Resource utilization in patients hospitalized with heart failure: Insights from a contemporary national hospital database
Resource utilization in patients hospitalized with heart failure: Insights from a contemporary national hospital database
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DOI：
10.1016/j.ahj.2008.01.015
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发表时间：
2008-06-01
影响因子：
4.8
通讯作者：
Schnitzler, Mark A.
中科院分区：
文献类型：
--
作者：
Hauptman, Paul J.;Swindle, Jason;Schnitzler, Mark A.
背景 因心力衰竭 (HF) 住院的患者的疾病严重程度和临床轨迹存在异质性。然而，人们对心力衰竭住院费用的变异性和影响因素知之甚少。我们在大型当代医院数据库中检查了与心力衰竭诊断相关的费用分布。方法系统地使用诊断和程序代码来确定参与 2004-2005 年 PREMIER 数据库的医院的主要住院心力衰竭患者。根据患者和住院特征，评估每日平均费用以及医院科室之间的费用划分。结果 住院总人数分别为 278 例、214 例； 36% 的住院时间 (LOS) > 5 天。静脉治疗类型、LOS、院内死亡率和费用之间存在明显的关联。例如，与住院期间进行的任何其他药物治疗相比，开始使用单一静脉正性肌力药物的患者平均 LOS 更长（9.6 天），住院死亡率更高（14.7%），平均总费用更高（18,411 美元）。成本的最大贡献者是食宿。诊断相关组代码 127 (n = 234, 204) 的住院治疗中有 46% 超出了平均医疗保险报销。与最高住院费用相关的入院变量是年龄
Background Heterogeneity of disease severity and clinical trajectory has been described among patients hospitalized with heart failure (HF). However, little is known about the variability in and contributors to costs associated with HF hospitalizations. We examined the distribution of costs associated with a HF diagnosis in a large contemporary hospital database.Methods Diagnosis and procedure codes were systematically used to identify primary inpatient HF admissions to hospitals participating in the PREMIER database 2004-2005. Average costs per day and division of costs among hospital departments were evaluated based on patient and hospitalization characteristics.Results Total number of hospitalizations was 278, 214; 36% had a length of stay (LOS) >5 days. There was a clear association between type of intravenous therapy, LOS, inhospital mortality, and cost. For example, patients initiated on a single intravenous inotrope had a longer mean LOS (9.6 days), greater inhospital mortality rate (14.7%), and higher mean total cost ($18,411) than any other medical therapy administered during hospitalization. The single largest contributor to cost was room and board. Forty-six percent of hospitalizations with diagnosis-related group code 127 (n = 234, 204) exceeded average Medicare reimbursement. Variables on admission associated with highest cost hospitalizations were age