The cost estimator in the TraumaRegister DGU
The cost estimator in the TraumaRegister DGU
复制标题
DOI：
10.1007/s00113-016-0266-1
复制
发表时间：
2017-12-01
期刊：
影响因子：
--
通讯作者：
Franz, D.
中科院分区：
文献类型：
--
作者：
Lefering, R.;Mahlke, L.;Franz, D.
严重受伤患者的估计治疗费用经常被添加到基于登记的分析中。过去，TraumaRegister DGUA（R）为此使用模块化成本估算器。德国创伤协会（DGU）最近发起的一项研究项目评估了德国DRG系统中严重受伤患者的报销情况。该项目还改进了登记册费用估算的更新，从10家参加TraumaRegister DGUA（R）的医院获得了严重受伤患者急性治疗的详细费用数据。使用医院代码、入院日期、年龄、性别和住院时间匹配费用和登记数据。以住院费用作为因变量的多变量回归分析包括损伤严重程度评分（ISS）ae 9分且住院至少3天的患者。所有损伤均采用简明损伤量表（AIS）进行编码。2007年和2008年治疗的1002例患者成功匹配。根据德国DRG研究所（InEK）提供的计算方法收集每例病例的成本数据。平均年龄为44岁，73%为男性;平均ISS为27分。以下方面与总住院费用显著相关：在重症监护室（ICU）的住院时间（1152 a，每天无体征）;插管/通气时长（568 a，每天不签名）;在普通病房的住院时间（531 a，每天无签名）;血液制品数量（浓缩红细胞;新鲜冷冻血浆）输血，直至入住ICU（258 a，每单位无符号）;严重腹部损伤（AIS ae 3; 2849 a，无体征）;不稳定骨盆骨折伴相关失血（AIS 5; 7505 a，无体征）;四肢严重损伤（AIS 3-4; 2418 a，无体征）。按上述公式计算的总治疗费用平均为22，138美元/例。与测量的真实的成本（21，546 a，每例）的偏差小于3%.TraumaRegister DGUA（R）中仅使用注册表中所有患者可用的关键数据，现在可以获得急性护理成本的有效成本估计。
Estimated treatment costs of severely injured patients were often added to registry-based analyses. In the past, the TraumaRegister DGUA (R) used a modular cost estimator for this purpose. A recent research project initiated by the German Trauma Society (DGU) evaluated the reimbursement of severely injured patients in the German DRG system. This project also allowed the generation of an improved update of the registry's cost estimator.Detailed cost data for the acute therapy of severely injured patients were available from 10 hospitals that also participate in the TraumaRegister DGUA (R). Cost and registry data were matched using hospital code, date of admission, age, sex, and length of stay. A multivariate regression analysis with hospital costs as dependent variable included patients with an injury severity score (ISS) ae 9 points who stayed in hospital at least three days. All injuries were coded using the abbreviated injury scale (AIS).A total of 1002 patients treated in 2007 and 2008 were successfully matched. Cost data was collected for each case according to the method of calculation provided by the German DRG Institute (InEK).The mean age was 44 years and 73 % were males; the mean ISS was 27 points. The following aspects were significantly associated with the overall hospital costs: length of stay on the intensive care unit (ICU) (1152 a,notsign per day); length on intubation/ventilation (568 a,notsign per day); length of stay on normal ward (531 a,notsign per day); number of blood products (packed red blood cells; fresh frozen plasma) transfused until ICU admission (258 a,notsign per unit); a serious abdominal injury (AIS ae3; 2849 a,notsign); an instable pelvic fracture with relevant blood loss (AIS 5; 7505 a,notsign); and a serious injury of the extremities (AIS 3-4; 2418 a,notsign). The estimated overall treatment costs calculated by the above mentioned formula averaged 22,138 a,notsign per case. The deviation from the measured real costs (21,546 a,notsign per case) was less than 3 %.Using only key data available for all patients in the registry, a valid cost estimator for acute care costs is now available in the TraumaRegister DGUA (R).