Reed S D, Blough D K, Meyer K, Jarvik J G
Pharmaceutical Outcomes Research & Policy Program, School of Pharmacy, University of Washington, Seattle, USA.
Neurology. 2001 Jul 24;57(2):305-14. doi: 10.1212/wnl.57.2.305.
Accurate estimates of inpatient cost, length of stay (LOS), and mortality are necessary for the development of economic models to estimate the cost-effectiveness of stroke-related treatments. Estimates based on data from academic institutions may not be generalizable to community hospitals. In this study, the authors estimated inpatient costs, LOS, and in-hospital mortality for patients with subarachnoid hemorrhage (SAH), intracerebral hemorrhage (ICH), ischemic cerebral infarction (ICI), and TIA who were treated in community hospitals.
The authors selected patients using International Classification of Diseases-9-Clinical Modification primary diagnosis codes from the HBSI EXPLORE database. They analyzed patient-level data and inpatient costs, derived from detailed utilization data, for all patients admitted to 137 community hospitals in 1998. Multivariate statistical techniques were used to examine patient-, hospital-, and outcome-related factors associated with inpatient costs.
Patients with SAH incurred the highest average cost ($23,777, n = 1,124), followed by patients with ICH ($10,241, n = 3,139), ICI ($5,837, n = 18,740), and TIA ($3,350, n = 7,861). Patient subgroups ranked in the same order for average LOS at 11.5 days for SAH, 7.5 days for ICH, 5.9 days for ICI, and 3.4 days for TIA. Almost one third of patients with SAH (29.0%) and ICH (33.1%) died during hospitalization, whereas 7.0% with ICI and 0.2% with TIA died. For each event, as patient age increased, average costs consistently decreased. Also, average costs were higher among patients treated in community teaching hospitals compared to community nonteaching hospitals for each cerebrovascular event (10 to 29%).
Inpatient costs, LOS, and mortality for patients with cerebrovascular disease are dependent on patient and hospital characteristics.
准确估计住院费用、住院时间（LOS）和死亡率对于开发经济模型以评估与中风相关治疗的成本效益是必要的。基于学术机构数据的估计可能不适用于社区医院。在本研究中，作者估计了在社区医院接受治疗的蛛网膜下腔出血（SAH）、脑出血（ICH）、缺血性脑梗死（ICI）和短暂性脑缺血发作（TIA）患者的住院费用、住院时间和院内死亡率。
作者从HBSI EXPLORE数据库中使用国际疾病分类第九版临床修订版初级诊断代码选择患者。他们分析了1998年入住137家社区医院的所有患者的患者层面数据和来自详细使用数据的住院费用。使用多变量统计技术检查与住院费用相关的患者、医院和结果相关因素。
SAH患者的平均费用最高（23,777美元，n = 1,124），其次是ICH患者（10,241美元，n = 3,139）、ICI患者（5,837美元，n = 18,740）和TIA患者（3,350美元，n = 7,861）。患者亚组的平均住院时间排名顺序相同，SAH为11.5天，ICH为7.5天，ICI为5.9天，TIA为3.4天。近三分之一的SAH患者（29.0%）和ICH患者（33.1%）在住院期间死亡，而ICI患者为7.0%，TIA患者为0.2%。对于每种情况，随着患者年龄的增加，平均费用持续下降。此外，对于每种脑血管事件，在社区教学医院接受治疗的患者的平均费用高于社区非教学医院（10%至29%）。
脑血管疾病患者的住院费用、住院时间和死亡率取决于患者和医院的特征。
