Cost-efficient radical prostatectomy with a clinical care path.

PURPOSE: We assessed changes in hospital costs and resource use among patients undergoing radical prostatectomy following implementation of a clinical care path. MATERIALS AND METHODS: A standardized clinical care path for patient management before and after radical prostatectomy was developed and implemented at a large academic medical center in California. All 577 consecutive patients undergoing radical prostatectomy during the 3 years before and 1 year after implementation of the care path were included in the study. Each patient was entered prospectively into a hospital-wide financial data base, which served as the source for observations on hospital costs, hospital charges and length of stay. RESULTS: After implementation of the radical prostatectomy care path hospital costs decreased by 12% ($7,916 versus $6,934, p < 0.001), hospital charges decreased by 20% ($17,005 versus $13,524, p < 0.0001) and length of stay decreased by 28% (5 versus 3.6 days, p < 0.0001). Decreases were noted in all categories of the hospital patient financial profile, except operating room charges. CONCLUSIONS: By standardizing preoperative and postoperative management for patients undergoing radical prostatectomy, significant savings can be achieved over and above existing trends toward shorter hospital stays and lower hospital costs.

Why do sicker patients cost more? A charge-based analysis of patients undergoing prostatectomy.

Hospitals are reimbursed a greater amount for Medicare patients undergoing prostate surgery who have comorbid and complicating conditions than for patients without these conditions, since the former have been shown to have higher hospital costs and charges. We attempted to determine whether the higher hospital charges are due to duration of hospital stay and/or intensity of services. We analyzed hospital discharge data from 799 patients undergoing radical or transurethral prostatectomy during a 3-year period (1988 to 1991) at 2 major teaching hospitals by examining length of stay (duration), charges per hospital day (intensity) and total charges per stay. Mean lengths of stay were significantly longer for sicker versus healthier patients undergoing radical prostatectomy (7.4 versus 6.8 days at hospital 1 and 8.9 versus 7.8 days at hospital 2, p < 0.05) and transurethral prostatectomy (3.5 versus 2.8 days at hospital 1 and 3.5 versus 2.5 days at hospital 2, p < 0.05). Total hospital charges were significantly higher for sicker versus healthier patients undergoing radical prostatectomy ($14,557 versus $13,357 at hospital 1 and $17,864 versus $16,080 at hospital 2, p < 0.05) and transurethral prostatectomy ($6,446 versus $5,012 at hospital 1 and $5,468 versus $3,710 at hospital 2, p < 0.05). However, sicker and healthier patients had similar charges per day for radical prostatectomy ($1,959 versus $1,961 at hospital 1 and $2,006 versus $2,073 at hospital 2, p not significant) and for transurethral prostatectomy ($1.839 versus $1,800 at hospital 1 and $1.544 versus $1,488 at hospital 2, p not significant). On specified hospital days the charges per day for room/nursing, medical/surgical supplies, laboratory services and pharmacy services were similar for patients with and without comorbid conditions. Patients who are more ill at admission remain hospitalized longer after prostatectomy. However, they do not receive more intense care during their stays. For these procedures duration and not intensity appears to be the primary determinant of higher hospital charges for sicker patients.

Marijuana exposure in vivo and human lymphocyte chromosomes.

Sequential chromosome examinations of peripheral lymphocte cultures were carried out on 21 adult male volunteers who smoked natural blend marijuana cigarettes containing about 1%, 2%, or no delta9-THC. For a limited number of subjects, blood samples from a single venipuncture were cultured independently in two cytogenetic laboratories, and later the slides were exchaged for re-analysis. There were significant differences between laboratories in the absolute break frequencies recorded. These inter-laboratory differences were demonstrated for both techniques of cell culture and metaphase analysis. Neither laboratory found a statistically significant increase in break frequencies asssociated with marijuana smoking. The present study, therefore, failed to detect a measurable effect of marijuana smoking on chromosomal aberrations in subjects experienced in the use of the drug.