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Sirur AJN, Pillai K R. Pricing of hospital services: evidence from a thematic review. HEALTH ECONOMICS, POLICY, AND LAW 2024; 19:234-252. [PMID: 38314528 DOI: 10.1017/s1744133123000397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2024]
Abstract
The management implications of pricing healthcare services, especially hospitals, have received insufficient scholarly attention. Additionally, disciplinary overlaps have led to scattered academic efforts in this domain. This study performs a thematic synthesis of the literature and applies retrospective analysis to hospital service pricing articles to address these issues. The study's inputs were sourced from well-known online repositories, using a structured search string and PRISMA flow chart to select the pertinent documents. Our thematic analysis of pricing literature encompasses: (a) comprehension of hospital service pricing nature; (b) pricing objectives, strategies and practices differentiation; (c) presentation of factors impacting hospital service pricing. We observe that hospital pricing is an intricate and unclear matter. The terms 'pricing strategies' and 'pricing practices' are often used interchangeably in academic literature. Hospital service pricing is influenced by costs, demand and supply factors, market structure, pricing regulation and third-party reimbursements. The study's findings provide policy implications for service pricing in hospitals, in addition to suggesting avenues for future research on hospital pricing.
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Affiliation(s)
- Andria J N Sirur
- Department of Commerce, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Rajasekharan Pillai K
- Manipal Institute of Management, Manipal Academy of Higher Education, Manipal, Karnataka, India
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Taha A, Xu H, Ahmed R, Karim A, Meunier J, Paul A, Jawad A, Patel ML. Medical and economic burden of delirium on hospitalization outcomes of acute respiratory failure: A retrospective national cohort. Medicine (Baltimore) 2023; 102:e32652. [PMID: 36637939 PMCID: PMC9839276 DOI: 10.1097/md.0000000000032652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Although delirium in patients with acute respiratory failure (ARF) may evolve in any hospital setting, previous studies on the impact of delirium on ARF were restricted to those in the intensive care unit (ICU). The data about the impact of delirium on ARF hospitalizations outside of the ICU is limited. Therefore, we conducted the first national study to examine the effect-magnitude of delirium on ARF in all hospital settings, that is, in the ICU as well as on the general medical floor. We searched the 2016 and 2017 National Inpatient Sample databases for ARF hospitalizations and created "Delirium" and "No delirium" groups. The outcomes of interest were mortality, endotracheal intubation, length of stay (LOS), and hospitalization costs. We also aimed to explore any potential demographic, racial, or healthcare disparities that may be associated with the diagnosis of delirium among ARF patients. Multivariable logistic regression was used to control for demographics and comorbidities. Delirium was present in 12.7% of the sample. Racial disparities among African Americans were also significant. Delirious patients had more comorbidities, higher mortality, and intubation rates (17.5% and 9.2% vs 10.6% and 6.1% in the "No delirium" group [P < .001], respectively). Delirious patients had a longer LOS and higher hospitalization costs (5.9 days and $15,395 USD vs 3.7 days and $9393 USD in "No delirium" [P < .001], respectively). Delirium was associated with worse mortality (adjusted odds ratio 1.49, confidence interval [CI] = 1.41, 1.57), higher intubation rates (adjusted odds ratio 1.46, CI = 1.36, 1.56), prolonged LOS (adjusted mean ratio 1.40, CI = 1.37, 1.42), and increased hospitalization costs (adjusted mean ratio 1.49, CI = 1.46, 1.52). A racial disparity in the diagnosis of delirium among African Americans hospitalized with ARF was noted in our sample. Patients in small, non-teaching hospitals were diagnosed with delirium less frequently compared to large, urban, teaching centers. Delirium predicts worse mortality and morbidity for ARF patients, regardless of bed placement and severity of the respiratory failure.
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Affiliation(s)
- Ahmed Taha
- School of Medicine, Indiana University, Indianapolis, IN
- Department of Medicine, Deaconess Health System, Evansville, IN
- * Correspondence: Ahmed Taha, Deaconess Health System, 600 Mary St, Evansville, IN (e-mail: )
| | - Huiping Xu
- Department of Biostatistics and Health Data Science, School of Medicine, Indiana University, Indianapolis, IN
| | - Roaa Ahmed
- School of Medicine, Ahfad University for Women, Omdurman, Sudan
| | - Ahmad Karim
- Department of Medicine, Deaconess Health System, Evansville, IN
| | - John Meunier
- Department of Medicine, Deaconess Health System, Evansville, IN
| | - Amal Paul
- School of Medicine, Indiana University, Indianapolis, IN
- Department of Medicine, Deaconess Health System, Evansville, IN
| | - Ahmed Jawad
- School of Medicine, Indiana University, Indianapolis, IN
- Department of Pulmonary and Critical Care, Deaconess Health System, Evansville, IN
| | - Manish L. Patel
- Division of Pulmonary & Critical Care, Texas Tech University Health Sciences Center, Amarillo, TX
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Naar L, Maurer LR, Dorken Gallastegi A, El Hechi MW, Rao SR, Coughlin C, Ebrahim S, Kadambi A, Mendoza AE, Saillant NN, Renne BCB, Velmahos GC, Kaafarani HMA, Lee J. Hospital Academic Status and the Volume-Outcome Association in Postoperative Patients Requiring Intensive Care: Results of a Nationwide Analysis of Intensive Care Units in the United States. J Intensive Care Med 2022; 37:1598-1605. [PMID: 35437045 DOI: 10.1177/08850666221094506] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: To determine whether the outcomes of postoperative patients admitted directly to an intensive care unit (ICU) differ based on the academic status of the institution and the total operative volume of the unit. Methods: This was a retrospective analysis using the eICU Collaborative Research Database v2.0, a national database from participating ICUs in the United States. All patients admitted directly to the ICU from the operating room were included. Transfer patients and patients readmitted to the ICU were excluded. Patients were stratified based on admission to an ICU in an academic medical center (AMC) versus non-AMC, and to ICUs with different operative volume experience, after stratification in quartiles (high, medium-high, medium-low, and low volume). Primary outcomes were ICU and hospital mortality. Secondary outcomes included the need for continuous renal replacement therapy (CRRT) during ICU stay, ICU length of stay (LOS), and 30-day ventilator free days. Results: Our analysis included 22,180 unique patients; the majority of which (15,085[68%]) were admitted to ICUs in non-AMCs. Cardiac and vascular procedures were the most common types of procedures performed. Patients admitted to AMCs were more likely to be younger and less likely to be Hispanic or Asian. Multivariable logistic regression indicated no meaningful association between academic status and ICU mortality, hospital mortality, initiation of CRRT, duration of ICU LOS, or 30-day ventilator-free-days. Contrarily, medium-high operative volume units had higher ICU mortality (OR = 1.45, 95%CI = 1.10-1.91, p-value = 0.040), higher hospital mortality (OR = 1.33, 95%CI = 1.07-1.66, p-value = 0.033), longer ICU LOS (Coefficient = 0.23, 95%CI = 0.07-0.39, p-value = 0.038), and fewer 30-day ventilator-free-days (Coefficient = -0.30, 95%CI = -0.48 - -0.13, p-value = 0.015) compared to their high operative volume counterparts. Conclusions: This study found that a volume-outcome association in the management of postoperative patients requiring ICU level of care immediately after a surgical procedure may exist. The academic status of the institution did not affect the outcomes of these patients.
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Affiliation(s)
- Leon Naar
- Division of Trauma, Emergency Surgery & Surgical Critical Care, Department of Surgery, 2348Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Lydia R Maurer
- Division of Trauma, Emergency Surgery & Surgical Critical Care, Department of Surgery, 2348Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Ander Dorken Gallastegi
- Division of Trauma, Emergency Surgery & Surgical Critical Care, Department of Surgery, 2348Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Majed W El Hechi
- Division of Trauma, Emergency Surgery & Surgical Critical Care, Department of Surgery, 2348Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Sowmya R Rao
- MGH Biostatistics Center, Harvard Medical School; Department of Global Health, 27118Boston University School of Public Health, Boston, MA, USA
| | - Catherine Coughlin
- Division of Trauma, Emergency Surgery & Surgical Critical Care, Department of Surgery, 2348Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Senan Ebrahim
- Hikma Health, San Jose, CA, USA
- 1811Harvard Medical School, Boston, MA, USA
| | - Adesh Kadambi
- Hikma Health, San Jose, CA, USA
- 7938University of Toronto, Toronto, ON, USA
| | - April E Mendoza
- Division of Trauma, Emergency Surgery & Surgical Critical Care, Department of Surgery, 2348Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Noelle N Saillant
- Division of Trauma, Emergency Surgery & Surgical Critical Care, Department of Surgery, 2348Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - B Christian B Renne
- Division of Trauma, Emergency Surgery & Surgical Critical Care, Department of Surgery, 2348Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - George C Velmahos
- Division of Trauma, Emergency Surgery & Surgical Critical Care, Department of Surgery, 2348Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Haytham M A Kaafarani
- Division of Trauma, Emergency Surgery & Surgical Critical Care, Department of Surgery, 2348Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jarone Lee
- Division of Trauma, Emergency Surgery & Surgical Critical Care, Department of Surgery, 2348Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Department of Emergency Medicine, 2348Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Hildenbrand FF, Murray FR, von Känel R, Deibel AR, Schreiner P, Ernst J, Zipser CM, Böettger S. Predisposing and precipitating risk factors for delirium in gastroenterology and hepatology: Subgroup analysis of 718 patients from a hospital-wide prospective cohort study. Front Med (Lausanne) 2022; 9:1004407. [PMID: 36530904 PMCID: PMC9747774 DOI: 10.3389/fmed.2022.1004407] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 11/15/2022] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND AND AIMS Delirium is the most common acute neuropsychiatric syndrome in hospitalized patients. Higher age and cognitive impairment are known predisposing risk factors in general hospital populations. However, the interrelation with precipitating gastrointestinal (GI) and hepato-pancreato-biliary (HPB) diseases remains to be determined. PATIENTS AND METHODS Prospective 1-year hospital-wide cohort study in 29'278 adults, subgroup analysis in 718 patients hospitalized with GI/HPB disease. Delirium based on routine admission screening and a DSM-5 based construct. Regression analyses used to evaluate clinical characteristics of delirious patients. RESULTS Delirium was detected in 24.8% (178/718). Age in delirious patients (median 62 years [IQR 21]) was not different to non-delirious (median 60 years [IQR 22]), p = 0.45). Dementia was the strongest predisposing factor for delirium (OR 66.16 [6.31-693.83], p < 0.001). Functional impairment, and at most, immobility increased odds for delirium (OR 7.78 [3.84-15.77], p < 0.001). Patients with delirium had higher in-hospital mortality rates (18%; OR 39.23 [11.85-129.93], p < 0.001). From GI and HPB conditions, cirrhosis predisposed to delirium (OR 2.11 [1.11-4.03], p = 0.023), while acute renal failure (OR 4.45 [1.61-12.26], p = 0.004) and liver disease (OR 2.22 [1.12-4.42], p = 0.023) were precipitators. Total costs were higher in patients with delirium (USD 30003 vs. 10977; p < 0.001). CONCLUSION Delirium in GI- and HPB-disease was not associated with higher age per se, but with cognitive and functional impairment. Delirium needs to be considered in younger adults with acute renal failure and/or liver disease. Clinicians should be aware about individual risk profiles, apply preventive and supportive strategies early, which may improve outcomes and lower costs.
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Affiliation(s)
- Florian F. Hildenbrand
- Department of Gastroenterology and Hepatology, University Hospital, University of Zurich, Zurich, Switzerland
- Department of Gastroenterology and Hepatology, Stadtspital Zurich, Zurich, Switzerland
| | - Fritz R. Murray
- Department of Gastroenterology and Hepatology, University Hospital, University of Zurich, Zurich, Switzerland
- Department of Gastroenterology and Hepatology, Stadtspital Zurich, Zurich, Switzerland
| | - Roland von Känel
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, Zurich, Switzerland
| | - Ansgar R. Deibel
- Department of Gastroenterology and Hepatology, University Hospital, University of Zurich, Zurich, Switzerland
| | - Philipp Schreiner
- Department of Gastroenterology and Hepatology, University Hospital, University of Zurich, Zurich, Switzerland
| | - Jutta Ernst
- Center of Clinical Nursing Science, University of Zurich, University Hospital of Zurich, Zurich, Switzerland
| | - Carl M. Zipser
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, Zurich, Switzerland
- Department of Neurology and Neurophysiology, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Soenke Böettger
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, Zurich, Switzerland
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