Rijnstate Research Center, Rijnstate Hospital, Arnhem, The Netherlands.
Department of Health Technology and Services Research, Faculty of Behavioural, Management & Social Sciences, Technical Medical Centre, University of Twente, Enschede, The Netherlands.
BMJ Open. 2022 Aug 1;12(8):e051833. doi: 10.1136/bmjopen-2021-051833.
To determine the budget impact of virtual care.
We conducted a budget impact analysis of virtual care from the perspective of a large teaching hospital in the Netherlands. Virtual care included remote monitoring of vital signs and three daily remote contacts. Net budget impact over 5 years and net costs per patient per day (costs/patient/day) were calculated for different scenarios: implementation in one ward, in two different wards, in the entire hospital, and in multiple hospitals. Sensitivity analyses included best-case and worst-case scenarios, and reducing the frequency of daily remote contacts.
Net budget impact over 5 years was €2 090 000 for implementation in one ward, €410 000 for two wards and €-6 206 000 for the entire hospital. Costs/patient/day in the first year were €303 for implementation in one ward, €94 for two wards and €11 for the entire hospital, decreasing in subsequent years to a mean of €259 (SD=€72), €17 (SD=€10) and €-55 (SD=€44), respectively. Projecting implementation in every Dutch hospital resulted in a net budget impact over 5 years of €-445 698 500. For this scenario, costs/patient/day decreased to €-37 in the first year, and to €54 in subsequent years in the base case.
With present cost levels, virtual care only saves money if it is deployed at sufficient scale or if it can be designed such that the active involvement of health professionals is minimised. Taking a greenfield approach, involving larger numbers of hospitals, further decreases costs compared with implementing virtual care in one hospital alone.
确定虚拟护理的预算影响。
我们从荷兰一家大型教学医院的角度对虚拟护理进行了预算影响分析。虚拟护理包括生命体征的远程监测和每天三次远程联系。为不同场景计算了 5 年内的净预算影响和每位患者每天的净费用（costs/patient/day）：一个病房实施、两个不同病房实施、整个医院实施和多家医院实施。敏感性分析包括最佳情况和最差情况，以及减少每日远程联系的频率。
一个病房实施的 5 年内净预算影响为 209 万欧元，两个病房实施的为 41 万欧元，整个医院实施的为-620.6 万欧元。第一年每个病房实施的 cost/patient/day 为 303 欧元，两个病房实施的为 94 欧元，整个医院实施的为-55 欧元，随后几年逐年下降，平均值分别为 259 欧元（SD=72 欧元）、17 欧元（SD=10 欧元）和-55 欧元（SD=44 欧元）。假设在每个荷兰医院实施，5 年内的净预算影响为-44569.85 万欧元。在这种情况下，cost/patient/day 第一年降至-37 欧元，随后几年在基础情况下降至 54 欧元。
以目前的成本水平，如果虚拟护理的部署规模足够大，或者可以设计成尽量减少卫生专业人员的积极参与，那么它才能节省成本。采用全新的方法，涉及更多的医院，与仅在一家医院实施虚拟护理相比，进一步降低了成本。
