Methods to estimate and analyze medical care resource use - An example from liver transplantation

This paper describes a method to construct a standardized health care resou rce use database, Billing and clinical data were analyzed for 916 patients who received liver transplantations at three medical centers over a 4-year period. Data were checked for completeness by assessing whether each patien t's bill included charges covering specified dates and for specific service s, and for accuracy by comparing a sample of bills to medical records. Deta iled services were matched to a standardized service list from one of the c enters, and a single price list was applied. For certain services, clinical data were used to estimate service use or, if a match was not possible, ad justed charges for the services were used, Twenty-three patients were elimi nated from the database because of incomplete resource use data. There was very good correspondence between bills and medical records, except for bloo d products. Direct matches to the standardized service list accounted for 6 9.3% of services overall; 9.4% of services could not be matched to the stan dardized service list acid were thus adjusted for center and/or time period . Clinical data were used to estimate resource use for blood products, oper ating room time, and medications; these estimations accounted for 21.3% of services overall. A database can be constructed that allows comparison of s tandardized resource use and avoids biases due to accounting, geographic, o r temporal factors, Clinical data are essential for the creation of such a database. The methods described are particularly useful in studies of the c ost-effectiveness of medical technologies.