Fine M J, Pratt H M, Obrosky D S, Lave J R, McIntosh L J, Singer D E, Coley C M, Kapoor W N
Division of General Internal Medicine, Department of Medicine (MJF, DSO, WNK), Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
Am J Med. 2000 Oct 1;109(5):378-85. doi: 10.1016/s0002-9343(00)00500-3.
Patients with pneumonia often remain hospitalized after becoming clinically stable, without demonstrated benefits on outcome. The purposes of this study were to assess the relation between length of hospital stay and daily medical care costs and to estimate the potential cost savings associated with a reduced length of stay for patients with pneumonia.
As part of a prospective study of adults hospitalized with community-acquired pneumonia at a community hospital and two university teaching hospitals, daily medical care costs were estimated by multiplying individual charges by department-specific cost-to-charge ratios obtained from each hospital's Medicare cost reports.
The median total cost of hospitalization for all 982 inpatients was $5, 942, with a median daily cost of $836, including $491 (59%) for room and $345 (41%) for non-room costs. Average daily non-room costs were 282% greater on the first hospital day, 59% greater on the second day, and 19% greater on the third day than the average daily cost throughout the hospitalization (all P <0.05), and were 14% to 72% lower on the last 3 days of hospitalization. Average daily room costs remained relatively constant throughout the hospital stay, with the exception of the day of discharge. A projected mean savings of $680 was associated with a 1-day reduction in length of stay.
Despite institutional differences in total costs, patterns of daily resource use throughout hospitalization were similar at all institutions. A 1-day reduction in length of stay might yield substantial cost-savings.
肺炎患者在临床症状稳定后往往仍需住院治疗，且未显示出对预后有明显益处。本研究的目的是评估住院时间与每日医疗费用之间的关系，并估计缩短肺炎患者住院时间可能节省的费用。
作为一项对一家社区医院和两家大学教学医院收治的社区获得性肺炎成年患者的前瞻性研究的一部分，通过将个人收费乘以从每家医院的医疗保险费用报告中获取的各科室成本与收费比率来估算每日医疗费用。
982名住院患者的住院总费用中位数为5942美元，每日费用中位数为836美元，其中包括491美元（59%）的病房费用和345美元（41%）的非病房费用。住院第一天的平均每日非病房费用比整个住院期间的平均每日费用高282%，第二天高59%，第三天高19%（均P<0.05），而在住院的最后3天则低14%至72%。除出院当天外，住院期间每日病房费用相对保持稳定。住院时间每缩短一天预计平均可节省680美元。
尽管各机构的总费用存在差异，但所有机构住院期间的每日资源使用模式相似。住院时间缩短一天可能会节省大量费用。
