Study of Hospitalization Costs in Patients with Cerebral Ischemia Based on E-CHAID Algorithm

Diagnosis-related groups study of uterine leiomyoma patients based on E-CHAID

Diagnosis-related groups (DRG) is emerging as an effective tool for measuring the quality and efficiency of medical services. This study aims to explore a DRG combination scheme for control the hospitalization costs in patients with uterine leiomyoma (UL). This study enrolled a total of 3087 UL patients from a tertiary hospital in Chongqing between year 2017 and 2021. The data of front sheet of the medical record of each UL patient were retrospectively extracted. Mann-Whitney U test and Kruskal-Wallis H test, and subsequent multivariate logistic regression analysis were used to identify the significant factor influencing the hospitalization cost. Then, a decision tree model was performed to establish the DRG case mix model, and to calculate the payment standards and cost caps for each DRG group. The average age of all patients was 43.03 years old, the average length of stay (LOS) was 6.66 days, and the average total hospitalization cost was 22,436.11 yuan. The highest proportion of the total hospitalization cost was treatment cost (29.46%), followed by diagnostic cost (28.98%), consumable cost (26.01%), etc. Factors including surgery type, LOS, and complications or comorbidities had significant impact on hospitalization costs, among which surgery type were the main influencing factor. Using the three factors as classification nodes, a total of 10 DRG groups were established by a decision tree model. The value of reduction in variance was 0.68, indicating significant heterogeneity between groups. The coefficient of variation for hospitalization costs ranged from 0.08 to 0.44, indicating minimal variation and reasonable grouping result. The established hospitalization cost scheme for patients with UL is reasonable in this study. It provides a reference for the advancement and implementation of DRG payments in local area.

Comparison of COVID-19 hospitalization costs across care pathways: a patient-level time-driven activity-based costing analysis in a Brazilian hospital

BACKGROUND

The COVID-19 pandemic raised awareness of the need to better understand where and how patient-level costs are incurred in health care organizations, as health managers and other decision-makers need to plan and quickly adapt to the increasing demand for health care services to meet patients' care needs. Time-driven activity-based costing offers a better understanding of the drivers of cost throughout the care pathway, providing information that can guide decisions on process improvement and resource optimization. This study aims to estimate COVID-19 patient-level hospital costs and to evaluate cost variability considering the in-hospital care pathways of COVID-19 management and the patient clinical classification.

METHODS

This is a prospective cohort study that applied time-driven activity-based costing (TDABC) in a Brazilian reference center for COVID-19. Patients hospitalized during the first wave of the disease were selected for their data to be analyzed to estimate in-hospital costs. The cost information was calculated at the patient level and stratified by hospital care pathway and Ordinal Scale for Clinical Improvement (OSCI) category. Multivariable analyses were applied to identify predictors of cost variability in the care pathways that were evaluated.

RESULTS

A total of 208 patients were included in the study. Patients followed five different care pathways, of which Emergency + Ward was the most followed (n = 118, 57%). Pathways which included the intensive care unit presented a statistically significant influence on costs per patient (p <  0.001) when compared to Emergency + Ward. The median cost per patient was I$2879 (IQR 1215; 8140) and mean cost per patient was I$6818 (SD 9043). The most expensive care pathway was the ICU only, registering a median cost per patient of I$13,519 (IQR 5637; 23,373) and mean cost per patient of I$17,709 (SD 16,020). All care pathways that included the ICU unit registered a higher cost per patient.

CONCLUSIONS

This is one of the first microcosting study for COVID-19 that applied the TDABC methodology and demonstrated how patient-level costs vary as a function of the care pathways followed by patients. These findings can be used to develop value reimbursement strategies that will inform sustainable health policies in middle-income countries such as Brazil.

Implementation of Lean Management Tools Using an Example of Analysis of Prolonged Stays of Patients in a Multi-Specialist Hospital in Poland

Healthcare institutions in Poland constantly encounter challenges related both to the quality of provided services and to the pressures associated with treatment effectiveness and economic efficiency. The implemented solutions have a goal of improving the service quality of lowering the continuously increasing operational costs. The aim of this paper is to present the application of Lean Management (LM) tools in a Polish hospital, which allowed for the identification of prolonged stays as one of the main issues affecting the service costs and the deteriorating financial results of the hospital. The study was conducted in the neurology department and involved an analysis of data for the whole of 2019 and the first half of 2022. In addition, surveys were conducted among the medical staff to help identify the main causes of prolonged stays. Methods of data analysis and feasible solutions were developed in order to improve the economic efficiency of the unit. The analysis shows that the application of LM tools may contribute to improvement in the functioning of hospitals and that further studies should focus on the development of the method to evaluate efficiency of the implemented solutions intended at shortening the hospital stays of the patients.