Wall T C, Fargason C A, Johnson V A
Department of Pediatrics, School of Public Health, University of Alabama at Birmingham 35233, USA.
Pediatrics. 1997 Feb;99(2):175-9. doi: 10.1542/peds.99.2.175.
To compare inpatient hospital charges generated within a children's hospital by academic and nonacademic pediatric services for common medical diagnoses.
Hospital admissions to a free-standing children's hospital between 9/1/90 and 8/30/94 were selected for patients who were hospitalized 1 to 14 days, with one of six selected diagnoses, and with discharge attending of record either a private pediatrician or an academic subspecialist. Discharge diagnoses, based on ICD-9 codes, included asthma (n = 1983), bronchiolitis (n = 692), gastroenteritis (n = 733), rule out sepsis (n = 1065), urinary tract infection (n = 516), and viral meningitis (n = 288). Charges associated with patient records were dichotomized as above or below the median charge for each diagnostic category. Each category was analyzed separately using a logistic regression model where the dichotomous-dependent variable was charges above the median charge for each diagnosis. Independent variables included physician type, payor status, patient residence, ICD-9 code as primary or secondary diagnosis, patient age, and presence of complicating conditions.
By univariate comparison, academic physicians cared for a higher percentage of underinsured patients, and their care was more expensive. Complicated claims were associated with higher charges than uncomplicated claims for all diagnostic categories. Academic and nonacademic physicians were equally likely to generate above-median charges for five of the six diagnostic categories when controlling for confounding factors. A linear regression model in which charge was the dependent variable generated similar results.
Within the same pediatric health care facility, no consistent difference was found between charges incurred on academic vs private inpatient services.
比较儿童医院内学术性和非学术性儿科服务针对常见医学诊断所产生的住院费用。
选取1990年9月1日至1994年8月30日期间入住一家独立儿童医院的患者，这些患者住院1至14天，患有六种选定诊断之一，且出院主治医生为私人儿科医生或学术专科医生。基于国际疾病分类第九版（ICD - 9）编码的出院诊断包括哮喘（n = 1983）、细支气管炎（n = 692）、肠胃炎（n = 733）、排除败血症（n = 1065）、尿路感染（n = 516）和病毒性脑膜炎（n = 288）。与患者记录相关的费用被分为高于或低于每个诊断类别的费用中位数。使用逻辑回归模型对每个类别分别进行分析，其中二分因变量是每个诊断高于费用中位数的费用。自变量包括医生类型、支付方状态、患者居住地、作为主要或次要诊断的ICD - 9编码、患者年龄以及是否存在并发症。
通过单因素比较，学术医生诊治的未充分投保患者比例更高，且他们的诊疗费用更高。对于所有诊断类别，复杂索赔的费用均高于非复杂索赔。在控制混杂因素后，学术医生和非学术医生在六个诊断类别中的五个类别中产生高于中位数费用的可能性相同。以费用为因变量的线性回归模型得出了类似结果。
在同一儿科医疗保健机构内，学术性住院服务和私人住院服务所产生的费用之间未发现一致差异。
