Publication: Değer temelli sağlık hizmetleri uygulaması olarak entegre sağlık ekiplerinin sağlık göstergeleri ve yaşam kalitesine etkisi
Abstract
Amaç: Araştırmanın temel amacı, değer temelli sağlık hizmeti sunumuna yönelik olarak, Entegre Sağlık Ekibi uygulamasının kalça ve diz protez cerrahisinde; taburcu olma süreleri, komplikasyonlar nedeniyle acile yeniden başvurular ve servise yeniden yatışlar, toplam yatış süreleri, maliyetler gibi göstergeler ile hasta yaşam kalitesi üzerindeki etkisinin belirlenmesidir. Gereç ve Yöntem: Kesitsel tipte ve tanımlayıcı olan araştırma İstanbul ilinde faaliyet gösteren bir eğitim araştırma hastanesinde gerçekleştirilmiştir. Araştırmanın verileri Entegre Sağlık Ekibi uygulaması öncesi ve sonrası olmak üzere iki aşamada toplanmıştır. Bu kapsamda hastanede Diz ve Kalça Protezi Cerrahisi uygulanan 18 yaş üstü, tedavisi tamamlanan ve verisi tam olan hastaların epikrizleri, ameliyata özgü tüm kalemleri içeren maliyet verileri ile operasyon sonrası komplikasyon durumlarını belirlemek amacıyla, hastaların hastaneye başvuru tarih ve nedenlerine ilişkin veriler alınmıştır. Ayrıca uygulama öncesi hastaların retrospektif olarak yaşam kalitesi verileri, Short Form- 36 (SF-36) Yaşam Kalitesi Ölçeği kullanılarak elde edilmiştir. Uygulama öncesi verilerden hareketle Entegre Sağlık Ekibi oluşturulmasına yönelik öneriler geliştirilmiştir. Entegre Sağlık Ekibi uygulaması sonrası durum karşılaştırılması yapılmıştır. Bulgular: Entegre sağlık ekibi uygulamasının diz ve kalça protezi cerrahisinde komplikasyonlar, hastanede geçirilen süreler, maliyetler, acil servis başvuruları ve servise yeniden yatışlar ile yeniden cerrahi operasyonlar üzerinde olumlu etkileri olduğu saptanmıştır. Komplikasyon gelişme durumları (χ²=7,929; p=0,019), acile yeniden başvurular (χ²=7,333; p=0,026) ve maliyetlerde (U = 5025,0; p <0,001), uygulama öncesi ve sonrası arasında, sonrası lehine olacak şekilde anlamlı farklılık bulunmuştur. Sonuç: Çalışmanın sonuçları, daha yüksek değerli bakımın sağlanmasında Entegre Sağlık Ekibi uygulamasının önemli bir yeri olduğunu göstermektedir. Entegre sağlık ekipleri bakımın maliyetlerini düşürürken kalite, hasta sonuçları ve deneyimlerinde iyileşme sağlayarak, sağlık hizmetlerinin sürdürülebilirliğine önemli katkı sağlama potansiyeli taşımaktadır. Modelin başarısı için hizmet sunumunun birinci basamak ve taburculuk sonrası hizmetlerle entegrasyonu sağlanmalıdır. Bu bağlamda, tele-tıp uygulamaları ve entegre bilgi işlem sistemlerinin kullanımı, süreçlerin daha az maliyet ve insan gücü ile daha etkin hale getirilmesini sağlayabilir. Ekibin işleyişini kolaylaştırmak adına iş süreçleri ve görev tanımları ekibin başarısını sağlayacak şekilde yeniden düzenlenmelidir. Hasta ve hastalığa özgü veriler sistematik olarak toplanarak analiz edilmelidir. Değer temelli sağlık hizmetlerinin finansal teşvik mekanizmaları ile desteklenmesi gerekmektedir. Bu noktada, değeri asıl yaratacak olan ödeyici kurumların bu teşvik mekanizmalarını oluşturmaları ve uygulanması konusunda ısrarcı davranmaları olacaktır. Ekip üyelerinin bu modele olan isteği ve inancı eğitim programları ile güçlendirilmeli, hastaların kendi sağlık yönetimlerinde aktif rol almaları teşvik edilmelidir.
Objective: The main purpose of the study is to investigate the impact of the Integrated Practise Units on indicators such as discharge times, readmissions and readmissions to the emergency department due to complications, total hospitalization times, costs and patient quality of life in hip and knee replacement surgery for value-based healthcare service delivery. Materials and Methods: The cross-sectional and descriptive study was conducted at a training and research hospital in Istanbul. The data of the study were collected in two stages, before and after the Integrated Practise Unit implementation. In this context, epicrises of patients over the age of 18 who underwent Knee and Hip Replacement Surgery at the hospital, whose treatment was completed and whose data were complete, cost data including all items specific to the operation, and data on the date and reasons of admission to the hospital were obtained to determine the postoperative complication status of the patients. In addition, retrospective quality of life data of the patients before the application were obtained using the Short Form-36 (SF-36) Quality of Life Scale. Based on the pre-implementation data, suggestions were made for the establishment of an Integrated Practise Unit, and the situation was compared after the implementation of the Integrated Practise Unit. Results: The implementation of Integrated Practise Unit has been found to have positive effects on complications, length of hospital stay, costs and hospital readmissions in knee and hip replacement surgeries. Significant differences were observed between pre- and post- implementation periods in favor of the latter, with regard to the occurrence of complications (χ²=7.929, p=0.019), emergency readmissions (χ²=7.333, p=0.026), and surgery costs (U = 5025.0, p <0.001). Conclusion: The findings of the study demonstrate the significant role of the Integrated Practise Unit approach in delivering higher-value care. Integrated Practise Units have the potential to make a substantial contribution to the sustainability of healthcare by reducing costs while simultaneously improving quality, patient outcomes, and experiences.. For the success of this model, integration of service delivery with primary care and post-discharge services should be ensured. In this context, the use of tele-medicine applications and integrated information processing systems can make the processes more efficient with less cost and manpower. In order to facilitate the functioning of the team, the service delivery process and job descriptions should be reorganized. Value-based healthcare must be supported by financial incentive mechanisms. At this point, it is crucial that payer institutions, which are the primary creators of value, design these incentive mechanisms and insist on their implementation. The willingness and belief of team members should be strengthened through education. Patients should be involved in their own treatment process.
Objective: The main purpose of the study is to investigate the impact of the Integrated Practise Units on indicators such as discharge times, readmissions and readmissions to the emergency department due to complications, total hospitalization times, costs and patient quality of life in hip and knee replacement surgery for value-based healthcare service delivery. Materials and Methods: The cross-sectional and descriptive study was conducted at a training and research hospital in Istanbul. The data of the study were collected in two stages, before and after the Integrated Practise Unit implementation. In this context, epicrises of patients over the age of 18 who underwent Knee and Hip Replacement Surgery at the hospital, whose treatment was completed and whose data were complete, cost data including all items specific to the operation, and data on the date and reasons of admission to the hospital were obtained to determine the postoperative complication status of the patients. In addition, retrospective quality of life data of the patients before the application were obtained using the Short Form-36 (SF-36) Quality of Life Scale. Based on the pre-implementation data, suggestions were made for the establishment of an Integrated Practise Unit, and the situation was compared after the implementation of the Integrated Practise Unit. Results: The implementation of Integrated Practise Unit has been found to have positive effects on complications, length of hospital stay, costs and hospital readmissions in knee and hip replacement surgeries. Significant differences were observed between pre- and post- implementation periods in favor of the latter, with regard to the occurrence of complications (χ²=7.929, p=0.019), emergency readmissions (χ²=7.333, p=0.026), and surgery costs (U = 5025.0, p <0.001). Conclusion: The findings of the study demonstrate the significant role of the Integrated Practise Unit approach in delivering higher-value care. Integrated Practise Units have the potential to make a substantial contribution to the sustainability of healthcare by reducing costs while simultaneously improving quality, patient outcomes, and experiences.. For the success of this model, integration of service delivery with primary care and post-discharge services should be ensured. In this context, the use of tele-medicine applications and integrated information processing systems can make the processes more efficient with less cost and manpower. In order to facilitate the functioning of the team, the service delivery process and job descriptions should be reorganized. Value-based healthcare must be supported by financial incentive mechanisms. At this point, it is crucial that payer institutions, which are the primary creators of value, design these incentive mechanisms and insist on their implementation. The willingness and belief of team members should be strengthened through education. Patients should be involved in their own treatment process.