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Abstract
Objective. To analyze home care services in Cuba and determine how length of stay, per- day cost, and per- patient cost vary by diagnosis and by the area of the country in which the services are rendered. Methods. Patient information was analyzed for 837 individuals who were enrolled in home care services between July 2001 and June 2002 in the following four municipalities: (1) Playa municipality ( a metropolitan urban area) in the province of the City of Havana; Cruces municipality ( an urban, but not metropolitan, area) in the province of Cienfuegos; Union de Reyes municipality ( a rural area) in the province of Matanzas; and Fomento municipality ( a mountainous rural area) in the province of Sancti Spiritus Analysis of the mean length of stay for home care services was conducted using the Kaplan- Meier survival curve method. The impact of the following criteria on the probability and timing of discharge was also assessed: diagnosis at time of enrollment ( respiratory, gastrointestinal, obstetrical/ gynecological, hospital discharge follow- up, and other causes), area in which services were rendered, and patient gender and age. The total service, per- patient, and per- day costs were determined for each municipality. Adjusted multilinear regression models were used to determine how length of stay, diagnosis upon enrollment, and service area affected cost. Results. The diagnoses most frequently requiring home care were respiratory illness ( 31.4%), hospital follow- up of acute condition ( 15.5%), obstetrical/ gynecological illness ( 10.8%), and gastrointestinal disorder ( 8.1%). The mean length of stay was 6 days ( 95% confidence interval: 5.75 to 6.25). In Fomento, the probability of patients enrolling in home care was 66% lower than in Cruces and 30% lower than in Playa and UniUn de Reyes. The total direct cost of home care in the municipalities studied ranged, in Cuban pesos, from $ 3 983.54 to $ 9 624.87. The per- day cost ranged from $ 2.57 to $ 6.88, and the per- patient cost from $ 23.04 to $ 42.78. The length of stay had a direct impact on per- patient cost ( P < 0.0001). Conclusions. A longer length of stay was observed in the mountainous rural area; however, this was where the lowest per- patient and per- day costs were incurred. Length of stay can be used as an indicator for measuring the quality of home care services. From a cost perspective, length of stay must be evaluated based on diagnosis and geographic area.
Keywords
hospital-based home care services, MODELS, SCHEME, REGRESSION, MINIMIZATION ANALYSIS, RANDOMIZED CONTROLLED-TRIAL, INPATIENT HOSPITAL-CARE, length of stay, health expenditures, Cuba

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Chicago
Barroso Utra, Isabel M, Anai Garcia Farioas, Armando Rodriguez Salva, Pol de Vos, Mariano Bonet Gorbea, and Patrick Van Der Stuyft. 2007. “El Ingreso En El Hogar y Su Costo Directo En Cuba.” Revista Panamericana De Salud Publica-pan American Journal of Public Health 21 (2-3): 85–95.
APA
Barroso Utra, I. M., Garcia Farioas, A., Rodriguez Salva, A., de Vos, P., Bonet Gorbea, M., & Van Der Stuyft, P. (2007). El ingreso en el hogar y su costo directo en Cuba. REVISTA PANAMERICANA DE SALUD PUBLICA-PAN AMERICAN JOURNAL OF PUBLIC HEALTH, 21(2-3), 85–95.
Vancouver
1.
Barroso Utra IM, Garcia Farioas A, Rodriguez Salva A, de Vos P, Bonet Gorbea M, Van Der Stuyft P. El ingreso en el hogar y su costo directo en Cuba. REVISTA PANAMERICANA DE SALUD PUBLICA-PAN AMERICAN JOURNAL OF PUBLIC HEALTH. 2007;21(2-3):85–95.
MLA
Barroso Utra, Isabel M et al. “El Ingreso En El Hogar y Su Costo Directo En Cuba.” REVISTA PANAMERICANA DE SALUD PUBLICA-PAN AMERICAN JOURNAL OF PUBLIC HEALTH 21.2-3 (2007): 85–95. Print.
@article{385797,
  abstract     = {Objective. To analyze home care services in Cuba and determine how length of stay, per- day cost, and per- patient cost vary by diagnosis and by the area of the country in which the services are rendered. Methods. Patient information was analyzed for 837 individuals who were enrolled in home care services between July 2001 and June 2002 in the following four municipalities: (1) Playa municipality ( a metropolitan urban area) in the province of the City of Havana; Cruces municipality ( an urban, but not metropolitan, area) in the province of Cienfuegos; Union de Reyes municipality ( a rural area) in the province of Matanzas; and Fomento municipality ( a mountainous rural area) in the province of Sancti Spiritus Analysis of the mean length of stay for home care services was conducted using the Kaplan- Meier survival curve method. The impact of the following criteria on the probability and timing of discharge was also assessed: diagnosis at time of enrollment ( respiratory, gastrointestinal, obstetrical/ gynecological, hospital discharge follow- up, and other causes), area in which services were rendered, and patient gender and age. The total service, per- patient, and per- day costs were determined for each municipality. Adjusted multilinear regression models were used to determine how length of stay, diagnosis upon enrollment, and service area affected cost. Results. The diagnoses most frequently requiring home care were respiratory illness ( 31.4%), hospital follow- up of acute condition ( 15.5%), obstetrical/ gynecological illness ( 10.8%), and gastrointestinal disorder ( 8.1%). The mean length of stay was 6 days ( 95% confidence interval: 5.75 to 6.25). In Fomento, the probability of patients enrolling in home care was 66% lower than in Cruces and 30% lower than in Playa and UniUn de Reyes. The total direct cost of home care in the municipalities studied ranged, in Cuban pesos, from $ 3 983.54 to $ 9 624.87. The per- day cost ranged from $ 2.57 to $ 6.88, and the per- patient cost from $ 23.04 to $ 42.78. The length of stay had a direct impact on per- patient cost ( P < 0.0001). Conclusions. A longer length of stay was observed in the mountainous rural area; however, this was where the lowest per- patient and per- day costs were incurred. Length of stay can be used as an indicator for measuring the quality of home care services. From a cost perspective, length of stay must be evaluated based on diagnosis and geographic area.},
  author       = {Barroso Utra, Isabel M and Garcia Farioas, Anai and Rodriguez Salva, Armando and de Vos, Pol and Bonet Gorbea, Mariano and Van Der Stuyft, Patrick},
  issn         = {1020-4989},
  journal      = {REVISTA PANAMERICANA DE SALUD PUBLICA-PAN AMERICAN JOURNAL OF PUBLIC HEALTH},
  keywords     = {hospital-based home care services,MODELS,SCHEME,REGRESSION,MINIMIZATION ANALYSIS,RANDOMIZED CONTROLLED-TRIAL,INPATIENT HOSPITAL-CARE,length of stay,health expenditures,Cuba},
  language     = {spa},
  number       = {2-3},
  pages        = {85--95},
  title        = {El ingreso en el hogar y su costo directo en Cuba},
  url          = {http://dx.doi.org/10.1590/s1020-49892007000200004},
  volume       = {21},
  year         = {2007},
}

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