Rs. Rhodes et al., EFFECT OF PATIENT FACTORS ON HOSPITAL COSTS FOR MAJOR BOWEL SURGERY -IMPLICATIONS FOR MANAGED HEALTH-CARE, Surgery, 117(4), 1995, pp. 443-450
Background. We examined the effects of patient factors on hospital res
ource consumption for patients who had undergone major bowel operation
(diagnosis-related groups [DRGs] 148 and 149) at an urban, university
hospital. Methods. We performed cross-sectional analysis of computeri
zed hospital discharge abstracts and charts of 491 consecutive dischar
ges in these DRGs. Total hospital charges and length of stay were depe
ndent variables. Independent variables included admission status, admi
ssion service, previous admissions, payer type, service type, diagnosi
s, reoperation, and death. Results. Patient factors accounted for sign
ificant variability in resource consumption. By univariate analysis al
l of the above variables significantly affected total charges, and all
but service type significantly affected length of stay. By multivaria
te analysis DRGs 148/149 alone explained 4.2% of the variance, whereas
all the variables together increased R(2) to 52.1%. Logistic regressi
on of reoperation and of death as dependent variables suggested that p
atient factors also accounted for significant variance in these outcom
es. Conclusions. Because patient factors may not be directly controlla
ble by hospitals or physicians, differences among hospitals in costs a
nd in ''quality'' may relate more to differences in patient mix than t
o efficiency. DRGs alone are not a sufficient management tool, and add
itional measures are needed to adequately measure both efficiency and
quality.