Activity and analysis of costs in a dedicated weaning centre.
OBJECTIVE
To analyse the diagnosis-related characteristics and the costs of treating patients with difficult/prolonged weaning from mechanical ventilation we have undertaken a retrospective observational study.


METHODS
The study has considered all the patients admitted to our weaning unit of a regional Rehabilitation department during 3 consecutive periods since the opening date. Characteristics of the admitted patients and the DRG-related cares delivered have been recorded. A cost analysis has been obtained over time.


RESULTS
The number of beds allocated to this unit (from 4 in the 1st period to 6 in the 2nd and 3rd periods) and the number of patients cared for (from 32 to 43 and to 65, respectively) increased over time. In particular, the COPD to non-COPD patient ratio (from 2.2 to 1.3 and to 1.0) and the DRG/patient weight (from 3.0 +/- 0.3 to 3.1 +/- 0.2 and to 3.3 +/- 0.2 point) changed significantly (p < 0.05). The daily reimbursement per patient from the public health care system only slightly increased, whereas the operating margin (reimbursement less costs) per patient significantly improved (from -304, to +17 and +55 Euro/pt/day, respectively, p < 0.05) due to a gradual restriction in the variable costs. Length of stay, mortality rate and weaning rate did not change over time.


CONCLUSIONS
The weaning centre is a hospital area where economic burdens should be carefully evaluated. Given the actual reimbursement received on a national level for these patients, variable costs might be better spread, thus optimising the burdens without losing out on clinical outcomes.
Institute of Respiratory Diseases, University of Modena-Reggio Emilia, Pavullo, MO, Italy. enrico.clini@unimore.it
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D015331:Cohort Studies; D003365:Costs and Cost Analysis; D006801:Humans; D007558:Italy; D007902:Length of Stay / Q000191:economics; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications / Q000191:economics / Q000628:therapy; D012051:Reimbursement Mechanisms / Q000191:economics; D012124:Respiratory Care Units / Q000191:economics*; D012189:Retrospective Studies; D015300:Ventilator Weaning / Q000191:economics*