Department of Economics, University of Bergen, Postboks 7802, 5020, Bergen, Norway.
Department of Social Sciences, NORCE Norwegian Research Centre, Bergen, Norway.
BMC Health Serv Res. 2021 Aug 28;21(1):884. doi: 10.1186/s12913-021-06805-6.
To provide value-based care for patients with multi-morbidity, innovative integrated care programmes and comprehensive evaluations of such programmes are required. In Norway, a new programme called "Holistic Continuity of Patient Care" (HCPC) addresses the issue of multi-morbidity by providing integrated care within learning networks for frail elderly patients who receive municipal home care services or a short-term stay in a nursing home. This study conducts a multi-criteria decision analysis (MCDA) to evaluate whether the HCPC programme performs better on a large set of outcomes corresponding to the 'triple aim' compared to usual care.
Prospective longitudinal survey data were collected at baseline and follow-up after 6-months. The assessment of HCPC was implemented by a novel MCDA framework. The relative weights of importance of the outcomes used in the MCDA were obtained from a discrete choice experiment among five different groups of stakeholders. The performance score was estimated using a quasi-experimental design and linear mixed methods. Performance scores were standardized and multiplied by their weights of importance to obtain the overall MCDA value by stakeholder group.
At baseline in the HCPC and usual care groups, respectively, 120 and 89 patients responded, of whom 87 and 41 responded at follow-up. The average age at baseline was 80.0 years for HCPC and 83.6 for usual care. Matching reduced the standardized differences between the groups for patient background characteristics and outcome variables. The MCDA results indicated that HCPC was preferred to usual care irrespective of stakeholders. The better performance of HCPC was mostly driven by improvements in enjoyment of life, psychological well-being, and social relationships and participation. Results were consistent with sensitivity analyses using Monte Carlo simulation.
Frail elderly with multi-morbidity represent complex health problems at large costs for society in terms of health- and social care. This study is a novel contribution to assessing and understanding HCPC programme performance respecting the multi-dimensionality of desired outcomes. Integrated care programmes like HCPC may improve well-being of patients, be cost-saving, and contribute to the pursuit of evidence based gradual reforms in the care of frail elderly.
为了为患有多种疾病的患者提供基于价值的护理，需要创新的综合护理计划和对这些计划的全面评估。在挪威，一项名为“患者整体护理的连贯性”（HCPC）的新计划通过为接受市立家庭护理服务或短期入住疗养院的体弱老年患者提供学习网络内的综合护理来解决多种疾病问题。本研究进行了多准则决策分析（MCDA），以评估与“三重目标”相对应的一整套结果中，HCPC 计划是否比常规护理表现更好。
在基线和 6 个月后的随访中收集了前瞻性纵向调查数据。通过新的 MCDA 框架评估 HCPC。MCDA 中使用的结果的相对重要性权重是通过五个不同利益相关者群体的离散选择实验获得的。使用准实验设计和线性混合方法估计绩效得分。通过乘以其重要性权重对绩效得分进行标准化，以获得按利益相关者群体计算的整体 MCDA 值。
在 HCPC 和常规护理组的基线时，分别有 120 名和 89 名患者做出了回应，其中 87 名和 41 名在随访时做出了回应。基线时 HCPC 的平均年龄为 80.0 岁，常规护理为 83.6 岁。匹配减少了组间患者背景特征和结果变量的标准化差异。MCDA 结果表明，无论利益相关者如何，HCPC 都优于常规护理。HCPC 表现更好主要是因为生活乐趣、心理健康和社会关系和参与度的提高。结果与使用蒙特卡罗模拟的敏感性分析一致。
患有多种疾病的体弱老年人代表了社会在健康和社会护理方面面临的复杂健康问题，成本巨大。本研究是评估和理解 HCPC 计划绩效的新颖贡献，尊重了期望结果的多维性。像 HCPC 这样的综合护理计划可以改善患者的幸福感，节省成本，并有助于追求基于证据的对体弱老年人护理的渐进式改革。
