Estimating Resource Utilization in Congenital Heart Surgery.
Estimating Resource Utilization in Congenital Heart Surgery.
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DOI：
10.1016/j.athoracsur.2020.01.013
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发表时间：
2020-09
期刊：
影响因子：
--
通讯作者：
Jacobs JP
中科院分区：
文献类型：
--
作者：
Pasquali SK;Chiswell K;Hall M;Thibault D;Romano JC;Gaynor JW;Shahian DM;Jacobs ML;Gaies MG;O'Brien SM;Norton EC;Hill KD;Cowper PA;Pinto NM;Shah SS;Mayer JE;Jacobs JP
评估先天性心脏病手术资源利用的最佳方法仍不清楚。我们比较了传统的成本费用比方法与新的标准化成本方法，旨在更直接地评估资源消耗。STS数据库的临床数据与儿科健康信息系统数据库（2010-2015）的资源使用数据相关联。制定了先天性心脏病手术人群的标准化成本方法，并与成本费用比方法进行了比较。使用调整病例组合的分层混合效应模型描述了总体人群的资源使用和医院间的变异性。共纳入43家医院（65，331例患者）。用这两种方法估计的资源使用分布情况在人口一级的差异极小。在医院层面，使用标准化成本与成本收费比方法，总体（变异系数20%与25%）和复杂性（STAT）类别之间的资源使用差异不明显。当医院按资源使用分为三分位时，33%的医院根据使用的资源使用方法改变了分类（26%按一个三分位数，7%按两个三分位数）。在先天性心脏病人群的标准化成本方法的首次评估中，我们发现在人群水平上与传统方法的差异很小。在医院层面，标准化成本方法的资源使用变化幅度较小，约1/3的中心根据所使用的方法改变了资源使用类别。由于这些差异，在今后的研究和基准/报告工作中，在选择最佳方法时应注意。
Optimal methods to assess resource utilization in congenital heart surgery remain unclear. We compared traditional cost-to-charge ratio methods with newer standardized cost methods which aim to more directly assess resources consumed. Clinical data from the STS Database were linked with resource use data from the Pediatric Health Information Systems Database (2010–2015). Standardized cost methods specific to the congenital heart surgery population were developed and compared to cost-to-charge ratio methods. Resource use in the overall population and variability across hospitals were described using hierarchical mixed effect models adjusting for case-mix. Overall 43 hospitals (65,331 patients) were included. There were minimal population-level differences in the distribution of resource use as estimated by the two methods. At the hospital-level, there was less apparent variability in resource use across centers with the standardized cost vs. cost-to-charge ratio method, overall (coefficient of variation 20% vs. 25%) and across complexity (STAT) categories. When hospitals were categorized into tertiles by resource use, 33% changed classification depending on which resource use method was used (26% by one tertile and 7% by two tertiles). In this first evaluation of standardized cost methodology in the congenital heart population, we found minimal differences vs. traditional methods at the population-level. At the hospital-level, the magnitude of variation in resource use was less with standardized cost methods and ~1/3 of centers changed resource use categories depending on the methodology used. Because of these differences, care should be taken in future studies and benchmarking/reporting efforts in selecting optimal methodology.
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影响因子：
4.6
作者：
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通讯作者：
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作者：
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DOI：
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发表时间：
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影响因子：
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DOI：
10.1377/hlthaff.2011.0783
发表时间：
2011-11
期刊：
Health affairs (Project Hope)
影响因子：
--
作者：
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通讯作者：
Birkmeyer JD
影响因子：
26.1
作者：
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通讯作者：
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