Ross Edward A, Alza Rita E, Jadeja Neerav N
Division of Nephrology, Hypertension & Transplantation, University of Florida, Gainesville, FL 32610-0224, USA.
Clin J Am Soc Nephrol. 2006 Nov;1(6):1234-40. doi: 10.2215/CJN.01210406. Epub 2006 Sep 6.
More than $18 billion annually is attributed to care of patients with ESRD, with the perception of high renal costs for a relatively small population. It was proposed that accounting methods exaggerate resource utilization that often occurs with rather than because of kidney failure. The dialysis patients in this study had nearly all of their care at university facilities with one financial database. For 1 yr, 112 chronic hemodialysis patients were studied using demographic, insurance, and hospital facility (diagnoses, length of stay, charges, costs, and net income) variables. Substantial inpatient costs and hospitalizations were for nonrenal primary diagnoses, including malignancies, substance abuse, trauma, HIV, and psychiatric diseases: 37% of admissions, 36% of inpatient days, and 32% of charges. Dialysis patients were healthier than indicated by averaged length of stay and cost data, because results were very skewed: Mean 17.3 inpatient days but median only 2.4 d; 43% of patients had 0 to 1 inpatient days (1.3% of charges), 23% had 2 to 7 d (charges 7.6%), 18% had 8 to 30 d (charges 26%), and 16% had >30 d (charges 66%). Lengthy hospitalizations had disproportionately high operating room and respiratory care costs. The large group of relatively healthy outpatients did not avoid hospitalization by high use of facility resources. The true costs for medical care that results from ESRD are not as high as publicized, as a result of misclassification of inpatient expenses from nonrenal comorbidities. When not confounded by analyses that use data means, it is clear that substantial numbers of hemodialysis patients have very brief hospitalizations with low resource utilization.
每年用于终末期肾病（ESRD）患者护理的费用超过180亿美元，人们认为相对较少的患者群体却产生了高昂的肾脏治疗费用。有人提出，会计方法夸大了资源利用情况，而这些资源利用往往是由而非因肾衰竭发生的。本研究中的透析患者几乎所有护理都在有一个财务数据库的大学设施中进行。在1年时间里，使用人口统计学、保险和医院设施（诊断、住院时间、收费、成本和净收入）变量对112名慢性血液透析患者进行了研究。大量住院费用和住院是由于非肾脏原发性诊断，包括恶性肿瘤、药物滥用、创伤、艾滋病毒和精神疾病：占入院人数的37%、住院天数的36%和收费的32%。透析患者比平均住院时间和成本数据显示的更健康，因为结果非常不均衡：平均住院天数为17.3天，但中位数仅为2.4天；43%的患者住院天数为0至1天（占收费的1.3%），23%的患者为2至7天（收费7.6%），18%的患者为8至30天（收费26%），16%的患者超过30天（收费66%）。长时间住院的手术室和呼吸护理成本过高。大量相对健康的门诊患者并未因大量使用设施资源而避免住院。由于非肾脏合并症住院费用的错误分类，ESRD导致的医疗护理实际成本并不像宣传的那么高。当不被使用数据均值的分析混淆时，很明显大量血液透析患者住院时间非常短，资源利用低。
