Smith Andrew H, Gay James C, Patel Neal R
Thomas P. Graham Jr. Division of Pediatric Cardiology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tenn, USA; Division of Pediatric Critical Care Medicine, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tenn, USA.
Congenit Heart Dis. 2014 Mar-Apr;9(2):96-105. doi: 10.1111/chd.12103. Epub 2013 Jun 5.
While neonates account for a significant proportion of health care expenditures related to inpatient care for congenital heart disease, key drivers of resource utilization among this population are poorly defined.
Data from 2005 through 2011 were extracted from the Pediatric Health Information System for patients assigned a discharge All Patient Refined Diagnosis Related Group of 630 (neonates with birthweight >2499 g undergoing a major cardiovascular procedure). Mortality risk adjustment for patients undergoing operative interventions was performed with the Risk Adjusment in Congenital Heart Surgery (RACHS-1) score.
A total of 13 156 cases were included in the analysis. Despite only a 3% increase in case mix index and no significant change in operative acuity over the study period (RACHS classifications of 3 or greater 67% in 2005 vs. 66% in 2011, P = .64), there were inflation-adjusted increases in both total estimated cost per case of (50% to $151 760 in 2011, P < .001), and mean charge per case (33% to $433 875 in 2011, P < .001). Pharmacy charges increased by 16% (P < .001), with agents including chlorothiazide and albumin accounting for the highest patient charges over the study period. Imaging charges increased by 42% (P < .001), with an average of 5.7 echocardiograms and $6517 in associated charges per case by 2011. While the proportion of patients receiving nitric oxide remained consistent, mean duration of administration increased by 25% to 6.6 days by 2011, accounting for average charges of $52 141 per patient exposed.
Among neonates with serious congenital heart disease, increases in both institutional costs and charges to the patient are associated with relatively consistent utilization practices in recent years. Multiinstitutional collaboration may prove useful in aligning evidence-based reductions in practice variation with limitations in resource utilization without compromising the quality of care.
虽然新生儿在先天性心脏病住院治疗的医疗保健支出中占很大比例，但该人群资源利用的关键驱动因素尚不明确。
从儿科健康信息系统中提取2005年至2011年的数据，这些患者出院时被分配到所有患者细化诊断相关组630（出生体重>2499克的新生儿接受重大心血管手术）。对接受手术干预的患者进行死亡风险调整，采用先天性心脏病手术风险调整（RACHS-1）评分。
分析共纳入13156例病例。尽管在研究期间病例组合指数仅增加了3%，手术敏锐度没有显著变化（2005年RACHS分类为3或更高的占67%，2011年为66%，P = 0.64），但经通胀调整后，每例病例的估计总成本（从2005年的101173美元增加50%至2011年的151760美元，P < 0.001）和每例病例的平均费用（从2005年的326371美元增加33%至2011年的433875美元，P < 0.001）均有所增加。药房费用增加了16%（P < 0.001），在研究期间，包括氯噻嗪和白蛋白在内的药物占患者费用最高。影像检查费用增加了42%（P < 0.001），到2011年，平均每例病例有5.7次超声心动图检查及相关费用6517美元。虽然接受一氧化氮治疗的患者比例保持一致，但到2011年，平均给药持续时间增加了25%，达到6.6天，每名接受治疗的患者平均费用为52141美元。
在患有严重先天性心脏病的新生儿中，近年来机构成本和患者费用的增加与相对一致的使用模式相关。多机构合作可能有助于在不影响护理质量的前提下，将基于证据的实践差异减少与资源利用限制相协调。
