医师教育和组织变革在慢性哮喘保健中的作用的一项多址随机试验:儿科哮喘保健患者转归研究队列II的成本效益分析

来源 :世界核心医学期刊文摘(儿科学分册) | 被引量 : 0次 | 上传用户:junxiaohao
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Background: A decision to implement innovative disease management intervention s in health plans often requires evidence of clinical benefit and financial impa ct. The Pediatric Asthma Care Patient Outcomes Research Team II trial evaluated 2 asthma care strategies: a peer leader-based physician behavior change interve ntion (PLE) and a practice-based redesign called the planned asthma care interv ention (PACI). Objective: To estimate the cost-effectiveness of the interventio ns. Methods: This was a 3-arm, cluster randomized trial conducted in 42 primary care practices. A total of 638 children (age range, 3-17 years) with mild to m oderate persistent asthma were followed up for 2 years. Practices were randomize d to PLE (n = 226), PACI (n = 213), or usual care (n = 199). The primary outcome was symptom-free days (SFDs). Costs included asthma-related health care utili zation and intervention costs. Results: Annual costs per patient were as follows : PACI, $1292; PLE, $504; and usual care, $385. The difference in annual SFDs was 6.5 days (95%confidence interval [CI], -3.6 to 16.9 days) for PLE vs usual care and 13.3 days (95%CI, 2.1-24.7 days) for PACI vs usual care. Comp ared with usual care, the incremental costeffectiveness ratio was $18 per SFD g ained for PLE (95%CI, $5.21-dominated) and $68 per SFD gained for PACI (95% CI, $37.36-$361.16). Conclusions: Results of this study show that it is possi ble to increase SFDs in children and move organizations toward guideline recomme ndations on asthma control in settings where most children are receiving control ler medications at baseline. However, the improvements were realized with an inc rease in the costs associated with asthma care. Background: A decision to implement innovative disease management intervention s in health plans often requires evidence of clinical benefit and financial impa ct. The Pediatric Asthma Care Patient Outcomes Research Team II trial evaluated 2 asthma care strategies: a peer leader-based physician behavior change interve Objective: To estimate the cost-effectiveness of the interventio ns. Methods: This was a 3-arm, cluster randomized trial conducted in 42 primary A total of 638 children (age range, 3-17 years) with mild to moderate persistent asthma were up for 2 years. Practices were randomized to PLE (n = 226), PACI (n = 213) The primary outcome was symptom-free days (SFDs). Costs included asthma-related health care utili zation and intervention costs. Results: Annual costs per patient were as follows: PACI, $ 1292; PLE , $ 504; and usual care, $ 385. The difference in annual SFDs was 6.5 days (95% confidence interval [CI], -3.6 to 16.9 days) for PLE vs usual care and 13.3 days (95% CI, 2.1-24.7 days) Care was performed with the incremental costeffectiveness ratio was $ 18 per SFD gined for PLE (95% CI, $ 5.21-dominated) and $ 68 per SFD gained for PACI (95% CI, $ 37.36- $ 361.16) Conclusions: Results of this study show that it is possi ble to increase SFDs in children and move organizations toward guideline recommendations on asthma control in settings where most children are receiving control ler medications at baseline. However, the improvements were realized with an inc rease in the costs associated with asthma care.
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