背景:识别肌肉骨骼服务成本的变化需要使用特定的标准化指标。人们一直非常关注成本计算,效率,和急性肌肉骨骼环境中的标准化指标,但在初级保健和社区环境中的关注要少得多。目标:(a)评估主要基于初级和社区环境的肌肉骨骼经济分析中使用的成本核算方法的质量,以及(b)确定哪些成本变量是这些环境中肌肉骨骼医疗保健成本的关键驱动因素。方法:Medline,AMED,EMBASE,CINAHL,HMIC,BNI,和HBE电子数据库被搜索为符合条件的研究。两名审阅者独立提取数据,并使用已建立的清单评估成本计算方法的质量。结果:22项研究符合综述纳入标准。大多数研究证明了中等到高质量的成本计算方法。成本计算问题包括研究未能充分证明经济观点的合理性,不区分短期和长期成本。最高的单位成本是住院,门诊就诊,和成像。最高平均利用率如下:全科医生(GP)就诊,门诊就诊,和物理治疗访问。每位患者的平均费用最高是全科医生就诊,门诊就诊,和物理治疗访问。结论:本综述确定了许多关键资源使用变量,这些变量正在推动社区/初级保健环境中的肌肉骨骼保健费用。这些资源的高利用率(而不是高单位成本)似乎是增加平均医疗保健成本的主要因素。有,然而,需要更多的细节来捕捉这些关键的成本驱动因素,进一步提高成本核算信息的准确性。
Background: Identifying variation in musculoskeletal service costs requires the use of specific standardized metrics. There has been a large focus on costing, efficiency, and standardized metrics within the acute musculoskeletal setting, but far less attention in primary care and community settings. Objectives: To (a) assess the quality of costing methods used within musculoskeletal economic analyses based primarily in primary and community settings and (b) identify which cost variables are the key drivers of musculoskeletal health care costs within these settings. Methods: Medline, AMED, EMBASE, CINAHL, HMIC, BNI, and HBE electronic databases were searched for eligible studies. Two reviewers independently extracted data and assessed quality of costing methods using an established checklist. Results: Twenty-two studies met the
review inclusion criteria. The majority of studies demonstrated moderate- to high-quality costing methods. Costing issues included studies failing to fully justify the economic perspective, and not distinguishing between short- and long-run costs. Highest unit costs were hospital admissions, outpatient visits, and imaging. Highest mean utilization were the following: general practitioner (GP) visits, outpatient visits, and physiotherapy visits. Highest mean costs per patient were GP visits, outpatient visits, and physiotherapy visits. Conclusion: This
review identified a number of key resource use variables that are driving musculoskeletal health care costs in the community/primary care setting. High utilization of these resources (rather than high unit cost) appears to be the predominant factor increasing mean health care costs. There is, however, need for greater detail with capturing these key cost drivers, to further improve the accuracy of costing information.