title: A clinical economics workstation for risk-adjusted health care cost management.
abstract: This paper describes a healthcare cost accounting system which is under development at Duke University Medical Center. Our approach differs from current practice in that this system will dynamically adjust its resource usage estimates to compensate for variations in patient risk levels. This adjustment is made possible by introducing a new cost accounting concept, Risk-Adjusted Quantity (RQ). RQ divides case-level resource usage variances into their risk-based component (resource consumption differences attributable to differences in patient risk levels) and their non-risk-based component (resource consumption differences which cannot be attributed to differences in patient risk levels). Because patient risk level is a factor in estimating resource usage, this system is able to simultaneously address the financial and quality dimensions of case cost management. In effect, cost-effectiveness analysis is incorporated into health care cost management.
authors.affiliation: Division of Medical Informatics, Duke University Medical Center, USA.
authors.forename: E L
authors.initials: EL
authors.lastname: Eisenstein
authors.forename: J W
authors.initials: JW
authors.lastname: Hales
mesh_terms: D000046:Academic Medical Centers; D000066:Accounting; D003363:Cost Control / Q000379:methods; D003365:Costs and Cost Analysis; D003953:Diagnosis-Related Groups; D005377:Financial Management, Hospital / Q000379:methods*; D006785:Hospitals, University / Q000191:economics*; D006801:Humans; D018803:Models, Economic; D009657:North Carolina; D019095:Point-of-Care Systems; D012307:Risk Factors