Showstack J A, Stone M H, Schroeder S A
N Engl J Med. 1985 Nov 7;313(19):1201-7. doi: 10.1056/NEJM198511073131905.
To assess whether changes in clinical practice have contributed to rising hospital costs, we studied 2011 patients who were hospitalized at the University of California, San Francisco, in 1972, 1977, or 1982. For most of the 10 diagnoses studied, there was little change in total use of services by patients. In-hospital survival did not differ during the decade, and length of stay, numbers of special-care days, and use of laboratory services generally remained the same or declined. Only for patients with acute myocardial infarction did the use of imaging procedures increase substantially (e.g., cardiac catheterization was provided to 2 per cent of patients in 1977 and 40 per cent in 1982). Contrary to conventional wisdom, "little-ticket" procedures, such as laboratory tests, did not contribute to rising costs, and new imaging techniques were commonly substituted for older, more invasive procedures. The primary causes of rising costs were the provision of surgery to patients admitted for acute myocardial infarction, delivery, or respiratory distress syndrome of the newborn and the provision of other intensive treatments for the critically ill.
为评估临床实践的变化是否导致了医院成本的上升，我们研究了1972年、1977年或1982年在加州大学旧金山分校住院的2011名患者。在所研究的10种诊断中，大多数情况下患者的服务总使用量变化不大。在这十年间，住院生存率没有差异，住院时间、特殊护理天数以及实验室服务的使用情况总体保持不变或有所下降。仅急性心肌梗死患者的成像检查使用量大幅增加（例如，1977年2%的患者接受了心脏导管插入术，1982年这一比例为40%）。与传统观念相反，诸如实验室检查等“小额”检查并未导致成本上升，新的成像技术通常替代了旧的、侵入性更强的检查。成本上升的主要原因是为因急性心肌梗死、分娩或新生儿呼吸窘迫综合征入院的患者进行手术，以及为重症患者提供其他强化治疗。
