护理院和社区意外入院的成本比较:使用常规收集的关联数据进行回顾性队列研究

Claudia Geue, Giorgio Ciminata, Govardhan Reddy Mukka, Daniel F Mackay, Jim Lewsey, Jocelyn M Friday, Ruth Dundas, Tran Quoc Bao Tran, Denise Brown, Frederick Ho, Claire Hastie, Michael Fleming, Alan Stevenson, Clea DuToit, Sandosh Padmanabhan, Jill P Pell
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引用次数: 0

摘要

住在护理院的人往往有多种疾病和复杂的医疗保健需求,这可能会导致更频繁地使用医疗保健服务(计划内和计划外),并增加成本。从资源使用的角度来看,从护理院环境出发的计划外医院就诊通常被视为系统故障、徒劳无益且效率低下。然而,目前还缺乏与这些就诊相关的成本方面的证据。这项回顾性队列研究旨在估算这些成本,并按常住地进行比较。数据来自英国国家医疗服务系统(NHS)大格拉斯哥和克莱德地区安全港参考数据集。在记录急诊入院情况的 Trak ED 和其他常规医疗数据集之间建立了个人层面的记录链接。医疗成本采用两部分模型进行估算。第一部分使用 probit 模型估算医疗资源利用率为正的概率,第二部分使用 GLM 估算成本,条件是成本为正。总体而言,护理院居民的年平均成本高于社区居民,而且在男性和女性以及所有贫困五分位数中都是如此。年龄小于 65 岁和无合并症的护理院居民在成本上没有明显差异。我们的研究结果表明,与社区居民相比,居住在护理院的居民在发生意外急症护理事件后的医疗支出明显增加,这强调了针对这一人群的独特需求制定干预措施的重要性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Cost comparison of unplanned hospital admissions from care home and community settings: A retrospective cohort study using routinely collected linked data
People living in care homes often have multiple morbidities and complex healthcare needs, potentially leading to more frequent healthcare utilisation (planned and unplanned) and increased costs. Unscheduled hospital attendance from a care home setting is often regarded as system failure, futile and inefficient in terms of resource use. However, there is a lack of evidence on the costs associated with these attendances. This retrospective cohort study aims to estimate these costs and provides a comparison by usual place of residence. Data were obtained from NHS Greater Glasgow and Clyde Safe Haven reference datasets. Individual-level record linkage between Trak ED, recording emergency admissions, and other routine healthcare datasets was carried out. Healthcare costs were estimated using a two-part model. The first part used a probit model to estimate the probability of positive healthcare resource utilisation, and the second part used a GLM to estimate costs, conditional on costs being positive. Annual mean costs were higher for care home residents than community-dwellers overall and in both men and women and all deprivation quintiles. No significant difference in costs was observed for care home residents who were younger than 65 years and those with no comorbidity. Our results indicate a notable increase in healthcare expenditure for individuals residing in care homes compared to those living in the community following unplanned acute care incidents, emphasising the importance of developing interventions that are specifically designed to meet the unique requirements of this demographic.
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