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A model for calculating costs of hospital wards: an Italian experience.

Journal of management in medicine 1999年第2-3期13卷 71-82页

作者： Garattini, L. Giuliani, G. Pagano, E. Centre for Health Economics CESAV Mario Negri Institute for Pharmacological Research BG Ranica Italy

Until recently Italian hospitals had no cost accounting or activity data collection systems, being formally required only to do financial book-keeping. The cost analysis method presented here might be used to set up detailed and complete hospital cost accounting, which would permit a better understanding of patterns of resource distribution among departments, better opportunities for cost saving and cost control for hospital managers and health authorities. The study first identified a framework within which to assess the annual cost related to a hospital ward, then calculated the mean bed day cost for each speciality. Cost data were collected over one year in 1996 from manually compiled records, at one local hospital in Northern Italy. Costs were estimated following a step-down allocation method. Wards requiring a major amount of resources per day of stay are intensive cardio-coronary unit (US$650.689), and ophthalmology (US$483.322). The less expensive ward is general medicine (US$148.645). The cost analysis method presented in this study might be used to set a detailed and complete hospital cost database, which is a necessary tool for hospital managers to realise cost control and cost recovery.

关键词：会计学/方法辅助服务医院/经济学病床利用率/经济学费用分配/方法直接服务费用/统计学和数值数据财务管理医院/方法医院费用/统计学和数值数据医院科室/经济学医院专科病房/经济学意大利模型经济计量学门诊部医院/经济学病房/经济学专业医学/经济学

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The use of patient mix-adjusted control charts to compare in-hospital costs of care

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Health Care Management Science 1999年第4期2.0卷 193-198页

作者： Eisenstein, Eric L. Bethea, Charles F. Duke University Medical Center Durham NC 27710 United States Baptist Medical Center Oklahoma City OK United States

We introduce a technique for patient mix-adjusting x̄ charts and compared differences between unadjusted and patient mix-adjusted results. Our data came from coronary artery bypass graft (CABG) surgery patients at Baptist Medical Center, Oklahoma City, Oklahoma. We first developed an unadjusted x̄ control chart to compare monthly changes in CABG surgery costs and then used a published model to patient mix-adjust our x̄ control chart information. Before adjustment, the average log costs for three of ten months were outside the 90% control limit lines, and there was a trend toward increasing costs. After adjustment, two months had average costs outside the 90% lower control limit lines, and the trend toward increasing costs had been explained by differences in patient acuity. © Baltzer Science Publishers BV.

关键词：会计学/方法冠状动脉分流术/经济学费用分配/方法诊断相关患者组/分类诊断相关患者组/经济学卫生服务研究/方法医院费用/统计学和数值数据医院社区/经济学住院时间/统计学和数值数据模型经济计量学俄克拉何马老年人人类中年人

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Contracting for Emergency Room Coverage by Rural Hospitals

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The Journal of Rural Health 1994年第1期10卷 31-37页

作者： Wakefield, Douglas S. Tracy, Roger Myer, Mark Wallace, Robert University of Iowa Iowa Iowa United States The College of Medicine The University of Iowa in Iowa City Iowa United States Hospital and Health Administration University of Iowa in Iowa City Iowa City Iowa United States Univerity of Iowa Iowa City Iowa United States

Obtaining adequate physician availability remains a challenge to many rural communities. To ensure 24‐hour emergency room physician coverage, many rural hospitals contracted for emergency room services from out‐of‐area and/or local physician. Survey findings for 99 rural and rural referral Iowa hospitals addressing the nature, extent, and cost of contracting physician coverage of the emergency room are presented. While nearly two‐thirds of the hospitals reported contracting for at least some emergency room coverage, the extent and costs of contracts vary widely. Advantages and disadvantages of contracting for emergency room services are discussed. Copyright © 1994, Wiley Blackwell. All rights reserved

关键词：评价研究卫生服务研究医院费用/统计学和数值数据医院乡村/经济学医院乡村/人力医院乡村/组织与管理采访衣阿华

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Public, private and voluntary residential mental health care: Is there a cost difference?

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Journal of Health Services Research and Policy 1998年第3期3卷 141-148页

作者： Knapp, M. Chisholm, D. Astin, J. Lelliott, P. Audini, B. Centre Economics of Mental Health Institute of Psychiatry London SE5 8BB 7 Windsor Walk United Kingdom

Objectives: To determine how public (NHS or local government), private (for-profit) and voluntary (non-profit) providers of residential mental health care compare. Do they support different clienteles? And do their services cost different amounts? Methods: Based on a cross-sectional survey of residential care facilities and their residents in eight English and Welsh localities, the characteristics and costs of care in the different sectors (NHS, local government, private, voluntary) were compared. Variations in cost were examined in relation to residents' characteristics using multiple regression analyses, which also allowed standardisation of results before making inter-sectoral comparisons. Results: Private and voluntary providers of residential care support different clienteles from the public sector. The patterns of inter-sectoral cost differences vary between London and non-London localities. In London, voluntary sector facilities may be more cost-efficient than the other sectors, but local government/private sector comparisons show no consistent difference. Outside London, the results suggest clear cost advantages for the private and voluntary sectors over the local government sector. Conclusions: Private and voluntary providers may have some economic advantages over their public counterparts. However, outcomes for residents were not studied, leaving unanswered the question of comparative cost-effectiveness.

关键词：社区精神卫生服务/经济学社区精神卫生服务/利用合同业务/经济学横断面研究英格兰卫生保健费用/统计学和数值数据医院费用/统计学和数值数据医院私营/经济学医院精神病/经济学医院公立/经济学医院慈善/经济学所有权公费医疗/经济学威尔士人类

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Constant observation practices in the general hospital setting -: A national survey

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PSYCHOSOMATICS 2000年第4期41卷 301-310页

作者： Worley, LLM Kunkel, EJS Gitlin, DF Menefee, LA Conway, G Univ Arkansas Med Sci Dept Psychiat Little Rock AR 72205 USA Thomas Jefferson Univ Dept Psychiat & Human Behav Philadelphia PA 19107 USA Univ Massachusetts Med Ctr Dept Psychiat Amherst MA 01003 USA

The authors conducted a national survey of 355 general medical/surgical hospitals to assess constant observation (CO) practices. The authors assessed overall use, expense, staffing patterns, funding strategies, and cost-saving interventions. Virtually all responding hospitals (N=102) reported using some form of CO. Several hospitals reported significant decreases in CO expenditures after the implementation of cost-saving interventions (the largest annual decrease reported was $340,000). Cost-saving interventions included utilizing consolidated bed spaces, relocating patients near nursing stations, placing at-risk patients in bed enclosure devices, and regularly assisting patients to the toilet. In addition, less costly personnel were hip-ed, and volunteers and/or patient family members provided CO (or were required to assist with the cost of CO). Finally, hospital staff were educated about the costs and the appropriate use of CO. They were also taught to recognize and effectively treat delirium.

关键词：费用节省/统计学和数值数据谵妄痴呆遗忘认知障碍/经济学医院费用/统计学和数值数据医院综合病人医疗护理计划/经济学病人医疗小组/经济学精神病科医院/经济学安全/经济学美国人类

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Child and adolescent psychiatry in general children's hospitals : A survey of chairs of psychiatry

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PSYCHOSOMATICS 2000年第2期41卷 128-133页

作者： Campo, JV Kingsley, RS Bridge, J Mrazek, D Childrens Hosp Pittsburgh Behav Sci Div Pittsburgh PA 15213 USA Univ Pittsburgh Sch Med Western Psychiat Inst & Clin Pittsburgh PA USA Alfred I DuPont Hosp Children Div Behav Hlth Wilmington DE USA George Washington Univ Sch Med Dept Psychiat & Behav Sci Washington DC USA

This article characterizes the academic, administrative, clinical service, and fiscal characteristics of departments of psychiatry in traditional children's hospitals to determine the characteristics of fiscally successful programs. A survey of chairs of psychiatry from short-term general children Is hospitals was conducted based on 38 questions addressing the descriptive characteristics of their respective departments. The characteristics of psychiatry programs identified as fiscally succcessful were compared to those of programs that required subsidy. Nine of 45 eligible children's hospitals (20%) did not have a department or section of psychiatry, and surveys were returned by 35 of 36 department chairs (97% response). Considerable variation exists in the academic, administrative, clinical services, and fiscal characteristics of programs, although over half are operating at a deficit. Fiscal success was associated with availability of inpatient and intermediate levels of psychiatric care, better integration of the psychiatry program within the children's hospital, and adequate fiscal information being provided to the psychiatry chair: Additional research regarding the potential of psychiatric services to generate clinical success and cost savings is warranted. pediatric health care professionals and third-party payers should be educated regarding the relevance of psychiatric services within children's hospitals and in physically ill children.

关键词：青春期精神病学/经济学预算儿童精神病学/经济学费用效益分析医院费用/统计学和数值数据医院儿科/经济学病人医疗小组/经济学转诊和会诊/经济学美国青少年儿童人类

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Designing a carotid endarterectomy critical pathway for your organization

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MILITARY MEDICINE 2000年第5期165卷 385-389页

作者： Jano, S Harlin, SA Keesler Med Ctr Dept Surg Keesler AFB MS 39534 USA

Background: Carotid endarterectomy [CEA) is one of the top-five surgical diagnosis-related groups at Keesler Medical Center. The geometric mean length of stay for CEA during fiscal year (FY) 1996 was 5.84 days (N = 41), compared with 1.79 for a benchmark facility. Objective: Create a critical pathway to standardize care, maintain/improve patient outcomes, reduce lengths of stay, and decrease costs. Methods: A multidisciplinary team was formed to evaluate four patient-flow options. The team decided to discharge patients directly from the intensive care unit to meet both patient and staff needs. Results: The geometric mean length of stay decreased to 1.70 days (N = 54) in FY 1998, compared with 2.42 days (N = 40) in FY 1997. The cost savings was $5,841 per case, compared with $1,684 before creation of the pathway. This represents an annual savings of more than $224,000 and a 30% reduction in length of stay. Conclusions: The CEA pathway has standardized the care received by this group of patients. By decreasing variation, processes have become routine and more efficient.

关键词：规范/组织和管理费用控制费用节省临床路径/组织和管理颈动脉内膜切除术/经济学颈动脉内膜切除术/标准医院费用/统计学和数值数据医院教学住院时间/经济学住院时间/统计学和数值数据密西西比结果与过程评价(卫生保健)/组织和管理病人医疗小组/组织和管理规划制订/方法方案评价质量保证卫生保健/组织和管理全面质量管理/组织和管理老年人女(雌)性人类男(雄)性

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