Arnold D J, Funk G F, Karnell L H, Chen A H, Hoffman H T, Ricks J M, Zimmerman M B, Corbae D P, Zhen W, McCulloch T M, Graham S M
Department of Otolaryngology--Head and Neck Surgery, University of Miami, Florida, USA.
Laryngoscope. 2000 Jan;110(1):1-7. doi: 10.1097/00005537-200001000-00001.
To examine the relationship of various pretreatment case-mix characteristics and treatment modalities with medical charges incurred during diagnosis, treatment, and 2-year follow-up for patients with laryngeal cancer.
Retrospective chart review and billing record analysis.
The charts and billing records of patients diagnosed with laryngeal cancer at the University of Iowa Hospitals and Clinics (UIHC) between January 1, 1991 and December 31, 1994 were reviewed. The independent variables included various pretreatment patient-mix and tumor characteristics (age, AJCC TNM clinical stage, smoking history, ASA class, and comorbidity as defined by Kaplan-Feinstein grade) as well as type of treatment. The dependent variables included total physician, office, and university hospital-based charges incurred during the pretreatment evaluation and 0- to 3-, 3- to 12, and 12- to 24-month billing periods after the initiation of cancer-directed therapy. Total 1-year and 2-year charges were also evaluated. Univariate and multivariate analyses were used to investigate the relationships between dependent and independent variables and to develop models predictive of management charges during the individual and total billing periods.
Pretreatment charges showed no significant associations (P < .05) with any of the independent variables. Multiple regression analyses indicated that comorbidity, stage, and initial treatment modality were significant variables in one or more of the models predicting charges incurred during the 0- to 3-month, 3- to 12-month, total 1-year, and total 2-year billing periods. The models yielded R2 values for the total 1- and 2-year billing periods of 0.5246 and 0.5055, respectively.
This work supports continued study of measures that may result in earlier detection of laryngeal cancer as a potential means of reducing management charges. These results also indicate that a more accurate method of stratifying the disease severity of laryngeal cancer patients for reimbursement purposes would include measurements of the severity of the index disease as well as comorbid diseases.
研究喉癌患者在诊断、治疗及2年随访期间，各种预处理病例组合特征和治疗方式与医疗费用之间的关系。
回顾性病历审查和计费记录分析。
对1991年1月1日至1994年12月31日期间在爱荷华大学医院及诊所（UIHC）被诊断为喉癌的患者的病历和计费记录进行审查。自变量包括各种预处理患者组合和肿瘤特征（年龄、美国癌症联合委员会TNM临床分期、吸烟史、美国麻醉医师协会分级以及由卡普兰 - 费因斯坦分级定义的合并症）以及治疗类型。因变量包括在预处理评估期间以及癌症导向治疗开始后的0至3个月、3至12个月和12至24个月计费期内产生的总医师、门诊和大学医院费用。还评估了1年和2年的总费用。采用单因素和多因素分析来研究因变量和自变量之间的关系，并建立预测各个计费期和总计费期管理费用的模型。
预处理费用与任何自变量均无显著关联（P <.05）。多元回归分析表明，合并症、分期和初始治疗方式在预测0至3个月、3至12个月、总1年和总2年计费期内产生的费用的一个或多个模型中是显著变量。这些模型在总1年和2年计费期的R2值分别为0.5246和0.5055。
这项工作支持继续研究可能导致喉癌早期检测的措施，作为降低管理费用的潜在手段。这些结果还表明，为报销目的对喉癌患者疾病严重程度进行分层的更准确方法将包括测量指数疾病以及合并症的严重程度。
