Method of medicare reimbursement and the rate of potentially ineffective care of critically III patients.
Context. - The worst outcome of critical care may not be death itself ; rather, the worst may be an extended death process in which a patient's and his or her family's suffering has been prolonged by services that are ultimately impotent.
We have previously used potentially ineffective care (PIC) as a proxy measure for this type of care.
- To determine if PIC is delivered less often to Medicare patients enrolled in health maintenance organizations (HMOs) than those in traditional fee-for-service health plans.
- All Medicare patients hospitalized in intensive care units in California during fiscal year 1994.
- Potentially ineffective care was defined as the concurrence of in-hospital death or death within 100 days of hospital discharge and resource use (total hospital costs) above the 90th percentile.
- Hospital costs were adjusted for institution-specific cost-to-charge ratios and local wage indices derived from Health Care Financing Administration cost reports.
A multivariate regression model adjusted PIC rates for age, sex, race, elective admission to the hospital, Charlson index diseases, the 15 most common diagnosis related groups for death by 100 days, intensive care unit size, and number of residents at the hospital.
- A total of 3914 (4.8%) of 81 494 patients experienced PIC and used 21.6% of total intensive care unit resources.
The occurrence of PIC was less common among HMO members.
(adjusted odds ratio, 0. (...)
Mots-clés Pascal : Soin intensif, Etude comparative, Tarification, Inefficacité, Soin palliatif, Coût, Critère sélection, Evaluation, Homme, Relation médecin malade, Réanimation, Organisation santé, Economie santé
Mots-clés Pascal anglais : Intensive care, Comparative study, Tariffication, Inefficiency, Palliative care, Costs, Selection criterion, Evaluation, Human, Physician patient relation, Resuscitation, Public health organization, Health economy
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 97-0505800
Code Inist : 002B30A04C. Création : 13/02/1998.