科研之友
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摘要
Aims The UK National Health Service in England pays for inpatients using a formula ('tariff'). The appropriateness of the tariff for people with diabetes is unknown. We have compared the tariff paid and costs for inpatients with/without diabetes and tested the concept of a 'diabetes-attributable hospitalization cost'.
Methods This was a cross-sectional, retrospective 12-month audit in a single teaching hospital assessing mortality, bed days per annum and 'diabetes-attributable hospitalization cost' (i.e. the proportion of costs for all patients with diabetes in excess of that paid for comparable patients without diabetes).
Results There were 64 82(inpatient admissions, with 4864 of those coded as having diabetes; 12.9% was estimated to be the number of patients having diabetes but not coded. People with diabetes occupied 13.9% of all bed days and were 18.1% (1.3-37.8%) more likely to die (age adjusted). The mean bed days per annum were greatest among those with (vs. without) diabetes (men 10.9 +/- 17.0 vs. 6.3 +/- 12.8; women 11.4 +/- 19.4 vs. 5.9 +/- 11.6; P < 0.001). The greatest excess admission rates were among those aged 25-64 years. The annual mean tariff was greater for those with diabetes (5380 pound +/- 8740) than thosewithout diabetes (3706 pound +/- 6221) (P < 0.001). The overall cost was even higher among those with diabetes: 5835 pound +/- 11 246 vs. 3567 pound +/- 7238 (P < 0.001). The diabetes-attributable hospitalization cost was 46.5% (9 pound 125 085). An HbA(1c) > 10.0% (> 86 mmol/mol) was associated with excess hospitalization.
Conclusions Those with diabetes cost more and are more likely to die when inpatients. The tariff paid for diabetes is high, but in this centre less than the actual costs. Approaches known to reduce hospitalization are urgently required.
- 出版日期2011-9
