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Antibiotic use and cost indicators at a rural hospital: A pilot project

AMERICAN JOURNAL OF INFECTION CONTROL 2000年第6期28卷 415-420页

作者： Mylotte, JM Weislo, P SUNY Buffalo Sch Med & Biomed Sci Dept Med Buffalo NY 14260 USA SUNY Buffalo Sch Med & Biomed Sci Dept Microbiol Buffalo NY 14260 USA Lake Shore Hlth Care Ctr Serv Pharm Irving TX USA

Background: Recently, simple antibiotic use and cost indicators were developed for use in long-term care facilities. It was hypothesized that these indicators also may be applicable to the acute hospital setting. Methods: For a 24-month period, data were collected quarterly on antibiotic use and cost indicators for 11 primary care physicians in a 40-bed rural hospital. Indicators included antimicrobial use ratio (AUR, ratio of the number of antibiotic days to the number of patient care days), cost per antibiotic day, and cost of antibiotics per patient care day. One-way analysis of variance and simple linear regression were used to analyze data. Results: Quinolones (oral plus parenteral) accounted for 26% of the total antibiotic days (N = 6020) followed by ceftriaxone (19%) and cefuroxime (11.8%;oral plus parenteral). Overall trends in antibiotic use and cost included a significant increase in quarterly AUR (R-2 = 0.78, P = .004) and cost per patient care day (R-2 = 0.82, P = .002) but no significant change in quarterly total antibiotic costs or cost per antibiotic day. Among physicians there was a significant difference in mean quarterly AUR (P < .001) and mean quarterly cost per patient care day (P < .001) but no significant difference in mean quarterly cost per antibiotic day. Variation in physician-specific cost per patient care day was best explained by variation in AUR (R-2 = 0.75, P < .001). Conclusions: Significant variation in simple antibiotic use and cost indicators was identified at a rural hospital from both the facility and physician perspective. Standardized methods for antibiotic use and cost monitoring, like the one described in this article, are required before the relationship between antibiotic use ana resistance can be fully understood.

关键词：方差分析抗菌药/经济学抗菌药/治疗应用药费支出/统计学和数值数据药物利用评审/经济学药物利用评审/统计学和数值数据家庭医学/经济学家庭医学/统计学和数值数据卫生服务研究医院病床数 100张以下医院费用/统计学和数值数据医院乡村/经济学医院乡村/统计学和数值数据内科学/经济学内科学/统计学和数值数据住院时间/经济学住院时间/统计学和数值数据线性模型纽约试点项目前瞻性研究人类

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Trauma services: A profit center?

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JOURNAL OF THE AMERICAN COLLEGE OF SURGEONS 1999年第4期188卷 349-354页

作者： Taheri, PA Butz, DA Watts, CM Griffes, LC Greenfield, LJ Univ Michigan Med Ctr Div Trauma Burn & Emergency Surg Dept Surg Ann Arbor MI 48109 USA Univ Michigan Dept Pulm Med Ann Arbor MI 48109 USA Univ Michigan Sch Business Div Business Econ Ann Arbor MI 48109 USA Univ Michigan Hosp Hosp Finance Ann Arbor MI 48109 USA

Background: Previous studies have demonstrated inadequate reimbursement for severely injured patients with a resultant negative economic impact for the trauma service and hospital. The purpose of this study was to assess the total cost of care for all injured patients discharged from the trauma service in fiscal year 1997, and to determine the proportion of costs for the most severely injured on total cost. In addition, we assessed the total service costs and the revenue for treatment of the most severely ill. The final result nas the determination of the profit (loss) margin for the entire service. Study Design: All patients discharged from our Level I Trauma Center in fiscal year 1997 were included (n = 696). The population was then stratified into 2 subgroups using the Injury Severity Score (ISS). Patient grouping was facilitated by integration of the trauma registry with the hospital cost accounting system. The population was sub-divided into 2 distinct groups. Group A represented all patients with an ISS > 15 (n = 192). Group B contained all patients with an ISS < 15 (n = 504). Length of stay and mortality of each group was recorded. Cost of care was determined by the hospital cost accounting system TSI (Transition System Incorporated, Boston, MA), which is designed to generate cost center data on a cost per patient basis. Total costs were determined for the entire population and Groups A and B. The proportion of costs consumed by each group was then calculated. Reimbursement was determined by calculating expected payments for each patient. These calculations are based on previously agreed upon allowances from each insurer and are reconciled at the end of each fiscal year to ensure accuracy. Results: The average length of stay for the population and Groups A and B were 7.5, 9.8, and 6.7 days respectively. Mortality in each group was 9.7%, 19.3%, and 6%. Over 92% of the population sustained blunt mechanism injury and only 8% were penetrating. When controlled for

关键词：费用分配诊断相关患者组/分类诊断相关患者组/经济学医院费用/统计学和数值数据医院大学/经济学损伤严重度评分保险住院密执安创伤诊治中心/经济学美国创伤和损伤/分类创伤和损伤/经济学人类

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The Chinese experience of hospital price regulation

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HEALTH POLICY AND PLANNING 2000年第2期15卷 157-163页

作者： Liu, XZ Liu, YL Chen, NS Harvard Univ Sch Publ Hlth Program Hlth Care Financing Cambridge MA 02138 USA Shandong Med Univ Inst Social Med & Hlth Policy Jinan Peoples R China

This paper analyzes the distortion effects of the hospital pricing policies in China. To help maintain equitable access to hospital services, the Chinese government regulates prices of hospital services, and provides subsidies to public hospitals. Comparing the regulated fees of selected hospital services with their average unit costs indicates that the average cost-recovery rate of the fees is only 50%, The fees for 90% of the services are less than their average unit costs, while the fees for the high-tech services exceed their costs, Moreover, the State Price Commission allowed a drug profit margin of 15-20% over the wholesale price. The distorted fee schedule affects the behaviour of hospitals. Empirical evidence revealed problems of violation of price regulations (charging a fee exceeding the regulated fee), over-provision of profitable high-tech services and over-prescription of drugs, The Chinese experience shows that low regulated fees cannot reduce the economic burden on patients, and that distorted medical fees can result in distorted service provision and low efficiency of medical resources, Strategies to correct for the price distortions are discussed.

关键词：中国费用控制/立法和法学药费支出费用医疗/统计学和数值数据卫生保健改革卫生政策/立法和法学医院收费/立法和法学医院收费/统计学和数值数据医院费用/统计学和数值数据工艺学高成本

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Role of perspective and other uncertainties in cost-effectiveness assessments in advanced prostate cancer

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JNCI-JOURNAL OF THE NATIONAL CANCER INSTITUTE 2000年第21期92卷 1704-1706页

作者： Hillner, BE Roberts, JD Virginia Commonwealth Univ Dept Internal Med Richmond VA 23298 USA Virginia Commonwealth Univ Massey Canc Ctr Richmond VA 23298 USA

Both its natural history and typical age at presentation make prostate cancer a disease for whose treatment the largest third-party payer is the U.S. taxpayer. Medicare payments for prostate cancer treatment were estimated to be $1.4 billion in 1994 (1). Therefore, the cost-effectiveness analysis by Bayoumi et al. (2) in this issue of the Journal, addressing three critical issues in advanced prostate cancer—medical versus surgical castration, the role of total androgen blockade with castration plus nonsteroidal antiandrogens, and the optimal timing of any of these—is timely and appropriate. Substantial attention has been directed at potential biases in the reporting and funding of cost-effectiveness analyses of pharmaceutical agents (3,4). Identifying such biases has been easier since de facto national standards were established by the 1996 U.S. Public Health Service's Panel on Cost-effectiveness in Health and Medicine (5). This report, commissioned by a federal agency (the Agency for Healthcare Research and Quality) at the request of the Health Care Finance Administration (Medicare), has an unusual potential bias: It assumes that the government's perspective is aligned with that of society—i.e., one that incorporates all costs and effects regardless of who incurs them. In this editorial, we highlight a variety of methods, concerns, and clinical issues within (not against) the cost-effectiveness paradigm. The costs and quality-of-life tradeoffs associated with the form of therapy intended to lower serum testosterone levels lead to completely different conclusions about the optimal form of therapy depending on one's perspective. The consensus is that medical and surgical castration is equally effective (or ineffective) at prolonging life and delaying disease-specific complications (6). From a societal and Medicare perspective, the obvious preferred strategy is orchiectomy based on lower cost. The current choice of 75% of U.S. men is to receive luteinizing hormone rel

关键词：雄激素拮抗药/经济学抗肿瘤药激素/经济学选择行为费用效益分析疾病恶化药费支出/统计学和数值数据促性腺素释放激素/激动剂医院费用/统计学和数值数据 Medicare 睾丸切除术/经济学前列腺特异抗原/血液前列腺肿瘤/药物疗法前列腺肿瘤/经济学前列腺肿瘤/免疫学前列腺肿瘤/病理学前列腺肿瘤/外科学前列腺肿瘤/治疗生活质量时间因素治疗结果美国人类男(雄)性

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Acute and long-term cost implications of coronary stenting

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JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY 1999年第6期33卷 1610-1618页

作者： Peterson, ED Cowper, PA DeLong, ER Zidar, JP Stack, RS Mark, DB Duke Univ Med Ctr Div Cardiol Dept Med Durham NC 27710 USA Duke Univ Med Ctr Dept Community & Family Med Div Biometry Durham NC 27710 USA

OBJECTIVES We compared the acute and one year medical costs and outcomes of coronary stenting with those for balloon angioplasty (percutaneous transluminal coronary angioplasty) in contemporary clinical practice. BACKGROUND While coronary stent implantation reduces the need for repeat revascularization, it has been associated with Significantly higher acute costs compared with coronary angioplasty. METHODS We studied patients treated at Duke University between September 1995 and June 1996 who received either coronary stent (n = 384) or coronary angioplasty(n = 159) and met eligibility criteria. Detailed cost data were collected initially and up to one year following the procedure. Our primary analyses compared six and 12 month cumulative costs for coronary angioplasty-and stent-treated cohorts. We also compared treatment costs after excluding nontarget vessel interventions;after limiting analysis to those without prior revascularization;and:after risk-adjusting cumulative cost estimates. RESULTS Baseline clinical characteristics Were generally similar between the two treatment groups. The mean in-hospital cost for stent patients was $3,268 higher than for those receiving coronary angioplasty ($14,802 vs. $11,534, p < 0.001). However, stent patients were less likely to be rehospitalized (22% vs. 34%, p = 0.002) or to undergo repeat revascularization (9% vs. 26%, p = 0.001) than coronary angioplasty patients within six months of the procedure. As such, mean cumulative costs at 6 months ($19,598 vs. $19,820, p = 0.18) and one year ($22,140 vs. $22,571, p = 0.26) were similar for the two treatments. Adjusting for baseline predictors of cost and selectively examining target vessel revascularization, or those without prior coronary intervention yielded similar conclusions. CONCLUSIONS In contemporary practice, coronary Stenting provides equivalent or better one-year patient Outcomes without increasing cumulative health care costs. (C) 1999 by the American College of Cardi

关键词：血管成形术气囊冠状动脉/经济学血管成形术气囊冠状动脉/仪器和设备冠心病/经济学冠心病/治疗费用效益分析随访研究医院费用/统计学和数值数据住院时间/经济学心肌梗死/经济学心肌梗死/治疗心肌血管重建术/经济学北卡罗来纳结果与过程评价(卫生保健) 病人再入院/经济学支架/经济学老年人女(雌)性人类男(雄)性中年人

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Laparoscopic versus open appendectomy

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AMERICAN JOURNAL OF SURGERY 2000年第5期179卷 375-378页

作者： Merhoff, AM Merhoff, GC Franklin, ME Texas Lutheran Univ Seguin TX 78155 USA Merle W Med Ctr Klamath Falls OR USA Texas Endosurg Inst San Antonio TX USA

BACKGROUND: Laparoscopic appendectomy is commonly performed and has been presumed to offer economic benefits similar to those of laparoscopic cholecystectomy. This study was done to examine that premise. METHODS: TWO surgical groups contributed consecutively operated patients with a clinical diagnosis of appendicitis. One group did all appendectomies open and the other group did them laparoscopically. Hospital expenses were compared using a single billing formula. Hospital length of stay, time to return to work, and complications were analyzed. RESULTS: Operating room times were longer for the laparoscopic group, median 80 minutes, versus median 50 minutes for the open group. Hospital length of stay and return to work were the same, median 1 day and median 10 days, respectively. Wound complications were less common in the laparoscopic group, 0 of 30, than in the open group, 3 of 18;however, there was 1 intra-abdominal abscess in the laparoscopic group. Median cost of the laparoscopic group was $2,915 versus $1,747 for the open group. CONCLUSIONS: Laparoscopic appendectomy is more expensive than appendectomy but does not reduce hospital length of stay nor change the time to return to work;however, wound complications are less common. (C) 2000 by Excerpta Medica, Inc.

关键词：缺勤急性病阑尾切除术/经济学阑尾切除术/仪器和设备阑尾切除术/方法阑尾炎/外科学费用效益分析医院收费医院费用/统计学和数值数据腹腔镜检查/经济学腹腔镜检查/方法住院时间/统计学和数值数据回顾性研究技术评估生物医学时间因素伤口感染/病因学青少年成年人老年人儿童女(雌)性人类男(雄)性中年人

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Effect of risk factors on the costs of coronary surgery

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AMERICAN JOURNAL OF CARDIOLOGY 2000年第11期85卷 1338-+页

作者： Robicsek, F Carolinas Heart Inst Dept Thorac & Cardiovasc Surg Carolinas Med Ctr Charlotte NC USA

In the era of modern coronary surgery, with appropriate institutional support, cardiac surgeons are expected to provide an uneventful perioperative course for low-risk patients (i.e., low morbidity and mortality, short hospital stay, ergo proper low hospital costs). In a high-risk patient population, however, only surgical excellence can cope with the inherent difficulty of keeping complication rates minimal, hospital stays short. and costs low.

关键词：冠状动脉分流术/经济学冠心病/经济学冠心病/病因学冠心病/外科学成本及成本分析健康状况指标医院费用/统计学和数值数据手术后并发症/经济学手术后并发症/病因学人类

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Identifying pre- and postoperative predictors of cost and length of stay for coronary artery bypass surgery

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American Journal of Medical Quality 1999年第6期14卷 248-254页

作者： Ghali, William A. Hall, Ruth E. Ash, Arlene S. Moskowitz, Mark A. Health Care Research Unit Section of General Internal Medicine Boston Medical Center Boston MA United States Faculty of Medicine University of Calgary Calgary Alta. Canada Inst. for Clin. Evaluative Sciences University of Toronto Toronto Ont. Canada Faculty of Medicine University of Calgary Calgary Alta. T2N 4N1 3330 Hospital Drive NW Canada

Prior studies of resource use for coronary artery bypass graft (CABG) surgery have either focused on a limited number of hospitals or have used charges instead of costs. We used a large statewide database (n = 6791) to study predictors of cost and length of stay (LOS) for CABG surgery. We used linear regression to sequentially model (a) specific procedures performed, (b) preoperative patient characteristics, and (c) postoperative events to determine the relative impact of these 3 factors on resource use. We then used the resulting models to calculate adjusted mean hospital costs and LOS. These 3 factors were all significantly associated with resource use. Postoperative events were the greatest determinant of costs, while preoperative characteristics were the greatest determinant of LOS. Despite risk adjustment for these factors, resource use differed significantly across 12 hospitals (mean cost range, $22,200 to $41,900;mean LOS range, 11 to 18 days), suggesting that some institutions may need to reduce their resource use.

关键词：方差分析规范/经济学规范/利用冠状动脉分流术/经济学冠状动脉分流术/统计学和数值数据卫生资源/经济学卫生资源/统计学和数值数据卫生资源/利用医院费用/统计学和数值数据住院时间/经济学住院时间/统计学和数值数据线性模型马萨诸塞/流行病学手术后并发症/经济学手术后并发症/流行病学预后疾病严重程度指数治疗结果老年人女(雌)性人类男(雄)性中年人

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Measuring the benefit of performance improvement and decision support

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American Journal of Medical Quality 1999年第6期14卷 262-269页

作者： Rosenstein, Alan H. VHA West Coast Pleasanton CA 94588 4900 Hopyard Road United States

In an effort to provide high quality care in a more cost-effective manner, health care providers have found it necessary to implement a series of decision support strategies designed to improve outcomes of care. While each of these strategies has measurable benefits, each comes along with additional costs. As more and more technology becomes available and more labor resources are devoted to these efforts, it becomes crucial to be able to assess the costs and benefits of these programs. A return-on-investment methodology is used to assess the financial impact of service-related operating expenses compared to revenue gains from service delivery. However, unlike traditional return-on-investment models, in health care, benefits are frequently gained from cost avoidance rather than from revenue enhancement activities. This article will describe a methodology for measuring the direct and indirect costs and qualitative and quantitative benefits of decision support activities.

关键词：坚持准则卫生保健公平提供医院费用/统计学和数值数据投资/经济学投资/统计学和数值数据规划制订方案评价质量保证卫生保健/经济学回顾性研究美国

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Graduate medical education costs in nonacademic health center teaching hospitals: Evidence from Maryland

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MEDICAL CARE RESEARCH AND REVIEW 2000年第1期57卷 3-23页

作者： Duffy, SQ Ruseski, JE Cavanaugh, S Subst Abuse & Mental Hlth Serv Adm Off Appl Studies Rockville MD 20857 USA Fed Trade Commiss Washington DC 20580 USA

As managed care has grown, much concern has been expressed about the potential plight of the nation's 125 academic health centers (AHCs). Less concern has focused on non-AHC teaching hospitals, although most studies of graduate medical education (GME) costs include these hospitals in their estimates. While most studies have found:that costs increase positively with various measures of "teaching intensity, " some have concluded that hospitals with smaller programs have costs that are the same or less than comparable nonteaching hospitals. However,few studies have tested whether AHCs' cost structures are sufficiently similar to those of other hospitals to reliably include them in the same estimation. This article tests that assumption for Maryland hospitals,finds it violated, and presents-results for non-AHC teaching hospitals. The results: reveal that, at least in Maryland, even small teaching programs add to hospital costs.

关键词：医学科学研究中心/经济学成本及成本分析教育医学研究生/经济学卫生服务研究医院费用/统计学和数值数据医院教学/经济学实习医师和住院医师职务/经济学马里兰医务人员医院/教育模型经济计量学教学/经济学教学/方法培训资助/经济学人类

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