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The Impact of Patient Profiles and Procedures on Hospitalization Costs through Length of Stay in Community-Acquired Pneumonia Patients Based on a Japanese Administrative Database.

Uematsu H, Kunisawa S, Yamashita K, Imanaka Y - PLoS ONE (2015)

Bottom Line: The severity factors were also associated with longer length of stay durations.The ratio of indirect effects to direct effects on total hospitalization costs showed that the former was greater than the latter in the factors, except in the use of mechanical ventilation.Furthermore, the profiles were generally shown to have greater indirect effects (through length of stay) on hospitalization costs than direct effects.

View Article: PubMed Central - PubMed

Affiliation: Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Kyoto City, Kyoto, Japan.

ABSTRACT

Background: Community-acquired pneumonia is a common cause of patient hospitalization, and its burden on health care systems is increasing in aging societies. In this study, we aimed to investigate the factors that affect hospitalization costs in community-acquired pneumonia patients while considering the intermediate influence of patient length of stay.

Methods: Using a multi-institutional administrative claims database, we analyzed 30,041 patients hospitalized for community-acquired pneumonia who had been discharged between April 1, 2012 and September 30, 2013 from 289 acute care hospitals in Japan. Possible factors associated with hospitalization costs were investigated using structural equation modeling with length of stay as an intermediate variable. We calculated the direct, indirect (through length of stay), and total effects of the candidate factors on hospitalization costs in the model. Lastly, we calculated the ratio of indirect effects to direct effects for each factor.

Results: The structural equation model showed that higher disease severities (using A-DROP, Barthel Index, and Charlson Comorbidity Index scores), use of mechanical ventilation, and tube feeding were associated with higher hospitalization costs, regardless of the intermediate influence of length of stay. The severity factors were also associated with longer length of stay durations. The ratio of indirect effects to direct effects on total hospitalization costs showed that the former was greater than the latter in the factors, except in the use of mechanical ventilation.

Conclusions: Our structural equation modeling analysis indicated that patient profiles and procedures impacted on hospitalization costs both directly and indirectly. Furthermore, the profiles were generally shown to have greater indirect effects (through length of stay) on hospitalization costs than direct effects. These findings may be useful in supporting the more appropriate distribution of health care resources.

No MeSH data available.


Related in: MedlinePlus

A path showing the relationship between each variable using structural equation modeling.Abbreviations: BI, Barthel index; CCI, Charlson comorbidity index; MV, Mechanical ventilator; TF, Tube feeding; PPB, Physicians per beds; NPB, Nurses per beds; LOS, Length of stay; THC, Total hospitalization costs; ε; error term *Age, ADROP scores, Barthel index and Charlson comorbidity index include dummy variables in each box.
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pone.0125284.g002: A path showing the relationship between each variable using structural equation modeling.Abbreviations: BI, Barthel index; CCI, Charlson comorbidity index; MV, Mechanical ventilator; TF, Tube feeding; PPB, Physicians per beds; NPB, Nurses per beds; LOS, Length of stay; THC, Total hospitalization costs; ε; error term *Age, ADROP scores, Barthel index and Charlson comorbidity index include dummy variables in each box.

Mentions: SEM analysis was conducted using LOS as an intermediate variable. Fig 2 shows the path diagram of the model, which presents the relationship between each variable. From the DPC data, we explored the following candidate independent variables identified from existing evidence [10–13] or based on clnical rationare: patient age, sex, A-DROP score, BI score, Charlson Comorbidity Index (CCI) score (Dartmouth-Manitoba version [18]), mechanical ventilation use, tube feeding (enteral nutrition), and LOS. In order to adjust for differences in hospital structural characteristics, we also included the number of physicians per 10 beds and number of nurses per bed as independent variables. Patient age, A-DROP scores, BI scores, and CCI scores were measured upon admission. These variables were included in analysis as ordinal dummy variables, and their cutoff points were determined using the interquartile range. All variables were analyzed as observation variables in this model.


The Impact of Patient Profiles and Procedures on Hospitalization Costs through Length of Stay in Community-Acquired Pneumonia Patients Based on a Japanese Administrative Database.

Uematsu H, Kunisawa S, Yamashita K, Imanaka Y - PLoS ONE (2015)

A path showing the relationship between each variable using structural equation modeling.Abbreviations: BI, Barthel index; CCI, Charlson comorbidity index; MV, Mechanical ventilator; TF, Tube feeding; PPB, Physicians per beds; NPB, Nurses per beds; LOS, Length of stay; THC, Total hospitalization costs; ε; error term *Age, ADROP scores, Barthel index and Charlson comorbidity index include dummy variables in each box.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4414582&req=5

pone.0125284.g002: A path showing the relationship between each variable using structural equation modeling.Abbreviations: BI, Barthel index; CCI, Charlson comorbidity index; MV, Mechanical ventilator; TF, Tube feeding; PPB, Physicians per beds; NPB, Nurses per beds; LOS, Length of stay; THC, Total hospitalization costs; ε; error term *Age, ADROP scores, Barthel index and Charlson comorbidity index include dummy variables in each box.
Mentions: SEM analysis was conducted using LOS as an intermediate variable. Fig 2 shows the path diagram of the model, which presents the relationship between each variable. From the DPC data, we explored the following candidate independent variables identified from existing evidence [10–13] or based on clnical rationare: patient age, sex, A-DROP score, BI score, Charlson Comorbidity Index (CCI) score (Dartmouth-Manitoba version [18]), mechanical ventilation use, tube feeding (enteral nutrition), and LOS. In order to adjust for differences in hospital structural characteristics, we also included the number of physicians per 10 beds and number of nurses per bed as independent variables. Patient age, A-DROP scores, BI scores, and CCI scores were measured upon admission. These variables were included in analysis as ordinal dummy variables, and their cutoff points were determined using the interquartile range. All variables were analyzed as observation variables in this model.

Bottom Line: The severity factors were also associated with longer length of stay durations.The ratio of indirect effects to direct effects on total hospitalization costs showed that the former was greater than the latter in the factors, except in the use of mechanical ventilation.Furthermore, the profiles were generally shown to have greater indirect effects (through length of stay) on hospitalization costs than direct effects.

View Article: PubMed Central - PubMed

Affiliation: Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Kyoto City, Kyoto, Japan.

ABSTRACT

Background: Community-acquired pneumonia is a common cause of patient hospitalization, and its burden on health care systems is increasing in aging societies. In this study, we aimed to investigate the factors that affect hospitalization costs in community-acquired pneumonia patients while considering the intermediate influence of patient length of stay.

Methods: Using a multi-institutional administrative claims database, we analyzed 30,041 patients hospitalized for community-acquired pneumonia who had been discharged between April 1, 2012 and September 30, 2013 from 289 acute care hospitals in Japan. Possible factors associated with hospitalization costs were investigated using structural equation modeling with length of stay as an intermediate variable. We calculated the direct, indirect (through length of stay), and total effects of the candidate factors on hospitalization costs in the model. Lastly, we calculated the ratio of indirect effects to direct effects for each factor.

Results: The structural equation model showed that higher disease severities (using A-DROP, Barthel Index, and Charlson Comorbidity Index scores), use of mechanical ventilation, and tube feeding were associated with higher hospitalization costs, regardless of the intermediate influence of length of stay. The severity factors were also associated with longer length of stay durations. The ratio of indirect effects to direct effects on total hospitalization costs showed that the former was greater than the latter in the factors, except in the use of mechanical ventilation.

Conclusions: Our structural equation modeling analysis indicated that patient profiles and procedures impacted on hospitalization costs both directly and indirectly. Furthermore, the profiles were generally shown to have greater indirect effects (through length of stay) on hospitalization costs than direct effects. These findings may be useful in supporting the more appropriate distribution of health care resources.

No MeSH data available.


Related in: MedlinePlus