Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada.
Centre for Health Economics and Policy Analysis (CHEPA), McMaster University, Hamilton, Ontario, Canada.
JAMA Netw Open. 2021 Feb 1;4(2):e210055. doi: 10.1001/jamanetworkopen.2021.0055.
Mobile integrated health care (MIH) is a new model of community-based health care to provide on-site urgent or nonurgent care. Niagara emergency medical services (NEMS) started MIH in 2018 to serve the Niagara region of Ontario, Canada. However, its economic impact is unknown.
To compare time on task and cost between MIH and ambulance delivered by NEMS from a public payer's perspective.
DESIGN, SETTING, AND PARTICIPANTS: This economic evaluation was an analysis of the NEMS databases regarding responses to emergency calls by the NEMS from 2016 to 2019. Emergency calls serviced by MIH in 2018 to 2019 were used as an intervention cohort. Propensity score matching was used to identify a 1:1 matched cohort of calls serviced by regular ambulance response for the same period and 2 years prior. Statistical analyses were performed from January to April 2020.
MIH compared with matched ambulance services.
The main outcomes were the time on task (including time on scene and time at hospital) and costs. Costs were calculated in 2019 Canadian dollars using cost per minute and compared with the 3 ambulance cohorts.
In 2018 to 2019, there were 1740 calls serviced by MIH for which a matched ambulance cohort was identified for the same period and 2 years prior. The mean (SD) time on task was 72.7 (51.0) minutes for MIH, compared with 84.1 (52.0) minutes, 84.3 (54.1) minutes, and 79.4 (42.0) minutes for matched ambulance in 2018 to 2019, 2017 to 2018, and 2016 to 2017, respectively. Of calls serviced by MIH, 498 (28.6%) required ED transport (ie, after MIH team assessment, transport to ED was deemed to be necessary or demanded by the patient), compared with 1300 (74.7%) calls serviced by ambulance in 2018 to 2019, 1294 (74.4%) in 2017 to 2018, and 1359 (78.1%) in 2016 to 2017. The mean (SD) total cost per 1000 calls was $122 760 ($78 635) for MIH compared with $294 336 ($97 245), $299 797 ($104 456), and $297 269 ($81 144) for regular ambulance responses in the 3 matched cohorts, respectively.
Compared with regular ambulance response, MIH was associated with a substantial reduction in the proportion of patients transported to the ED, leading to a substantial saving in total costs. This finding suggests that the MIH model is a promising and viable solution to meeting urgent health care needs in the community, while substantially improving the use of scarce health care resources.
移动综合医疗保健（MIH）是一种新的社区医疗模式，旨在提供现场紧急或非紧急护理。安大略省尼亚加拉地区的尼亚加拉紧急医疗服务（NEMS）于 2018 年开始实施 MIH。然而，其经济影响尚不清楚。
从公共支付者的角度比较 MIH 与 NEMS 救护车提供服务的任务时间和成本。
设计、地点和参与者：本经济评估是对 NEMS 数据库的分析，涉及 2016 年至 2019 年 NEMS 对紧急呼叫的响应。2018 年至 2019 年 MIH 提供服务的紧急呼叫被用作干预队列。采用倾向评分匹配法，为同期和 2 年前的常规救护车反应识别了 1:1 匹配的呼叫队列。统计分析于 2020 年 1 月至 4 月进行。
MIH 与匹配的救护车服务相比。
主要结果是任务时间（包括现场时间和医院时间）和成本。使用每分钟成本在 2019 年加元中计算成本，并与 3 个救护车队列进行比较。
在 2018 年至 2019 年期间，有 1740 个 MIH 提供服务的呼叫确定了同期和 2 年前的匹配救护车队列。MIH 的平均（SD）任务时间为 72.7（51.0）分钟，而匹配的救护车在 2018 年至 2019 年、2017 年至 2018 年和 2016 年至 2017 年的任务时间分别为 84.1（52.0）分钟、84.3（54.1）分钟和 79.4（42.0）分钟。在 MIH 提供服务的呼叫中，有 498 次（28.6%）需要 ED 转运（即，在 MIH 小组评估后，认为有必要或患者要求将其转运至 ED），而在 2018 年至 2019 年、2017 年至 2018 年和 2016 年至 2017 年的救护车呼叫中，分别有 1300 次（74.7%）、1294 次（74.4%）和 1359 次（78.1%）。每 1000 次呼叫的平均（SD）总成本为 MIH 为 122760 美元（78635 加元），而常规救护车反应在 3 个匹配队列中的总成本分别为 294336 美元（97245 加元）、299797 美元（104456 加元）和 297269 美元（81144 加元）。
与常规救护车反应相比，MIH 与送往 ED 的患者比例显著降低，从而显著降低了总费用。这一发现表明，MIH 模式是满足社区紧急医疗保健需求的一种有前途和可行的解决方案，同时大大提高了稀缺医疗资源的利用效率。
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