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与基于人群的对照组相比,ICU 幸存者在入住 ICU 前后的医疗费用更高:一项结合医疗保险数据和荷兰国家质量登记数据的描述性研究。

Healthcare costs of ICU survivors are higher before and after ICU admission compared to a population based control group: A descriptive study combining healthcare insurance data and data from a Dutch national quality registry.

机构信息

Academic Medical Center, University of Amsterdam, Department: Medical Informatics, Amsterdam Public Health research institute, Amsterdam, The Netherlands; National Intensive Care Evaluation (NICE) foundation, Amsterdam, The Netherlands.

Academic Medical Center, University of Amsterdam, Department: Medical Informatics, Amsterdam Public Health research institute, Amsterdam, The Netherlands; National Intensive Care Evaluation (NICE) foundation, Amsterdam, The Netherlands.

出版信息

J Crit Care. 2018 Apr;44:345-351. doi: 10.1016/j.jcrc.2017.12.005. Epub 2017 Dec 14.

Abstract

PURPOSE

To identify subgroups of ICU patients with high healthcare utilization for healthcare expenditure management purposes such as prevention and targeted care.

MATERIALS AND METHODS

We conducted a descriptive cohort study, combining a national health insurance claims database and a national quality registry database for ICUs. Claims data in the timeframe 2012-2014 were combined with the clinical data of ICU patients admitted to an ICU during 2013. A population based control group was created based on the ICU population.

RESULTS

56,760 ICU patients and 75,232 controls from the general population were included. Median healthcare costs per day alive for the ICU population were significantly higher during the year before (€8.9 (IQR €2.4; €32.1)) and the year after ICU admission (€15.4 (IQR €5.4; €51.2)) compared to the control group ((€2.8 (IQR €0.7; €8.8) and €3.1 (IQR €0.8; €10.1)). ICU patients with more chronic conditions had significantly higher healthcare costs before and after ICU admission compared to ICU patients with less chronic conditions.

CONCLUSIONS

ICU patients have three to five times higher healthcare costs per day alive compared to a control population. Our findings can be used to optimize the healthcare trajectories of ICU patients with high healthcare utilization after discharge.

摘要

目的

为了进行医疗支出管理,如预防和有针对性的护理,确定 ICU 患者中有高医疗利用度的亚组人群。

材料和方法

我们进行了一项描述性队列研究,将国家健康保险索赔数据库和 ICU 的国家质量登记数据库相结合。将 2012 年至 2014 年的索赔数据与 2013 年期间入住 ICU 的 ICU 患者的临床数据相结合。根据 ICU 人群创建了基于人群的对照组。

结果

纳入了 56760 名 ICU 患者和 75232 名来自普通人群的对照组。与对照组相比,ICU 人群在 ICU 入住前一年(€8.9(IQR €2.4;€32.1))和 ICU 入住后一年(€15.4(IQR €5.4;€51.2))期间,每天的医疗费用中位数明显更高(€2.8(IQR €0.7;€8.8)和 €3.1(IQR €0.8;€10.1))。与慢性疾病较少的 ICU 患者相比,慢性疾病较多的 ICU 患者在 ICU 入住前后的医疗费用明显更高。

结论

与对照组相比,ICU 患者每天的存活医疗费用高 3 至 5 倍。我们的研究结果可用于优化出院后高医疗利用率 ICU 患者的医疗轨迹。

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