Munoz E, Boiardo R, Mulloy K, Goldstein J, Tenenbaum N, Wise L
Department of Surgery, Long Island Jewish Medical Center, New Hyde Park, New York.
Neurosurgery. 1990 Jan;26(1):156-60; discussion 160-1. doi: 10.1097/00006123-199001000-00027.
Hospitals face an increasingly competitive environment in the era of diagnostic related group (DRG) prospective pricing. Further reductions in Medicare outlays relative to hospital costs are likely, given the looming federal deficit. We analyzed the relationship of individual neurosurgical volume, hospital costs, and outcome. All neurosurgical patients (n = 1002) treated for a 3-year period at our large academic medical center were grouped into those treated by low-volume neurosurgeons versus those treated by high-volume neurosurgeons (arbitrarily defined by us); 95% of patients admitted for neurosurgical procedures fit into one of these two categories. Patients of low-volume neurosurgeons had higher hospital costs (even after correction for DRG case-mix and severity of illness) (P less than 0.01), a much worse financial position under DRGs (P less than 0.01), but a similar outcome for both emergency and nonemergency admissions when compared to patients of higher volume neurosurgeons. Pearson correlation showed an inverse relationship between declining cost per patient and increasing neurosurgical volume for both nonemergency patients -0.340 (P less than 0.0001), and emergency patients, -0.321 (P less than 0.0001). These findings suggest that the volume of neurosurgical procedures performed by an individual neurosurgeon is related to hospital resource utilization. This study also suggests that the DRG prospective payment system could provide incentives that may affect both neurosurgical practice and the access to neurosurgical care.
在诊断相关分组（DRG）预定价时代，医院面临着日益激烈的竞争环境。鉴于联邦赤字逼近，医疗保险支出相对于医院成本可能会进一步降低。我们分析了个体神经外科手术量、医院成本和治疗结果之间的关系。在我们大型学术医疗中心接受为期3年治疗的所有神经外科患者（n = 1002）被分为由低手术量神经外科医生治疗的患者和由高手术量神经外科医生治疗的患者（由我们任意定义）；95%接受神经外科手术的患者属于这两类之一。低手术量神经外科医生治疗的患者医院成本更高（即使在对DRG病例组合和疾病严重程度进行校正之后）（P < 0.01），在DRG下财务状况更差（P < 0.01），但与高手术量神经外科医生治疗的患者相比，急诊和非急诊入院患者的治疗结果相似。Pearson相关性分析显示，非急诊患者每位患者成本下降与神经外科手术量增加之间呈负相关，-0.340（P < 0.0001），急诊患者为-0.321（P < 0.0001）。这些发现表明，个体神经外科医生进行的神经外科手术量与医院资源利用有关。这项研究还表明，DRG预付费系统可能会提供一些激励措施，这些措施可能会影响神经外科实践以及神经外科护理的可及性。
