Munoz E, Boiardo R, Mulloy K, Goldstein J, Brewster J G, Wise L
Department of Surgery, Long Island Jewish Medical Center, New Hyde Park, NY.
Urology. 1990 Nov;36(5):471-6. doi: 10.1016/s0090-4295(90)80301-3.
Diagnosis Related Group (DRG) hospital payment has begun to squeeze hospitals financially and is likely to do so in the future. This study analyzed the relationship between the volume of urologic procedures by an individual urologist, hospital costs per patient, and outcome. We used a three-year DRG database of urology patients (N = 2,980) at an academic medical center to analyze these. Low-volume urologists (arbitrarily defined by us) had higher hospital costs per patient, financial losses versus profits under DRGs, and a poorer outcome when compared with high-volume urologists. Pearson correlation showed a positive relationship between cost per patient and physician volume for nonemergency patients (-0.129, p less than 0.0001) and emergency patients (-0.368, p less than 0.0001). This may have been explained (in part) by a greater severity of illness for patients of low-volume urologists. These findings suggest, however, that the volume of urologic procedures per urologist may be related to hospital resource consumption. The health care financing environment of the future should provide substantial interest in this finding for those involved in the consumption of urologic services.
诊断相关分组（DRG）医院支付方式已开始给医院带来财务压力，且未来可能仍会如此。本研究分析了个体泌尿科医生的泌尿外科手术量、每位患者的医院成本与治疗结果之间的关系。我们使用了某学术医疗中心三年的泌尿外科患者DRG数据库（N = 2980）来进行分析。与高手术量的泌尿科医生相比，低手术量的泌尿科医生（由我们任意定义）每位患者的医院成本更高，在DRG模式下财务亏损而非盈利，且治疗结果更差。Pearson相关性分析显示，非急诊患者（-0.129，p < 0.0001）和急诊患者（-0.368，p < 0.0001）的每位患者成本与医生手术量之间呈正相关。这可能（部分）是由于低手术量泌尿科医生的患者病情更严重所致。然而，这些发现表明，每位泌尿科医生的泌尿外科手术量可能与医院资源消耗有关。未来的医疗保健融资环境应会让那些参与泌尿外科服务消费的人对这一发现产生浓厚兴趣。
