Payne J L, McCarty K R, Drougas J G, Chapman W C, Wright J K, Pinson N Y, Beliles K E, Newsom V L, Hunter E B, Raiford D S, Awad J A, Burk R F, Donovan K L, Van Buren D H, Pinson C W
Division of Hepatobiliary Surgery and Liver Transplantation, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
Am Surg. 1996 Apr;62(4):320-5.
Healthcare reform has mandated scrutiny of the fiscal aspects of patient care as well as medical outcomes. Therefore, we reviewed our experience with 50 liver transplant recipients from a multidisciplinary collaborative transplant team. From February 1991 to July 1994, of 175 patients referred, 75 were formally evaluated for transplantation; 56 (76%) of these patients were accepted for transplantation; 50 patients underwent 53 transplants. Operative mortality of 6 per cent, retransplantation rate of 6 per cent, 6-month actuarial survival of 88 per cent, 1-year survival of 86 per cent, and the 2 and 3-year survival of 83 per cent were unchanged over time. Quality of life evaluated by the Karnofsky Performance Status was a mean of 55 pretransplant, 72 at 3 months, 79 at 6 months, 84 at 1 year, 88 at 2 years, and 95 at 3 years, demonstrating improved general health and functional rehabilitation after transplantation. Psychosocial Adjustment to Illness Scale scores demonstrated significant improvement following transplantation, improving most dramatically in the vocation environment, domestic environment, and sexual relationship domains. Postoperative length of stay has declined with an average of 28 days in 1991, 22 days in 1992, 19 days in 1993, and 14 days in 1994. Average total hospital, organ procurement, and physician charges for the transplantation hospitalization was $165,000. Average 91-92 hospital charges were $154,000 and were reduced in 93-95 to $103,000 (P < .05). We found that charges and length of stay decreased over time, while the outcome and quality of patient care was maintained. We believe the collaborative practice, case management, and revised patient care protocols are responsible.
医疗改革要求对患者护理的财务方面以及医疗结果进行审查。因此，我们回顾了一个多学科协作移植团队对50例肝移植受者的治疗经验。从1991年2月到1994年7月，在175例转诊患者中，75例接受了移植的正式评估；其中56例（76%）患者被接受进行移植；50例患者接受了53次移植。手术死亡率为6%，再次移植率为6%，6个月实际生存率为88%，1年生存率为86%，2年和3年生存率为83%，这些数据随时间未发生变化。通过卡诺夫斯基功能状态评分评估的生活质量，移植前平均为55分，3个月时为72分，6个月时为79分，1年时为84分，2年时为88分，3年时为95分，表明移植后总体健康状况和功能恢复得到改善。疾病心理社会适应量表评分显示移植后有显著改善，在职业环境、家庭环境和性关系领域改善最为显著。术后住院时间有所下降，1991年平均为28天，1992年为22天，1993年为19天，1994年为14天。移植住院的平均总医院费用、器官获取费用和医生费用为16.5万美元。1991 - 1992年的平均医院费用为15.4万美元，在1993 - 1995年降至10.3万美元（P < .05）。我们发现费用和住院时间随时间减少，而患者护理的结果和质量得以维持。我们认为协作实践、病例管理和修订后的患者护理方案起到了作用。
