Gladman J, Whynes D, Lincoln N
Department of Health Care of the Elderly, University Hospital, Nottingham.
Age Ageing. 1994 May;23(3):241-5. doi: 10.1093/ageing/23.3.241.
The DOMINO study (DOMiciliary rehabilitation In NOttingham) was a randomized controlled trial comparing domiciliary and hospital-based rehabilitation for stroke patients after discharge from hospital, stratified according to the ward at hospital discharge. The outcomes of these patients have been reported previously. In this paper, we present estimates of health service costs of care. No difference in outcome had been found between the overall services, but we have found the hospital-based costs to be 27% cheaper. However, different cost-effectiveness patterns are observable when the strata are analysed. Patients from geriatric wards had been shown to be 2.4 times less likely to die or become institutionalized by 6 months if allocated to a day hospital service, although the cost of this service was 25% more than that of the domiciliary service. Patients from the Stroke Unit who had received domiciliary rehabilitation had been shown to have greater household and leisure abilities at 6 months than those treated in outpatient departments, but the domiciliary service was found to cost 2.6 times more. Patients from general medical wards had similar outcomes whether treated at home or in outpatient departments, but the cost of the latter service was 56% of the former. Some patients may be best cared for in day hospitals and others may do better if treated at home, but for these groups the clinical advantages are achieved at an expense greater than that incurred by the alternative services. Other patients may do as well if treated in outpatient departments as at home, but the former approach is cheaper. A range of services is required for stroke patients leaving hospital.
多米诺研究（诺丁汉居家康复研究）是一项随机对照试验，比较出院后中风患者的居家康复和住院康复情况，并根据出院时所在病房进行分层。这些患者的治疗结果此前已有报道。在本文中，我们给出了护理的卫生服务成本估算。总体服务在治疗结果上未发现差异，但我们发现住院康复的成本要便宜27%。然而，对各层进行分析时可观察到不同的成本效益模式。研究表明，分配到日间医院服务的老年病房患者在6个月内死亡或被收容机构照护的可能性降低2.4倍，尽管这项服务的成本比居家服务高出25%。接受居家康复的卒中单元患者在6个月时的家庭和休闲能力比门诊治疗的患者更强，但居家服务的成本是后者的2.6倍。普通内科病房的患者无论在家治疗还是在门诊治疗，治疗结果相似，但后者服务的成本是前者的56%。一些患者可能在日间医院接受护理效果最佳，而另一些患者在家治疗可能效果更好，但对于这些群体而言，临床优势的实现是以高于替代服务的成本为代价的。其他患者在门诊治疗和在家治疗的效果可能一样好，但前一种方法成本更低。出院后的中风患者需要一系列服务。
