[Determinants of health care expenses during cardiac rehabilitation].
OBJECTIVE
Diagnosis-related systems (ICD-10, OPS, PCCL) are used in acute medical care as part of the multidisciplinary classification of overall care and related costs. In contrast, such systems, reflecting therapeutic requirements and distinguishing between patients according to the level of effort and costs incurred, are still not available for use in clinical rehabilitation units.


METHODS
215 consecutive patients (aged 63.8 +/- 11.1 years; 68.2% males ) were included in a single-center prospective registry during inpatient cardiac rehabilitation (CR). The following data were included: clinical condition, diagnosis of diseases, length of acute hospitalization and various parameters of physical and psychological state (Karnofsky performance score, Hospital Anxiety and Depression Scale [HADS]). Efforts out of normal care by nurses. doctors and laboratories were measured in minutes and divided into quartiles. Logistic regression models were used to estimate the odds for predictive parameters for patients requiring care and efforts above the highest quartile.


RESULTS
Mean acute in-hospital stay was 14.7 +/- 14.5 days, duration of CR 21.8 +/- 3.5 days. Mean duration of nursing efforts was 221 +/- 170 min, of medical staff efforts 5564 min, of physiotherapy 174 +/- 281 min. In the multivariate model five determinants were significantly associated with increased care provision during CR: duration of hospitalization, diabetes, arterial hypertension, low exercise capacity and anxiety as measured by HADS. Increased laboratory testing was predominantly the result of diabetes mellitus and an increased Karnofsky score.


CONCLUSIONS
Prolonged acute hospitalization, anxiety and diabetes mellitus were associated with increased nursing/medical/phyisiotherapeutic care during CR. These factors should be taken into account in any cost classification system that needs to be developed for use in rehabilitation clinics so as to provide better transparency in cost assessment.
Reibis
R
R
Klinik am See, Kardiologie, Rehabilitationszentrum für Innere Medizin, Berlin.
Völler
H
H
Treszl
A
A
Langheim
E
E
Buhlert
H
H
Wegscheider
K
K
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000191:economics* / Q000534:rehabilitation*; D001008:Anxiety Disorders / Q000191:economics / Q000534:rehabilitation; D015992:Body Mass Index; D003131:Combined Modality Therapy / Q000191:economics / Q000706:statistics & numerical data; D015897:Comorbidity; D001026:Coronary Artery Bypass / Q000191:economics* / Q000534:rehabilitation*; D003327:Coronary Disease / Q000191:economics* / Q000534:rehabilitation*; D003924:Diabetes Mellitus, Type 2 / Q000191:economics / Q000534:rehabilitation; D005260:Female; D005858:Germany; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006333:Heart Failure / Q000191:economics* / Q000534:rehabilitation*; D006349:Heart Valve Diseases / Q000191:economics* / Q000534:rehabilitation*; D019918:Heart Valve Prosthesis Implantation / Q000191:economics* / Q000534:rehabilitation*; D006801:Humans; D006973:Hypertension / Q000191:economics / Q000534:rehabilitation; D007902:Length of Stay / Q000191:economics; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009313:National Health Programs / Q000191:economics* / Q000706:statistics & numerical data; D010348:Patient Care Team / Q000191:economics* / Q000706:statistics & numerical data; D026741:Physical Therapy Modalities / Q000191:economics / Q000706:statistics & numerical data; D012047:Rehabilitation Centers / Q000191:economics / Q000706:statistics & numerical data; D012737:Sex Factors; D014600:Utilization Review / Q000706:statistics & numerical data