Fleming S T
Health Services Management, University of Missouri-Columbia 65211, USA.
Clin Perform Qual Health Care. 1995 Jan-Mar;3(1):23-30.
The purpose of this paper is to compare the resource utilization and outcomes of care of elderly hospitalized patients with multiple sclerosis (MS) as a comorbidity to a comparison group without multiple sclerosis, matched by age, gender, and diagnosis related group (DRG) using the 1989 Quality Care (QC) MEDPAR file. The results of this paper demonstrate some differences in resource use. MS discharges incur lower average charges ($8698 for MS discharges, $8977 for controls), although the results are not statistically significant. Proportionately fewer MS discharges use intensive or coronary care services (14.7% versus 18.5%, P < .05). MS patients had a lower, but not statistically significant, 30-day mortality rate than the comparison group matched by age, sex, and DRG (7.6% versus 8.8%), a lower rate of readmission (13.9% versus 16.7%, P < .05), and a lower rate of complications (2.6% versus 4.7%, P < .05), although the results are not consistent across DRGs. Charges, length of stay, and intensive/coronary care utilization were lower, as expected, for a subset of less comorbid MS discharges and controls with, at most, four diagnoses. In this subset, MS discharges and controls were not statistically different, with the exception of overall complication rates (1.0% for MS versus 4.1% for controls, P < .05) and surgical complication rates (2.1% for MS versus 10.0% for controls, P < .05). It is unclear whether these results are due to differences in disease severity, case-mix within DRG, surgical risk, patient surveillance, or quality of care.
本文旨在使用1989年质量护理（QC）医疗出院摘要文件，比较患有多发性硬化症（MS）合并症的老年住院患者与无多发性硬化症的对照组在资源利用和护理结果方面的差异，对照组按年龄、性别和诊断相关组（DRG）进行匹配。本文结果表明在资源使用方面存在一些差异。MS患者出院时的平均费用较低（MS患者出院费用为8698美元，对照组为8977美元），尽管结果无统计学意义。使用重症或冠心病护理服务的MS患者出院比例相对较少（分别为14.7%和18.5%，P<.05）。与按年龄、性别和DRG匹配的对照组相比，MS患者的30天死亡率较低，但无统计学意义（分别为7.6%和8.8%），再入院率较低（分别为13.9%和16.7%，P<.05），并发症发生率较低（分别为2.6%和4.7%，P<.05），尽管不同DRG的结果并不一致。正如预期的那样，对于合并症较少、诊断最多为四项的MS患者出院子集和对照组，费用、住院时间以及重症/冠心病护理利用率较低。在这个子集中，MS患者出院与对照组在统计学上没有差异，但总体并发症发生率（MS患者为1.0%，对照组为4.1%，P<.05）和手术并发症发生率（MS患者为2.1%，对照组为10.0%，P<.05）除外。尚不清楚这些结果是由于疾病严重程度、DRG内病例组合、手术风险、患者监测还是护理质量的差异所致。
