Effect of casemix funding on outcomes in patients admitted to hospital with suspected unstable angina.

Abstract

OBJECTIVES: To determine the effect of the introduction of casemix funding on resource utilisation and clinical outcomes in patients admitted to hospital with suspected unstable angina. DESIGN: A prospective cohort study with a 6-month follow-up. SETTING: A suburban community hospital in Melbourne, Victoria. PATIENTS: 336 consecutive patients admitted to the coronary care unit with suspected unstable angina before (156) and after (180) the introduction of casemix funding. INTERVENTION: Introduction of casemix funding in July 1993. MAIN OUTCOME MEASURES: Indices of resource utilisation: length of stay in hospital, length of stay in the coronary care unit, and total cost of investigations (pathology and radiology). Rates of serious cardiac events during hospital stay and after discharge. Readmissions within 28 days and 6 months of discharge. RESULTS: After the introduction of casemix funding there was a 1% increase in duration of hospital stay and a 5% increase in time spent in the coronary care unit, but neither of these increases was statistically significant. However, there was a significant reduction in total cost of investigations (39% decrease; 95% confidence interval, 14%-70%; P < 0.001). The rate of serious cardiac events after discharge did not increase, and neither did readmission rates, either within 28 days or over the 6 months' follow-up. CONCLUSION: Casemix funding had no effect on short term clinical outcomes but resulted in significantly reduced investigation costs.