肿瘤学与姑息治疗整合模式:巴西一家医院的成本分析研究。

Tânia V V Guimarães, Alessandro G Campolina, Luciana M Rozman, Toshio Chiba, Patrícia C de Soárez, Maria D P Estevez Diz
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引用次数: 0

摘要

背景2019 年,圣保罗州立癌症研究所(ICESP)实施了一种将肿瘤学与姑息治疗专家相结合的新模式。我们评估了该模式对医疗资源利用率和成本的影响。研究方法我们分析了巴西 ICESP 于 2 月(模式实施前 1 个月)和 11 月(模式实施后 8 个月)去世的所有患者的数据。我们从电子病历中获取了医疗利用率数据,包括急诊就诊、入院和重症监护室、化疗和放疗的使用情况。单位成本值来自行政数据库。研究结果共有 198 名 2 月份死亡的患者和 196 名 11 月份死亡的患者被纳入分析。两组患者在性别、年龄、ECOG、癌症类型、既往姑息治疗门诊咨询和死亡地点(病房:56.6% 在干预前,50% 在干预后)方面具有相似性。每位患者的平均费用在干预前为 13,226.29 美元,干预后为 11,445.82 美元(P = .007)。在外科病房住院天数(227 天 vs 115 天)、急诊就诊次数(233 次 vs 45 次)、化疗疗程(140 次 vs 26 次)和放疗疗程(146 次 vs 10 次)方面,差异具有统计学意义。除去门诊治疗,生命最后30天的化疗和放疗总费用在干预前为16924.45美元,干预后为7851.65美元。ECOG 3-4 患者的费用降低更为明显(P = 0.039)。结论我们的数据表明,整合模式与减少生命最后一个月的潜在不当治疗有关,从而降低了医疗使用率和成本。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Oncology and Palliative Care Integration Model: A Cost Analysis Study in a Brazilian Hospital Setting.

Background: In 2019, the São Paulo State Cancer Institute (ICESP) implemented a novel model integrating Oncology with Palliative Care specialists. We evaluated the impact of this model on healthcare resource utilization and costs. Methods: We analyzed data from all patients who passed away in February (1 month prior to implementation) and November (8 months after model implementation group) at ICESP, Brazil. Healthcare utilization data, including emergency department visits, hospital and intensive care unit admissions, chemotherapy, and radiotherapy use, were retrieved from Electronic Medical Records. Unit cost values were obtained from the administrative database. Results: A total of 198 patients who died in February and 196 in November were included in the analysis. Groups exhibited similarities in sex, age, ECOG, cancer type, previous outpatient palliative care consultations, and place of death (ward: 56.6% pre-intervention, 50% post-intervention). The mean cost per patient was US$13,226.29 pre-intervention and US$11,445.82 post-intervention (P = .007). Statistically significant differences were noted in days hospitalized in the surgical ward (227 vs 115), emergency department visits (233 vs 45), chemotherapy sessions (140 vs 26), and radiotherapy sessions (146 vs 10). Excluding outpatient treatments, the total costs for chemotherapy and radiotherapy in the last 30 days of life were US$16,924.45 pre-intervention and US$7851.65 post-intervention. Reductions were more pronounced in patients with ECOG 3-4 (P = .039). Conclusion: Our data suggests that the integration model was associated with a reduction in potentially inappropriate treatments during the last month of life, leading to decreased healthcare utilization and costs.

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