缩短ST段抬高型心肌梗死患者门球时间的经济影响：单中心经验
Financial impact of reducing door-to-balloon time in ST-elevation myocardial infarction: a single hospital experience.
作者信息
Khot Umesh N, Johnson-Wood Michele L, Geddes Jason B, Ramsey Curtis, Khot Monica B, Taillon Heather, Todd Randall, Shaikh Saeed R, Berg William J
机构信息
Indiana Heart Physicians, Indianapolis, Indiana, USA.
出版信息
BMC Cardiovasc Disord. 2009 Jul 26;9:32. doi: 10.1186/1471-2261-9-32.
BACKGROUND
The impact of reducing door-to-balloon time on hospital revenues, costs, and net income is unknown.
METHODS
We prospectively determined the impact on hospital finances of (1) emergency department physician activation of the catheterization lab and (2) immediate transfer of the patient to an immediately available catheterization lab by an in-house transfer team consisting of an emergency department nurse, a critical care unit nurse, and a chest pain unit nurse. We collected financial data for 52 consecutive ST-elevation myocardial infarction patients undergoing emergency percutaneous intervention from October 1, 2004-August 31, 2005 and compared this group to 80 consecutive ST-elevation myocardial infarction patients from September 1, 2005-June 26, 2006 after protocol implementation.
RESULTS
Per hospital admission, insurance payments (hospital revenue) decreased ($35,043 +/- $36,670 vs. $25,329 +/- $16,185, P = 0.039) along with total hospital costs ($28,082 +/- $31,453 vs. $18,195 +/- $9,242, P = 0.009). Hospital net income per admission was unchanged ($6962 vs. $7134, P = 0.95) as the drop in hospital revenue equaled the drop in costs. For every $1000 reduction in total hospital costs, insurance payments (hospital revenue) dropped $1077 for private payers and $1199 for Medicare/Medicaid. A decrease in hospital charges ($70,430 +/- $74,033 vs. $53,514 +/- $23,378, P = 0.059), diagnosis related group relative weight (3.7479 +/- 2.6731 vs. 2.9729 +/- 0.8545, P = 0.017) and outlier payments with hospital revenue>$100,000 (7.7% vs. 0%, P = 0.022) all contributed to decreasing ST-elevation myocardial infarction hospitalization revenue. One-year post-discharge financial follow-up revealed similar results: Insurance payments: $49,959 +/- $53,741 vs. $35,937 +/- $23,125, P = 0.044; Total hospital costs: $39,974 +/- $37,434 vs. $26,778 +/- $15,561, P = 0.007; Net Income: $9984 vs. $9159, P = 0.855.
CONCLUSION
All of the financial benefits of reducing door-to-balloon time in ST-elevation myocardial infarction go to payers both during initial hospitalization and after one-year follow-up.
TRIAL REGISTRATION
ClinicalTrials.gov ID: NCT00800163.
背景
缩短门球时间对医院收入、成本和净利润的影响尚不清楚。
方法
我们前瞻性地确定了以下两项措施对医院财务状况的影响：（1）急诊科医生启动导管室；（2）由急诊科护士、重症监护室护士和胸痛单元护士组成的内部转运团队将患者立即转运至随时可用的导管室。我们收集了2004年10月1日至2005年8月31日连续52例接受急诊经皮介入治疗的ST段抬高型心肌梗死患者的财务数据，并将该组患者与2005年9月1日至2006年6月26日实施方案后的80例连续ST段抬高型心肌梗死患者进行比较。
结果
每次住院时，保险支付（医院收入）减少（35,043美元±36,670美元对25,329美元±16,185美元，P = 0.039），医院总成本也减少（28,082美元±31,453美元对18,195美元±9,242美元，P = 0.009）。每次住院的医院净利润不变（6962美元对7134美元，P = 0.95），因为医院收入的下降与成本的下降相当。医院总成本每减少1000美元，私人支付者的保险支付（医院收入）下降1077美元，医疗保险/医疗补助支付者下降1199美元。医院收费减少（70,430美元±74,033美元对53,514美元±23,378美元，P = 0.059）、诊断相关组相对权重降低（3.7479±2.6731对2.9729±0.8545，P = 0.017）以及医院收入超过100,美元的异常支付减少（7.7%对0%，P = 0.022）均导致ST段抬高型心肌梗死住院收入下降。出院后一年的财务随访显示了类似结果：保险支付：49,959美元±53,741美元对3,937美元±23,125美元，P = 0.044；医院总成本：39,974美元±37,434美元对26,778美元±15,561美元，P = 0.007；净利润：9984美元对9159美元，P = 0.855。
结论
缩短ST段抬高型心肌梗死门球时间的所有财务收益在初始住院期间和一年随访后均归支付者所有。
试验注册
ClinicalTrials.gov标识符：NCT00800163。
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