Rizzo J A, Simons W R
Yale University, School of Medicine, New Haven, CT 06520, USA.
Am J Manag Care. 1998 Nov;4(11):1543-58.
To identify key factors affecting hospital charge variations in the treatment of congestive heart failure.
The determinants of total charges and average charges (the latter being a measure of treatment intensity) were evaluated using hospital discharge abstract data from 1994. Multivariate regression methods were used to help isolate the impact of key predictors of charges. In addition to relating a variety of factors (e.g., drug treatment regimens, patient comorbidities, demographic characteristics, insurance status, treatment course) to hospital charges, the analysis controlled for hospital-specific fixed effects. The study includes the effects of pharmacologic agents--information typically unavailable on inpatient claims-based data.
Drug treatment regimens, particularly treatment with inotropic agents, were associated with substantially higher total charges. Comorbidities also increased the cost of treating congestive heart failure, particularly when septicemia, pneumonia, or acute myocardial infarction were involved. In contrast, gender, race, and insurance status bore little relationship to total charges or average charges.
The fixed-effects estimates revealed that substantial interhospital variations in charges persisted, suggesting that there may be significant opportunities to control the inpatient costs of treating congestive heart failure.
确定影响充血性心力衰竭治疗中医院收费差异的关键因素。
利用1994年医院出院摘要数据评估总费用和平均费用（后者作为治疗强度的一种衡量指标）的决定因素。采用多变量回归方法来帮助分离费用关键预测因素的影响。除了将各种因素（如药物治疗方案、患者合并症、人口统计学特征、保险状况、治疗过程）与医院费用相关联外，分析还控制了医院特定的固定效应。该研究纳入了药物制剂的影响——这一信息通常无法从基于住院患者索赔的数据中获取。
药物治疗方案，尤其是使用强心剂进行治疗，与总费用大幅升高相关。合并症也增加了充血性心力衰竭的治疗成本，特别是当涉及败血症、肺炎或急性心肌梗死时。相比之下，性别、种族和保险状况与总费用或平均费用关系不大。
固定效应估计显示，医院收费存在显著的院间差异，这表明在控制充血性心力衰竭住院治疗费用方面可能存在重大机会。
