RESUMO
Hospital administrators, nurses, and physicians must strive to improve efficiency as new payment systems constrain health care spending. Our purpose in this project was to confirm the hypothesis that four clinical variables (emergency or intensive care unit [ICU] admission, and blood or plasma product use) could predict hospital costs and outcome for adult patients with hypertension. We analyzed hospital costs (exclusive of physician fees) for all patients with either a primary or secondary diagnosis of hypertension (N = 4289) receiving treatment during a 2-year period at an academic medical center. In addition to predicting outcome (i.e., whether the patient lived or died), these four clinical variables predicted differences in hospital cost per patient, and financial risk per Diagnosis-Related Group (DRG) as measured by percentage of "outliers" (patients whose length of stay exceeds the cutoff point) or profit/loss per patient under DRG prospective hospital payment. The cost and predictive effect on cost and mortality of the variables were also cumulative; patients with hypertension with one variable had two times the cost of patients with no variables; patients with hypertension with two variables, 2.2 times the cost; patients with three variables, 4.3 times; and patients with four variables, 6.8 times. The mortality of patients with no variables was 0.8%; one variable, 7.7%; two variables, 12.7%; three variables, 15.7%; and four variables, 25.8%. Patients with hypertension can thus be stratified by cost and outcome by clinical events that occur during the patient's hospital stay.(ABSTRACT TRUNCATED AT 250 WORDS)
Assuntos
Hospitalização/economia , Hipertensão/economia , Adulto , Custos e Análise de Custo , Cuidados Críticos/economia , Grupos Diagnósticos Relacionados , Departamentos Hospitalares/economia , Hospitais de Ensino/economia , Hospitais Filantrópicos/economia , Humanos , Cidade de Nova IorqueRESUMO
Little data have been accumulated on the health care problems of underserved, urban Hispanic-Americans. The purpose of this study was to determine the prevalence of hypertension and the adequacy of treatment for Hispanic-Americans (predominately Puerto Ricans) and blacks living in the South Bronx section of New York City.Almost three fourths (74.5 percent) of the study subjects (n = 145) knew what hypertension was, and 40.7 percent said they had hypertension. However, 52.3 percent of subjects (Hispanic, 49.2 percent and black, 61.5 percent) who responded that they were not hypertensive had hypertension. Of those who said they had hypertension, only 55.9 percent were taking medication (Hispanic, 57.5 percent and black, 57.1 percent). For those taking medication, the majority did not have their hypertension controlled (Hispanic, 78.2 percent and black, 100 percent).These data suggest that for urban Hispanics and blacks, both hypertensive awareness and control is poor. This population thus appears likely to suffer excess morbidity and mortality from hypertension. Public policy programs for surveillance and control of hypertension in urban Hispanic and black populations may decrease the rate of morbidity and mortality from this treatable disease.