RESUMO
OBJECTIVE: Efforts to decrease the cost of orthotopic liver transplantation (OLT) must address the impact of specific interventions on clinical outcome. We hypothesized that an intervention designed to decrease the length of hospitalization would reduce costs without jeopardizing clinical outcome. We further sought to identify predictors of length of stay and cost for hospitalization after liver transplantation. METHODS: The study group included 47 children who underwent OLT from September 1996 to April 1999, and the control group included 36 children who underwent OLT from March 1994 to August 1996. The intervention was a transition to home program in which patients were discharged to a family living center when they met established clinical criteria and their families met predefined educational goals. We analyzed patients who survived 3 months after OLT. RESULTS: For the intervention group, the mean length of stay, total costs, and surgical costs were 29%, 36%, and 34% lower, respectively. Organ type, height z score, race, hepatic artery thrombosis, early allograft rejection, and participation in the transition to home program predicted length of stay and total costs. CONCLUSION: An early discharge program based on defined criteria can be used to decrease length of stay and cost after OLT without jeopardizing clinical outcome.
Assuntos
Hospitais Pediátricos/economia , Transplante de Fígado/economia , Pré-Escolar , Feminino , Serviços Hospitalares de Assistência Domiciliar/economia , Custos Hospitalares/estatística & dados numéricos , Hospitais Pediátricos/estatística & dados numéricos , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Análise Multivariada , Ohio , Avaliação de Resultados em Cuidados de Saúde , Alta do Paciente , Projetos de PesquisaRESUMO
OBJECTIVE: To assess the effect of an early discharge program on the use of hospital-based health care services in the first 3 months of life. DESIGN: Retrospective cohort study. SETTING: Metropolitan university hospital and a children's hospital. PATIENTS: Term infants cared for in a single term nursery, before and after implementation of an early discharge program. INTERVENTION: Early discharge program. METHODS: Linking of the birth hospital and the children's hospital records and chart review. OUTCOME MEASURES: Pattern of emergency department visits and rehospitalizations in the first 3 months of life. RESULTS: The early discharge group had a shorter stay, 32 +/- 21 hours (mean +/- SD) than the control group (48 +/- 22 hours). There was no effect of early discharge on mean age at rehospitalization, rehospitalization rate, or reason for rehospitalization. Twenty-eight percent of infants in both study and control groups had at least one emergency department visit by 3 months of age. There was no difference between study and control groups in mean age or frequency of emergency department visits. Maternal age and race had a significant effect on the odds of visiting the emergency department. For any maternal age, nonwhite mothers were more likely to visit the emergency department. CONCLUSIONS: Early discharge of newborn infants to inner city parents can be accomplished without increasing hospital-based resource use in the first 3 months of life provided coordinated postdischarge care and home visiting services are available.
Assuntos
Serviço Hospitalar de Emergência/estatística & dados numéricos , Cuidado do Lactente/estatística & dados numéricos , Tempo de Internação , Alta do Paciente , Adulto , Estudos de Coortes , Feminino , Registros Hospitalares/estatística & dados numéricos , Hospitais Pediátricos , Hospitais Universitários , Humanos , Lactente , Recém-Nascido , Tempo de Internação/estatística & dados numéricos , Idade Materna , Berçários Hospitalares , Ohio , Avaliação de Resultados em Cuidados de Saúde/estatística & dados numéricos , Alta do Paciente/estatística & dados numéricos , Readmissão do Paciente/estatística & dados numéricos , Pobreza , Estudos RetrospectivosRESUMO
The effect of a cost-containment program focused on decreasing the lengths of hospital stay of high-risk neonates was assessed by comparison of discharge weights and lengths of stay for 257 study infants, discharged from a neonatal intensive care unit (NICU) after an early-discharge program began, with those of 477 control infants discharged during a prior 1-year period. Demographic data and costs, as well as data on emergency department use and hospital readmissions, were included in the comparisons. There was a significant decrease in mean discharge weight and length of stay for infants in the study group. During a 7-month period, an estimated 2073 days of hospital care and approximately $2,700,000 in hospital charges were saved, or $10,609 per infant discharged. The cost of instituting and maintaining the program was $120,413, or $468 per infant. Seven visits were made to the emergency department by the study infants during the first 14 days after discharge. One infant was readmitted for a 4-day hospital stay for suspected sepsis. Significantly earlier discharge of high-risk neonates produced a decrease in hospital charges without causing excessive morbidity. The success of the program was coincident and presumed related to the institution of multiple elements focused toward family support through early-discharge planning. The reduction in hospital charges was 30 times higher than program expenses.
Assuntos
Custos Hospitalares/estatística & dados numéricos , Recém-Nascido de Baixo Peso , Unidades de Terapia Intensiva Neonatal/estatística & dados numéricos , Tempo de Internação/economia , Alta do Paciente , Assistência ao Convalescente/economia , Estudos de Casos e Controles , Controle de Custos , Feminino , Serviços de Assistência Domiciliar/economia , Humanos , Recém-Nascido , Unidades de Terapia Intensiva Neonatal/economia , Masculino , Ohio , Avaliação de Resultados em Cuidados de Saúde , Readmissão do Paciente , Desenvolvimento de Programas , Avaliação de Programas e Projetos de Saúde , Fatores de TempoRESUMO
OBJECTIVE: The Medicus Patient Classification System (PCS) and the lameter Acuity Index Method (AIM) are two proprietary scoring systems in common use for stratifying patient populations before making comparisons of the medical care they receive. In this study the validities of these scores were tested when the scores were used to evaluate cost-related elements of high-risk neonatal intensive care. METHODS: A total of 687 surviving inborn infants cared for in a university hospital newborn intensive care unit provided data for these analyses. The infants were stratified into the five diagnosis-related groups (DRGs) for surviving neonates (386, 387, 388, 389, and 390), as determined from their discharge diagnoses. Each infant's summed total of daily PCS scores, a single AIM score, and birth weight were extracted from the hospital's decision-support data files and used as independent variables in regression analyses to determine correlations with lengths of hospital stay, ancillary resource utilizations, and hospital charges. RESULTS: The Medicus scores, which are computed prospectively on a daily basis, when summed retrospectively, correlated highly with lengths of stay, ancillary resource utilization, and associated hospital charges. The lameter scores, which are assigned retrospectively, were far less predictive of these outcome variables and generally worse than birth weight in explaining outcome variances. CONCLUSIONS: Although in common use, the lameter AIM could not be validated as an appropriate method for assessing cost-related outcomes after newborn intensive care. The Medicus PCS produced daily scores that, when summed after patient discharge, correlated highly with the same outcome variables. There is a need to test further these and other proprietary methods now used to compare the cost-related elements of care provided by different hospitals and physicians.
Assuntos
Terapia Intensiva Neonatal/estatística & dados numéricos , Peso ao Nascer , Grupos Diagnósticos Relacionados/estatística & dados numéricos , Feminino , Idade Gestacional , Custos Hospitalares , Registros Hospitalares/estatística & dados numéricos , Humanos , Recém-Nascido , Terapia Intensiva Neonatal/economia , Tempo de Internação/economia , Masculino , Ohio , Avaliação de Resultados em Cuidados de Saúde , Discrepância de GDH/economia , Discrepância de GDH/estatística & dados numéricos , Estudos Prospectivos , Estados UnidosRESUMO
The clinical effects of fluid therapy designed to maintain different degrees of negative water balance during the first five days of life were determined prospectively in 88 very low-birth-weight infants. Infants with birth weights of 750 to 1,500 gm were matched for birth weight in 250 gm increments. RDS or no RDS, asphyxiated or not, and inborn or outborn. Each infant was randomized to either Group 1--fluids managed to allow 1 to 2% loss of BW per day to a maximum loss of 8 to 10%, or Group 2--fluids managed to allow 3 to 5% loss of BW per day to a maximum loss of 13 to 15%. The mean five-day cumulative fluid input in Group 2 was 220 ml/kg less than in Group 1, yet Group 2 lost only 41 gm/kg more than did Group 1 (8.8% of BW lost in Group 1 vs 12.9% of BW lost in Group 2, P less than 0.001). There were no statistically significant differences between the groups in incidence of clinically significant patent ductus arteriosus, intracranial hemorrhage, bronchopulmonary dysplasia, necrotizing enterocolitis, dehydration, acute renal failure, or metabolic disturbances. There was no difference in duration of respiratory support required, in time to regain BW, or in time to discharge. There was no difference in the neonatal mortality rate. Fluid input in VLBW infants can be flexible to allow the gradual loss of 5 to 15% of birth weight during the first week of life without adversely affecting outcome.