A Comprehensive Analysis of the Costs of Severe Maternal Morbidity.
A Comprehensive Analysis of the Costs of Severe Maternal Morbidity.
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DOI：
10.1016/j.whi.2021.12.006
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发表时间：
2022-07
影响因子：
3.2
通讯作者：
Phibbs, Ciaran S.
中科院分区：
文献类型：
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作者：
Phibbs, Claire M.;Kozhimannil, Katy B.;Leonard, Stephanie A.;Lorch, Scott A.;Main, Elliott K.;Schmitt, Susan K.;Phibbs, Ciaran S.
这项研究的目的是在估计严重孕产妇发病率（SMM）的总成本中包括再入院和医师成本，以考虑SMM对孕产妇住院时间（LOS）的影响，并检查这些对SMM的限制定义，而SMM的定义不包括仅排血案件。
在辅助数据分析中使用了加利福尼亚州的2009 - 2011年（n = 1,262,862）的出生证书出院数据（n = 1,262,862），并使用了LOS。费用比率用于估算费用的成本，调整通货膨胀。医师的付款是从特定诊断相关组的平均付款中估计的。广义线性模型估计了SMM与成本与LOS之间的关联。
除了再入院和医师费用外，SMM与医院费用增加了60％（边际效果（ME）$ 3,550），LOS增加了33％（ME 0.9天）。当包括物理成本和再选中时，这些增加到70％（我$ 5,806）和46％（我1.3天）。对于仅需要输血（49％，我4,056美元和31％，我0.9天）的患者，SMM的影响大约是一半，而SMM的另一个患者（93％，我7,664美元，7,664美元和62％，我1.7天）。
产后医院再入院和医师费用很重要，以前是SMM成本的未报告的贡献者。与SMM相关的超额成本和LOS的差异差异很大。成本效应大于LOS效应，表明SMM超出了LOS的增加，可以提高治疗强度，而减少SMM的健康和成本收益可能比以前所理解的更广泛。
The objectives of this study were to include readmissions and physician costs in the estimates of total costs of severe maternal morbidity (SMM), to consider the effect of SMM on maternal length of stay (LOS), and to examine these for the more restricted definition of SMM that excludes transfusion-only cases. California linked birth certificate-patient discharge data for 2009-2011 (N=1,262,862) with complete costs and LOS were used in a secondary data analysis. Cost-to-charge ratios were used to estimate costs from charges, adjusting for inflation. Physician payments were estimated from mean payments for specific diagnosis related groups. Generalized linear models estimated the association between SMM and costs and LOS. Excluding readmissions and physician costs, SMM was associated with a 60% increase in hospital costs (marginal effect (ME) $3,550) and 33% increase in LOS (ME 0.9 days). These increased to 70% (ME $5,806) and 46% (ME 1.3 days) when physican costs and readmissions were included. The effects of SMM were roughly half as large for patients who only required a blood transfusion (49%, ME $4,056 and 31%, ME 0.9 days) as for patients who had another indicator for SMM (93%, ME $7,664 and 62%, ME 1.7 days). Postpartum hospital readmissions and physician costs are important and previously unreported contributors to the costs of SMM. Excess costs and LOS associated with SMM vary considerably by indication. Cost effects were larger than the LOS effects, indicating that SMM increases treatment intensity beyond increasing LOS, and reducing SMM may have broader health and cost benefits than previously understood.
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影响因子：
2
作者：
Chen, Han-Yang;Chauhan, Suneet P.;Blackwell, Sean C.
通讯作者：
Blackwell, Sean C.
影响因子：
7.2
作者：
Main, Elliott K.;McCain, Christy L.;Lawton, Elizabeth S.
通讯作者：
Lawton, Elizabeth S.
DOI：
10.1016/j.ogc.2019.01.014
发表时间：
2019-06-01
影响因子：
3.2
作者：
Markow, Cathie;Main, Elliott K.
通讯作者：
Main, Elliott K.
影响因子：
7.2
作者：
Admon, Lindsay K.;Winkelman, Tyler N. A.;Dalton, Vanessa K.
通讯作者：
Dalton, Vanessa K.
影响因子：
7.2
作者：
通讯作者：
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