- 期刊
Retrospective Cost Estimation on the Use of the American Thoracic Society (ATS) Guidelines for Elder Inpatients with Pneumonia of Unspecified Pathogen - a Pilot Experience in Taiwan
依照美國胸腔學會(ATS)治療準則處理老年非特定病原肺炎之回溯性成本估計－台灣之初步經驗
摘要
Community acquired pneumonia (CAP；pneumonia, organism unspecified) has become highly prevalent in the elderly population which is associated with substantial morbidity and mortality. Several CAP management guidelines have been proposed, and most of the focus has been placed on American Thoracic Society (ATS) CAP guidelines in 1993. The practicality, validity and influence of the guidelines on elderly patients have not been evaluated systemically in Taiwan. Cost-containment handling has been an important goal for hospital administrators and practitioners as well as for health insurance organizations. We have performed a retrospective estimation by assessing the cost under certain aspects linked with the therapeutic intervention of ATS guidelines. This estimation compares the outcomes (such as the patients' length of stay, drug expense, antibiotics expense, number of antibiotics used, total expense, and the daily cost incurred during the hospitalization) of 64 elder inpatients receiving the diagnosis of pneumonia of unknown pathogen (Coded 486 in ICD-9-CM) from one medical center in Taiwan during 1996, whose anti-microbial therapy was either consistent or inconsistent with this very set of guidelines. The results showed, patients whose therapeutic management was consistent with the ATS guidelines had a shorter length of stay (LOS) (13.5 days v.s. 24.1 days, p=.002), cheaper total drug cost (US$823.8 v.s. US$1,901.3, p＜.0001), less antibiotics cost (US$363.10 v.s. US$875.96, p＜.005), and fewer number of parenteral antibiotics (1.19 v.s. 2.56, p=.0001). Notwithstanding, their total hospital expense, and daily cost did not appear to be more favorable (p＞.05; NS). Results suggest that therapeutic intervention of ATS guidelines for treating elder inpatients with pneumonia of unspecified pathogen brings about lower health care expenditure only under certain aspects. In addition to providing the basis for further investigation, this study can also partially offer an important empirical trial for the guidelines as a reasonable and feasible basis in our intervention/treatment for elderly CAP. Moreover, our research findings may become an enlightening reference for clinical practice as well as the reimbursement scheme of National Health Insurance Program in Taiwan.
並列摘要
Community acquired pneumonia (CAP；pneumonia, organism unspecified) has become highly prevalent in the elderly population which is associated with substantial morbidity and mortality. Several CAP management guidelines have been proposed, and most of the focus has been placed on American Thoracic Society (ATS) CAP guidelines in 1993. The practicality, validity and influence of the guidelines on elderly patients have not been evaluated systemically in Taiwan. Cost-containment handling has been an important goal for hospital administrators and practitioners as well as for health insurance organizations. We have performed a retrospective estimation by assessing the cost under certain aspects linked with the therapeutic intervention of ATS guidelines. This estimation compares the outcomes (such as the patients' length of stay, drug expense, antibiotics expense, number of antibiotics used, total expense, and the daily cost incurred during the hospitalization) of 64 elder inpatients receiving the diagnosis of pneumonia of unknown pathogen (Coded 486 in ICD-9-CM) from one medical center in Taiwan during 1996, whose anti-microbial therapy was either consistent or inconsistent with this very set of guidelines. The results showed, patients whose therapeutic management was consistent with the ATS guidelines had a shorter length of stay (LOS) (13.5 days v.s. 24.1 days, p=.002), cheaper total drug cost (US$823.8 v.s. US$1,901.3, p＜.0001), less antibiotics cost (US$363.10 v.s. US$875.96, p＜.005), and fewer number of parenteral antibiotics (1.19 v.s. 2.56, p=.0001). Notwithstanding, their total hospital expense, and daily cost did not appear to be more favorable (p＞.05; NS). Results suggest that therapeutic intervention of ATS guidelines for treating elder inpatients with pneumonia of unspecified pathogen brings about lower health care expenditure only under certain aspects. In addition to providing the basis for further investigation, this study can also partially offer an important empirical trial for the guidelines as a reasonable and feasible basis in our intervention/treatment for elderly CAP. Moreover, our research findings may become an enlightening reference for clinical practice as well as the reimbursement scheme of National Health Insurance Program in Taiwan.