| Objective Cost-effectiveness analysis was used to evaluate the cost and effect of "Internet + nursing service" mode applied to discharged patients with cholelithiasis with T tube from the perspective of health economics.Methods This research used a non-randomized parallel controlled trial.Patients who underwent laparoscopic minimally invasive surgery +T tube drainage in a tertiary class A hospital in Changsha City due to cholelithiasis as the research objects from May to December 2020.According to the inclusion and exclusion criteria,110 patients were divided into the control group and the experimental group in line with T-tube care mode choice.The patients who performed the T-tube maintenance in the hospital’s outpatient department were the control group and the patients who completed the T-tube maintenance under the "Internet + Nursing Service" model.For the experimental group,each group had 55 cases.Before discharge,the two groups of patients received regular health education,issued a health education handbook,and informed the patients or family members of using the home care service platform and demonstrated it.The investigators distributed questionnaires one day before discharge and one month after discharge,then analyzed and compared the two groups of patients’ general information,T tube nursing knowledge and scores,self-care ability scores,T tube related complications,and the time cost and medical cost of T-tube maintenance.The study used SPSS23.0 software for data analysis and processing,described the data of two groups using mean±standard deviation,frequency and percentage,and adopted the chi-square test,Fisher exact probability method,nonparametric test,and t-test for statistical inference.The bilateral test standard α is 0.05,and the difference was statistically significant at P<0.05.The cost-effectiveness analysis method calculates the cost-effectiveness ratio and the incremental cost-effectiveness ratio to evaluate the health economics of the two service models,conduct a sensitivity analysis of the research results.Results During the study,according to the termination and disengagement criteria,51 people were enrolled in the experimental group and 53 people in the control group.(1)Comparison of general information:There was no statistically significant difference between the two groups of patients in gender,age,education level,occupation,previous history,smoking history,medical expenses payment method,and other general data(P<0.05),and the baseline data were comparable.(2)Comparison of T tube nursing knowledge scores before and after intervention:At discharge(before intervention),there was no statistical significance in the scores of T-tube nursing knowledge mastery between the experimental group and the control group(P>0.05).One month after discharge(after intervention),the scores of T-tube nursing knowledge mastery in both groups were improved compared with those before discharge,the control group reached the general level,and the experimental group reached the better grade,with statistical significance(P<0.05).One month after discharge(after intervention),the score of T-tube nursing knowledge mastery in the experimental group was higher than that in the control group,the difference was statistically significant (P<0.05).(3)Comparison of scores of self-care ability before and after intervention: at discharge(before intervention),there was no statistical significance difference in the scores of total scores of self-care ability and scores of each dimension between the two groups(P>0.05);One month after discharge(after intervention),the total score of self-care ability and scores of each dimension of patients in both groups were improved compared with before intervention,with statistical significance(P<0.05).One month after discharge(after intervention),the total score of self-care ability and scores of each dimension in the experimental group were higher than those in the control group,with statistical significance(P<0.05).(4)Comparison of the incidence of T-tube-related complications and indwelling time: there was no tube plugging or tube break between the experimental group and the control group.There was no statistical significance in the of drainage tube’s prolonged indwelling time and catheter slide incidence(P>0.05).There was statistical significance in the incidence of infection between the two groups(P<0.05).Compared with the T tube’s indwelling time,the average indwelling time of the experimental group was lower than that of the control group(P<0.05).(5)Cost comparison: the total cost of the experimental group was2758.70 yuan,the direct medical price was 2719.70 yuan,the direct non-medical price was 39.01 yuan,and the examination cost was 0 yuan;The total cost of the control group was 2792.07 yuan,the direct medical cost was 1445.75 yuan,the direct non-medical cost was 104.15 yuan,and the indirect cost was 1242.16 yuan.The total cost of T tube maintenance in the two groups was the same.The experimental group’s direct medical price was higher than that in the control group.In contrast,the direct non-medical cost and indirect cost were lower than that in the control group.The T tube’s maintenance time in the experimental group was53.14 minutes,and that in the control group was 101.70 minutes,saving54.56 minutes on average in the experimental group.(6)Cost-effect analysis: the experimental group spent 82.37 yuan for improving self-care ability and 265.51 yuan to improve T-tube nursing knowledge.In comparison,the control group spent 115.18 yuan for improving self-care ability and 409.99 yuan for improving T-tube nursing ability.The unit effect costs were all higher than those of the experimental group.Compared with the experimental group,the control group needed to spend 910.73 yuan for every 1 case of reduced complication.Conclusion The "Internet + nursing service" model is applied to cholelithiasis patients,improving the knowledge level of T-tube nursing and self-care ability of patients discharged from hospital with T-tube,reducing the incidence of infection complications,shortening and saving the time of taking the tube,cost and unit effect.It is superior to the traditional nursing model and has better social and economic benefits. |
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