Economic comparison between Hospital at Home and traditional hospitalization using a simulation‐based approach

Journal of Enterprise Information Management - Tập 26 Số 1/2 - Trang 135-153 - 2013
CarlosRodríguez Verjan1, VincentAugusto1, XiaolanXie1, ValérieButhion2
1Centre for Health Engineering Department, Ecole Nationale Supérieure des Mines de Saint‐Etienne, Saint‐Etienne, France
2COACTION University of Lyon, associated to Léon Bérard Cancer Center, Lyon, France

Tóm tắt

PurposeHospital at Home (HAH) is a concept slowly expanding over time. At first this type of organization was used to accomplish low‐technical tasks. The main objective was to increase bed availability in hospitals for new patients. Nowadays, HAH structures are able to undertake more technical complex care such as (but not limited to) end‐of‐life care, chemotherapy and rehabilitation. The purpose of this paper is to propose a new methodology to make an unbiased economic comparison between HAH structures and traditional hospitalization.Design/methodology/approachThis article accomplishes two main objectives: in the first part the authors propose a comprehensive literature review dealing with the comparison between traditional hospital and home care structures from an economic standpoint, showing that results are highly dependent on initial conditions of the study (patient health state, territory settings, bio‐medical parameters); in the second part the authors propose an unbiased economic comparison approach between health care provided in traditional hospital and home care network using formal modelling with Petri nets and discrete event simulation. As an example for the comparison a multi‐session treatment is proposed. Various scenarios are tested to ensure that results will be maintained even if initial conditions change. Relevant performance indicators used for comparison are economic costs from the point of view of the insurance and economic costs related to the consumption of resources.FindingsIt is found that HAHS can be used to control and improve patients flow on hospitals. Decisions about offering a multi‐session treatments at home must be taken, not only because of economic impacts on hospitals, but also because it follows strategic goals of the organization. This decision must be issued following a strategic analysis. Some important questions are: How should newly available beds be used in the hospital? Which territories will be covered? What is the best logistic strategy for delivering the medicines?Originality/valueComparing HAH with traditional hospitalization can provide useful information to healthcare authorities when deciding to create, or not, new HAH structures.

Từ khóa


Tài liệu tham khảo

Anderson, C., Ni Mhurchu, C., Rubenach, S., Clark, M., Spencer, C. and Winsor, A. (2000), “Home or hospital for stroke rehabilitation? Results of a randomized controlled trial: II: cost minimization analysis at 6 months”, Stroke, Vol. 31 No. 5, pp. 1032‐7.

Anderson, H., Addington‐Hall, J.M., Peake, M.D., McKendrik, J., Keane, K. and Thatcher, N. (2003), “Domiciliary chemotherapy with gemcitabine is safe and acceptable to advanced non‐small‐cell lung cancer patients: results of a feasibility study”, British Journal of Cancer, Vol. 89 No. 12, pp. 2190‐6.

Angelis, V.D., Felici, G. and Impelluso, P. (2003), “Integrating simulation and optimisation in health care centre management”, European Journal of Operational Research, Vol. 150 No. 1, pp. 101‐14.

Armstrong, C.D., Hogg, W., Lemelin, J., Dahrouge, S., Martin, C., Viner, G. and Saginur, R. (2008), “Home‐based intermediate care program vs hospitalization: cost comparison study”, Canadian Family Physician, Vol. 54 No. 1, pp. 66‐73.

Baesler, F.F. and Sepúlveda, J.A. (2002), “Multi‐objective simulation optimization for a cancer treatment center”, Dans Proceedings of the Winter Simulation Conference, 2001, pp. 1405‐11.

Barcala, F.J.G., Pose Reino, A., Paz Esquete, J.J., De la Fuente Cid, R., Masa Vazquez, L.A., Alvarez Calderon, P. and Vaudes Cuadrado, L. (2006), “Hospital at home for acute respiratory patients”, European Journal of Internal Medicine, Vol. 17 No. 6, pp. 402‐7.

Borras, J.M., Sanchez‐Hernandez, A., Navarro, M., Martinez, M., Mendez, E., Ponton, J.L.L., Espinas, J.A. and Germa, J.R. (2001), “Compliance, satisfaction, and quality of life of patients with colorectal cancer receiving home chemotherapy or outpatient treatment: a randomised controlled trial”, British Medical Journal, Vol. 322 No. 7290, pp. 8‐26.

Buthion, V., Fanidi, A. and Lagrange, T. (2010), “La chimiothérapie à domicile: complémentarité ou concurrence dans la stratégie des structures hospitalières”, available at: https://sites.google.com/site/buthionvalerie/in‐the‐news/lachimiotherapieadomicile (accessed March 1, 2011).

Carrère, M.‐O., Devaux, Y., Havet, N., Morelle, M., Remonnay, R. and Kante, V. (2008), “Administration des transfusions sanguines à l’hôpital ou à domicile? Le choix des patients atteints de cancer”, Bulletin du cancer, Vol. 95 No. 11, pp. 1‐7.

Chataway, J., Porter, B., Riazi, A., Heaney, D., Watt, H., Hobart, J. and Thompson, A. (2006), “Home versus outpatient administration of intravenous steroids for multiple‐sclerosis relapses: a randomized controlled trial”, American Journal of Ophthalmology, Vol. 142 No. 3, pp. 565‐71.

Coast, J., Richards, S.H., Peters, T.J., Gunnell, D.J., Darlow, M.‐A. and Pounsford, J. (1998), “Hospital at home or acute hospital care? A cost minimisation analysis”, British Medical Journal, Vol. 316 No. 7147, p. 1802‐6.

De Conno, F., Caraceni, A., Groff, L., Brunelli, C., Donati, I., Tamburini, M. and Ventafridda, V. (1996), “Effect of home care on the place of death of advanced cancer patients”, European Journal of Cancer, Vol. 32 No. 7, pp. 1142‐7.

Eldabi, T., Paul, R.J. and Taylor, S.J. (1999), “Computer simulation in healthcare decision making”, Computers & Industrial Engineering, Vol. 37 Nos 1‐2, pp. 235‐8.

Frick, K.D. Burton, L., Clark, R., Mader, S.L., Naughton, B., Burl, J., Greenough, W.B. III, Steinwachs, D. and Leff, B. (2009), “Substitutive hospital at home for older persons: effects on costs”, Am J Manag Care, Vol. 15 No. 1, pp. 49‐56.

Goulet, C., Gévry, H., Gauthier, R.J., Lepage, L., Fraser, W. and Aita, M. (2001), “A controlled clinical trial of home care management versus hospital care management for preterm labour”, International Journal of Nursing Studies, Vol. 38 No. 3, pp. 259‐69.

Hermiz, O., Comino, E., Marks, G., Daffurn, K., Wilson, S. and Harris, M. (2002), “Randomised controlled trial of home based care of patients with chronic obstructive pulmonary disease”, British Medical Journal, Vol. 325 No. 7370, p. 938.

Jester, R. (2003), “Early discharge to hospital at home: should it be a matter of choice?”, Journal of Orthopedic Nursing, Vol. 7 No. 2, pp. 64‐9.

Kelton, W.D. and Law, A.M. (2000), Simulation Modeling and Analysis, McGraw Hill, New York, NY.

Launois, R. and Perrocheau, G. (1996), “Chimiothérapie ambulatoire: Les enjeux économiques”, Bull Cancer, Vol. 83 No. S12, pp. 974‐6.

Leff, B., Burton, L., Mader, S.L., Naughton, B., Burl, J., Inouye, S.K., Greenough, W.B. III, Guido, S., Langston, C. and Frick, K.D. (2005), “Hospital at home: feasibility and outcomes of a program to provide hospital‐level care at home for acutely ill older patients”, Annals of Internal Medicine, Vol. 143 No. 11, pp. 798‐809.

Leff, B., Burton, L., Mader, S.L., Naughton, B., Burl, J., Koehn, D., Clark, R., Greenough, W.B. III, Guido, S., Steinwachs, S. and Burton, J.R. (2008), “Comparison of stress experienced by family members of patients treated in hospital at home with that of those receiving traditional acute hospital care”, Journal of the American Geriatrics Society, Vol. 56 No. 1, pp. 117‐23.

Leff, B., Burton, L., Mader, S.L., Naughton, B., Burl, J., Greenough, W.B. III, Guido, S. and Steinwachs, D. (2009), “Comparison of functional outcomes associated with hospital at home care and traditional acute hospital care”, Journal of the American Geriatrics Society, Vol. 57 No. 2, pp. 273‐8.

Oterino‐de‐la‐Fuente, D., Peiro, S., Ridao, M. and Marchan, C. (1998), “Variations in diagnostic and therapeutic intensity between home and conventional hospitalization”, International Journal for Quality in Health Care, Vol. 10 No. 4, pp. 331‐8.

Proth, J.M. and Xie, X. (1995), Les réseaux de Petri pour la conception et la gestion des systèmes de production, Masson, Paris.

Remonnay, R., Devaux, Y., Chvetzoff, G., Morelle, M. and Carrère, M.O. (2005), “Cancer treatment at home or in the hospital: what are the costs for French public health insurance?: findings of a comprehensive‐cancer centre”, Health Policy, Vol. 72 No. 2, pp. 141‐8.

Richards, S.H., Coast, J., Gunnell, D.J., Peters, T.J., Pounsford, J. and Darlow, M.A. (1998), “Randomised controlled trial comparing effectiveness and acceptability of an early discharge, hospital at home scheme with acute hospital care”, British Medical Journal, Vol. 316 No. 7147, p. 1796.

Rischin, D., White, M.A., Matthews, J.P., Toner, G.C., Watty, K., Sulkowski, A.J., Clarke, J.L. and Buchanan, L. (2000), “A randomised crossover trial of chemotherapy in the home: patient preferences and cost analysis”, Medical Journal of Australia, Vol. 173 No. 3, pp. 125‐7.

Rodriguez‐Cerrillo, M., Alvarez‐Arcaya, A., Fernandez‐Diaz, E. and Fernandez‐Cruz, A. (2009), “A prospective study of the management of non‐massive pulmonary embolism in the home”, European Journal of Internal Medicine, Vol. 20 No. 6, pp. 598‐600.

Santibanez, P., Chow, V.S., French, J., Puterman, M.L. and Tyldesley, S. (2009), “Reducing patient wait times and improving resource utilization at British Columbia Cancer Agency's ambulatory care unit through simulation”, Health Care Management Science, Vol. 12 No. 4, pp. 392‐407.

Sepúlveda, J.A., Thompson, W.J., Baesler, F.F., Alvarez, M.I and Cahoon, L.E. III (1999), “The use of simulation for process improvement in a cancer treatment center”, Dans Proceedings of the 31st Conference on Winter Simulation: Simulation – A Bridge to the Future – Volume 2, pp. 1541‐8.

Shepperd, S. and Iliffe, S. (1998), “The effectiveness of hospital at home compared with in‐patient hospital care: a systematic review”, Journal of Public Health, Vol. 20 No. 3, p. 344.

Shepperd, S., Harwood, D., Gray, A., Vessey, M. and Morgan, P. (1998), “Randomised controlled trial comparing hospital at home care with inpatient hospital care. II: cost minimisation analysis”, British Medical Journal, Vol. 316 No. 7147, p. 1791.

Shepperd, S., Doll, H., Angus, R.M., Clarke, M.J., Iliffe, S., Kalra, L., Ricauda, N.A., Tibaldi, V. and Wilson, A.D. (2009), “Avoiding hospital admission through provision of hospital care at home: a systematic review and meta‐analysis of individual patient data”, Canadian Medical Association Journal, Vol. 180 No. 2, pp. 175‐80.

Takezako, Y., Tamiya, N. and Kajii, E. (2007), “The nursing home versus the hospital as the place of dying for nursing home residents in Japan”, Health Policy, Vol. 81 No. 2‐3, pp. 280‐8.

Taylor, R.S., Watt, A., Dalal, H., Evans, P.H., Campbell, J.L., Read, K.L.Q., Mourant, A.J., Wingham, J., Thompson, D.R. and Pereira Gray, D.J. (2007), “Home‐based cardiac rehabilitation versus hospital‐based rehabilitation: a cost effectiveness analysis”, International Journal of Cardiology, Vol. 119 No. 2, pp. 196‐201.

Tibaldi, V., Aimonino, N., Ponzetto, M., Stasi, M.F., Amati, D., Raspo, S., Roglia, D., Molaschi, M. and Fabris, F. (2004), “A randomized controlled trial of a home hospital intervention for frail elderly demented patients: behavioral disturbances and caregiver's stress”, Archives of Gerontology and Geriatrics, Vol. 38 No. 9, pp. 431‐6.

Vergnenègre, A., Decroisette, C., Vincent, F., Dalmay, F., Melloni, B., Bonnaud, F. and Eichler, B. (2006), “Analyse économique de l’administration d’une chimiothérapie en hospitalisation à domicile (HAD) comparée à l’hospitalisation de jour dans les cancers bronchopulmonaires non à petites cellules de stade IV”, Revue des Maladies Respiratoires, Vol. 23 No. 3, pp. 255‐63.

Werker, G., Sauré, A., French, J., Shechter, S. (2009), “The use of discrete‐event simulation modelling to improve radiation therapy planning processes”, Radiotherapy and Oncology, Vol. 92 No. 1, pp. 76‐82.

Thông tin
Thông tin xuất bản

Journal of Enterprise Information Management

Tập 26 Số 1/2

135-153

Thông tin tác giả