与医院入院后脱水相关的经济负担。

Economic burden associated with hospital postadmission dehydration.

作者信息

Pash Elizabeth, Parikh Niraj, Hashemi Lobat

机构信息

Covidien LP, Mansfield, Massachusetts

Covidien LP, Mansfield, Massachusetts.

出版信息

JPEN J Parenter Enteral Nutr. 2014 Nov;38(2 Suppl):58S-64S. doi: 10.1177/0148607114550316. Epub 2014 Sep 18.

DOI:10.1177/0148607114550316

PMID:25233943

Abstract

BACKGROUND

Development of dehydration after hospital admission can be a measure of quality care, but evidence describing the incidence, economic burden, and outcomes of dehydration in hospitalized patients is lacking.

OBJECTIVE

The objective of this study was to compare costs and resource utilization of U.S. patients experiencing postadmission dehydration (PAD) with those who do not in a hospital setting.

METHODS

All adult inpatient discharges, excluding those with suspected dehydration present on admission (International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM] codes for dehydration: 276.0, 276.1, 276.5), were identified from the Premier database using ICD-9-CM codes. PAD and no-PAD (NPAD) groups were matched on propensity score adjusting for demographics (age, sex, race, medical, elective patients), patient severity (All Patient Refined Diagnosis-Related Groups severity scores), and hospital characteristics (geographic location, bed size, teaching and urban hospital). Costs, length of stay (LOS), and incidence of mortality and catheter-associated urinary tract infection (CAUTI) were compared between groups using the t test for continuous variables and the χ(2) test for categorical variables.

RESULTS

In total, 86,398 (2.1%) of all the selected patients experienced PAD. Postmatching mean total costs were significantly higher for the PAD group compared with the NPAD group ($33,945 vs $22,380; P < .0001). Departmental costs were also significantly higher for the PAD group (all P < .0001). Compared with the NPAD group, the PAD group had a higher mean LOS (12.9 vs 8.2 days), a higher incidence of CAUTI (0.6% vs 0.5%), and higher in-hospital mortality (8.6% vs 7.8%) (all P < .05). The results for subgroup analysis also showed significantly higher total cost and longer LOS days for patients with PAD (all P < .05).

CONCLUSIONS

The economic burden associated with hospital PAD in medical and surgical patients was substantial.

摘要

背景

入院后发生脱水情况可作为衡量医疗质量的一项指标，但目前缺乏有关住院患者脱水的发生率、经济负担及后果的相关证据。

目的

本研究旨在比较美国住院患者中发生入院后脱水（PAD）的患者与未发生脱水的患者的费用及资源利用情况。

方法

使用国际疾病分类第九版临床修订本（ICD-9-CM）编码，从Premier数据库中识别出所有成年住院患者出院病例，但不包括入院时疑似脱水的患者（ICD-9-CM中脱水编码：276.0、276.1、276.5）。根据倾向得分对PAD组和无PAD（NPAD）组进行匹配，调整人口统计学因素（年龄、性别、种族、内科、择期手术患者）、患者严重程度（所有患者精细诊断相关组严重程度评分）及医院特征（地理位置、床位规模、教学医院及城市医院）。使用t检验比较连续变量组间的费用、住院时间（LOS）以及死亡率和导管相关尿路感染（CAUTI）的发生率，使用χ²检验比较分类变量组间情况。

结果

在所有选定患者中，共有86398例（2.1%）发生PAD。匹配后，PAD组的平均总费用显著高于NPAD组（33945美元对22380美元；P < .0001）。PAD组的科室费用也显著更高（所有P < .0001）。与NPAD组相比，PAD组的平均LOS更长（12.9天对8.2天），CAUTI发生率更高（0.6%对0.5%），院内死亡率更高（8.6%对7.8%）（所有P < .05）。亚组分析结果也显示，PAD患者的总费用显著更高，LOS天数更长（所有P < .05）。