期刊论文详细信息
BMC Palliative Care
Exploring the costs, consequences and efficiency of three types of palliative care day services in the UK: a pragmatic before-and-after descriptive cohort study
Federico Ricciardi1  Erna Haraldsdottir2  Sarah Cudmore2  Joanna Coast3  Gareth Myring3  Paul Mark Mitchell3  W. George Kernohan4  Laurie McKibben4  Lisa Graham-Wisener5  Anne M. Finucane6  Victoria Vickerstaff7  Louise Jones7  Joanne Jordan8  Kevin Brazil9  Alistair Hewison1,10  Shazia Zafar1,10 
[1] Department of Statistical Science, University College London;Division of Nursing, Queen Margaret University;Health Economics Bristol, Population Health Sciences, University of Bristol;Institute of Nursing and Health Research, Ulster University;Marie Curie Hospice, Belfast and School of Psychology, Queen’s University Belfast;Marie Curie Hospice, Edinburgh and Usher Institute, The University of Edinburgh;Marie Curie Palliative Care Research Department, University College London;School of Health, Wellbeing and Social Care, The Open University;School of Nursing and Midwifery, Queen’s University Belfast;School of Nursing, Institute of Clinical Sciences, University of Birmingham;
关键词: Palliative care day services;    Costs;    Health economics;    Quality of life;    End of life;   
DOI  :  10.1186/s12904-020-00624-y
来源: DOAJ
【 摘 要 】

Abstract Background Palliative Care Day Services (PCDS) offer supportive care to people with advanced, progressive illness who may be approaching the end of life. Despite the growth of PCDS in recent years, evidence of their costs and effects is scarce. It is important to establish the value of such services so that health and care decision-makers can make evidence-based resource allocation decisions. This study examines and estimates the costs and effects of PCDS with different service configurations in three centres across the UK in England, Scotland and Northern Ireland. Methods People who had been referred to PCDS were recruited between June 2017 and September 2018. A pragmatic before-and-after descriptive cohort study design analysed data on costs and outcomes. Data on costs were collected on health and care use in the 4 weeks preceding PCDS attendance using adapted versions of the Client Service Receipt Inventory (CSRI). Outcomes, cost per attendee/day and volunteer contribution to PCDS were also estimated. Outcomes included quality of life (MQOL-E), health status (EQ-5D-5L) and capability wellbeing (ICECAP-SCM). Results Thirty-eight attendees were recruited and provided data at baseline and 4 weeks (centre 1: n = 8; centre 2: n = 8, centre 3: n = 22). The cost per attendee/day ranged from £121–£190 (excluding volunteer contribution) to £172–£264 (including volunteer contribution) across the three sites. Volunteering constituted between 28 and 38% of the total cost of PCDS provision. There was no significant mean change at 4 week follow-up from baseline for health and care costs (centre 1: £570, centre 2: -£1127, centre 3: £65), or outcomes: MQOL-E (centre 1: − 0.48, centre 2: 0.01, centre 3: 0.24); EQ-5D-5L (centre 1: 0.05, centre 2: 0.03, centre 3: − 0.03) and ICECAP-SCM (centre 1:0.00, centre 2: − 0.01, centre 3: 0.03). Centre costs variation is almost double per attendee when attendance rates are held constant in scenario analysis. Conclusions This study highlights the contribution made by volunteers to PCDS provision. There is insufficient evidence on whether outcomes improved, or costs were reduced, in the three different service configurations for PCDS. We suggest how future research may overcome some of the challenges we encountered, to better address questions of cost-effectiveness in PCDS.

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