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首页> 外文期刊>Journal of health services research & policy >Marginal costs of hospital-acquired conditions: information for priority-setting for patient safety programmes and research.
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Marginal costs of hospital-acquired conditions: information for priority-setting for patient safety programmes and research.

机译：医院获得性疾病的边际成本：确定患者安全计划和研究重点的信息。

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OBJECTIVE: To estimate the relative inpatient costs of hospital-acquired conditions. METHODS: Patient level costs were estimated using computerized costing systems that log individual utilization of inpatient services and apply sophisticated cost estimates from the hospital's general ledger. Occurrence of hospital-acquired conditions was identified using an Australian 'condition-onset' flag for diagnoses not present on admission. These were grouped to yield a comprehensive set of 144 categories of hospital-acquired conditions to summarize data coded with ICD-10. Standard linear regression techniques were used to identify the independent contribution of hospital-acquired conditions to costs, taking into account the case-mix of a sample of acute inpatients (n = 1,699,997) treated in Australian public hospitals in Victoria (2005/06) and Queensland (2006/07). RESULTS: The most costly types of complications were post-procedure endocrine/metabolic disorders, adding AUDollars 21,827 to the cost of an episode, followed by MRSA (AUDollars 19,881) and enterocolitis due to Clostridium difficile (AUDollars 19,743). Aggregate costs to the system, however, were highest for septicaemia (AUDollars 41.4 million), complications of cardiac and vascular implants other than septicaemia (AUDollars 28.7 million), acute lower respiratory infections, including influenza and pneumonia (AUDollars 27.8 million) and UTI (AUDollars 24.7 million). Hospital-acquired complications are estimated to add 17.3% to treatment costs in this sample. CONCLUSIONS: Patient safety efforts frequently focus on dramatic but rare complications with very serious patient harm. Previous studies of the costs of adverse events have provided information on 'indicators' of safety problems rather than the full range of hospital-acquired conditions. Adding a cost dimension to priority-setting could result in changes to the focus of patient safety programmes and research. Financial information should be combined with information on patient outcomes to allow for cost-utility evaluation of future interventions.
机译：目的：估计医院获得性疾病的相对住院费用。方法：使用计算机成本核算系统估算患者水平的成本，该系统记录个人对住院服务的利用情况，并应用医院总分类账中的复杂成本估算。使用澳大利亚的“病情发作”标记来识别医院获得性疾病的发生，以诊断入院时不存在的诊断。将这些分组以产生144种医院获得性疾病的综合集合，以汇总使用ICD-10编码的数据。考虑到在澳大利亚维多利亚州公立医院接受治疗的急性住院患者（n = 1,699,997）的样本组合（2005/06），使用标准线性回归技术确定医院获得性疾病对费用的独立贡献。昆士兰（2006/07）。结果：并发症最昂贵的类型是术后内分泌/代谢紊乱，增加发作费用AUDollars 21,827，其次是MRSA（AUDollars 19,881）和因艰难梭菌引起的小肠结肠炎（AUDollars 19,743）。但是，该系统的总成本最高的是败血症（4140万澳元），除败血症以外的心脏和血管植入物并发症（2870万澳元），包括流感和肺炎在内的急性下呼吸道感染（2780万澳元）和UTI（ 2470万澳元）。据估计，该样本中医院获得性并发症的治疗费用增加了17.3％。结论：患者安全方面的努力通常集中在严重但对患者造成严重伤害的戏剧性但罕见的并发症上。以前对不良事件成本的研究已经提供了有关安全问题的“指标”的信息，而不是有关医院获得性疾病的全部信息。在优先级确定中增加成本维度可能会导致患者安全计划和研究重点的变化。财务信息应与患者预后信息相结合，以便对未来干预措施进行成本效用评估。

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