2007年至2008年美国全甲状腺切除术费用的差异
Variation in cost of total thyroidectomy across the United States, 2007 to 2008.
作者信息
Reinke Caroline E, Sonnenberg Elizabeth M, Karakousis Giorgos C, Fraker Douglas L, Kelz Rachel R
机构信息
Department of Surgery, 4 Silverstein 3400 Spruce Street, Hospital of the University of Pennsylvania, Philadelphia, PA 19103, USA; Center for Surgery and Health Economics, Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA.
Center for Surgery and Health Economics, Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA.
出版信息
Am J Surg. 2015 Aug;210(2):302-8. doi: 10.1016/j.amjsurg.2014.12.039. Epub 2015 Mar 28.
BACKGROUND
Variation in cost of surgical care across state lines is poorly understood. We sought to examine state-level variation in wage-adjusted total cost (WATC) of a common surgical procedure.
METHODS
We performed a retrospective cohort study of patients undergoing total thyroidectomy in the Nationwide Inpatient Sample (2007 to 2008). WATC was calculated from charges and adjusted for the area wage index. Hierarchical linear modeling was used to investigate the variation in WATC explained by variables at the patient, hospital, and state levels.
RESULTS
We identified 11,058 eligible patients from 35 states. The overall mean WATC was $8,132; 37% of the WATC variance was because of differences across hospitals, whereas 28% was explained by patient-level factors and 8% because of differences across states.
CONCLUSIONS
More than a quarter of the variation in cost of total thyroidectomy was not explained by patient-, hospital-, or state-level factors. Further research is needed to understand the unexplained residual variation.
背景
州际间外科护理费用的差异尚不清楚。我们试图研究一种常见外科手术的工资调整后总成本（WATC）的州级差异。
方法
我们对全国住院患者样本（2007年至2008年）中接受全甲状腺切除术的患者进行了一项回顾性队列研究。WATC根据收费计算，并根据地区工资指数进行调整。采用分层线性模型研究患者、医院和州层面变量所解释的WATC差异。
结果
我们从35个州中识别出11058名符合条件的患者。总体平均WATC为8132美元；37%的WATC差异是由于医院之间的差异，而28%由患者层面因素解释，8%是由于州之间的差异。
结论
全甲状腺切除术费用差异的四分之一以上无法由患者、医院或州层面因素解释。需要进一步研究以了解无法解释的残余差异。
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