Marrin C A, Johnson L C, Beggs V L, Batalden P B
Dartmouth Medical School, Hanover, New Hampshire, USA.
Ann Thorac Surg. 1997 Sep;64(3):690-4. doi: 10.1016/s0003-4975(97)00526-2.
New systems of reimbursement are exerting enormous pressure on clinicians and hospitals to reduce costs. Using cheaper supplies or reducing the length of stay may be a satisfactory short-term solution, but the best strategy for long-term success is radical reduction of costs by reengineering the processes of care. However, few clinicians or institutions know the actual costs of medical care; nor do they understand, in detail, the activities involved in the delivery of care. Finally, there is no accepted method for linking the two.
Clinical process cost analysis begins with the construction of a detailed flow diagram incorporating each activity in the process of care. The cost of each activity is then calculated, and the two are linked. This technique was applied to Diagnosis Related Group 75 to analyze the real costs of the operative treatment of lung cancer at one institution.
Total costs varied between $6,400 and $7,700. The major driver of costs was personnel time, which accounted for 55% of the total. Forty percent of the total cost was incurred in the operating room. The cost of care decreased progressively during hospitalization.
Clinical process cost analysis provides detailed information about the costs and processes of care. The insights thus obtained may be used to reduce costs by reengineering the process.
新的报销制度给临床医生和医院带来了巨大的成本削减压力。使用更便宜的耗材或缩短住院时间可能是一个令人满意的短期解决方案，但长期成功的最佳策略是通过重新设计护理流程从根本上降低成本。然而，很少有临床医生或机构了解医疗护理的实际成本；他们也没有详细了解护理过程中涉及的活动。最后，目前还没有公认的方法将这两者联系起来。
临床流程成本分析首先要构建一个详细的流程图，纳入护理过程中的每一项活动。然后计算每项活动的成本，并将两者联系起来。这项技术应用于诊断相关组75，以分析一家机构肺癌手术治疗的实际成本。
总成本在6400美元至7700美元之间。成本的主要驱动因素是人员时间，占总成本的55%。总成本的40%发生在手术室。住院期间护理成本逐渐下降。
临床流程成本分析提供了有关护理成本和流程的详细信息。由此获得的见解可用于通过重新设计流程来降低成本。
