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Ren S, Yang L, Du J, He M, Shen B. DRGKB: a knowledgebase of worldwide diagnosis-related groups' practices for comparison, evaluation and knowledge-guided application. Database (Oxford) 2024; 2024:baae046. [PMID: 38843311 PMCID: PMC11155695 DOI: 10.1093/database/baae046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 01/08/2024] [Accepted: 05/15/2024] [Indexed: 06/09/2024]
Abstract
As a prospective payment method, diagnosis-related groups (DRGs)'s implementation has varying effects on different regions and adopt different case classification systems. Our goal is to build a structured public online knowledgebase describing the worldwide practice of DRGs, which includes systematic indicators for DRGs' performance assessment. Therefore, we manually collected the qualified literature from PUBMED and constructed DRGKB website. We divided the evaluation indicators into four categories, including (i) medical service quality; (ii) medical service efficiency; (iii) profitability and sustainability; (iv) case grouping ability. Then we carried out descriptive analysis and comprehensive scoring on outcome measurements performance, improvement strategy and specialty performance. At last, the DRGKB finally contains 297 entries. It was found that DRGs generally have a considerable impact on hospital operations, including average length of stay, medical quality and use of medical resources. At the same time, the current DRGs also have many deficiencies, including insufficient reimbursement rates and the ability to classify complex cases. We analyzed these underperforming parts by domain. In conclusion, this research innovatively constructed a knowledgebase to quantify the practice effects of DRGs, analyzed and visualized the development trends and area performance from a comprehensive perspective. This study provides a data-driven research paradigm for following DRGs-related work along with a proposed DRGs evolution model. Availability and implementation: DRGKB is freely available at http://www.sysbio.org.cn/drgkb/. Database URL: http://www.sysbio.org.cn/drgkb/.
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Affiliation(s)
- Shumin Ren
- Department of Pharmacy and Institutes for Systems Genetics, West China Hospital, Sichuan University, Frontiers Science Center for Disease-Related Molecular Network, Xinchuan Road 2222, Chengdu 610041, China
- Department of Computer Science and Information Technology, University of A Coruña, Faculty of Infomation, Campus of Elvina, A Coruña 15071, Spain
| | - Lin Yang
- Department of Pharmacy and Institutes for Systems Genetics, West China Hospital, Sichuan University, Frontiers Science Center for Disease-Related Molecular Network, Xinchuan Road 2222, Chengdu 610041, China
| | - Jiale Du
- Department of Pharmacy and Institutes for Systems Genetics, West China Hospital, Sichuan University, Frontiers Science Center for Disease-Related Molecular Network, Xinchuan Road 2222, Chengdu 610041, China
| | - Mengqiao He
- Department of Pharmacy and Institutes for Systems Genetics, West China Hospital, Sichuan University, Frontiers Science Center for Disease-Related Molecular Network, Xinchuan Road 2222, Chengdu 610041, China
| | - Bairong Shen
- Department of Pharmacy and Institutes for Systems Genetics, West China Hospital, Sichuan University, Frontiers Science Center for Disease-Related Molecular Network, Xinchuan Road 2222, Chengdu 610041, China
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Yuan B, Quan L. Comprehensive evaluation of disease coding quality in gastroenterology and its impact on the diagnosis-related group system: a cross-sectional study. BMC Health Serv Res 2023; 23:1451. [PMID: 38129876 PMCID: PMC10740297 DOI: 10.1186/s12913-023-10299-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 11/08/2023] [Indexed: 12/23/2023] Open
Abstract
OBJECTIVE According to the diagnosis-related group (DRG) requirement, issues of diagnosis and procedure coding in the gastroenterology department of our hospital were analyzed and improvement plans were proposed to lay the foundation for effective implementation of DRGs. METHODS The title page of case-history of 1600 patients admitted to the Department of Gastroenterology of this hospital from January 1, 2021 to December 31, 2021 was sampled as a data source, and the primary and other diagnostic codes, operation or procedure codes involved in the title page of case-history were categorized and statistically analyzed. RESULTS Of the 531 cases treated with gastrointestinal endoscopy in our hospital in 2021, coding errors were identified in 66 cases and unsuccessful DRG enrollment in 35 cases, including 14 cases with incorrect coding of the primary diagnosis (8 cases with unsuccessful DRG enrollment), 37 cases with incorrect coding of the primary operation (23 cases with unsuccessful DRG enrollment), and 8 cases with incorrect coding of both the primary diagnosis and the primary operation (4 cases with unsuccessful DRG enrollment). Analysis of 66 inpatient cases with coding problems showed a total of 167 deficiencies, including 36 deficiencies in major diagnoses, 84 deficiencies in other diagnoses, and 47 deficiencies in surgery or operation coding. CONCLUSION The accuracy of coding of disease diagnosis and surgical operation is the basis for the smooth implementation of DRGs. The medical staff of this hospital has poor cognition of DRGs coding and fails to recognize the important role of the title page of case-history quality to DRGs system, and their attention to DRGs and knowledge base of disease classification coding should be improved. In addition, the high incidence of coding errors, especially the omission of disease diagnosis, requires increased training of physicians and nurses on clinical knowledge and requirements for DRGs medical records, thereby improving the quality of medical cases and ensuring the accuracy of DRGs information.
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Affiliation(s)
- Baiyang Yuan
- Department of Medical Record Statistics Section, Anhui No.2 Provincial People's Hospital, Hefei, Anhui, China
| | - Lili Quan
- School of Public Health, Anhui Medical College, Hefei, Anhui, China.
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3
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Hodiamont F, Schatz C, Schildmann E, Syunyaeva Z, Hriskova K, Rémi C, Leidl R, Tänzler S, Bausewein C. The impact of the COVID-19 pandemic on processes, resource use and cost in palliative care. BMC Palliat Care 2023; 22:36. [PMID: 37024852 PMCID: PMC10077306 DOI: 10.1186/s12904-023-01151-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 03/24/2023] [Indexed: 04/08/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic impacts on working routines and workload of palliative care (PC) teams but information is lacking how resource use and associated hospital costs for PC changed at patient-level during the pandemic. We aim to describe differences in patient characteristics, care processes and resource use in specialist PC (PC unit and PC advisory team) in a university hospital before and during the first pandemic year. METHODS Retrospective, cross-sectional study using routine data of all patients cared for in a PC unit and a PC advisory team during 10-12/2019 and 10-12/2020. Data included patient characteristics (age, sex, cancer/non-cancer, symptom/problem burden using Integrated Palliative Care Outcome Scale (IPOS)), information on care episode, and labour time calculated in care minutes. Cost calculation with combined top-down bottom-up approach with hospital's cost data from 2019. Descriptive statistics and comparisons between groups using parametric and non-parametric tests. RESULTS Inclusion of 55/76 patient episodes in 2019/2020 from the PC unit and 135/120 episodes from the PC advisory team, respectively. IPOS scores were lower in 2020 (PCU: 2.0 points; PC advisory team: 3.0 points). The number of completed assessments differed considerably between years (PCU: episode beginning 30.9%/54.0% in 2019/2020; PC advisory team: 47.4%/40.0%). Care episodes were by one day shorter in 2020 in the PC advisory team. Only slight non-significant differences were observed regarding total minutes/day and patient (PCU: 150.0/141.1 min., PC advisory team: 54.2/66.9 min.). Staff minutes showed a significant decrease in minutes spent in direct contact with relatives (PCU: 13.9/7.3 min/day in 2019/2020, PC advisory team: 5.0/3.5 min/day). Costs per patient/day decreased significantly in 2020 compared to 2019 on the PCU (1075 Euro/944 Euro for 2019/2020) and increased significantly for the PC advisory team (161 Euro/200 Euro for 2019/2020). Overhead costs accounted for more than two thirds of total costs. Direct patient cost differed only slightly (PCU: 134.7 Euro/131.1 Euro in 2019/2020, PC advisory team: 54.4 Euro/57.3 Euro). CONCLUSIONS The pandemic partially impacted on daily work routines, especially on time spent with relatives and palliative care problem assessments. Care processes and quality of care might vary and have different outcomes during a crisis such as the COVID-19 pandemic. Direct costs per patient/day were comparable, regardless of the pandemic.
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Affiliation(s)
- Farina Hodiamont
- Department of Palliative Medicine, University Hospital, LMU Munich, Munich, Germany.
| | - Caroline Schatz
- Helmholtz Zentrum München, Institute of Health Economics and Health Care Management, Munich, Germany
- Ludwig-Maximilians-Universität München, LMU Munich School of Management, Institute of Health Economics and Health Care Management, Munich, Germany
| | - Eva Schildmann
- Department of Palliative Medicine, University Hospital, LMU Munich, Munich, Germany
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Department of Hematology, Oncology and Cancer Immunology, Oncological Palliative Care & Charité Comprehensive Cancer Center, Berlin, Germany
| | - Zulfiya Syunyaeva
- Charité Universitätsmedizin Berlin, Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine and Cystic Fibrosis Center, Berlin, Germany
| | - Katerina Hriskova
- Department of Palliative Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Constanze Rémi
- Department of Palliative Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Reiner Leidl
- Helmholtz Zentrum München, Institute of Health Economics and Health Care Management, Munich, Germany
- Ludwig-Maximilians-Universität München, LMU Munich School of Management, Institute of Health Economics and Health Care Management, Munich, Germany
| | - Susanne Tänzler
- Department of Palliative Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Claudia Bausewein
- Department of Palliative Medicine, University Hospital, LMU Munich, Munich, Germany
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4
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Perdikouri K, Katharaki M, Kydonaki K, Grammatopoulou E, Baltopoulos G, Katsoulas T. Cost and reimbursement analysis of end-of-life cancer inpatients. The case of the Greek public healthcare sector. J Cancer Policy 2023; 35:100408. [PMID: 36720307 DOI: 10.1016/j.jcpo.2023.100408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 01/24/2023] [Indexed: 01/31/2023]
Abstract
BACKGROUND While hospital-based Palliative Care services are usually covered through the main funding healthcare framework, traditional reimbursement methods have been criticized for their appropriateness. The present study investigates for the first time the case of treating end-of-life cancer patients in a Greek public hospital in terms of cost and reimbursement. METHODS This retrospective observational study used health administrative data of 135 deceased cancer patients who were hospitalized in the end of their lives. Following the cost estimation procedure, which indentified both the individual patient and overhead costs, we compared the relevant billing data and reimbursement requests to the estimated costs. RESULTS The average total cost per patient per day was calculated to be 97 EUR, with equal participation of individual patient's and overhead costs. Length of stay was identified as the main cost driver. Reimbursement was performed either by per-diem fees or by Diagnosis Related Groups' (DRGs), which were correspondingly associated with under or over reimbursement risks. In the case of the combined use of the two available reimbursement alternatives a cross-subsidization phenomenon was described. CONCLUSION Although the cost of end-of-life care proved to be quite low, the national per-diem rate fails to cover it. DRGs designed for acute care needs are rather unsuitable for such sub acute hospitalizations. POLICY SUMMARY There is a concrete need for reconsidering the current reimbursement schemes for this group of patients as part of any national plan concerning the integration and reformation of Palliative Care services. Otherwise, there is a serious danger for public institutions' reluctance to admit them with a serious impact on access and equity of end-of-life cancer care.
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Affiliation(s)
- Kalliopi Perdikouri
- Department of Nursing, National and Kapodistrian University of Athens, 1 A Dilou St., 11527 Athens, Greece.
| | - Maria Katharaki
- School of Health Sciences, Department of Nursing, Frederick University, 7 Y. Frederickou Str., Pallouriotisa, 1036 Nicosia, Cyprus.
| | - Kalliopi Kydonaki
- School of Health and Social Care, Edinburgh Napier University, 9 Sightill Ct, EH114BN Edinburgh, UK.
| | - Eirini Grammatopoulou
- Department of Physiotherapy, University of West Attica, 28 Agiou Spyridonos St., Aigaleo, Athens 12243, Greece.
| | - George Baltopoulos
- Department of Nursing, National and Kapodistrian University of Athens, 1 A Dilou St., 11527 Athens, Greece.
| | - Theodoros Katsoulas
- Department of Nursing, National and Kapodistrian University of Athens, 1 A Dilou St., 11527 Athens, Greece.
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Hodiamont F, Schatz C, Gesell D, Leidl R, Boulesteix AL, Nauck F, Wikert J, Jansky M, Kranz S, Bausewein C. COMPANION: development of a patient-centred complexity and casemix classification for adult palliative care patients based on needs and resource use - a protocol for a cross-sectional multi-centre study. BMC Palliat Care 2022; 21:18. [PMID: 35120502 PMCID: PMC8814797 DOI: 10.1186/s12904-021-00897-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 12/17/2021] [Indexed: 12/03/2022] Open
Abstract
Background A casemix classification based on patients’ needs can serve to better describe the patient group in palliative care and thus help to develop adequate future care structures and enable national benchmarking and quality control. However, in Germany, there is no such an evidence-based system to differentiate the complexity of patients’ needs in palliative care. Therefore, the study aims to develop a patient-oriented, nationally applicable complexity and casemix classification for adult palliative care patients in Germany. Methods COMPANION is a mixed-methods study with data derived from three subprojects. Subproject 1: Prospective, cross-sectional multi-centre study collecting data on patients’ needs which reflect the complexity of the respective patient situation, as well as data on resources that are required to meet these needs in specialist palliative care units, palliative care advisory teams, and specialist palliative home care. Subproject 2: Qualitative study including the development of a literature-based preliminary list of characteristics, expert interviews, and a focus group to develop a taxonomy for specialist palliative care models. Subproject 3: Multi-centre costing study based on resource data from subproject 1 and data of study centres. Data and results from the three subprojects will inform each other and form the basis for the development of the casemix classification. Ultimately, the casemix classification will be developed by applying Classification and Regression Tree (CART) analyses using patient and complexity data from subproject 1 and patient-related cost data from subproject 3. Discussion This is the first multi-centre costing study that integrates the structure and process characteristics of different palliative care settings in Germany with individual patient care. The mixed methods design and variety of included data allow for the development of a casemix classification that reflect on the complexity of the research subject. The consecutive inclusion of all patients cared for in participating study centres within the time of data collection allows for a comprehensive description of palliative care patients and their needs. A limiting factor is that data will be collected at least partly during the COVID-19 pandemic and potential impact of the pandemic on health care and the research topic cannot be excluded. Trial registration German Register for Clinical Studies trial registration number: DRKS00020517.
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Affiliation(s)
- Farina Hodiamont
- Department of Palliative Medicine, LMU University Hospital, Munich, Germany.
| | - Caroline Schatz
- Helmholtz Zentrum München, Institute of Health Economics and Health Care Management, Munich, Germany.,Ludwig-Maximilians-Universität München, LMU Munich School of Management, Institute of Health Economics and Health Care Management, Munich, Germany
| | - Daniela Gesell
- Department of Palliative Medicine, LMU University Hospital, Munich, Germany
| | - Reiner Leidl
- Helmholtz Zentrum München, Institute of Health Economics and Health Care Management, Munich, Germany.,Ludwig-Maximilians-Universität München, LMU Munich School of Management, Institute of Health Economics and Health Care Management, Munich, Germany
| | - Anne-Laure Boulesteix
- Ludwig-Maximilians-Universität München, Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Munich, Germany
| | - Friedemann Nauck
- Clinic for Palliative Medicine, University Medical Center, Göttingen, Germany
| | - Julia Wikert
- Department of Palliative Medicine, LMU University Hospital, Munich, Germany
| | - Maximiliane Jansky
- Clinic for Palliative Medicine, University Medical Center, Göttingen, Germany
| | - Steven Kranz
- German Association for Palliative Medicine, Berlin, Germany
| | - Claudia Bausewein
- Department of Palliative Medicine, LMU University Hospital, Munich, Germany
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6
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Jacobs K, Roman E, Lambert J, Moke L, Scheys L, Kesteloot K, Roodhooft F, Cardoen B. Variability drivers of treatment costs in hospitals: A systematic review. Health Policy 2021; 126:75-86. [PMID: 34969532 DOI: 10.1016/j.healthpol.2021.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 12/08/2021] [Accepted: 12/14/2021] [Indexed: 12/15/2022]
Abstract
OBJECTIVES Studies on variability drivers of treatment costs in hospitals can provide the necessary information for policymakers and healthcare providers seeking to redesign reimbursement schemes and improve the outcomes-over-cost ratio, respectively. This systematic literature review, focusing on the hospital perspective, provides an overview of studies focusing on variability in treatment cost, an outline of their study characteristics and cost drivers, and suggestions on future research methodology. METHODS We adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and Cochrane Handbook for Systematic Reviews of Interventions. We searched PubMED/MEDLINE, Web of Science, EMBASE, Scopus, CINAHL, Science direct, OvidSP and Cochrane library. Two investigators extracted and appraised data for citation until October 2020. RESULTS 90 eligible articles were included. Patient, treatment and disease characteristics and, to a lesser extent, outcome and institutional characteristics were identified as significant variables explaining cost variability. In one-third of the studies, the costing method was classified as unclear due to the limited explanation provided by the authors. CONCLUSION Various patient, treatment and disease characteristics were identified to explain hospital cost variability. The limited transparency on how hospital costs are defined is a remarkable observation for studies wherein cost variability is the main focus. Recommendations relating to variables, costs, and statistical methods to consider when designing and conducting cost variability studies were provided.
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Affiliation(s)
- Karel Jacobs
- KU Leuven, Faculty of Medicine, LIGB (Leuven Institute for Health Policy), Leuven, Belgium; KU Leuven, Faculty of Medicine, IORT (Institute for Orthopaedic Research and Training), Leuven, Belgium; Vlerick Business School, Ghent, Belgium.
| | - Erin Roman
- Vlerick Business School, Ghent, Belgium; KU Leuven, Faculty of Economics and Business, Leuven, Belgium
| | - Jo Lambert
- Ghent University Hospital, department of Dermatology, Ghent, Belgium
| | - Lieven Moke
- KU Leuven, Faculty of Medicine, IORT (Institute for Orthopaedic Research and Training), Leuven, Belgium
| | - Lennart Scheys
- KU Leuven, Faculty of Medicine, IORT (Institute for Orthopaedic Research and Training), Leuven, Belgium
| | - Katrien Kesteloot
- KU Leuven, Faculty of Medicine, LIGB (Leuven Institute for Health Policy), Leuven, Belgium
| | - Filip Roodhooft
- Vlerick Business School, Ghent, Belgium; KU Leuven, Faculty of Economics and Business, Leuven, Belgium
| | - Brecht Cardoen
- Vlerick Business School, Ghent, Belgium; KU Leuven, Faculty of Economics and Business, Leuven, Belgium
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7
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Isenberg SR, Meaney C, May P, Tanuseputro P, Quinn K, Qureshi D, Saunders S, Webber C, Seow H, Downar J, Smith TJ, Husain A, Lawlor PG, Fowler R, Lachance J, McGrail K, Hsu AT. The association between varying levels of palliative care involvement on costs during terminal hospitalizations in Canada from 2012 to 2015. BMC Health Serv Res 2021; 21:331. [PMID: 33849539 PMCID: PMC8045222 DOI: 10.1186/s12913-021-06335-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Accepted: 03/30/2021] [Indexed: 12/11/2022] Open
Abstract
Background Inpatient palliative care is associated with lower inpatient costs; however, this has yet to be studied using a more nuanced, multi-tiered measure of inpatient palliative care and a national population-representative dataset. Using a population-based cohort of Canadians who died in hospital, our objectives were to: describe patients’ receipt of palliative care and active interventions in their terminal hospitalization; and examine the relationship between inpatient palliative care and hospitalization costs. Methods Retrospective cohort study using data from the Discharge Abstract Database in Canada between fiscal years 2012 and 2015. The cohort were Canadian adults (age ≥ 18 years) who died in hospital between April 1st, 2012 and March 31st, 2015 (N = 250,640). The exposure was level of palliative care involvement defined as: medium-high, low, or no palliative care. The main measure was acute care costs calculated using resource intensity weights multiplied by the cost of standard hospital stay, represented in 2014 Canadian dollars (CAD). Descriptive statistics were represented as median (IQR), and n(%). We modelled cost as a function of palliative care using a gamma generalized estimating equation (GEE) model, accounting for clustering by hospital. Results There were 250,640 adults who died in hospital. Mean age was 76 (SD 14), 47% were female. The most common comorbidities were: metastatic cancer (21%), heart failure (21%), and chronic obstructive pulmonary disease (16%). Of the decedents, 95,450 (38%) had no palliative care involvement, 98,849 (38%) received low involvement, and 60,341 (24%) received medium to high involvement. Controlling for age, sex, province and predicted hospital mortality risk at admission, the cost per day of a terminal hospitalization was: $1359 (95% CI 1323: 1397) (no involvement), $1175 (95% CI 1146: 1206) (low involvement), and $744 (95% CI 728: 760) (medium-high involvement). Conclusions Increased involvement of palliative care was associated with lower costs. Future research should explore whether this relationship holds for non-terminal hospitalizations, and whether palliative care in other settings impacts inpatient costs. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06335-1.
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Affiliation(s)
- Sarina R Isenberg
- Bruyère Research Institute, 43 Bruyère St, Office 264J-G, Ottawa, ON, K1N 5C8, Canada. .,Department of Family and Community Medicine, University of Toronto, Toronto, Canada. .,Institute for Health Policy Management and Evaluation, University of Toronto, Toronto, Canada. .,Department of Medicine, University of Ottawa, Ottawa, Canada.
| | - Christopher Meaney
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada
| | - Peter May
- Centre for Health Policy and Management, Trinity College Dublin, Dublin, Ireland.,The Irish Longitudinal study on Ageing (TILDA), Trinity College Dublin, Dublin, Ireland
| | - Peter Tanuseputro
- Bruyère Research Institute, 43 Bruyère St, Office 264J-G, Ottawa, ON, K1N 5C8, Canada.,Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, Canada.,Ottawa Hospital Research Institute, Ottawa, Canada
| | - Kieran Quinn
- Institute for Health Policy Management and Evaluation, University of Toronto, Toronto, Canada.,Department of Medicine, University of Toronto, Toronto, Canada.,Department of Medicine, Division of Internal Medicine, Sinai Health, Toronto, Canada
| | - Danial Qureshi
- Bruyère Research Institute, 43 Bruyère St, Office 264J-G, Ottawa, ON, K1N 5C8, Canada.,Ottawa Hospital Research Institute, Ottawa, Canada
| | | | - Colleen Webber
- Bruyère Research Institute, 43 Bruyère St, Office 264J-G, Ottawa, ON, K1N 5C8, Canada.,Ottawa Hospital Research Institute, Ottawa, Canada
| | - Hsien Seow
- Department of Oncology, McMaster University, Hamilton, Canada
| | - James Downar
- Bruyère Research Institute, 43 Bruyère St, Office 264J-G, Ottawa, ON, K1N 5C8, Canada.,Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, Canada
| | - Thomas J Smith
- Department of Medicine, Johns Hopkins Hospital and Health System, Baltimore, USA.,Department of Oncology, Johns Hopkins Hospital and Health System, Baltimore, USA
| | - Amna Husain
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada.,Temmy Latner Centre for Palliative Care, Sinai Health, Toronto, Canada
| | - Peter G Lawlor
- Bruyère Research Institute, 43 Bruyère St, Office 264J-G, Ottawa, ON, K1N 5C8, Canada.,Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, Canada.,Ottawa Hospital Research Institute, Ottawa, Canada
| | - Rob Fowler
- Institute for Health Policy Management and Evaluation, University of Toronto, Toronto, Canada.,Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada.,Tory Trauma Program, Sunnybrook Hospital, Toronto, Canada
| | - Julie Lachance
- End-of-Life Care Unit, Strategic Policy Branch, Health Canada, Ottawa, Canada
| | - Kimberlyn McGrail
- Centre for Health Services and Policy Research, School of Population and Public Health, The University of British Columbia, Vancouver, Canada
| | - Amy T Hsu
- Bruyère Research Institute, 43 Bruyère St, Office 264J-G, Ottawa, ON, K1N 5C8, Canada.,Ottawa Hospital Research Institute, Ottawa, Canada
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8
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Rozman LM, Campolina AG, Patiño EG, de Soárez PC. Factors Associated with the Costs of Palliative Care: A Retrospective Cost Analysis at a University Cancer Hospital in Brazil. J Palliat Med 2021; 24:1481-1488. [PMID: 33656925 DOI: 10.1089/jpm.2020.0600] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: There have been few studies evaluating the costs of palliative care (PC) in low- and middle-income countries (LMICs), especially for patients with cancer. Objectives: The objective of this study was to identify the sociodemographic and clinical variables that could explain the cost per day of PC for cancer in Brazil. Methods: This was a retrospective cost analysis of PC at a quaternary cancer center in São Paulo, Brazil, between January 2010 and December 2013. Factors influencing the cost per day were assessed with generalized linear models and generalized linear-mixed models in which the random effect was the site of the cancer. Results: The study included 2985 patients. The mean total cost per patient was $12,335 (standard deviation [SD] = 14,602; 95% confidence interval [CI] = 11,803 to 12,851). The mean cost per day per patient was $325.50 (SD = 246.30, 95% CI = 316.60 to 334.30). There were statistically significant differences among cancer sites in terms of the mean cost per day. Multivariate analysis revealed that the drivers of cost per day were Karnofsky performance status, the number of hospital admissions, referral to PC, and place of death. Place of death had the greatest impact on the cost per day; death in a hospital and in hospice care increased the mean cost per day by $1.56 and $1.83, respectively. Conclusion: To allocate resources effectively, PC centers in LMICs should emphasize early enrollment of patients at PC outpatient clinics, to avoid hospital readmission, as well as advance planning of the place of death.
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Affiliation(s)
- Luciana Martins Rozman
- Department of Preventive Medicine, University of São Paulo School of Medicine, São Paulo, Brazil
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9
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Sandgren A, García-Fernández FP, Gutiérrez Sánchez D, Strang P, López-Medina IM. Hospitalised patients with palliative care needs: Spain and Sweden compared. BMJ Support Palliat Care 2020:bmjspcare-2020-002417. [PMID: 33361093 DOI: 10.1136/bmjspcare-2020-002417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 11/23/2020] [Accepted: 11/26/2020] [Indexed: 11/04/2022]
Abstract
OBJECTIVES This study aimed to describe and compare symptoms, care needs and types of diagnoses in hospitalised patients with palliative care needs in Spain and Sweden. METHODS A cross-sectional, population-based study was carried out at two hospitals in both Spain and Sweden. Using a questionnaire, we performed 154 one-day inventories (n=4213) in Spain and 139 in Sweden (n=3356) to register symptoms, care needs and diagnoses. Descriptive analyses were used. RESULTS The proportion of patients with care needs in the two countries differed (Spain 7.7% vs Sweden 12.4%, p<0.001); however, the percentage of patients with cancer and non-cancer patients was similar. The most prevalent symptoms in cancer and non-cancer patients in both countries were deterioration, pain, fatigue and infection. The most common cancer diagnosis in both countries was lung cancer, although it was more common in Spain (p<0.01), whereas prostate cancer was more common among Swedish men (p<0.001). Congestive heart failure (p<0.001) was a predominant non-cancer diagnosis in Sweden, whereas in Spain, the most frequent diagnosis was dementia (p<0.001). Chronic obstructive pulmonary disease was common in both countries, although its frequency was higher in Spain (p<0.05). In total, patients with cancer had higher frequencies of pain (p<0.001) and nausea (p<0.001), whereas non-cancer patients had higher frequencies of deterioration (p<0.001) and infections (p<0.01). CONCLUSIONS The similarities in symptoms among the patients indicate that the main focus in care should be on patient care needs rather than diagnoses. Integrating palliative care in hospitals and increasing healthcare professional competency can result in providing optimal palliative care.
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Affiliation(s)
- Anna Sandgren
- Center for Collaborative Palliative Care, Department of Health and Caring Sciences, Linnaeus University, Växjö, Sweden
| | | | - Daniel Gutiérrez Sánchez
- Nursing and Podiatry, University of Malaga, Malaga, Spain
- Biomedical Research Institute of Málaga, Málaga, Spain
| | - Peter Strang
- Oncology-Pathology, Karolinska Institute, Stockholm, Sweden
- Stockholms Sjukhem Forskning utbildning och utveckling, Stockholm, Sweden
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10
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Jordan RI, Allsop MJ, ElMokhallalati Y, Jackson CE, Edwards HL, Chapman EJ, Deliens L, Bennett MI. Duration of palliative care before death in international routine practice: a systematic review and meta-analysis. BMC Med 2020; 18:368. [PMID: 33239021 PMCID: PMC7690105 DOI: 10.1186/s12916-020-01829-x] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 10/27/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Early provision of palliative care, at least 3-4 months before death, can improve patient quality of life and reduce burdensome treatments and financial costs. However, there is wide variation in the duration of palliative care received before death reported across the research literature. This study aims to determine the duration of time from initiation of palliative care to death for adults receiving palliative care across the international literature. METHODS We conducted a systematic review and meta-analysis that was registered with PROSPERO (CRD42018094718). Six databases were searched for articles published between Jan 1, 2013, and Dec 31, 2018: MEDLINE, Embase, CINAHL, Global Health, Web of Science and The Cochrane Library, as well undertaking citation list searches. Following PRISMA guidelines, articles were screened using inclusion (any study design reporting duration from initiation to death in adults palliative care services) and exclusion (paediatric/non-English language studies, trials influencing the timing of palliative care) criteria. Quality appraisal was completed using Hawker's criteria and the main outcome was the duration of palliative care (median/mean days from initiation to death). RESULTS One hundred sixty-nine studies from 23 countries were included, involving 11,996,479 patients. Prior to death, the median duration from initiation of palliative care to death was 18.9 days (IQR 0.1), weighted by the number of participants. Significant differences between duration were found by disease type (15 days for cancer vs 6 days for non-cancer conditions), service type (19 days for specialist palliative care unit, 20 days for community/home care, and 6 days for general hospital ward) and development index of countries (18.91 days for very high development vs 34 days for all other levels of development). Forty-three per cent of studies were rated as 'good' quality. Limitations include a preponderance of data from high-income countries, with unclear implications for low- and middle-income countries. CONCLUSIONS Duration of palliative care is much shorter than the 3-4 months of input by a multidisciplinary team necessary in order for the full benefits of palliative care to be realised. Furthermore, the findings highlight inequity in access across patient, service and country characteristics. We welcome more consistent terminology and methodology in the assessment of duration of palliative care from all countries, alongside increased reporting from less-developed settings, to inform benchmarking, service evaluation and quality improvement.
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Affiliation(s)
- Roberta I Jordan
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Matthew J Allsop
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK.
| | - Yousuf ElMokhallalati
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Catriona E Jackson
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | - Helen L Edwards
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Emma J Chapman
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Luc Deliens
- End-of-Life Care Research Group, Ghent University, Ghent, Belgium.,Vrije Universiteit Brussel, Brussels, Belgium
| | - Michael I Bennett
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
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11
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Fu PK, Yang MC, Wang CY, Lin SP, Kuo CT, Hsu CY, Tung YC. Early Do-Not-Resuscitate Directives Decrease Invasive Procedures and Health Care Expenses During the Final Hospitalization of Life of COPD Patients. J Pain Symptom Manage 2019; 58:968-976. [PMID: 31404645 DOI: 10.1016/j.jpainsymman.2019.07.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Revised: 07/28/2019] [Accepted: 07/30/2019] [Indexed: 10/26/2022]
Abstract
CONTEXT Nearly 70% of do-not-resuscitate (DNR) directives for chronic obstructive pulmonary disease (COPD) patients are established during their terminal hospitalization. Whether patient use of end-of-life resources differs between early and late establishment of a DNR is unknown. OBJECTIVES The objective of this study was to compare end-of-life resource use between patients according to DNR directive status: no DNR, early DNR (EDNR) (established before terminal hospitalization), and late DNR (LDNR) (established during terminal hospitalization). METHODS Electronic health records from all COPD decedents in a teaching hospital in Taiwan were analyzed retrospectively with respect to medical resource use during the last year of life and medical expenditures during the last hospitalization. Multivariate linear regression analysis was used to determine independent predictors of cost. RESULTS Of the 361 COPD patients enrolled, 318 (88.1%) died with a DNR directive, 31.4% of which were EDNR. COPD decedents with EDNR were less likely to be admitted to intensive care units (12.0%, 55.5%, and 60.5% for EDNR, LDNR, and no DNR, respectively), had lower total medical expenditures, and were less likely to undergo invasive mechanical ventilator support during their terminal hospitalization. The average total medical cost during the last hospitalization was nearly twofold greater for LDNR than for EDNR decedents. Multivariate linear regression analysis revealed that nearly 60% of medical expenses incurred were significantly attributable to no EDNR, younger age, longer length of hospital stay, and more comorbidities. CONCLUSION Although 88% of COPD decedents died with a DNR directive, 70% of these directives were established late. LDNR results in lower quality of care and greater intensive care resource use in end-of-life COPD patients.
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Affiliation(s)
- Pin-Kuei Fu
- Institute of Health Policy and Management, National Taiwan University, Taipei, Taiwan; Department of Critical Care Medicine, Taichung Veterans General Hospital, Taichung, Taiwan; College of Human Science and Social Innovation, Hungkuang University, Taichung, Taiwan; Science College, Tunghai University, Taichung, Taiwan
| | - Ming-Chin Yang
- Institute of Health Policy and Management, National Taiwan University, Taipei, Taiwan
| | - Chen-Yu Wang
- Department of Critical Care Medicine, Taichung Veterans General Hospital, Taichung, Taiwan; Department of Nursing, Hungkuang University, Taichung, Taiwan
| | - Shin-Pin Lin
- Computer & Communications Center, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Chen-Tsung Kuo
- Computer & Communications Center, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Chiann-Yi Hsu
- Biostatistics Task Force, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Yu-Chi Tung
- Institute of Health Policy and Management, National Taiwan University, Taipei, Taiwan.
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12
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Schildmann E, Hodiamont F, Leidl R, Maier BO, Bausewein C. Which Reimbursement System Fits Inpatient Palliative Care? A Qualitative Interview Study on Clinicians' and Financing Experts' Experiences and Views. J Palliat Med 2019; 22:1378-1385. [PMID: 31210558 DOI: 10.1089/jpm.2019.0028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Context: Internationally, a variety of reimbursement systems exists for palliative care (PC). In Germany, PC units (PCUs) may choose between per-diem rates and diagnosis-related groups (DRGs). Both systems are controversially discussed. Objectives: To explore the experiences and views of German PCU clinicians and experts for PCU financing regarding per-diem rates and DRGs as reimbursement systems with a focus on (1) cost coverage, (2) strengths and weaknesses of both financing systems, and (3) options for further development of funding PCUs. Design: Qualitative semistructured interviews with PCU clinicians and experts for PCU financing, analyzed by thematic analysis using the Framework approach. Setting/Subjects/Measurements: Ten clinicians and 13 experts for financing were interviewed June-October 2015 on both reimbursement systems for PCU. Results: Interviewees had divergent experiences with both reimbursement systems regarding cost coverage. A described strength of per-diem rates was the perceived possibility of individual care without direct financial pressure. The nationwide variation of per-diem rates and the lack of quality standards were named as weaknesses. DRGs were criticized for incentives perceived as perverse and inadequate representation of PC-specific procedures. However, the quality standards for PCUs required within the German DRG system were described as important strength. Suggestions for improvement of the funding system pointed toward a combination of per-diem rates with a grading according to disease severity/complexity of care. Conclusions: Expert opinions suggest that neither current DRGs nor per-diem rates are ideal for funding of PCUs. Suggested improvements regarding adequate funding of PCUs resemble and supplement international developments.
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Affiliation(s)
- Eva Schildmann
- Department of Palliative Medicine, University Hospital, Ludwig-Maximilians-Universitaet (LMU) Munich, Munich, Germany
| | - Farina Hodiamont
- Department of Palliative Medicine, University Hospital, Ludwig-Maximilians-Universitaet (LMU) Munich, Munich, Germany
| | - Reiner Leidl
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum Munich-German Research Center for Environmental Health, Munich, Germany.,Munich School of Management, Institute of Health Economics and Health Care Management, Munich Center of Health Sciences, Ludwig-Maximilians-Universitaet (LMU) Munich, Munich, Germany
| | - Bernd Oliver Maier
- Department for Palliative Medicine and Interdisciplinary Oncology, St. Josef-Hospital, Wiesbaden, Germany
| | - Claudia Bausewein
- Department of Palliative Medicine, University Hospital, Ludwig-Maximilians-Universitaet (LMU) Munich, Munich, Germany
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Becker C, Leidl R, Schildmann E, Hodiamont F, Bausewein C. A pilot study on patient-related costs and factors associated with the cost of specialist palliative care in the hospital: first steps towards a patient classification system in Germany. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2018; 16:35. [PMID: 30349423 PMCID: PMC6192371 DOI: 10.1186/s12962-018-0154-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Accepted: 10/09/2018] [Indexed: 11/25/2022] Open
Abstract
Background Specialist palliative care in the hospital addresses a heterogeneous patient population with complex care needs. In Germany, palliative care patients are classified based on their primary diagnosis to determine reimbursement despite findings that other factors describe patient needs better. To facilitate adequate resource allocation in this setting, in Australia and in the UK important steps have been undertaken towards identifying drivers of palliative care resource use and classifying patients accordingly. We aimed to pioneer patient classification based on determinants of resource use relevant to specialist palliative care in Germany first, by calculating the patient-level cost of specialist palliative care from the hospital’s perspective, based on the recorded resource use and, subsequently, by analysing influencing factors. Methods Cross-sectional study of consecutive patients who had an episode of specialist palliative care in Munich University Hospital between 20 June and 4 August, 2016. To accurately reflect personnel intensity of specialist palliative care, aside from administrative data, we recorded actual use of all involved health professionals’ labour time at patient level. Factors influencing episode costs were assessed using generalized linear regression and LASSO variable selection. Results The study included 144 patients. Mean costs of specialist palliative care per palliative care unit episode were 6542€ (median: 5789€, SE: 715€) and 823€ (median: 702€, SE: 31€) per consultation episode. Based on multivariate models that considered both variables recorded at beginning and at the end of episode, we identified factors explaining episode cost including phase of illness, Karnofsky performance score, and type of discharge. Conclusions This study is an important step towards patient classification in specialist palliative care in Germany as it provides a feasible patient-level costing method and identifies possible starting points for classification. Application to a larger sample will allow for meaningful classification of palliative patients.
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Affiliation(s)
- Christian Becker
- 1Institute of Health Economics and Health Care Management, Helmholtz Zentrum München-German Research Center for Environmental Health, Ingolstädter Landstraße 1, 85758 Neuherberg, Germany.,2Munich School of Management, Institute of Health Economics and Health Care Management & Munich Centre of Health Sciences, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Reiner Leidl
- 1Institute of Health Economics and Health Care Management, Helmholtz Zentrum München-German Research Center for Environmental Health, Ingolstädter Landstraße 1, 85758 Neuherberg, Germany.,2Munich School of Management, Institute of Health Economics and Health Care Management & Munich Centre of Health Sciences, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Eva Schildmann
- Department of Palliative Medicine, University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Farina Hodiamont
- Department of Palliative Medicine, University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Claudia Bausewein
- Department of Palliative Medicine, University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
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