ICU 患者的日费用：23 家法国重症监护病房的微观成本研究。

The daily cost of ICU patients: A micro-costing study in 23 French Intensive Care Units.

机构信息

Division anesthésie réanimation douleur urgences, faculté de médecine, université Montpellier 1, CHU de Nîmes, place du Professeur-Robert-Debré, 30029 Nîmes cedex 9, France.

Service de réanimation et de surveillances médico-chirurgicales polyvalentes, centre hospitalier du Pays d'Aix, Aix-en-Provence, France.

出版信息

Anaesth Crit Care Pain Med. 2015 Jun;34(3):151-7. doi: 10.1016/j.accpm.2014.09.004. Epub 2015 May 16.

DOI:10.1016/j.accpm.2014.09.004

PMID:25986476

Abstract

OBJECTIVES

To estimate the daily cost of intensive care unit (ICU) stays via micro-costing.

METHODS

A multicentre, prospective, observational, cost analysis study was carried out among 21 out of 23 French ICUs randomly selected from French National Hospitals. Each ICU randomly enrolled 5 admitted adult patients with a simplified acute physiology II score ≥ 15 and with at least one major intensive care medical procedure. All health-care human resources used by each patient over a 24-hour period were recorded, as well as all medications, laboratory analyses, investigations, tests, consumables and administrative expenses. All resource costs were estimated from the hospital's perspective (reference year 2009) based on unitary cost data.

RESULTS

One hundred and four patients were included (mean age: 62.3 ± 14.9 years, mean SAPS II: 51.5 ± 16.1, mean SOFA on the study day: 6.9 ± 4.3). Over 24 hours, 29 to 186 interventions per patient were performed by different caregivers, leading to a mean total time spent for patient care of 13:32 ± 05:00 h. The total daily cost per patient was € 1425 ± € 520 (95% CI = € 1323 to € 1526). ICU human resources represented 43% of total daily cost. Patient-dependent expenses (€ 842 ± € 521) represented 59% of the total daily cost. The total daily cost was correlated with the daily SOFA score (r = 0.271, P = 0.006) and the bedside-time given by caregivers (r = 0.716, P < 0.0001).

CONCLUSION

The average cost of one day of ICU care in French National Hospitals is strongly correlated with the duration of bedside-care carried out by human resources.

摘要

目的

通过微观成本估算来估计重症监护病房（ICU）住院的日费用。

方法

这是一项多中心、前瞻性、观察性的成本分析研究，在法国国立医院随机选择的 23 家 ICU 中的 21 家进行。每个 ICU 随机招募了 5 名入住的成年患者，简化急性生理学评分 II （SAPS II）≥ 15 分，且至少有一项主要的 ICU 医疗程序。记录每位患者在 24 小时内使用的所有医疗人力资源，以及所有药物、实验室分析、检查、测试、耗材和行政费用。所有资源成本均根据医院的角度（参考年为 2009 年）基于单位成本数据进行估算。

结果

共纳入 104 名患者（平均年龄：62.3 ± 14.9 岁，SAPS II 平均：51.5 ± 16.1，研究日 SOFA 平均：6.9 ± 4.3）。不同护理人员在 24 小时内对每位患者进行了 29 至 186 次干预，导致患者护理总时间平均为 13:32 ± 05:00 h。每位患者的每日总费用为 1425 ± 520 欧元（95%CI = 1323 至 1526 欧元）。ICU 人力资源占总日费用的 43%。患者相关费用（842 ± 521 欧元）占总日费用的 59%。总日费用与每日 SOFA 评分（r = 0.271，P = 0.006）和护理人员提供的床边时间（r = 0.716，P < 0.0001）相关。