Institute of Health Economics, Edmonton, Alberta, Canada.
Institute of Health Economics, Edmonton, Alberta, Canada; School of Public Health, University of Alberta, Edmonton, Alberta, Canada.
J Crit Care. 2019 Jun;51:175-183. doi: 10.1016/j.jcrc.2019.02.025. Epub 2019 Feb 26.
Intensive care is resource intensive, with costs representing a substantial quantity of total hospitalization costs. Strained ICU capacity compromises care quality and adversely impacts outcomes; however, the association between strain and healthcare costs has not been explored.
Population-based cohort study performed in 17 adult ICUs in Alberta, Canada. Data were captured on hospitalizations, ambulatory care, physician services and drug dispenses occurring 1-year before and 1-year after index ICU admission. Strain was defined as occupancy ≥90%; with 21 additional definitions evaluated. Patients were categorized as strain and non-strain admissions. Costs attributable to strain, were calculated as difference-in-difference costs using propensity-score matching.
30,557 patients were included (strain: 11,830 [38.7%]; non-strain: 18,727 [61.3%]). At 1-year, strain admissions had adjusted-incremental per-patient cost of CA$9406 (95%CI, $5654-13,157) compared to non-strain admissions, due to hospitalization costs (CA$7930; 95%CI, $4553-11,307) and physician claims (CA$844; 95%CI, $430-1259). This equated to CA$111.3 million (95%CI, $66.9-155.6 million) in excess attributable costs. Strain portended longer hospitalization (3.3 days; 95%CI, 1.1-5.5); and more ambulatory visits (1.0; 95%CI, 0.1-2.0) and physician claims (9.5; 95%CI, 6.2-12.7). Incremental costs were robust across strain definitions.
Admissions to ICUs experiencing strain incur incremental costs, attributed to longer hospitalization and physician services.
重症监护需要大量资源，其费用占总住院费用的很大一部分。重症监护病房（ICU）的紧张状况会影响医疗质量和预后，但紧张状况与医疗费用之间的关系尚未得到探索。
这是在加拿大艾伯塔省的 17 个成人 ICU 进行的基于人群的队列研究。数据采集了 ICU 入院前 1 年和入院后 1 年的住院、门诊护理、医生服务和药物配给情况。紧张状态定义为入住率≥90%；并评估了 21 种其他定义。将患者分为紧张和非紧张入院。使用倾向评分匹配计算归因于紧张的成本差异。
共纳入 30557 例患者（紧张：11830 例[38.7%]；非紧张：18727 例[61.3%]）。在 1 年时，与非紧张入院相比，紧张入院的每位患者的调整后增量成本为 9406 加元（95%CI，5654-13157），这归因于住院费用（7930 加元；95%CI，4553-11307）和医生费用（844 加元；95%CI，430-1259）。这相当于超额可归因成本为 1.113 亿加元（95%CI，6690-15560 万加元）。紧张状况预示着更长的住院时间（3.3 天；95%CI，1.1-5.5）；以及更多的门诊就诊次数（1.0；95%CI，0.1-2.0）和医生费用（9.5；95%CI，6.2-12.7）。紧张状况的各种定义都具有稳健性。
入住紧张的 ICU 的患者会产生增量成本，这归因于住院时间和医生服务的延长。
