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Diabetes Specialist Nurses

Diabetes Specialist Nurses. Cost-Effectivenes Analysis. AIM. Would the implementation of Diabetes Specialist Nurses (DSN), for the somatic inpatients, be cost-efffective in the region of Copenhagen (RegionH)? - carry out a Cost-Effectiveness Analysis (CEA). Background.

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Diabetes Specialist Nurses

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  1. Diabetes Specialist Nurses Cost-Effectivenes Analysis

  2. AIM Would the implementation of Diabetes Specialist Nurses (DSN), for the somatic inpatients, be cost-efffective in the region of Copenhagen (RegionH)? - carry out a Cost-Effectiveness Analysis (CEA)

  3. Background RegionH: • Population 1,6 million people • 14 Hospitals • 4 smaller regions (North, South, Middle and City)

  4. Background (2) The prevalence of diabetes is increasing in DK (4,1%) • Incidens stabile • Mortality decreasing (still higher for diabetics) • In the resent years several studies (especially English) shows the effect of DSN´s at length of stay (LOS) and the quality of care. • Diabetics are known to have a longer LOS in average than other patient-groups • DSN ‘s interventions shows greater effect on • acute vs. elective patients • medical vs. surgical patients • Patients ˂ 60 years • It is known that there is a connection between LOS and early death.

  5. Dession-tree

  6. Definitions • Insulin treated patients at hospital somatic wards • type 1-diabetes • type 2-diabetes • secondary diabetes (ex. prednisolon) • other types • Diabetes specialist nurse: • Education/training: as recommended in RegionH* 2. Good glycaemic control: BG 4-10 mmmol/l**

  7. Defenitions (2) 3. Bad glucaemic control or newly diagnosed Services form DSN’s includes: 3.aStart of insulin treatment • Injectionstehnique/ training • Symptoms on high/low BG and how to respond • Training in BG mesurement and how to use the results 3.bAdjusting insulin treatment by • checking injectionstechnique • Adjusting insulin – teaching the patient • Find out the reason for bad glucaemic control

  8. Cost • Direct: Estimates: • Salaries for DSN’s: 375.000 kr/year • RegionH – number of DSN’s needed for 8500 beds - (4,5 DSN/1200 beds)* (8500:1200) x 4.5 = 32 DSN’s* Cost for implementation of DSN’s: 375.000 Dkr/year x 32 = 12.000.000 Dkr/year

  9. Cost (2) • Indirect cost: • Reduction in length of stay (LOS) • 25%* • Number of inpatients with diabetes: • 10 % of all inpatients (401.000 excess beds) • 40.100 inpatients with diabetes (2005) • 2% decrease/year in LOS • 2005-2009: 8% • 40.100 x 0,08 = 3208 2009: 40.100 - 3208 = 36.892 excess beds • The average price for a diabetic in a hospital bed is by Diagnose Register Groups (DRG) DRG09: 21.761 Dkr

  10. Cost (3) • Indirect cost: • Education* • Counseling/Backup from doctors • Administration

  11. Effect • Estimate of the average reduction in excess LOS for diabetics in RegionH if implementing DSN-service (2009): (Number of excess beds x Average cost (DRG)) x Reduction in LOS* (36.892x 21.761 Dkr ) x 0,25= 802.806.812 Dkr x 0,25 = 200.701.703Dkr

  12. Effects (2) Other effects of implementing DSN’s: • Improving diabetes care skills in ward staff • Lower readmission rates for diabetics • Lower mortality • Highersatisfaction among patients

  13. Result of CEA Estimated benefit of introducing DSN’s for inpatients in RegionH • Effect: 200.701.703 Dkr • Cost: 12.000.000 Dkr • Benefit: 198.701.703 Dkr

  14. Health-economic perspective and discussion • Can be used as part of a Tecnology Assesment of DSN’s where the focus are: • Cost and Benefits for society? • Compared with the alternative is the tecnology then cost-effective? • Is there a health gain? • How big are the investments and running costs? • Are there any cut-backs or earnings? • Who are paying? • Are there any economic consequenses for the patients?

  15. References (1) http://www.sst.dk/publ/tidsskrifter/nyetal/pdf/2009/01_09.pdf • Medicinsk Teknologivurdering. 2009. • Nationale Diabetesregister (2007) • DRG registreing (2) Diabetes nurse case manager program lowers costs, improves glycemic control. Capitation Manag Rep 1998 Jun;5(6):93-5. (3) Cavan DA, Hamilton P, Everett J, Kerr D. Reducing hospital inpatient length of stay for patients with diabetes. Diabet Med 2001 Feb;18(2):162-4. (4) Levetan CS, Salas JR, Wilets IF, Zumoff B. Impact of endocrine and diabetes team consultation on hospital length of stay for patients with diabetes. Am J Med 1995 Jul;99(1):22-8. (5) Newton CA, Young S. Financial implications of glycemic control: results of an inpatient diabetes management program. Endocr Pract 2006 Jul;12 Suppl 3:43-8. (6) Waller L, Ehnberg S, Welin L. [The diabetes-nurse--a resource probably saving money and shortening the length of stay]. Lakartidningen 1992 Jun 3;89(23):2104-5. (8) DSR: Lønstatistik. 2009.

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