Titre
Health economic evaluation of a nurse-led care model from the nursing home perspective focusing on residents' hospitalisations.
Type
article
Institution
UNIL/CHUV/Unisanté + institutions partenaires
Périodique
Auteur(s)
Bartakova, J.
Auteure/Auteur
Zúñiga, F.
Auteure/Auteur
Guerbaai, R.A.
Auteure/Auteur
Basinska, K.
Auteure/Auteur
Brunkert, T.
Auteure/Auteur
Simon, M.
Auteure/Auteur
Denhaerynck, K.
Auteure/Auteur
De Geest, S.
Auteure/Auteur
Wellens, NIH
Auteure/Auteur
Serdaly, C.
Auteure/Auteur
Kressig, R.W.
Auteure/Auteur
Zeller, A.
Auteure/Auteur
Popejoy, L.L.
Auteure/Auteur
Nicca, D.
Auteure/Auteur
Desmedt, M.
Auteure/Auteur
De Pietro, C.
Auteure/Auteur
Liens vers les personnes
Liens vers les unités
ISSN
1471-2318
Statut éditorial
Publié
Date de publication
2022-06-09
Volume
22
Numéro
1
Première page
496
Peer-reviewed
Oui
Langue
anglais
Notes
Publication types: Clinical Trial ; Journal Article ; Multicenter Study
Publication Status: epublish
Publication Status: epublish
Résumé
Health economic evaluations of the implementation of evidence-based interventions (EBIs) into practice provide vital information but are rarely conducted. We evaluated the health economic impact associated with implementation and intervention of the INTERCARE model-an EBI to reduce hospitalisations of nursing home (NH) residents-compared to usual NH care.
The INTERCARE model was conducted in 11 NHs in Switzerland. It was implemented as a hybrid type 2 effectiveness-implementation study with a multi-centre non-randomised stepped-wedge design. To isolate the implementation strategies' costs, time and other resources from the NHs' perspective, we applied time-driven activity-based costing. To define its intervention costs, time and other resources, we considered intervention-relevant expenditures, particularly the work of the INTERCARE nurse-a core INTERCARE element. Further, the costs and revenues from the hotel and nursing services were analysed to calculate the NHs' losses and savings per resident hospitalisation. Finally, alongside our cost-effectiveness analysis (CEA), a sensitivity analysis focused on the intervention's effectiveness-i.e., regarding reduction of the hospitalisation rate-relative to the INTERCARE costs. All economic variables and CEA were assessed from the NHs' perspective.
Implementation strategy costs and time consumption per bed averaged 685CHF and 9.35 h respectively, with possibilities to adjust material and human resources to each NH's needs. Average yearly intervention costs for the INTERCARE nurse salary per bed were 939CHF with an average of 1.4 INTERCARE nurses per 100 beds and an average employment rate of 76% of full-time equivalent per nurse. Resident hospitalisation represented a total average loss of 52% of NH revenues, but negligible cost savings. The incremental cost-effectiveness ratio of the INTERCARE model compared to usual care was 22'595CHF per avoided hospitalisation. As expected, the most influential sensitivity analysis variable regarding the CEA was the pre- to post-INTERCARE change in hospitalisation rate.
As initial health-economic evidence, these results indicate that the INTERCARE model was more costly but also more effective compared to usual care in participating Swiss German NHs. Further implementation and evaluation of this model in randomised controlled studies are planned to build stronger evidential support for its clinical and economic effectiveness.
clinicaltrials.gov ( NCT03590470 ).
The INTERCARE model was conducted in 11 NHs in Switzerland. It was implemented as a hybrid type 2 effectiveness-implementation study with a multi-centre non-randomised stepped-wedge design. To isolate the implementation strategies' costs, time and other resources from the NHs' perspective, we applied time-driven activity-based costing. To define its intervention costs, time and other resources, we considered intervention-relevant expenditures, particularly the work of the INTERCARE nurse-a core INTERCARE element. Further, the costs and revenues from the hotel and nursing services were analysed to calculate the NHs' losses and savings per resident hospitalisation. Finally, alongside our cost-effectiveness analysis (CEA), a sensitivity analysis focused on the intervention's effectiveness-i.e., regarding reduction of the hospitalisation rate-relative to the INTERCARE costs. All economic variables and CEA were assessed from the NHs' perspective.
Implementation strategy costs and time consumption per bed averaged 685CHF and 9.35 h respectively, with possibilities to adjust material and human resources to each NH's needs. Average yearly intervention costs for the INTERCARE nurse salary per bed were 939CHF with an average of 1.4 INTERCARE nurses per 100 beds and an average employment rate of 76% of full-time equivalent per nurse. Resident hospitalisation represented a total average loss of 52% of NH revenues, but negligible cost savings. The incremental cost-effectiveness ratio of the INTERCARE model compared to usual care was 22'595CHF per avoided hospitalisation. As expected, the most influential sensitivity analysis variable regarding the CEA was the pre- to post-INTERCARE change in hospitalisation rate.
As initial health-economic evidence, these results indicate that the INTERCARE model was more costly but also more effective compared to usual care in participating Swiss German NHs. Further implementation and evaluation of this model in randomised controlled studies are planned to build stronger evidential support for its clinical and economic effectiveness.
clinicaltrials.gov ( NCT03590470 ).
PID Serval
serval:BIB_B84E6B031BCC
PMID
Open Access
Oui
Date de création
2022-06-21T12:02:01.125Z
Date de création dans IRIS
2025-05-21T04:51:23Z
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35681157_BIB_B84E6B031BCC.pdf
Version du manuscrit
published
Licence
https://creativecommons.org/licenses/by/4.0
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1.2 MB
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Adobe PDF
PID Serval
serval:BIB_B84E6B031BCC.P001
URN
urn:nbn:ch:serval-BIB_B84E6B031BCC9
Somme de contrôle
(MD5):4d3c737e5322e283b56a7058131e4324