Kelleher Dan, Barry Luke, McGowan Bernie, Doherty Edel, Carey John J, Kane David
Health Economics and Policy Analysis Centre, National University of Ireland, Galway, Galway, Ireland.
Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland.
Rheumatol Adv Pract. 2020 Dec 13;4(2):rkaa059. doi: 10.1093/rap/rkaa059. eCollection 2020.
To estimate the budget impact from the perspective of the Irish health-care system attributable to a reconfiguration in the diagnostic care pathway for patients with suspected RA by adopting an early identification and referral model (EIM).
The budget impact model evaluated the total health-care use and costs attributable to an EIM to diagnose patients with suspected RA relative to the reference scenario of current practice. The modelling also assessed a primary outcome of effect, which examined how many patients can be diagnosed by a rheumatologist within 3 months of symptom onset. The budget impact analysis model was estimated over a 5-year time frame.
The EIM generated a cost saving for the Irish health-care system of €237 547 over the time frame relative to current practice. The cost savings were realized owing to a reduction in the number of general practitioner (GP) visits of 18 790 and a reduction in diagnostic tests carried out by GPs. The results showed that 1027 (510%) more patients were diagnosed within 3 months of symptom onset in the EIM compared with current practice.
This paper has presented an alternative rheumatologist-led service design that can be used in diagnosing patients with suspected RA. The rheumatologist-led service provision detailed in this study has the potential simultaneously to reduce demand for primary care services and to improve the health outcomes of patients. The use of an EIM sees rheumatologist activity incorporate patient demand.
从爱尔兰医疗保健系统的角度评估，采用早期识别和转诊模式（EIM）对疑似类风湿关节炎（RA）患者的诊断护理路径进行重新配置所产生的预算影响。
预算影响模型评估了相对于当前实践参考方案，采用EIM诊断疑似RA患者所导致的医疗保健总使用量和成本。该模型还评估了一个主要的效果指标，即研究有多少患者能够在症状出现后的3个月内被风湿病专家确诊。预算影响分析模型是在5年的时间范围内进行评估的。
在该时间范围内，相对于当前实践，EIM为爱尔兰医疗保健系统节省了237547欧元的成本。成本节约是由于全科医生（GP）就诊次数减少了18790次以及GP进行的诊断测试减少。结果显示，与当前实践相比，在EIM模式下，有1027名（510%）更多的患者在症状出现后的3个月内被确诊。
本文提出了一种由风湿病专家主导的替代性服务设计，可用于诊断疑似RA患者。本研究中详细介绍的由风湿病专家主导的服务提供方式有可能同时减少对初级保健服务的需求，并改善患者的健康结局。使用EIM可使风湿病专家的活动纳入患者需求。
