title: Estimating the Cost of Care for Emergency Department Syncope Patients: Comparison of Three Models.
abstract: BACKGROUND
  We sought to compare three hospital cost-estimation models for patients undergoing evaluation for unexplained syncope using hospital cost data. Developing such a model would allow researchers to assess the value of novel clinical algorithms for syncope management.
  
  
  METHODS
  We collected complete health services data, including disposition, testing, and length of stay (LOS), on 67 adult patients (age 60 years and older) who presented to the emergency department (ED) with syncope at a single hospital. Patients were excluded if a serious medical condition was identified. We created three hospital cost-estimation models to estimate facility costs: V1, unadjusted Medicare payments for observation and/or hospital admission; V2: modified Medicare payment, prorated by LOS in calendar days; and V3: modified Medicare payment, prorated by LOS in hours. Total hospital costs included unadjusted Medicare payments for diagnostic testing and estimated facility costs. We plotted these estimates against actual cost data from the hospital finance department, and performed correlation and regression analyses.
  
  
  RESULTS
  Of the three models, V3 consistently outperformed the others with regard to correlation and goodness of fit. The Pearson correlation coefficient for V3 was 0.88 (95% confidence interval [CI] 0.81, 0.92) with an R-square value of 0.77 and a linear regression coefficient of 0.87 (95% CI 0.76, 0.99).
  
  
  CONCLUSIONS
  Using basic health services data, it is possible to accurately estimate hospital costs for older adults undergoing a hospital-based evaluation for unexplained syncope. This methodology could help assess the potential economic impact of implementing novel clinical algorithms for ED syncope.
authors.affiliation: Icahn School of Medicine at Mount Sinai, Department of Emergency Medicine, New York, New York.
authors.forename: Marc A
authors.initials: MA
authors.lastname: Probst
authors.affiliation: Oregon Heath & Science University, Center for Health Systems Effectiveness, Department of Emergency Medicine, Portland, Oregon.
authors.forename: John K
authors.initials: JK
authors.lastname: McConnell
authors.affiliation: University of California, Los Angeles, Department of Biostatistics, Los Angeles, California.
authors.forename: Robert E
authors.initials: RE
authors.lastname: Weiss
authors.affiliation: Oregon Heath & Science University, Center for Policy and Research in Emergency Medicine, Portland, Oregon.
authors.forename: Amber L
authors.initials: AL
authors.lastname: Laurie
authors.affiliation: Oregon Heath & Science University, Center for Policy and Research in Emergency Medicine, Portland, Oregon.
authors.forename: Annick N
authors.initials: AN
authors.lastname: Yagapen
authors.affiliation: Icahn School of Medicine at Mount Sinai, Department of Emergency Medicine, New York, New York.
authors.forename: Michelle P
authors.initials: MP
authors.lastname: Lin
authors.affiliation: The Ohio State University Wexner Medical Center, Department of Emergency Medicine, Columbus, Ohio.
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Caterino
authors.affiliation: University of Wisconsin, Madison, Department of Emergency Medicine, Madison, Wisconsin.
authors.forename: Manish N
authors.initials: MN
authors.lastname: Shah
authors.affiliation: Oregon Heath & Science University, Center for Policy and Research in Emergency Medicine, Portland, Oregon.
authors.forename: Benjamin C
authors.initials: BC
authors.lastname: Sun
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D004636:Emergency Service, Hospital / Q000191:economics*; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D018803:Models, Economic; D010343:Patient Admission / Q000191:economics; D011446:Prospective Studies; D058996:Quality Improvement / Q000191:economics; D013575:Syncope / Q000175:diagnosis / Q000191:economics* / Q000628:therapy*; D014481:United States