Discharges with surgical procedures performed less often than once per month per hospital account for two-thirds of hospital costs of inpatient surgery
Discharges with surgical procedures performed less often than once per month per hospital account for two-thirds of hospital costs of inpatient surgery
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DOI：
10.1016/j.jclinane.2017.07.003
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发表时间：
2017-09-01
影响因子：
6.7
通讯作者：
Epstein, Richard H.
中科院分区：
文献类型：
--
作者：
O'Neill, Liam;Dexter, Franklin;Epstein, Richard H.
研究目的：在普通医院，大多数手术出院（54%）是由于该医院每月不超过一次的手术。我们假设，这种不常见的手术在该医院所有外科手术的总费用中所占的比例甚至更高。设计：观察性研究。背景：德克萨斯州医院出院摘要数据：2015年第四季度和2016年第一季度。病人：住院病人出院后的主要治疗（“手术”）程序。测量方法：根据国际疾病分类第10版程序编码系统（ICD-10-PCS）对N = 343家医院的每个程序或组合程序进行分类，获得每个程序或组合程序的出院数、住院总时间（LOS）、诊断相关组（DRG）病例组合权重和收费总额。每次出院分为两类，不常见与不常见，定义为每月最多一次的手术与每月多于一次的手术。主要结果：每家医院每月最多进行一次的主要手术平均占所有主要治疗手术相关住院总费用的68%。平均而言，与不常见手术相关的总成本百分比比预期高出26%，这是基于它们在总出院中所占的份额（P < 0.00001）。平均百分比差异对终点不敏感，患者天数百分比和DRG病例混合权重百分比的结果相似。结论：大约三分之二（平均68%）的外科患者住院费用可归因于每家医院每月最多进行一次手术。发现这些不常见的程序占成本的很大比例是很重要的，因为按程序核算成本的方法通常不适合它们。(C) 2017爱思唯尔公司版权所有。
Study Objective: Most surgical discharges (54%) at the average hospital are for procedures performed no more often than once per month at that hospital. We hypothesized that such uncommon procedures would be associated with an even greater percentage of the total cost of performing all surgical procedures at that hospital.Design: Observational study.Setting: State of Texas hospital discharge abstract data: 4th quarter of 2015 and 1st quarter of 2016.Patients: Inpatients discharged with a major therapeutic ("operative") procedure.Measurements: For each of N = 343 hospitals, counts of discharges, sums of lengths of stay (LOS), sums of diagnosis related group (DRG) case-mix weights, and sums of charges were obtained for each procedure or combination of procedures, classified by International Classification of Diseases version 10 Procedure Coding System (ICD-10-PCS). Each discharge was classified into 2 categories, uncommon versus not, defined as a procedure performed at most once per month versus those performed more often than once per month.Main results: Major procedures performed at most once per month per hospital accounted for an average among hospitals of 68% of the total inpatient costs associated with all major therapeutic procedures. On average, the percentage of total costs associated with uncommon procedures was 26% greater than expected based on their share of total discharges (P < 0.00001). Average percentage differences were insensitive to the endpoint, with similar results for the percentage of patient days and percentage of DRG case-mix weights.Conclusions: Approximately 2/3rd (mean 68%) of inpatient costs among surgical patients can be attributed to procedures performed at most once per month per hospital. The finding that such uncommon procedures account for a large percentage of costs is important because methods of cost accounting by procedure are generally unsuitable for them. (C) 2017 Elsevier Inc. All rights reserved.