Changes in hospital admissions and inpatient tariff associated with a Diabetes Integrated Care Initiative: Preliminary findings (与糖尿病综合护理计划相关的住院以及住院费用的变化:初步调查结果)

Authors


Abstract

Background

The Diabetes Integrated Care Initiative (DICI) has tested whether hospital admissions and total amounts paid for inpatient care have declined through closer (integrated) working between primary, secondary and community diabetes services in Cambridgeshire.

Method

Poisson regression models were used to compare the percentage change in hospital admissions, and tariff paid, before and after each of 43 months (April 2007 – November 2010). East Cambridgeshire and Fenland (ECF) practices were divided into those fully (n = 10) and less (n = 7) “engaged” with the intervention defined by the extent of their uptake of intervention components between July 2009 and June 2010. Other parts of the county were “controls”.

Results

Among patients with diabetes in the fully engaged ECF practices, the monthly average hospital admission rate was 19.0% (13.9, 24.2) higher (7.7 hospital admissions per 1000 patients) and the monthly tariff paid was 28.8% (28.7, 28.9) higher (£19.60 per patient per month), at the time of introducing the DICI versus the pre-implementation period (April 2007 to June 2009). These differences, had dropped to 8.7% (1.9, 15.6) and 13.4% (13.2, 13.5) (£9.92 per patient per month) higher 12 months after introduction. Comparable reductions in the rate of increase were not seen among those without diabetes or in control areas.

Conclusion

During the DICI, patients with diabetes from “fully engaged” practices experienced increased hospitalization and amount paid for in-patient care, the extent of which trended downwards by 12 months. Further time is needed to monitor whether this trend is sustained.

摘要

背景

通过在剑桥郡的初级、二级以及社区糖尿病服务中心之间的更紧密的(综合)护理工作,测试糖尿病综合护理计划是否能减少住院和住院治疗总费用。

方法

在每个月前后都使用Poisson回归模型来比较住院以及住院费用的百分比变化,共43个月(2007年4月–2010年11月)。在2009年7月至2010年6月之间,根据其采取干预的程度将东剑桥郡与芬兰德的医疗机构划分为完全(n = 10)与不完全(n = 7)干预组。其他的郡为“对照组”。

结果

在芬兰德进行完全干预的医疗机构的糖尿病患者中,实施糖尿病综合护理计划期间与实施前(2007年4月–2009年6月)相比,平均每月住院率升高19.0%(13.9,24.2)(每1000名患者有7.7名住院),每月的费用升高28.8%(28.7,28.9)(每名患者每月19.60英镑)。实施糖尿病综合护理计划12个月以后,这种差异降至升高8.7%(1.9,15.6)与13.4%(13.2,13.5)(每名患者每月9.92英镑)。在那些没有糖尿病的患者或者其他地区的对照组中,没有看到增长率有可比性的下降。

结论

在实施糖尿病综合护理计划期间,来自“进行完全干预”医疗机构的糖尿病患者的住院率与住院治疗费用都增加了,经过12个月后这种情况有了向下的趋势。需要更多的时间来监测这种趋势是否持续不变。

Ancillary