Spector William D, Limcangco Rhona, Owens Pamela L, Steiner Claudia A
*Agency for Healthcare Research & Quality, US Department of Health & Human Services, Rockville †Social & Scientific Systems Inc., Silver Spring, MD.
Med Care. 2016 Sep;54(9):845-51. doi: 10.1097/MLR.0000000000000558.
Patients who develop hospital-acquired pressure ulcers (HAPUs) are more likely to die, have longer hospital stays, and are at greater risk of infections. Patients undergoing surgery are prone to developing pressure ulcers (PUs).
To estimate the hospital marginal cost of a HAPU for adults patients who were hospitalized for major surgeries, adjusted for patient characteristics, comorbidities, procedures, and hospital characteristics.
Data are from the Healthcare Cost and Utilization Project (HCUP) State Inpatient Databases and the Medicare Patient Safety Monitoring System for 2011 and 2012. PU information was obtained using retrospective structured record review from trained MPMS data abstractors. Costs are derived using HCUP hospital-specific cost-to-charge ratios. Marginal cost estimates were made using Extended Estimating Equations. We estimated the marginal cost at the 25th, 50th, and 75th percentiles of the cost distribution using Simultaneous Quantile Regression.
We find that 3.5% of major surgical patients developed HAPUs and that the HAPUs added ∼$8200 to the cost of a surgical stay after adjusting for comorbidities, patient characteristics, procedures, and hospital characteristics. This is an ∼44% addition to the cost of a major surgical stay but less than half of the unadjusted cost difference. In addition, we find that for high-cost stays (75th percentile) HAPUs added ∼$12,100, whereas for low-cost stays (25th percentile) HAPUs added ∼$3900.
This paper suggests that HAPUs add ∼44% to the cost of major surgical hospital stays, but the amount varies depending on the total cost of the visit.
发生医院获得性压疮（HAPU）的患者死亡可能性更高、住院时间更长，且感染风险更大。接受手术的患者容易发生压疮（PU）。
估算成年患者因接受大手术住院期间发生HAPU的医院边际成本，并根据患者特征、合并症、手术及医院特征进行调整。
数据来自2011年和2012年医疗成本与利用项目（HCUP）的州住院数据库以及医疗保险患者安全监测系统。通过训练有素的医疗保险患者安全监测系统数据提取人员进行回顾性结构化记录审查来获取PU信息。成本是使用HCUP特定医院的成本收费比率得出的。边际成本估计采用扩展估计方程。我们使用联立分位数回归估计了成本分布第25、50和75百分位数处的边际成本。
我们发现，3.5%的大手术患者发生了HAPU，在对合并症、患者特征、手术及医院特征进行调整后，HAPU使手术住院成本增加了约8200美元。这相当于大手术住院成本增加了约44%，但不到未调整成本差异的一半。此外，我们发现，对于高成本住院（第75百分位数），HAPU使成本增加了约12100美元，而对于低成本住院（第25百分位数），HAPU使成本增加了约3900美元。
本文表明，HAPU使大手术住院成本增加了约44%，但增加的金额因就诊总成本而异。
