小儿创伤性脑损伤神经重症监护项目的成本：一项回顾性队列研究。
The cost of a pediatric neurocritical care program for traumatic brain injury: a retrospective cohort study.
作者信息
Howard Steven W, Zhang Zidong, Buchanan Paula, Bernell Stephanie L, Williams Christine, Pearson Lindsey, Huetsch Michael, Gill Jeff, Pineda Jose A
机构信息
Saint Louis University, Health Management and Policy, Salus Center 374, 3545 Lafayette Ave., St. Louis, MO, 63104, USA.
Saint Louis University, School of Medicine, St. Louis, MO, USA.
出版信息
BMC Health Serv Res. 2018 Jan 12;18(1):20. doi: 10.1186/s12913-017-2768-0.
BACKGROUND
Inpatient care for children with severe traumatic brain injury (sTBI) is expensive, with inpatient charges averaging over $70,000 per case (Hospital Inpatient, Children Only, National Statistics. Diagnoses- clinical classification software (CCS) principal diagnosis category 85 coma, stupor, and brain damage, and 233 intracranial injury. Diagnoses by Aggregate charges [ https://hcupnet.ahrq.gov/#setup ]). This ranks sTBI in the top quartile of pediatric conditions with the greatest inpatient costs (Hospital Inpatient, Children Only, National Statistics. Diagnoses- clinical classification software (CCS) principal diagnosis category 85 coma, stupor, and brain damage, and 233 intracranial injury. Diagnoses by Aggregate charges [ https://hcupnet.ahrq.gov/#setup ]). The Brain Trauma Foundation developed sTBI intensive care guidelines in 2003, with revisions in 2012 (Kochanek, Carney, et. al. PCCM 3:S1-S2, 2012). These guidelines have been widely disseminated, and are associated with improved health outcomes (Pineda, Leonard. et. al. LN 12:45-52, 2013), yet research on the cost of associated hospital care is limited. The objective of this study was to assess the costs of providing hospital care to sTBI patients through a guideline-based Pediatric Neurocritical Care Program (PNCP) implemented at St. Louis Children's Hospital, a pediatric academic medical center in the Midwest United States.
METHODS
This is a retrospective cohort study. We used multi-level regression to estimate pre-/post-implementation effects of the PNCP program on inflation adjusted total cost of in-hospital sTBI care. The study population included 58 pediatric patient discharges in the pre-PNCP implementation group (July 15, 1999 - September 17, 2005), and 59 post-implementation patient discharges (September 18, 2005 - January 15, 2012).
RESULTS
Implementation of the PNCP was associated with a non-significant difference in the cost of care between the pre- and post-implementation periods (e = 1.028, p = 0.687).
CONCLUSIONS
Implementation of the PNCP to support delivery of guideline-based care for children with sTBI did not change the total per-patient cost of in-hospital care. A key strength of this study was its use of hospital cost data rather than charges. Future research should consider the longitudinal post-hospitalization costs of this approach to sTBI care.
背景
重度创伤性脑损伤（sTBI）患儿的住院治疗费用高昂，每例住院费用平均超过70,000美元（医院住院患者，仅儿童，国家统计数据。诊断 - 临床分类软件（CCS）主要诊断类别85昏迷、木僵和脑损伤，以及233颅内损伤。按总费用诊断[https://hcupnet.ahrq.gov/#setup]）。这使sTBI在儿科疾病住院费用最高的四分位中名列前茅（医院住院患者，仅儿童，国家统计数据。诊断 - 临床分类软件（CCS）主要诊断类别85昏迷、木僵和脑损伤，以及233颅内损伤。按总费用诊断[https://hcupnet.ahrq.gov/#setup]）。脑创伤基金会在2003年制定了sTBI重症监护指南，并于2012年进行了修订（科查内克、卡尼等人。《危重病医学》3：S1 - S2，2012年）。这些指南已广泛传播，并与改善健康结果相关（皮内达、伦纳德等人。《神经危重症》12：45 - 52，2013年），但关于相关医院护理费用的研究有限。本研究的目的是评估通过美国中西部一家儿科学术医疗中心圣路易斯儿童医院实施的基于指南的儿科神经重症监护项目（PNCP）为sTBI患者提供医院护理的成本。
方法
这是一项回顾性队列研究。我们使用多层次回归来估计PNCP项目实施前后对经通胀调整的sTBI住院护理总成本的影响。研究人群包括PNCP实施前组的58例儿科患者出院病例（1999年7月15日 - 2005年9月17日），以及实施后组的59例患者出院病例（2005年9月18日 - 2012年1月15日）。
结果
PNCP的实施与实施前后护理成本的差异无统计学意义（e = 1.028，p = 0.687）。
结论
实施PNCP以支持为sTBI患儿提供基于指南的护理并未改变每位患者的住院护理总成本。本研究一个关键优势是使用了医院成本数据而非收费数据。未来研究应考虑这种sTBI护理方法的出院后长期成本。
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