High-cost users of hospital beds in Western Australia: a population-based record linkage study
High-cost users of hospital beds in Western Australia: a population-based record linkage study
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DOI：
10.5694/j.1326-5377.2006.tb00289.x
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发表时间：
2006-04-17
影响因子：
11.4
通讯作者：
McCaul, KA
中科院分区：
文献类型：
--
作者：
Calver, J;Brameld, KJ;McCaul, KA
目的：描述西澳大利亚州住院护理的高成本用户与其他用户在年龄、健康问题和资源使用方面的差异。设计和数据来源：对2002年西澳大利亚州数据链接系统的医院数据和相关死亡率数据，以及2001- 2002财政年度国家医院成本数据收集的成本数据进行二次分析。结果测量：在年龄、健康状况（主要诊断类别）和资源利用（年化费用、离职和住院日）方面比较高费用使用者和其他住院护理使用者。结果：老年高成本使用者（>= 65岁）的治疗费用并不比年轻高成本使用者（在患者水平）高，但由于其不成比例的代表性（n=8466; 55.9%），作为一个整体群体，治疗费用更高。慢性稳定和不稳定状况是高成本使用者的主要特征，包括终末期肾病、心绞痛、抑郁症和继发性恶性肿瘤。高成本用户占住院费用和住院天数的38%，占住院分离的26%。结论：人口老龄化与住院护理高成本用户比例的增加有关。高成本似乎是由需求驱动的。限制住院病人使用高费用需要更加注重预防慢性病的发生和进展，并减少弱势群体的手术并发症和损伤。
Objective: To describe how high-cost users of inpatient care in Western Australia differ from other users in age, health problems and resource use.Design and data sources: Secondary analysis of hospital data and linked mortality data from the WA Data Linkage System for 2002, with cost data from the National Hospital Cost Data Collection (2001-02 financial year).Outcome measures: Comparison of high-cost users and other users of inpatient care in terms of age, health profile (major diagnostic category) and resource use (annualised costs, separations and bed days).Results: Older high-cost users (>= 65 years) were not more expensive to treat than younger high-cost users (at the patient level), but were costlier as a group overall because of their disproportionate representation (n=8466; 55.9%). Chronic stable and unstable conditions were a key feature of high-cost users, and included end stage renal disease, angina, depression and secondary malignant neoplasms. High-cost users accounted for 38% of both inpatient costs and inpatient days, and 26% of inpatient separations.Conclusion: Ageing of the population is associated with an increase in the proportion of high-cost users of inpatient care. High costs appear to be needs-driven. Constraining high-cost inpatient use requires more focus on preventing the onset and progression of chronic disease, and reducing surgical complications and injuries in vulnerable groups.