Muñoz E, Angus G, Calabro S, Mulloy K, Wise L
Department of Surgery, Long Island Jewish Medical Center, New Hyde Park, NY.
Plast Reconstr Surg. 1988 Jul;82(1):116-24.
The purpose of this study was to analyze hospital cost, resource utilization, and outcome by age for a large group of hospitalized plastic surgical patients using the DRG format. Hospital cost per patient for all plastic surgical admissions (both inpatient and potentially ambulatory patients) treated (N = 1632) at an academic medical center increased with age and peaked for plastic surgical patients 75 to 80 years of age ($11,585 per patient). Although DRG payment would have produced an aggregate profit of $2,404,854, older plastic surgical patients (65 years of age and above) generally produced losses. Older plastic surgical patients demonstrated a longer hospital length of stay, a greater severity of illness, a higher percent of outliers, and a greater mortality than younger plastic surgical patients. In addition, older plastic surgical patients had higher clinical resource utilization based on a number of clinical parameters such as emergency admission, SICU utilization, need for blood transfusions, and need for plasma product infusions. This study suggests that the current DRG reimbursement methodology may be inequitable vis-à-vis the older plastic surgical patient. As additional pressures encourage the performance of more ambulatory procedures (previously performed as inpatients), our profit margins may decline and possibly affect our ability to provide quality plastic surgical care.
本研究的目的是使用疾病诊断相关分组（DRG）格式，分析一大群住院整形外科患者的医院成本、资源利用情况及按年龄划分的结果。在一家学术医疗中心接受治疗的所有整形外科住院患者（包括住院患者和可能的门诊患者）（N = 1632）的人均医院成本随年龄增长而增加，在75至80岁的整形外科患者中达到峰值（每位患者11,585美元）。尽管DRG支付本可产生总计2,404,854美元的利润，但老年整形外科患者（65岁及以上）总体上产生了亏损。与年轻整形外科患者相比，老年整形外科患者住院时间更长、病情更严重、异常值百分比更高且死亡率更高。此外，根据一些临床参数，如急诊入院、外科重症监护病房（SICU）的使用、输血需求和血浆制品输注需求，老年整形外科患者的临床资源利用率更高。本研究表明，当前的DRG报销方法相对于老年整形外科患者可能不公平。随着更多门诊手术（以前作为住院手术进行）的实施受到更多鼓励，我们的利润率可能会下降，并可能影响我们提供优质整形外科护理的能力。
