评估老年医学项目的生活质量、住院时间和成本效益:一项探索性概念验证研究。

Pub Date : 2023-01-01 DOI:10.14283/jfa.2022.40
M J Pereira, E Chong, J A D Molina, S H X Ng, E F Goh, B Zhu, M Chan, W S Lim
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引用次数: 1

摘要

背景:急诊科虚弱干预(EDIFY)项目是为了在急诊科(ED)提供早期老年专科干预而开发的。EDIFY在减少老年人急性入院方面取得了成功。目的:我们旨在检验EDIFY在改善健康相关生活质量(HRQOL)和住院时间(LOS)方面的有效性,并评估EDIFY的成本效益。设计:准实验研究。环境:拥有1700个床位的三级医院急诊科。受试者:经EDIFY团队筛选可能适合出院或转至低视力护理区的急性住院患者(≥85岁)。干预:EDIFY与标准护理。测量:收集了人口统计学、合并症、病前功能和虚弱状态的数据。6个月内用EQ-5D-5L测定HRQOL。我们使用人行横道方法从EQ-5D-5L反应中计算新加坡特定指数得分,并计算获得的质量调整生命年(QALYs)。获得ED出席者(包括入场费,如适用)补贴前的LOS和新加坡元账单。我们估计了平均程序化EDIFY成本,并对丢失的数据进行了多次插入(MI)。比较了获得的质量质量ys、LOS和成本。对潜在的不确定性也进行了研究。结果:100名受试者中(EDIFY=43;标准护理=57例),61例提供完整资料。对于完整病例,EDIFY在3个月时(系数=0.032,p=0.004)和总体(系数=0.096,p=0.002)获得了显著的QALYs,而两组之间的治疗费用相似。对于心肌梗死,我们仅观察到EDIFY获得的总体质量aly(系数=0.102,p=0.001)。EDIFY降低了17%的LOS(事件风险比=0.83,p=0.015)。在确定性敏感性分析中,EDIFY的成本阈值为2,500新元,主要结论在其他不确定性情景下是一致的。平均账单为:EDIFY=SGD$4562.70;标准治疗= SGD 5530.90美元。EDIFY的平均项目成本约为469.30新元。结论:这项探索性的概念验证研究发现EDIFY对QALYs和LOS有好处,成本相当,并且具有潜在的成本效益。这个项目现在已经成为我们中心急诊老年人的标准护理。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Evaluating Quality-of-Life, Length of Stay and Cost-Effectiveness of a Front-Door Geriatrics Program: An Exploratory Proof-of-Concept Study.

Background: The Emergency Department Interventions for Frailty (EDIFY) program was developed to deliver early geriatric specialist interventions at the Emergency Department (ED). EDIFY has been successful in reducing acute admissions among older adults.

Objectives: We aimed to examine the effectiveness of EDIFY in improving health-related quality-of-life (HRQOL) and length of stay (LOS), and evaluate EDIFY's cost-effectiveness.

Design: A quasi-experiment study.

Setting: The ED of a 1700-bed tertiary hospital.

Participants: Patients (≥85 years) pending acute hospital admission and screened by the EDIFY team to be potentially suitable for discharge or transfer to low-acuity care areas.

Intervention: EDIFY versus standard-care.

Measurements: Data on demographics, comorbidities, premorbid function, and frailty status were gathered. HRQOL was measured using EQ-5D-5L over 6 months. We used a crosswalk methodology to compute Singapore-specific index scores from EQ-5D-5L responses and calculated quality-adjusted life-years (QALYs) gained. LOS and bills in Singapore-dollars (SGD) before subsidy from ED attendances (including admissions, if applicable) were obtained. We estimated average programmatic EDIFY cost and performed multiple imputation (MI) for missing data. QALYs gained, LOS and cost were compared. Potential uncertainties were also examined.

Results: Among 100 participants (EDIFY=43; standard-care=57), 61 provided complete data. For complete cases, there were significant QALYs gained at 3-month (coefficient=0.032, p=0.004) and overall (coefficient=0.096, p=0.002) for EDIFY, whilst treatment cost was similar between-groups. For MI, we observed only overall QALYs gained for EDIFY (coefficient=0.102, p=0.001). EDIFY reduced LOS by 17% (Incident risk ratio=0.83, p=0.015). In a deterministic sensitivity analysis, EDIFY's cost-threshold was SGD$2,500, and main conclusions were consistent in other uncertainty scenarios. Mean bills were: EDIFY=SGD$4562.70; standard-care=SGD$5530.90. EDIFY's average programmatic cost approximated SGD$469.30.

Conclusions: This exploratory proof-of-concept study found that EDIFY benefits QALYs and LOS, with equivalent cost, and is potentially cost-effective. The program has now been established as standard-care for older adults attending the ED at our center.

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