中国慢病临终期医疗决策与预先医疗指示制度的卫生经济学研究

Medical care in the end-of-life (EOL) makes up a majority of life-medical consumption, which is an important part in medical service. At present, China is lack of research on scientific health economics, to select the optimized decision-making and reasonable allocation of resource for terminal ill patients. Based on the clinical and costs database of Chinese EOL patients, Evidence-Based Medicine, the version of People-Centered Integrated Care, this study aims to analyze the usage of medical resource, and compare the cost-effectiveness between Palliative Care (PC) and usual care in clinical decision-making. Moreover, This study employs two methods (SM，Propensity Score Matching) and ( DID，Difference in Difference) to evaluate the policy on the effects of EOL palliative service packages. Additionally, the systematic research aims to combine the international advanced advance directive (AD) experiences with local circumstances. Finally, to explore the model in the combination advance directive and health care policy. This study thus provides empirical evidence on the clinical decision-making, and efficiency of medical usage, to make rational policy.

临终期医疗投入占一生总医疗消耗的绝大部分，是医疗服务中非常重要的环节。目前我国对疾病终末期患者临终阶段的优化治疗决策和合理资源配置，缺乏科学的卫生经济学评价研究指导。本研究基于课题组已建立的中国临终患者临床与费用实证数据库，结合国内外循证医学证据，从“整合式医疗”角度对中国目前慢病临终期医疗资源利用现状进行研究，并对针对临床治疗决策方案进行成本效果研究；本课题使用倾向得分匹配和双重差分联合方法对临终照护服务包试点开展政策效果定量评价；对预先医疗指示制度结合国情展开系统性研究；探索预先医疗指示制度和临终期患者的医疗服务体系结合模式。本课题为优化临终期治疗决策，提高医疗资源利用效率，制定合理政策干预手段提供高质量研究证据。

临终期医疗投入占一生总医疗消耗的绝大部分，是医疗服务中非常重要的环节。目前我国对疾病终末期患者临终阶段的优化治疗决策和合理资源配置，缺乏科学的卫生经济学评价研究指导。本研究基于湖北省中国临终患者临床与费用实证数据库，结合国内外循证医学证据，从人全生命周期角度对中国目前慢病临终期医疗资源利用现状进行研究，并对针对姑息疗法的社会收益进行评估研究；本课题利用荆门市护理保险对失能人群使用倾向得分匹配和双重差分联合方法开展了政策效果定量评价；对预先医疗指示制度结合国情展开可行性研究；并对社区临终照护卫生服务包支付区间进行测算；其结果转化出台了预先医疗指示协议和服务包预付费支付制度结合的新型支付模式相关支付政策的推动；本课题为优化临终期治疗决策，提高医疗资源利用效率，制定合理政策干预手段提供高质量研究证据。

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