Iapichino G, Radrizzani D, Simini B, Rossi C, Albicini M, Ferla L, Colombo A, Pezzi A, Brazzi L, Melotti R, Rossi G
Istituto di Anestesiologia e Rianimazione dell'Università degli Studi di Milano, Azienda Ospedaliera - Polo Universitario San Paolo, Milano, Italy.
Acta Anaesthesiol Scand. 2004 Aug;48(7):820-6. doi: 10.1111/j.1399-6576.2004.00421.x.
To establish the effectiveness of ICU treatment and the efficiency in the use of resources in patients stratified according to 10 diagnosis and two levels-of-care. To propose strategies aimed at reducing costs and improving efficiency in each patient group.
Multicentre prospective observational study. ICUs enrolled two cohorts of up to 10 consecutive patients with ICU stay >/= 48 h. Each with one of these diagnoses: trauma, brain-trauma, brain-hemorrhage, stroke, acute-on-chronic-obstructive-pulmonary disease, lung-injury/acute respiratory distress syndrome, heart failure, and scheduled/unscheduled abdominal surgery. The presence of active-life support divides high from low level-of-care treatments. Variable ICU costs were collected daily (bottom-up) for 21 days. We evaluated effectiveness (hospital survival) and efficiency (hospital-survivors variable-cost as a ratio of overall cost).
Forty-two Italian general ICUs recruited 529 patients in 5 months. Mean ICU variable-costs significantly differed with diagnosis and level-of-care. Costs were positively affected by ICU length-of-stay, by duration of active-treatment. Outcome variably influenced costs. Medians of variable-costs per patient (1715 Euro) and patient-groups efficiencies (60.7%) identified four possible combinations between (low and high) cost and (low and high) efficiency groups. Moreover, efficiency was better than effectiveness in stroke, brain-hemorrhage and trauma, while it was worse in heart failure, acute-on-COPD or acute-lung injury. Overall ICU cost attributed only to survivors ranged from 699 (scheduled surgical) to 5906 (unscheduled surgical) Euro. Cost of non-survivors distributed to all patient was between 95 (scheduled-surgical) to 1633 (unscheduled-surgical) Euro.
Analysis of variable patient-specific cost was used as a tool to assess intensive care performance in patient subgroups with different diagnosis and levels-of-care.
为确定根据10种诊断和两种护理级别分层的患者的重症监护病房（ICU）治疗效果及资源利用效率。提出旨在降低各患者组成本并提高效率的策略。
多中心前瞻性观察性研究。ICU纳入了两组各10名连续入住ICU且住院时间≥48小时的患者。每组患者的诊断分别为：创伤、脑外伤、脑出血、中风、慢性阻塞性肺疾病急性加重、肺损伤/急性呼吸窘迫综合征、心力衰竭以及计划性/非计划性腹部手术。是否存在积极的生命支持将高护理级别治疗与低护理级别治疗区分开来。连续21天每天收集ICU的可变成本（自下而上）。我们评估了有效性（医院生存率）和效率（医院存活患者的可变成本与总成本之比）。
42家意大利综合性ICU在5个月内招募了529名患者。ICU平均可变成本因诊断和护理级别而有显著差异。成本受到ICU住院时间和积极治疗持续时间的正向影响。结局对成本有不同程度的影响。每位患者的可变成本中位数（1715欧元）和患者组效率（60.7%）确定了（低和高）成本与（低和高）效率组之间的四种可能组合。此外，中风、脑出血和创伤患者的效率优于有效性，而心力衰竭、慢性阻塞性肺疾病急性加重或急性肺损伤患者的效率则较差。仅归因于存活患者的ICU总成本从699欧元（计划性手术）到5906欧元（非计划性手术）不等。分配给所有患者的非存活患者成本在95欧元（计划性手术）到1633欧元（非计划性手术）之间。
分析患者特定的可变成本被用作评估不同诊断和护理级别患者亚组重症监护表现的工具。
Zotero 插件