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基于社区的护理依赖风险老年人干预措施的卫生经济学视角——一项前瞻性准实验研究的结果

Health economic perspective on a community-based intervention for older people at risk of care dependency - results of a prospective quasi-experimental study.

作者信息

Lampe David, Hasemann Lena, Nebling Thomas, Thiem Ulrich, Greiner Wolfgang

机构信息

AG 5 - Department of Health Economics and Health Care Management, Bielefeld University, School of Public Health, Bielefeld, Germany.

Techniker Krankenkasse, Department Care Management, Hamburg, Germany.

出版信息

Gerontol Geriatr Med. 2022 Nov 23;8:23337214221140222. doi: 10.1177/23337214221140222. eCollection 2022 Jan-Dec.

DOI:10.1177/23337214221140222
PMID:36458264
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9706052/
Abstract

This prospective, quasi-experimental study aims to compare healthcare resource utilization (HCRU) and costs of a multi-component care approach for older people in a community setting (intervention group (IG)) with usual care in a matched control group (CG) during a 21-month observation period. The reablement-oriented intervention included a geriatric assessment, a case and network management and digital supporting tools. Regression models were applied to determine intervention effects regarding hospitalization, total hospital length of stay (LOS), number of physician consultations, and healthcare costs using claims data. 872 subjects were included in the IG and 1,768 in the CG. The analyses showed that the intervention did not affect hospitalization ( = 1.153; 95% CI: 0.971-1.369,  = .105). However, participating in the IG lead to a small but significant increase of physician contacts by a factor of 1.078 (Exp() = 1.078; 95% CI: 1.011-1.149;  = .022). A non-significant mean difference in costs of €1,183 (95% CI: €-261.6 to €2,627.6,  = .108) per participant was identified. Further research is needed to generate robust evidence on the optimal design of care approaches for older people and the health economic implications of such interventions to improve care and resource allocation decision-making. The study was registered at the German Clinical Trials Register (DRKS00027866).

摘要

这项前瞻性的准实验研究旨在比较社区环境中针对老年人的多组分护理方法(干预组(IG))与匹配对照组(CG)的常规护理在21个月观察期内的医疗资源利用(HCRU)和成本。以恢复能力为导向的干预措施包括老年评估、病例和网络管理以及数字支持工具。应用回归模型,利用索赔数据确定干预措施对住院治疗、总住院时长(LOS)、医生会诊次数和医疗成本的影响。干预组纳入了872名受试者,对照组纳入了1768名受试者。分析表明,干预措施对住院治疗没有影响(=1.153;95%置信区间:0.971 - 1.369,=0.105)。然而,参与干预组导致医生接触次数有小幅但显著的增加,增加系数为1.078(指数()=1.078;95%置信区间:1.011 - 1.149;=0.022)。确定每位参与者的成本平均差异为1183欧元(95%置信区间:-261.6欧元至2627.6欧元,=0.108),差异不显著。需要进一步研究以产生关于老年人护理方法的最佳设计以及此类干预措施对改善护理和资源分配决策的健康经济影响的有力证据。该研究已在德国临床试验注册中心(DRKS00027866)注册。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0be7/9706052/e3583fb09ba7/10.1177_23337214221140222-fig1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0be7/9706052/e3583fb09ba7/10.1177_23337214221140222-fig1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0be7/9706052/e3583fb09ba7/10.1177_23337214221140222-fig1.jpg

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本文引用的文献

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Reablement through time and space: a scoping review of how the concept of 'reablement' for older people has been defined and operationalised.跨越时空的再能力化:对老年人“再能力化”概念的定义和操作化的范围综述。
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Age Ageing. 2019 Sep 1;48(5):665-671. doi: 10.1093/ageing/afz088.
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