PMID- 23852985
OWN - NLM
STAT- MEDLINE
DCOM- 20131119
LR  - 20220408
IS  - 1179-1896 (Electronic)
IS  - 1175-5652 (Linking)
VI  - 11
IP  - 4
DP  - 2013 Aug
TI  - The trade-off between costs and quality of care in the treatment of psychosomatic 
      patients with somatoform pain disorder.
PG  - 359-68
LID - 10.1007/s40258-013-0042-0 [doi]
AB  - BACKGROUND: The introduction of efficiency-oriented provider payment systems in 
      inpatient mental healthcare in various Western countries may lead to the use of 
      less healthcare resources in the treatment of patients. To avoid unintended 
      effects on quality of care that may result from reductions in resource 
      utilization, it is essential for decision and policy makers to know whether there 
      is a trade-off between costs and quality of care. AIM OF THE STUDY: The aim of 
      this study was to investigate and quantify the relationship between costs and 
      outcomes in psychosomatic inpatients with somatoform pain disorder. METHODS: The 
      inclusion criteria for patient selection (n = 101) were (i) a main diagnosis of 
      somatoform pain disorder according to International Classification of Diseases-10 
      (ICD-10) [F45.4, F45.40, F45.41]; (ii) complete data on the mental component 
      summary reflecting overall functioning of mental health (MCS-8) measured with the 
      Short Form-8 Health Survey (SF-8) within 3 days of the admission and discharge 
      dates; and (iii) treatment at Charite Universitaetsmedizin (Berlin, Germany) 
      during the period January 2006-June 2010. The change in the MCS-8 score incurred 
      over the treatment period was used as an indicator of quality of care. Treatment 
      costs were calculated from the provider's perspective, mainly using bottom-up 
      micro-costing. The year of valuation for cost calculation was 2008 (with no 
      inflation adjustment); for costs provided by the accounting department for 
      services consumed by the patient, the valuation year was based on the year of 
      service provision. We hypothesized that the outcome 'change in MCS-8 score' was a 
      function of the independent variable costs, patient characteristics, 
      socio-demographic variables, pain-related variables, co-morbidities and 
      subjective illness attribution, i.e. whether patients attributed the origin of 
      pain mainly to a somatic cause or not. An interaction term between costs and 
      illness attribution was included to control for the hypothesized differing 
      effects of resource input or costs on the outcome variable conditional on 
      patients' illness attribution. Hausman tests indicated that endogeneity was not 
      present, thus, ordinary least squares regression (OLS) was conducted. We assessed 
      whether the change in the MCS-8 score was clinically meaningful and perceptible 
      by the patient, using the minimal clinical important difference (MCID). For Short 
      Form Health Surveys, the MCID for changes in the mental component summary is 
      typically around 3 points. RESULTS: We found a trade-off between costs and 
      outcome for patients without or with only minor somatic illness attribution (77 % 
      of the sample). This patient group improved 0.4 points in outcome after every 100 
      <euro> increase in total costs per case (F 1,77 = 13.836, t(77) = 3.72, p = 
      0.0004). For patients with mainly somatic illness beliefs (23 % of the sample), 
      we did not find a trade-off between costs and outcome. CONCLUSION: For the 
      majority of patients, we found a trade-off between costs and health outcome, 
      thus, it seems advisable to carefully monitor outcome parameters when applying 
      cost containment measures.
FAU - Haas, Laura
AU  - Haas L
AD  - Department of Psychosomatic Medicine, Charite Center for Internal Medicine and 
      Dermatology, Charite Universitaetsmedizin, Luisenstr. 13a, 10117, Berlin, 
      Germany. laura.haas@charite.de
FAU - Stargardt, Tom
AU  - Stargardt T
FAU - Schreyoegg, Jonas
AU  - Schreyoegg J
FAU - Schlosser, Rico
AU  - Schlosser R
FAU - Klapp, Burghard F
AU  - Klapp BF
FAU - Danzer, Gerhard
AU  - Danzer G
LA  - eng
PT  - Journal Article
PL  - New Zealand
TA  - Appl Health Econ Health Policy
JT  - Applied health economics and health policy
JID - 101150314
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Female
MH  - Germany
MH  - Hospitalization/economics
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Outcome Assessment, Health Care/*economics
MH  - Pain/*nursing/psychology
MH  - Psychophysiologic Disorders/*nursing
MH  - Quality of Health Care/*economics
MH  - Somatoform Disorders/*nursing
MH  - Surveys and Questionnaires
MH  - Young Adult
EDAT- 2013/07/16 06:00
MHDA- 2013/11/20 06:00
CRDT- 2013/07/16 06:00
PHST- 2013/07/16 06:00 [entrez]
PHST- 2013/07/16 06:00 [pubmed]
PHST- 2013/11/20 06:00 [medline]
AID - 10.1007/s40258-013-0042-0 [doi]
PST - ppublish
SO  - Appl Health Econ Health Policy. 2013 Aug;11(4):359-68. doi: 
      10.1007/s40258-013-0042-0.