Relation between length of hospital stay and costs of care for patients with community-acquired pneumonia.

PURPOSE: Patients with pneumonia often remain hospitalized after becoming clinically stable, without demonstrated benefits on outcome. The purposes of this study were to assess the relation between length of hospital stay and daily medical care costs and to estimate the potential cost savings associated with a reduced length of stay for patients with pneumonia. SUBJECTS AND METHODS: As part of a prospective study of adults hospitalized with community-acquired pneumonia at a community hospital and two university teaching hospitals, daily medical care costs were estimated by multiplying individual charges by department-specific cost-to-charge ratios obtained from each hospital's Medicare cost reports. RESULTS: The median total cost of hospitalization for all 982 inpatients was $5, 942, with a median daily cost of $836, including $491 (59%) for room and $345 (41%) for non-room costs. Average daily non-room costs were 282% greater on the first hospital day, 59% greater on the second day, and 19% greater on the third day than the average daily cost throughout the hospitalization (all P <0.05), and were 14% to 72% lower on the last 3 days of hospitalization. Average daily room costs remained relatively constant throughout the hospital stay, with the exception of the day of discharge. A projected mean savings of $680 was associated with a 1-day reduction in length of stay. CONCLUSIONS: Despite institutional differences in total costs, patterns of daily resource use throughout hospitalization were similar at all institutions. A 1-day reduction in length of stay might yield substantial cost-savings.

Incremental cost of department-wide implementation of a picture archiving and communication system and computed radiography.

PURPOSE: To determine the incremental cash flows associated with department-wide implementation of a picture archiving and communication system (PACS) and computed radiography (CR) at a large academic medical center. MATERIALS AND METHODS: The authors determined all capital and operational costs associated with PACS implementation during an 8-year time horizon. Economic effects were identified, adjusted for time value, and used to calculate net present values (NPVs) for each section of the department of radiology and for the department as a whole. RESULTS: The chest-bone section used the most resources. Changes in cost assumptions for the chest-bone section had a dominant effect on the department-wide NPV. The base-case NPV (i.e., that determined by using the initial assumptions) was negative, indicating that additional net costs are incurred by the radiology department from PACS implementation. PACS and CR provide cost savings only when a 12-year hardware life span is assumed, when CR equipment is removed from the analysis, or when digitized long-term archives are compressed at a rate of 10:1. CONCLUSION: Full PACS-CR implementation would not provide cost savings for a large, subspecialized department. However, institutions that are committed to CR implementation (for whom CR implementation would represent a sunk cost) or institutions that are able to archive images by using image compression will experience cost savings from PACS.

In vivo conversion of 5-oxoproline to glutamate by higher plants.

l-(U-(14)C)-5-oxoproline (pyrollidone carboxylic acid or pyroglutamic acid) was infiltrated into detached leaves of a number of species and incubated for 1 to 6 hours. In every case, conversion to labeled glutamate and glutamine was observed. The amount converted varied from 1 to 64% of the total label fed depending on the species. The ratio of glutamate-(14)C to glutamine-(14)C ranged from 5 in Vicia faba to 1 in sugar beet. This ratio could be affected by preinfiltrating various compounds before allowing the uptake of the 5-oxoproline. When l-methionine-dl-sulfoximine was prefed to sugar beet leaves, the glutamate-glutamine ratio increased from 1 to 10. Prior treatment of V. faba leaves with azaserine resulted in essentially only labeled glutamine being recovered. Preinfiltration with NaF or ATP gave similar results in that the glutamate-glutamine ratio was greatly decreased. The results are consistent with glutamate being produced from the 5-oxoproline and then being converted to glutamine.