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Chen M, Yang J, Hou H, Zheng B, Xia S, Wang Y, Yu J, Wu G, Sun H, Jia X, Ning H, Chang H, Zhang X, Yuan Y, Wang Z. Analysis of factors influencing hospitalization cost of patients with distal radius fractures: an empirical study based on public traditional Chinese medicine hospitals in two cities, China. BMC Health Serv Res 2024; 24:605. [PMID: 38720277 PMCID: PMC11080218 DOI: 10.1186/s12913-024-10953-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 04/04/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Distal radius fractures (DRFs) have become a public health problem for all countries, bringing a heavier economic burden of disease globally, with China's disease economic burden being even more acute due to the trend of an aging population. This study aimed to explore the influencing factors of hospitalization cost of patients with DRFs in traditional Chinese medicine (TCMa) hospitals to provide a scientific basis for controlling hospitalization cost. METHODS With 1306 cases of DRFs patients hospitalized in 15 public TCMa hospitals in two cities of Gansu Province in China from January 2017 to 2022 as the study object, the influencing factors of hospitalization cost were studied in depth gradually through univariate analysis, multiple linear regression, and path model. RESULTS Hospitalization cost of patients with DRFs is mainly affected by the length of stay, surgery and operation, hospital levels, payment methods of medical insurance, use of TCMa preparations, complications and comorbidities, and clinical pathways. The length of stay is the most critical factor influencing the hospitalization cost, and the longer the length of stay, the higher the hospitalization cost. CONCLUSIONS TCMa hospitals should actively take advantage of TCMb diagnostic modalities and therapeutic methods to ensure the efficacy of treatment and effectively reduce the length of stay at the same time, to lower hospitalization cost. It is also necessary to further deepen the reform of the medical insurance payment methods and strengthen the construction of the hierarchical diagnosis and treatment system, to make the patients receive reasonable reimbursement for medical expenses, thus effectively alleviating the economic burden of the disease in the patients with DRFs.
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Affiliation(s)
- Mengen Chen
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, 102400, China
- School of Management, Beijing University of Chinese Medicine, Beijing, 102400, China
| | - Jingyu Yang
- School of Health Management, Gansu University of Chinese Medicine, Lanzhou, 730000, China
- School of Public Health, Lanzhou University, Lanzhou, 730000, China
| | - Haojia Hou
- School of Public Health, Gansu University of Chinese Medicine, Lanzhou, 730000, China
| | - Baozhu Zheng
- School of Stomatology, Capital Medical University, Beijing, 100050, China
| | - Shiji Xia
- School of Management, Beijing University of Chinese Medicine, Beijing, 102400, China
| | - Yuhan Wang
- School of Management, Beijing University of Chinese Medicine, Beijing, 102400, China
| | - Jing Yu
- School of Management, Beijing University of Chinese Medicine, Beijing, 102400, China
| | - Guoping Wu
- School of Management, Beijing University of Chinese Medicine, Beijing, 102400, China
| | - Henong Sun
- School of Management, Beijing University of Chinese Medicine, Beijing, 102400, China
| | - Xuan Jia
- School of Management, Beijing University of Chinese Medicine, Beijing, 102400, China
| | - Hao Ning
- School of Management, Beijing University of Chinese Medicine, Beijing, 102400, China
| | - Hui Chang
- School of Management, Beijing University of Chinese Medicine, Beijing, 102400, China
| | - Xiaoxi Zhang
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, 102400, China
- School of Management, Beijing University of Chinese Medicine, Beijing, 102400, China
- Guang'anmen Hospital, China Academy of Chinese Medicine Sciences, Beijing, 100053, China
| | - Youshu Yuan
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, 102400, China
- School of Management, Beijing University of Chinese Medicine, Beijing, 102400, China
| | - Zhiwei Wang
- School of Management, Beijing University of Chinese Medicine, Beijing, 102400, China.
- National Institute of Chinese Medicine Development and Strategy, Beijing, 102400, China.
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Boel S, Vinther A, Hansen AØ, Juhl CB, Landgren M, Jacobsen NS, Paulsen CP, Jørgensen CT, Kristensen HK. Factors influencing functioning after volar locking plate fixation of distal radius fractures: a scoping review of 148 studies. Acta Orthop 2023; 94:280-286. [PMID: 37293983 PMCID: PMC10253938 DOI: 10.2340/17453674.2023.13431] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 04/23/2023] [Indexed: 06/10/2023] Open
Abstract
BACKGROUND AND PURPOSE A better understanding of factors that influence functioning may improve the identification of patients with distal radius fractures (DRFs) who need hand therapy. The purpose of this scoping review was to provide a comprehensive overview of factors that have been evaluated for their influence on hand functioning following volar plate fixation of DRFs. MATERIAL AND METHODS 6 databases were searched from 2005 to 2021 for publications regarding surgical treatment for a DRF with a volar locking plate. Included studies evaluated demographic, perioperative, and postoperative factors within the 6 weeks post-surgery for their influence on functioning at least 3 months post-surgery. Functioning was assessed with patient-reported outcome measures. The factors were categorized into themes and mapped to the International Classification of Functioning, Disability and Health (ICF). RESULTS 148 studies were included. 708 factors were categorized into 39 themes (e.g. pain) and mapped to the ICF components. The themes were primarily mapped to "body functions and structures" (n = 26) and rarely to "activities and participation" (n = 5). Fracture type (n = 40), age (n = 38), and sex (n = 22) were the most frequently evaluated factors. CONCLUSION This scoping review identified an extensive number of factors evaluated within 6 weeks after surgery for their influence on functioning at least 3 months after volar plate fixation of a DRF and the existing research has primarily evaluated factors related to "body functions and structures," with limited focus on factors related to "activities and participation."
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Affiliation(s)
- Susanne Boel
- Department of Physiotherapy and Occupational Therapy, Copenhagen University Hospital, Herlev and Gentofte; Department of Clinical Research, University of Southern Denmark, Odense; Centre for Innovative Medical Technology, Odense University Hospital, Odense.
| | - Anders Vinther
- Department of Physiotherapy and Occupational Therapy, Copenhagen University Hospital, Herlev and Gentofte; Hospital Secretariat and Communications, Research, Herlev and Gentofte, Copenhagen University Hospital
| | - Alice Ø Hansen
- Department of Clinical Research, University of Southern Denmark, Odense; Department of Orthopedic Surgery and Traumatology, Odense University Hospital, Odense
| | - Carsten B Juhl
- Department of Physiotherapy and Occupational Therapy, Copenhagen University Hospital, Herlev and Gentofte; Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense
| | - Marcus Landgren
- Department of Orthopedic Surgery, Hand Surgery Unit, Herlev and Gentofte, Copenhagen University Hospital; Department of Evidence-Based Medicine (EBM), Danish Health Authority, Copenhagen
| | - Nicolaj S Jacobsen
- Department of Orthopedic Surgery and Traumatology, Odense University Hospital, Odense
| | - Camilla P Paulsen
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen
| | | | - Hanne Kaae Kristensen
- Department of Clinical Research, University of Southern Denmark, Odense; Centre for Innovative Medical Technology, Odense University Hospital, Odense; Health Sciences Research Centre, UCL University College, Odense, Denmark
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Freidl M, Wegerer M, Litvan Z, König D, Alexandrowicz RW, Portela-Millinger F, Gruber M. Determinants of quality of life improvements in anxiety and depressive disorders-A longitudinal study of inpatient psychotherapy. Front Psychiatry 2022; 13:937194. [PMID: 36590609 PMCID: PMC9798124 DOI: 10.3389/fpsyt.2022.937194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 11/21/2022] [Indexed: 12/23/2022] Open
Abstract
Background Quality of life (QoL) is substantially impaired in patients with anxiety disorders (AD) and depressive disorders (DD) and improvements in symptom burden after psychotherapy are not always paralleled by similar improvements in QoL. So far, little is known about treatment outcome in terms of QoL and predictors of QoL improvements following inpatient psychotherapy with a focus on cognitive behavior therapy (CBT). The current study aimed at investigating the relationship between changes in symptoms and QoL across different life domains. Additionally, predictors of a positive treatment outcome were evaluated. Methods 122 patients with AD and/or DD undergoing an 8-weeks inpatient CBT program completed self-report measures of psychopathological symptoms and QoL at pre- and post-treatment. Mixed effects models were used to investigate changes, a confirmatory factor analysis was applied to analyze the latent factor structure of the anxiety sensitivity index and binary logistic regression analyses were performed for predictors of QoL improvements. Results Patients showed moderate to strong decreases in anxious and depressive symptoms and moderate to strong improvements in general QoL, particularly in the psychological and physical QoL subdomains. Changes in symptom burden correlated most strongly with psychological and physical QoL. In addition, poor QoL before treatment and low levels of specific anxiety sensitivity symptoms (items 1 and 5) significantly predicted improvement in QoL. Conclusion Patients with poor QoL who are not as inhibited to openly express their anxious feelings particularly benefit from inpatient psychotherapy (individual and group) to improve their QoL. In contrast, our research suggests that patients who are too anxious to openly express their nervousness should receive additional social skills training, more focused treatment to build sufficient self-confidence to better engage in the treatment program.
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Affiliation(s)
- Marion Freidl
- Clinical Division of Social Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Melanie Wegerer
- Clinical Division of Social Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Zsuzsa Litvan
- Clinical Division of Social Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Daniel König
- Clinical Division of Social Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | | | - Filipe Portela-Millinger
- Clinical Division of Social Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Maria Gruber
- Clinical Division of Social Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
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Giladi AM, Giberson-Chen CC, Parker AM, Desale S, Rozental TD. Adhering to Radiographic Clinical Practice Guidelines for Distal Radial Fracture Management Is Associated with Improved Outcomes and Lower Costs. J Bone Joint Surg Am 2019; 101:1829-1837. [PMID: 31626007 DOI: 10.2106/jbjs.18.01245] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The American Academy of Orthopaedic Surgeons Clinical Practice Guideline on the Treatment of Distal Radius Fractures has not been evaluated in clinical practice. We hypothesized that adhering to the distal radial fracture radiographic clinical practice guideline (CPG) improves outcomes and reduces costs. METHODS We reviewed 266 patients with distal radial fractures treated at 1 institution. Based on CPG radiographic parameters (Recommendation 3), care was rated as "appropriate" or "inappropriate." QuickDASH (an abbreviated version of the Disabilities of the Arm, Shoulder and Hand [DASH] questionnaire) scores were collected. The direct costs of distal radial fracture care were determined. Descriptive statistics and nonparametric tests were used to evaluate demographic characteristics and outcomes across groups. QuickDASH scores, grouped by postoperative time interval, were analyzed using linear mixed effect models to predict outcome trends. RESULTS In this study, 145 patients in the operative treatment group and 121 patients in the nonoperative treatment group were included. Of the 145 patients in the operative treatment group, 6 underwent an inappropriate surgical procedure, limiting any analyses of that group. Of the 121 patients in the nonoperative treatment group, 68 were treated inappropriately. For the patients in the nonoperative treatment group, appropriate care provided a significant outcome benefit by 1 year; the median QuickDASH score was 10.1 points for the appropriate treatment group and 19.5 points for the inappropriate treatment group (p = 0.05). The total direct costs for inappropriate nonoperative treatment were, on average, 60% higher than appropriate nonoperative treatment. In predictive models, patients with appropriate care in the operative treatment group and the nonoperative treatment group had better outcomes than patients with inappropriate nonoperative treatment at all time points after 29 days. CONCLUSIONS When nonoperative distal radial fracture management was aligned with radiographic CPG criteria, patients in our cohort had improved patient-reported outcomes with lower costs. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Aviram M Giladi
- The Curtis National Hand Center, MedStar Union Memorial Hospital, Baltimore, Maryland
| | - Carew C Giberson-Chen
- Department of Orthopedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Amber M Parker
- Department of Orthopedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Sameer Desale
- Department of Biostatistics and Bioinformatics, MedStar Health Research Institute, Hyattsville, Maryland
| | - Tamara D Rozental
- Department of Orthopedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
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