The Cost Impact of Hospital-Acquired Conditions Among Critical Care Patients
ABSTRACT The modifications introduced to the inpatient prospective payment system on October 1, 2008, to disallow payment for 8 secondary conditions, if not present on admission (POA), constitute a significant shift that is expected to be followed by similar steps by private payers.
To investigate the cost impact of hospital-acquired complications (HACs).
Discharges that included critical care (CC) stay cases, stratified by diagnosis-related groups, were categorized into (1) cases with HACs-those cases where 1 or more of complications were acquired during the course of treatment; (2) cases with complications that were POA; and (3) cases with no HACs or complications on admission. Twelve diagnostic condition groupings or HACs were examined.
Sepsis was the most common condition among single-occurrence HACs, as well as those where 2 HACs occurred. Among the 22 diagnosis-related groups examined, total discharge and CC costs, length of stay, and CC length of stay were consistently the highest among discharges where a HAC occurred, followed by discharges with the presence of a POA complication. Conversely, the lowest level of resource use was associated with discharges where no complication occurred.
The estimates provided in this study should enable hospitals to identify how improvements in care can also result in cost savings. Focusing this study on CC cases enables hospitals to address highest cost cases that consume crucial resources in their CC settings.
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ABSTRACT: China is experiencing increasing burden of acute myocardial infarction (AMI) in the face of limited medical resources. Hospital length of stay (LOS) is an important indicator of resource utilization. We used data from the Retrospective AMI Study within the China Patient-centered Evaluative Assessment of Cardiac Events, a nationally representative sample of patients hospitalized for AMI during 2001, 2006, and 2011. Hospital-level variation in risk-standardized LOS (RS-LOS) for AMI, accounting for differences in case mix and year, was examined with two-level generalized linear mixed models. A generalized estimating equation model was used to evaluate hospital characteristics associated with LOS. Absolute differences in RS-LOS and 95% confidence intervals were reported. The weighted median and mean LOS were 13 and 14.6 days, respectively, in 2001 (n = 1,901), 11 and 12.6 days in 2006 (n = 3,553), and 11 and 11.9 days in 2011 (n = 7,252). There was substantial hospital level variation in RS-LOS across the 160 hospitals, ranging from 9.2 to 18.1 days. Hospitals in the Central regions had on average 1.6 days (p = 0.02) shorter RS-LOS than those in the Eastern regions. All other hospital characteristics relating to capacity for AMI treatment were not associated with LOS. Despite a marked decline over the past decade, the mean LOS for AMI in China in 2011 remained long compared with international standards. Inter-hospital variation is substantial even after adjusting for case mix. Further improvement of AMI care in Chinese hospitals is critical to further shorten LOS and reduce unnecessary hospital variation.BMC Cardiovascular Disorders 01/2015; 15(1):9. DOI:10.1186/1471-2261-15-9 · 1.50 Impact Factor
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ABSTRACT: In an era of ever-increasing healthcare costs, new treatments must not only improve outcomes and quality of care but also be cost-effective. This is most challenging for emergency and critical care. Bigger and better has been the mantra of Western medical care for decades, leading to costlier but not necessarily better care. Recent advances focused on new implementation processes for evidence-based best practices such as checklists and bundles have transformed medical care. We outline recent advances in medical practice that have positively affected both the quality of care and its cost-effectiveness. Future medical care must be smarter and more effective if we are to meet the increasing demands of an aging patient population in the context of ever more limited resources. Expected final online publication date for the Annual Review of Medicine Volume 65 is January 14, 2014. Please see http://www.annualreviews.org/catalog/pubdates.aspx for revised estimates.Annual review of medicine 10/2013; 65. DOI:10.1146/annurev-med-060112-095857 · 9.94 Impact Factor
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ABSTRACT: Research on hospital-acquired infections (HAIs) requires the highest methodological standards to minimize the risk of bias and to avoid misleading interpretation. There are two major issues related specifically to studies in this area, namely the timing of infection and the occurrence of so-called competing risks, which deserve special attention. Just as a patient who acquires a serious infection during hospital admission needs appropriate antibiotic treatment, data being collected in studies on hospital-acquired infections need appropriate statistical analysis. We illustrate the urgent need for appropriate statistical treatment of hospital-acquired infections with some examples from recently conducted studies.The considerations presented are relevant for investigations on risk factors for HAIs as well as for outcome studies.International Journal of Epidemiology 09/2013; 42(5). DOI:10.1093/ije/dyt111 · 9.20 Impact Factor