Phibbs C S, Mortensen L
Institute for Health Policy Studies, University of California, San Francisco.
Pediatrics. 1992 Jul;90(1 Pt 1):22-6.
Many neonates are referred to neonatal intensive care units (NICUs) for specialized care far from their parents' residence. This distance can add to the stress of the parents and reduce the contact of the parents with their newborn. Small studies have found that back transporting these neonates to hospitals closer to their homes is safe and cost-effective. Despite these findings, the reluctance of many insurers to pay for back transports prevents or delays many back transports. Insurers may not consider the findings of the previous studies to be conclusive, given that the comparisons were between small numbers of neonates back transported and neonates who remained in tertiary care, and the potential for differences in severity of illness between the groups is significant. In this study the effect on hospital charges of back transports was examined by comparing the charges for care in community hospitals with what these charges would have been in a tertiary care center. The advantage of this method is that it avoids case-mix differences between the groups and thus minimizes the potential for small-sample bias. Data were collected for all back transports from a NICU to non-tertiary care centers (n = 90) for a 9-month period. We were able to obtain the itemized bills for the care at community hospitals for 42 of these patients. Each bill was recalculated using the charges for the NICU to determine potential for savings. The average charges for recovery care were about $6200 lower at the community hospital than they would have been at the NICU.(ABSTRACT TRUNCATED AT 250 WORDS)
许多新生儿被转诊到新生儿重症监护病房（NICU）接受特殊护理，而这些病房距离他们父母的住所很远。这种距离会增加父母的压力，并减少父母与新生儿的接触。小型研究发现，将这些新生儿转回离家更近的医院是安全且具有成本效益的。尽管有这些发现，但许多保险公司不愿为转回运输付费，这阻止或延迟了许多转回运输。鉴于之前的研究比较的是少量转回运输的新生儿和留在三级医疗机构的新生儿，且两组之间疾病严重程度的差异可能性很大，保险公司可能不认为之前研究的结果具有决定性。在本研究中，通过比较社区医院的护理费用与在三级护理中心的费用，研究了转回运输对医院费用的影响。这种方法的优点是避免了两组之间的病例组合差异，从而将小样本偏差的可能性降至最低。收集了9个月期间从一个新生儿重症监护病房转回非三级护理中心的所有转回运输的数据（n = 90）。我们能够获得其中42名患者在社区医院的详细护理账单。每张账单都使用新生儿重症监护病房的收费标准重新计算，以确定节省费用的可能性。社区医院康复护理的平均费用比在新生儿重症监护病房低约6200美元。（摘要截断于250字）
