Keren Ron, Luan Xianqun, Localio Russell, Hall Matt, McLeod Lisa, Dai Dingwei, Srivastava Rajendu
Division of General Pediatrics, Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA.
Arch Pediatr Adolesc Med. 2012 Dec;166(12):1155-64. doi: 10.1001/archpediatrics.2012.1266.
To use information about prevalence, cost, and variation in resource utilization to prioritize comparative effectiveness research topics in hospital pediatrics.
Retrospective analysis of administrative and billing data for hospital encounters.
Thirty-eight freestanding US children's hospitals from January 1, 2004, through December 31, 2009.
Children hospitalized with conditions that accounted for either 80% of all encounters or 80% of all charges.
Condition-specific prevalence, total standardized cost, and interhospital variation in mean standardized cost per encounter, measured in 2 ways: (1) intraclass correlation coefficient, which represents the fraction of total variation in standardized costs per encounter due to variation between hospitals; and (2) number of outlier hospitals, defined as having more than 30% of encounters with standardized costs in either the lowest or highest quintile across all encounters.
Among 495 conditions accounting for 80% of all charges, the 10 most expensive conditions accounted for 36% of all standardized costs. Among the 50 most prevalent and 50 most costly conditions (77 in total), 26 had intraclass correlation coefficients higher than 0.10 and 5 had intraclass correlation coefficients higher than 0.30. For 10 conditions, more than half of the hospitals met outlier hospital criteria. Surgical procedures for hypertrophy of tonsils and adenoids, otitis media, and acute appendicitis without peritonitis were high cost, were high prevalence, and displayed significant variation in interhospital cost per encounter.
Detailed administrative and billing data can be used to standardize hospital costs and identify high-priority conditions for comparative effectiveness research--those that are high cost, are high prevalence, and demonstrate high variation in resource utilization.
利用患病率、成本及资源利用差异等信息，确定医院儿科比较效果研究课题的优先顺序。
对医院诊疗的行政和计费数据进行回顾性分析。
2004年1月1日至2009年12月31日期间美国38家独立儿童医院。
因某些疾病住院的儿童，这些疾病占所有诊疗次数的80%或所有费用的80%。
特定疾病的患病率、总标准化成本以及每次诊疗平均标准化成本的医院间差异，通过两种方式衡量：（1）组内相关系数，代表每次诊疗标准化成本总变异中因医院间差异所致的比例；（2）异常值医院数量，定义为在所有诊疗中，标准化成本处于最低或最高五分位数的诊疗次数超过30%的医院。
在占所有费用80%的495种疾病中，10种最昂贵的疾病占所有标准化成本的36%。在50种最常见和50种最昂贵的疾病（共77种）中，26种疾病的组内相关系数高于0.10，5种疾病的组内相关系数高于0.30。对于10种疾病，超过半数的医院符合异常值医院标准。扁桃体和腺样体肥大、中耳炎以及无腹膜炎的急性阑尾炎的外科手术成本高且患病率高，每次诊疗的医院间成本存在显著差异。
详细的行政和计费数据可用于规范医院成本，并确定比较效果研究的高优先级疾病——即那些成本高、患病率高且资源利用差异大的疾病。
