病例组合指数与医院的住院费用

目的研究病例组合指数及病例组合指数与医院住院费用的关系。方法讨论各医院病例组合指数的计算、病例组合指数与医院总费用的关系,如何利用病例组合指数对医院费用进行补偿。结果计算出各医院病例组合指数及病例组合指数与医院总费用的关系。结论病例组合指数是评价整个医院医疗费用的标准化度量,与医院总费用呈幂函数关系并是医院费用的补偿基础。     

我国病例组合方案研究概述

目的：利用我国现有的病案信息,形成真正意义上的病例组合方案。方法：论述病例组合的研究背景及国内外研究和应用现状,介绍度量医疗“产出”的病例组合模式、数据来源和统计分类方法。结果：形成了军队住院病人的病例组合方案、地方住院病人的病例组合方案和门诊病人的病例组合方案,研制出能在Windows95/98操作环境下运行的医院病例组合指数的计算软件。结论：建立基于我国病案首页的病例组合方案已具备理论方法和数据条件。根据大样本数据建立的组合方案,已经可以用于医疗费用的控制、医院医疗“产出”的评价和医院经费补偿的测算。     

综合医院综合效益评价的病例组合模型研究

目的建立一种考虑病人病例组合的医院综合效益评价模型,以控制传统评价模型中各医院救治病人疾病复杂程度不同所致的偏倚。方法各医院病人疾病复杂程度由根据信息理论计算的病例组合指数(CMI)进行测量。采用病例组合指数对综合效益传统评价模型中指标进行调整(标化)得到新的病例组合评价模型。分别采用传统评价模型与病例组合评价模型评价2003年南充地区9所综合医院综合效益,比较两种模型得到的各医院综合效益排序情况。评价主要步骤包括从投入和产出角度构建评价指标体系,采用层次分析法确定各评价指标权重,根据投入产出比构建综合评价指数。结果9所医院的CMI值不同,其中有6所医院的CMI<1,3所医院的CMI值>1。9所医院中有7所医院采用病例组合模型得到的综合效益位次与采用传统评价模型得到的一致,另2所医院采用病例组合模型得到的位次与传统评价模型得到的位次不同。结论相对于传统评价模型,病例组合评价模型考虑了医院病人疾病复杂程度的影响,得出的结论更为客观真实。     

基于住院病人CADRG1 201病例组合方案分组及CMI测算的程序实现

目的 探讨基于CADRG1 201（China Adjusted DRG 1 201）病例组合方案处理海量数据分组及病例组合指数（CMI，Casc MIX Index）计算的程序实现。方法 利用结构化查询语言（SQL，Structured Query Language）及构建矩阵的方法实现大型数据集的分类与计算。结果 通过对CADRG的专用软件CAHSTAT的设计，计算了1998年全国200所医院100余万条住院病人的病案首页数据,得到了各医院的CMI值。结论在计算机程序设计中，通过对分组设计及计算方法进行优化，提高了计算CMI的效率及准确性。     

基于住院病人病例组合分类结果的评价

目的 对病例组合分类结果是否合理进行评价。方法 利用医院实际的总费用与病例组合后的标准费用的比较、回代医院的费用、RIV和ROC4种方法对病例组合分类结果进行评价。结果 回代样本和全部例数的实际费用与建立病例组合后的标准费用相比，标准费用可以解释医疗消费70％以上的费用；所计算的R／V值为36．71％；ROC方法可以看出3条ROC曲线有差别，说明各组之间的费用差异有统计学意义。结论 对病例组合分类结果评价方法进行了探索。前3种方法可以从总的方面考察病例组合分类是否合理；用ROC可以从病例组合每一分组各组内的费用是否有差别，从而考察病例组合每一类是否合理。     

住院病人内外科治疗的病例组合研究

住院病人的病例组合研究是基于大样本患者的病情和治疗信息。我们依据军队医院完整、准确的病案首页数据库 ,建立内、外科治疗分开的住院病人病例组合方案。资料与方法(一 )资料来源 :收集 1998年数百所军队医院收治的全部住院病人的病案首页 ,共 142 0 6 92例。(二 )方法 :回顾性方法 病例组合分类法。1 .资料预处理 :删除缺失病例及不符合逻辑的病例 ,再滤过合计总费用 >5 0 0 0 0元及 <5 0元的病例 ,剔除住院天数 <1天和 >10 0天的病例 ,共得到1147783例有效病例 ,占全部病例数的 80 8%。2 .设计分组 :(1)首先将病例组合样本按照有无…     

病例组合分类结果的评价

目的对病例组合分类结果是否合理进行评价方法的探讨。方法利用医院实际的总费用与病例组合后的标准费用的比较、利用回代医院的费用、RIV和ROC四种方法对病例组合分类结果进行评价。结果利用回代样本和全部例数的实际费用与建立病例组合后的标准费用相比,标准费用可以解释医疗消费的70%以上的费用;所计算的RIV值为36·71%;ROC方法可以看出三条ROC曲线有差别,说明各组之间的费用有差异。结论对病例组合分类结果评价方法进行探索。前三种方法可以从总的方面考察病例组合分类是否合理,用ROC可以从病例组合每一分组各组内的费用是否有差别,从而考察病例组合每一类是否合理进行评价。     

在DEA模型中应用病例组合指数评价医院服务效率

目的 应用病例组合指数在DEA模型中估计医院的相对服务效率。方法 首先应用信息理论计算病例组合指数，再将其与出院人数的乘积(产出量)作为产出指标，在DEA模型中估计医院的相对服务效率。结果 应用病例组合指数所得到的效率值更加合理准确；大多数医院处于规模收益递减、低效率的运行状态。结论 此方法考虑到了疾病严重程度对于医院服务效率的影响，使估计的效率值更加准确、可靠。     

用信息理论计算病例组合指数

目的 分析医院住院病人多产出组成，并进行定量测量。方法 根据信息理论，采用病例组合指数，考虑到疾病分类的权重，将18种疾病分类的出院人数转变为一个病例组合指数，从而用一个自变量代替了18个自为量。结果 医院级别不同，病例组合指数不同，且与医院病种复杂程度相符合。结论 病例组合指数作为综合衡量每个医院病种复杂性的量工，大大地减少了自为量的个数，解决了以往岭回归模型中存在的一些问题。     

住院病人病例组合方法的探讨

目的病例组合是评价医疗质量或医疗费用管理的疾病分组体系,或者说是一种医疗产出的测量模型,用于评价医院医疗产出.方法采用树型模型-AID算法,对12所医院的住院病例进行了病例组合方法的探索.结果以住院费用为组合轴心,13项患者特征为组合变量,形成249个病例组合.结论对病例组合方法进行探索.     

Hospital case mix and average charge per case: an initial study.

The use of case mix to explain hospital costs has been refined in previous research on the cost of hospital-based health care. This study demonstrates the significance of hospital case mix in explaining charges for health care treatment. By assuming that the variables which influence cost should also influence charges, an evaluative function is added to the basic investigative analysis potential of the hospital production process model. The relationship between case mix and charges is found to be weaker than the relationship between case mix and costs. This difference is qualified by methodological variation and possibly explained by cross-subsidization of patient services and lack of adequate controls on charge determination. Further, the relationship between case mix and charges is found to differ between Medicare and Blue Cross patients. This evidence suggests that hospital accounting may not be recovering costs evenly and equitably from clients.     

Risk factors and costs associated with methicillin-resistant Staphylococcus aureus bloodstream infections.

OBJECTIVES: To compare the cost of hospitalization of patients with methicillin-resistant Staphylococcus aureus (MRSA) bloodstream infection (BSI) versus patients with methicillin-sensitive S. aureus (MSSA) BSI, controlling for severity of underlying illness; and to identify risk factors associated with MRSA BSI. DESIGN: Retrospective case-control study based on medical chart review. SETTING: A 640-bed, tertiary-care hospital in Seattle, Washington. PATIENTS: All patients admitted to the hospital between January 1, 1997, and December 31, 1999, with S. aureus BSI confirmed by culture. RESULTS: Twenty patients with MRSA BSI were compared with 40 patients with MSSA BSI. Univariate analysis identified 5 risk factors associated with MRSA BSI. Recent hospital admission (P = .006) and assisted living (P = .004) remained significant in a multivariate model. Costs were significantly higher per patient-day of hospitalization for MRSA BSI than for MSSA BSI (dollar 5,878 vs dollar 2,073; P = .003). When patients were stratified according to severity of illness as measured by the case mix index, a difference of dollar 5,302 per patient-day was found between the two groups for all patients with a case mix index greater than 2 (P < .001). CONCLUSION: These observations suggest that MRSA BSI significantly increases hospitalization costs compared with MSSA BSI, even when controlling for the severity of the patient's underlying illness. As MRSA BSI was also found to be significantly associated with a group of patients who have repeated hospitalizations, such infections contribute substantially to the increasing cost of medical care.     

Medicaid inpatient costs and nested structural analysis using a hierarchical linear modeling (HLM) approach

This research investigates the factors affecting Medicaid inpatient costs using the nested relationship between hospital and patient levels. Using the 2005 Hospital Quarterly Financial and Utilization Data for the hospital level data and the 2005 Inpatient Discharge Data for the patient level data in California, we derive Medicaid inpatient costs by calculating a ratio of costs to charges at the hospital level, and then multiplying the ratio by each inpatient charge. Based on the selected factors of hospital (i.e., Hirschman–Herfindahl index, case mix index, number of BEDS, ownership, and teaching status) and patient (i.e., AGE, length of stay [LOS], diagnosis-related group weights, number of secondary diagnoses, race, and gender) levels, this study tests not only the cause and effect between factors and Medicaid inpatient costs but also the structural effects in terms of the hierarchical linear model (HLM). We confirm the theoretical arguments from previous literature but we have explored and provided more advanced causalities that the previous literature had not explored. Within the nested structure, the effects of LOS and number of secondary diagnoses are positively or negatively influenced by hospital characteristics such as hospital competition, for-profit status, and teaching hospital. We conclude that the HLM can examine both hospital and patient information and observe more accurate statistical relationships that the previous research had not investigated.     

基于CHAID决策树模型的病例组合方案应用研究

目的利用出院患者病案数据进行病例组合,探讨应用病例组合方案进行公立医院绩效考评与成本管控的可行性。方法基于CHAID决策树模型,以住院费用为目标变量,选取手术操作级别等作为预测变量,建立病例组合方案;对分组结果进行统计学检验,评价组内同质性与组间异质性,测量相对权重对住院费用的拟合优度。结果建立了覆盖某公立医院全部病种的病例组合方案,分组结果组间差异具有统计学意义,组内同质性与组间异质性较高,相对权重对住院费用拟合情况良好。结论通过CHAID决策树模型建立的病例组合方案评价结果良好,可用于开展医疗质量评价与病种管理。     

Nursing home case-mix reimbursement in Mississippi and South Dakota

OBJECTIVE: To evaluate the effects of nursing home case-mix reimbursement on facility case mix and costs in Mississippi and South Dakota. DATA SOURCES: Secondary data from resident assessments and Medicaid cost reports from 154 Mississippi and 107 South Dakota nursing facilities in 1992 and 1994, before and after implementation of new case-mix reimbursement systems. STUDY DESIGN: The study relied on a two-wave panel design to examine case mix (resident acuity) and direct care costs in 1-year periods before and after implementation of a nursing home case-mix reimbursement system. Cross-lagged regression models were used to assess change in case mix and costs between periods while taking into account facility characteristics. DATA COLLECTION: Facility-level measures were constructed from Medicaid cost reports and Minimum Data Set-Plus assessment records supplied by each state. Resident case mix was based on the RUG-III classification system. PRINCIPAL FINDINGS: Facility case-mix scores and direct care costs increased significantly between periods in both states. Changes in facility costs and case mix were significantly related in a positive direction. Medicare utilization and the rate of hospitalizations from the nursing facility also increased significantly between periods, particularly in Mississippi. CONCLUSIONS: The case-mix reimbursement systems appeared to achieve their intended goals: improved access for heavy-care residents and increased direct care expenditures in facilities with higher acuity residents. However, increases in Medicare utilization may have influenced facility case mix or costs, and some facilities may have been unprepared to care for higher acuity residents, as indicated by increased rates of hospitalization.     

Is case-mix adjustment necessary for an expanded dialysis bundle?

Congress has required CMS to expand the Medicare outpatient prospective payment system (PPS) for dialysis services to include as many drugs and diagnostic procedures provided to end stage renal disease (ESRD) patients as possible. One important implementation question is whether dialysis facility case mix should be reflected in payment. We use fiscal year (FY) 2000 cost report and patient billing and clinical data to determine the relationship between costs and case mix, as represented by several patient demographic, diagnostic, and clinical characteristics. Results indicate considerable variability in costs and case mix across facilities and a significant and substantial relationship between case mix and facility cost, suggesting case mix payment adjustment may be important.     

The Costs of Change: Direct Medical Costs of Solid Organ Transplantation in British Columbia, Canada, 1995–2003

Objectives:  Solid organ transplantations are among the most expensive treatments yet relatively few investigators have reported well-characterized and reliable information on costs. The objective here was to compare the direct medical costs of kidney, liver, heart, and lung transplantations in British Columbia (BC), Canada.
Methods:  Using data from a province-wide population-based registry, resource utilization data were collated for 1333 patients who underwent solid organ transplantation between 1995 and 2003. Resource categories included hospital stays, physician fees, laboratory and diagnostic testing, and immunosuppressants. Mean costs (2003 $CDN) were derived for the index hospitalization and each of the 2 years after hospital discharge. To enable valid comparisons, the same costing methodology was applied to all four programs.
Results:  The mean costs of transplantation varied from $27,695 for kidney recipients to $89,942 for lung recipients, with inpatient hospital stays comprising the largest component. Mean costs for the first and second follow-up years ranged from $27,592 and $11,424 for lung recipients to $21,144 and $8086 for liver recipients. Immunosuppressants accounted for between two-thirds and three-fourths of costs by the second year. Within each program, variations in costs could not be accounted for by demographic factors.
Conclusions:  We observed in BC a threefold variation in mean costs of organ transplantation procedures, with the variations between programs diminishing during follow-up. Policymakers and decision-makers seeking to better understand the deployment of resources for transplantation may focus on clinical factors at the time of hospitalization and factors that influence use and costs of immunosuppressants during the induction and maintenance phases.     

495例肝脓肿患者疾病经济负担及其影响因素

目的分析2010-2019年住院治疗的肝脓肿患者基本情况、住院费用及其结构变化和影响因素,评估肝脓肿直接经济负担,探寻有效减轻肝脓肿疾病经济负担的方法。方法回顾性收集中南大学湘雅医院2010年1月-2019年12月收治的495例肝脓肿住院患者资料,分析逐年住院费用变化、各项住院费用变化、各临床特征与住院费用的相关关系,多元逐步回归分析住院费用影响因素。结果 495例病例中,平均住院日为15.93 d,人均住院费用34 548.02元,所有项目费用中西药类占比最高;既往有肝胆手术史、肿瘤病史、治疗过程中合并胸腔积液、肺部感染、采用手术治疗患者住院费用显著升高(P<0.05);多因素回归分析提示住院天数越长、治疗手段越复杂、合并肿瘤史、出现胸腔积液患者住院费用更高。结论 2010-2019年住院治疗肝脓肿人均费用34 548.02元,其中西药费用占比最高,诊断类费用逐年增长,不同特征患者住院费用有差异。住院日、治疗手段、肿瘤史、合并胸腔积液均会对住院费用产生影响。