Luleeya Ocharot, Jiruth Sriratanaban, Sureerat Ngamkiatphaisan and Narin Hiransuthikul
The impact of adverse events on costs of medical care in developing countries is more limited than in developed countries.
To estimate uncompensated medical care costs as a result of adverse events in hospitalized patients.
Retrospective study based on a panel reviews of the medical records and hospital charges relating to 574 inpatients in the electronic database of a tertiary-care university hospital in Bangkok, Thailand, of which 138 were identified to have adverse events in 2009. The main outcome measure was hospital charges for medical care standardized by Thai diagnosis-related groups (Thai-DRGs).
After controlling for personal and clinical factors, the average medical cost of an adverse event was estimated at US $128.98 per adjusted relative weight of Thai-DRGs, equivalent to 52% of the standard payment rate paid to the hospital set by a Universal Coverage Scheme.
Adverse events in the hospital increased the cost of medical care despite adjustment for the case-mix based on DRG. Under the close-ended DRG-based payments for hospitals in Thailand, this meant that adverse events resulted in significant amounts of uncompensated care.
Kanisshanone Chuayruang, Jiruth Sriratanaban, Narin Hiransuthikul and Sompongse Suwanwalaikorn
Effectiveness of self-care and treatment of diabetes mellitus depends upon patient awareness of their own health and disease outcomes. Physician decisions are improved by insight into patient perspectives.
To develop an instrument for patient-reported outcomes in Thai patients with type 2 diabetes mellitus (PRO-DM-Thai).
The study consisted of: (1) content development using a literature review and in-depth interviews of providers and patients, and validity testing using a content validity index (CVI); (2) construct validity and reliability testing by confirmatory factor and Cronbach’s α analyses of data from a cross-sectional descriptive survey of 500 participants from May to June, 2011; and, (3) criterion-related validity from a cross-sectional analytical survey of 200 participants from September to November, 2011.
PRO-DM-Thai passed all of the validity tests. The instrument comprises seven dimensions and 44 items, including physical function, symptoms, psychological well-being, self-care management, social well-being, global judgments of health, and satisfaction with care and flexibility of treatment. The CVI at the item-level (I-CVI) were between 0.83 to 1.00 and the scale-level average agreement (S-CVI/Ave) was 0.98. All dimension models had overall fit with empirical data, while the hypothesized model demonstrated a good fit (χ2 = 5.23; (df = 6), P > 0.05, AGFI = 0.986, RMSEA = 0.000). Cronbach’s α for the total scale was 0.91 and for the subscales was 0.72-0.90. The total scores effectively discriminated groups of patients with different levels of disease control.
PRO-DM-Thai showed satisfactory levels of validity and reliability when applied to Thai diabetic patients.