title: [Analysis of the medical management and the economic impact of patients who have represented extreme costs at a university hospital].
abstract: Treatment costs for some patients are extremely high and might let think that medical care could have been inadequate. As hospital financing systems move towards reimbursement by diagnostic groups, it is essential to assess whether inadequate care is provided, to try to identify these patients upon admission, and make sure that their outcome is good. For the years 1995 and 1997, treatment costs exceeding by 6 standard deviations the average cost of their APDRG category were identified, and the charts of the 50 patients with the highest variable costs were analyzed. The total number of patients with such extreme costs diminished from 391 in 1995 to 328 in 1997 (-16%). For the 50 most expensive patients, long stays in several services were frequent, but 90% of these patients left the hospital alive, and about half directly to their home. They presented an important variation in diagnoses and operations, but no evidence for inadequate care. Thus, patients qualified as extreme from an economic perspective cannot be qualified as such from a medical perspective, and their outcome is good. To face the pressure linked with the change in financing system, hospitals must develop an internal review system for assessing the adequacy of care, based on clinical characteristics, if they want to guarantee good quality of care and identify potentially inadequate practice.
authors.affiliation: CHUV, 1011 Lausanne. wkamm@bluewin.ch
authors.forename: Willy
authors.initials: W
authors.lastname: Kamm
authors.forename: Jean-Blaise
authors.initials: JB
authors.lastname: Wasserfallen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D017721:Hospital Costs; D006785:Hospitals, University / Q000191:economics* / Q000592:standards*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011785:Quality Assurance, Health Care; D013557:Switzerland