Cowan John D
Palliative Care Service, Advanced Illness Assistance Team, Blount Memorial Hospital, Maryville, Tennessee, USA.
Am J Hosp Palliat Care. 2004 May-Jun;21(3):177-90. doi: 10.1177/104990910402100306.
Defining financial parameters of palliative care (PC) is important for providing sustainable programming. In our study, we evaluated hospital length of stay (LOS) and charges for the first 164 inpatient PC consultations performed by the Advanced Illness Assistance (AIA) team at Blount Memorial Hospital (BMH). These AIA patients had a median LOS of 11 days (range, 3-114 days), mean total charges per patient of 65,795 dollars, and mean daily charges of 3,809 dollars. Higher mean daily charges (p = 2.74 E-08, chi-square) were associated with patients who received consultation because of nonphysical symptom reasons. Patients were followed in PC consultation (AIA follow-up days) for a median of five days (range, 1-48), and had mean daily charges of 3,117 dollars. These mean daily charges were 414 dollars less than the charges for the five days prior to PC consultation (pre-AIA days) (p = 0.04, t-test). There was a significant decrease in laboratory and imaging charges during AIA follow-up (p = 0.04, t-test). The study included a reference group of patients whose information was obtained retrospectively from the BMH Atlas (MediQual, Marlborough, MA) database. These reference group patients were hospitalized at BMH during the same time, but they were not seen by the AIA team. The reference group was matched by Diagnosis Related Group (DRG), Admission Severity Grade (ASG), and disposition to the AIA patients. The Atlas patients had a shorter median LOS of six days (range, 1-105 days), and significantly greater mean daily charges of 4,105 dollars (p = 0.006, t-test) compared with AIA patients. Mean daily charges decreased for Atlas patients, as their day of discharge approached (p < 0.001). Estimates of potential charge savings were calculated in two ways: 1) by evaluating the effect of decreasing the LOS of Atlas patients with long LOS (more than seven days) to the level of AIA patients with long LOS, and 2) by comparing the actual mean patient charges during AIA follow-up with using the pre-AIA mean daily charges during the AIA follow-up period and correcting for the effect of decreasing charges that occurred as discharge approached. The estimated savings achieved by decreasing long LOS were more than 100,000 dollars per year, and estimated savings achieved using AIA follow-up charges were more than 1,801,930 dollars per year.
确定姑息治疗（PC）的财务参数对于提供可持续的项目规划至关重要。在我们的研究中，我们评估了布朗特纪念医院（BMH）的高级疾病援助（AIA）团队进行的前164例住院PC会诊的住院时间（LOS）和费用。这些AIA患者的中位住院时间为11天（范围为3 - 114天），每位患者的平均总费用为65,795美元，平均每日费用为3,809美元。较高的平均每日费用（p = 2.74 E - 08，卡方检验）与因非身体症状原因接受会诊的患者相关。患者在PC会诊期间（AIA随访天数）的中位随访时间为5天（范围为1 - 48天），平均每日费用为3,117美元。这些平均每日费用比PC会诊前五天（AIA前天数）的费用少414美元（p = 0.04，t检验）。在AIA随访期间，实验室和影像检查费用显著下降（p = 0.04，t检验）。该研究包括一个参考组患者，其信息是从BMH地图集（MediQual，马萨诸塞州马尔伯勒）数据库中回顾性获取的。这些参考组患者在同一时间在BMH住院，但未被AIA团队诊治。参考组根据诊断相关组（DRG）、入院严重程度等级（ASG）和处置情况与AIA患者进行匹配。与AIA患者相比，地图集患者的中位住院时间较短，为6天（范围为1 - 105天），平均每日费用显著更高，为4,105美元（p = 0.006，t检验）。随着出院日期临近，地图集患者的平均每日费用下降（p < 0.001）。潜在费用节省的估计通过两种方式计算：1）通过评估将住院时间长（超过7天）的地图集患者的住院时间降低到住院时间长的AIA患者的水平的效果，以及2）通过比较AIA随访期间的实际平均患者费用与使用AIA随访期间AIA前的平均每日费用并校正随着出院临近费用下降的影响。通过减少长住院时间实现的估计节省每年超过100,000美元，使用AIA随访费用实现的估计节省每年超过1,801,930美元。
