Kramolowsky E V, Wood N L, Rollins K L, Glasheen W P, Nelson C M
Urology Center, Medical College of Virginia/Virginia Commonwealth University, Richmond, USA.
J Am Coll Surg. 1995 May;180(5):513-8.
Continuing effort is being made to provide the best medical care in a cost-effective manner, requiring an evaluation of factors that control charges. The number of cases of carcinoma of the prostate gland and the number of radical retropubic prostatectomies performed have increased in recent years, with an estimate of several hundred million dollars being spent annually on this procedure in the United States of America. Because physicians are reported to effect the majority of charges for a hospitalization, this study examines the influence of notification of the physician of hospital charges on the overall hospital charges for radical retropubic prostatectomy.
Total hospital charge and duration per hospitalization were determined for all patients having radical prostatectomies performed at five community hospitals in Richmond, VA, between January 1991 and December 1993. Patients included 625 males diagnosed with carcinoma of the prostate gland undergoing radical prostatectomy by one of 20 urologists from several different private practice groups. Halfway into the time period studied, physicians were notified of data collection and of factors that seemed to have a role in hospital charges. Total hospital charges before and after physician notification were measured to determine whether or not physicians could effect hospital charges.
Overall, hospital charges decreased significantly after notification of physicians in the study. The decline in total charges continued throughout the follow-up period. Duration of hospitalization decreased throughout the entire study period, while total charge per hospital day increased.
Physician awareness of hospital charges for operative procedures and accompanying hospitalizations may influence the overall decrease in charges.
人们一直在努力以具有成本效益的方式提供最佳医疗服务，这就需要对控制费用的因素进行评估。近年来，前列腺癌病例数和耻骨后根治性前列腺切除术的实施例数均有所增加，据估计，在美国每年在该手术上的花费达数亿美元。由于据报道医生对住院费用的影响占大多数，因此本研究探讨了向医生通报住院费用对耻骨后根治性前列腺切除术总体住院费用的影响。
确定了1991年1月至1993年12月期间在弗吉尼亚州里士满的五家社区医院接受根治性前列腺切除术的所有患者的每次住院总费用和住院时长。患者包括625名被诊断为前列腺癌的男性，他们由来自几个不同私人执业团体的20名泌尿科医生之一进行了根治性前列腺切除术。在研究时间段进行到一半时，向医生通报了数据收集情况以及似乎对住院费用有影响的因素。测量了医生收到通知前后的住院总费用，以确定医生是否能够影响住院费用。
总体而言，在研究中向医生通报情况后，住院费用显著下降。在整个随访期内，总费用持续下降。住院时长在整个研究期间都有所减少，而每日住院总费用增加。
医生对手术及相关住院的医院费用的认知可能会影响费用的总体降低。
