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Spending more, doing more, or both? An alternative method for quantifying utilization during hospitalizations.

ABSTRACT: Because relative value unit (RVU)-based costs vary across hospitals, it is difficult to use them to compare hospital utilization.To compare estimates of hospital utilization using RVU-based costs and standardized costs.Retrospective cohort.Years 2009 to 2010 heart failure hospitalizations in a large, detailed hospital billing database that contains an itemized log of costs incurred during hospitalization.We assigned every item in the database with a standardized cost that was consistent for that item across all hospitals.Standardized costs of hospitalization versus RVU-based costs of hospitalization.We identified 234 hospitals with 165,647 heart failure hospitalizations. We observed variation in the RVU-based cost for a uniform "basket of goods" (10th percentile cost $1,552; 90th percentile cost of $3,967). The interquartile ratio (Q75/Q25) of the RVU-based costs of a hospitalization was 1.35 but fell to 1.26 after costs were standardized, suggesting that the use of standardized costs can reduce the "noise" due to differences in overhead and other fixed costs. Forty-six (20%) hospitals had reported costs of hospitalizations exceeding standardized costs (indicating that reported costs inflated apparent utilization); 42 hospitals (17%) had reported costs that were less than standardized costs (indicating that reported costs underestimated utilization).Standardized costs are a novel method for comparing utilization across hospitals and reduce variation observed with RVU-based costs. They have the potential to help hospitals understand how they use resources compared to their peers and will facilitate research comparing the effectiveness of higher and lower utilization.

SUBMITTER: Lagu T

PROVIDER: S-EPMC4014449 | biostudies-literature | 2013 Jul

REPOSITORIES: biostudies-literature

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Spending more, doing more, or both? An alternative method for quantifying utilization during hospitalizations.

Lagu Tara T Krumholz Harlan M HM Dharmarajan Kumar K Partovian Chohreh C Kim Nancy N Mody Purav S PS Li Shu-Xia SX Strait Kelly M KM Lindenauer Peter K PK

Journal of hospital medicine 20130612 7

<h4>Background</h4>Because relative value unit (RVU)-based costs vary across hospitals, it is difficult to use them to compare hospital utilization.<h4>Objective</h4>To compare estimates of hospital utilization using RVU-based costs and standardized costs.<h4>Design</h4>Retrospective cohort.<h4>Setting and patients</h4>Years 2009 to 2010 heart failure hospitalizations in a large, detailed hospital billing database that contains an itemized log of costs incurred during hospitalization.<h4>Interve ...[more]

PMID: 23757115

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Project description:BackgroundAlthough antipsychotics are used for treatment of delirium/agitation in hospitalized patients, their scope of use has not been investigated in a large, multicenter cohort.ObjectiveTo determine rates of use and hospital variation in use of antipsychotics in nonpsychiatric admissions.Design, setting, patientsCohort study of adult, nonpsychiatric admissions to 300 US hospitals contributing data to the Premier database, from July 1, 2009 to June 30, 2010.MeasurementsAntipsychotic exposure defined using pharmacy charges. Potentially excessive dosing defined using guidelines for long-term care facilities.ResultsOur cohort included 2,695,081 admissions (median age, 63 years; 56% female). Antipsychotic exposure occurred in 160,773 (6%) admissions; 102,148 (64%) received atypical antipsychotics, 76,979 (48%) received typical, and 18,354 (11%) received both. Among exposed admissions, 47% received ≥1 potentially excessive daily dose. Among the variables we analyzed, the strongest predictors of antipsychotic receipt were delirium (relative risk [RR]: 2.93, 95% CI: 2.88-2.98) and dementia (RR: 2.78, 95% CI: 2.72-2.83). After adjustment for patient characteristics, patients admitted to hospitals in the highest antipsychotic prescribing quintile were more than twice as likely to be exposed compared to patients admitted to hospitals in the lowest prescribing quintile (RR: 2.56, 95% CI: 2.50-2.61). This relationship was similar across subgroups of admissions with delirium and dementia.ConclusionsAntipsychotic medication exposure is common in nonpsychiatric admissions to US hospitals. The observed variation in antipsychotic prescribing was not fully explained by measured patient characteristics, suggesting the possibility of differing hospital prescribing cultures. Additional research and guidelines are necessary to define appropriate use of these potentially harmful medications in the hospital setting. Journal of Hospital Medicine 2016;11:543-549. © 2016 Society of Hospital Medicine.

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Spending more, doing more, or both? An alternative method for quantifying utilization during hospitalizations.

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Spending more, doing more, or both? An alternative method for quantifying utilization during hospitalizations.

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