Cohort study evaluating pressure ulcer management in clinical practice in the UK following initial presentation in the community: costs and outcomes.
Cohort study evaluating pressure ulcer management in clinical practice in the UK following initial presentation in the community: costs and outcomes.
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DOI：
10.1136/bmjopen-2018-021769
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发表时间：
2018-07-25
期刊：
影响因子：
2.9
通讯作者：
Vowden KR
中科院分区：
文献类型：
--
作者：
Guest JF;Fuller GW;Vowden P;Vowden KR
本研究的目的是估计的护理模式和年度水平的医疗资源使用归因于管理压疮（PU）在临床实践中，在社区由英国的国家卫生服务（NHS），和患者管理的相关费用。这是一项回顾性队列分析，分析了从健康改善网络（THIN）数据库中随机选择的6000例患有任何类型伤口的患者中确定的209例患者的记录，这些患者在社区发生了PU，排除了医院获得性PU。患者的特征，伤口相关的健康结果和医疗保健资源使用从最初的介绍超过12个月进行了量化，并在2015/2016价格估计相应的总NHS患者管理成本。50%的PU在首次出现后12个月内愈合，但这一比例在1类溃疡的100%和4类溃疡的21%之间变化。平均愈合时间范围为1类溃疡1.0个月至3/4类溃疡8个月和不可分期溃疡10个月。患者主要由护士在社区进行管理，临床专家的临床参与最少。高达53%的所有溃疡在出现时可能已被临床感染，35%的患者随后在首次出现后平均4.7个月发生了假定的伤口感染。12个月内伤口护理的平均NHS成本范围从1类溃疡的1400英镑到其他类别溃疡的> 8500英镑。此外，治疗未愈合溃疡的成本是治疗已愈合溃疡的2.4倍（平均每溃疡5140英镑vs 12300英镑）。这项研究提供了重要的见解，在临床实践中的PU管理的一些方面，在社区，已难以确定从其他研究，并提供了最佳的估计NHS资源的使用和成本，以告知政策和预算决策。
The aim of this study was to estimate the patterns of care and annual levels of healthcare resource use attributable to managing pressure ulcers (PUs) in clinical practice in the community by the UK’s National Health Service (NHS), and the associated costs of patient management. This was a retrospective cohort analysis of the records of 209 patients identified within a randomly selected population of 6000 patients with any type of wound obtained from The Health Improvement Network (THIN) Database, who developed a PU in the community and excluded hospital-acquired PUs. Patients’ characteristics, wound-related health outcomes and healthcare resource use were quantified over 12 months from initial presentation, and the corresponding total NHS cost of patient management was estimated at 2015/2016 prices. 50% of all the PUs healed within 12 months from initial presentation, but this varied between 100% for category 1 ulcers and 21% for category 4 ulcers. The mean time to healing ranged from 1.0 month for a category 1 ulcer to 8 months for a category 3/4 ulcer and 10 months for an unstageable ulcer. Patients were predominantly managed in the community by nurses with minimal clinical involvement of specialist clinicians. Up to 53% of all the ulcers may have been clinically infected at the time of presentation, and 35% of patients subsequently developed a putative wound infection a mean 4.7 months after initial presentation. The mean NHS cost of wound care over 12 months ranged from £1400 for a category 1 ulcer to >£8500 for the other categories of ulcer. Additionally, the cost of managing an unhealed ulcer was 2.4 times more than that of managing a healed ulcer (mean of £5140 vs £12 300 per ulcer). This study provides important insights into a number of aspects of PU management in clinical practice in the community that have been difficult to ascertain from other studies, and provides the best estimate available of NHS resource use and costs with which to inform policy and budgetary decisions.
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影响因子：
1.9
作者：
Dealey, C.;Posnett, J.;Walker, A.
通讯作者：
Walker, A.
影响因子：
1.9
作者：
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影响因子：
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影响因子：
2.5
作者：
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影响因子：
3.1
作者：
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通讯作者：
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