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Havranek MM, Ondrej J, Bollmann S, Widmer PK, Spika S, Boes S. Identification and assessment of a comprehensive set of structural factors associated with hospital costs in Switzerland. PLoS One 2022; 17:e0264212. [PMID: 35176112 PMCID: PMC8853497 DOI: 10.1371/journal.pone.0264212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 02/05/2022] [Indexed: 11/20/2022] Open
Abstract
Structural factors can influence hospital costs beyond case-mix differences. However, accepted measures on how to distinguish hospitals with regard to cost-related organizational and regional differences are lacking in Switzerland. Therefore, the objective of this study was to identify and assess a comprehensive set of hospital attributes in relation to average case-mix adjusted costs of hospitals. Using detailed hospital and patient-level data enriched with regional information, we derived a list of 23 cost predictors, examined how they are associated with costs, each other, and with different hospital types, and identified principal components within them. Our results showed that attributes describing size, complexity, and teaching-intensity of hospitals (number of beds, discharges, departments, and rate of residents) were positively related to costs and showed the largest values in university (i.e., academic teaching) and central general hospitals. Attributes related to rarity and financial risk of patient mix (ratio of rare DRGs, ratio of children, and expected loss potential based on DRG mix) were positively associated with costs and showed the largest values in children's and university hospitals. Attributes characterizing the provision of essential healthcare functions in the service area (ratio of emergency/ ambulance admissions, admissions during weekends/ nights, and admissions from nursing homes) were positively related to costs and showed the largest values in central and regional general hospitals. Regional attributes describing the location of hospitals in large agglomerations (in contrast to smaller agglomerations and rural areas) were positively associated with costs and showed the largest values in university hospitals. Furthermore, the four principal components identified within the hospital attributes fully explained the observed cost variations across different hospital types. These uncovered relationships may serve as a foundation for objectifying discussions about cost-related heterogeneity in Swiss hospitals and support policymakers to include structural characteristics into cost benchmarking and hospital reimbursement.
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Affiliation(s)
- Michael M. Havranek
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Josef Ondrej
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Stella Bollmann
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | | | - Simon Spika
- University Hospital Zurich, Zurich, Switzerland
| | - Stefan Boes
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
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Duszynska W, Rosenthal VD, Szczesny A, Zajaczkowska K, Fulek M, Tomaszewski J. Device associated -health care associated infections monitoring, prevention and cost assessment at intensive care unit of University Hospital in Poland (2015-2017). BMC Infect Dis 2020; 20:761. [PMID: 33066740 PMCID: PMC7562760 DOI: 10.1186/s12879-020-05482-w] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 10/06/2020] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Device-associated health care-associated infections (DA-HAIs) in intensive care unit (ICU) patients constitute a major therapeutic issue complicating the regular hospitalisation process and having influence on patients' condition, length of hospitalisation, mortality and therapy cost. METHODS The study involved all patients treated > 48 h at ICU of the Medical University Teaching Hospital (Poland) from 1.01.2015 to 31.12.2017. The study showed the surveillance and prevention of DA-HAIs on International Nosocomial Infection Control Consortium (INICC) Surveillance Online System (ISOS) 3 online platform according to methodology of the INICC multidimensional approach (IMA). RESULTS During study period 252 HAIs were found in 1353 (549F/804M) patients and 14,700 patient-days of hospitalisation. The crude infections rate and incidence density of DA-HAIs was 18.69% and 17.49 ± 2.56 /1000 patient-days. Incidence density of ventilator-associated pneumonia (VAP), central line-associated bloodstream infection (CLA-BSI) and catheter-associated urinary tract infection (CA-UTI) per 1000 device-days were 12.63 ± 1.49, 1.83 ± 0.65 and 6.5 ± 1.2, respectively. VAP(137) constituted 54.4% of HAIs, whereas CA-UTI(91) 36%, CLA-BSI(24) 9.6%.The most common pathogens in VAP and CA-UTI was multidrug-resistant (MDR) Acinetobacter baumannii (57 and 31%), and methicillin-resistant Staphylococcus epidermidis (MRSE) in CLA-BSI (45%). MDR Gram negative bacteria (GNB) 159 were responsible for 63.09% of HAIs. The length of hospitalisation of patients with a single DA-HAI at ICU was 21(14-33) days, while without infections it was 6.0 (3-11) days; p = 0.0001. The mortality rates in the hospital-acquired infection group and no infection group were 26.1% vs 26.9%; p = 0.838; OR 0.9633;95% CI (0.6733-1.3782). Extra cost of therapy caused by one ICU acquired HAI was US$ 11,475/Euro 10,035. Hand hygiene standards compliance rate was 64.7%, while VAP, CLA-BSI bundles compliance ranges were 96.2-76.8 and 29-100, respectively. CONCLUSIONS DA-HAIs was diagnosed at nearly 1/5 of patients. They were more frequent than in European Centre Disease Control report (except for CLA-BSI), more frequent than the USA CDC report, yet less frequent than in limited-resource countries (except for CA-UTI). They prolonged the hospitalisation period at ICU and generated substantial additional costs of treatment with no influence on mortality. The Acinetobacter baumannii MDR infections were the most problematic therapeutic issue. DA-HAIs preventive methods compliance rate needs improvement.
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Affiliation(s)
- Wieslawa Duszynska
- Department and Clinic of Anaesthesiology and Intensive Therapy, Wroclaw Medical University, L.Pasteura Street 1, 50-367 Wroclaw, Poland
| | | | - Aleksander Szczesny
- Department and Clinic of Anaesthesiology and Intensive Therapy, Wroclaw Medical University, L.Pasteura Street 1, 50-367 Wroclaw, Poland
| | - Katarzyna Zajaczkowska
- The Students Scientific Association by Department and Clinic of Anaesthesiology and Intensive Therapy, Wroclaw, Poland
| | - Michal Fulek
- The Students Scientific Association by Department and Clinic of Anaesthesiology and Intensive Therapy, Wroclaw, Poland
| | - Jacek Tomaszewski
- The Students Scientific Association by Department and Clinic of Anaesthesiology and Intensive Therapy, Wroclaw, Poland
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Soni A, Smith BS, Scornavacca T, McElnea B, Shakman A, Dickson E, McManus DD. Association of Use of an Integrated Specialty Pharmacy With Total Medical Expenditures Among Members of an Accountable Care Organization. JAMA Netw Open 2020; 3:e2018772. [PMID: 33021648 PMCID: PMC7539116 DOI: 10.1001/jamanetworkopen.2020.18772] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
This cohort study examines the association of integrated specialty pharmacy use among members of a university hospital accountable care organization (ACO) with total medical expenditure.
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Affiliation(s)
- Apurv Soni
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester
| | | | - Thomas Scornavacca
- Office of Clinical Integration, UMass Memorial Health Care, Worcester, Massachusetts
| | - Bill McElnea
- Shields Health Solutions, Stoughton, Massachusetts
| | - Alice Shakman
- Clinical Services, UMass Memorial Medical Center, Worcester, Massachusetts
| | - Eric Dickson
- Department of Emergency Medicine, University of Massachusetts Medical School, Worcester
| | - David D. McManus
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester
- Department of Cardiovascular Medicine, University of Massachusetts Medical School, Worcester
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Tamburrano A, Vallone D, Carrozza C, Urbani A, Sanguinetti M, Nicolotti N, Cambieri A, Laurenti P. Evaluation and cost estimation of laboratory test overuse in 43 commonly ordered parameters through a Computerized Clinical Decision Support System (CCDSS) in a large university hospital. PLoS One 2020; 15:e0237159. [PMID: 32760101 PMCID: PMC7410244 DOI: 10.1371/journal.pone.0237159] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 07/21/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Computerized Clinical Decision Support Systems (CCDSS) have become increasingly important in ensuring patient safety and supporting all phases of clinical decision making. The aim of this study is to evaluate, through a CCDSS, the rate of the laboratory tests overuse and to estimate the cost of the inappropriate requests in a large university hospital. METHOD In this observational study, hospital physicians submitted the examination requests for the inpatients through a Computerized Physician Order Entry. Violations of the rules in tests requests were intercepted and counted by a CCDSS, over a period of 20 months. Descriptive and inferential statistics (Student's t-test and ANOVA) were made. Finally, the monthly comprehensive cost of the laboratory tests was calculated. RESULTS During the observation period a total of 5,716,370 requests were analyzed and 809,245 violations were counted. The global rate of overuse was 14.2% ± 3.0%. The most inappropriate exams were Alpha Fetoprotein (85.8% ± 30.5%), Chlamydia trachomatis Nucleic Acid Amplification (48.7% ± 8.8%) and Alkaline Phosphatase (20.3% ± 6.5%). The monthly cost of over-utilization was 56,534€ for basic panel, 14,421€ for coagulation, 4,758€ for microbiology, 432€ for immunology exams. All the exams, generated an estimated avoidable cost of 1,719,337€ (85,967€ per month) for the hospital. CONCLUSIONS The study confirms the wide variability in over-utilization rates of laboratory tests. For these reasons, the real impact of inappropriateness is difficult to assess, but the generated costs for patients, hospitals and health systems are certainly high and not negligible. It would be desirable for international medical communities to produce a complete panel of prescriptive rules for all the most common laboratory exams that is useful not only to reduce costs, but also to ensure standardization and high-quality care.
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Affiliation(s)
- Andrea Tamburrano
- Section of Hygiene - Institute of Public Health, Università Cattolica del Sacro Cuore, Roma, Italia
| | - Doriana Vallone
- Section of Hygiene - Institute of Public Health, Università Cattolica del Sacro Cuore, Roma, Italia
| | - Cinzia Carrozza
- Unit of Biochemical Chemistry and Clinical Molecular Biology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia
| | - Andrea Urbani
- Unit of Biochemical Chemistry and Clinical Molecular Biology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia
| | - Maurizio Sanguinetti
- Department of Laboratory Sciences and Infectious Diseases, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia
| | - Nicola Nicolotti
- Hospital Health Management, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia
| | - Andrea Cambieri
- Hospital Health Management, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia
| | - Patrizia Laurenti
- Section of Hygiene - Institute of Public Health, Università Cattolica del Sacro Cuore, Roma, Italia
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O'Shea J, Ewings C, Corbett M, McGovern R, O'Shea M, Hatton S, O'Connor M. The Cost Efficiency of an Online Echocardiography Booking System. Ir Med J 2020; 113:29. [PMID: 32407014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- J O'Shea
- Division of Ageing and Therapeutics, Mid-West Regional Hospital, Co. Limerick
| | - C Ewings
- Division of Ageing and Therapeutics, Mid-West Regional Hospital, Co. Limerick
| | - M Corbett
- Division of Ageing and Therapeutics, Mid-West Regional Hospital, Co. Limerick
| | - R McGovern
- Division of Ageing and Therapeutics, Mid-West Regional Hospital, Co. Limerick
| | - M O'Shea
- Division of Ageing and Therapeutics, Mid-West Regional Hospital, Co. Limerick
| | - S Hatton
- Division of Ageing and Therapeutics, Mid-West Regional Hospital, Co. Limerick
| | - M O'Connor
- Division of Ageing and Therapeutics, Mid-West Regional Hospital, Co. Limerick
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Munyaneza M, Jayaraman S, Ntirenganya F, Rickard J. Factors Influencing Seeking and Reaching Care in Patients With Peritonitis in Rwanda. J Surg Res 2019; 246:236-242. [PMID: 31610351 DOI: 10.1016/j.jss.2019.09.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 08/29/2019] [Accepted: 09/13/2019] [Indexed: 01/09/2023]
Abstract
BACKGROUND Peritonitis is an emergency which frequently requires surgical intervention. The aim of this study was to describe factors influencing seeking and reaching care for patients with peritonitis presenting to a tertiary referral hospital in Rwanda. METHODS This was a cross-sectional study of patients with peritonitis admitted to University Teaching Hospital of Kigali. Data were collected on demographics, prehospital course, and in-hospital management. Delays were classified according to the Three Delays Model as delays in seeking or reaching care. Chi square test and logistic regression were used to determine associations between delayed presentation and various factors. RESULTS Over a 9-month period, 54 patients with peritonitis were admitted. Twenty (37%) patients attended only primary school and 15 (28%) never went to school. A large number (n = 26, 48%) of patients were unemployed and most (n = 45, 83%) used a community-based health insurance. For most patients (n = 44, 81%), the monthly income was less than 10,000 Rwandan francs (RWF) (11.90 U.S. Dollars [USD]). Most (n = 51, 94%) patients presented to the referral hospital with more than 24 h of symptoms. More than half (n = 31, 60%) of patients had more than 4 d of symptoms on presentation. Most (n = 37, 69%) patients consulted a traditional healer before presentation at the health care system. Consultation with a traditional healer was associated with delayed presentation at the referral hospital (P < 0.001). Most (n = 29, 53%) patients traveled more than 2 h to reach a health facility and this was associated with delayed presentation (P = 0.019). The cost of transportation ranged between 5000 and 1000 RWF (5.95-11.90 USD) for most patients and was not associated with delayed presentation (P = 0.449). CONCLUSIONS In this study, most patients with peritonitis present in a delayed fashion to the referral hospital. Factors associated with seeking and reaching care included sociodemographic characteristics, health-seeking behaviors, cost of care, and travel time. These findings highlight factors associated with delays in seeking and reaching care for patients with peritonitis.
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Affiliation(s)
- Martin Munyaneza
- Department of Surgery, University of Rwanda, Kigali, Rwanda; Department of Surgery, University Teaching Hospital of Butare, Butare, Rwanda
| | - Sudha Jayaraman
- Department of Surgery, Virginia Commonwealth University, Richmond, Virginia
| | - Faustin Ntirenganya
- Department of Surgery, University of Rwanda, Kigali, Rwanda; Department of Surgery, University Teaching Hospital of Kigali, Kigali, Rwanda
| | - Jennifer Rickard
- Department of Surgery, University Teaching Hospital of Kigali, Kigali, Rwanda; Department of Surgery, University of Minnesota, Minneapolis, Minnesota.
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Abstract
PURPOSE The purpose of this paper is to examine from the viewpoint of resource utilization the Japanese surgical payment system which was revised in April 2016. DESIGN/METHODOLOGY/APPROACH The authors collected data from surgical records in the Teikyo University electronic medical record system from April 1 till September 30, 2016. The authors defined the decision-making unit as a surgeon with the highest academic rank in the surgery. Inputs were defined as the number of medical doctors who assisted surgery, and the time of operation from skin incision to closure. An output was defined as the surgical fee. The authors calculated each surgeon's efficiency score using output-oriented Charnes-Cooper-Rhodes model of data envelopment analysis. The authors compared the efficiency scores of each surgical specialty using the Kruskal-Wallis and the Steel method. FINDINGS The authors analyzed 2,558 surgical procedures performed by 109 surgeons. The difference in efficiency scores was significant (p = 0.000). The efficiency score of neurosurgery was significantly greater than obstetrics and gynecology, general surgery, orthopedics, emergency surgery, urology, otolaryngology and plastic surgery (p<0.05). ORIGINALITY/VALUE The authors demonstrated that the surgeons' efficiency was significantly different among their specialties. This suggests that the Japanese surgical reimbursement scales fail to reflect resource utilization despite the revision in 2016.
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Affiliation(s)
| | - Yuichi Watanabe
- Graduate School of Economics, Waseda University , Tokyo, Japan
| | - Hiroto Narimatsu
- Cancer Prevention & Control Division, Kanagawa Cancer Center Research Institute, Yokohama, Japan
| | | | - Hiroshi Otake
- Department of Anesthesiology, Showa University , Tokyo, Japan
| | - Tomohiro Sawa
- Medical Information and System Research Center, Teikyo University , Tokyo, Japan
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Affiliation(s)
- Wai-Kit Ming
- School of Pharmacy, Chinese University of Hong Kong, Shatin, NT, Hong Kong
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Affiliation(s)
- Kenji Shibuya
- Department of Global Health Policy, University of Tokyo, Tokyo 113-0033, Japan.
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Hedayati E, Fracheboud L, Srikant V, Greber D, Wallberg S, Linder Stragliotto C. Economic benefits of subcutaneous trastuzumab administration: A single institutional study from Karolinska University Hospital in Sweden. PLoS One 2019; 14:e0211783. [PMID: 30716137 PMCID: PMC6361452 DOI: 10.1371/journal.pone.0211783] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 01/22/2019] [Indexed: 01/03/2023] Open
Abstract
Introduction Adjuvant trastuzumab is a standard of care in the treatment of Human Epidermal growth factor Receptor 2 (HER2) positive early breast cancer (eBC). Initially trastuzumab could only be administered intravenously (IV), however since 2013, a subcutaneous (SC) formulation with comparable efficacy and safety profile is available and preferred by patients. Trastuzumab SC does not require pharmacy preparation and has shorter administration time. The objective of this study was to estimate the economic efficiency of the SC formulation of trastuzumab by assessing the economic benefits of actual SC-driven process changes at one single Swedish healthcare institution. Methods This study analyzes changes in trastuzumab administration practice after the SC formulation was introduced at the Karolinska University Hospital. Process changes were identified and introduced in order to capitalize on the inherent work efficiency benefits of the SC formulation. Actual hospital data for 2015 were used to quantitatively estimate the annual economic impact of the changes. It encompassed administrative (i.e. non-medical) data of 178 newly diagnosed HER2-positive eBC patients and a total of 2,769 SC administrations. Realized economic benefits were expressed in hours saved by nurses, direct monetary cost savings and potential infusion fee revenue that could be earned through infrastructural revenue gains. Results In 2015, the replacement of IV infusion to SC administration generated total time savings of more than 1,100 hours, and led to direct monetary cost savings of 603,000 EUR. It unlocked a capacity gain of 1–2 additional administrations daily within the existing facility infrastructure. Given the current remuneration structure per administration, this revenue gain translated into an incremental revenue potential of up to 3 million EUR. Conclusion Data from this study showed that the shift from trastuzumab IV to SC formulation resulted in significant economic effects in terms of departmental resources related to time, direct monetary cost savings, and infrastructural revenue gains.
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Affiliation(s)
- Elham Hedayati
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
- Breast Cancer Flow, Patient Area of Breast Cancer Sarcoma and Endocrine Tumors, Theme Cancer, Karolinska University Hospital, Stockholm, Sweden
- * E-mail:
| | | | | | - David Greber
- The Boston Consulting Group AG, Zurich, Switzerland
| | - Susanne Wallberg
- Breast Cancer Flow, Patient Area of Breast Cancer Sarcoma and Endocrine Tumors, Theme Cancer, Karolinska University Hospital, Stockholm, Sweden
| | - Christina Linder Stragliotto
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
- Breast Cancer Flow, Patient Area of Breast Cancer Sarcoma and Endocrine Tumors, Theme Cancer, Karolinska University Hospital, Stockholm, Sweden
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Fernández Castañer M, Salazar Soler A, Bartolomé Sarvisé C, Ridao March ML, Casado Garcia MA, Castilla Fuentes M, Ortiga Fontgivell B, García Díaz A, Corbella X. [Impact of the financial crisis on activity and efficiency at a high-technology university hospital]. Rev Esp Salud Publica 2018; 92:e201808052. [PMID: 30141465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 08/05/2018] [Indexed: 06/08/2023] Open
Abstract
OBJECTIVE The financial crisis that begun in 2008 significantly decreased the budget of the public health system on Spain. The aim of this study was to evaluate the impact of the financial crisis on the activity, quality and efficiency of a high-technology university hospital. METHODS We retrospectively analyzed the outcomes of four sets of hospital management indicators between 2007 and 2016 (A: activity; B: quality and complexity of inpatientcare; C: staff, global production and budget expenses; D: patients satisfaction survey). The data were obtained from the center's information systems and treated as longitudinal series of descriptive type. The impact of the crisis was assessed by analyzing the percentage deviations of the different indicators in relation to the values of the year 2009, the year before initial budget adjustments. RESULTS The overall activity of the hospital, adjusted for complexity, decreased 9% during the first two years of the crisis and recovered later. Inpatient complexity increased 14%. Quality set indicators did not deteriorate. Expenses decreased 16% between the years 2009 and 2014, and efficiency and global productivity improved by 13%. Patient satisfaction survey results did not change. CONCLUSIONS The financial crisis and the subsequent decrease of budget provoked an initial reduction of hospital activity, associated with a complexity increase. It was progressively made up for with increased efficiency and global productivity. The financial crisis did not have negative effects on quality of care or patient satisfaction.
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Affiliation(s)
- Miguel Fernández Castañer
- Comité de dirección 2007-2012. Hospital Universitario de Bellvitge. L'Hospitalet de Llobregat. Barcelona.España
- Comité de dirección 2012-2015. Hospital Universitario de Bellvitge. L'Hospitalet de Llobregat. Barcelona. España
| | - Albert Salazar Soler
- Comité de dirección 2007-2012. Hospital Universitario de Bellvitge. L'Hospitalet de Llobregat. Barcelona.España
| | - Carlos Bartolomé Sarvisé
- Comité de dirección 2007-2012. Hospital Universitario de Bellvitge. L'Hospitalet de Llobregat. Barcelona.España
- Comité de dirección 2012-2015. Hospital Universitario de Bellvitge. L'Hospitalet de Llobregat. Barcelona. España
| | - Maria Luisa Ridao March
- Comité de dirección 2007-2012. Hospital Universitario de Bellvitge. L'Hospitalet de Llobregat. Barcelona.España
| | - Maria Antonia Casado Garcia
- Comité de dirección 2007-2012. Hospital Universitario de Bellvitge. L'Hospitalet de Llobregat. Barcelona.España
- Comité de dirección 2012-2015. Hospital Universitario de Bellvitge. L'Hospitalet de Llobregat. Barcelona. España
| | - Montserrat Castilla Fuentes
- Comité de dirección 2007-2012. Hospital Universitario de Bellvitge. L'Hospitalet de Llobregat. Barcelona.España
- Comité de dirección 2012-2015. Hospital Universitario de Bellvitge. L'Hospitalet de Llobregat. Barcelona. España
| | - Berta Ortiga Fontgivell
- Comité de dirección 2007-2012. Hospital Universitario de Bellvitge. L'Hospitalet de Llobregat. Barcelona.España
- Comité de dirección 2012-2015. Hospital Universitario de Bellvitge. L'Hospitalet de Llobregat. Barcelona. España
| | - Alfredo García Díaz
- Comité de dirección 2007-2012. Hospital Universitario de Bellvitge. L'Hospitalet de Llobregat. Barcelona.España
- Comité de dirección 2012-2015. Hospital Universitario de Bellvitge. L'Hospitalet de Llobregat. Barcelona. España
| | - Xavier Corbella
- Comité de dirección 2007-2012. Hospital Universitario de Bellvitge. L'Hospitalet de Llobregat. Barcelona.España
- Facultad de Medicina y Ciencias de la Salud. Universidad Internacional de Cataluña. Barcelona. España
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Muñoz Romo R, M Borobia Pérez A, A Muñoz M, Carballo Cardona C, Cobo Mora J, Carcas Sansuán AJ. Efficient diagnosis and treatment of acute paracetamol poisoning: cost-effectiveness analysis of approaches based on a hospital toxicovigilance program. Emergencias 2018; 30:169-176. [PMID: 29687671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVES To evaluate 5 diagnostic-therapeutic strategies for suspected acute paracetamol poisoning in terms of cost-effectiveness in a tertiary university hospital with an active, validated poisoning surveillance program (SAT-HULP). MATERIAL AND METHODS Cost-effectiveness analysis of the 5 diagnostic-therapeutic alternatives considered when attending patients with suspected paracetamol poisoning. The alternatives were chosen by means of a decision tree. We studied patients detected by the SAT-HULP program between April 1, 2011, and January 31, 2015. The diagnostic-therapeutic alternatives were as follows: 1) systematic treatment of all patients with N-acetylcysteine (NAC), 2) NAC treatment according to the reported dose; 3) NAC treatment according to a Rümack-Matthew nomogram; 4) NAC treatment according to urine test results confirmed by a blood test, and 5) treatment according to elimination half-life calculation. Probability data were obtained from the SAT-HULP program and validation studies corresponding to the diagnostic tests. Deterministic and probabilistic sensitivity analyses were performed. RESULTS The approaches that were most cost-effective were those guided by reported doses and nomograms. The incremental cost-effectiveness of treatment according to reported dose was €5985.37. The sensitivity analysis showed that the model was highly dependent on variations in the main variables; the probabilistic sensitivity analysis indicated an incremental cost-effectiveness of €25 111.06 (SD, €1 534 420.16; range, €42 136.03-€92 358.75) between the first approach (treat all cases) and last (calculate elimination half-life); half-life calculation was the more efficient. CONCLUSION Treating according to nomogram was the most efficient diagnostic-therapeutic approach to treating paracetamol poisoning in our hospital. However, when the prevalence of paracetamol poisoning is higher and uncertainty is greater, it would be more efficient to treat based on calculating the half-life.
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Ayele AA, Gebresillassie BM, Erku DA, Gebreyohannes EA, Demssie DG, Mersha AG, Tegegn HG. Prospective evaluation of Ceftriaxone use in medical and emergency wards of Gondar university referral hospital, Ethiopia. Pharmacol Res Perspect 2018; 6:e00383. [PMID: 29417764 PMCID: PMC5817827 DOI: 10.1002/prp2.383] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2017] [Accepted: 10/27/2017] [Indexed: 11/29/2022] Open
Abstract
Ceftriaxone is among the most commonly utilized antibiotics owing to its high potency, wide spectrum of activity, and low risk of toxicity. It is used to treat different types of bacterial infections including pneumonia, bone infections, abdominal infections, Skin and soft tissue infections, urinary tract infections. However, evidence around the globe shows the misuse of Ceftriaxone. This study aimed at evaluating the appropriateness of ceftriaxone use in medical and emergency wards of Gondar university referral hospital (GURH), Northwest Ethiopia. A prospective, cross-sectional study design was employed to evaluate the use of ceftriaxone. The medical records of patients who received ceftriaxone were reviewed prospectively between January 1 and March 30, 2017. Appropriateness of ceftriaxone use was evaluated as per the protocol developed from current treatment guidelines. A total of 390 patients' medical records were reviewed. The utilization rate of ceftriaxone was found to be high with a point prevalence of 59%. Ceftriaxone was empirically used in 79.5% of cases. The most common indications of Ceftriaxone were respiratory tract infections (29.3%), central nervous system infections (24.1%), and prophylactic indications (16.4%). The mean duration of ceftriaxone therapy in our study was 11.47 days, with a range of 1-52 days. More than two-thirds (80.2%) of ceftriaxone use were found to be inappropriate and majority of unjustified ceftriaxone use emanated from inappropriate frequency of administration (78.3%), absence of culture and sensitivity test (68.7%), and duration of therapy (47%). Empiric treatment with ceftriaxone and the presence of coadministered drugs was significantly associated with its inappropriate use. The present study revealed a very high rate of inappropriate use of ceftriaxone which may potentially lead to emergence of drug-resistant microorganisms and ultimately exposes the patient to treatment failure and increased cost of therapy.
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Affiliation(s)
- Asnakew Achaw Ayele
- Department of Clinical PharmacySchool of PharmacyCollege of Medicine and Health SciencesUniversity of GondarGondarEthiopia
| | - Begashaw Melaku Gebresillassie
- Department of Clinical PharmacySchool of PharmacyCollege of Medicine and Health SciencesUniversity of GondarGondarEthiopia
| | - Daniel Asfaw Erku
- Department of Clinical PharmacySchool of PharmacyCollege of Medicine and Health SciencesUniversity of GondarGondarEthiopia
| | - Eyob Alemayehu Gebreyohannes
- Department of Clinical PharmacySchool of PharmacyCollege of Medicine and Health SciencesUniversity of GondarGondarEthiopia
| | | | - Amanual Getnet Mersha
- School of MedicineCollege of Medicine and Health SciencesUniversity of GondarGondarEthiopia
| | - Henok Getachew Tegegn
- Department of Clinical PharmacySchool of PharmacyCollege of Medicine and Health SciencesUniversity of GondarGondarEthiopia
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Engbers R, Fluit CRMG, Bolhuis S, de Visser M, Laan RFJM. Implementing medical teaching policy in university hospitals. Adv Health Sci Educ Theory Pract 2017; 22:985-1009. [PMID: 27853908 PMCID: PMC5579150 DOI: 10.1007/s10459-016-9737-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Accepted: 11/07/2016] [Indexed: 05/13/2023]
Abstract
Within the unique and complex settings of university hospitals, it is difficult to implement policy initiatives aimed at developing careers in and improving the quality of academic medical teaching because of the competing domains of medical research and patient care. Factors that influence faculty in making use of teaching policy incentives have remained underexplored. Knowledge of these factors is needed to develop theory on the successful implementation of medical teaching policy in university hospitals. To explore factors that influence faculty in making use of teaching policy incentives and to develop a conceptual model for implementation of medical teaching policy in university hospitals. We used the grounded theory methodology. We applied constant comparative analysis to qualitative data obtained from 12 semi-structured interviews conducted at the Radboud University Medical Center. We used a constructivist approach, in which data and theories are co-created through interaction between the researcher and the field and its participants. We constructed a model for the implementation of medical teaching policy in university hospitals, including five factors that were perceived to promote or inhibit faculty in a university hospital to make use of teaching policy incentives: Executive Board Strategy, Departmental Strategy, Departmental Structure, Departmental Culture, and Individual Strategy. Most factors we found to affect individual teachers' strategies and their use of medical teaching policy lie at the departmental level. If an individual teacher's strategy is focused on medical teaching and a medical teaching career, and the departmental context offers support and opportunity for his/her development, this promotes faculty's use of teaching policy incentives.
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Affiliation(s)
- Rik Engbers
- Department for Research in Learning and Education, Radboudumc Health Academy, Radboud University Medical Center, P.O. Box 9101, NL-6500 HB, Nijmegen (43), The Netherlands.
| | - Cornelia R M G Fluit
- Department for Research in Learning and Education, Radboudumc Health Academy, Radboud University Medical Center, P.O. Box 9101, NL-6500 HB, Nijmegen (43), The Netherlands
| | - Sanneke Bolhuis
- Department for Research in Learning and Education, Radboudumc Health Academy, Radboud University Medical Center, P.O. Box 9101, NL-6500 HB, Nijmegen (43), The Netherlands
| | - Marieke de Visser
- Department for Research in Learning and Education, Radboudumc Health Academy, Radboud University Medical Center, P.O. Box 9101, NL-6500 HB, Nijmegen (43), The Netherlands
| | - Roland F J M Laan
- Department for Research in Learning and Education, Radboudumc Health Academy, Radboud University Medical Center, P.O. Box 9101, NL-6500 HB, Nijmegen (43), The Netherlands
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15
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Dos Anjos KC, de Rezende MR, Mattar R. Social and hospital costs of patients admitted to a university hospital in Brazil due to motorcycle crashes. Traffic Inj Prev 2017; 18:585-592. [PMID: 28436733 DOI: 10.1080/15389588.2017.1293823] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Accepted: 02/07/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE This study aimed to investigate the social and hospital costs of patients treated at a public hospital who were motorcycle crash victims. METHOD This prospective study was on 68 motorcycle riders (drivers or passengers), who were followed up from hospital admission to 6 months after the crash. A questionnaire covering quantitative and qualitative questions was administered. RESULTS Motorcycle crash victims were responsible for 12% of the institution's hospital admissions; 54.4% were young (18-28 years of age); 92.6% were the drivers; 91.2% were male; and 50% used their motorcycles as daily means of transportation. Six months afterward, 94.1% needed help from someone; 83.8% had changed their family dynamics; and 73.5% had not returned to their professional activities. Among the injuries, 94.7% had some type of fracture, of which 53.5% were exposed fractures; 35.3% presented temporary sequelae; and 32.4% presented permanent sequelae. They used the surgical center 2.53 times on average, with a mean hospital stay of 18 days. The per capita hospital cost of these victims' treatment was US$17,481.50. CONCLUSION The social and hospital costs were high, relative to the characteristics of a public institution. Temporary or permanent disability caused changes to family dynamics, as shown by the high numbers of patients who were still away from their professional activities more than 6 months afterward.
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Affiliation(s)
- Katia Campos Dos Anjos
- a Hospital das Clínicas , Institute of Orthopedics and Traumatology , São Paulo , Brazil
| | | | - Rames Mattar
- a Hospital das Clínicas , Institute of Orthopedics and Traumatology , São Paulo , Brazil
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Abstract
The prevalence of epilepsy in people with intellectual disability is higher than in the general population and prevalence rates increase with increasing levels of disability. Prevalence rates of epilepsy are highest among those living in residential care. The healthcare needs of people with intellectual disability and epilepsy are complex and deserve special consideration in terms of healthcare provision and access to specialist epilepsy clinics, which are usually held in acute hospital campuses. This patient population is at risk of suboptimal care because of significant difficulties accessing specialist epilepsy care which is typically delivered in the environs of acute hospitals. In 2014, the epilepsy service at Cork University Hospital established an Epilepsy Outreach Service providing regular, ambulatory outpatient follow up at residential care facilities in Cork city and county in an effort to improve access to care, reduce the burden and expense of patient and carer travel to hospital outpatient appointments, and to provide a dedicated specialist phone service for epilepsy related queries in order to reduce emergency room visits when possible. We present the findings of an economic analysis of the outreach service model of care compared to the traditional hospital outpatient service and demonstrate significant cost savings and improved access to care with this model. Ideally these cost savings should be used to develop novel ways to enhance epilepsy care for persons with disability. We propose that this model of care can be more suitable for persons with disability living in residential care who are at risk of losing access to specialist epilepsy care.
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Affiliation(s)
- Eimer Maloney
- Department of Neurology, Cork University Hospital, Wilton, Cork, Ireland.
| | - Ronan N McGinty
- Department of Neurology, Cork University Hospital, Wilton, Cork, Ireland
| | - Daniel J Costello
- Department of Neurology, Cork University Hospital, Wilton, Cork, Ireland
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Kanamori T, Kimura F, Kikuchi Y, Tada H, Kuriyama N, Jin T, Kamiya H. [Trial of the Profit Optimization of the Department of Cardiac Surgery in the Local National University Hospital]. Kyobu Geka 2017; 70:336-341. [PMID: 28496078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
In recent years economic sense is required in hospital management, the national university hospital is also no exception. We performed duty improvement efforts as well as the current state analysis in the department of cardiac surgery for the purpose of revenue optimization in our hospital. At result, we succeeded in the improvement of the medical index as well as medical profit and found the key of solution to the serious problem that national university hospital has.
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Affiliation(s)
- Taro Kanamori
- Department of Cardiovascular Surgery, Kawaguchi Cardiovascular and Respiratory Hospital, Kawaguchi, Japan
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Williamsson C, Ansari D, Andersson R, Tingstedt B. Postoperative pancreatic fistula-impact on outcome, hospital cost and effects of centralization. HPB (Oxford) 2017; 19:436-442. [PMID: 28161218 DOI: 10.1016/j.hpb.2017.01.004] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Revised: 01/04/2017] [Accepted: 01/06/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND One of the most serious complications after pancreaticoduodenectomy (PD) is postoperative pancreatic fistula (POPF). This study investigated the incidence of POPF before and after centralization of pancreatic surgery in Southern Sweden and its impact on outcome and health care costs. METHODS The local registry comprising all pancreatic resections at Skåne University Hospital, Lund, Sweden, was searched for PDs from 2005 to 2015. The patients were analysed in three groups: low-volume, high-volume and after introduction of an enhanced recovery program. Only the clinically relevant POPF grades B and C (CR-POPF) were investigated. RESULTS 322 consecutive patients were identified. The annual operation volume increased almost threefold and the postoperative length of stay and total hospital cost decreased concurrently. The incidence of CR-POPF did not decrease over time. The group with CR-POPF had more complications and prolonged length of stay. The cost was 1.5 times higher for patients with CR-POPF and the cost did not decline despite the increase of hospital volume. CONCLUSION Centralization of pancreatic surgery did not decrease the rate of CR-POPF nor its subsequent impact on LOS and costs. Further efforts must be made to reduce the incidence of CR-POPF.
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Affiliation(s)
- Caroline Williamsson
- Department of Surgery, Skåne University Hospital at Lund and Clinical Sciences, Lund University, Sweden
| | - Daniel Ansari
- Department of Surgery, Skåne University Hospital at Lund and Clinical Sciences, Lund University, Sweden
| | - Roland Andersson
- Department of Surgery, Skåne University Hospital at Lund and Clinical Sciences, Lund University, Sweden
| | - Bobby Tingstedt
- Department of Surgery, Skåne University Hospital at Lund and Clinical Sciences, Lund University, Sweden.
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Riu M, Chiarello P, Terradas R, Sala M, Garcia-Alzorriz E, Castells X, Grau S, Cots F. Incremental cost of nosocomial bacteremia according to the focus of infection and antibiotic sensitivity of the causative microorganism in a university hospital. Medicine (Baltimore) 2017; 96:e6645. [PMID: 28445264 PMCID: PMC5413229 DOI: 10.1097/md.0000000000006645] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Revised: 03/09/2017] [Accepted: 03/28/2017] [Indexed: 11/27/2022] Open
Abstract
To estimate the incremental cost of nosocomial bacteremia according to the causative focus and classified by the antibiotic sensitivity of the microorganism.Patients admitted to Hospital del Mar in Barcelona from 2005 to 2012 were included. We analyzed the total hospital costs of patients with nosocomial bacteremia caused by microorganisms with a high prevalence and, often, with multidrug-resistance. A control group was defined by selecting patients without bacteremia in the same diagnosis-related group.Our hospital has a cost accounting system (full-costing) that uses activity-based criteria to estimate per-patient costs. A logistic regression was fitted to estimate the probability of developing bacteremia (propensity score) and was used for propensity-score matching adjustment. This propensity score was included in an econometric model to adjust the incremental cost of patients with bacteremia with differentiation of the causative focus and antibiotic sensitivity.The mean incremental cost was estimated at &OV0556;15,526. The lowest incremental cost corresponded to bacteremia caused by multidrug-sensitive urinary infection (&OV0556;6786) and the highest to primary or unknown sources of bacteremia caused by multidrug-resistant microorganisms (&OV0556;29,186).This is one of the first analyses to include all episodes of bacteremia produced during hospital stays in a single study. The study included accurate information about the focus and antibiotic sensitivity of the causative organism and actual hospital costs. It provides information that could be useful to improve, establish, and prioritize prevention strategies for nosocomial infections.
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Affiliation(s)
- Marta Riu
- Management Control Department, Hospital del Mar
- IMIM (Hospital del Mar Medical Research Institute)
| | - Pietro Chiarello
- Management Control Department, Hospital del Mar
- IMIM (Hospital del Mar Medical Research Institute)
- Doctoral Program in Public Health, Department of Pediatrics, Obstetrics and Gynecology, Preventive Medicine and Public Health, Universitat Autònoma de Barcelona (UAB)
| | - Roser Terradas
- IMIM (Hospital del Mar Medical Research Institute)
- School of Nursing
| | - Maria Sala
- IMIM (Hospital del Mar Medical Research Institute)
- Department of Epidemiology and Evaluation, Hospital del Mar
- REDISSEC (Red de Investigación en Servicios Sanitarios en enfermedades crónicas)
- Universitat Autònoma de Barcelona (UAB)
| | - Enric Garcia-Alzorriz
- Management Control Department, Hospital del Mar
- IMIM (Hospital del Mar Medical Research Institute)
| | - Xavier Castells
- IMIM (Hospital del Mar Medical Research Institute)
- Department of Epidemiology and Evaluation, Hospital del Mar
- REDISSEC (Red de Investigación en Servicios Sanitarios en enfermedades crónicas)
- Universitat Autònoma de Barcelona (UAB)
| | - Santiago Grau
- Universitat Autònoma de Barcelona (UAB)
- Department of Pharmacy, Hospital del Mar, Barcelona, Spain
| | - Francesc Cots
- Management Control Department, Hospital del Mar
- IMIM (Hospital del Mar Medical Research Institute)
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Marques-Vidal P, Khalatbari-Soltani S, Sahli S, Coti Bertrand P, Pralong F, Waeber G. Undernutrition is associated with increased financial losses in hospitals. Clin Nutr 2017; 37:681-686. [PMID: 28258776 DOI: 10.1016/j.clnu.2017.02.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Revised: 01/27/2017] [Accepted: 02/12/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND & AIMS Undernutrition is associated with increased hospital costs. Whether these increased costs are totally compensated by third payer systems has not been assessed. We aimed to assess the differences between actual and reimbursed hospital costs according to presence/absence of nutritional risk, defined by a Nutritional risk screening-2002 (NRS-2002) score ≥3. METHODS Retrospective study. Administrative data for years 2013 and 2014 of the department of internal medicine of the Lausanne university hospital. The data included total and specific costs (i.e. clinical biology, treatments, pathology). Reimbursed costs were based on the Swiss Diagnosis Related Group (DRG) system. RESULTS 2200 admissions with NRS-2002 data were included (mean age 76 years, 53.9% women), 1398 (63.6%) of which were considered nutritionally 'at-risk'. After multivariate adjustment, patients nutritionally 'at-risk' had higher costs (multivariate-adjusted difference ± standard error: 34,206 ± 1246 vs. 22,214 ± 1666 CHF, p < 0.001) and higher reimbursements (26,376 ± 1105 vs. 17,783 ± 1477 CHF, p < 0.001). Still, the latter failed to cover the costs, leading to a deficit between costs and reimbursements of 7831 ± 660 CHF in patients 'at-risk' vs. 4431 ± 881 in patients 'not at-risk' (p < 0.003). Being nutritionally 'at-risk' also led to a lower likelihood of complete coverage of costs: multivariate-adjusted odds ratio and 95% confidence interval 0.77 (0.62-0.97). Patients 'at-risk' had lower percentage of total costs in medical interventions, food, imaging and "other", but the absolute differences were less than 2%. CONCLUSION Hospital costs of patients nutritionally 'at-risk' are less well reimbursed than of patients 'not at-risk'. Better reporting of undernutrition in medical records and better reimbursement of undernourished patients is needed.
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Affiliation(s)
- Pedro Marques-Vidal
- Department of Medicine, Internal Medicine, Lausanne University Hospital, Lausanne, Switzerland.
| | - Saman Khalatbari-Soltani
- Department of Medicine, Internal Medicine, Lausanne University Hospital, Lausanne, Switzerland; Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Lausanne, Switzerland.
| | - Sahbi Sahli
- Department of Medicine, Internal Medicine, Lausanne University Hospital, Lausanne, Switzerland.
| | - Pauline Coti Bertrand
- Service of Endocrinology, Diabetes and Metabolism, Lausanne University Hospital, Lausanne, Switzerland.
| | - François Pralong
- Service of Endocrinology, Diabetes and Metabolism, Lausanne University Hospital, Lausanne, Switzerland.
| | - Gérard Waeber
- Department of Medicine, Internal Medicine, Lausanne University Hospital, Lausanne, Switzerland.
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Sales MM, Taniguchi LU, Fonseca LAM, Ferreira-Junior M, Aguiar FJB, Sumita NM, Lichtenstein A, Duarte AJS. Laboratory Tests Ordering Pattern by Medical Residents From a Brazilian University Hospital. Am J Clin Pathol 2016; 146:694-700. [PMID: 27940426 DOI: 10.1093/ajcp/aqw188] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES The adequacy of laboratory test orders by medical residents is a longstanding issue. The aim of this study is to analyze the number, types, and pattern of repetition of tests ordered by medical residents. METHODS We studied all tests ordered over a 1-year period for inpatients of an internal medicine ward in a university hospital. Types, results, and repetition pattern of tests were analyzed in relation to patients' diagnoses. RESULTS We evaluated 117,666 tests, requested for 1,024 inpatients. The mean number of tests was 9.5 per day. The test repetition pattern was similar, regardless of patients' diagnoses, previous test results, or duration of stay. The probability of an abnormal result after a sequence of three normal tests was lower than 25%, regardless of the diagnosis. CONCLUSIONS Number of tests and repetition were both high, imposing costs, discomfort, and risks to patients, thus warranting further investigation.
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Affiliation(s)
- Maria M Sales
- From the Division of Clinical Pathology, Department of Pathology,
| | | | - Luiz A M Fonseca
- Department of Internal Medicine, Clinical Immunology and Allergy Service
| | - Mario Ferreira-Junior
- Department of Internal Medicine, General Practice and Propedeutic Service, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | | | - Nairo M Sumita
- From the Division of Clinical Pathology, Department of Pathology
| | - Arnaldo Lichtenstein
- Department of Internal Medicine, General Practice and Propedeutic Service, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
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Pförringer D, Markgraf B, Weber M, Seidl F, Crönlein M, Friedl G, Hoffmann R, Biberthaler P. [Determination of training costs associated with surgical procedures during specialization as an orthopaedic and trauma surgeon]. Unfallchirurg 2016; 120:844-853. [PMID: 27470255 DOI: 10.1007/s00113-016-0222-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Trauma surgery is a discipline in which the training phase for specialization requires a technical and time-intensive learning curve, including the repetitive training of manual skills. This results in prolonged operation times and thus elevated costs. OBJECTIVES The present study retrospectively examines operations in trauma surgery and orthopaedics at a Munich university hospital according to the required curriculum for further specialist training. The duration of procedures at the various training levels and the resulting costs were compared. MATERIAL AND METHODS Based on digital surgical records, more than 2,000 surgical interventions were analysed and checked that they fulfilled the practical requirements. Patients with multiple injuries and polytrauma, in addition to irregularly complex cases, were removed from the calculation to ensure high comparability of the individual cases. This yielded more than 1,000+ cases for evaluation. The per-minute cost was calculated to allow for the translation of operating time into costs. RESULTS The study shows a prolonged duration of operating time of 19.75 % when the procedure was conducted by residents. This prolongation can be split into 37 subgroups according to body region and type of procedure. The prolongation of operation time could be quantified as a specific prolongation per cluster, in addition to cumulative prolongation. By including the operating costs, the operation-dependent training costs are shown as an exact sum of Euros. CONCLUSION Surgical training of residents costs hospitals the appropriate amounts of time and money and reduces the overall number of procedures performed, justifying special consideration of the financing of training hospitals.
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Affiliation(s)
- D Pförringer
- Klinikum rechts der Isar, Klinik und Poliklinik für Unfallchirurgie, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland.
| | - B Markgraf
- Fakultät für Wirtschaftswissenschaften, Lehrstuhl für BWL - Controlling, Technische Universität München, München, Deutschland
| | - M Weber
- Fakultät für Wirtschaftswissenschaften, Lehrstuhl für BWL - Controlling, Technische Universität München, München, Deutschland
| | - F Seidl
- Klinikum rechts der Isar, Klinik und Poliklinik für Unfallchirurgie, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland
| | - M Crönlein
- Klinikum rechts der Isar, Klinik und Poliklinik für Unfallchirurgie, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland
| | - G Friedl
- Fakultät für Wirtschaftswissenschaften, Lehrstuhl für BWL - Controlling, Technische Universität München, München, Deutschland
| | - R Hoffmann
- BG Unfallklinik Frankfurt am Main gGmbH, Frankfurt, Germany
| | - P Biberthaler
- Klinikum rechts der Isar, Klinik und Poliklinik für Unfallchirurgie, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland
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Sritipsukho P, Matchimmadamrong K, Chinratanapisit S, Deerojanawong J. Economic Burden of Hospitalization with Acute Wheezing in Preschool Children: A Multi-Center Study. J Med Assoc Thai 2016; 99 Suppl 4:S239-S245. [PMID: 29927174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND Wheezing is an important health problem in Thailand especially among preschool age. OBJECTIVE The aim of this study was to estimate costs of wheezing for hospitalization in preschool children under patient, provider, and societal perspectives. MATERIAL AND METHOD Two hundred and thirty-four participants who were admitted with acute wheezing at 4 hospitals including Thammasat University Hospital, Saraburi Hospital, Bhumibol Adulyadej Hospital and King Chulalongkorn Memorial Hospital during July 2014 to June 2015 were included in the present study. Data from hospital financial database and caregivers’ expenses were collected. Cost-to-charge ratio method was employed for valuation of direct medical costs. Informal care costs were determined by human capital approach. RESULTS The means of patient, provider and societal costs per admission were 3,020 THB (SD = 6,632 THB), 18,126 THB (SD = 16,898 THB), and 20,269 THB (SD = 20,537 THB) respectively. The main cost component in provider and societal perspective were accommodation costs during admission. Informal care cost was a major cost component for direct nonmedical costs. The economic burden of acute wheezing admission of preschool children in Thailand was estimated as 759 million THB per year. CONCLUSION These costs of illness analysis provided an evidence of economic burden and costs of preschool wheezing in hospitalization in Thailand.
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Schmidt-Rumposch A. [In process]. Pflege Z 2016; 69:389-391. [PMID: 29414223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
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González-Vélez AE, Romero-Martín M, Villanueva-Orbaiz R, Díaz-Agero-Pérez C, Robustillo-Rodela A, Monge-Jodra V. The cost of infection in hip arthroplasty: a matched case-control study. Rev Esp Cir Ortop Traumatol (Engl Ed) 2016; 60:227-33. [PMID: 27161768 DOI: 10.1016/j.recot.2016.02.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Revised: 01/22/2016] [Accepted: 02/09/2016] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Surgical site infection (SSI) represents 30% of all causes of health care-associated infection (HAI) and is one of the most dreaded complications in surgical patients. We estimated the excess direct costs of SSI using a matched nested case-control study in acute-term care at Ramon y Cajal University Hospital in Spain. MATERIAL AND METHOD Cases were patients who developed a first episode of SSI according to the criteria established by the CDC's National Healthcare Safety Network. Controls were matched to cases in 1:1 ratio taking into account the American Society of Anesthesiologists score, age, sex, surgery date, and principal diagnosis. RESULTS This study found that infection in hip replacement increased direct costs by 134%. Likewise, the excess cost due to the infections caused by methicillin resistant Staphylococcus aureus was 69% higher than the excess cost attributable to infections caused by other microorganisms. CONCLUSIONS SSI after hip replacement continues to be a costly complication from the hospital perspective. Costs due to SSI can be used to prioritise preventive interventions to monitor and control HAI.
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Affiliation(s)
| | - M Romero-Martín
- Departamento de Medicina Preventiva, Salud Pública e Historia de la Ciencia, Universidad Complutense de Madrid, Madrid, España
| | - R Villanueva-Orbaiz
- Departamento de Medicina Preventiva, Salud Pública e Historia de la Ciencia, Universidad Complutense de Madrid, Madrid, España
| | | | | | - V Monge-Jodra
- Hospital Universitario Ramón y Cajal, Madrid, España
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Birgand G, Leroy C, Nerome S, Luong Nguyen LB, Lolom I, Armand-Lefevre L, Ciotti C, Lecorre B, Marcade G, Fihman V, Nicolas-Chanoine MH, Pelat C, Perozziello A, Fantin B, Yazdanpanah Y, Ricard JD, Lucet JC. Costs associated with implementation of a strict policy for controlling spread of highly resistant microorganisms in France. BMJ Open 2016; 6:e009029. [PMID: 26826145 PMCID: PMC4735214 DOI: 10.1136/bmjopen-2015-009029] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE To assess costs associated with implementation of a strict 'search and isolate' strategy for controlling highly drug-resistant organisms (HDRO). DESIGN Review of data from 2-year prospective surveillance (01/2012 to 12/2013) of HDRO. SETTING Three university hospitals located in northern Paris. METHODS Episodes were defined as single cases or outbreaks of glycopeptide-resistant enterococci (GRE) or carbapenemase-producing Enterobacteriacae (CPE) colonisation. Costs were related to staff reinforcement, costs of screening cultures, contact precautions and interruption of new admissions. Univariate analysis, along with simple and multiple linear regression analyses, was conducted to determine variables associated with cost of HDRO management. RESULTS Overall, 41 consecutive episodes were included, 28 single cases and 13 outbreaks. The cost (mean ± SD) associated with management of a single case identified within and/or 48 h after admission was €4443 ± 11,552 and €11,445 ± 15,743, respectively (p<0.01). In an outbreak, the total cost varied from €14,864 ± 17,734 for an episode with one secondary case (€7432 ± 8867 per case) to €136,525 ± 151,231 (€12,845 ± 5129 per case) when more than one secondary case occurred. In episodes of single cases, contact precautions and microbiological analyses represented 51% and 30% of overall cost, respectively. In outbreaks, cost related to interruption of new admissions represented 77-94% of total costs, and had the greatest financial impact (R(2)=0.98, p<0.01). CONCLUSIONS In HDRO episodes occurring at three university hospitals, interruption of new admissions constituted the most costly measure in an outbreak situation.
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Affiliation(s)
- Gabriel Birgand
- INSERM, IAME, UMR 1137, Paris, France
- Univ Paris Diderot, IAME, UMR 1137, Sorbonne Paris Cité, Paris, France
- Infection Control Unit, AP-HP, Hôpital Bichat-Claude Bernard, Paris, France
| | - Christophe Leroy
- Emergency Department, AP-HP, Hôpital Louis Mourier, Colombes, France
| | - Simone Nerome
- Infection Control Unit, AP-HP, Hôpital Beaujon, Clichy, France
| | | | - Isabelle Lolom
- Infection Control Unit, AP-HP, Hôpital Bichat-Claude Bernard, Paris, France
| | | | - Céline Ciotti
- Infection Control Unit, AP-HP, Hôpital Beaujon, Clichy, France
| | - Bertrand Lecorre
- Internal Medicine Department, AP-HP, Hôpital Beaujon, Clichy, France
| | - Géraldine Marcade
- Infection Control Unit, AP-HP, Hôpital Louis Mourier, Colombes, France
| | - Vincent Fihman
- Infection Control Unit, AP-HP, Hôpital Louis Mourier, Colombes, France
| | | | - Camille Pelat
- INSERM, IAME, UMR 1137, Paris, France
- Univ Paris Diderot, IAME, UMR 1137, Sorbonne Paris Cité, Paris, France
| | - Anne Perozziello
- AP-HP, Hôpital Bichat-Claude Bernard, Medical Information Systems Program (PMSI), Paris, France
| | - Bruno Fantin
- Internal Medicine Department, AP-HP, Hôpital Beaujon, Clichy, France
| | - Yazdan Yazdanpanah
- INSERM, IAME, UMR 1137, Paris, France
- Univ Paris Diderot, IAME, UMR 1137, Sorbonne Paris Cité, Paris, France
- Infectious Diseases Department, AP-HP, Hôpital Bichat-Claude Bernard, Paris, France
| | - Jean-Damien Ricard
- INSERM, IAME, UMR 1137, Paris, France
- Univ Paris Diderot, IAME, UMR 1137, Sorbonne Paris Cité, Paris, France
- Intensive Care Unit, AP-HP, Hôpital Louis Mourier, Colombes, France
| | - Jean-Christophe Lucet
- INSERM, IAME, UMR 1137, Paris, France
- Univ Paris Diderot, IAME, UMR 1137, Sorbonne Paris Cité, Paris, France
- Infection Control Unit, AP-HP, Hôpital Bichat-Claude Bernard, Paris, France
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Abstract
Objective Many studies on the cost of Parkinson disease (PD) have been published; however, there are limited studies pertaining to this issue in Asia. This study looks to assess the direct medical costs of patients with PD at a university hospital in Japan by calculating the average monthly direct medical costs of PD patients from July to December 2008. Methods We enrolled 724 consecutive patients (411 women and 313 men) with PD who were registered in Japan's "Specified Disease Treatment Research Program" and obtained data on the total direct medical costs of all patients. Results Values are reported as the mean (standard deviation). The major finding of the direct medical cost analysis was that the outpatient clinic cost per subject (n=715) was USD 485.74 (376.31) per month. A multivariate analysis revealed that a younger age, the presence of wearing-off, hallucination, and longer disease duration increased the direct medical cost significantly. Disease severity had no influence on the direct medical costs. A longer disease duration was significantly correlated with higher hospitalization costs. Conclusion The direct medical cost of PD in Japan was found to be similar to that in Western countries. Costs due to productivity loss exceeded the direct costs, and they may be reduced through the better integration of PD patients in the work environment.
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Affiliation(s)
- Asako Yoritaka
- Department of Neurology, Juntendo University Koshigaya Hospital, Japan
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Stochkendahl MJ, Myburgh C, Young AE, Hartvigsen J. Manager Experiences with the Return to Work Process in a Large, Publically Funded, Hospital Setting: Walking a Fine Line. J Occup Rehabil 2015; 25:752-762. [PMID: 25916307 DOI: 10.1007/s10926-015-9583-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
PURPOSE Previous research on the role of managers in the return to work (RTW) process has primarily been conducted in contexts where the workplace has declared organizational responsibility for the process. While this is a common scenario, in some countries, including Denmark, there is no explicit legal obligation on the workplace to accommodate RTW. The aim of this study was to gain knowledge about the potential roles and contributions of managers in supporting returning employees in a context where they have no legal obligation to actively support RTW. METHODS Nineteen Danish hospital managers participated in a one-on-one interview or focus group discussions aimed at identifying barriers and facilitators for supporting employees in their RTW. Five individual interviews and two focus group discussions were conducted. Transcripts were analysed using thematic content analysis. RESULTS Four main themes were identified: (1) 'Coordinator and collaborator'; (2) 'Dilemmas of the RTW policy enforcer'; (3) 'The right to be sick and absent'; and (4) 'Keep the machinery running…'. Our findings indicated that supervisors' capacity to support returning workers was related to individual, communication, organizational, and policy factors. Instances were observed where supervisors faced the dilemma of balancing ethical and managerial principles with requirements of keeping staffing budgets. CONCLUSION Although it is not their legislative responsibility, Danish managers play a key role in the RTW process. As has been observed in other contexts, Danish supervisors struggle to balance considerations for the returning worker with those of their teams.
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Affiliation(s)
| | - Corrie Myburgh
- Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230, Odense M, Denmark
| | - Amanda Ellen Young
- Center for Disability Research, Liberty Mutual Research Institute for Safety, 71 Frankland Road, Hopkinton, MA, 01748, USA
| | - Jan Hartvigsen
- Nordic Institute of Chiropractic and Clinical Biomechanics, Campusvej 55, 5230, Odense M, Denmark
- Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230, Odense M, Denmark
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de Soárez PC, Lara AN, Sartori AMC, Abdala E, Haddad LBDP, D’Albuquerque LAC, Novaes HMD. Healthcare resource utilization and costs of outpatient follow-up after liver transplantation in a university hospital in São Paulo, Brazil: cost description study. SAO PAULO MED J 2015; 133:171-8. [PMID: 26039536 PMCID: PMC10876370 DOI: 10.1590/1516-3180.2013.7000011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2013] [Revised: 04/09/2013] [Accepted: 03/07/2014] [Indexed: 11/22/2022] Open
Abstract
CONTEXT AND OBJECTIVE Data on the costs of outpatient follow-up after liver transplantation are scarce in Brazil. The purpose of the present study was to estimate the direct medical costs of the outpatient follow-up after liver transplantation, from the first outpatient visit after transplantation to five years after transplantation. DESIGN AND SETTING Cost description study conducted in a university hospital in São Paulo, Brazil. METHODS Cost data were available for 20 adults who underwent liver transplantation due to acute liver failure (ALF) from 2005 to 2009. The data were retrospectively retrieved from medical records and the hospital accounting information system from December 2010 to January 2011. RESULTS Mean cost per patient/year was R$ 13,569 (US$ 5,824). The first year of follow-up was the most expensive (R$ 32,546 or US$ 13,968), and medication was the main driver of total costs, accounting for 85% of the total costs over the five-year period and 71.9% of the first-year total costs. In the second year after transplantation, the mean total costs were about half of the amount of the first-year costs (R$ 15,165 or US$ 6,509). Medication was the largest contributor to the costs followed by hospitalization, over the five-year period. In the fourth year, the costs of diagnostic tests exceeded the hospitalization costs. CONCLUSION This analysis provides significant insight into the costs of outpatient follow-up after liver transplantation due to ALF and the participation of each cost component in the Brazilian setting.
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Affiliation(s)
- Patricia Coelho de Soárez
- DDS, MPH, PhD. Adjunct Professor, Department of Preventive Medicine, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil.
| | - Amanda Nazareth Lara
- MD. Attending Physician, Infectious and Parasitic Diseases Clinic, Hospital das Clínicas (HC), Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil.
| | - Ana Marli Christovam Sartori
- MD, MSc, PhD. Attending Physician, Infectious and Parasitic Diseases Clinic, Hospital das Clínicas (HC) Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil.
| | - Edson Abdala
- MD, MSc, PhD. Attending Physician, Digestive Organ Transplantation Service, Department of Gastroenterology, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil.
| | - Luciana Bertocco de Paiva Haddad
- MD, MSc. Attending Physician, Digestive Organ Transplantation Service, Department of Gastroenterology, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil.
| | - Luiz Augusto Carneiro D’Albuquerque
- MD, MSc, PhD. Titular Professor, Digestive Organ Transplantation Service, Department of Gastroenterology, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil.
| | - Hillegonda Maria Dutilh Novaes
- MD, MSc, PhD. Associate Professor, Department of Preventive Medicine, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil.
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Wolff J, McCrone P, Patel A, Auber G, Reinhard T. A time study of physicians' work in a German university eye hospital to estimate unit costs. PLoS One 2015; 10:e0121910. [PMID: 25803022 PMCID: PMC4372295 DOI: 10.1371/journal.pone.0121910] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Accepted: 02/09/2015] [Indexed: 11/18/2022] Open
Abstract
Background Technical efficiency of hospital services is debated since performance has been heterogeneous. Staff time represents the main resource in patient care and its inappropriate allocation has been identified as a key factor of inefficiency. The aim of this study was to analyse the utilisation of physicians’ work time stratified by staff groups, tasks and places of work. A further aim was to use these data to estimate resource use per unit of output. Methods A self-reporting work-sampling study was carried during 14-days at a University Eye Hospital. Staff costs of physicians per unit of output were calculated at the wards, the operating rooms and the outpatient unit. Results Forty per cent of total work time was spent in contact with the patient. Thirty per cent was spent with documentation tasks. Time spent with documentation tasks declined monotonically with increasing seniority of staff. Unit costs were 56 € per patient day at the wards, 77 € and 20 € per intervention at the operating rooms for inpatients and outpatients, respectively, and 33 € per contact at the outpatient unit. Substantial differences in resources directly dedicated to the patient were found between these locations. Conclusion The presented data provide unprecedented units costs in inpatient Ophthalmology. Future research should focus on analysing factors that influence differences in time allocation, such as types of patients, organisation of care processes and composition of staff.
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Affiliation(s)
- Jan Wolff
- Centre for the Economics of Mental and Physical Health, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
- Department of Management and Controlling, Medical Centre—University of Freiburg, Freiburg, Germany
- * E-mail:
| | - Paul McCrone
- Centre for the Economics of Mental and Physical Health, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
| | - Anita Patel
- Centre for the Economics of Mental and Physical Health, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
| | - Gerd Auber
- Department of Management and Controlling, Medical Centre—University of Freiburg, Freiburg, Germany
| | - Thomas Reinhard
- Eye Centre, Medical Centre—University of Freiburg, Freiburg, Germany
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Åkerlund B. [Where do the visions of the Karolinska University Hospital go?]. Lakartidningen 2015; 112:DCSL. [PMID: 25647114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Wisplinghoff H, Cornely OA, Moser S, Bethe U, Stützer H, Salzberger B, Fätkenheuer G, Seifert H. Outcomes of Nosocomial Bloodstream Infections in Adult Neutropenic Patients: A Prospective Cohort and Matched Case-Control Study. Infect Control Hosp Epidemiol 2015; 24:905-11. [PMID: 14700405 DOI: 10.1086/502158] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
AbstractObjective:To examine the clinical and epidemiologic features, excess length of stay, extra costs, and mortality attributable to bloodstream infection (BSI) in neutropenic patients with hematologic malignancies.Design:Prospective cohort and matched case-control study.Patients:All adult neutropenic patients with hematologic malignancies admitted to Cologne University Hospital between May 1, 1997, and April 30, 1998, were prospectively observed. Case-patients were defined as patients with nosocomial BSI; control-patients were selected among patients without BSI.Results:During the study period, the BSI rate in neutropenic patients was 14.3 per 100 neutropenic episodes. Eighty-four case-patients were included. Matching was successful for 96% of the cohort; 81 matched pairs were studied. The mean total length of stay was significantly longer for patients with BSI than for control-patients (37 vs 29 days;P= .002). Extra costs attributable to the infection averaged $3,200 (U.S.) per patient. The crude mortality rates of case-patients and control-patients were 16% and 4%, respectively (P= .013), with an attributable mortality of 12% (odds ratio, 11). Eighty-seven percent of patients met the criteria for sepsis according to the American College of Chest Physicians/Society of Critical Care Medicine. Severe sepsis or septic shock occurred in 13% of patients and was correlated with mortality (55% vs 10% in patients without severe sepsis or septic shock;P=.01).Conclusions:Nosocomial BSI in neutropenic patients is significantly associated with an excess length of hospital stay, extra costs, and excess mortality. Severe sepsis and septic shock are closely correlated with an adverse outcome.
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Affiliation(s)
- Hilmar Wisplinghoff
- Institute for Medical Microbiology, Immunology and Hygiene, and Department of Internal Medicine, University of Cologne, Cologne, Germany
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Zürcher S. [Improving quality and reducing cost: the ERAS concept]. Krankenpfl Soins Infirm 2015; 108:16-19. [PMID: 25946804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Takamuku M. [Issues related to national university medical schools: focusing on the low wages of university hospital physicians]. Nihon Geka Gakkai Zasshi 2015; 116:70-75. [PMID: 25842820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
University hospitals, bringing together the three divisions of education, research, and clinical medicine, could be said to represent the pinnacle of medicine. However, when compared with physicians working at public and private hospitals, physicians working at university hospitals and medical schools face extremely poor conditions. This is because physicians at national university hospitals are considered to be "educators." Meanwhile, even after the privatization of national hospitals, physicians working for these institutions continue to be perceived as "medical practitioners." A situation may arise in which physicians working at university hospitals-performing top-level medical work while also being involved with university and postgraduate education, as well as research-might leave their posts because they are unable to live on their current salaries, especially in comparison with physicians working at national hospitals, who focus solely on medical care. This situation would be a great loss for Japan. This potential loss can be prevented by amending the classification of physicians at national university hospitals from "educators" to "medical practitioners." In order to accomplish this, the Japan Medical Association, upon increasing its membership and achieving growth, should act as a mediator in negotiations between national university hospitals, medical schools, and the government.
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Rodríguez Ramírez M, del Barrio Manso MI, Martín Sánchez MD. Intravitreal injections: what do patients prefer? Analysis of patient's satisfaction and preferences about where to perform intravitreal injections. Arch Soc Esp Oftalmol 2014; 89:477-483. [PMID: 25176313 DOI: 10.1016/j.oftal.2014.05.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2013] [Revised: 04/23/2014] [Accepted: 05/28/2014] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To analyse satisfaction and patient preferences on the location where they receive an intravitreal injection. METHOD A survey was conducted with the intention of analysing these patients who attended the macula clinic and have been intervened using an intravitreal injection at least once in the day hospital or in the theatre setting, comparing both locations. RESULTS The majority of the interviewed patients preferred the day hospital (50.0 versus 37.5%), mostly because of the comfort and the quick service. In patients with severe age-related macular degeneration (AMD) the option is reversed. The overall satisfaction level was positive in both cases (with 87.5% of patients satisfied or very satisfied in the day hospital and 91.1% in the theatre setting). Through the analysis of different aspects of clinical care the assessment was the same or superior for 75.0% of these patients, except in the waiting time. There were no cases of endophthalmitis. CONCLUSION In general, patients prefer the clinical intervention in the consulting room than in the theatre setting because of the quicker service. There are several characteristics that can influence this choice and should be taken into account.
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Affiliation(s)
- M Rodríguez Ramírez
- Servicio de Oftalmología, Hospital Universitario Infanta Cristina, Parla, Madrid, España.
| | - M I del Barrio Manso
- Servicio de Oftalmología, Hospital Universitario Infanta Cristina, Parla, Madrid, España
| | - M D Martín Sánchez
- Servicio de Oftalmología, Hospital Universitario Infanta Cristina, Parla, Madrid, España
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Guérin A, Bédard P, Lebel D, Bussières JF. [Approach to upgrading pharmaceutical care: the example of immunization]. Sante Publique 2014; 26:813-828. [PMID: 25629676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
AIM This article describes an approach to upgrading pharmaceutical care in healthcare facilities. METHODS This is a descriptive study supporting the upgrade of pharmaceutical care in the field of immunization [blinded for review], in a 500-bed mother-child university hospital. Our approach consisted of 3 steps: (1) a review of the literature, (2) a description of the profile of the sector and (3) a description of upgrading of pharmacists' practices in immunization. RESULTS A total of 19 articles were reviewed. No specific pharmaceutical activity based on very good quality data was identified (A).However, eight pharmaceutical activities based on good quality data (B) or with an insufficient level of proof (D) related to immunization practices were identified. A review of pharmaceutical activities (2013-2014) accounted for an annual expenditure of $ CAN 4,227 for vaccines compared to $ SCAN 27,633,944 for all drugs. A total of 9,254 doses of vaccines were prescribed for 3,544 patients. The planned revision of immunization activities includes a medication reconciliation process targeting immunization requirements, systematic consultation of pharmacy dispensing records for patients hospitalized for more than one month to ensure adherence to the Quebec Immunization Protocol, systematic reporting of vaccine adverse reactions, and implementation of information reviews about new vaccines. CONCLUSION Few data are available concerning the impact of pharmacists in immunization. This descriptive study proposes a number of steps designed to upgrade pharmaceutical practices in a university hospital.
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Moriates C, Mourad M, Novelero M, Wachter RM. Development of a hospital-based program focused on improving healthcare value. J Hosp Med 2014; 9:671-7. [PMID: 24980982 DOI: 10.1002/jhm.2235] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Revised: 06/12/2014] [Accepted: 06/12/2014] [Indexed: 11/08/2022]
Abstract
BACKGROUND Frontline physicians face increasing pressure to improve the quality of care they deliver while simultaneously decreasing healthcare costs. Although hospitals and physicians are beginning to implement initiatives targeting this new goal of healthcare value, few of them have a well-developed infrastructure to support this work. METHODS In March 2012, we launched a high-value care (HVC) program within the Division of Hospital Medicine at the University of California, San Francisco. The HVC program is co-led by a physician and the division's administrator, and includes other hospitalists, resident physicians, pharmacists, and administrators. The program aims to (1) use financial and clinical data to identify areas with clear evidence of waste in the hospital, (2) promote evidence-based interventions that improve both quality of care and value, and (3) pair interventions with evidence-based cost awareness education to drive culture change. RESULTS We identified 6 ongoing projects during our first year. Preliminary data for our inaugural projects are encouraging. One initiative, which targeted decreasing nebulizer use on a high-acuity medical floor (often using metered-dose inhalers instead) led to a decrease in rates of more than 50%. CONCLUSIONS The HVC program is proving to be a successful mechanism to promote improved healthcare value and clinician engagement.
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Affiliation(s)
- Christopher Moriates
- Division of Hospital Medicine, University of California, San Francisco, San Francisco, California
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Aitken SL, Joseph TB, Shah DN, Lasco TM, Palmer HR, DuPont HL, Xie Y, Garey KW. Healthcare resource utilization for recurrent Clostridium difficile infection in a large university hospital in Houston, Texas. PLoS One 2014; 9:e102848. [PMID: 25057871 PMCID: PMC4109955 DOI: 10.1371/journal.pone.0102848] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Accepted: 06/24/2014] [Indexed: 01/14/2023] Open
Abstract
Background There are limited data examining healthcare resource utilization in patients with recurrent Clostridium difficile infection (CDI). Methods Patients with CDI at a tertiary-care hospital in Houston, TX, were prospectively enrolled into an observational cohort study. Recurrence was assessed via follow-up phone calls. Patients with one or more recurrence were included in this study. The location at which healthcare was obtained by patients with recurrent CDI was identified along with hospital length of stay. CDI-attributable readmissions, defined as a positive toxin test within 48 hours of admission and a primary CDI diagnosis, were also assessed. Results 372 primary cases of CDI were identified of whom 64 (17.2%) experienced at least one CDI recurrence. Twelve of 64 patients experienced 18 further episodes of CDI recurrence. Of these 64 patients, 33 (50.8%) patients with recurrent CDI were readmitted of which 6 (18.2%) required ICU care, 29 (45.3%) had outpatient care only, and 2 (3.1%) had an ED visit. Nineteen (55.9%) readmissions were defined as CDI-attributable. For patients with CDI-attributable readmission, the average length of stay was 6±6 days. Conclusion Recurrent CDI leads to significant healthcare resource utilization. Methods of reducing the burden of recurrent CDI should be further studied.
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Affiliation(s)
- Samuel L. Aitken
- University of Houston College of Pharmacy, Houston, Texas, United States of America
- Baylor St. Luke’s Medical Center, Houston, Texas, United States of America
| | - Tiby B. Joseph
- Baylor St. Luke’s Medical Center, Houston, Texas, United States of America
| | - Dhara N. Shah
- University of Houston College of Pharmacy, Houston, Texas, United States of America
- Baylor St. Luke’s Medical Center, Houston, Texas, United States of America
| | - Todd M. Lasco
- Baylor St. Luke’s Medical Center, Houston, Texas, United States of America
| | - Hannah R. Palmer
- Baylor St. Luke’s Medical Center, Houston, Texas, United States of America
| | - Herbert L. DuPont
- University of Houston College of Pharmacy, Houston, Texas, United States of America
- Baylor St. Luke’s Medical Center, Houston, Texas, United States of America
- University of Texas School of Public Health, Houston, Texas, United States of America
- Baylor College of Medicine, Houston Texas, United States of America
| | - Yang Xie
- Merck & Co., Whitehouse Station, New Jersey, United States of America
| | - Kevin W. Garey
- University of Houston College of Pharmacy, Houston, Texas, United States of America
- Baylor St. Luke’s Medical Center, Houston, Texas, United States of America
- University of Texas School of Public Health, Houston, Texas, United States of America
- * E-mail:
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Gupta D, Haber H. Emetogenicity-risk procedures in same day surgery center of an academic university hospital in United States: a retrospective cost-audit of postoperative nausea vomiting management. Middle East J Anaesthesiol 2014; 22:493-502. [PMID: 25137866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND Despite the variable results of published studies, it is imperative for ambulatory surgery centers to self-audit local cost-implications for post-operative nausea and vomiting (PONV) management. OBJECTIVE Our retrospective cost-audit assessed if there were comparative peri-anesthesia care cost-trends among patients who had undergone Low-Emetogenicity-Risk Procedures (LERP), Moderate-Emetogenicity-Risk Procedures (MERP) and Severe-Emetogenicity-Risk Procedures (SERP). METHODS This study was a review of Same Day Surgery Center practices in an academic university hospital setting during a three-year period (2010-2012). The patient lists were accessed from CIS and CITRIX App Bar for time audit and OR (operating room) schedule reports. Subsequently, OR pharmacy department ran a search for peri-operative anti-emetics and opioids that were billed for the patients at Same Day Surgery Center for the review period. The primary outcomes were the comparative costs/charges of these medications and comparative durations/ charges for these patients' stay in the post-anesthesia care unit (PACU). Secondary outcomes analyzed in the study included peri-anesthesia durations. RESULTS A total of 8,657 patient records were analyzed. Almost all analyzed variables revealed statistically significant inter-variable positive correlations. The patients' age was significantly (P < 0.001) different among LERP/MERP/SERP patients (LERP: 48.8 +/- 14.7 years; MERP: 61.8 +/- 14.6 years; SERP: 51.3 +/- 14.5 years). In regards to primary and secondary outcomes, the statistical significant differences among LERP/MERP/SERP patients (after correcting for both patients' age as well as patients' sex) were only achieved for preoperative times (P = 0.002; Power = 0.9), operating room recovery times (P = 0.003; Power = 0.9), PACU stay times (P < 0.001; Power = 1.0), and PACU charges (P < 0.001; Power = 1.0). CONCLUSION PACU stay times and PACU charges were significantly higher in patients who had undergone SERP as compared to patients who had undergone LERP or MERP at our Same Day Surgery Center.
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Boivin J. Formula for successful cost control includes hard data plus surgeon champion. OR Manager 2014; 30:14-18. [PMID: 24783382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Barsuk JH, Feinglass J, Kozmic SE, Hohmann SF, Ganger D, Wayne DB. Specialties performing paracentesis procedures at university hospitals: implications for training and certification. J Hosp Med 2014; 9:162-8. [PMID: 24493399 DOI: 10.1002/jhm.2153] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Revised: 12/22/2013] [Accepted: 12/23/2013] [Indexed: 11/08/2022]
Abstract
BACKGROUND Paracentesis procedure competency is not required for internal medicine or family medicine board certification, and national data show these procedures are increasingly referred to interventional radiology (IR). However, practice patterns at university hospitals are less clear. OBJECTIVE To evaluate which specialties perform paracentesis procedures at university hospitals, compare characteristics of patients within each specialty, and evaluate length of stay (LOS) and hospital costs. DESIGN, SETTING, PATIENTS Observational administrative database review of patients with liver disease who underwent paracentesis procedures in hospitals participating in the University HealthSystem Consortium (UHC) Database from January 2010 through December 2012. UHC is an alliance of 120 academic medical centers and their 290 affiliated hospitals. EXPOSURE Patients with liver disease who underwent inpatient paracentesis procedures. MEASUREMENTS We compared characteristics of patients who underwent paracentesis procedures by physician specialty, modeling the effects of patient characteristics on the likelihood of IR referral. We also analyzed LOS and hospital costs among patients with a >20% predicted probability of IR referral. RESULTS There were 97,577 paracentesis procedures performed during 70,862 hospital stays in 204 hospitals. IR performed 29% of paracenteses versus 49% by medicine and medicine subspecialties including gastroenterology/hepatology. Patients who were female, obese, and those with lower severity of illness were more likely to be referred to IR. Patients with a medicine or gastroenterology/hepatology paracentesis had a similar LOS compared to IR. Hospital costs were an estimated as $1308 less for medicine and $803 less for gastroenterology/hepatology compared to admissions with IR procedures (both P = 0.0001). CONCLUSIONS Internal medicine- and family medicine-trained clinicians frequently perform paracentesis procedures on complex inpatients but are not currently required to be competent in the procedure. Increasing bedside paracentesis procedures may reduce healthcare costs.
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Affiliation(s)
- Jeffrey H Barsuk
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Stein PS, Kim J, Adkins B, Stearley S. Dental pain in the ED: costs that hurt patients and EDs. J Am Coll Dent 2014; 81:46-51. [PMID: 25951683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND AND OBJECTIVES The objective of this retrospective study was to determine if the collection rates for dental related visits to the emergency department (ED) are less than collection rates for ED visits for other problems. METHODS Data were analyzed from one Kentucky hospital's electronic health record system from April 2010 to April 2012. Collection rates for patients who received care in the ED for uncomplicated dental problems were compared to collection rates for all patients who received care in the ED for any reason. RESULTS Each month during the study period, an average of 77 patients presented to the ED for dental problems. Compensation rates for physician fees were 9.8% for dental related care and 39% for all patients who received care for any reason. Compensation rates for hospital fees were 16% for dental related care and 20.1% for all patients who received care for any reason. Uninsured patients accounted for 68.8% of physician fees and 62.4% of hospital fees for dental related care. CONCLUSIONS Using the ED as a dental safety net is costly to the patient because the underlying problem is typically not resolved and costly to the hospital because of very low collection rates. In addition, other patients who present to the ED for non-dental, high acuity problems may have delayed care or no care because of the number of patients using the ED for dental pain.
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Wieder R, DeLaRosa N, Bryan M, Hill AM, Amadio WJ. Prescription coverage in indigent patients affects the use of long-acting opioids in the management of cancer pain. Pain Med 2014; 15:42-51. [PMID: 24106748 PMCID: PMC3947034 DOI: 10.1111/pme.12238] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE We tested the hypothesis that prescription coverage affects the prescribing of long-acting opiates to indigent inner city minority patients with cancer pain. MATERIALS AND METHODS We conducted a chart review of 360 patients treated in the Oncology Practice at University of Medicine and Dentistry of New Jersey University Hospital, who were prescribed opiate pain medications. Half the patients were charity care or self-pay (CC/SP), without the benefit of prescription coverage, and half had Medicaid, with unlimited prescription coverage. We evaluated patients discharged from a hospitalization, who had three subsequent outpatient follow-up visits. We compared demographics, pain intensity, the type and dose of opiates, adherence to prescribed pain regimen, unscheduled emergency department visits, and unscheduled hospitalizations. RESULTS There was a significantly greater use of long-acting opiates in the Medicaid group than in the CC/SP group. The Medicaid group had significantly more African American patients and a greater rate of smoking and substance use, and the CC/SP group disproportionately more Hispanic and Asian patients and less smoking and substance use. Hispanic and Asian patients were less likely to have long-acting opiates prescribed to them. Pain levels and adherence were equivalent in both groups and were not affected by any of these variables except stage of disease, which was equally distributed in the two groups. CONCLUSION Appropriate use of long-acting opiates for equivalent levels of cancer pain was influenced only by the availability of prescription coverage. The group without prescription coverage and receiving fewer long-acting opiates had disproportionately more Hispanic and Asian patients.
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Affiliation(s)
- Robert Wieder
- Department of Medicine and the New Jersey Medical School Cancer Center, Rutgers New Jersey Medical School, Newark, NJ
- Direct correspondence to: Robert Wieder, MD, PhD, 205 South Orange Avenue, Cancer Center H-1216, Newark, NJ 07103, Tel: 973-972-4871, Fax: 973-972-2668,
| | - Nila DeLaRosa
- New York University Langone Medical Center, New York, NY
| | - Margarette Bryan
- Department of Medicine and the New Jersey Medical School Cancer Center, Rutgers New Jersey Medical School, Newark, NJ
| | - Ann Marie Hill
- Edward J. Bloustein School of Planning and Public Policy, Rutgers University, New Brunswick, NJ
| | - William J. Amadio
- Department of Information Systems and Supply Chain Management, Rider University, Lawrenceville, NJ
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Sobkowski M, Opala T. Practical aspects of change management at the Obstetrics and Gynecology Clinic at the University Hospital of Medical Sciences in Poznań, Poland. Ann Agric Environ Med 2014; 21:314-319. [PMID: 24959781 DOI: 10.5604/1232-1966.1108596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
INTRODUCTION AND OBJECTIVES Recent changes to the Polish healthcare system have forced healthcare managers and administrators to implement modern instruments for strategic and operations management. The main aim of the study was to analyze the effect of managerial decisions in the area of human resources, resulting from the adopted restructuring program, on the economic situation of the OGCH, PUMS. MATERIAL AND METHODS The research material comprised of secondary sources on finance, accounting and human resources data: financial statements, analysis of costs incurred by individual hospital departments, reports on the implementation of NHF contracts for providing health services and on hospital workforce at the time of the study, as well as the results of patient satisfaction survey at the OGCH, PUMS. RESULTS After implementation of the restructuring program all clinics apart from one - Surgical Gynecology Clinic - reached better beds occupancy rates in 2012 as compared to 2009, as well as significantly improved profit/per hospital bed. Over the course of three years, since the launch of the hospital restructuring program, a significant (20%) increase in the revenues from selling healthcare services and a simultaneous decrease (2%) of the operating cost was observed. CONCLUSIONS Inclusion of department heads into the decision making processes of managerial accounting seems to be necessary to improve the overall financial condition of a hospital. However, it requires a more flexible hospital structure, what can be achieved by implementing a divisional organizational structure, which grants individual organizational units a certain autonomy in the process of making medical-financial decisions.
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Affiliation(s)
- Maciej Sobkowski
- Department of Maternal and Child Health, Poznań University of Medical Sciences, Polna 33, 60-535 Poznań
| | - Tomasz Opala
- Department of Maternal and Child Health, Poznań University of Medical Sciences, Polna 33, 60-535 Poznań
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Dyer C. Two Staffordshire hospitals to remain open under rescue plan. BMJ 2013; 347:f7619. [PMID: 24355391 DOI: 10.1136/bmj.f7619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Guyot JP. [On the social responsibilities of medical faculties to teach efficient medicine]. Rev Med Suisse 2013; 9:1755-1756. [PMID: 24187747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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Boushehri E, Khamseh ME, Farshchi A, Aghili R, Malek M, Ebrahim Valojerdi A. Effects of morning report case presentation on length of stay and hospitalisation costs. Med Educ 2013; 47:711-716. [PMID: 23746160 DOI: 10.1111/medu.12152] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2012] [Accepted: 01/14/2013] [Indexed: 06/02/2023]
Abstract
CONTEXT The primary goal of discussing patient cases during the morning report is to teach appropriate clinical decision making. In addition, the selection of the best diagnostic strategy and application of evidence-based patient care are important. Reducing hospital costs is fundamental to controlling inflation in health care costs, especially in university hospitals that are subject to budget constraints in developing countries. The goal of this study was to explore the effect of morning report case presentation on length of stay (LoS) and hospitalisation costs in a university teaching hospital. METHODS A total of 54 patients whose cases had been presented at morning report sessions in the department of internal medicine during a 3-month period (presented group) were selected and their medical records reviewed for data on final diagnosis, hospital LoS and detailed hospital costs. A control group of 104 patients, whose cases had not been presented, were selected on the basis that their final diagnoses matched with those of the presented group. In addition, the groups were matched for age, sex, occupation, comorbidities and insurance coverage. Final diagnoses were based on International Classification of Disease 10 (ICD-10) diagnostic code criteria. RESULTS The mean ± standard deviation (SD) hospital LoS was 8.32 ± 4.11 days in the presented group and 10.46 ± 4.92 days in the control group (p = 0.045). Mean ± SD hospitalisation costs per patient were significantly lower in the presented group (US$553.43 ± 92.16) than the control group (US$1621.93 ± 353.14) (p = 0.004). Although costs for paraclinical services were similar, there were very significant reductions in costs for medications used during hospitalisation and bed-days (p = 0.002). CONCLUSIONS Discussing clinical aspects of patient cases in morning report sessions facilitates the management process and has a significant effect on LoS and hospitalisation costs in patients admitted to hospital.
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Affiliation(s)
- Elham Boushehri
- Department of Medical Education, Tehran University of Medical Sciences, Tehran, Iran
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Poole P, Shulruf B. Choosing study outcomes: keeping an eye on the big picture. Med Educ 2013; 47:645-648. [PMID: 23746154 DOI: 10.1111/medu.12210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- Phillippa Poole
- Department of Medicine, University of Auckland, Auckland, New Zealand.
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Tsuchiya T. [Laboratory management fee; laboratory physician's work at university hospital]. Rinsho Byori 2013; 61:518-530. [PMID: 23947191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The laboratory additional management fee is subdivided into I to IV. Each additional management fee is a large source of income for hospitals. This is important in order to show the value to hospitals of laboratory physicians and clinical laboratory technologists. At this symposium, in order to charge an additional management fee correctly according to a laboratory physician's work at Surugadai Nihon University Hospital, an outline of a laboratory physician's duties is described.
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Affiliation(s)
- Tatsuyuki Tsuchiya
- Division of Laboratory Medicine, Department of Pathology and Microbiology, Nihon University Medical School, Tokyo 101-8309, Japan.
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Saito AI. With warm hearts and strong wills: hospital volunteering in Japan. Can Fam Physician 2013; 59:527-528. [PMID: 23673592 PMCID: PMC3653660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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