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Characteristics and outcome of high-cost ICU patients

Authors Aung YN, Nur AM, Ismail A, Aljunid SM

Received 18 March 2019

Accepted for publication 1 July 2019

Published 2 August 2019 Volume 2019:11 Pages 505—513


Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 2

Editor who approved publication: Professor Dean Smith

Yin Nwe Aung,1,2 Amrizal M Nur,2 Aniza Ismail,2,3 Syed M Aljunid2,4

1Department of Laboratory Diagnostic Services and Community Medicine, Faculty of Medicine and Health Sciences, UCSI University, Kuala Lumpur, Malaysia; 2International Centre for Casemix and Clinical Coding, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia; 3Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia; 4Department of Health Policy and Management, Faculty of Public Health, Kuwait University, Hawally, Kuwait

Purpose: Care at ICUs is expensive and variable depending on the type of care that the patients received. Knowing the characteristics of the patient and his or her disease is always useful for improving health services and cost containment.
Patients and methods: An observational study was conducted at four different intensive care units of an academic medical institution. Demographic characteristics, disease-management casemix information, cost and outcome of the high costing decile, and the rest of the cases were compared.
Results: A total of 3,220 discharges were included in the study. The high-cost group contributed 35.4% of the ICU stays and 38.8% of the total ICU expenditure. Diseases of the central nervous system had higher odds to be in the top decile of costly patients whereas the cardiovascular system was more likely to be in the non-high cost category. The high-cost patients were more likely to have death as an outcome (19.2% vs 9.3%; p<0.001). The most common conditions that were in the high-cost groups were craniotomy, other ear, nose, mouth, and throat operations, simple respiratory system operations, complex intestinal operations, and septicemia. These five diagnostic groups made up 43% of the high-cost decile.
Conclusion: High-cost patients utilized almost 40% of the ICU cost although they were only 10% of the ICU patients. The chances of admission to the ICU increased with older age and severity level of the disease. Central nervous system diseases were the major problem of patients aged 46–69 years old. In addition to cost reduction strategies at the treatment level, detailed analysis of these cases was needed to explore and identify pre-event stage prevention strategies.

Keywords: casemix, MY-DRG, utilization, burden, health services, Malaysia

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