0.29，95%置信区间为-0.59至0.01，P = 0.06）。干预措施显示出成本效益（增量成本效益比为6505.52欧元，约合7582美元）。