2983 Impact of Proper History Taking Upon Healthcare Cost

Abstract

INTRODUCTION: The most important action that a healthcare provider can take to establish an accurate diagnosis is to elicit a precise history from the patient, however its the most neglected part. In this modern world, physicians rely on machines for diagnosing the pathology. In this study, we evaluated the outcome of proper history taking on establishing a diagnosis and its effect on hospital length of stay and cost. METHODS: A cross-sectional analysis was conducted using the de-identified data from the national health database, the Healthcare Cost and Utilization Project (HCUP). We identified the hospital encounters for “Spontaneous bacterial peritonitis (SBP)” using international classification of Diseases (ICD-9) diagnostic codes from 2011 to 2014. We assessed the prevalence of abdominal pain in the inpatient SBP cohort and determined whether the prevalence of abdominal pain varied with hospital stay and cost. The inclusion criteria included age between 30-60 years, history of liver cirrhosis, and ascites. Exclusion criteria included a history of dementia and hepatic encephalopathy as these patients were unable to provide history on admission. P-values less than 0.05 indicated a statistically significant association. Age was compared with Student T-test, and Categorical factors were compared with Chi-square tests. Data were analyzed using SPSS. RESULTS: A total of 1,854 SBP inpatient admissions were identified with prevalence of abdominal pain (history) 3.61%. Demographics between abdominal pain and without it included; age - mean with standard deviation (SD) 49.40 + 11.04 yrs vs. 55.15 + 22.10 yrs (P = 0.16), sex - male 47 (70.1%) vs. 1212 (67.8%), length of stay (mean with SD) 4.82 + 3.03 yrs vs. 6.25 + 5.44 yrs (P = 0.03), number of diagnosis on discharge (mean with SD) 15.78 + 5.2 vs. 14.87 + 5.1 (P = 0.15), number of procedures (mean with SD) 2.03 + 2.139 vs. 2.30 + 2.121 (P = 0.3) and hospital charges (mean with SD) $31757.79 + $23904 vs. $47650 + $58501 (P = 0.02). CONCLUSION: This study concluded that the proper history taking streamlined the patients into the accurate diagnosis and management of the disease, reducing the hospital length of stay and healthcare cost. Through our study, the awareness will spread in the healthcare society about the significance of the history and physical examination, therefore, decreasing the healthcare cost.