Department of Pathology and Community Medicine, Faculty of Medicine and Health Sciences, UCSI University, Kuala Lumpur, Malaysia; International Center for Casemix and Clinical Coding, Universiti Kebangsaan Malaysia, Bangi, Malaysia.
International Center for Casemix and Clinical Coding, Universiti Kebangsaan Malaysia, Bangi, Malaysia.
Value Health Reg Issues. 2020 May;21:149-156. doi: 10.1016/j.vhri.2019.09.006. Epub 2020 Jan 17.
Escalating healthcare costs calls for the efficiency of health services, especially in the intensive care unit (ICU) where the bulk of resources are used. This study aims to identify the length of stay (LOS) and cost of care at ICUs, which are proxy indicators of efficiency and the factors determining them.
A cross-sectional study of patients requiring ICU admissions in a teaching hospital in Malaysia from 2013 to 2015 was conducted. The cost at the ICU was estimated using the step down approach. Factors that determined the cost and LOS at the ICU were also explored by using multivariate regression analysis.
Each day of stay cost $427 (USD) at the pediatric intensive care unit and $1324 at the general intensive care unit. The mean LOS at the ICU was 5.7 days (standard deviation [SD]: 8.4) with a median of 4 days (95% confidence interval [CI] 1-16.7 days). Average cost of care at the ICU per episode of care was $5473 (SD $6499), and the median was $3463. ICU patients spent 29.3% of the total stay and 47.2% of the cost at ICU units. Upon multivariate regression analysis, severity, case base-group, and type of ICU that the patient was admitted to were associated with the cost and LOS at ICU.
Compared with critical care practices in hospitals from more developed nations, a Malaysian teaching hospital required a longer length of ICU stay. Hence, implementations of strategies that can reduce the length of stay and hospital costs without compromising healthcare quality are required.
不断上涨的医疗保健成本要求提高卫生服务的效率，尤其是在重症监护病房（ICU），那里消耗了大量资源。本研究旨在确定 ICU 的住院时间（LOS）和护理成本，这是效率的替代指标及其决定因素。
对马来西亚一家教学医院 2013 年至 2015 年期间需要入住 ICU 的患者进行了横断面研究。使用下台阶方法估计 ICU 的成本。还通过多变量回归分析探讨了决定 ICU 成本和 LOS 的因素。
儿科 ICU 每天的住院费用为 427 美元（USD），普通 ICU 为 1324 美元。ICU 的平均 LOS 为 5.7 天（标准差[SD]：8.4），中位数为 4 天（95%置信区间[CI] 1-16.7 天）。每次 ICU 护理的平均护理费用为 5473 美元（SD 6499 美元），中位数为 3463 美元。ICU 患者在 ICU 病房的总住院时间中占 29.3%，在 ICU 病房的总费用中占 47.2%。多元回归分析表明，严重程度、病例基础组和患者入住的 ICU 类型与 ICU 的成本和 LOS 相关。
与来自发达国家的医院的重症监护实践相比，马来西亚的教学医院需要更长的 ICU 住院时间。因此，需要实施可以在不影响医疗质量的情况下缩短住院时间和降低医院成本的策略。
