Richter J M, Wang T C, Fawaz K, Bynum T E, Fallon D, Shapleigh C
Medical Service, Massachusetts General Hospital, Boston 02114.
J Clin Gastroenterol. 1991 Jun;13(3):268-73. doi: 10.1097/00004836-199106000-00005.
We conducted an observational study at three hospitals in Boston to examine the patterns of practice and the costs involved in the medical management of noncirrhotic, upper gastrointestinal bleeding. A total of 111 patients were identified and studied: 42 from hospital 1, 38 from hospital 2, and 31 from hospital 3. There were no significant differences in the management of the patients, except for the more frequent use of upper gastrointestinal radiography at hospital 3 and the more frequent use of cimetidine at hospital 2. Only a small percentage (3-7%) of patients required surgery, and overall mortality (0-8%) was low. The average cost of hospitalization, determined by using the New England Medical Center cost model, was calculated for direct costs ($3,180). The majority of costs incurred were for hospital bed or intensive care unit stay (63%) and transfusion of blood products (14%), with costs for physicians' services (9%), endoscopy (2%), and upper gastrointestinal radiography (1%) accounting for only a small percentage. This study demonstrates remarkable similarity in practice patterns and resource utilization at three different hospitals and provides data on the actual costs involved in hospitalization for noncirrhotic, upper gastrointestinal hemorrhage.
我们在波士顿的三家医院开展了一项观察性研究，以调查非肝硬化性上消化道出血的医疗管理模式及相关成本。共确定并研究了111例患者：医院1有42例，医院2有38例，医院3有31例。除了医院3更频繁地使用上消化道造影以及医院2更频繁地使用西咪替丁外，患者的治疗管理并无显著差异。仅一小部分（3 - 7%）患者需要手术，总体死亡率（0 - 8%）较低。使用新英格兰医学中心成本模型确定的平均住院费用为直接成本（3180美元）。产生的大部分费用用于住院床位或重症监护病房（63%）以及血液制品输注（14%），医师服务费用（9%）、内镜检查（2%）和上消化道造影（1%）仅占小部分。本研究表明三家不同医院在治疗模式和资源利用方面具有显著相似性，并提供了非肝硬化性上消化道出血住院实际成本的数据。
