Resource utilization and pathways : Meeting the challenge of cost containment.
Annual Meeting of the Southern California Chapter, American College of Surgeons. Santa Barbara, California USA, 1996/01/19.
The 1990s will bring sweeping changes with managed care and capitation.
To address this cost/quality paradox, selective intensive care utilization is coupled with clinical pathways as an innovative change for all patients having cerebral revascularization (CVR) or femoral revascularization (FR).
From January 1,1991 through June 30,1995, data were accumulated on 2023 procedures in 1524 patients.
The study was based on 848 CVRs and 1175 FRs.
Intensive care unit (ICU) observation was necessary in 73 patients (3.6%) for cardiac or hypertensive management.
Twenty-six patients (1.2%) transported to a vascular surgical floor from the postanesthesia recovery room required return to an ICU for complications during hospitalization.
There were nine strokes or transient ischemic attacks (0.4%) in the CVR group, four myocardial infarctions (0.2%), and five perioperative deaths (0.3%). In the FR group, there were 14 deaths (0.9%). Readmission during the perioperative period, 30 days, was necessary in 46 patients (3.1%). Financial cost analysis revealed the mean adjusted cost for CVR in 1990 adjusted to 1995 dollars was $7223.
The institution of case management reduced this to $4490 (37.8 per cent reduction in total hospital costs).
The cost for FR in 1990 dollars adjusted to 1995 was $14,332 reduced to $5541 (a 59 per cent reduction in total hospital costs). (...)
Mots-clés Pascal : Athérosclérose, Revascularisation, Artère fémorale, Carotide, Analyse avantage coût, Système santé, Etats Unis, Amérique du Nord, Amérique, Traitement, Evaluation, Homme, Appareil circulatoire pathologie, Vaisseau sanguin pathologie, Chirurgie
Mots-clés Pascal anglais : Atherosclerosis, Revascularization, Femoral artery, Carotid, Cost benefit analysis, Health system, United States, North America, America, Treatment, Evaluation, Human, Cardiovascular disease, Vascular disease, Surgery
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 96-0505321
Code Inist : 002B25F. Création : 10/04/1997.