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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.
Intensive Care Medicine
|December 5, 1998
Summary
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.