August 1988

Hospital Costs, Resource Characteristics, and the Dynamics of Death for Patients With Hypertension

Author Affiliations

From the Departments of Medicine (Dr Chalfin) and Surgery (Drs Muñoz, Birnbaum, Cohen, and Wise and Mr Goldstein), Long Island Jewish Medical Center, New Hyde Park, NY; and the Department of Surgery, State University of New York (SUNY), Stony Brook, NY (Drs Muñoz, Cohen, and Wise).

Arch Intern Med. 1988;148(8):1729-1732. doi:10.1001/archinte.1988.00380080033011

• A great deal of interest has begun to focus on outcome data for hospitals. We analyzed hospital resource consumption for 4289 patients with hypertension by outcome (ie, survivors vs mortalities). The 211 mortalities had a much greater intensity of hospital resource utilization and a substantial financial risk under diagnosis related group (DRG) pricing schemes compared with the 4078 survivors. Only mortalities within one week of admission to the hospital were profitable under DRGs. A long hospital length of stay (LOS) for mortalities was very unprofitable (mortalities with >60-day LOS generated a $40 673 loss per patient). Patients admitted under emergency conditions who died tended to have a shorter hospital LOS and less financial risk under DRGs compared with those who were not emergency admissions and died. Mortalities referred from other clinical services tended to have greater resource utilization and financial risk under DRGs compared with nonreferred mortalities. These data suggest notable inequities in the DRG prospective payment system vis-à-vis patients who died with hypertension. They also demonstrated variables predictive of greater hospital resource utilization for patients who died with hypertension, including longer hospital LOS, nonemergency admission, and referral from another clinical service.

(Arch Intern Med 1988;148:1729-1732)