Abstract：
UNASSIGNED: Demand for stroke services is increasing. To save time and costs, stroke care could be reorganised using a transdisciplinary assessment model embracing overlapping allied health professional skills. The study compares transdisciplinary assessment to discipline-specific allied health assessment on an acute stroke unit, by evaluating assessment time, quality of care, and cost implications.
UNASSIGNED: The pre-/post- clinical study used non-randomised groups and 3-month follow-up after hospital admission. Patients with confirmed/suspected stroke received usual discipline-specific allied health assessment (pre-implementation phase) or the novel transdisciplinary assessment (post-implementation phase). Staff/student assessment times (primary outcome) and medical record data (secondary outcomes) were collected. Time differences were estimated using multivariable linear regression controlling for confounding factors. Cost minimisation and sensitivity analyses estimated change in hospital resource use.
UNASSIGNED: When the transdisciplinary assessment was used (N = 116), compared to usual assessment (N = 63), the average time saving was 37.6 min (95% CI -47.5, -27.7; p < 0.001) for staff and 62.2 min (95% CI -74.1, -50.3; p < 0.001) for students. The median number of allied health occasions of service reduced from 8 (interquartile range 4-23) to 5 (interquartile range 3-10; p = 0.011). There were no statistically significant or clinically important changes in patient safety, outcomes or stroke guideline adherence. Improved efficiency was associated with an estimated cost saving of $379.45 per patient (probabilistic 95% CI -487.15, -271.48).
UNASSIGNED: Transdisciplinary stroke assessment has potential for reorganising allied health services to save assessment time and reduce healthcare costs. The transdisciplinary stroke assessment could be considered for implementation in other stroke services.
UNASSIGNED: The pre-/post- clinical study used non-randomised groups and 3-month follow-up after hospital admission. Patients with confirmed/suspected stroke received usual discipline-specific allied health assessment (pre-implementation phase) or the novel transdisciplinary assessment (post-implementation phase). Staff/student assessment times (primary outcome) and medical record data (secondary outcomes) were collected. Time differences were estimated using multivariable linear regression controlling for confounding factors. Cost minimisation and sensitivity analyses estimated change in hospital resource use.
UNASSIGNED: When the transdisciplinary assessment was used (N = 116), compared to usual assessment (N = 63), the average time saving was 37.6 min (95% CI -47.5, -27.7; p < 0.001) for staff and 62.2 min (95% CI -74.1, -50.3; p < 0.001) for students. The median number of allied health occasions of service reduced from 8 (interquartile range 4-23) to 5 (interquartile range 3-10; p = 0.011). There were no statistically significant or clinically important changes in patient safety, outcomes or stroke guideline adherence. Improved efficiency was associated with an estimated cost saving of $379.45 per patient (probabilistic 95% CI -487.15, -271.48).
UNASSIGNED: Transdisciplinary stroke assessment has potential for reorganising allied health services to save assessment time and reduce healthcare costs. The transdisciplinary stroke assessment could be considered for implementation in other stroke services.
摘要：
■对中风服务的需求正在增加。为了节省时间和成本，可以使用包含重叠的专职医疗专业技能的跨学科评估模型来重组中风护理。该研究将跨学科评估与针对急性卒中单元的特定学科的专职健康评估进行了比较，通过评估评估时间，护理质量,和成本影响。
临床前/后研究使用非随机分组和入院后3个月的随访。确诊/疑似中风的患者接受了常规特定学科的专职健康评估（实施前阶段）或新的跨学科评估（实施后阶段）。收集员工/学生评估时间（主要结果）和病历数据（次要结果）。使用控制混杂因素的多变量线性回归估计时间差。成本最小化和敏感性分析估计医院资源使用的变化。
■当使用跨学科评估时（N=116），与通常的评估相比（N=63），员工平均节约时间为37.6分钟(95%CI-47.5,-27.7;p<0.001),学生平均节约时间为62.2分钟(95%CI-74.1,-50.3;p<0.001).专职医疗服务次数的中位数从8（四分位数范围4-23）减少到5（四分位数范围3-10；p=0.011）。患者安全性无统计学意义或临床重要变化，结果或卒中指南依从性。效率的提高与估计每位患者节省379.45美元的成本相关(概率95%CI-487.15,-271.48)。
■跨学科中风评估有可能重组相关医疗服务，以节省评估时间并降低医疗成本。可以考虑在其他中风服务中实施跨学科中风评估。
临床前/后研究使用非随机分组和入院后3个月的随访。确诊/疑似中风的患者接受了常规特定学科的专职健康评估（实施前阶段）或新的跨学科评估（实施后阶段）。收集员工/学生评估时间（主要结果）和病历数据（次要结果）。使用控制混杂因素的多变量线性回归估计时间差。成本最小化和敏感性分析估计医院资源使用的变化。
■当使用跨学科评估时（N=116），与通常的评估相比（N=63），员工平均节约时间为37.6分钟(95%CI-47.5,-27.7;p<0.001),学生平均节约时间为62.2分钟(95%CI-74.1,-50.3;p<0.001).专职医疗服务次数的中位数从8（四分位数范围4-23）减少到5（四分位数范围3-10；p=0.011）。患者安全性无统计学意义或临床重要变化，结果或卒中指南依从性。效率的提高与估计每位患者节省379.45美元的成本相关(概率95%CI-487.15,-271.48)。
■跨学科中风评估有可能重组相关医疗服务，以节省评估时间并降低医疗成本。可以考虑在其他中风服务中实施跨学科中风评估。
