醫師居家訪視對老年人來說頗具成本效益


  May 16, 2003 -由醫師進行居家訪視,可以減少老年人的住院比例、住院時間以及急診比例,而且可能是比較省錢的方式。這是根據一項,發表在五月十六日馬里蘭州巴爾的摩舉辦的美國老年醫學會(American Geriatric Society)2003年年會上的隨機控制實驗的結果。
  
  來自德州達拉斯Baylor醫療體系的主要作者Ziad R. Haydar醫師告訴Medscape,由於有這種財務上的優勢,醫師應該可以尋求贊助醫院,支持居家訪視計畫。在這項研究之前,對贊助醫院的財務影響沒有人知道。
  
  從1987年七月到2002年一月,共有432名年齡在六十五歲以上的居家病患,隨機選出接受六個月的一般照護,或由一群老年醫學專家、護理人員、一名社工人員及一名牧師,進行跨領域整合居家訪視,這些人員每週進行一次協調會議。接受收容服務或等候療養院入院許可的人不包括在內。兩組的人口統計學變數相似,且都有明顯的認知及機能缺損。
  
  在六個月的研究期間,進入贊助醫院的比例在統計學上並沒有顯著的差異,其中55名來自家訪組,44名來自控制組。在家訪組中急救的比例顯著較少,每名病患的急救比例為0.12 vs. 0.24; P = .016。家訪組平均住院時間為5.64天,控制組為8.48天P < .001。較短的住院時間可以產生$934的利潤,相較於控制組住院時間較長而損失$1,576。
  
  Haydar博士表示,所有的醫院都在醫療保險償還款項縮減的狀況下,努力爭取生存。同時,不管是為了正確或錯誤的理由,他們都試圖增加對老年人的醫療,贊助居家訪視可以同時達成這兩個目標。
  
  Merck基金會透過支持相關計畫的研究資金,間接贊助這項研究。
  

Physician House Calls Cost-Eff

By Laurie Barclay, MD
Medscape Medical News

May 16, 2003 — Physician house calls reduced hospitalizations, length of stay, and emergency department visits, and they may be financially favorable, according to the results of a randomized controlled trial presented at the American Geriatric Society 2003 Annual Scientific Meeting on May 16 in Baltimore, Maryland.

"Physicians should feel empowered by these financial facts as they seek support for house calls from sponsoring hospitals," lead author Ziad R. Haydar, MD, from Baylor Health Care System in Dallas, Texas, told Medscape. "Before this study, the financial impact on the sponsoring hospital was unknown."

Between July 1987 and January 2002, 432 homebound subjects 65 years or older were randomized to receive six months of either usual care or interdisciplinary house calls from a team of geriatricians, nurse practitioners, a social worker and a chaplain, coordinated by a weekly team meeting. Subjects receiving hospice services or awaiting nursing home admission were excluded. Both groups were similar in terms of demographic variables, and both had significant cognitive and functional impairment.

During the six-month study, there was no statistically significant difference in admissions to the sponsoring hospital (55 from the home visit group and 44 from the control group). Emergency department visits were significantly less in the home visit group (0.12 vs. 0.24 per subject; P = .016). Average length of stay was 5.64 days in the home visit group and 8.48 days in the control group (P < .001). The shorter length of stay was associated with a margin of $934 compared with a loss equal to $1,576 for the longer length of stay in the control group.

"All hospitals are struggling to survive shrinking Medicare reimbursement," Dr. Haydar said. "At the same time, sometimes for the right reasons and sometimes for the wrong reasons, they are trying to identify strategies to maximize care to their seniors. Sponsoring house calls is one strategy that could help accomplish both goals."

The Merck Foundation helped support this study indirectly through research funding of related projects. The authors list no pertinent financial disclosures.

AGS 2003 Annual Meeting: Abstract A21. Presented May 16, 2003.

Reviewed by Gary D. Vogin, MD

    
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