Bangor University, Bangor, UK.
University of Nottingham, Nottingham, UK.
Inquiry. 2024 Jan-Dec;61:469580241246468. doi: 10.1177/00469580241246468.
Regular exercise and community engagement may slow the rate of function loss for people with dementia. However, the evidence is uncertain regarding the cost-effectiveness and social return on investment (SROI) of home exercise with community referral for people with dementia. This study aimed to compare the social value generated from the in-person PrAISED program delivered before March 2020 with a blended PrAISED program delivered after March 2020. SROI methodology compared in-person and blended delivery formats of a home exercise program. Stakeholders were identified, a logic model was developed, outcomes were evidenced and valued, costs were calculated, and SROI ratios were estimated. Five relevant and material outcomes were identified: 3 outcomes for patient participants (fear of falling, health-related quality of life, and social connection); 1 outcome for carer participants (carer strain), and 1 outcome for the National Health Service (NHS) (health service resource use). Data were collected at baseline and at 12-month follow-up. The in-person PrAISED program generated SROI ratios ranging from £0.58 to £2.33 for every £1 invested. In-person PrAISED patient participants gained social value from improved health-related quality of life, social connection, and less fear of falling. In-person PrAISED carer participants acquired social value from less carer strain. The NHS gained benefit from less health care service resource use. However, the blended PrAISED program generated lower SROI ratios ranging from a negative ratio to £0.08:£1. Compared with the blended program, the PrAISED in-person program generated higher SROI ratios for people with early dementia. An in-person PrAISED intervention with community referral is likely to provide better value for money than a blended one with limited community referral, despite the greater costs of the former.: ISRCTN Registry ISRCTN15320670.
定期运动和社区参与可能会减缓痴呆症患者功能丧失的速度。然而，对于有痴呆症的人进行家庭锻炼并通过社区转介的成本效益和社会投资回报率（SROI）尚不确定。本研究旨在比较 2020 年 3 月之前提供的面对面 PrAISED 计划与 2020 年 3 月之后提供的混合 PrAISED 计划所产生的社会价值。SROI 方法比较了家庭锻炼计划的面对面和混合交付形式。确定了利益相关者，制定了逻辑模型，证明和评估了结果，计算了成本，并估算了 SROI 比率。确定了 5 个相关和重要的结果：患者参与者的 3 个结果（跌倒恐惧、健康相关生活质量和社会联系）；照顾者参与者的 1 个结果（照顾者压力）和 NHS（卫生服务资源使用）的 1 个结果。数据在基线和 12 个月随访时收集。面对面 PrAISED 计划产生的 SROI 比率从每投资 1 英镑的 0.58 英镑到 2.33 英镑不等。面对面 PrAISED 患者参与者从改善健康相关生活质量、社会联系和减少跌倒恐惧中获得了社会价值。面对面 PrAISED 照顾者参与者从减少照顾者压力中获得了社会价值。NHS 从减少医疗保健服务资源使用中受益。然而，混合 PrAISED 计划产生的 SROI 比率较低，从负数到 0.08:1 不等。与混合计划相比，针对早期痴呆症患者的面对面 PrAISED 计划产生了更高的 SROI 比率。尽管前者的成本更高，但具有社区转介的面对面 PrAISED 干预措施可能比社区转介有限的混合干预措施更具成本效益。
