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The relation between TISS and real paediatric ICU costs: a case study with generalizable methodology
N F de Keizer1, G J Bonsel, M J Al
1Department of Medical Informatics, Academic Medical Center, Amsterdam, The Netherlands.
Insights
The Therapeutic Intervention Scoring System (TISS) is key in determining pediatric intensive care costs. This study shows TISS and clinical data can accurately estimate real-world intensive care expenses.
Area of Science:
- Pediatric critical care medicine
- Health economics
- Healthcare management
Background:
- Accurate cost assessment in pediatric intensive care units (PICUs) is crucial for resource allocation and performance evaluation.
- Existing methods may not fully capture the complexity of direct medical costs in PICUs.
Purpose of the Study:
- To establish a quantitative relationship between the Therapeutic Intervention Scoring System (TISS) and other clinical variables with the actual costs of pediatric intensive care.
- To develop a feasible model for estimating direct medical costs in PICUs.
Main Methods:
- A prospective, observational study was conducted in a 10-bed university children's hospital PICU.
- Data from 611 consecutive admissions were collected over 17 months, with a 21-day calibration period for detailed cost analysis.
- The Multi Moment Measurement method was used to quantify nurse/physician time and medication use for cost estimation.
Main Results:
- Regression models incorporating TISS and clinical variables accurately estimated personnel and medication costs.
- These models successfully predicted total daily and per-admission costs across different patient groups.
- TISS emerged as the most significant determinant of total direct medical costs.
Conclusions:
- Direct medical costs in PICUs can be reliably calculated using a few accessible clinical variables, with TISS being the primary factor.
- The developed methodology offers valuable tools for assessing and improving PICU performance.
Objective:
To determine the quantitative relation between the Therapeutic Intervention Scoring System (TISS) in combination with other relevant clinical variables and the real costs of (paediatric) intensive care.
Design:
A prospective, observational study.
Setting:
A Ten-bed paediatric intensive care unit in a university children's hospital.
Patients And Participants:
In a 17-months registration period we collected patient- and treatment-related data for all 611 consecutive admissions. A 21-day calibration period was used to collect detailed data to calculate the real costs of 33 consecutive admissions, in addition to the same data as in the registration period.
Measurements And Results:
We used the Multi Moment Measurement method to measure time spent by nurses and physicians and medication used in the 21-day calibration period. The calibration period data set with explanatory variables including TISS was used to build a regression model to estimate nurse and physician time, which were converted to personnel costs, and to estimate medication costs. The regression models built from the calibration period were subsequently used to estimate the total costs per day and per admission in different patient groups in the registration period.
Conclusion:
It was feasible to calculate total direct medical costs based on a limited number of readily available clinical variables related to patient characteristics and treatment, of which TISS was the most important determinant. The proposed methods provide further tools for assessment of (paediatric) intensive care unit performance.