Clinical care costing method for the Clinical Care Classification System.

PURPOSE: To provide a means for calculating the cost of nursing care using the Clinical Care Classification System (CCCS). DATA SOURCES: Three CCCS indicators of care components, actions, and outcomes in conjunction with Clinical Care Pathways (CCPs). DATA SYNTHESIS: The cost of patient care is based on the type of action time multiplied by care components and nursing costs. CONCLUSIONS: The CCCM for the CCCS makes it possible to measure and cost out clinical practice. IMPLICATIONS FOR PRACTICE: The CCCM may be used with CCPs in the electronic patient medical record. The CCPs make it easy to track the clinical nursing care across time, settings, population groups, and geographical locations. Collected data may be used many times, allowing for improved documentation, analysis, and costing out of care.

[Costs, costs and more costs: which one should we use?]. / Notions et mesure des coûts en fonction de la perspective choisie.

A cost is not an intrinsic feature of a product in the same way as temperature is for water and air. It is a calculation based on theory and convention. Costs may be characterised by their object (an hospital admission, a hospitalization day, a diagnostic related group, a treatment phase), their contents (costs directly attributable to the patient, controllable costs, including not only departmental operating costs but also costs resulting from the department's activity, full costs including administrative and infrastructure overhead costs), the point of reference from where the costs are considered (from the point of view of the family, the health professionals suppliers, the buyers, the health care system, or society) and the time when the costs were calculated. The cost framework which must be considered in any economic evaluation must relate to the budgetary concerns of the party whose involvement is sought in a health care project. There is no all encompassing study in this field; an evaluation performed for one type of contributor must only consider this party's point of view.

Impact of global bundled payments on hospital costs of coronary artery bypass grafting.

The Health Care Financing Administration began the Medicare Participating Heart Bypass Center Demonstration in 1991, in which hospitals and physicians are paid a single negotiated global price for all inpatient care for heart bypass patients. This article analyzed the changes in total and departmental direct variable costs during the 1991-1993 period using micro-cost data. The results indicate that all participating hospitals had significant reductions in total direct variable costs, after controlling for preoperative risk factors and postoperative outcomes. However, the patterns in cost reductions across major departments were different across hospitals. The cost reductions primarily came from nursing intensive care unit, routine nursing, pharmacy, and catheter lab.

Cost identification of abdominal aortic aneurysm imaging by using time and motion analyses.

PURPOSE: To compare the costs of performing helical computed tomographic (CT) angiography with three-dimensional rendering versus intraarterial digital subtraction angiography (DSA) for preoperative imaging of abdominal aortic aneurysms (AAAs). MATERIALS AND METHODS: A single observer determined the variable direct costs of performing nine intraarterial DSA and 10 CT angiographic examinations in age- and general health-matched patients with AAA by using time and motion analyses. All personnel directly involved in the cases were tracked, and the involvement times were recorded to the nearest minute. All material items used during the procedures were recorded. The cost of labor was determined from personnel reimbursement data, and the cost of materials, from vendor pricing. The variable direct costs of laboratory tests and using the ambulatory treatment unit for postprocedural monitoring, as well as all fixed direct costs, were assessed from hospital accounting records. The total costs were determined for each procedure and compared by using the Student t test and calculating the CIs. RESULTS: The mean total direct cost of intraarterial DSA (+/- SD) was $1,052 +/- 71, and that of CT angiography was $300 +/- 30, which are significantly different (P < 4.1 x 10(-11)). With 95% confidence, intraarterial DSA cost 3.2-3.7 times more than CT angiography for the assessment of AAA. CONCLUSION: Assuming equal diagnostic utility and procedure-related morbidity, institutions may have substantial cost savings whenever CT angiography can replace intraarterial DSA for imaging AAAs.

Diagnostic and therapeutic approaches for nonmetastatic breast cancer in Canada, and their associated costs.

In an era of fiscal restraint, it is important to evaluate the resources required to diagnose and treat serious illnesses. As breast cancer is the major malignancy affecting Canadian women, Statistics Canada has analysed the resources required to manage this disease in Canada, and the associated costs. Here we report the cost of initial diagnosis and treatment of nonmetastatic breast cancer, including adjuvant therapies. Treatment algorithms for Stages I, II, and III of the disease were derived by age group (< 50 or > or = 50 years old), principally from Canadian cancer registry data, supplemented, where necessary, by the results of surveys of Canadian oncologists. Data were obtained on breast cancer incidence by age, diagnostic work-up, stage at diagnosis, initial treatment, follow-up practice, duration of hospitalization and direct care costs. The direct health care costs associated with 'standard' diagnostic and therapeutic approaches were calculated for a cohort of 17,700 Canadian women diagnosed in 1995. Early stage (Stages I and II) breast cancer represented 87% of all incident cases, with 77% of cases occurring in women > or = 50 years. Variations were noted in the rate of partial vs total mastectomy, according to stage and age group. Direct costs for diagnosis and initial treatment ranged from $8014 for Stage II women > or = 50 years old, to $10,897 for Stage III women < 50 years old. Except for Stage III women < 50 years old, the largest expenditure was for hospitalization for surgery, followed by radiotherapy costs. Chemotherapy was the largest cost component for Stage III women < 50 years old. This report describes the cost of diagnosis and initial treatment of nonmetastatic breast cancer in Canada, assuming current practice patterns. A second report will describe the lifetime costs of treating all stages of breast cancer. These data will then be incorporated into Statistics Canada's Population Health Model (POHEM) to perform cost-effectiveness studies of new therapeutic interventions for breast cancer, such as the cost-effectiveness of day surgery, or of radiotherapy to all breast cancer patients undergoing breast surgery.

Follow-up of breast cancer in primary care vs specialist care: results of an economic evaluation.

A randomized controlled trial (RCT) comparing primary-care-centred follow-up of breast cancer patients with the current standard practice of specialist-centred follow-up showed no increase in delay in diagnosing recurrence, and no increase in anxiety or deterioration in health-related quality of life. An economic evaluation of the two schemes of follow-up was conducted concurrent with the RCT Because the RCT found no difference in the primary clinical outcomes, a cost minimization analysis was conducted. Process measures of the quality of care such as frequency and length of visits were superior in primary care. Costs to patients and to the health service were lower in primary care. There was no difference in total costs of diagnostic tests, with particular tests being performed more frequently in primary care than in specialist care. Data are provided on the average frequency and length of visits, and frequency of diagnostic testing for breast cancer patients during the follow-up period.

Impacto sobre la prevención del nacimiento de bajo peso de un programa de atención primaria de la embarazada de bajo nivel socio-económico / Impact on low birth weigth prevention of a perinatal primary health care program in a low income population at La Matanza district

Introducción: Estudios epidemiológicos realizados en el Hospital Paroissien del partido de La Matanza (Prov. de Bs. As.) demostraron que la ausencia de control del embarazo fue la variable más importante relacionada con una mayor frecuencia de bajo peso al nacer y una tasa de mortalidad perinatal más alta. Objetivo: Se evaluó el impacto de un programa de atención primaria de la embarazada en una población de muy bajo nivel socio-económico y con malos resultados perinatales a fin de conocer su eficiencia para disminuir el daño perinatal. Material y métodos: Se efectuó un estudio durante el período (1987 a 1988) en un grupo de gestantes atendidas por el programa de atención primaria, comparando los resultados neonatales con los observados en un grupo control cuyo embarazo fue atendido con los estándares habituales del Hospital Paroissien para la población que demanda espontáneamente a la institución. Resultados: La muestra estuvo constituida por 570 embarazadas para cada grupo. Se observó una menor frecuencia de bajo peso al nacer (7,5 por ciento) en el grupo de estudio en comparación con el grupo control (12,5 por ciento). Asimismo el grupo de intervención tuvo menor mortalidad fetal (14 por mil) y perinatal (24,5 por mil) en relación al grupo control (22,8 por mil y 36,8 por mil respectivamente) (p < 0,005). Conclusiones: Estos resultados demostraron el efecto favorable de un programa comunitario de atención primaria de las embarazadas al disminuir el daño perinatal

Cáncer de pulmón: costo econámico de una sobrevida quirúrgica a 5 años / Lung cancer: economic cost of survival of 5 years

Se estudio el costo, expresado en dólares, de cada sobrevida a 5 años en los pacientes operados por cáncer del pulmón de acuerdo con el estadio en tres instituciones de distinta categoría. El costo de una sobrevida para un Estadio I osciló entre 2.932 y 17.716; para un Estadio II, entre 4.397 y 26.574; para un Estadio IIIa, entre 8.795 y 53.147 y para un Estadio IIIb entre 35.179 y 212.589. El costo considerando una sobrevida global de 33% fue entre 5.330 y 32.211 por paciente vivo a los 5 años. El alto costo de una sobrevida en un Estadio IIIb es un factor a menudo no tenido en cuenta por los cirujanos, pero de interés para los administradores de la salud. Los honorarios del cirujano han tenido escasa incidencia en el costo total, en contraste con los estudios por imágenes y los gastos sanatoriales

Specialty costs in English hospitals--a statistical approach based upon a cost component model.

A previous paper in this Journal compared various regression models designed to relate hospital recurrent expenditure to corresponding measures of hospital activity and services provided. The paper concluded by discussing briefly an alternative approach designed to avoid some of the criticisms raised and to reconcile the differing viewpoints inherent in the existing models. The objective of the present paper is to describe this alternative approach in more detail. The model introduced is concerned with the separate modelling of a number of broad components of hospital inpatient expenditure, rather than with the total expenditure in isolation. A system of simultaneous regression models is proposed, each related to a particular area of expenditure, the structure of each being determined by means of empirical analyses based upon data from some 1505 English hospitals. It is shown that when the total costs generated by aggregating the cost components are considered, the models provide a better representation of the cost structure of English hospitals than the models based upon total costs published in the recent literature. Various applications of the models in the management and planning of hospital services involving the use of micro- or other computers are discussed.