Multiple sclerosis as a comorbidity: a study of resource utilization and outcomes of care.
The purpose of this paper is to compare the resource utilization and outcomes of care of elderly hospitalized patients with multiple sclerosis (MS) as a comorbidity to a comparison group without multiple sclerosis, matched by age, gender, and diagnosis related group (DRG) using the 1989 Quality Care (QC) MEDPAR file. The results of this paper demonstrate some differences in resource use. MS discharges incur lower average charges ($8698 for MS discharges, $8977 for controls), although the results are not statistically significant. Proportionately fewer MS discharges use intensive or coronary care services (14.7% versus 18.5%, P < .05). MS patients had a lower, but not statistically significant, 30-day mortality rate than the comparison group matched by age, sex, and DRG (7.6% versus 8.8%), a lower rate of readmission (13.9% versus 16.7%, P < .05), and a lower rate of complications (2.6% versus 4.7%, P < .05), although the results are not consistent across DRGs. Charges, length of stay, and intensive/coronary care utilization were lower, as expected, for a subset of less comorbid MS discharges and controls with, at most, four diagnoses. In this subset, MS discharges and controls were not statistically different, with the exception of overall complication rates (1.0% for MS versus 4.1% for controls, P < .05) and surgical complication rates (2.1% for MS versus 10.0% for controls, P < .05). It is unclear whether these results are due to differences in disease severity, case-mix within DRG, surgical risk, patient surveillance, or quality of care.
Fleming
S T
ST
Health Services Management, University of Missouri-Columbia 65211, USA.
D000368:Aged; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003625:Data Collection; D003953:Diagnosis-Related Groups / Q000145:classification / Q000706:statistics & numerical data; D017048:Health Care Costs / Q000706:statistics & numerical data; D006761:Hospitals / Q000706:statistics & numerical data*; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data; D006278:Medicare / Q000706:statistics & numerical data; D009103:Multiple Sclerosis / Q000150:complications / Q000191:economics / Q000401:mortality; D010359:Patient Readmission / Q000706:statistics & numerical data; D012189:Retrospective Studies; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D014600:Utilization Review / Q000191:economics / Q000706:statistics & numerical data