title: Economic study in surgical patients of a new model of nutrition therapy integrating hospital and home vs the conventional hospital model.
abstract: BACKGROUND
  Dehospitalization is a trend in the health sector justified by humanitarian and socials aspects for the patient and relatives. From the financing institutions' perspective, whether government or third party, the positive results arise from an optimization of hospital bed use and favorable cost-benefit ratio. The "integrated home-hospital" model was created with the purpose of optimization of resources without detriment to the patients' nutritional care. The objective of this study was an economic evaluation regarding nutrition therapy of the integrated hospital-home model in comparison with an exclusively hospital model.
  
  
  METHODS
  A retrospective controlled study, paired (age, sex, disease, and surgical procedure), was performed on 56 digestive surgery patients divided into 2 groups: study (SG; n = 30) and control (CG; n = 26). The data collected included total expenses with hospitalization, nutritional benefits, minimization cost analysis, cost-effectiveness ratio analysis, cost-benefit ratio analysis, hospital length of stay, and hospital-bed optimization.
  
  
  RESULTS
  The patients from the SG achieved the same nutritional benefits as those in the CG, but with expenses 3 times lower (median Brazil Reals (R)$3237.18 vs R$8647.93; p < .05). The new model resulted in economic benefit to the institution, as shown by the cost-effectiveness ratio, mainly resulting from the savings of the days of hospitalization avoided. The cost-benefit ratio showed an important savings per patient for the institution (US $3100).
  
  
  CONCLUSIONS
  The home-hospital model also reduced length of hospital stay 2.7 times and optimized the hospital bed usage, as it promoted higher hospital-bed rotation (3 times greater).
authors.affiliation: Laboratório de Fisiologia e Distúrbios Esfincterianos, Departemento de Gastroenterologia da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
authors.forename: Yara Carnevalli
authors.initials: YC
authors.lastname: Baxter
authors.forename: Maria Carolina G
authors.initials: MC
authors.lastname: Dias
authors.forename: Janete
authors.initials: J
authors.lastname: Maculevicius
authors.forename: Ivan
authors.initials: I
authors.lastname: Cecconello
authors.forename: Bernard
authors.initials: B
authors.lastname: Cotteleng
authors.forename: Dan Linetzky
authors.initials: DL
authors.lastname: Waitzberg
mesh_terms: D003362:Cost-Benefit Analysis; D005260:Female; D006699:Home Care Services / Q000191:economics*; D006760:Hospitalization / Q000191:economics / Q000639:trends; D006801:Humans; D007902:Length of Stay / Q000191:economics; D008297:Male; D008875:Middle Aged; D018529:Nutritional Support / Q000191:economics*; D012189:Retrospective Studies