连续性护理与老年尿失禁患者住院、门诊和总医疗费用的关联。

The associations of continuity of care with inpatient, outpatient, and total medical care costs among older adults with urinary incontinence.

机构信息

Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.

Department of Public Health Science, Graduate School of Public Health, Seoul National University, Seoul, South Korea.

出版信息

BMC Health Serv Res. 2023 Apr 6;23(1):344. doi: 10.1186/s12913-023-09232-x.

DOI:10.1186/s12913-023-09232-x

PMID:37024901

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10080744/

Abstract

INTRODUCTION

Urinary incontinence is a significant health problem with considerable social and economic consequences among older adults. The objective of this study was to investigate the financial impact of continuity of care (CoC) among older urinary incontinence patients in South Korea.

METHODS

We used the NHIS-Senior cohort patient data between January 1, 2010, and December 31, 2010. Patients who were diagnosed with urinary incontinence in 2010 were included. Operational definition of CoC included referrals, number of providers, and number of visits. A generalized linear model (GLM) with γ-distributed errors and the log link function was used to examine the relationship between health cost and explanatory variables. Additionally, we conducted a two-part model analysis for inpatient cost. Marginal effect was calculated.

RESULTS

Higher CoC was associated with a decrease in total medical cost (-0.63, P < .0001) and in outpatient costs (-0.28, P < .001). Higher Charlson Comorbidity Index (CCI) score was a significant predictor for increasing total medical cost (0.59, P < .0001) and outpatient cost (0.22, P < .0001). Higher CoC predict a reduced medical cost of $360.93 for inpatient cost (P = 0.044) and $23.91 for outpatient cost (P = 0.008) per patient.

CONCLUSION

Higher CoC was associated with decrease in total medical costs among older UI patients. Policy initiatives to promote CoC of older UI patients in the community setting could lead to greater financial sustainability of public health insurance in South Korea.

摘要

介绍

尿失禁是老年人面临的一个严重健康问题，会产生相当大的社会和经济后果。本研究旨在探讨连续性护理（CoC）对韩国老年尿失禁患者的经济影响。

方法

我们使用了 NHIS- Senior 队列患者数据，时间范围为 2010 年 1 月 1 日至 12 月 31 日。纳入在 2010 年被诊断为尿失禁的患者。CoC 的操作定义包括转诊、服务提供者数量和就诊次数。采用具有γ分布误差和对数链接函数的广义线性模型（GLM）来检验健康成本与解释变量之间的关系。此外，我们对住院费用进行了两部分模型分析。计算了边际效应。

结果

较高的 CoC 与总医疗费用的降低（-0.63，P <.0001）和门诊费用的降低（-0.28，P <.001）相关。较高的 Charlson 合并症指数（CCI）评分是总医疗费用增加（0.59，P <.0001）和门诊费用增加（0.22，P <.0001）的显著预测因素。较高的 CoC 可预测每位患者的住院费用降低 360.93 美元（P =.044）和门诊费用降低 23.91 美元（P =.008）。