Determination of the cost of treatment of patients with complicated spinal injury at the thoracic and lumbar levels in a multidisciplinary hospital

A. Kordonsky, A. Perminov, N. S. Fomenko, A. R. Samarin, V. A. Khamurzov, K. V. Gretskikh, A. Grin
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Abstract

Introduction. The dramatic increase in the cost of treating patients with spinal cord injury is associated with the currently accepted active surgical tactics, as well as the use of new technologies, more expensive implants. Currently, a standardized method for calculating the costs of treating patients has not been developed, which may in the future lead to an incorrect assessment of the economic effectiveness of a particular treatment strategy.Aim. To assess the cost of diagnosis and treatment of patients with spinal injury of the thoracic and / or lumbar spine in a multidisciplinary emergency hospital.Materials and methods. The study was carried out in the Clinic of Emergency Neurosurgery of the N. V. Sklifosovsky Research Institute for Emergency Medicine, Moscow Healthcare Department during 2018–2021. A working group was formed from the doctors of the neurosurgical department. Further, a model of the therapeutic and diagnostic process was compiled with a reflection of all its characteristics: 1) compilation of a mo dified operogram, 2) transformation of the operogram into a technological map, 3) comparison of the obtained characteristics of the process of diagnosis and treatment of patients with spinal injury with actual data, correction.Results. The operogram included 136 steps of the process from the moment of admission of a patient with spinal injury to the emergency department to the moment of discharge (surgery is the 77th step), and also reflected the interactions of 38 participants in the process and took into account the variety of possible methods and tactics of treatment, taking into account the average frequency of their use. Based on the developed process model, a technological map was prepared, which combined quantitative parameters for all key resource characteristics of the process.Conclusions. Hospital costs for the treatment of a patient with isolated complicated spinal injury at the level of the thoracic and lumbar spine in a specialized hospital amount to 600,652.41 rubles. Out of the total amount of expenses, surgical intervention costs amount to 48.7 %.
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多学科医院胸腰椎复杂脊柱损伤患者治疗费用的测定
介绍。治疗脊髓损伤患者的费用急剧增加与目前接受的主动手术策略以及新技术的使用和更昂贵的植入物有关。目前,还没有一种标准化的方法来计算治疗患者的成本,这可能在未来导致对特定治疗策略的经济效益的不正确评估。评估多学科急诊医院胸椎和/或腰椎脊柱损伤患者的诊断和治疗成本。材料和方法。该研究于2018-2021年在莫斯科卫生部门急诊医学研究所急诊神经外科诊所进行。神经外科的医生组成了一个工作小组。在此基础上,构建了一个反映其所有特征的治疗诊断过程模型:1)编制了一个修改过的过图,2)将过图转化为技术图,3)将得到的脊髓损伤患者诊断和治疗过程特征与实际数据进行了比较,并对结果进行了修正。该操作图包括从脊髓损伤患者进入急诊科到出院的136个步骤(手术是第77个步骤),也反映了38个参与者在这一过程中的相互作用,并考虑了各种可能的治疗方法和策略,考虑了它们的平均使用频率。在开发的工艺模型的基础上,编制了工艺图,并结合了工艺中所有关键资源特征的定量参数。在专科医院治疗一名胸椎和腰椎孤立的复杂脊柱损伤患者的住院费用为600 652.41卢布。手术费用占总费用的48.7%。
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