Resource utilization and costs of stroke unit care in Germany
Resource utilization and costs of stroke unit care in Germany
复制标题
DOI：
10.1111/j.1524-4733.2004.72314.x
复制
发表时间：
2004-03-01
期刊：
影响因子：
4.5
通讯作者：
Back, T
中科院分区：
文献类型：
--
作者：
Dodel, RC;Haacke, C;Back, T
目标：中风给个人和社会带来相当大的经济负担。最近，多个国家建立了综合卒中单元的概念，以改善患者的预后。本研究评估了一个卒中单元中不同脑血管损伤的急性护理费用。方法：研究人群包括2000年1月1日至6月30日期间连续入住马尔堡菲利普斯大学神经内科的340例诊断为卒中或短暂性脑缺血发作（TIA）的患者。采用Barthel指数和改良Rankin量表评估临床状态和病程。我们采用“自下而上”的方法，从医院和第三方付款人的角度，使用提供部门和其他公开来源的数据来计算费用。结果：TIA 住院费用为 3020 美元（3290 美元），缺血性中风（IS）为 3480 美元（3790 美元），脑出血（ICH）为 5080 美元（5540 美元），并且差异显着在这些亚组中 (P < .05)。患者亚组的平均住院时间排名相同，TIA 为 9.4 天，IS 为 10.2 天，ICH 为 11.9 天（P > .05）。大约 30% 的医院费用来自医生费用和护理。影像学占总成本的 10%，实验室检查占总成本的 14%，与诊断无关。急性后期治疗，包括住院康复，每位患者的费用为 9880 美元。在所有诊断组中，出院时观察到平均临床改善。结论：中风病房中脑血管事件患者的护理导致对资源的大量需求，并对医疗保健支出产生相当大的影响。因此，有必要对卒中单元概念与卒中护理中的其他策略进行比较，以评估卒中单元概念，以便合理利用脑血管事件患者的可用资源。
Objectives: Stroke imposes a considerable economic burden on the individual and society. Recently, the concept of an integrated stroke unit has been established in several countries to improve the outcome of patients. This study evaluates the costs of acute care of the different cerebrovascular insults in a stroke unit.Methods: The study population included 340 patients who were consecutively admitted to the Department of Neurology, Philipps University Marburg, with the diagnosis of stroke or transient ischemic attack (TIA) between January 1 and June 30, 2000. Clinical status and course were evaluated by using the Barthel index and the modified Rankin scale. Employing a "bottom-up" approach, we calculated the costs from the perspective of the hospital and the third-party payer using data from provider departments and other published sources.Results: Inpatient costs were 3020 (US$3290) for TIA, 3480 (US$3790) for ischemic stroke (IS), and 5080 (US-$5540) for intracerebral hemorrhage (ICH) and differed significantly among these subgroups (P < .05). Patient subgroups ranked in the same order for average length of stay at 9.4 days for TIA, 10.2 days for IS, and 11.9 days for ICH (P > .05). Approximately 30% of the hospital costs are due to physician charges and care. Imaging amounted to 10% and lab investigations to 14% of total costs, independent of the diagnosis. Postacute treatment, including inpatient rehabilitation, cost 9880 per patient. Across all diagnostic groups, a mean clinical improvement was observed at time of discharge.Conclusions: Care of patients with cerebrovascular events in a stroke unit causes a high demand of resources and has a considerable impact on health-care expenditure. Therefore, investigations comparing the stroke unit concept with other strategies in stroke care are necessary to evaluate the stroke unit concept for a rational use of available resources in patients with cerebrovascular events.