PDF(Pubmed)
Abstract：
Heart failure (HF) is one of the most common diagnoses on admission to hospital in Germany, and one which incurs high costs. Integrated care in case management programs (CMPs) aims to improve treatment quality in the sense of guideline-driven treatment, while reducing hospital admissions, hospital costs, and mortality. A total of 1,844 patient data records from 11 German statutory health insurance companies enrolled in the CMP (intervention group [IG]) were compared with 1,844 standard-care patients (control group) using propensity score matching. The two groups were assessed over three follow-up observation periods regarding the endpoints\' treatment costs, hospitalization rate, indicators for treatment quality (diagnostics, physician contact), and mortality. The evaluation revealed no significant differences regarding overall costs. The IG incurred significantly higher outpatient costs, but the medication costs and inpatient costs were not significantly different. There were also no significant differences in the number of hospital admissions. Patients within the CMP had significantly more frequent contact with a cardiologist, and underwent echocardiographic examination significantly more frequently. Mortality during the first follow-up observation year was considerably more favorable for the IG. There are indications that treatment quality is improved in HF patients.
摘要：
心力衰竭（HF）是德国住院时最常见的诊断之一，而且会产生很高的成本。病例管理计划中的综合护理（CMP）旨在提高指南驱动治疗意义上的治疗质量，在减少住院的同时，医院费用,和死亡率。使用倾向评分匹配，将参加CMP（干预组[IG]）的11家德国法定健康保险公司的1,844名患者数据记录与1,844名标准护理患者（对照组）进行了比较。两组在三个随访观察期评估终点治疗费用，住院率，治疗质量指标(诊断，医生联系)，和死亡率。评估显示，在总体成本方面没有显着差异。IG产生了明显更高的门诊费用，但药物费用和住院费用没有显著差异.入院人数也没有显着差异。CMP内的患者与心脏病专家的接触频率明显更高，并且接受超声心动图检查的频率明显更高。第一个随访观察年的死亡率对IG更为有利。有迹象表明HF患者的治疗质量得到改善。
