RESUMO
To determine whether the diagnosis related group (DRG) hospital payment system is causing financial pressure on pediatric hospitals similar to that shown in our previous work in other settings, we analyzed resource consumption for pediatric patients in any of the 251 DRGs not stratified by comorbidities. The new DRG prospective "all payor system" is in effect at our hospital. Analysis of 12,771 pediatric patients by payer (Medicaid and commercial insurance such as Blue Cross) in these DRGs for a 3-year period demonstrated that, as a group, pediatric patients with more comorbidities generated higher total hospital costs, a longer hospital length of stay, a greater percentage of procedures per patient, financial risk under DRG payment, more outliers (expensive patients), and a higher mortality rate than pediatric patients in the same DRGs with fewer comorbidities. This study confirms major inequities in DRG prospective hospital payment for many pediatric patients.
Assuntos
Comorbidade , Grupos Diagnósticos Relacionados , Hospitais Pediátricos/economia , Criança , Hospitais Especializados , Humanos , Reembolso de Seguro de Saúde/economia , Tempo de Internação , Medicaid/economia , Estados UnidosRESUMO
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
Techniques for using the triploid cell marker for studying cell lineage during the development and regeneration of the axolotl limb are described. Triploid animals possess cells with three nucleoli while diploid animals possess cells with two nucleoli. We have developed a technique for isolating the limb dermis as a sheet of cells for whole-mount analysis of cellular ploidy. Whole-mount tissue preparations as well as paraffin-embedded sectioned tissues were stained specifically for nucleoli with bismuth. Cell counts from a number of triploid and diploid dermal preparations show that (1) diploid dermal cells never possess three nucleoli, (2) the frequency of trinucleolate cells in whole-mount triploid dermal preparations is not 100% but varies between animals from 30 to 76%, (3) within a single triploid animal, the frequency of trinucleolate cells in different dermal preparations is constant. These data establish the usefulness of this technique and emphasize the need for appropriate control cell counts when using the triploid cell marker in the axolotl.