Plehn Gunnar, Butz Thomas, Maagh Petra, Meissner Axel
Department of Cardiology, Johanniter-Hospital Duisburg Rheinhausen, Kreuzacker 1-7, 47228, Duisburg, Germany.
Ruhr-University of Bochum, Universitätsstrasse 150, 44801, Bochum, Germany.
BMC Health Serv Res. 2017 Jan 18;17(1):49. doi: 10.1186/s12913-017-1999-4.
Due to a continuing age shift in the German society hospital providers are concerned about the additional costs associated with the treatment of elderly patients. It is not clear if cardiac catheterization in aged patients leads to higher resource utilization and if DRG-revenues do compensate for this factor.
Procedure-related and administrative data of all patients who underwent cardiac catheterization at a tertiary heart center between 2007 and 2011 were collected and analyzed. Then a profitability analysis was performed by comparing the case related variable costs with the Diagnosis-related group (DRG) per case revenues. A particular emphasis was placed on a comparative analysis of identical clusters of procedures.
The most frequently performed catheterization procedure (n = 1800) was associated with significantly higher material expenditure in very old patients (178 ± 48 €) than in old (171 ± 28; p = 0.001) and young patients (172 ± 39; p = 0.046). Furthermore, radiation time and the length of hospital stay were increased in very old patients (3.5 ± 3.8 min and 6.2 ± 4.8 days) compared to old (2.7 ± 2.8 min and 4.6 ± 3.8 days; p < 0.001) and young patients (2.5 ± 2.5 min and 4.5 ± 3.9 days; p < 0.001). Due to higher DRG revenues very old patients achieved higher absolute contribution margins (2065 ± 1033 €) than old (1804 ± 1902 €; p < 0.001) and young patients (1771 ± 902 €; p < 0.001). However, the contribution margins per day were significantly smaller (440 ± 226 €) than those in old (488 ± 234 €; p = 0.001) and young patients (484 ± 206 €; p = 0.001).
Catheterization of very old patients is related to lower contribution margins per day despite higher material and time expenditures. Since efforts to reduce the length of hospital stay of these patients are limited, this may result in a competitive disadvantage of hospitals which are more affected by the demographic change.
由于德国社会年龄结构持续变化，医院提供者担心老年患者治疗带来的额外成本。目前尚不清楚老年患者的心脏导管插入术是否会导致更高的资源利用，以及诊断相关分组（DRG）收入是否能弥补这一因素。
收集并分析了2007年至2011年期间在一家三级心脏中心接受心脏导管插入术的所有患者的手术相关和管理数据。然后通过比较病例相关可变成本与每个病例的诊断相关分组（DRG）收入进行盈利能力分析。特别强调了对相同手术组的比较分析。
最常进行的导管插入术（n = 1800）在高龄患者（178 ± 48欧元）中的材料支出明显高于老年患者（171 ± 28；p = 0.001）和年轻患者（172 ± 39；p = 0.046）。此外，高龄患者的放射时间和住院时间（3.5 ± 3.8分钟和6.2 ± 4.8天）比老年患者（2.7 ± 2.8分钟和4.6 ± 3.8天；p < 0.001）和年轻患者（2.5 ± 2.5分钟和4.5 ± 3.9天；p < 0.001）有所增加。由于DRG收入较高，高龄患者实现了比老年患者（1804 ± 1902欧元；p < 0.001）和年轻患者（1771 ± 902欧元；p < 0.001）更高的绝对边际贡献（2065 ± 1033欧元）。然而，高龄患者每天的边际贡献（440 ± 226欧元）明显低于老年患者（488 ± 234欧元；p = 0.001）和年轻患者（484 ± 206欧元；p = 0.001）。
尽管高龄患者的材料和时间支出较高，但他们每天的边际贡献较低。由于缩短这些患者住院时间的努力有限，这可能导致受人口结构变化影响更大的医院处于竞争劣势。
