Expenditure on hospitalization of the elderly in intensive care units in private hospitals in a capital of the Brazilian northeast

Abstract Objective: Analyze the association between demographic variables, morbidity and relative to the conditions of hospitalization with the expenses resulting from the admission of elderly people in intensive care units (ICU) of private hospitals in a capital of northeastern Brazil. Method: This is an epidemiological, analytical and sectional study, with a quantitative approach, in which data were collected regarding 312 hospitalizations of elderly people in the ICU of all private hospitals in Natal (RN), Brazil. The dependent variable was the cost of hospitalization and the independent variables related to the characterization of individuals in terms of socio-demographic profile, morbid condition and characteristics of hospitalization. Data were analyzed using descriptive statistics, Chi-square test, t test and multiple logistic regression with prevalence ratios (PR). Results: The average cost per hospitalization was R$ 4.266,05±3.322,50 for the low cost group and R$ 39.753,162±4.929,12 for the high cost group. It was found that hospitalization due to clinical (PR=1,81; 95%CI=1,06-3,09) and respiratory conditions (PR=2,48; 95CI%=1,48-5,24), the need for mechanical ventilation (PR=2,33; 95%CI=1,43-3,78) and complete or partial disorientation at the time of admission (PR=1,81; 95%CI=1,15-2,84) were associated with higher expenditure on hospitalizations in the multiple statistical model. Conclusion: The knowledge produced by the study may serve as a subsidy for the implementation of actions capable of promoting better health conditions for the elderly, reducing expenses related to their hospitalization in highly specialized sectors. In addition, the research raises evidence that the construction of protocols and lines of care guiding the work process in the intensive care sector, specifically created for the elderly, may be relevant in reducing the expenses resulting from hospitalization of the elderly.

摘要：
目的：分析巴西东北部北大河州首府纳塔尔市所有私立医院重症监护室（Intensive Care Unit，ICU）老年住院患者的人口统计学变量、患病情况与住院相关特征同住院费用之间的关联。
方法：本研究为流行病学分析性横断面研究，采用定量研究方法，共收集巴西纳塔尔地区所有私立医院重症监护室内312例老年住院患者的相关数据。本研究的因变量为住院费用，自变量涵盖研究对象的社会人口学特征、患病情况及住院相关特征。数据分析采用描述性统计、卡方检验、t检验及携带患病率比（Prevalence Ratio，PR）的多因素logistic回归模型。
结果：低费用组患者单次住院平均费用为4266.05±3322.50雷亚尔，高费用组则为39753.16±4929.12雷亚尔。多因素统计模型分析结果显示，因临床病症（PR=1.81；95%置信区间[CI]=1.06-3.09）、呼吸系统疾病（PR=2.48；95%CI=1.48-5.24）住院，需实施机械通气（PR=2.33；95%CI=1.43-3.78），以及入院时存在完全或部分定向力障碍（PR=1.81；95%CI=1.15-2.84）均与更高的住院费用显著相关。
结论：本研究所得结果可为制定改善老年人群健康状况的相关举措提供参考依据，进而降低其在高度专业化医疗科室的住院费用。此外，本研究还证实，针对老年人群制定专属的重症监护科室工作流程指南与护理方案，或可有效降低老年患者的住院费用。