| アブストラクト | BACKGROUND: The effect of hospital spending on the mortality rate of patients with sepsis has not yet been fully elucidated. We hypothesized that hospitals that consume more medical resources would have lower mortality rates among patients with sepsis. METHODS: This retrospective study used administrative data from 2010 to 2017. The enrolled hospitals were divided into quartiles based on average daily medical cost per sepsis case. The primary and secondary outcomes were the average in-hospital mortality rate of patients with sepsis and the effective cost per survivor among the enrolled hospitals, respectively. A multiple regression model was used to determine the significance of the differences among hospital categories to adjust for baseline imbalances. RESULTS: Among 997 hospitals enrolled in this study, the crude in-hospital mortality rates were 15.7% and 13.2% in the lowest and highest quartiles of hospital spending, respectively. After adjusting for confounding factors, the highest hospital spending group demonstrated a significantly lower in-hospital mortality rate than the lowest hospital spending group (coefficient = -0.025, 95% confidence interval [CI] -0.034 to -0.015; p < 0.0001). Similarly, the highest hospital spending group was associated with a significantly higher effective cost per survivor than the lowest hospital spending group (coefficient = 77.7, 95% CI 73.1 to 82.3; p < 0.0001). In subgroup analyses, hospitals with a small or medium number of beds demonstrated a consistent pattern with the primary test, whereas those with a large number of beds or academic affiliations displayed no association. CONCLUSIONS: Using a nationwide Japanese medical claims database, this study indicated that hospitals with greater expenditures were associated with a superior survival rate and a higher effective cost per survivor in patients with sepsis than those with lower expenditures. In contrast, no correlations between hospital spending and mortality were observed in hospitals with a large number of beds or academic affiliations. |
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| ジャーナル名 | Heliyon |
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| Pubmed追加日 | 2024/1/4 |
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| 投稿者 | Oami, Takehiko; Abe, Toshikazu; Nakada, Taka-Aki; Imaeda, Taro; Aizimu, Tuerxun; Takahashi, Nozomi; Yamao, Yasuo; Nakagawa, Satoshi; Ogura, Hiroshi; Shime, Nobuaki; Umemura, Yutaka; Matsushima, Asako; Fushimi, Kiyohide |
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| 組織名 | Department of Emergency and Critical Care Medicine, Chiba University Graduate;School of Medicine, Chiba, Japan.;Health Services Research and Development Center, University of Tsukuba, Tsukuba,;Japan.;Department of Emergency and Critical Care Medicine, Tsukuba Memorial Hospital,;Tsukuba, Japan.;Department of Critical Care Medicine, National Center for Child Health and;Development, Tokyo, Japan.;Department of Traumatology and Acute Critical Medicine, Osaka University Graduate;School of Medicine, Osaka, Japan.;Department of Emergency and Critical Care Medicine, Graduate School of Biomedical;and Health Sciences, Hiroshima University, Hiroshima, Japan.;Department of Emergency and Critical Care, Nagoya City University Graduate School;of Medical Sciences, Aichi, Japan.;Department of Health Policy and Informatics, Tokyo Medical and Dental University;Graduate School of Medical and Dental Sciences, Tokyo, Japan. |
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| Pubmed リンク | https://www.ncbi.nlm.nih.gov/pubmed/38170111/ |
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