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Total Hospital Costs (total + hospital_cost)
Selected AbstractsThe Effect of High Nursing Surveillance on Hospital CostJOURNAL OF NURSING SCHOLARSHIP, Issue 2 2008Leah L. Shever Purpose: The purpose of this study was to determine the cost of one nursing treatment, surveillance, for older, hospitalized adults at risk for falling. Design: An observational study using information from data repositories at one Midwestern tertiary hospital. The inclusion criteria included patients age >60 years, admitted to the hospital between July 1, 1998 and June 31, 2002, at risk for falls or received the nursing treatment of fall prevention. Methods: Data came from clinical and administrative data repositories that included Nursing Interventions Classification (NIC). The nursing treatment of interest was surveillance and total hospital cost associated with surveillance was the dependent variable. Propensity-score analysis and generalized estimating equations (GEE) were used as methods to analyze the data. Independent variables related to patient characteristics, clinical conditions, nurse staffing, medical treatments, pharmaceutical treatments, and other nursing treatments were controlled for statistically. Findings: The total median cost per hospitalization was $9,274 for this sample. The median cost was different (p = 0.050) for patients who received high versus low surveillance. High surveillance delivery cost $191 more per hospitalization than did low surveillance delivery. Conclusion: Propensity scores were applied to determine the cost of surveillance among hospitalized adults at risk for falls in this observational study. The findings show the effect of high surveillance delivery on total hospital cost compared to low surveillance delivery and provides an example of a useful method of determining cost of nursing care rather than including it in the room rate. More studies are needed to determine the effects of nursing treatments on cost and other patient outcomes in order for nurses to provide cost-effective care. Propensity scores were a useful method for determining the effect of nursing surveillance on hospital cost in this observational study. Clinical Relevance: The results of this study along with possible clinical benefits would indicate that frequent nursing surveillance is important and might support the need for additional nursing staff to deliver frequent surveillance. [source] Hospital Economics of the HospitalistHEALTH SERVICES RESEARCH, Issue 3 2003Douglas Gregory Objective To determine the economic impact on the hospital of a hospitalist program and to develop insights into the relative economic importance of variables such as reductions in mean length of stay and cost, improvements in throughput (patients discharged per unit time), payer methods of reimbursement, and the cost of the hospitalist program. Data Sources The primary data source was Tufts-New England Medical Center in Boston. Patient demographics, utilization, cost, and revenue data were obtained from the hospital's cost accounting system and medical records. Study Design The hospitalist admitted and managed all patients during a six-week period on the general medical unit of Tufts-New England Medical Center. Reimbursement, cost, length of stay, and throughput outcomes during this period were contrasted with patients admitted to the unit in the same period in the prior year, in the preceding period, and in the following period. Principal Findings The hospitalist group compared with the control group demonstrated: length of stay reduced to 2.19 days from 3.45 days (p<.001); total hospital costs per admission reduced to $1,775 from $2,332 (p<.001); costs per day increased to $811 from $679 (p<.001); no differences for readmission within 30 days of discharge to extended care facilities. The hospital's expected incremental profitability with the hospitalist was,$1.44 per admission excluding incremental throughput effects, and it was most sensitive to changes in the ratio of per diem to case rate reimbursement. Incremental throughput with the hospitalist was estimated at 266 patients annually with an associated incremental profitability of $1.3 million. Conclusion Hospital interventions designed to reduce length of stay, such as the hospitalist, should be evaluated in terms of cost, throughput, and reimbursement effects. Excluding throughput effects, the hospitalist program was not economically viable due to the influence of per diem reimbursement. Throughput improvements occasioned by the hospitalist program with high baseline occupancy levels are substantial and tend to favor a hospitalist program. [source] Laparoscopic anterior resection for rectosigmoid cancer: Patient outcomes after implementation of a clinical pathwayASIAN JOURNAL OF ENDOSCOPIC SURGERY, Issue 1 2010T.W. Hsu Abstract Introduction: A clinical pathway designed for a single type of laparoscopic colorectal surgery for cancer might be helpful in decreasing complication rates and total hospital costs. It has been reported to be effective in reducing costs and shortening length of hospital stays in many situations such as laparoscopic cholecystectomy, colon resection, total colectomy, and gastrointestinal bleeding, as well as when caring for patients in the intensive care unit. Materials and Methods: A clinical pathway, including surgical details and perioperative management, for patients undergoing laparoscopic anterior resection for rectosigmoid cancer was designed and implemented. From January 2003 to December 2006, it was applied to 80 patients. Results: The average length of a hospital stay for these patients was 9.06 d. The mean hospital stay and total cost decreased year by year. The overall complication rate was 8.75% without perioperative mortality, and 47.5% of patients with underlying diseases were treated safely. Discussion: Laparoscopic anterior resection for rectosigmoid cancer, with curative or palliative intent, was safe after standardization of surgical details and perioperative management. The total hospital costs for each patient was predictable and decreased year by year. [source] Estimating the costs of drug-related hospital separations in AustraliaAUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH, Issue 2 2008Steven Riddell Abstract Objective: To estimate the total hospital costs of drug-related separations in Australia from 1999/2000 to 2004/05, and separate costs for the following illicit drug classes: opioids, amphetamine, cannabis and cocaine. Methods: Australian hospital separations between 1999/2000 to 2004/05 from the National Hospital Morbidity Dataset (NHMD) with a principal diagnosis of opioids, amphetamine, cannabis or cocaine were included, as were indirect estimates of additional ,drug-caused' separations using aetiological fractions. The costs were estimated using the year-specific case weights and costs for each respective Diagnostic Related Group (DRG). Results: Total constant costs decreased from $50.8 million in 1999/2000 to $43.8 million in 2002/03 then increased to $46.7 million in 2004/05. The initial decrease was driven by a decline in numbers of opioid-related separations (with costs decreasing by $11.5 million) between 1999/2000 and 2001/02. Decreases were evident in separations within the opioid use, dependence and poisoning DRGs. Increases in costs were observed between 1999/00 and 2004/05 for amphetamine (an increase of $2.4 million), cannabis ($1.8 million) and cocaine ($330,000) related separations. Several uncommon but very expensive drug-related separations constituted 12.7% of the total drug-related separations. Conclusions and Implications: Overall, the costs of drug-related hospital separations have decreased by $4.1 million between 1999 and 2005, which is primarily attributable to fewer opioid-related separations. Small reductions in the number of costly separations through harm reduction strategies have the potential to significantly reduce drug-related hospital costs. [source] | ||||||||||