Coto Jeffrey A, Yehle Karen S, Foli Karen J
Author Affiliations: Term Lecturer, Purdue University North Central, Purdue University School of Nursing (Dr Coto), Westville; Associate Professor, College of Health and Human Sciences, Purdue University School of Nursing, Faculty Associate, Center on Aging and the Life Course, and Faculty Associate, Regenstrief Center for Healthcare Engineering (Dr Yehle), West Lafayette, Indiana; and Assistant Professor, College of Health and Human Sciences, Purdue University School of Nursing (Dr Foli), West Lafayette, Indiana.
Clin Nurse Spec. 2014 Sep-Oct;28(5):283-7. doi: 10.1097/NUR.0000000000000071.
PURPOSE/OBJECTIVE: The purpose of this study was to examine the relationship between hospitalization cost and discharge blood glucose levels among adult diabetes mellitus type 2 patients hospitalized with uncontrolled glycemia without complications.
Retrospective cohort analysis examined healthcare billing and laboratory data.
The study was performed in Chicago, Illinois, in a 269-bed medical center between January 1, 2011, and December 31, 2011.
Patients were placed into 1 of 2 groups at discharge: blood glucose level less than 250 mg/dL or blood glucose level 250 mg/dL or greater.
Of the 579 patients with uncontrolled glycemia, 366 met inclusion criteria: diabetes mellitus without complications (International Classification of Diseases, Ninth Revision; 250.0) with abnormal fasting blood glucose (International Classification of Diseases, Ninth Revision; 790.21). Discharge blood glucose levels were 250 mg/dL or greater in 74 patients and less than 250 mg/dL in 292 patients. Mean age of the 2 cohorts was 71.4 (SD, 13.41) years. The majority was male (52.1% and 59.7%, respectively). The median healthcare cost for the entire sample was $3964.34. The mean cost of healthcare for the group with blood glucose of 250 mg/dL or greater at discharge was $4182.65, with a mean length of stay of 8.22 (SD, 3.468) days, while the mean cost of healthcare for the group with blood glucose of less than 250 mg/dL at discharge was $3826.25 and mean length of stay 7.826 (SD, 6.073) days. Analysis of cost was conducted using Pearson χ and was significant for α = .05 (P = .037). The odds ratio of having increased healthcare cost with blood glucose of 250 mg/dL or greater was 1.732 with a 95% confidence interval of 0.998 to 3.012.
The group discharged with blood glucose levels of 250 mg/dL or greater accrued greater cost during hospitalization than did patients who were discharged with blood glucose levels of less than 250 mg/dL.
Today's healthcare system is struggling with cost containment, quality control, and standardization of care. Clinical nurse specialists can evaluate current patient care practices and ensure that the practice setting is fiscally beneficial to future patients and healthcare organizations.
目的/目标：本研究旨在探讨2型糖尿病成年患者在血糖控制不佳且无并发症情况下住院时，住院费用与出院时血糖水平之间的关系。
回顾性队列分析，研究医疗计费和实验室数据。
该研究于2011年1月1日至2011年12月31日在伊利诺伊州芝加哥市一家拥有269张床位的医疗中心进行。
患者出院时被分为两组：血糖水平低于250mg/dL或血糖水平为250mg/dL及以上。
在579例血糖控制不佳的患者中，366例符合纳入标准：无并发症的糖尿病（国际疾病分类第九版；250.0）且空腹血糖异常（国际疾病分类第九版；790.21）。74例患者出院时血糖水平为250mg/dL及以上，292例患者出院时血糖水平低于250mg/dL。两个队列的平均年龄为71.4（标准差，13.41）岁。大多数为男性（分别为52.1%和59.7%）。整个样本的医疗费用中位数为3964.34美元。出院时血糖水平为250mg/dL及以上的组的平均医疗费用为4182.65美元，平均住院天数为8.22（标准差，3.468）天，而出院时血糖水平低于250mg/dL的组的平均医疗费用为3826.25美元，平均住院天数为7.826（标准差，6.073）天。使用Pearson χ进行费用分析，α = 0.05时具有统计学意义（P = 0.037）。血糖水平为250mg/dL及以上时医疗费用增加的优势比为1.732，95%置信区间为0.998至3.012。
出院时血糖水平为250mg/dL及以上的患者在住院期间产生的费用高于出院时血糖水平低于250mg/dL的患者。
当今的医疗保健系统在成本控制、质量控制和护理标准化方面面临挑战。临床护理专家可以评估当前的患者护理实践，并确保实践环境对未来患者和医疗保健组织在财务上有益。
