手術併發症增加癌症照護費用


  【24drs.com】根據一篇新研究,手術導致之併發症顯著增加癌症病患的照護費用。
  
  研究者報告指出,癌症照護在這方面獲得的注意比較少,但是,藉由減少常見錯誤改善病患安全,將可改善健康照護品質與減少費用。
  
  他們的研究發現,手術併發症的相關費用持續偏高,認為探討這些議題可以改善病患結果且節省健康照護費用。
  
  這篇研究線上登載於2013年12月30日的癌症期刊。
  
  第一作者、休士頓Rice大學James A. Baker III公共政策研究中心、資深分析師Marah Short解釋,雖然目前還沒有醫師可運用於臨床實務的清楚資訊,這些結果應可幫助醫師瞭解到這些併發症會造成費用增加。
  
  她表示,因為許多併發症是由多種因素造成,應致力改善病患照護品質、以及考慮腫瘤本身和照護者之因素。
  
  她們這個研究團隊計畫繼續研究這些併發症比率,以釐清是否有潛在因素及手術量與費用之關聯有關。Short女士表示,希望這可以提供更清楚且可應用的建議。
  
  根據醫學研究院最近的報告,美國的癌症照護相當昂貴,費用佔比持續迅速攀升;癌症照護費用從2004年的720億美元增加到2010年的1,250億美元,預估到2020年會增加39%、高達1,730億美元。
  
  Short女士等人指出,不像許多良性情況,當涉及癌症治療時,併發症的耐受性閾值通常較高;因為病患、腫瘤、多病症治療、照護者因素等複雜關聯都可能造成不良結果,因此其併發症的直接原因也比較難確認。
  
  這篇研究中,研究團隊使用健康照護研究暨品質局的病患安全指標(PSIs)確認Medicare資料庫的病患安全相關併發症;PSIs是一套公開的結果測量方法,提供可能的住院併發症、手術或分娩後之不良事件的資訊。
  
  研究團隊分析了50州、2005-2009年的Medicare資料,探討以下6種癌症手術併發症與費用的關聯:結腸切除術(n= 150,733)、肺葉切除術(n= 52,202)、直腸切除術(n= 25,892)、胰切除術(n= 12,135)、食道切除(n= 3857)、肺切除(n= 2981),各種手術在手術頻率、平均死亡率、每名病患的平均費用等有明顯差異。
  
  最常見的PSI是手術住院病患因嚴重併發症死亡、術後呼吸衰竭、術後肺栓塞或深部靜脈血栓、意外穿孔或裂傷;其他併發症與麻醉、手術時將外來物留在病患體內、術後髖骨骨折、術後生理和代謝紊亂等有關。
  
  多種PSIs會增加多種癌症手術之住院費用超過20%,校正病患、醫院、腫瘤因素等之後,呼吸衰竭使費用從53%增加到77%,無嚴重情況之住院病患手術死亡使費用從20%增加到54%,術後肺栓塞或深部靜脈血栓使費用從28%增加到37%,各種手術的褥瘡使費用從28%增加到60%(P< .001)。
  
  Short女士等人也檢視了醫院特徵,以確認各醫院之PSI比率差異,以釐清可能的系統性差異。對許多PSIs而言,低手術量和高手術量醫院之間的發生率相似,只有一些有差異。例如,低手術量機構的術後出血/血腫比率、術後肺栓塞或深部靜脈血栓率較低,高手術量機構的住院病患手術死亡率、醫源性氣胸、術後呼吸衰竭比率較低。
  
  教學醫院有某些PSIs的比率高於非教學醫院,但許多比率相似或更低—非教學醫院的術後髖骨骨折和傷口裂開比率較高。
  
  Short女士表示,如果能探討外科醫師的特徵資料可能會更有趣。雖然我們的研究結果並沒有提到這方面資料,我們有能力控制外科醫師的手術量與次專科。
  
  次專科係數的結果認為,對於多種手術,執刀醫師的次專科和費用之間有關聯,但因為對外科醫師資訊所知有限,難以詮釋這些結果或提出政策建議。她解釋,我們可能無法對外科醫師和醫院費用造成的各種併發症進行測量,不過,因為我們對照護者資源、照護過程、併發症、與費用之關聯所知有限,這篇分析對檢視這些關聯提供了重要的開端。
  
  資料來源:http://www.24drs.com/professional/list/content.asp?x_idno=7043&x_classno=0&x_chkdelpoint=Y
  

Surgical Complications Up Cancer Care Costs

By Roxanne Nelson
Medscape Medical News

Complications stemming from surgery can substantially increase the cost of care in cancer patients, according to a new study.

This area of cancer care has received less attention than other issues, but improvements in patient safety, by reducing common errors, will improve healthcare quality and cut costs, researchers report.

In their study, they found consistently higher costs associated with cancer surgery complications, and suggest that addressing these issue could improve patient outcomes and result in substantial healthcare savings.

The study was published online December 30, 2013, in Cancer.

Although there is currently no clear message for physicians that can be applied to clinical practice, these results should help make them aware that these complications contribute greatly to costs, explained first author Marah Short, MA, senior research analyst at the James A. Baker III Institute for Public Policy, Rice University, in Houston.

"Since many complications are caused by multiple factors, efforts to improve quality will need to take into account patient and tumor factors in addition to provider issues," she told Medscape Medical News.

Her team plans to continue studying these complication rates to identify whether any of them are underlying factors for the association between procedure volume and costs. "The hope is that this will provide a more clear and applicable recommendation," Short said.

Cancer care in the United States is already quite expensive, and costs continue to increase faster than other sectors of medicine. Cancer costs jumped from $72 billion in 2004 to $125 billion in 2010, and are expected to increase by 39%, up to $173 billion, by 2020, according to a recent report from the Institute of Medicine.

Short and colleagues note that unlike many benign conditions, there tends to be a higher threshold of tolerance for complications when it comes to cancer treatment. The direct cause of complications is also more difficult to ascertain because of the complex interactions between the patient, tumor, multimodality therapy, and provider factors that can all contribute to adverse outcomes.

Substantially Increase Costs

In this study, the research team used definitions from the Agency for Healthcare Research and Quality's Patient Safety Indicators (PSIs) to identify patient safety-related complications in Medicare claims data. PSIs are a set of transparent outcome measures developed to give information on potential in-hospital complications and adverse events after procedures, surgery, or childbirth.

The team conducted an analysis of Medicare claims data from 2005 to 2009 for all 50 states to look at the relation between costs and patient complications for 6 cancer resections: colectomy (n = 150,733), pulmonary lobectomy (n = 52,202), rectal resection (n = 25,892), pancreatic resection (n = 12,135), esophagectomy (n = 3857), and pneumonectomy (n = 2981). There was substantial variation in the frequency of procedures, average mortality rate, and average cost per patient for the different resections.

The most frequent PSIs were death in surgical inpatients with serious treatable complications, postoperative respiratory failure, postoperative pulmonary embolism or deep vein thrombosis, and accidental puncture/laceration. Other complications were related to anesthesia, a foreign object being left inside a patient during a procedure, postoperative hip fractures, and postoperative physiologic and metabolic derangement.

Several of the PSIs increased the cost of hospitalization by more than 20% for most types of cancer surgery. After adjustment for patient, hospital, and tumor factors, costs jumped by 53% to 77% for respiratory failure, 20% to 54% for death in surgical inpatients with serious treatable conditions, 28% to 37% for postoperative pulmonary embolism or deep vein thrombosis, and 28% to 60% for decubitus ulcer for all procedures (P < .001).

Hospital Characteristics Similar

Short and colleagues also examined hospital characteristics to determine the difference in PSI rates between hospitals and to identify potentially systemic differences. The occurrence rates for low-volume and high-volume hospitals were similar for many of the PSIs, but there were some differences. For example, low-volume facilities had a lower rate of postoperative hemorrhage/hematoma and postoperative pulmonary embolism or deep vein thrombosis, whereas high-volume facilities had lower rates of death in surgical inpatients with treatable complications, iatrogenic pneumothorax, and postoperative respiratory failure.

Teaching hospitals had higher rates of some PSIs than nonteaching hospitals, but several rates were similar or even lower — nonteaching hospitals had higher rates of postoperative hip fracture and wound dehiscence.

"It would be interesting to have better access to data about surgeon characteristics," said Short. "Although it was not highlighted in our results, we were able to control for surgeon volume and subspecialty."

The results for the subspecialty coefficients suggest that, for several of the procedures, there is a correlation between the subspecialty of the operating surgeon and cost, but without knowing more about the surgeons, it is difficult to interpret these results or make a policy recommendation. "We may not have identified all of the complication measures that are determinants of surgeon and hospital costs," she explained. "However, because we know so little about the links between provider volume, care processes, complications, and costs, this analysis represents an important first step in examining these relations."

The study was supported by grants from the National Cancer Institute and the Cancer Prevention and Research Institute of Texas. Coauthor Thomas A. Aloia, MD, from the University of Texas M.D. Anderson Cancer Center in Houston, reports receiving personal fees from Medtronic, Inc.

Cancer. Published online December 30, 2013.

    
相關報導
定期健康檢查似乎不會影響死亡率
2013/1/22 上午 11:55:39
延長診間服務時間可降低健康方面的支出
2012/9/21 上午 09:27:01
過度強調病患滿意度可能會引起問題
2012/2/17 上午 11:40:29

上一頁
   1   2   3   4   5   6   7  




回上一頁