Document Detail


Improved cost-effectiveness for management of chronic heart failure by combined home-based intervention with clinical nursing specialists.
MedLine Citation:
PMID:  17475609     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND/PURPOSE: The influence of home- and clinic-based caring system on the economic burden of heart failure remains unknown. METHODS: Between January 2004 and December 2004, chronic heart failure patients who were followed up by specialist nurse-led telephone visiting regularly were enrolled. Clinical and economic data half a year before enrollment were collected as control. RESULTS: A total of 247 patients (168 males, 79 females; mean age, 60 +/- 17 years) were enrolled. The mean follow-up period was 139 +/- 96 days. The mean left ventricular ejection fraction was 35%. There were 1618 times of specialist nurse-led telephone visiting (average 8 +/- 6 times/patient). The mortality rate was 5.7%. Before enrollment, the total hospitalization fees were 624,020 US dollars. After enrollment, the cost was reduced to 362,722 US dollars (41.8% reduction). The mean functional class (New York Heart Association) also improved from 2.27 +/- 0.80 to 1.9 6 +/- 0.90 (p < 0.001). The mean duration of hospital stay due to heart failure was reduced by 5.3 days (26.2% decrement). The total numbers of admission were reduced to 36 times (33.0% decrement). The readmission rate due to etiologies other than heart failure (such as infection, gastrointestinal bleeding, etc.) was reduced from 15.9% to 7.7%. The total fees of visiting emergency station were reduced from 6528 US dollars to 6101 US dollars (6.5% decrement). On the other hand, the frequency of visiting the outpatient department (OPD) increased from 5.2 +/- 3.2 to 6.6 +/- 4.1 times/patient (p < 0.001). The total fees of visiting OPD increased from 90,783 US dollars to 94,855 US dollars(4.4% increment). CONCLUSION: The home- and clinic-based caring system is capable of decreasing adverse outcomes, most notably hospitalization and length of stay, and could trigger significant cost savings in the management of heart failure.
Authors:
Yi-Lwun Ho; Tse-Pin Hsu; Chiou-Ping Chen; Chu-Yuan Lee; Yen-Hung Lin; Ron-Bin Hsu; Yen-Wen Wu; Nai-Kuan Chou; Chi-Ming Lee; Shoei-Shen Wang; Hsiu-Tzu Ting; Ming-Fong Chen
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of the Formosan Medical Association = Taiwan yi zhi     Volume:  106     ISSN:  0929-6646     ISO Abbreviation:  J. Formos. Med. Assoc.     Publication Date:  2007 Apr 
Date Detail:
Created Date:  2007-05-03     Completed Date:  2007-07-19     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  9214933     Medline TA:  J Formos Med Assoc     Country:  China (Republic : 1949- )    
Other Details:
Languages:  eng     Pagination:  313-9     Citation Subset:  IM    
Affiliation:
Graduate Institute of Clinical Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan.
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MeSH Terms
Descriptor/Qualifier:
Chi-Square Distribution
Cost-Benefit Analysis
Female
Follow-Up Studies
Heart Failure / mortality,  nursing*
Home Care Services, Hospital-Based / economics*
Humans
Length of Stay / statistics & numerical data
Male
Middle Aged
Nurse Clinicians*
Patient Readmission / statistics & numerical data
Regression Analysis
Treatment Outcome

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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