Department of Internal Medicine, Singapore General Hospital, Singapore.
Medicine Academic Clinical Programme, SingHealth Duke-NUS, Singapore.
JAMA Netw Open. 2023 Sep 5;6(9):e2334936. doi: 10.1001/jamanetworkopen.2023.34936.
During COVID-19, Singapore simultaneously experienced a dengue outbreak, and acute hospitals were under pressure to lower bed occupancy rates. This led to new models of care to treat patients with acute, low-severity medical conditions either at home, in a hospital-at-home (HaH) model, or in a clinic-style setting sited at the emergency department in an ambulatory care team (ACT) model, but a reliable cost analysis for these models is lacking.
To compare personnel costs of HaH and ACT with inpatient care.
DESIGN, SETTING, AND PARTICIPANTS: In this economic evaluation study, time-driven activity-based costing was used to compare the personnel cost of inpatient care with treating dengue via HaH and treating chest pain via ACT. Participants were patients with nonsevere dengue and chest pain unrelated to a coronary event admitted via the emergency department to the internal medicine service of a tertiary hospital in Singapore.
HaH for dengue and ACT for chest pain.
A process map was created for the patient journey for a typical patient with each condition. The amount of time personnel spent on delivering care was estimated and the cost per minute determined based on their wages in 2022. The total cost of care was calculated by multiplying the time spent by the per-minute cost of the personnel resource and summing all costs.
Compared with inpatient care, HaH used 50% less nursing time (418 minutes, 95% uncertainty interval [UI], 370 to 465 minutes) but 80% more medical time (303 minutes, 95% UI, 270 to 338 minutes) per case of dengue. If implemented nationally, HaH would save an estimated 56 828 SGD per year (95% UI, -169 497 to 281 412 SGD [US $41 856; 95% UI, -$124 839 to $207 268]). The probability that HaH is cost saving was 69.2%. Compared with inpatient care, ACT used 15% less nursing time (296 minutes, 95% UI, 257 to 335 minutes) and 50% less medical time (57 minutes, 95% UI, 46 to 69 minutes) per case of chest pain. If implemented nationally, ACT would save an estimated 1 561 185 SGD per year (95% UI, 1 040 666 to 2 086 518 SGD [US $1 149 862; 95% UI, $766 483 to $1 536 786]). The probability that ACT is cost saving was 100%.
This economic evaluation found that the HaH and ACT models decreased the overall personnel cost of care. Reorganizing hospital resources may help hospitals reap the benefits of reduced hospital-acquired infections, improved patient recovery, and reduced hospital bed occupancy rates.
重要性：在 COVID-19 期间，新加坡同时爆发了登革热疫情，急性医院面临降低病床占用率的压力。这导致了新的护理模式，以在家中、医院内居家（HaH）模式或在急诊科设立的诊所式环境中治疗患有急性、低严重程度的医疗条件的患者，或者在以门诊为基础的护理团队（ACT）模式下治疗患者，但这些模式缺乏可靠的成本分析。
目的：比较 HaH 和 ACT 与住院治疗的人员成本。
设计、地点和参与者：在这项经济评估研究中，使用时间驱动的活动基础成本法来比较 HaH 治疗登革热和 ACT 治疗胸痛的人员成本与住院治疗。参与者为因非严重登革热和与冠状动脉事件无关的胸痛而通过急诊部门入住新加坡一家三级医院内科服务的患者。
暴露：HaH 治疗登革热和 ACT 治疗胸痛。
主要结果和措施：为每种疾病的典型患者创建了一个患者旅程的流程图。估计了人员提供护理所花费的时间，并根据他们 2022 年的工资确定了每分钟的成本。通过将花费的时间乘以人员资源的每分钟成本并将所有成本相加来计算总护理成本。
结果：与住院治疗相比，HaH 治疗登革热每例病例分别节省 50%的护理时间（418 分钟，95%不确定性区间[UI]，370 至 465 分钟）和 80%的医疗时间（303 分钟，95% UI，270 至 338 分钟）。如果在全国范围内实施，HaH 每年预计可节省 56828 新加坡元（95% UI，-169497 至 281412 新加坡元[41856 美元；95% UI，-124839 至 207268 美元]）。HaH 具有成本效益的概率为 69.2%。与住院治疗相比，ACT 治疗胸痛每例病例分别节省 15%的护理时间（296 分钟，95% UI，257 至 335 分钟）和 50%的医疗时间（57 分钟，95% UI，46 至 69 分钟）。如果在全国范围内实施，ACT 每年预计可节省 1561185 新加坡元（95% UI，1040666 至 2086518 新加坡元[1149862 美元；95% UI，766483 至 1536786 美元]）。ACT 具有成本效益的概率为 100%。
结论和相关性：这项经济评估发现，HaH 和 ACT 模型降低了整体护理人员成本。重新组织医院资源可能有助于医院从降低医院获得性感染、改善患者康复和降低病床占用率中获益。
