Defining care products to finance health care in the Netherlands

A case-mix project started in the Netherlands with the primary goal to define a complete set of health care products for hospitals. The definition of the product structure was completed 4 years later. The results are currently being used for billing purposes. This paper focuses on the methodology and techniques that were developed and applied in order to define the casemix product structure. The central research question was how to develop a manageable product structure, i.e., a limited set of hospital products, with acceptable cost homogeneity. For this purpose, a data warehouse with approximately 1.5 million patient records from 27 hospitals was build up over a period of 3 years. The data associated with each patient consist of a large number of a priori independent parameters describing the resource utilization in different stages of the treatment process, e.g., activities in the operating theatre, the lab and the radiology department. Because of the complexity of the database, it was necessary to apply advanced data analysis techniques. The full analyses process that starts from the database and ends up with a product definition consists of four basic analyses steps. Each of these steps has revealed interesting insights. This paper describes each step in some detail and presents the major results of each step. The result consists of 687 product groups for 24 medical specialties used for billing purposes

Elevated factor VIII increases the risk of cerebral venous thrombosis: a case–control study

Background: Elevated factor VIII (FVIII) is a risk factor for leg-vein thrombosis and pulmonary embolism. We assessed whether elevated FVIII is also a risk factor for cerebral venous thrombosis (CVT). Methods: We performed a matched case–control study. We assessed patients with CVT, as cases, admitted between July 2006 and December 2016. The controls were healthy hospital-staff employees matched for age (within 5 years) and sex. FVIII activity was measured at least 3 months after CVT diagnosis. Elevated FVIII was defined as activity > 150 IU/dl. We used logistic regression analysis, adjusting for age and sex. Results: We included 116 cases and 116 controls (85% women for both groups). Mean age was 40 (SD 11) and 41 (SD 11) years for cases and controls, respectively. Median time between CVT diagnosis and blood collection was 18 months (IQR 7–39 months). Cases more often had elevated FVIII as compared to controls (83.6 vs 28.4%, p < 0.001). After adjustment, elevated FVIII was associated with a 15-fold increased risk of CVT (OR 15.3, 95% CI 7.8–30.1). Stratification by sex showed a stronger association in men (OR 22.8, 95% CI 2.8–184.3) than in women (OR 14.7, 95% CI 7.2–30.2). Conclusion: Elevated FVIII occurs frequently in patients with CVT and is a strong risk factor for this condition