Dusek Jeffery A, Griffin Kristen H, Finch Michael D, Rivard Rachael L, Watson David
1 Allina Health, Integrative Health Research Center, Penny George Institute for Health and Healing , Minneapolis, MN.
2 Children's Minnesota, Children's Minnesota Research Institute , Minneapolis, MN.
J Altern Complement Med. 2018 Jun;24(6):557-563. doi: 10.1089/acm.2017.0203. Epub 2018 Feb 23.
An important task facing hospitals is improving pain management without raising costs. Integrative medicine (IM), a promising nonpharmacologic pain management strategy, is yet to be examined for its cost implications in an inpatient setting. This institution has had an inpatient IM department for over a decade. The purpose was to examine the relationship between changes in patients' pain, as a result of receiving IM therapy, and total cost of care during an inpatient hospital admission.
In this retrospective analysis, data from an EPIC-based electronic health record (EHR) patient demographics, length of stay (LOS), and All Patient Refined Diagnosis Related Groups (APR-DRG) severity of illness measures were utilized. IM practitioners collected and entered patient-reported pain scores into the EHR. The authors regressed the demographic, change in pain, LOS, and APR-DRG variables with changes in pain on total cost for the hospital admission. To estimate cost savings to the hospital, they computed the average reduction in cost associated with reduction in pain by multiplying the coefficient for change in pain by average total cost.
SETTING/LOCATION: A large, tertiary care hospital in Minneapolis, MN.
Adult inpatient admissions, 2730, during the study period where patients received IM for pain and met eligibility criteria.
IM services provided to inpatients.
Change in pain on an 11-point numeric rating scale before and after initial IM sessions; total costs for hospital admissions.
Both LOS and age were found to increase cost, as did being white, male, married, and having APR-DRG severity coded as extreme. For patients receiving IM therapies, pain was reduced by an average of 2.05 points and this pain reduction was associated with a cost savings of $898 per hospital admission.
For patients receiving IM therapies, pain was significantly reduced and costs were lowered by about 4%.
医院面临的一项重要任务是在不增加成本的情况下改善疼痛管理。综合医学（IM）是一种很有前景的非药物疼痛管理策略，但在住院环境中的成本影响尚未得到研究。该机构拥有一个住院综合医学科室已超过十年。目的是研究接受综合医学治疗后患者疼痛变化与住院期间总护理成本之间的关系。
在这项回顾性分析中，使用了基于EPIC的电子健康记录（EHR）中患者人口统计学数据、住院时间（LOS）以及所有患者精细化诊断相关组（APR - DRG）疾病严重程度测量数据。综合医学从业者收集患者报告的疼痛评分并录入电子健康记录。作者将人口统计学、疼痛变化、住院时间和APR - DRG变量与疼痛变化对住院总费用进行回归分析。为了估计医院节省的成本，他们通过将疼痛变化系数乘以平均总成本来计算与疼痛减轻相关的平均成本降低。
明尼苏达州明尼阿波利斯市的一家大型三级护理医院。
研究期间接受综合医学治疗疼痛且符合资格标准的2730例成年住院患者。
为住院患者提供综合医学服务。
初次综合医学治疗前后11点数字评分量表上的疼痛变化；住院总费用。
发现住院时间和年龄都会增加成本，白人、男性、已婚以及APR - DRG疾病严重程度编码为极重度的患者也是如此。对于接受综合医学治疗的患者，疼痛平均减轻2.05分，这种疼痛减轻与每次住院节省898美元的成本相关。
对于接受综合医学治疗的患者，疼痛显著减轻，成本降低了约4%。
