Management patterns and healthcare costs for hospitalized patients with cerebral infarction
Management patterns and healthcare costs for hospitalized patients with cerebral infarction
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DOI：
10.1016/j.healthpol.2008.01.013
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发表时间：
2008-10-01
期刊：
影响因子：
3.3
通讯作者：
Imanaka, Yuichi
中科院分区：
文献类型：
--
作者：
Sekimoto, Miho;Kakutani, Chieko;Imanaka, Yuichi
目的：尽管有证据表明对脑梗塞患者进行专科重症监护的重要性，但目前尚不清楚资源在发病初期是否得到了慷慨的使用，以及医疗资源利用模式与提供者的特征和患者预后的关系。在这项研究中，我们利用行政医疗索赔数据分析了日常医疗费用的变化规律，并确定了每个案例的管理模式。方法：我们使用日本的行政数据来确定日常医疗费用。对14家医疗机构3136例急性脑梗塞患者的资料进行分析。利用这些数据，我们从第三方支付方的角度计算了成本。根据住院前2天医疗费用的分布情况，将机构分为3组，比较患者背景、治疗过程和结果。结果：住院初期医疗费用不一定集中分摊。不同机构的医疗费用使用模式存在很大差异。首次住院期间的医疗费用差异似乎更多地受到ICU利用和机构管理政策的影响，而不是患者的临床状况。结论：我们提出了一种利用行政索赔数据来检验缺血性中风管理模式的方法。我们相信，使用我们的方法，结合准确和详细的临床数据，可以帮助阐明急性期医疗资源利用、护理过程和患者预后之间的关系。(C)2008爱思唯尔爱尔兰有限公司。保留所有权利。
Objectives: Although evidence shows the importance of specialized intensive care of patients with cerebral infarction, it is not well known whether resources are generously applied in the initial period and how patterns of medical resource utilization are associated with characteristics of providers and patient outcomes. In this study, we analyzed changing patterns of daily medical cost using administrative healthcare claim data and identified a management pattern in each case.Methods: We used Japan's administrative data to identify medical costs on a day-to-day basis. Data of 3136 patients with acute cerebral infarction from 14 medical institutions were included in the analyses. Using the data, we calculated the costs from the perspective of the third-party payer. Institutions were divided into three groups according to the distribution of medical costs in the first 2 days, and patient background, treatment process, and outcomes were compared across the groups.Results: Medical cost was not necessarily intensively allocated during the early hospitalization period. Wide variations were observed in medical cost utilization patterns across institutions. The differences in medical cost for the initial hospitalization period appears to be more influenced by ICU utilization and management policies of institutions than the clinical condition of patients.Conclusions: We proposed a methodology that uses administrative claim data to examine management patterns of ischemic stroke. We believe that the use of our method, in conjunction with accurate and detailed clinical data, can help elucidate the relationship among acute-period medical resource utilization, process of care, and patient outcomes. (C) 2008 Elsevier Ireland Ltd. All rights reserved.