Detailed analysis of in-hospital costs for adult patients with type III intestinal failure: A single-center study with global implications.

JPEN. Journal of parenteral and enteral nutrition Pub Date : 2022-03-01 Epub Date: 2021-06-11 DOI:10.1002/jpen.2136
Adrian H Y Siu, Sharon Carey, Lynn Jones, Rachael L Morton, Cherry E Koh
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引用次数: 1

Abstract

Background: Home parenteral nutrition (HPN) is the recommended treatment for patients with type III intestinal failure (IF). However, owing to IF's rarity, the economic cost of managing these patients is not well understood. These patients often develop complications resulting in readmissions, which in turn contribute to ongoing costs. This study aims to document the costs of type III IF within the hospital, from initial admission, including readmissions, and to compare incurred costs with current government reimbursement.

Methods: A retrospective study design reviewed costs and reimbursement for 25 consecutive patients commencing HPN at a quaternary hospital (October 2011 to September 2017). Hospital admissions were separated into the initial admission and readmission(s) period. Healthcare use and cost data were collected using electronic medical records. Hospital reimbursement costs were retrieved from Sydney Local Health District's Targeted Activity and Reporting Systems. Patient demographics were tabulated, and healthcare use and cost data were compared using Wilcoxon signed rank tests.

Results: The median cost of the initial hospital admission was substantially higher than the median reimbursement ($36,675; interquartile range [IQR], $23,196-$67,439 vs $19,247; IQR, $7485-$41,090; P < .001). Similar results were observed in the readmissions period, with median incurred costs of $13,898; (IQR, $11,151-$32,130) vs reimbursement of $8469 (IQR, $5625-$13,078) (P = .001).

Conclusion: Results indicate that type III IF patients have high inpatient costs, which substantially outweigh current reimbursement. Improved funding models are needed to ensure hospitals that accept the management challenge of type III IF patients are not unduly penalized.

成人III型肠衰竭患者住院费用的详细分析:一项具有全球意义的单中心研究
背景:家庭肠外营养(HPN)是III型肠衰竭(IF)患者的推荐治疗方法。然而,由于IF罕见,管理这些患者的经济成本尚不清楚。这些患者经常出现并发症,导致再入院,这反过来又增加了持续的费用。本研究旨在记录医院内III型IF的费用,从首次入院开始,包括再入院,并将发生的费用与当前政府报销进行比较。方法:回顾性研究设计回顾了一家第四医院(2011年10月至2017年9月)连续25例开始HPN的患者的成本和报销情况。入院时间分为初次入院期和再入院期。使用电子医疗记录收集医疗保健使用和成本数据。医院报销费用从悉尼地方卫生区目标活动和报告系统中检索。将患者人口统计数据制成表格,并使用Wilcoxon签名秩检验比较医疗保健使用和成本数据。结果:初次住院的中位数费用大大高于报销的中位数(36,675美元;四分位数区间(IQR): 23,196- 67,439美元vs 19,247美元;差,7485 - 41090美元;P < 0.001)。在再入院期间也观察到类似的结果,费用中位数为13,898美元;(IQR, 11,151- 32,130美元)与报销8469美元(IQR, 5625- 13,078美元)(P = 0.001)。结论:结果表明,III型IF患者的住院费用很高,大大超过了目前的报销。需要改进供资模式,以确保接受III型IF患者管理挑战的医院不会受到不当惩罚。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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