Gregory Douglas, DeNofrio David, Konstam Marvin A
Cardiovascular Clinical Studies and Tufts University School of Medicine, Boston, Massachusetts, USA.
J Am Coll Cardiol. 2005 Aug 16;46(4):660-6. doi: 10.1016/j.jacc.2005.05.042.
This study was designed to determine the economic effect of a tertiary heart failure (HF) program at an academic medical center.
Most hospitals use cross-sectional financial models to analyze the economic contribution of clinical programs for a budget period. We estimated the incremental value of a tertiary hospital HF program on the basis of the longitudinal utilization of a sample of HF patients.
The primary data source was a sample of 82 HF patients referred for cardiac transplant evaluation at an academic medical center during calendar years 2000 to 2001. Cumulative recurrent rates of utilization, cost, and reimbursement for hospital services were computed as functions of time using reliability models. The economic contribution of patients transplanted was contrasted with those not transplanted.
Mean hospitalizations and outpatient encounters per patient at the end of the first year of follow-up for those transplanted were 2.1 (95% confidence interval [CI] 1.6 to 2.7) and 11.9 (95% CI 9.2 to 15.4), compared with 1.1 (95% CI 0.8 to 1.6) and 6.0 (95% CI 4.8 to 7.6), respectively, for those not transplanted. Mean revenue and direct cost per patient were 194,470 dollars (95% CI 136,683 dollars to 276,689 dollars) and 146,623 dollars (95% CI 96,377 dollars to 233,065 dollars), respectively, for transplanted patients and 43,587 dollars (95% CI 28,149 dollars to 67,503 dollars) and 33,424 dollars (95% CI 21,584 dollars to 51,760 dollars), respectively, for non-transplanted patients. The point estimates of first-year contribution margins per patient for transplanted and non-transplanted patients were 47,847 dollars and 10,163 dollars, respectively.
Newly evaluated patients for cardiac transplantation at an academic medical center generated substantial incident demands for inpatient and outpatient services over a two-year follow-up period. The estimated contribution margin associated with these services was positive. Hospitals without cardiac transplantation that serve high-acuity HF patients may generate favorable long-term contribution margins, on the basis of the results for the non-transplant group.
本研究旨在确定一所学术医疗中心的三级心力衰竭（HF）项目的经济影响。
大多数医院使用横断面财务模型来分析临床项目在一个预算期内的经济贡献。我们基于心力衰竭患者样本的纵向利用情况，估算了一家三级医院HF项目的增量价值。
主要数据来源是2000年至2001年期间在一所学术医疗中心被转诊进行心脏移植评估的82例HF患者的样本。使用可靠性模型将医院服务的利用、成本和报销的累积复发率计算为时间的函数。将接受移植的患者与未接受移植的患者的经济贡献进行对比。
在随访的第一年结束时，接受移植的患者每人的平均住院次数和门诊就诊次数分别为2.1次（95%置信区间[CI]为1.6至2.7）和11.9次（95%CI为9.2至15.4），而未接受移植的患者分别为1.1次（95%CI为0.8至1.6）和6.0次（95%CI为4.8至7.6）。接受移植的患者每人的平均收入和直接成本分别为194,470美元（95%CI为136,683美元至276,689美元）和146,623美元（95%CI为96,377美元至233,065美元），未接受移植的患者分别为43,587美元（95%CI为28,149美元至67,503美元）和33,424美元（95%CI为21,584美元至51,760美元）。接受移植和未接受移植的患者每人第一年的边际贡献点估计分别为47,847美元和10,163美元。
在一所学术医疗中心新评估的心脏移植患者在两年的随访期内对住院和门诊服务产生了大量的突发需求。与这些服务相关的估计边际贡献为正。根据未移植组的结果，为高 acuity HF 患者提供服务但没有心脏移植的医院可能会产生有利的长期边际贡献。
