Case mix, costs, and outcomes — differences between faculty and community services in a university hospital
Fuchs, Victor R.
Silverman, James F.
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CitationGarber, Alan M., Victor R. Fuchs, and James F. Silverman. 1984. Case mix, costs, and outcomes — differences between faculty and community services in a university hospital. New England Journal of Medicine 310, 19:1231-1237.
AbstractTo gain insight into the possible consequences of prospective payment for university hospitals, we studied 2025 admissions to the faculty and community services of a university hospital, measuring differences in case mix, costs, and mortality in the hospital. The faculty service had more of the patients with costly diagnoses, but even after adjustment for diagnosis-related groups (DRGs), costs were 11 per cent higher on the faculty service (95 per cent confidence limits, 4 to 18 per cent). The percentage differential was greatest for diagnostic costs. The differential was particularly large — 70 per cent (95 per cent confidence limits, 33 to 107 per cent) — for patients with a predicted probability of death of 0.25 or greater.
The in-hospital mortality rate was significantly lower on the faculty service after adjustment for case mix and patient characteristics (P<0.05); the difference was particularly large for patients in the high-death-risk category. Comparision of a matched sample of 51 pairs of admissions from the high-death-risk category confirmed the above results with respect to costs and in-hospital mortality, but follow-up revealed that the survival rates were equal for the two services at nine months after discharge.
The effect of prospective payment on the cost of care will be closely watched; we conclude that it will also be important to monitor the effect on outcomes, including hospital mortality rates.
Citable link to this pagehttp://nrs.harvard.edu/urn-3:HUL.InstRepos:11642548
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