| Abstract | Prijelomi proksimalnog dijela bedrene kosti kod osoba starije životne dobi danas predstavljaju značajan medicinsko - socijalni problem. Liječenje ovih prijeloma je operacijsko te zahtjeva multidisciplinaran pristup u pružanju zdravstvene skrbi zbog udruženih bolesti i rehabilitacije.
Osnovni cilj rada je prikazati utjecaj cijena implantata kod operacijskog liječenja bolesnika s prijelomom kuka na financijski prihod ustanove.
Koristeći Međunarodnu klasifikaciju bolesti (MKB) i dijagnostičko terapijsku skupinu (DTS) pacijenati se svrstavaju u skupine koje koristimo u izračunavanju troškova liječenja i način plaćanja bolničkoe usluge.
Razvrstavanjem pacijenata u skupine bez komplikacija i komorbiditeta i u skupine s komplikacijama i komorbiditetom dobije se uvid u način obračuna troškova liječenja i ukupan trošak liječenja po slučaju (epizodi).
Rezultati istraživanja pokazali su kako je pravilna klasifikacija akutnih bolničkih pacijenata u skupine koje zahtijevaju sličnu potrošnju bolničkih resursa, slične kliničke osobitosti jedan od vrlo bitnih čimbenika radi pravilne podjele pacijenata u DTS skupine.
Analiza rezultata pokazala je da su osteosinteza kratkim Gama čavlom (41,22%) i implantacija PEP-a (39,25%) najčešće korištene metode liječenja prijeloma proksimalnog dijela bedrene kosti.
Kod ugradnje BEP-a ukupna cijena implantata iznosi 2.749.00 KN, TEP-a 1.448,00 KN, PEP- 990.00 KN. Udio nabavne cijene implantata ovisi o podjeli slučaja s KK ili bez KK. Kod slučaja bez KK udio nabavne cijene je za BEP je 12,99%, TEP 6,99%, PEP 4,68%, a kod slučaja s KK udio nabavne cijene za BEP je 11,49%, TEP 6,18%, PEP 4,14%.
Kod osteosinteze kratkim Gama čavlom ukupna cijena implantata iznosi 2.575,00 KN, a cijena dugog Gama čavlom je 3.440,00 KN, a udio nabavne cijene ovisi o podjeli slučaja s KKi li bez KK. Kod slučaja bez KK udio nabavne cijene za kratki Gama čavao je 19,7 %, a za dugi Gama čavao je 26,36 %, a kod slučaja s KK udio nabavne cijene za kratki Gama čavao je 13,90 %, a za dugi Gama čavao 18,57 %.
U analiziranoj skupinu odnos pacijenata s prijelomom vrata bedrene kosti u odnosu na peritrohanterne prijelome je 43,4% : 56,6%, što odstupa od referentnih vrijednosti u literaturi.
Pacijenti s prijelomom vrata bedrene kosti koji su liječeni implantacijom nekog od navedenih tipova proteze kuka imaju značajno veću učestalost KK u odnosu na skupinu s peritrohanternim prijelomima gdje prevladavaju bolesnici bez KK.
Nužno je provesti druga opsežnija istraživanja, na cijelom području Republike Hrvatske, kako bi se mogli usporediti dobiveni podaci i povećati učinkovitost zdravstvenog sustava uz racionalizaciju troškova liječenja. |
| Abstract (english) | Today fractures of the proximal part of the femur in elderly represent a significant medico-social problem. The treatment of these fractures is surgical and requires a multidisciplinary approach to provide proper health care because of associated diseases and rehabilitation.
The main goal of this research is to present the influence of the price of the implant in surgical treatment of patients with hip fracture and it’s affect to financial income of the hospital.
Using the International Classification of Diseases (ICD) and diagnosis related groups (DRGs) patients are classified into groups that are used for calculation of the cost of treatment and method of payment for hospital service.
The proper distribution of patients into groups without complications and comorbidities (CC) and groups with complications and comorbidity (CC) gives an insight into calculating costs of treatment and total cost of treatment per case (episode).
The results showed that the correct classification of acute hospital patients in groups that require similar consumption of hospital resources, similar clinical characteristics are one of the very important factors for the correct division of the patients in the DRG.
Analysis of the results showed that osteosynthesis with short Gamma nail (41.22%) and hemiarthroplasty (39,25%) are the most commonly used methods of treatment of fractures of the proximal femur in elderly.
In uncemented hip arthroplasty (UHA) total implant price is 2,749.00 KN, in cemented hip arthroplasty (THA) implant price is 1,448.00 KN, and prosthesis for hemiarthroplasty (PHA) costs 990.00 KN. The percentage of purchase price of implants in total hospital costs depends on the division of cases with CC or without CC. In case of a case without CC the share of the purchase price for UHA implant is 12.99%, THA 6.99%, PHA 4.68%, and in case of CC the percentage of purchase price for UHA is 11.49%, THA 6.18% PHA 4.14%.
In osteosynthesis with short Gamma nail total price of implant is 2.575.00 KN, and long Gamma nail costs 3.440,00 KN, and also percentage of purchase price in total hospital costc depends on the division of cases with CC or without CC. In cases without CC percentage of purchase price in total costs for short Gamma nail is 19.7% and for long Gamma nail is 26.36%, and in case with CC percentage of the purchase price for short Gamma nail is 13.90% and for long Gamma nail 18, 57%.
In analyses group relation between patients with femoral neck fractures and patients with pertrochanteric fractures is 43,4% : 56,6%, what is different than reports in literature where ratio is 50%:50%.
Patients with femoral neck fractures treated with arthroplasty have much higher incidence of CC comparing to patients with pertrochanteric fractures where most of the patients were without CC.s
It is necessary to implement other large-scale research in Croatian hospitals, in order to compare the data and increase the efficiency of the health system with the rationalization of medical expenses. |
