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Type: Journal article
Title: Cost calculation and prediction in adult intensive care: A ground-up utilization study
Author: Moran, J.
Peisach, A.
Solomon, P.
Martin, J.
Citation: Anaesthesia and Intensive Care, 2004; 32(6):787-797
Publisher: Australian Soc Anaesthetists
Issue Date: 2004
ISSN: 0310-057X
Statement of
J. L. Moran, A. R. Peisach, P. J. Solomon, J. Martin
Abstract: The ability of various proxy cost measures, including therapeutic activity scores (TISS and Omega) and cumulative daily severity of illness scores, to predict individual ICU patient costs was assessed in a prospective “ground-up” utilization costing study over a six month period in 1991. Daily activity (TISS and Omega scores) and utilization in consecutive admissions to three adult university associated ICUs was recorded by dedicated data collectors. Cost prediction used linear regression with determination (80%) and validation (20%) data sets. The cohort, 1333 patients, had a mean (SD) age 57.5 (19.4) years, (41% female) and admission APACHE III score of 58 (27). ICU length of stay and mortality were 3.9 (6.1) days and 17.6% respectively. Mean total TISS and Omega scores were 117 (157) and 72 (113) respectively. Mean patient costs per ICU episode (1991 $AUS) were $6801 ($10311), with median costs of $2534, range $106 to $95,602. Dominant cost fractions were nursing 43.3% and overheads 16.9%. Inflation adjusted year 2002 (mean) costs were $9343 ($ AUS). Total costs in survivors were predicted by Omega score, summed APACHE III score and ICU length of stay; determination R2, 0.91; validation 0.88. Omega was the preferred activity score. Without the Omega score, predictors were age, summed APACHE III score and ICU length of stay; determination R2, 0.73; validation 0.73. In non-survivors, predictors were age and ICU length of stay (plus interaction), and Omega score (determination R2, 0.97; validation 0.91). Patient costs may be predicted by a combination of ICU activity indices and severity scores.
Keywords: Humans; Critical Illness; Critical Care; Length of Stay; Patient Admission; APACHE; Severity of Illness Index; Hospital Mortality; Probability; Risk Assessment; Survival Analysis; Cohort Studies; Predictive Value of Tests; Adult; Aged; Middle Aged; Intensive Care Units; Cost Savings; Hospital Costs; Hospital Charges; Utilization Review; Female; Male
Description: Publisher's copy made available with the permission of the publisher
Rights: © Australian Society of Anaesthetists
RMID: 0020041894
DOI: 10.1177/0310057x0403200610
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Appears in Collections:Applied Mathematics publications
Anaesthesia and Intensive Care publications

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