Lowering hospital charges in the trauma intensive care unit while maintaining quality of care by increasing resident and attending physician awareness
Lowering hospital charges in the trauma intensive care unit while maintaining quality of care by increasing resident and attending physician awareness
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DOI：
10.1097/00005373-199512000-00004
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发表时间：
1995-12-01
影响因子：
--
通讯作者：
Stein, MA
中科院分区：
文献类型：
--
作者：
Blackstone, ME;Miller, RS;Stein, MA
目的：本研究的目的是确定创伤重症监护室（TICU）的费用是否可以通过非正式的每日床边住院医师-主治医师讨论关于诊断和治疗替代方案的相对患者成本来降低，设计：这是一项前瞻性的干预前和干预后研究，设置：本研究在一家I级、基于社区的大学附属教学医院的TICU中进行，患者：连续91例患者在6个月期间入住TICU，材料和方法：连续两个3个月期间跟踪TICU的费用。前3个月作为对照，没有试图改变护理成本，居民不知道研究正在进行中，在随后的3个月期间，主治医生明确地与居民讨论了诊断和治疗干预的相对成本，试图降低收费，手术创伤团队的组成在整个研究中保持不变。测量和主要结果：两个研究组之间的中位和平均年龄、损伤严重程度评分、重症监护病房住院时间和性别比例没有统计学差异，干预后组的总中位日费用比对照组减少818美元/重症监护病房日（p = 0.0002），费用减少的主要类别包括药物（151美元/天，p = 0.003），实验室检查（120美元/天，p = 0.072），胸部X光片（61美元/天，p = 0.001），呼吸治疗（185美元/天，p = 0.21）和杂项费用（141美元/天，p = 0.055），死亡率和严重并发症数量在组间无统计学差异，结论：提高对成本因素的认识，并采取具体措施降低患者成本，从而在不影响护理质量的情况下，明显降低了TICU的每日收费。
Objective: The goal of this study was to determine if trauma intensive care unit (TICU) charges could be reduced through informal daily bedside resident-attending physician discussions regarding relative patient costs of diagnostic and therapeutic alternatives,Design: This was a prospective pre- and postinterventional study,Setting: The study took place in a TICU in a level I, community-based, university-affiliated teaching hospital,Patients: Ninety-one consecutive patients were admitted to the TICU during a 6-month period,Materials and Methods: The TICU charges were tracked over two consecutive 3-month periods. The first 3 months served as control, No attempt was made to alter cost of care, and residents were unaware that a study was in progress, During the ensuing 3-month period, attendings explicitly discussed with residents relative costs of diagnostic and therapeutic interventions in an attempt to lower charges, Composition of the surgical trauma team remained constant throughout the study.Measurement and Main Results: The median and mean age, Injury Severity Score, intensive care unit length of stay, and sex ratio were not statistically different between the two study groups, Total median daily charges of the postintervention group were reduced over the control group by $818/intensive care unit day (p = 0.0002), The major categories in which charges were reduced included medications ($151/day, p = 0.003), laboratory tests ($120/day, p = 0.072), chest x-ray films ($61/day, p = 0.001), respiratory therapy ($185/day, p = 0.21), and miscellaneous charges ($141/day, p = 0.055), Mortality rates and number of major complications were not statistically different between groups,Conclusions: Increased awareness of cost factors and specific attempts to achieve patient cost reduction resulted in a demonstrable decrease in daily TICU charges, without compromising the quality of care.