The impact of goals-of-care programs on acute hospitalization costs is unclear. We compared the hospitalization cost in an 8-month period before implementation of a multimodal interdisciplinary goals-of-care program (1 May 2019 to 31 December 2019) to an 8-month period after program implementation (1 May 2020 to 31 December 2020). Propensity score weighting was used to adjust for differences in potential covariates. The primary outcome was total direct cost during the hospital stay for each index hospitalization. This analysis included 6977 patients in 2019 and 5964 patients in 2020. The total direct cost decreased by 3% in 2020 but was not statistically significant (ratio 0.97, 95% CI 0.92, 1.03). Under individual categories, there was a significant decrease in medical oncology (ratio 0.58, 95% CI 0.50, 0.68) and pharmacy costs (ratio 0.86, 95% CI 0.79, 0.96), and an increase in room and board (ratio 1.06, 95% CI 1.01, 1.10). In subgroup analysis, ICU patients had a significant reduction in total direct cost after program implementation (ratio 0.83, 95% CI 0.72, 0.94). After accounting for the length of ICU admission, we found that the total direct cost per hospital day was no longer different between 2019 and 2020 (ratio 0.986, 95% CI 0.92, 1.05), suggesting that shorter ICU admissions likely explained much of the observed cost savings. This study provides real-world data on how “in-the-moment” GOC conversations may contribute to reduced hospitalization costs among ICU patients.
照护目标计划对急性住院费用的影响尚不明确。本研究比较了多模式跨学科照护目标计划实施前8个月（2019年5月1日至12月31日）与实施后8个月（2020年5月1日至12月31日）的住院费用，采用倾向评分加权法调整潜在协变量差异。主要结局指标为每次住院期间的总直接成本。分析纳入2019年6977例患者及2020年5964例患者。2020年总直接成本下降3%但无统计学意义（比值0.97，95% CI 0.92-1.03）。在细分项目中发现：肿瘤内科费用（比值0.58，95% CI 0.50-0.68）与药房费用（比值0.86，95% CI 0.79-0.96）显著降低，而食宿费用显著增加（比值1.06，95% CI 1.01-1.10）。亚组分析显示ICU患者在计划实施后总直接成本显著降低（比值0.83，95% CI 0.72-0.94）。经ICU住院时长校正后，2019年与2020年日均住院总直接成本无显著差异（比值0.986，95% CI 0.92-1.05），表明ICU住院时间缩短可能是成本节约的主要因素。本研究通过真实世界数据揭示了"即时"照护目标沟通如何助力降低ICU患者住院费用。
肿瘤(癌症)患者之家