EFFECT OF CASEMIX FUNDING ON OUTCOMES IN PATIENTS ADMITTED TO HOSPITAL WITH SUSPECTED UNSTABLE ANGINA

Objectives: To determine the effect of the introduction of casemix fun ding on resource utilisation and clinical outcomes in patients admitte d to hospital with suspected unstable angina. Design: A prospective co hort study with a 6-month follow-up. Setting: A suburban community hos pital in Melbourne, Victoria. Patients: 336 consecutive patients admit ted to the coronary care unit with suspected unstable angina before (1 56) and after (180) the introduction of casemix funding. Intervention: Introduction of casemix funding in July 1993. Main outcome measures: indices of resource utilisation: length of stay in hospital, length of stay in the coronary care unit, and total cost of investigations (pat hology and radiology). Rates of serious cardiac events during hospital stay and after discharge. Readmissions within 28 days and 6 months of discharge. Results: After the introduction of casemix funding there w as a 1% increase in duration of hospital stay and a 5% increase in tim e spent in the coronary care unit, but neither of these increases was statistically significant. However, there was a significant reduction in total cost of investigations (39% decrease; 95% confidence interval , 14%-70%; P < 0.001). The rate of serious cardiac events after discha rge did not increase, and neither did readmission rates, either within 28 days or over the 6 months' follow-up. Conclusion: Casemix funding had no effect on short term clinical outcomes but resulted in signific antly reduced investigation costs.