Cost-effectiveness of hospital discharge records for reaching selected endpoints in the surveillance of silicosis.
Cost-effectiveness of hospital discharge records for reaching selected endpoints in the surveillance of silicosis.
复制标题
出院记录对于达到矽肺监测选定终点的成本效益。
DOI：
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发表时间：
1998
影响因子：
3.5
通讯作者：
E. Socie
中科院分区：
文献类型：
--
作者：
C. Geidenberger;G. Nestel;E. Socie
背景
职业风险哨兵事件通知系统 (SENSOR) 是一个用于监测和干预职业状况的州/联邦系统。俄亥俄州 SENSOR 计划从多个数据源中识别矽肺病例，尽管出院记录在很大程度上被认为是实现 SENSOR 目标的最成功手段。然而，出院记录的成本效益尚未得到评估。因此，进行了成本分析，以比较出院记录与其他数据源的有效性，以实现矽肺监测的预防相关终点。
方法
回顾性地估计了达到三个终点（获取病例名称、识别工作地点和识别工作地点二氧化硅问题）的总成本，并以 1996 年美元为四个数据源进行衡量：医院出院记录、医生报告、工人赔偿索赔和死亡证明。然后将总成本除以每个源/端点组合的产出，以得出平均成本的估计值。
结果
每个病例的医院记录平均费用为 30 美元，医生报告费用为 212 美元，工人赔偿索赔费用为 19 美元，死亡证明费用为 7 美元。然而，为了确定有问题的工作地点，医院记录的成本最高，每个工作地点为 2,883 美元，而医生报告的费用为 2,558 美元，工人赔偿索赔的费用为 1,318 美元，死亡证明的费用为 1,310 美元。
结论
出院记录对于实现预防相关的监测目标来说成本效益最低。 SENSOR 下用于矽肺监测和干预的资源组合的变化，即从跟踪医院记录转向采用更具成本效益的方法来识别有二氧化硅问题的工作场所，可能会导致更有效地利用专门用于预防矽肺的公共卫生资源。
BACKGROUND
The Sentinel Event Notification System for Occupational Risks (SENSOR) is a state/federal system for the surveillance and intervention of occupational conditions. The Ohio SENSOR program identifies silicosis cases from a number of data sources, although hospital discharge records have largely been considered the most successful means of carrying out SENSOR objectives. However, the cost-effectiveness of hospital discharge records has not been evaluated. Thus, a cost analysis was conducted to compare the effectiveness of hospital discharge records with other data sources for achieving prevention-related endpoints of silicosis surveillance.
METHODS
Total costs of reaching three endpoints (obtaining case names, identifying work sites, and identifying silica problems in work sites) were estimated retrospectively and measured in 1996 dollars for four data sources: hospital discharge records, physician reports, workers' compensation claims, and death certificates. Total costs were then divided by output for each source/endpoint combination to produce estimates of average costs.
RESULTS
The average cost per case was $30 for hospital records, $212 for physician reports, $19 for workers' compensation claims, and $7 for death certificates. However, for identifying problem work sites, hospital records were most expensive at $2,883 per work site, compared with $2,558 for physician reports, $1,318 for workers' compensation claims, and $1,310 for death certificates.
CONCLUSIONS
Hospital discharge records were least cost-effective for accomplishing prevention-related goals of surveillance. A change in the mix of resources applied to silicosis surveillance and intervention under SENSOR, i.e., a shift away from follow-up of hospital records toward more cost-effective methods for identifying work sites with silica problems may result in more efficient use of public health resources devoted to the prevention of silicosis.