Brimhall Bradley B, Dean Troy, Hunt Edgar L, Siegrist Richard B, Reiquam William
Department of Pathology, University of Colorado School of Medicine, Denver, USA.
Arch Pathol Lab Med. 2003 Feb;127(2):169-77. doi: 10.5858/2003-127-169-AALCFH.
To examine the hypothesis that older hospitalized patients have higher laboratory costs than younger patients in the same severity-adjusted diagnosis-related group (DRG).
We obtained hospital case mix data sets (1995-1997) from the Massachusetts Division of Health Care Finance and Policy. We selected discharge abstracts from 4 medical DRGs, at 5 large academic hospitals (n = 15,265) and 5 midsized community hospitals (n = 10,540), for analysis. We converted laboratory and blood product charges to direct costs using the department-specific ratio of cost to charges. We adjusted diagnostic groups for severity of comorbid conditions and complications using the refined DRG method.
Hospital length of stay (LOS), laboratory direct cost (LDC) per hospitalization, LDC per hospital day, and ratio of LDC to total direct cost.
Hospital LOS was longer for older patients in all comparisons. Laboratory direct cost per hospitalization was higher for older patients in some DRGs, but lower in other DRGs. Laboratory direct cost per hospital day was almost always less for older patients than for younger patients, both at academic and community hospitals. Data stratification by gender, admission status, and principal diagnosis yielded substantially the same pattern of cost differences observed within the larger data set.
Older medical patients have longer hospital stays and generally higher costs. These patients also have a significantly decreased rate of laboratory resource consumption over the course of hospitalization (LDC per hospital day), as well as lower laboratory costs as a proportion of total costs. Age-specific differences in LOS and cost parameters were essentially unchanged after controlling for several potential sources of bias.
检验以下假设：在病情严重程度调整后的相同诊断相关组（DRG）中，老年住院患者的实验室检查费用高于年轻患者。
我们从马萨诸塞州医疗保健财务与政策司获取了医院病例组合数据集（1995 - 1997年）。我们从5家大型学术医院（n = 15265）和5家中型社区医院（n = 10540）中选取了4个内科DRG的出院摘要进行分析。我们使用各科室成本与收费的特定比例将实验室检查和血液制品收费转换为直接成本。我们采用改进的DRG方法对诊断组进行合并症和并发症严重程度的调整。
住院时间（LOS）、每次住院的实验室直接成本（LDC）、每日住院的LDC以及LDC与总直接成本的比率。
在所有比较中，老年患者的住院时间更长。部分DRG中，老年患者每次住院的实验室直接成本较高，但在其他DRG中则较低。在学术医院和社区医院，老年患者每日住院的实验室直接成本几乎总是低于年轻患者。按性别、入院状态和主要诊断进行数据分层，得到的成本差异模式与在更大数据集中观察到的基本相同。
老年内科患者住院时间更长，总体费用更高。这些患者在住院期间的实验室资源消耗率（每日住院的LDC）也显著降低，并且实验室成本占总成本的比例更低。在控制了几个潜在的偏倚来源后，LOS和成本参数的年龄特异性差异基本未变。
