Setting: An urban tuberculosis (TB) control program.
Objective: The use of medical services was analyzed from diagnosis through completion of treatment for TB patients in a public health system in order to estimate charges and service utilization.
Design: The in- and out-patient medical records, including long term care and jail health service records, were retrospectively reviewed for the first 100 patients diagnosed with TB in 1993 at a public hospital. Because the hospital did not have a cost-accounting system, charges were estimated based on a variety of sources.
Results: Complete records were available for 92 patients; one outlier was excluded. The resulting 91 patients represented 11% of newly diagnosed patients in Chicago in 1993. Overall, almost 99% of the charges reflected in-patient (acute and long term care) utilization. Total charges of $3,154,583 represent the charges to complete therapy for only 46 patients, or $68,578 per completed case.
Conclusions: This study attempts to overcome the limitations of aggregate data sets by looking at individual patients followed longitudinally through a complex public health system. Expensive in-patient care may be partially, but not completely, replaced by directly observed therapy. The findings may be used to predict resource utilization for diagnosis and treatment programs.