scholarly journals Effect of Disease Complications on Hospital Costs

2002 ◽  
Vol 48 (1) ◽  
pp. 140-149 ◽  
Author(s):  
Donald S Young ◽  
Bruce S Sachais ◽  
Leigh C Jefferies
Keyword(s):  
Length Of Stay ◽  
Diagnosis Related Groups ◽  
Hospital Costs ◽  
Drug Costs ◽  
University Hospitals ◽  
Use Of Resources ◽  
The Individual ◽  
The Cost ◽  
The University ◽  
Complicated Conditions

Abstract Background: To test the hypothesis that complications increase the use of resources in managing patients in hospitals, we examined the costs of managing patients with the same disease with and without complications. Methods: We used a database developed by the University HealthSystems Consortium that contains the costs of managing more than 1 million patients in 60 University hospitals. We created a simplified database of the costs of 457 445 patients in 111-paired diagnosis-related groups (DRGs) that were classified as either having or not having complications and/or comorbidities. Costs were calculated from the ratio of costs to charges within the individual hospitals. Results: The median costs of managing patients with complications were higher than those for managing patients without complications, confirming the appropriateness of the dual classification. Notably, these extra costs were largely incurred through increased length of stay. Of note, the cost per day for DRGs with complications and/or comorbidities was most often less than that for the corresponding uncomplicated conditions. Although accommodation costs generally were the largest single component of total costs for both complicated and uncomplicated conditions, in only 31 DRGs (15 with complications, 16 without) did they account for more than one-half the total costs. Laboratory and drug costs were higher for complicated conditions, but as a proportion of total costs were comparable for complicated and uncomplicated conditions. Conclusions: Complications in patients are associated with increased hospital costs, although the costs per day of hospitalization are often less than in patients without such complications.

scholarly journals Comparative Costs of Treating Adults and Children within Selected Diagnosis-related Groups

2002 ◽  
Vol 48 (1) ◽  
pp. 150-160
Author(s):  
Donald S Young ◽  
Bruce S Sachais ◽  
Leigh C Jefferies
Keyword(s):  
Large Scale ◽  
Diagnosis Related Groups ◽  
Hospital Costs ◽  
University Hospitals ◽  
Patient Admissions ◽  
Nominal Condition ◽  
Adults And Children ◽  
Pediatric Populations ◽  
The University ◽  
Effect Of Age

Abstract Background: There have been no large-scale analyses of resource utilization comparing the overall costs to treat pediatric patients vs adult patients. Likewise, there have been no studies evaluating the costs of the various components of hospitalization (e.g., accommodation, laboratory, radiology, and drugs) among adult and pediatric populations. Methods: To study the effect of age on the costs of treating patients, we have evaluated 43 conditions with matching diagnosis-related groups (DRGs) for children and adults. Using a database developed by the University HealthSystems Consortium, we examined the major non-physician components of hospital costs, including accommodation, surgery, pharmacy, radiology, and laboratory for 1 346 028 patient admissions to 60 University hospitals. These costs were derived from the ratio of costs to charges based on the Centers for Medicare and Medicaid Services PPS UB-2 cost reports. Results: The total non-physician cost of treating adults was generally greater than that for children within paired DRGs. Some of this difference may be attributable to the overall longer stay of adults in hospital. For conditions that were nominally the same, radiology, laboratory, and drug costs, especially tended to be higher for adults than for children. This was most marked when the costs were evaluated on a per diem basis. There tended to be greater variability in the costs of treating children than adults within the paired DRGs, as evidenced by greater differences between the median and mean costs. Conclusions: Among University hospitals, the costs of managing children are typically less than for adults with the same nominal condition. In these hospitals, there tends to be less use of laboratory, radiology, and pharmacy services for children than for adults.

scholarly journals The Costs of Disease

2000 ◽  
Vol 46 (7) ◽  
pp. 955-966 ◽  
Author(s):  
Donald S Young ◽  
Bruce S Sachais ◽  
Leigh C Jefferies
Keyword(s):  
Length Of Stay ◽  
Diagnosis Related Groups ◽  
Hospital Costs ◽  
University Hospital ◽  
Medical Diagnoses ◽  
Nursing Services ◽  
Costs Of Disease ◽  
Surgical Conditions ◽  
The University ◽  
Cost Components

Abstract Background: To date there have been no studies identifying and comparing the component costs to treat a large number of diseases for hospitalized inpatients. Methods: Hospital costs were analyzed for 486 diagnosis-related groups (DRGs) relating to >1.3 million patient discharges from 60 University Hospital members of the University HealthSystems Consortium. For each DRG, length of stay, total cost, and key cost components were analyzed, including accommodation, intensive care, and surgery. Results: In general, total costs of diseases classified as surgical exceeded those classified as medical. Diseases involving organ transplantation typically cost more than other diseases. However, within the studied population, the two DRGs accounting for most total healthcare dollars were percutaneous cardiovascular procedures and management of neonates with immaturity or respiratory failure. Conclusions: Considering six key cost components, as well as disease complexity and length of stay, the best predictors of total costs for medical conditions were the length of stay and accommodation (housing, meals, nursing services) costs, whereas for surgical conditions, the best predictor of total costs was laboratory costs. This analysis may be used within an individual institution to identify surgical or medical diagnoses with total or component costs at variance with the group mean. A hospital may focus its cost reduction efforts to make decisions to expand, alter, or eliminate particular clinical programs based on comparison of its own total and component costs with those from other hospitals in the database.

scholarly journals Impact of self-financed rotavirus vaccines on hospital stays and costs in Spain after a 3-year introductory period

2017 ◽  
Vol 145 (9) ◽  
pp. 1773-1785
Author(s):  
O. REDONDO-GONZÁLEZ ◽  
J.M. TENÍAS-BURILLO ◽  
J. RUIZ-GONZALO
Keyword(s):  
Diagnosis Related Groups ◽  
Hospital Costs ◽  
Accounting System ◽  
Data Set ◽  
Group Iii ◽  
Rotavirus Vaccination ◽  
Rotavirus Vaccines ◽  
Hospital Stays ◽  
Cost Accounting System ◽  
The Cost

SUMMARYVaccination has reduced rotavirus hospitalizations by 25% in European regions with low–moderate vaccine availability. We aimed to quantify the reduction in hospital costs after the longest period in which Rotarix® and Rotateq® were simultaneously commercially available in Spain. Cases, length of stay (LOS), and diagnosis-related groups (DRGs) were retrieved from the Minimum Basic Data Set. Healthcare expenditure was estimated through the cost accounting system Gescot®. DRGs were clustered: I, non-bacterial gastroenteritis with complications; II, without complications; III, requiring surgical/other procedures or neonatal cases (highest DRG weights). Comparisons between pre (2003–2005)- and post-vaccine (2007–2009) hospital stays and costs by DRG group were made. Rotaviruses were the most common agents of specific-coded gastroenteritis (N = 1657/5012). LOS and extended LOS of rotaviruses fell significantly in 2007–2009 (β-coefficient = −0·43, 95% confidence intervals (95% CI) −0·68 to −0·17; and odds ratio 0·62, 95% CI 0·50–0·76, respectively). Overall, costs attributable to rotavirus hospitalizations fell approximately €244 per patient (95% CI −365 to −123); the decrease in DRG group III was €2269 per patient (95% CI −4098 to −380). We concluded modest savings in hospital costs, largely attributable to cases with higher DRG weights, and a faster recovery. A universal rotavirus vaccination program deserves being re-evaluated, regarding its potential high impact on both at-risk children and societal costs.

scholarly journals Determinants of Hospital Costs for Management of Chronic-Disease Patients in Southern Thailand

2021 ◽  
Author(s):  
Wichayaporn Thongpeth ◽  
Apiradee Lim ◽  
Sunee Kraonual ◽  
Akemat Wongpairin ◽  
Thaworn Thongpeth
Keyword(s):  
Chronic Disease ◽  
Length Of Stay ◽  
Diagnosis Related Groups ◽  
Hospital Costs ◽  
Disease Patient ◽  
Tertiary Hospital ◽  
Primary Diagnosis ◽  
Linear Regression Models ◽  
Health Security ◽  
And Gender

Objective: Diagnosis-related groups (DRGs) are the main mechanism for assessing payments for medical treatment. This study aimed to analyze the determinants of costs for chronic-disease patient visits in a major public hospital.Material and Methods: Hospital cost data available from the hospital database relating to claims made to the Thailand Health Security Office were obtained from a major tertiary hospital for all such patients admitted and discharged in 2016. Linear regression models were created to predict the cost based on several determinants including age and gender, primary diagnosis, number of diagnoses, length of stay, number of procedures, and discharge status.Results: Only length of stay in hospital and number of procedures were significant predictors of the total hospital costs.Conclusion: It thus appears that just a combination of these two factors might be a better measure of the true hospital visit costs for patients with chronic disease than DRGs.

THE EFFECT OF COILING VERSUS CLIPPING OF RUPTURED AND UNRUPTURED CEREBRAL ANEURYSMS ON LENGTH OF STAY, HOSPITAL COST, HOSPITAL REIMBURSEMENT, AND SURGEON REIMBURSEMENT AT THE UNIVERSITY OF FLORIDA

Neurosurgery ◽  
2009 ◽  
Vol 64 (4) ◽  
pp. 614-621 ◽  
Author(s):  
Brian L. Hoh ◽  
Yueh-Yun Chi ◽  
Margaret A. Dermott ◽  
Paul J. Lipori ◽  
Stephen B. Lewis
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Length Of Stay ◽  
Hospital Costs ◽  
Cerebral Aneurysms ◽  
Hospital Charges ◽  
University Of Florida ◽  
Unruptured Aneurysms ◽  
Ruptured Aneurysms ◽  
The University ◽  
Length Of Hospitalization

Abstract OBJECTIVE There are few studies comparing the economic costs and reimbursements for aneurysm clipping versus coiling, and none are from the United States. Our hypothesis predicted that coiling would result in shorter lengths of hospitalization than clipping in patients with unruptured aneurysms and would therefore result in lower hospital charges. However, because of the severity of subarachnoid hemorrhage, there would be no difference in length of hospitalization or hospital charges in patients with ruptured aneurysms. METHODS We compared aneurysm coiling with aneurysm clipping in patients with unruptured and ruptured aneurysms treated at the University of Florida from January 2005 to June 2007 for differences in length of hospitalization, hospital costs, hospital collections, and surgeon collections. Patient demographic and aneurysm characteristic data were obtained from a clinical database. Length of hospitalization, cost, billing, and collection data were obtained from the hospital cost accounting database. Multivariate statistical analyses of length of hospitalization, hospital costs, hospital collections, and surgeon collections were performed using factors including patient age, sex, aneurysm size, aneurysm location, aneurysm treatment, presence of subarachnoid hemorrhage, clinical grade, payor, hospital billing, and surgeon billing. RESULTS There were 565 patients with cerebral aneurysms treated either surgically (306 patients, 54%) or endovascularly (259 patients, 46%). In patients without subarachnoid hemorrhage (unruptured aneurysms) (n = 367), surgery, compared with endovascular treatment, was associated with longer hospitalization (P < 0.001), but lower hospital costs (P < 0.001), higher surgeon collections (P = 0.003), and similar hospital collections. In patients with subarachnoid hemorrhage (ruptured aneurysms) (n = 198), surgery was associated with lower hospital costs (P = 0.011), but similar length of stay, surgeon collections, and hospital collections. Larger aneurysm size was significantly associated with longer hospitalization in the patients with unruptured aneurysms (P < 0.001) and higher hospital costs for both patients with unruptured (P < 0.001) and ruptured (P = 0.015) aneurysms. The payor was significantly associated with hospital costs in patients with ruptured aneurysms (P = 0.034) and length of stay (unruptured aneurysms, P < 0.001; ruptured aneurysms, P < 0.001), hospital collections (unruptured aneurysms, P < 0.001; ruptured aneurysms, P < 0.001), and surgeon collections (unruptured aneurysms, P < 0.001; ruptured aneurysms, P < 0.001) in both patients with unruptured and ruptured aneurysms. A worse clinical grade was significantly associated with higher hospital costs (P < 0.001). CONCLUSION Despite a shorter length of hospitalization in patients with unruptured aneurysms, coiling was associated with higher hospital costs in both patients with unruptured and ruptured aneurysms. This is likely attributable to the higher device cost of coils than clips. The advantages of coiling over clipping would be better realized if the cost of coils could be comparably reduced to that of clips.

scholarly journals 722 Review of The Introduction of Pre-Biopsy MRI Scanning in The Diagnostic Pathway for Prostate Cancer

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
A Soma
Keyword(s):  
Prostate Cancer ◽  
Treatment Time ◽  
National Standard ◽  
University Hospitals ◽  
Diagnostic Pathway ◽  
Mri Scans ◽  
The Individual ◽  
The University

Abstract Introduction The diagnostic pathway for prostate cancer has changed recently with the introduction of a pre-biopsy MRI. This audit aims to identify whether this change helps the University Hospitals of Morecambe Bay NHS Foundation Trust meet the national standard of referral to treatment time of 62 days. Method This audit will follow the individual journeys of patients on the previous (05/2017 – 05/2018) and new pathway (08/2018 – 04/2019). In addition, they will be divided based on the treatment they chose – surgery or radiotherapy. Results Old pathway: New pathway: Conclusions Comparing the new pathway to the previous, there is a reduced proportion meeting the RTT. One way to combat this is ensuring patients have their MRI scans, if suitable, prior to their first clinic, which shows to be the most effective way to meet the RTT.

Models for Determining Cost of Care and Length of Stay in Neonatal Intensive Care Units

1996 ◽  
Vol 12 (1) ◽  
pp. 62-71 ◽  
Author(s):  
Babak Khoshnood ◽  
Kwang-Sun Lee ◽  
Maria Corpuz ◽  
Michael Koetting ◽  
Hui-Lung Hsieh ◽  
...  
Keyword(s):  
Intensive Care ◽  
Length Of Stay ◽  
Neonatal Intensive Care ◽  
New Technologies ◽  
Temporal Trends ◽  
Hospital Costs ◽  
Cost Of Care ◽  
Neonatal Intensive Care Units ◽  
Useful Components ◽  
The Cost

AbstractNew models for determining the cost of care and length of stay in the neonatal intensive care unit (NICU) were developed using financial and clinical data from 588 admissions to our NICU. The model for determining costs explained 71% of the variability in total hospital costs. Models such as the ones developed in this study can be used to compare costs in different institutions, determine temporal trends in costs, and examine the financial impact of using new technologies. Such models can also be useful components of a rational prospective pricing system for the NICU.

Conflicts of interest in biofilms

Biofilms ◽  
2004 ◽  
Vol 1 (4) ◽  
pp. 265-276 ◽  
Author(s):  
J.-U. Kreft
Keyword(s):  
Environmental Changes ◽  
Conflicts Of Interest ◽  
Population Heterogeneity ◽  
Cooperative Behaviour ◽  
Use Of Resources ◽  
Close Proximity ◽  
The Face ◽  
Cooperative Investment ◽  
The Individual ◽  
The Cost

High cell density and close proximity of diverse species of microorganisms are typical of life in natural biofilms. These conditions give ample opportunity for both competitive and cooperative interactions between individuals of the same and different species. Cooperative behaviour benefits the group of neighbouring microbes but comes at a fitness cost for the cooperating individuals. This creates a conflict of interest between the fitness of the individual and the fitness of the group. Individuals that defect from cooperation and therefore do not pay the cost but nevertheless benefit from the cooperative behaviour of others are called cheaters. Cooperative behaviour in the presence of cheaters constitutes altruism towards the cheaters. The aim of this review is two-fold: first, to introduce key concepts from kin selection and group selection theory that allow us to understand how cooperative behaviour can evolve in the face of cheaters; secondly, to draw attention to the conflicts of interest prevalent in biofilms yet largely ignored in the biofilm literature. Examples discussed comprise growth restraint in stationary phase as an instance of the Prisoner's Dilemma, growth restraint to allow channel formation, restraint in resource consumption or economical use of resources as altruistic behaviour, population heterogeneity as insurance against environmental changes, cooperative investment in diffusible exoenzymes, cooperation of pathogens and virulence, diffusion sensing versus quorum sensing and the inflation of signals, antibiotic resistance as collective action, and programmed cell death.

A comparison of hospital costs with reimbursement received for patients undergoing the Norwood procedure for hypoplasia of the left heart

2005 ◽  
Vol 15 (5) ◽  
pp. 493-497 ◽  
Author(s):  
Vinod Mishra ◽  
Harald Lindberg ◽  
Egil Seem ◽  
Ingrid Klokkerud ◽  
Britt Fredriksen ◽  
...  
Keyword(s):  
Intensive Care ◽  
Diagnosis Related Groups ◽  
Hospital Costs ◽  
University Hospital ◽  
Norwood Procedure ◽  
Present System ◽  
Left Heart ◽  
Duration Of Surgery ◽  
Three Stages ◽  
The Cost

Objectives: To determine whether the present system of reimbursement, based on diagnosis-related groups and regular financial budgeting, covers the costs incurred during hospitalisation of 7 children undergoing the three stages of the Norwood sequence for surgical treatment of hypoplastic left heart syndrome. Methods: Between January and September 2003, 7 patients underwent initial surgical palliation with the Norwood procedure at the Rikshospitalet University Hospital. A prospective methodology was developed by our group to measure the costs associated with each individual patient. The patients were closely observed, and the relevant data was collected during their stay in hospital. The stay was divided into four different periods of requirements of resources, defined as heavy intensive care, light intensive care, intermediate care, and ordinary care. At each stage, we recorded the number of staff involved and the duration of surgery and other major procedures, as well as the cost of pharmaceuticals and other consumables. Based on these data, we calculated the cost for each patient. These costs were compared with the corresponding revenue received by the hospital for each of the patients. Results: We found the total mean cost for the three stages of the Norwood sequence was 138,934 American dollars, while the corresponding revenue received by the hospital was 43,735 American dollars. During this period, one patient died during the first stage of the Norwood sequence. Conclusions: Our study shows that steps involved in the Norwood sequence are low-volume but high-cost procedures. The reimbursement received by our hospital for the procedures was less than one-third of the recorded costs.

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