Guideline Adherence and Hospital Costs in Pediatric Severe Traumatic Brain Injury.
Guideline Adherence and Hospital Costs in Pediatric Severe Traumatic Brain Injury.
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DOI：
10.1097/pcc.0000000000000698
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发表时间：
2016-05
期刊：
影响因子：
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通讯作者：
Pediatric Guideline Adherence and Outcomes Study
中科院分区：
文献类型：
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作者：
Graves JM;Kannan N;Mink RB;Wainwright MS;Groner JI;Bell MJ;Giza CC;Zatzick DF;Ellenbogen RG;Boyle LN;Mitchell PH;Rivara FP;Wang J;Rowhani-Rahbar A;Vavilala MS;Pediatric Guideline Adherence and Outcomes Study
遵守儿科创伤性脑损伤 (TBI) 指南与提高生存率和改善功能结果相关。然而，指南依从性与住院费用之间的关系尚未得到研究。旨在评估通过急性护理临床指标衡量的儿科严重 TBI 指南的依从性与与严重 TBI 相关的住院总费用之间的关系。回顾性队列研究 附属于学术医疗中心的五个地区儿科创伤中心。包括严重脑外伤儿科患者（17 岁以下）的人口统计、伤害、治疗和收费数据。确定每位患者对临床指标的遵守百分比。成本费用比用于估算每位患者的 ICU 费用和医院总费用。广义线性模型评估了医疗保健费用和依从率之间的关联。检查了 235 名患者的费用数据。估计平均调整后住院费用为 103,485 美元（95% CI：98,553–108,416）；调整后的 ICU 费用为 82,071 美元（95% CI：78,559–85,582）。在调整患者和损伤特征后，未发现遵守指南与医院或 ICU 总费用之间存在关联。调整后的回归模型结果显示，医院和 ICU 费用的成本比率等于 1.01（95% CI：分别为 0.99-1.03 和 0.99-1.02）。在这 5 个领先的儿科创伤中心，遵守严重儿科创伤性脑损伤指南与住院和 ICU 费用的增加无关。因此，成本不应成为一个因素，因为机构和提供者努力为患有严重 TBI 的儿童提供基于证据的指导驱动的护理。
Adherence to pediatric traumatic brain injury (TBI) guidelines has been associated with improved survival and better functional outcome. However, the relationship between guideline adherence and hospitalization costs has not been examined. To evaluate the relationship between adherence to pediatric severe TBI guidelines, measured by acute care clinical indicators, and the total costs of hospitalization associated with severe TBI. Retrospective cohort study Five regional pediatric trauma centers affiliated with academic medical centers. Demographic, injury, treatment, and charge data were included for pediatric patients (age under 17 years) with severe traumatic brain injury. Percent adherence to clinical indicators was determined for each patient. Cost-to-charge ratios were used to estimate ICU and total hospital costs for each patient. Generalized linear models evaluated the association between healthcare costs and adherence rate. Cost data for 235 patients were examined. Estimated mean adjusted hospital costs were $103,485 (95% CI: 98,553–108,416); adjusted ICU costs were $82,071 (95% CI: 78,559–85,582). No association was found between adherence to guidelines and total hospital or ICU costs, after adjusting for patient and injury characteristics. Adjusted regression model results provided cost ratio equal to 1.01 for hospital and ICU costs (95% CI: 0.99–1.03 and 0.99–1.02, respectively). Adherence to severe pediatric traumatic brain injury guidelines at these 5 leading pediatric trauma centers was not associated with increased hospitalization and ICU costs. Therefore, cost should not be a factor as institutions and providers strive to provide evidence based guideline driven care of children with severe TBI.