Brunelli C, Spallarossa P, Pasdera A, Bezante G P, Zorzet F, Rossettin P
Dipartimento di Medicina Interna, Università degli Studi, Genova.
Cardiologia. 1998 Jan;43(1):67-75.
Patients with unstable angina fall into a wide prognostic and therapeutic spectrum but, in general, have great access to specialty care and invasive procedures. In the modern era, in which admissions for unstable angina outnumber those for myocardial infarction, and growing economic pressures are placed on health care systems, cardiologists must re-examine clinical strategies for treating unstable angina in the light of health-cost accounting. The aims of the present study were to examine the current management of patients admitted to our cardiology department and to calculate the medical costs. A patient schedule was drawn up to prospectively register the number and type of cardiac processes carried out during hospitalization for all unstable angina patients in the period between March 1st and May 30th, 1995. Time (minutes) actually spent by both physicians and nurses for each cardiac process were carefully recorded in order to calculate the activity budget. The effective economic budget was built for each cardiac process taking into account salaries, consumable supplies, equipment service contracts, depreciation and indirect medical and non medical costs for CCU and ward. Based to the Diagnosis Related Groups (DRG) system, 53 out of 318 patients (16%) were admitted with documented or suspected unstable angina and allocated to discharge into four DRGs: DRG 140-medically treated unstable angina: 18 patients; DRG 124-unstable angina with angiography: 16 patients; DRG 122-unstable angina evolving in myocardial infarction: 6 patients; DRG 112-unstable angina with angioplasty: 13 patients. The mean cost for hospitalized patient with unstable angina was 5,574,958 Italian Liras (DRG 140 = 2,687,719; DRG 124 = 2,800,347; DRG 122 = 6,086,563; DRG 112 = 12,751,454). The difference in costs was essentially related to the procedures involved in medical care, DRGs with expensive cardiac processes having higher costs. Furthermore, these data show a deep discrepancy between "real" costs and current DRG reimbursement. In conclusion, data show the standard management of unstable angina at our center; calculating the true costs of unstable angina is the first step towards maximizing resources and optimizing benefits.
不稳定型心绞痛患者的预后和治疗范围广泛，但总体而言，他们能较多地获得专科护理和侵入性治疗。在现代，不稳定型心绞痛的住院人数超过心肌梗死患者，且医疗保健系统面临着日益增长的经济压力，心脏病专家必须根据医疗成本核算重新审视治疗不稳定型心绞痛的临床策略。本研究的目的是检查我院心内科收治患者的当前治疗情况并计算医疗成本。制定了一份患者日程安排，前瞻性地记录1995年3月1日至5月30日期间所有不稳定型心绞痛患者住院期间进行的心脏诊疗项目的数量和类型。仔细记录医生和护士为每个心脏诊疗项目实际花费的时间（分钟），以计算活动预算。考虑到工资、消耗品、设备服务合同、折旧以及冠心病监护病房和病房的间接医疗和非医疗成本，为每个心脏诊疗项目建立了有效的经济预算。根据诊断相关分组（DRG）系统，318例患者中有53例（16%）因记录在案或疑似不稳定型心绞痛入院，并被分配到四个DRG组：DRG 140——药物治疗的不稳定型心绞痛：18例患者；DRG 124——行血管造影的不稳定型心绞痛：16例患者；DRG 122——进展为心肌梗死的不稳定型心绞痛：6例患者；DRG 112——行血管成形术的不稳定型心绞痛：13例患者。不稳定型心绞痛住院患者的平均费用为5574958意大利里拉（DRG 140 = 2687719；DRG 124 = 2800347；DRG 122 = 6086563；DRG 112 = 12751454）。成本差异主要与医疗护理所涉及的诊疗项目有关，涉及昂贵心脏诊疗项目的DRG组成本更高。此外，这些数据显示“实际”成本与当前DRG报销之间存在巨大差异。总之，数据展示了我院中心对不稳定型心绞痛的标准治疗情况；计算不稳定型心绞痛的真实成本是实现资源最大化和效益最优化的第一步。
