Sachdeva R C, Jefferson L S, Coss-Bu J, Done G, Campbell D, Nelson S I, Feigin R D
Department of Pediatrics, Critical Care Section, Texas Children's Hospital, Houston 77030,USA.
Crit Care Med. 1996 Mar;24(3):501-6. doi: 10.1097/00003246-199603000-00022.
To investigate the effects of the availability of daily patient-related charges to healthcare providers on practice patterns and cost containment in the pediatric intensive care unit (ICU) setting.
Prospective, nonrandomized, controlled trial.
Pediatric ICU.
All patients admitted to the pediatric ICU during the study period. This number included a prospective control group (n=325) and an intervention group (n=273). These 598 patients spent 2,274 patient days in the pediatric ICU.
The daily itemized patient charges related to diagnostic studies ordered in the pediatric ICU were made available to healthcare providers during the intervention period of the study.
Information was collected prospectively on patients in the control group before the intervention period. This information included data on demographics, daily severity of illness measures, daily resource consumption, intensity of nursing and medical interventions, and daily patient-related charges. Outcome information on survival and length of pediatric ICU stay was also collected. The same data were collected prospectively during the intervention period of the study. Measurements on quality assurance and morbidity were made to ensure that there was no compromise in patient care. There were no significant differences in patient demographics and diagnoses between the control and intervention groups. There was a reduction in the average daily laboratory (16.7%), radiology (9.1%) computerized axial tomography (8.5%), and pharmacy (25.1%) charges in the intervention group as compared with controls. The decreases in laboratory and pharmacy charges were statistically significant (p<.0001). The decreases in laboratory and pharmacy charges remained significant even after adjustment for severity of illness.
The availability of patient-related charges to healthcare providers can result in changes in practice patterns, producing a decrease of patient charges and an improvement in cost containment in the pediatric ICU.
探讨向医疗服务提供者提供每日与患者相关费用信息对儿科重症监护病房（ICU）的医疗行为模式及成本控制的影响。
前瞻性、非随机对照试验。
儿科ICU。
研究期间入住儿科ICU的所有患者。这一数字包括一个前瞻性对照组（n = 325）和一个干预组（n = 273）。这598名患者在儿科ICU共住院2274个患者日。
在研究的干预期间，向医疗服务提供者提供儿科ICU中与诊断检查相关的每日逐项患者费用信息。
在干预期之前前瞻性收集对照组患者的信息。这些信息包括人口统计学数据、每日疾病严重程度指标、每日资源消耗、护理和医疗干预强度以及每日与患者相关的费用。还收集了关于生存情况和儿科ICU住院时间的结局信息。在研究的干预期内前瞻性收集相同的数据。进行质量保证和发病率测量以确保患者护理质量不受影响。对照组和干预组在患者人口统计学和诊断方面无显著差异。与对照组相比，干预组的每日平均实验室检查费用（降低16.7%）、放射检查费用（降低9.1%）、计算机断层扫描费用（降低8.5%）和药房费用（降低25.1%）均有所下降。实验室检查费用和药房费用的降低具有统计学意义（p <.0001）。即使在对疾病严重程度进行调整后，实验室检查费用和药房费用的降低仍具有显著意义。
向医疗服务提供者提供与患者相关的费用信息可导致医疗行为模式发生改变，从而降低儿科ICU的患者费用并改善成本控制。
