Severity of illness and costs of medical care in patients with acute myocardial infarction

Field: Health Professions (Health Sciences)

A lot of other people not directly involved in this study have created a stimulating environment in which I could work on this thesis.I could always rely on the support and interest of my colleagues who have shared in the ups and downs of the project.I thank my friends for having a lot of patience and sympathy even during the moments that I could not give them the attention I would have liked.Although my parents and family remained in the background, their warmth and care was always very close to me.A very special place in all of this is for Sjeng.His positive attitude, his understanding and his music have meant a lot to me.February, /99J Historical information about the patient population can help hospitals to develop long-term plans.Expected changes in the patient population may require specific health care facilities.Anticipating changes in patient populations with the help of empirical data may contribute to a timely prediction of the consequences for the hospital.Patient classification systems can be used to examine resource utilization patterns among clinically similar groups of patients and to identify patterns that arc atypical.These atypical patterns can then be further evaluated by means of detailed case analysis.* mom'/oring //i<» fua/iiy o/care.Physician performance cannot be assessed appropriately without reference to the types of diseases treated.If quality criteria arc established for clinically similar groups of patients, deviations from the standard or norm may be observed and singled out for further inquiry. Research applications.Patient classification systems concerning resource use and costs provide detailed data on the types and amounts of health care services used.Such information may be valuable for scientific research in health care in addressing such questions as: What procedures arc being performed in various settings, and how often?What types of patients tend to make more use of a particular service?What arc the relative costs and outcomes of treating patients in different settings such as teaching versus non-teaching hospitals?Arc new services replacing old ones, answering unfulfilled needs, or just duplicating existing services and adding unnecessary costs?(Lichting 1986).Another application of such patient classification systems may lie in medical technology assessment studies.Classifying patients into clinically relevant categories which arc homogeneous with respect to costs may be seen as a precondition for performing these evaluation studies.After grouping, costs and effects of medical care may be determined and compared for each group of patients.Also the effect of changes in medical care (i.e. the introduction of a new technology) may be evaluated in terms of the direct or long-term consequences for the total treatment.* /?f/;i7iryThe most important criteria mentioned by both authors are the medical mcaningfulncss and the economic meaningfulness of a patient classification system.ion mfr/ru; Medical Meaningfulness/Content Validity.Both authors explicitly mention that a patient classification system must contain medically relevant patient categories.Medical mcaningfulncss is defined by Wood as 'the extent to which knowledge of a patient's case type alone -without other information about the individual patient -conveys clinical expectations and enables clinicians to exchange information about those expectations.For a group of clinicians, a medically meaningful classification stimulates expectations as to the natural history of the disease, the appropriate ways to manage the case, the prognosis, the likelihood of complications and the risk of death'.Hornbrook describes this requirement more generally as the content validity of a system and defines it as 'the representativeness and comprehensiveness of the content of the measuring instrument.For patient classification systems it refers to the breadth of coverage of the various case types and the dimensions of the patient population relevant for the purpose'.COMMON DKVHIITION STAC Hi OK NAMIi (X-Till: CONDITION 11 MYOCARMAI INFARCTION MANIFESTO) BY OII-.ST PAINS AN1I«)R UI.KTRO ( AKDKXIKAPHIC OK I.N7YMATK I HAN(iF-S< ONSISTI NT WITH DIAUNOMS 1 2 MYCX ARIHA1 INFARCTION Pil'S HI.AKT BUXK OR SIIPHA VHNTKK'I'IAR ARRIIYTMIA OK VENTRin>I.AR ARRHYTHMIA OTHIR THAN HBRH1ATION OR n.KK ARIimS |DRF"SSLF.itS SYNDROMK) 2 1 MYtXARIMAI INFARCTION Pll'S F.MBOIJ TO OTIIItf ORUAN SYXTliMS IJvAIHNl) TO A iminil.RAl VASO'lAR (XCl.l'SIONOR INFARCTION OF (il TRACT OR INFARCTION OF K1DNFY I 2 MYIXARIMAI INFARCTION MANIFF-STFi) BY CHKVT PAINS ANIM)K Fl.KTRO-1 ARI>l(XiRAPHIC OR F.N7YMATIC CHANOKS CONSISThNT WITH THH DIAGNOSIS PI 1 'S CONOKSTIVfi iniART FA1LIÜIE 2 1 ««KBRA1 VASTIWR Arni>RNT (CVA) 2 4 PAPIUARY M l ' S l j ; RITHRB 2 5 VENTKICnAR ANEIKYSM