Mamoli A, Censori B, Casto L, Sileo C, Cesana B, Camerlingo M
Neurologia 2, Ospedali Riuniti, Bergamo, Italy.
Neurology. 1999 Jul 13;53(1):112-6. doi: 10.1212/wnl.53.1.112.
To determine the direct costs of hospital care of acute ischemic stroke in a large Italian hospital, and to identify the main components of such costs.
Cost containment in stroke care requires an up-to-date assessment of expenditures in the different areas of stroke management. However, costs may vary among countries because of different health system organizations.
All patients with ischemic stroke admitted during 1996 were considered. Total cost was the sum of a daily component, reflecting personnel wages and general care, and an ancillary component, reflecting mostly investigations and treatments. The real costs were used, not fixed charges.
We included 245 patients, with a mean length of stay (LOS) of 13.1+/-7.0 days, and an in-hospital case fatality rate of 8.2%. The mean total cost per patient was 5,087,000+/-2,536,000 Italian Lira (LIT; $3,289+/-$1,640), with a mean cost per day of 388,000 LIT ($251). Approximately 80% of total costs were due to the daily component and 20% to the ancillary component. A multiple linear regression model of length of stay, which determines the daily cost, showed that the Rankin score at entry, the clinical syndrome type, and the destination at discharge independently contributed to LOS. A second linear regression model showed that younger age and longer LOS significantly increased ancillary costs.
The containment of hospital costs of ischemic stroke may be achieved mostly through measures that reduce LOS, such as effective treatments and a quicker deployment.
确定一家大型意大利医院急性缺血性卒中的住院直接费用，并找出此类费用的主要构成部分。
卒中护理中的成本控制需要对卒中管理不同领域的支出进行最新评估。然而，由于卫生系统组织不同，各国的成本可能存在差异。
纳入1996年期间收治的所有缺血性卒中患者。总成本是每日费用部分（反映人员工资和一般护理）与辅助费用部分（主要反映检查和治疗）之和。使用的是实际成本，而非固定费用。
我们纳入了245例患者，平均住院时间（LOS）为13.1±7.0天，院内病死率为8.2%。每位患者的平均总成本为5,087,000±2,536,000意大利里拉（LIT；3,289±1,640美元），每日平均成本为388,000 LIT（251美元）。总成本的约80%归因于每日费用部分，20%归因于辅助费用部分。一个决定每日成本的住院时间多元线性回归模型显示，入院时的Rankin评分、临床综合征类型和出院目的地独立影响住院时间。第二个线性回归模型显示，年龄较小和住院时间较长显著增加辅助成本。
缺血性卒中住院费用的控制主要可通过减少住院时间的措施来实现，如有效的治疗和更快的部署。
