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Estimate of the Costs Caused by Adverse Effects in Hospitalised Patients Due to Hip Fracture: Design of the Study and Preliminary Results. Geriatrics (Basel) 2018; 3:geriatrics3010007. [PMID: 31011055 PMCID: PMC6371163 DOI: 10.3390/geriatrics3010007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 02/08/2018] [Accepted: 02/09/2018] [Indexed: 01/02/2023] Open
Abstract
Introduction: Hip fracture is a health problem that presents high morbidity and mortality, negatively influencing the patient’s quality of life and generating high costs. Structured analysis of quality indicators can facilitate decision-making, cost minimization, and improvement of the quality of care. Methods: We studied 1571 patients aged 70 years and over with the diagnosis of hip fracture at Hospital Universitario de la Ribera in the period between 1 January 2012 and 31 December 2016. Demographic, clinical, functional, and quality indicator variables were studied. An indirect analysis of the costs associated with adverse events arising during hospital admission was made. A tool based on the “Minimum Basic Data Set (CMBD)” was designed to monitor the influence of patient risk factors on the incidence of adverse effects (AE) and their associated costs. Results: The average age of the patients analysed was 84.15 years (SD 6.28), with a length of stay of 8.01 days (SD 3.32), a mean preoperative stay of 43.04 h (SD 30.81), and a mortality rate of 4.2%. Likewise, the percentage of patients with AE was 41.44%, and 11.01% of patients changed their cost as a consequence of these AEs suffered during hospital admission. The average cost of patients was €8752 (SD: 1,864) and the average cost increase in patients with adverse events was €2321 (SD: 3,164). Conclusions: Through the analysis of the main clinical characteristics and the indirect estimation of the complexity of the patients, a simple calculation of the average cost of the attention and its adverse events can be designed in patients who are admitted due to hip fracture. Additionally, this tool can fit the welfare quality indicators by severity and cost.
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Huguenin FM, Pinheiro RS, Almeida RMVR, Infantosi AFC. Characterization of the variation of health care taking into account the costs of hospital admissions for acute myocardial infarction in Brazilian Unified Health System. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2016; 19:229-42. [PMID: 27532748 DOI: 10.1590/1980-5497201600020002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Accepted: 09/24/2015] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION The global epidemiologic scenario indicates an increase in cardiovascular disease rates, with special emphasis on acute myocardial infarction (AMI), owing to its large magnitude and severity. In Brazil, coronary diseases now account for about 5% of hospital admission expenditures. OBJECTIVE To characterize the admissions in the Brazilian Unified Health System of patients with AMI, by identifying clusters suggested by a traditional cluster analysis and by a multiple correspondence analysis (MCA). METHODS The records of the Hospital Information System/Brazilian Unified Health System with a primary diagnosis of AMI in the State of Rio de Janeiro, Brazil, 2002, were selected and subsequently related to the records of the Mortality Information System. Next, an MCA and a metric called the tolerance distance were used for cluster identification. The variable of interest was "hospital expenditures", classified into two categories (above and below BRL 905). RESULTS "Higher costs" were associated with "use of the Intensive Care Unit (ICU)" and "moderate severity of the case" and "lower costs" with "low severity" and "nonuse of the ICU". On the other hand, high severity cases, with no apparent association with "use of ICU" or other categories. Other associations identified were "lower costs" and "no displacement of the patient," "female," "age between 56 and 75 years," "death within 30 days," and "death within 1 year". CONCLUSIONS The nonclustered characteristic of the most serious cases and the association between "deaths" and "lower costs" suggests that the technological resources available during hospitalization for AMI are not being properly used.
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Affiliation(s)
- Felipe Machado Huguenin
- Programa de Engenharia Biomédica, Instituto Alberto Luiz Coimbra de Pós-graduação e Pesquisa de Engenharia, Universidade Federal do Rio de Janeiro - Rio de Janeiro (RJ), Brasil
| | - Rejane Sobrino Pinheiro
- Instituto de Estudos em Saúde Coletiva, Universidade Federal do Rio de Janeiro - Rio de Janeiro (RJ), Brasil
| | - Renan Moritz Varnier Rodrigues Almeida
- Programa de Engenharia Biomédica, Instituto Alberto Luiz Coimbra de Pós-graduação e Pesquisa de Engenharia, Universidade Federal do Rio de Janeiro - Rio de Janeiro (RJ), Brasil
| | - Antonio Fernando Catelli Infantosi
- Programa de Engenharia Biomédica, Instituto Alberto Luiz Coimbra de Pós-graduação e Pesquisa de Engenharia, Universidade Federal do Rio de Janeiro - Rio de Janeiro (RJ), Brasil
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Gili M, Ramírez G, Béjar L, López J, Franco D, Sala J. Trastornos por cocaína e infarto agudo de miocardio, prolongación de estancias y exceso de costes hospitalarios. Rev Esp Cardiol 2014. [DOI: 10.1016/j.recesp.2013.11.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Gili M, Ramírez G, Béjar L, López J, Franco D, Sala J. Cocaine use disorders and acute myocardial infarction, excess length of hospital stay and overexpenditure. ACTA ACUST UNITED AC 2014; 67:545-51. [PMID: 24952394 DOI: 10.1016/j.rec.2013.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Accepted: 11/06/2013] [Indexed: 11/29/2022]
Abstract
INTRODUCTION AND OBJECTIVES To investigate the relationship between the prevalence of cocaine use disorders and acute myocardial infarction in patients aged ≥ 18 years and to estimate the influence of cocaine use disorders on mortality, excess length of stay, and overexpenditure among hospitalized patients with acute myocardial infarction. METHODS Retrospective study of the minimum basic data set of 87 Spanish hospitals from 2008 to 2010. RESULTS Among 5 575 325 admissions reviewed, there were 24 126 patients with cocaine use disorders and 79 076 cases of acute myocardial infarction. The incidence of acute myocardial infarction among patients with cocaine use disorders increased with age and reached a peak at 55 years to 64 years (P < .0001). Multivariate analysis showed that cocaine use disorders were more prevalent among patients with acute myocardial infarction independently of age, sex, other addictive disorders, and 30 other comorbidities (odds ratio = 3.0). Among patients with acute myocardial infarction, those with cocaine use disorders did not show an increase of in-hospital death, but did show excess length of hospital stay (1.5 days) and overexpenditure (382 euros). CONCLUSIONS Cocaine use disorders are associated with acute myocardial infarction and increase the length of hospital stay and overexpenditure among acute myocardial infarction patients. Cessation of cocaine use among these patients should be one of the primary therapeutic goals after hospital discharge.
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Affiliation(s)
- Miguel Gili
- Unidad de Gestión Clínica de Medicina Preventiva, Vigilancia y Promoción de la Salud, Hospital Universitario Virgen Macarena, Seville, Spain; Departamento de Medicina Preventiva y Salud Pública, Universidad de Sevilla, Seville, Spain.
| | - Gloria Ramírez
- Unidad de Gestión Clínica de Medicina Preventiva, Vigilancia y Promoción de la Salud, Hospital Universitario Virgen Macarena, Seville, Spain; Departamento de Medicina Preventiva y Salud Pública, Universidad de Sevilla, Seville, Spain
| | - Luis Béjar
- Departamento de Medicina Preventiva y Salud Pública, Universidad de Sevilla, Seville, Spain
| | - Julio López
- Unidad de Gestión Clínica de Medicina Preventiva, Vigilancia y Promoción de la Salud, Hospital Universitario Virgen Macarena, Seville, Spain; Departamento de Medicina Preventiva y Salud Pública, Universidad de Sevilla, Seville, Spain
| | - Dolores Franco
- Unidad de Gestión Clínica de Salud Mental, Hospital Universitario Virgen Macarena, Seville, Spain; Departamento de Psiquiatría, Universidad de Sevilla, Seville, Spain
| | - José Sala
- Servicio de Documentación Clínica, Hospital Universitario Virgen Macarena, Seville, Spain
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Modelos de ajuste de riesgo para la evaluación de la mortalidad hospitalaria. Med Clin (Barc) 2011; 136:271-2. [DOI: 10.1016/j.medcli.2010.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2010] [Accepted: 02/04/2010] [Indexed: 11/20/2022]
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Zapatero Gaviria A, Barba Martín R, Canora Lebrato J, Losa García JE, Plaza Canteli S, Marco Martínez J. Mortalidad en los servicios de medicina interna. Med Clin (Barc) 2010; 134:6-12. [DOI: 10.1016/j.medcli.2009.04.050] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2009] [Accepted: 04/01/2009] [Indexed: 10/20/2022]
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Fernández-Quero M, Romero-Rodríguez N, Jiménez Díaz J, Ballesteros-Prada S. [Precordial ST-elevation in isolated right ventricular infarction: an unusual electrocardiographic presentation]. Med Clin (Barc) 2009; 133:767. [PMID: 19361816 DOI: 10.1016/j.medcli.2009.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2008] [Accepted: 02/05/2009] [Indexed: 11/25/2022]
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Hospital admissions for meningococcal infection in Spain (1997–2005). J Infect 2009; 58:15-20. [DOI: 10.1016/j.jinf.2008.10.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2008] [Revised: 10/22/2008] [Accepted: 10/25/2008] [Indexed: 11/20/2022]
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Ribera A, Marsal JR, Ferreira-González I, Cascant P, Pons JM, Mitjavila F, Salas T, Permanyer-Miralda G. Predicción de la mortalidad hospitalaria en la cirugía de derivación aortocoronaria mediante datos administrativos: comparación con un estudio observacional prospectivo. Rev Esp Cardiol 2008. [DOI: 10.1157/13124995] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Graciani A, Clemencia Zuluaga-Zuluaga M, Banegas JR, María León-Muñoz L, de la Cruz JJ, Rodríguez-Artalejo F. Mortalidad cardiovascular atribuible a la presión arterial elevada en la población española de 50 años o más. Med Clin (Barc) 2008; 131:125-9. [DOI: 10.1157/13124098] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Trujillano J, Sarria-Santamera A, Esquerda A, Badia M, Palma M, March J. Aproximación a la metodología basada en árboles de decisión (CART). Mortalidad hospitalaria del infarto agudo de miocardio. GACETA SANITARIA 2008; 22:65-72. [DOI: 10.1157/13115113] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Ruiz-Bailén M, Macías-Guaras I, Rucabado-Aguilar L, Torres-Ruiz JM, Castillo-Rivera AM, Pintor Mármol A, Expósito Ruiz M, Benitez-Parejo J, Rodríguez-García JJ, Ramos-Cuadra JA, García-Alcántara A, Macías-Guarasa J. [Mean length of stay and prognosis in unstable angina. Results from the ARIAM database]. Med Clin (Barc) 2007; 128:281-90; quiz 3 p following 320. [PMID: 17338861 DOI: 10.1157/13099578] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND OBJECTIVE The objective of this project is to investigate the factors predicting mortality and mean length of stay in patients diagnosed with unstable angina (UA) during admission to the Intensive Care Unit or Critical Care Unit (ICU/CCU). PATIENTS AND METHOD A retrospective cohort study including all the UA patients listed in the Spanish ARIAM register. The study period comprised from June, 1996 to December, 2003. The follow-up period is limited to the stay in the ICU/CCU. One univariate analysis was performed between deceased and live patients; and another between prolonged and non-prolonged stay patients. Three multivariate analyses were also performed; one to evaluate the factors related to mortality, another to evaluate the variables associated to percutaneous coronary intervention (PCI) and another to evaluate the factors associated to the prolonged mean stay in ICU/CCU. RESULTS 14,096 patients with UA were included in the study. The UA mortality rate during ICU/CCU admission was 1.1%. Mortality was associated to Killip classification, age, the need for CPR, development of cardiogenic shock, development of arrhythmia (such as VF, sinus tachycardia or high-degree atrioventricular block) and diabetes; whereas patients who smoke were associated to a lower mortality rate. PCI was only performed in 1,226 patients (8.9%), increasing over the years. The PCI-predicting variables were: age, being referred from another hospital, smoking, presenting prior acute myocardial infarction (AMI), complications consisting of cardiogenic shock or high-degree atrioventricular block and being treated with oral beta blockers. The mean length of stay in ICU/CCU was 3.15 (18.65) days (median, 2 days), depending on age, a coronariography having previously been performed, the Killip classification, having required coronariography and PCI or echocardiography or mechanical ventilation, and presenting complications such as angina that is difficult to control, arrhythmia, right ventricular failure or death. CONCLUSIONS The factors are associated to mortality were; greater age, diabetes, Killip classification, arrhythmia, cardiogenic shock and the need for CPR, whereas smoking is associated to a lower mortality rate. The patients on whom PCI was performed represent a less severe population. Management has changed over the years, with an increase in PCI. A prolonged mean length of stay is associated to the appearance of arrhythmia, right or left heart failure, angina that is difficult to control, age and PCI.
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Affiliation(s)
- Manuel Ruiz-Bailén
- Unidad de Cuidados Intensivos, Servicio de Cuidados Críticos y Urgencias, Hospital Universitario Médico-Quirúrgico, Complejo Hospitalario, Jaén, España.
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Barba R, Losa JE, Guijarro C, Zapatero A. [Reliability of minimal basic data set in the diagnosis of thromboembolic disease]. Med Clin (Barc) 2006; 127:255-7. [PMID: 16942729 DOI: 10.1157/13091266] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- Raquel Barba
- Unidad de Medicina Interna, Fundación Hospital Alcorcón, Alcorcón, Madrid, Spain.
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Iñigo J, Sendra JM, Díaz R, Bouza C, Sarría-Santamera A. Epidemiología y costes de la sepsis grave en Madrid. Estudio de altas hospitalarias. Med Intensiva 2006; 30:197-203. [PMID: 16938192 DOI: 10.1016/s0210-5691(06)74507-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND AND OBJECTIVE Severe sepsis is a complex syndrome to define, diagnose and treat. This population-based study describes the epidemiology of sepsis in the Region of Madrid, estimates its incidence and mortality, and assesses its impact on hospital stays and costs. PATIENTS AND METHODS The source of information was the Minimum Basic Hospital Data Set from the Region of Madrid in 2001. Severe sepsis cases were defined as discharges with a combination of organic failure and presence or suspicion of infection through a combination of codes previously proposed and utilized. A descriptive study was performed, incidence rates were calculated, lengths of stay and costs were estimated, and mortality was analyzed. RESULTS 6,968 episodes were identified. Mean age was 62.5 year. 59.7% were male. Annual incidence was 14.1/10,000 inhabitants, being highest for those 84 and older (230.8/10,000). 1.7 infections per episode were detected. More frequently identified microorganisms were Streptococcus sp., Staphylococcus sp., Escherichia coli and Candida sp. The most frequent organic dysfunctions were renal (39.7%) and respiratory (35.7%). Mortality was 33%. Mortality was higher in cases with more than one organic failure, hepatic dysfunction or cancer. Mean length of stay was 28.9 day. Annual overall costs were 70 million euros. CONCLUSIONS Severe sepsis is a frequent process, with a high mortality and a significant impact on health care resource utilization.
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Affiliation(s)
- J Iñigo
- Consejería de Sanidad y Consumo. Madrid, España
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Xavier Borrás-Pérez F. Bases de datos administrativas en el análisis clínico de la cardiopatía isquémica. Med Clin (Barc) 2005; 125:659-60. [PMID: 16324495 DOI: 10.1157/13081765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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