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Lin L, Parikh PJ. Impact of subsidy policies on the financial status of trauma centers. Health Care Manag Sci 2025:10.1007/s10729-025-09701-1. [PMID: 40266476 DOI: 10.1007/s10729-025-09701-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2024] [Accepted: 03/02/2025] [Indexed: 04/24/2025]
Abstract
Trauma centers (TCs) play a crucial role in improving patient safety of severely injured individuals, but require substantial financial resources to operate effectively. TCs in low-insured areas are particularly at risk of being confronted with financial deficits, and a threat of closure, due to the inability to recover costs from uncompensated care. While some states in the US provide financial subsidies to support these centers, the diversity of state subsidy policies and their impacts on TC financial viability are poorly understood. To address this, we introduce a generalized subsidy distribution formula that incorporates key components from various state policies. Based on that, we further propose a TC Financial Evaluation Model that employs Monte Carlo simulation to assess the effects of different subsidy policies along three proposed metrics. Utilizing realistic data from multiple US states and national insurance statistics, we conduct a comprehensive experimental study. Our findings suggest that the financial performance of TCs could be affected by the total subsidy amount, the Uninsured level within the Trauma Service Area (TSA), and the specific subsidy distribution policy employed. This research provides trauma decision-makers a quantitative tool to evaluate, compare, and design subsidy policies tailored to their unique demographic and economic contexts, potentially leading to a more standardized approach to mitigate existing policy disparities across states.
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Affiliation(s)
- Lin Lin
- Department of Industrial and Systems Engineering, University of Louisville, Louisville, KY, USA
| | - Pratik J Parikh
- Department of Industrial and Systems Engineering, University of Louisville, Louisville, KY, USA.
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de Goeij FHC, Wehrle CJ, Abassi F, Satish S, Zhang M, Panconesi R, Hashimoto K, Miller CM, Polak WG, Clavien PA, de Jonge J, Schlegel A. Mastering the narrative: Precision reporting of risk and outcomes in liver transplantation. J Hepatol 2025; 82:729-743. [PMID: 39557163 DOI: 10.1016/j.jhep.2024.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2024] [Revised: 11/06/2024] [Accepted: 11/11/2024] [Indexed: 11/20/2024]
Abstract
Liver transplantation is associated with a high risk of postoperative complications due to the complexity of the surgical procedure, recipient disease severity and the wide range of graft quality, which remains somewhat unpredictable. However, survival rates after transplantation continue to improve and the focus has thus turned to other clinically relevant endpoints including post-transplant complications, patient quality of life and costs. Procedures like liver transplantation offer the entire spectrum of post-surgical events, even in donor-recipient constellations deemed of low risk within recently defined benchmark criteria. The Clavien-Dindo classification and the CCI (comprehensive complication index) were established to assess postoperative morbidity and are widely utilised across surgical specialties. These scores depend on the number and grade of complications, which reflect the interventions required, and are frequently used to assess specific donor-recipient risk profiles and new approaches, such as machine perfusion. However, these scores are associated with inter-observer variability when used in practice, mainly due to the lack of uniform definitions. The concept of benchmarking was recently introduced in surgery and transplantation as a mechanism of standardising expected donor/recipient risk with outcomes within the first year after surgery. However, the management of complications differs significantly worldwide, as does the rating scale assigned to various complications. This may lead to inhomogeneous interpretation of study results, leading to difficulty in assessing the clinical effects of novel preservation technologies and other therapeutics in liver transplantation. This article critically discusses frequent challenges associated with risk and outcome assessment following liver transplantation.
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Affiliation(s)
- Femke H C de Goeij
- Department of Surgery, Division of Hepatopancreatobiliary and Transplant Surgery, Erasmus MC Transplant Institute, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Chase J Wehrle
- Transplantation Center, Cleveland Clinic, Cleveland, OH, USA
| | - Fariba Abassi
- Department of Abdominal Surgery and Transplantation, University of Zurich, Zurich, Switzerland; Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Sangeeta Satish
- Transplantation Center, Cleveland Clinic, Cleveland, OH, USA; Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Mingyi Zhang
- Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Rebecca Panconesi
- Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Koji Hashimoto
- Department of Surgery, Division of Hepatopancreatobiliary and Transplant Surgery, Erasmus MC Transplant Institute, University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of Abdominal Surgery and Transplantation, University of Zurich, Zurich, Switzerland
| | | | - Wojciech G Polak
- Department of Surgery, Division of Hepatopancreatobiliary and Transplant Surgery, Erasmus MC Transplant Institute, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | | | - Jeroen de Jonge
- Department of Surgery, Division of Hepatopancreatobiliary and Transplant Surgery, Erasmus MC Transplant Institute, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Andrea Schlegel
- Transplantation Center, Cleveland Clinic, Cleveland, OH, USA; Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA.
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Phillipi MA, Song AY, Yieh L, Gong CL. Costs and outcomes associated with the administration of Intravenous Acetaminophen in neonates after esophageal atresia and tracheoesophageal fistula repair. Pediatr Neonatol 2025; 66:157-161. [PMID: 38987066 DOI: 10.1016/j.pedneo.2024.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Revised: 01/15/2024] [Accepted: 02/16/2024] [Indexed: 07/12/2024] Open
Abstract
BACKGROUND Over the last decade, the intravenous (IV) formulation of acetaminophen (APAP) has gained popularity as a safe and effective first-line analgesic in the neonatal intensive care unit and it is especially useful in peri-operative settings where oral agents are contraindicated. The primary objective was to examine the outcomes and costs associated with the use of IV APAP in combination with opioids versus opioids alone as a pain management strategy after neonatal esophageal atresia (EA) and tracheoesophageal fistula (TEF) repair. METHODS Data from the Pediatric Health Information System was used to examine 1137 hospitalizations for EA/TEF repair from October 2015 to September 2018. Neonates administered opioids only, or IV APAP in combination with opioids as pain management, were included. RESULTS Neonates receiving IV APAP experienced a longer median LOS, but a significantly lower mortality rate, a decreased mean daily cost, and reduced opioid use compared to neonates given only opioids. The two groups had no significant differences in pharmacy and total costs. CONCLUSION Our findings suggest that the use of IV APAP alongside opioids in EA/TEF repair is associated with reduced mortality and opioid use, as well as longer LOS.
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Affiliation(s)
- Michael A Phillipi
- School of Medicine, California University of Science and Medicine, 1501 Violet St, Colton, CA, 92324, USA.
| | - Ashley Y Song
- Bloomberg School of Public Health, Johns Hopkins University, 615 N Wolfe St, Baltimore, MD, 21205, USA
| | - Leah Yieh
- Department of Clinical Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, 91101, USA
| | - Cynthia L Gong
- Keck School of Medicine, University of Southern California, 1975 Zonal Ave, Los Angeles, CA, 90033, USA
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Udeh BL, Thompson NR, Honomichl RD, Lapin BR, Katzan IL, Griffiths L, Gomes JA. The Case for Telemedicine-Enhanced Nighttime Staffing in a Neuro-ICU. Crit Care Explor 2025; 7:e1231. [PMID: 40042218 PMCID: PMC11884836 DOI: 10.1097/cce.0000000000001231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2025] Open
Abstract
IMPORTANCE This study compares the health outcomes and healthcare utilization of two staffing models for specialized neuro-ICU (NICU): a 24/7 intensive staffing (IS) model and a daytime 12-hour intensivist model with 12-hour nocturnal telemedicine-enhanced (TE) coverage. The IS model was studied from July 2016 to June 2017. The TE model was studied during the implementation period from July 2017 to June 2018. OBJECTIVES To compare the health outcomes and healthcare utilization of two staffing models for a specialized NICU. DESIGN Retrospective cohort study. SETTING AND PARTICIPANTS NICU with 24 beds in a 1200-bed urban, quaternary care, academic hospital in Northeast Ohio. Participants were critically ill patients with primary neurologic injuries admitted to the NICU between July 2016 and June 2018. MAIN OUTCOMES AND MEASURES Multivariable logistic, and negative binomial regression analysis compared the following outcomes: mortality, ICU length of stay (LOS), hospital LOS, and ventilator days. Demographics and patient characteristics, including Acute Physiology and Chronic Health Evaluation scores, were used in model adjustments. RESULTS Three thousand seventy-three patients were studied: n equals to 1542 IS (average age 61 yr [sd 17], 49% female, 73% White race) and n equals to 1531 TE (average age 62 yr (sd 17), 49% female, 70% White race). The TE model required less staff than IS model (5 vs. 9 staff intensivists), respectively. Compared with IS, the TE cohort had similar demographics and clinical indications, although the groups differed on the distribution of the body systems necessitating ICU admission. TE model was protective of ICU mortality compared with IS model (odds ratio = 0.59; 95% CI, 0.43-0.82; p = 0.002). However, TE was associated with a 10% increase in ICU LOS (incident rate ratio [IRR] = 1.10; 95% CI, 1.03-1.18; p = 0.006) and a 13% increase in total LOS (IRR = 1.13; 95% CI, 1.06-1.20; p < 0.001). There was no difference in ventilator days between groups. CONCLUSIONS AND RELEVANCE The availability of critical care staff is not keeping pace with demand, especially in specialized ICUs, including NICU. The TE model required fewer staff with similar clinical outcomes. This is a preliminary study highlighting that alternate specialized ICU staffing models could require fewer labor requirements while still maintaining quality of care. Further research is required to assess the true impact of LOS differences and examine the impact of these models on physician burnout and retention. This new understanding would provide additional guidance on ICU staffing options and telemedicine costs to hospitals, ensuring efficient and effective resource allocation as ICU demands continue to increase.
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Affiliation(s)
- Belinda L. Udeh
- Neurological Institute Center for Outcomes Research and Evaluation, Cleveland Clinic, Cleveland, OH
- Center for Population Health Research, Cleveland Clinic, Cleveland, OH
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH
| | - Nicolas R. Thompson
- Neurological Institute Center for Outcomes Research and Evaluation, Cleveland Clinic, Cleveland, OH
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH
| | - Ryan D. Honomichl
- Neurological Institute Center for Outcomes Research and Evaluation, Cleveland Clinic, Cleveland, OH
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH
| | - Brittany R. Lapin
- Neurological Institute Center for Outcomes Research and Evaluation, Cleveland Clinic, Cleveland, OH
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH
| | - Irene L. Katzan
- Neurological Institute Center for Outcomes Research and Evaluation, Cleveland Clinic, Cleveland, OH
- Neurological Institute, Cleveland Clinic, Cleveland, OH
| | | | - Joao A. Gomes
- Neurological Institute, Cleveland Clinic, Cleveland, OH
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5
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Jones RP. Capacity Planning (Capital, Staff and Costs) of Inpatient Maternity Services: Pitfalls for the Unwary. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2025; 22:87. [PMID: 39857540 PMCID: PMC11764809 DOI: 10.3390/ijerph22010087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2024] [Revised: 12/22/2024] [Accepted: 12/30/2024] [Indexed: 01/27/2025]
Abstract
This study investigates the process of planning for future inpatient resources (beds, staff and costs) for maternity (pregnancy and childbirth) services. The process of planning is approached from a patient-centered philosophy; hence, how do we discharge a suitably rested healthy mother who is fully capable of caring for the newborn baby back into the community? This demonstrates some of the difficulties in predicting future births and investigates trends in the average length of stay. While it is relatively easy to document longer-term (past) trends in births and the conditions relating to pregnancy and birth, it is exceedingly difficult to predict the future nature of such trends. The issue of optimum average bed occupancy is addressed via the Erlang B equation which links number of beds, average bed occupancy and turn-away. Turn-away is the proportion of times that there is not an immediately available bed for the next arriving inpatient. Data for maternity units show extreme and unexplained variation in turn-away. Economy of scale implied by queuing theory (and the implied role of population density) explains why many well intended community-based schemes fail to gain traction. The paper also addresses some of the erroneous ideas around the dogma that reducing length of stay 'saves' money. Maternity departments are encouraged to understand how their costs are calculated to avoid the trap where it is suggested by others that in reducing the length of stay, they will reduce costs and increase 'efficiency'. Indeed, up to 60% of calculated maternity 'costs' are apportioned from (shared) hospital overheads from supporting departments such as finance, personnel, buildings and grounds, IT, information, etc., along with depreciation charges on the hospital-wide buildings and equipment. These costs, known as 'the fixed costs dilemma', are totally beyond the control of the maternity department and will vary by hospital depending on how these costs are apportioned to the maternity unit. Premature discharge, one of the unfortunate outcomes of turn-away, is demonstrated to shift maternity costs into the pediatric and neonatal departments as 'boomerang babies', and then require the cost of avoidable inpatient care. Examples are given from the English NHS of how misdirected government policy can create unforeseen problems.
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Affiliation(s)
- Rodney P Jones
- Healthcare Analysis and Forecasting, Wantage OX12 0NE, UK
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Zubieta CS, Shabet C, Lin J, Muzaurieta A, Arora A, Maghsoodi N, Brummett CM, Edelman A. Financial model for a transitional pain service at a large tertiary academic center in the USA. Reg Anesth Pain Med 2025; 50:1-4. [PMID: 38124160 DOI: 10.1136/rapm-2023-104992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Accepted: 10/21/2023] [Indexed: 12/23/2023]
Abstract
Approximately 1 in 10 patients undergoing surgery is considered at high risk for poor pain and opioid-related outcomes due to chronic pain or persistent opioid use prior to surgery, leading to increased hospital lengths of stay, emergency department visits, hospital readmissions, and worse long-term outcomes. Multidisciplinary transitional pain services (TPSs) have been shown to effectively identify and optimize high-risk patients before surgery, leading to a reduction in healthcare utilization. We conducted a series of semistructured interviews, a literature search, and a financial analysis to develop a reproducible business case for establishing a TPS. These interviews involved discussions with clinicians and administrators at Michigan Medicine, as well as leaders of TPS initiatives at peer institutions across the USA and Canada. The aim was to understand possible operational structures and potential sources of revenue and cost savings that needed inclusion in our model. Subsequently, the authors developed a modifiable financial modeling tool, which is freely available for download and adaptable to any healthcare institution. The model suggests that the primary source of cost savings can be attributed to a reduction in length of stay. Furthermore, several operational options exist for incorporating a TPS that performs at breakeven or positive net profit. This tool and these findings are important for informing health systems of operational and financial considerations when implementing a TPS program. Future research should evaluate this financial tool's reproducibility in community health system contexts.
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Affiliation(s)
- Caroline S Zubieta
- University of Michigan Medical School, University of Michigan, Ann Arbor, Michigan, USA
- Michigan Ross School of Business, University of Michigan, Ann Arbor, Michigan, USA
| | - Christina Shabet
- University of Michigan Medical School, University of Michigan, Ann Arbor, Michigan, USA
- Michigan Ross School of Business, University of Michigan, Ann Arbor, Michigan, USA
| | - James Lin
- Michigan Ross School of Business, University of Michigan, Ann Arbor, Michigan, USA
| | - Aurelio Muzaurieta
- University of Michigan Medical School, University of Michigan, Ann Arbor, Michigan, USA
- Michigan Ross School of Business, University of Michigan, Ann Arbor, Michigan, USA
| | - Akul Arora
- University of Michigan Medical School, University of Michigan, Ann Arbor, Michigan, USA
- Michigan Ross School of Business, University of Michigan, Ann Arbor, Michigan, USA
| | - Nazanin Maghsoodi
- University of Michigan Medical School, University of Michigan, Ann Arbor, Michigan, USA
- Michigan Ross School of Business, University of Michigan, Ann Arbor, Michigan, USA
| | - Chad M Brummett
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, Michigan, USA
- Opioid Prescribing Engagement Network, Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA
- Opioid Research Institute, University of Michigan, Ann Arbor, Michigan, USA
| | - Anthony Edelman
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, Michigan, USA
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Warner MA, Ferreira R, Raphael J, Shore-Lesserson L, Grant MC, Hill SS, Morewood G, Popescu WM, Schwann N, Guinn NR. Return on Investment of Preoperative Anemia Management Programs in Cardiac Surgery: An Advisory From the Society of Cardiovascular Anesthesiologists Clinical Practice Improvement Committee With Endorsement by the Society for the Advancement of Patient Blood Management. Anesth Analg 2024:00000539-990000000-01037. [PMID: 39671509 PMCID: PMC12056166 DOI: 10.1213/ane.0000000000006721] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2024]
Abstract
Despite multiple recent guidelines recommending the diagnosis and treatment of anemia before elective cardiac surgery, few institutions have formal programs or methods in place to accomplish this. A major limitation is the perceived financial shortfall and the leadership buy-in required to undertake such an initiative. The purpose of this advisory from the Society of Cardiovascular Anesthesiologists (SCA) Clinical Practice Improvement Committee with endorsement by the Society for the Advancement of Patient Blood Management (SABM) is to provide an overview of preoperative anemia management programs with an emphasis on the associated financial implications. This advisory reviews the evidence for preoperative anemia management programs in both cardiac and noncardiac surgery, discusses options for managing preoperative anemia, provides novel financial modeling regarding the implementation of preoperative anemia management programs, and describes implementation challenges, potential solutions, and opportunities for improvement.
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Affiliation(s)
- Matthew A. Warner
- Department of Anesthesiology & Perioperative Medicine, Mayo Clinic, Minnesota
| | - Renata Ferreira
- Missoula Anesthesiology and International Heart Institute, Missoula, MT
| | - Jacob Raphael
- Department of Anesthesiology and Perioperative Medicine, Thomas Jefferson University Hospital, Sidney Kimmel Medical College, Philadelphia, Pennsylvania
| | - Linda Shore-Lesserson
- Department of Anesthesiology, Zucker School of Medicine at Hofstra/ Northwell, Manhasset, New York
| | - Michael C. Grant
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Shanna Sykes Hill
- Department of Anesthesiology, Weill Cornell Medicine, New York, New York
| | - Gordon Morewood
- Department of Anesthesiology, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
| | - Wanda M. Popescu
- Department of Anesthesiology, Yale School of Medicine, New Haven, Connecticut
| | - Nanette Schwann
- Department of Anesthesiology, Lehigh Valley Health Network and Department of Surgery Division of Surgical Anesthesiology, University of South Florida Morsani College of Medicine
| | - Nicole R. Guinn
- Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina
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Alarifi MI, Mostafa OAI, Alballaa R, Alqahtani RM, Almutawa NA, Almutawa F, Almutawa RA, Almutawa RA, Almusahel E, Alyahya L, AlNahdi MM, Alsaadon A, Temsah MH. Comparative Study Between Medical/Surgical Intensive Care Units vs. Mixed Intensive Care Units in Key Performance Indicators. Cureus 2024; 16:e74100. [PMID: 39712857 PMCID: PMC11661697 DOI: 10.7759/cureus.74100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2024] [Indexed: 12/24/2024] Open
Abstract
Background This comparative study evaluates the performance of medical/surgical and mixed intensive care units (ICUs) at a tertiary care university hospital in Riyadh, Saudi Arabia, using key performance indicators (KPIs). Since its establishment in 1982, the hospital has provided comprehensive medical services, including specialized, closed-model ICUs, including medical, surgical, and pediatric ICUs. In 2021, these ICUs transitioned to a mixed ICU model to enhance efficiency and patient care. This study aims to assess the impact of this transition on various KPIs, including mortality rate, ICU length of stay (LOS), bed occupancy rate (bOR), ICU readmission rate within 48 hours, unplanned extubation, glycemic control, and delayed ICU discharge. Methodology Data from 2018 to 2022 were analyzed, comparing the separate medical and surgical ICUs model (2018-2020) with the mixed ICU model (2021-2022). Statistical analyses were performed, including independent t-tests and analysis of variance (ANOVA), to determine significant differences between the ICU models. Results The transition to the mixed ICU model significantly improved several KPIs. The standardized mortality ratio (SMR) decreased from 0.575 in the specialized ICU model to 0.399 in the mixed ICU model, reflecting a marked improvement in patient outcomes. The average LOS also reduced from 4.989 days in the specialized ICUs to 4.481 days in the mixed ICU model. Additionally, the bOR significantly dropped from 91.00% to 72.08% (P = 0.000), enhancing resource efficiency. Readmission rates within 48 hours were reduced from 0.883 to 0.475 and delayed ICU discharge rates also improved, falling from 34.59% to 23.31%. Our findings revealed that the mixed ICU model outperformed the specialized ICU in most KPIs, reflecting notable enhancements in operational efficiency and patient outcomes. Conclusions The transition to a mixed ICU model led to significant improvements in KPIs, including reductions in mortality rate and average LOS, alongside enhanced bOR and lower readmission rates within 48 hours. Delayed ICU discharge rates and glycemic control also showed notable positive changes. These improvements likely stem from the interdisciplinary expertise and flexibility of the mixed ICU environment, which supports better resource allocation and patient care. The study underscores the potential of mixed ICUs to optimize both clinical outcomes and operational efficiency in hospitals. Implementing such models can serve as a robust strategy for improving ICU performance. However, further research is needed to evaluate the long-term effects and assess the applicability of this model in diverse healthcare settings to fully validate its benefits.
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Affiliation(s)
- Mohammed I Alarifi
- Department of Critical Care Medicine, College of Medicine, King Saud University, Riyadh, SAU
| | | | - Rashid Alballaa
- Department of Critical Care Medicine, King Saud University, Riyadh, SAU
| | - Rakan M Alqahtani
- Department of Critical Care Medicine, King Saud University, Riyadh, SAU
| | | | - Faisal Almutawa
- Department of Medicine, King Saud bin Abdulaziz University for Health Sciences (KSAU-HS), Riyadh, SAU
| | - Renad A Almutawa
- Department of Pediatric Surgery, King Saud University, Riyadh, SAU
| | | | | | - Lama Alyahya
- College of Medicine, King Saud University, Riyadh, SAU
| | - Maha M AlNahdi
- Department of Critical Care Medicine, King Saud University, Riyadh, SAU
| | | | - Mohamad-Hani Temsah
- Pediatric Intensive Care Unit, Department of Pediatrics, King Saud University Medical City, College of Medicine, King Saud University, Riyadh, SAU
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9
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Agri F, Möller W, Deslarzes P, Vogel CA, Hahnloser D, Hubner M, Demartines N, Grass F. Cost Analysis of Outpatient Colectomy in a Tertiary Center: A Projected Medico-Economic Evaluation. Health Serv Insights 2024; 17:11786329241284400. [PMID: 39347457 PMCID: PMC11439163 DOI: 10.1177/11786329241284400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Accepted: 09/02/2024] [Indexed: 10/01/2024] Open
Abstract
Aim of the study Short stay processes are incentives to unburden chronically stressed healthcare systems. The aim of this study is to analyze financial implications of day admission (DAS) and outpatient strategies for colon resections in a prospective payment system (PPS) using Diagnosis Related Group (DRG) coding. Methods Consecutive patients undergoing left and right colonic resections between January 1, 2019 and December 31, 2020 were included. Medico-economic evaluations of the virtual outpatient and day admission surgery groups based on predefined criteria were compared to the identical group of patients who underwent surgery in the actual traditional inpatient setting. In a second step, postoperative complications of the virtual outpatient group were assessed. Cost-revenue analysis was performed using a micro-costing approach including direct medical costs. Results Overall (N = 257), 97 (37.7%) colectomies would have been potentially eligible for an outpatient strategy. The global costs of the actual inpatient strategy totaled USD 3 634 392 with a global revenue of USD 3 571 069, corresponding to a cost coverage rate of 98%. The result of the virtual DAS strategy would have been a net loss of USD 15 800 (coverage rate of 99%) due to 4 low length of stay outliers triggering a reimbursement reduction and preventing a positive net result of USD 16 208. The pilot reference outpatient case's revenue and cost amounted to respectively USD 7479 and USD 6911 (cost coverage of 108%). Conclusion From both any given hospital and healthcare system point of view, elective outpatient colectomy for selected patients is the most cost-saving option. However, in a prospective payment system implemented to avoid bad incentives, the latter can unintentionally disadvantage best performing hospitals and impede widespread adoption of high-value strategies.
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Affiliation(s)
- Fabio Agri
- Department of Visceral Surgery, Lausanne University Hospital CHUV, University of Lausanne (UNIL), Lausanne, Switzerland
- Department of Administration and Finance, Lausanne University Hospital, Lausanne, Switzerland
| | - William Möller
- Department of Visceral Surgery, Lausanne University Hospital CHUV, University of Lausanne (UNIL), Lausanne, Switzerland
| | - Philip Deslarzes
- Department of Visceral Surgery, Lausanne University Hospital CHUV, University of Lausanne (UNIL), Lausanne, Switzerland
| | - Charles André Vogel
- Department of Administration and Finance, Lausanne University Hospital, Lausanne, Switzerland
| | - Dieter Hahnloser
- Department of Visceral Surgery, Lausanne University Hospital CHUV, University of Lausanne (UNIL), Lausanne, Switzerland
| | - Martin Hubner
- Department of Visceral Surgery, Lausanne University Hospital CHUV, University of Lausanne (UNIL), Lausanne, Switzerland
| | - Nicolas Demartines
- Department of Visceral Surgery, Lausanne University Hospital CHUV, University of Lausanne (UNIL), Lausanne, Switzerland
- General Direction, Lausanne University Hospital, Lausanne, Switzerland
| | - Fabian Grass
- Department of Visceral Surgery, Lausanne University Hospital CHUV, University of Lausanne (UNIL), Lausanne, Switzerland
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10
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Harris CM, Higgins C, Mehta AK. Trends in Specialty Palliative Care Service Utilization and In-Hospital Outcomes for Patients With Amyotrophic Lateral Sclerosis. J Palliat Med 2024; 27:521-525. [PMID: 38324041 DOI: 10.1089/jpm.2023.0444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2024] Open
Abstract
Background: Hospitalized people with amyotrophic lateral sclerosis (ALS) may benefit from specialty palliative care services (sPCS). Objective: To describe access to in-hospital sPCS for people with ALS (pALS). Methods: We compared years 2010-2011 to 2018-2019, and conducted trend analyses of sPCS from 2010 to 2019 stratified by race. Results: Of 103,193 pALS admitted during the study period, 13,885 (13.4%) received sPCS. Rates of sPCS increased over time (2010-2011: 8.9% vs. 2018-2019: 16.6%; p < 0.01). From 2010 to 2019, there was an increase in sPCS (p-trend<0.01) for all studied racial groups. Conclusions: Access to palliative care has increased over time for pALS admitted to hospitals in the United States.
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Affiliation(s)
- Che M Harris
- Department of Medicine, Johns Hopkins School of Medicine, Johns Hopkins Bayview Medical Center, Baltimore, Maryland, USA
| | | | - Ambereen K Mehta
- Palliative Care Program, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
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11
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Bisagni P, D'Abrosca V, Tripodi V, Armao FT, Longhi M, Russo G, Ballabio M. Cost saving in implementing ERAS protocol in emergency abdominal surgery. BMC Surg 2024; 24:70. [PMID: 38389067 PMCID: PMC10885507 DOI: 10.1186/s12893-024-02345-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Accepted: 02/04/2024] [Indexed: 02/24/2024] Open
Abstract
INTRODUCTION ERAS (Enhanced Recovery After Surgery) protocol is now proposed as the standard of care in elective major abdominal surgery. Implementation of the ERAS protocol in emergency setting has been proposed but his economic impact has not been investigated. Aim of this study was to evaluate the cost saving of implementing ERAS in abdominal emergency surgery in a single institution. METHODS A group of 80 consecutive patients treated by ERAS protocol for gastrointestinal emergency surgery in 2021 was compared with an analogue group of 75 consecutive patients treated by the same surgery the year before implementation of ERAS protocol. Adhesion to postoperative items, length of stay, morbidity and mortality were recorded. Cost saving analysis was performed. RESULTS 50% Adhesion to postoperative items was reached on day 2 in the ERAS group in mean. Laparoscopic approach was 40 vs 12% in ERAS and control group respectively (p ,002). Length of stay was shorter in ERAS group by 3 days (9 vs 12 days p ,002). Morbidity and mortality rate were similar in both groups. The ERAS group had a mean cost saving of 1022,78 € per patient. CONCLUSIONS ERAS protocol implementation in the abdominal emergency setting is cost effective resulting in a significant shorter length of stay and cost saving per patient.
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Affiliation(s)
- Pietro Bisagni
- Department of Surgery, Ospedale Maggiore di Lodi, Viale Savoia 1, 26900, Lodi, Italia.
- Università degli Studi Statale di Milano, Milano, Italy.
| | - Vera D'Abrosca
- Department of Surgery, Ospedale Maggiore di Lodi, Viale Savoia 1, 26900, Lodi, Italia
| | - Vincenzo Tripodi
- Department of Surgery, Ospedale Maggiore di Lodi, Viale Savoia 1, 26900, Lodi, Italia
| | - Francesca Teodora Armao
- Department of Surgery, Ospedale Maggiore di Lodi, Viale Savoia 1, 26900, Lodi, Italia
- Università degli Studi Statale di Milano, Milano, Italy
| | - Marco Longhi
- Department of Surgery, Ospedale Maggiore di Lodi, Viale Savoia 1, 26900, Lodi, Italia
| | - Gianluca Russo
- Department of Emergency, Ospedale Maggiore di Lodi, Lodi, Italy
- Università degli Studi Statale di Milano, Milano, Italy
| | - Michele Ballabio
- Department of Surgery, Ospedale Maggiore di Lodi, Viale Savoia 1, 26900, Lodi, Italia
- Università degli Studi Statale di Milano, Milano, Italy
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Ki Y, McAleavey AA, Moger TA, Moltu C. Cost structure in specialist mental healthcare: what are the main drivers of the most expensive episodes? Int J Ment Health Syst 2023; 17:37. [PMID: 37946305 PMCID: PMC10633930 DOI: 10.1186/s13033-023-00606-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 10/06/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Mental disorders are one of the costliest conditions to treat in Norway, and research into the costs of specialist mental healthcare are needed. The purpose of this article is to present a cost structure and to investigate the variables that have the greatest impact on high-cost episodes. METHODS Patient-level cost data and clinic information during 2018-2021 were analyzed (N = 180,220). Cost structure was examined using two accounting approaches. A generalized linear model was used to explain major cost drivers of the 1%, 5%, and 10% most expensive episodes, adjusting for patients' demographic characteristics [gender, age], clinical factors [length of stay (LOS), admission type, care type, diagnosis], and administrative information [number of planned consultations, first hospital visits, interval between two hospital episode]. RESULTS One percent of episodes utilized 57% of total resources. Labor costs accounted for 87% of total costs. The more expensive an episode was, the greater the ratio of the inpatient (ward) cost was. Among the top-10%, 5%, and 1% most expensive groups, ward costs accounted for, respectively, 89%, 93%, and 99% of the total cost, whereas the overall average was 67%. Longer LOS, ambulatory services, surgical interventions, organic disorders, and schizophrenia were identified as the major cost drivers of the total cost, in general. In particular, LOS, ambulatory services, and schizophrenia were the factors that increased costs in expensive subgroups. The "first hospital visit" and "a very short hospital re-visit" were associated with a cost increase, whereas "the number of planned consultations" was associated with a cost decrease. CONCLUSIONS The specialist mental healthcare division has a unique cost structure. Given that resources are utilized intensively at the early stage of care, improving the initial flow of hospital care can contribute to efficient resource utilization. Our study found empirical evidence that planned outpatient consultations may be associated with a reduced health care burden in the long-term.
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Affiliation(s)
- Yeujin Ki
- Department of Research and Innovation, Helse Førde, Førde, Norway.
| | - Andrew Athan McAleavey
- Department of Research and Innovation, Helse Førde, Førde, Norway
- Department of Health and Caring Sciences, Western Norway University of Applied Science, Bergen, Norway
| | - Tron Anders Moger
- Department of Health Management and Health Economics, University of Oslo, Oslo, Norway
- Section of Medical Statistics, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Christian Moltu
- Department of Psychiatry, Helse Førde, Førde, Norway
- Department of Health and Caring Sciences, Western Norway University of Applied Science, Bergen, Norway
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Ehrlich AL, Owodunni OP, Mostales JC, Efron J, Hundt J, Magnuson T, Gearhart SL. Implementation of a Multispecialty Geriatric Surgery Pathway Reduces Inpatient Cost for Frail Patients. Ann Surg 2023; 278:e726-e732. [PMID: 37203587 PMCID: PMC10524651 DOI: 10.1097/sla.0000000000005902] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
OBJECTIVE The objective of this study was to evaluate the effect of geriatric surgical pathway (GSP) implementation on inpatient cost of care. BACKGROUND Achieving high-value care for older patients is the goal of the American College of Surgeons Geriatric Verification Program (ACS-GSV). We have previously shown that implementation of our geriatric surgery pathway, which aligns with the ACS-GSV standards, resulted in a reduction in loss of independence and complications. METHODS Patients ≥65 years who underwent an inpatient elective surgical procedure included in the American College of Surgeons National Quality Improvement Program (ACS NSQIP) registry from July 2016 through December 2017 were compared with those patients from February 2018 to December 2019 who were cared for on our GSP. An amalgamation of Clinformatics DataMart, the electronic health record, and the ACS NSQIP registry produced the analytical dataset. We compared mean total and direct costs of care for the entire cohort as well as through propensity matching of frail surgical patients to account for differences in clinical characteristics. RESULTS The total mean cost of health care services during hospitalization was significantly lower in the cohort on our GSP ($23,361±$1110) as compared with the precohort ($25,452±$1723), P <0.001. On propensity-matched analysis, cost savings was more evident in our frail geriatric surgery patients. CONCLUSIONS This study shows that high-value care can be achieved with the implementation of a GSP that aligns with the ACS-GSV program.
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Affiliation(s)
- April L Ehrlich
- Division of Geriatrics, Johns Hopkins University School of Medicine, Baltimore, MD
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Oluwafemi P Owodunni
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Joshua C Mostales
- Division of Geriatrics, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Jonthan Efron
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
- Johns Hopkins University School of Medicine, Baltimore, MD
| | - John Hundt
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
- Johns Hopkins University School of Medicine, Baltimore, MD
| | - Tom Magnuson
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Susan L Gearhart
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
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Venishetty N, Sohn G, Nguyen I, Trivedi M, Mounasamy V, Sambandam S. Perioperative complications of legally blind patients undergoing total hip arthroplasty - A national in-patient sample database study. J Orthop 2023; 40:47-51. [PMID: 37188145 PMCID: PMC10172850 DOI: 10.1016/j.jor.2023.04.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 04/21/2023] [Indexed: 05/17/2023] Open
Abstract
Background Legally blind patients are more prone to injury-related falls, which may lead to hip fractures, often necessitating total hip arthroplasty (THA), as a corrective procedure. Many of these patients have unique medical needs and have increased rates of perioperative complications following surgical procedures. However, there is limited information on the hospitalization data and perioperative complications in this population following guidelines such as THA. The purpose of this study was to evaluate the patient characteristics, demographics, and prevalence of perioperative issues among THA patients who were legally blind. Methods Using 2016-2019 data from the Nationwide Inpatient Sample (NIS), the incidence of perioperative complications, length of stay (LOS), and the cost of care (COC) among patients undergoing THA who were categorized as legally blind patients, compared to those who were not were analyzed. Propensity matching was conducted to consider associated factors that may influence perioperative complications. Results From 2016 to 2019, 367,856 patients underwent THA, according to the NIS. Of those, 322 (0.1%) patients were categorized as legally blind, and the remaining 367,534 (99.9%) patients were not identified as legally blind (control). Legally blind patients were significantly younger than the control group (65.4 years vs. 66.7 years, p < 0.001). After propensity matching, legally blind patients had longer LOS (3.9 days vs. 2.8, p = 0.04), increased discharges to another facility (45.9% vs. 29.3%, p < 0.001), and fewer discharges to home (21.4% vs. 32.2%, p = 0.02) than control patients. Conclusions The legally blind group had significantly longer LOS, higher rates of discharge to another facility, and lower rates of discharge to home compared to the control group. This data will help providers make informed decisions about patient care and resource allocation for legally blind patients undergoing THA.
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Affiliation(s)
- Nikit Venishetty
- Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, 5001 El Paso Dr, El Paso, TX, USA
| | - Garrett Sohn
- University of Texas Southwestern, 5323 Harry Hines Blvd, Dallas, TX, USA
| | - Ivy Nguyen
- University of Texas Southwestern, 5323 Harry Hines Blvd, Dallas, TX, USA
| | - Meesha Trivedi
- Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, 5001 El Paso Dr, El Paso, TX, USA
| | - Varatharaj Mounasamy
- Department of Orthopedics, University of Texas Southwestern, Chief of Orthopedics, Dallas VAMC, 4500 South Lancaster Road, Dallas, TX, USA
| | - Senthil Sambandam
- University of Texas Southwestern, Staff Orthopedic Surgeon, Dallas VAMC, 4500 South Lancaster Road, Dallas, TX, USA
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Sletvold TP, Boland S, Schipmann S, Mahesparan R. Quality indicators for evaluating the 30-day postoperative outcome in pediatric brain tumor surgery: a 10-year single-center study and systematic review of the literature. J Neurosurg Pediatr 2023; 31:109-123. [PMID: 36401544 DOI: 10.3171/2022.10.peds22308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 10/12/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Surgery is the cornerstone in the management of pediatric brain tumors. To provide safe and effective health services, quantifying and evaluating quality of care are important. To do this, there is a need for universal measures in the form of indicators reflecting quality of the delivered care. The objective of this study was to analyze currently applied quality indicators in pediatric brain tumor surgery and identify factors associated with poor outcome at a tertiary neurosurgical referral center in western Norway. METHODS All patients younger than 18 years of age who underwent surgery for an intracranial tumor at the Department of Neurosurgery at Haukeland University Hospital in Bergen, Norway, between 2009 and 2020 were included. The primary outcomes of interest were classic quality indicators: 30-day readmission, 30-day reoperation, 30-day mortality, 30-day nosocomial infection, and 30-day surgical site infection (SSI) rates; and length of stay. The secondary aim was the identification of risk factors related to unfavorable outcome. The authors also conducted a systematic literature review. Articles concerning pediatric brain tumor surgery reporting at least two quality indicators were of interest. RESULTS The authors included 82 patients aged 0-17 years. The 30-day outcomes for unplanned reoperation, unplanned remission, mortality, nosocomial infection, and SSI were 9.8%, 14.6%, 0%, 6.1%, and 3.7%, respectively. Unplanned reoperation was associated with eloquent localization (p = 0.009), primary emergency surgery (p = 0.003), and CSF diversion procedures (p = 0.002). Greater tumor volume was associated with unplanned readmission (p = 0.008), nosocomial infection (p = 0.004), and CSF leakage (p = 0.005). In the systematic review, after full-text screening, 16 articles were included and provided outcome data for 1856 procedures. Overall, the 30-day mortality rate was low, varying from 0% to 9.3%. The 30-day reoperation rate varied from 1.5% to 12%. The SSI rate ranged between 0% and 3.9%, and 0% to 17.4% of patients developed CSF leakage. Four studies reported infratentorial tumor location as a risk factor for postoperative CSF leakage. CONCLUSIONS The 30-day outcomes in the authors' department were comparable to published outcomes. The most relevant factors related to unfavorable outcomes are tumor volume and location, both of which are not modifiable by the surgeon. This highlights the importance of risk adjustment. This evaluation of quality indicators reveals concerns related to the unclear and nonstandardized definitions of outcomes. Standardized outcome definitions and documentation in a large and multicentric database are needed in the future for further evaluation of quality indicators.
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Affiliation(s)
| | - Solveig Boland
- 1Department of Clinical Medicine, University of Bergen; and
| | | | - Rupavatana Mahesparan
- 1Department of Clinical Medicine, University of Bergen; and
- 2Department of Neurosurgery, Haukeland University Hospital, Bergen, Norway
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Lai KC, Lorch SA. Healthcare Costs of Major Morbidities Associated with Prematurity in US Children's Hospitals. J Pediatr 2022; 256:53-62.e4. [PMID: 36509157 DOI: 10.1016/j.jpeds.2022.11.038] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 10/14/2022] [Accepted: 11/20/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To evaluate the healthcare costs attributed to major morbidities associated with prematurity, namely, bronchopulmonary dysplasia (BPD), intraventricular hemorrhage, necrotizing enterocolitis (NEC), retinopathy of prematurity (ROP), and nosocomial infections. STUDY DESIGN This was a retrospective analysis of infants born at 24-30 weeks of gestation, admitted to children's hospitals in the Pediatric Health Information System between 2009 and 2018. Charges were adjusted by geographical price index, converted to costs using cost-to-charge ratios, inflated to 2018 US$, and total costs were accumulated for the initial hospitalization. Quantile regressions, which are less prone to bias from extreme outliers, were used to examine the incremental costs attributed to each morbidity across the entire cost distribution, including the median. RESULTS There were 19 232 patients from 30 children's hospitals who were eligible. Higher costs were seen in lower gestational age, more severe morbidity, and those with higher number of comorbidities. Patients with surgical NEC, severe ROP, and severe BPD were the costliest with median total costs of $430 860, $413 825, and $399 495, respectively. Quantile regressions showed surgical NEC had the highest adjusted median incremental total cost ($48 621; 95% CI, $39 617-$57 626) followed by severe BPD ($35 773; 95% CI, $32 018-$39 528) and severe ROP ($22 561; 95% CI, $16 699-$28 423). Quantile regressions also revealed that surgical NEC, severe BPD, and severe ROP had increasing incremental costs at higher total cost percentiles, indicating these morbidities have a greater cost impact on the costliest patients. CONCLUSIONS Severe BPD, surgical NEC, and severe ROP are the costliest morbidities and contribute the most incremental costs especially for the higher costs patients.
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Affiliation(s)
- Kuan-Chi Lai
- Division of Neonatology, The Children's Hospital of Philadelphia, Philadelphia, PA; Division of Neonatology, Children's Hospital Los Angeles, Los Angeles, CA.
| | - Scott A Lorch
- Division of Neonatology, The Children's Hospital of Philadelphia, Philadelphia, PA
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Keshavarzi F. Practical Concerns about the Metrics and Methods of Financial Outcome Measurement in Antimicrobial Stewardship Programs: A Narrative Review. IRANIAN JOURNAL OF MEDICAL SCIENCES 2022; 47:394-405. [PMID: 36117584 PMCID: PMC9445868 DOI: 10.30476/ijms.2021.92213.2343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 08/23/2021] [Accepted: 09/28/2021] [Indexed: 11/13/2022]
Abstract
Emerging pathogens in the meantime of paucity of new antibiotics discovery, put antimicrobial stewardship in the center of attention, to preserve the existing antimicrobial effect. Implementation of antimicrobial stewardship programs, however, needs approval from healthcare system managers. The approval process can be enhanced, when the beneficial effects of stewardship programs are supported by both clinical and financial evidence. Focusing on the financial outcome evaluation, the practitioners who run the stewardship programs, may choose certain methods and metrics, depending on the clinical setting scale and type, available human resources, and budget. The wise selection of the methods and metrics warrants a comprehensive insight of the existing methods and metrics, deployed by typically published works that set good examples to follow. This review is an attempt to provide such an insight along with typical relevant examples for each metric and method.
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Affiliation(s)
- Fazlollah Keshavarzi
- Department of Clinical Pharmacy, School of Pharmaceutical Sciences, UCSI University, Kuala Lumpur, Malaysia
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18
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The cost of treatments for retained traumatic hemothorax: A decision analysis. Injury 2022; 53:2930-2938. [PMID: 35871855 DOI: 10.1016/j.injury.2022.07.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 06/15/2022] [Accepted: 07/12/2022] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Early video-assisted thorascopic surgery (VATS) is the recommended intervention for retained hemothorax in trauma patients. Alternative options, such as lytic therapy, to avoid surgery remain controversial. The purpose of this decision analysis was to assess expected costs associated with treatment strategies. METHODS A decision tree analysis estimated the expected costs of three initial treatment strategies: 1) VATS, 2) intrapleural tissue plasminogen activator (TPA) lytic therapy, and 3) intrapleural non-TPA lytic therapy. Probability parameters were estimated from published literature. Costs were based on National Inpatient Sample data and published estimates. Our model compared overall expected costs of admission for each strategy. Sensitivity analyses were conducted to explore the impact of parameter uncertainty on the optimal strategy. RESULTS In the base case analysis, using TPA as the initial approach had the lowest total cost (U.S. $37,007) compared to VATS ($38,588). TPA remained the optimal initial approach regardless of the probability of complications after VATS. TPA was an optimal initial approach if TPA success rate was >83% regardless of the failure rate with VATS. VATS was the optimal initial strategy if its total cost of admission was <$33,900. CONCLUSION Lower treatment costs with lytic therapy does not imply significantly lower total cost of trauma admission. However, an initial approach with TPA lytic therapy may be preferred for retained traumatic hemothorax to lower the total cost of admission given its high probability of avoiding the operating room with its resultant increased costs. Future studies should identify differences in quality of life after recovery from competing interventions.
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Christou CD, Athanasiadou EC, Tooulias AI, Tzamalis A, Tsoulfas G. The process of estimating the cost of surgery: Providing a practical framework for surgeons. Int J Health Plann Manage 2022; 37:1926-1940. [PMID: 35191067 DOI: 10.1002/hpm.3431] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 10/25/2021] [Accepted: 01/21/2022] [Indexed: 02/05/2023] Open
Abstract
Over the last decades, health care costs have been increasing at an alarming, exponential rate which is considered unsustainable. Surgical care utilizes one-third of health care costs. Estimating, evaluating, and understanding the cost of surgery is a vital step towards cost management and reduction. Current cost estimation studies and cost-effectiveness studies have vast disparities in their methodology, with published costs of Operating Room varying from as low as $7 and as high as $113 per minute. Costs in surgery are distinguished as direct and indirect. Allocation of direct costs involves identification, measurement, and valuation processes. Allocation of indirect costs involves the allocation of capital and overhead costs and of indirect department costs. Annualised capital costs and overhead hospital costs are then allocated to surgery by either the cost-centre allocation or the activity-based allocation frameworks. Indirect department costs are allocated to a specific surgery by weighted service allocation or hourly rate allocation or inpatient day allocation, or marginal markup allocation. The growing societal, financial and political pressure for cost reduction has brought cost analysis to the forefront of healthcare discussions. Thus, we believe that almost every single surgeon will eventually enter the field of healthcare economics by necessity. This review aims to provide surgeons with a practical framework for engaging in cost estimation studies.
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Affiliation(s)
- Chrysanthos D Christou
- Organ Transplant Unit, Hippokration General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Eleni C Athanasiadou
- Surgical Oncology Department, Theageneio Anticancer Hospital of Thessaloniki, Thessaloniki, Greece
| | - Andreas I Tooulias
- First General Surgery Department, Papageorgiou General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Argyrios Tzamalis
- Second Department of Ophthalmology, Papageorgiou General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Georgios Tsoulfas
- Organ Transplant Unit, Hippokration General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Chouairi F, Mercier MR, Alperovich M, Clune J, Prsic A. Preoperative Deficiency Anemia in Digital Replantation: A Marker of Disparities, Increased Length of Stay, and Hospital Cost. J Hand Microsurg 2022; 14:147-152. [PMID: 35983290 PMCID: PMC9381176 DOI: 10.1055/s-0040-1714152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
Introduction The effects of preoperative anemia have been shown to be an independent risk factor associated with poor outcomes in both cardiac and noncardiac surgery. Socioeconomic status and race have also been linked to poor outcomes in a variety of conditions. This study was designed to study iron deficiency anemia as a marker of health disparities, length of stay and hospital cost in digital replantation. Materials and Methods Digit replantations performed between 2008 and 2014 were reviewed from the National Inpatient Sample (NIS) database using the ICD-9-CM procedure codes 84.21 and 84.22. Patients with more than one code or with an upper arm (83.24) or hand replantation (84.23) code were excluded. Extracted variables included age, race, comorbidities, hospital type, hospital region, insurance payer type, and median household income quartile. Digit replantations were separated into patients with and without deficiency anemia. Demographics, comorbidities, and access to care were compared between cohorts by chi-squared and t -tests. Multivariate regressions were utilized to assess the effects of anemia on total cost and length of stay. The regression controlled for demographics, region, income, insurance, hospital type, and comorbidities. Beta coefficient was calculated for length of stay and hospital cost. The regression controlled for significant age, race, region, and comorbidities in addition to the above variables. Results In the studied patient population of those without anemia, 59.5% were Caucasian, and in patients with anemia, 46.7% were Caucasian ( p < 0.001). Whereas in the in the studied patient population of those without anemia, 6.7% were Black, and in patients with anemia, 15.7% were Black ( p < 0.001). Median household income, payer information, length of stay and total cost of hospitalization had statistically significant differences. Using regression and β-coefficient, the effect of anemia on length of stay and cost was also significant ( p < 0.001). Regression controlled for age, race, region and comorbidities, with the β-coefficient for effect on cost 37327.18 and on length of stay 3.96. Conclusion These data show that deficiency anemias are associated with a significant increase in length and total cost of stay in patients undergoing digital replantation. Additionally, a larger percentage of patients undergoing digital replantations and who have deficiency anemia belong to the lowest income quartile. Our findings present an important finding for public health prevention and resource allocation. Future studies could focus on clinical intervention with iron supplementation at the time of digital replantation.
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Affiliation(s)
- Fouad Chouairi
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, United States
- Yale University School of Medicine, New Haven, Connecticut, United States
| | - Michael R. Mercier
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, United States
- Yale University School of Medicine, New Haven, Connecticut, United States
| | - Michael Alperovich
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, United States
- Yale University School of Medicine, New Haven, Connecticut, United States
| | - James Clune
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, United States
- Yale University School of Medicine, New Haven, Connecticut, United States
| | - Adnan Prsic
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, United States
- Yale University School of Medicine, New Haven, Connecticut, United States
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Chavez MA, Bogert JN, Soe-Lin H, Jacobs JV, Chapple KM, Weinberg JA. Length of stay and trauma center finances: A disparity of payer source at a Level I trauma center. J Trauma Acute Care Surg 2022; 92:683-690. [PMID: 34991123 DOI: 10.1097/ta.0000000000003529] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND In an effort to reduce costs, hospitals focus efforts on reducing length of stay (LOS) and often benchmark LOS against the geometric LOS (GMLOS) as predicted by the assigned diagnosis-related group (DRG) used by the Centers for Medicare and Medicaid Services. The objective of this cross-sectional study was to evaluate the impact of exceeding GMLOS on hospital profit/loss with respect to payer source. METHODS Contribution margin for each insured patient admitted to a Level I trauma center between July 1, 2016, and June 30, 2019, was determined. Age, ethnicity, race, DRG weight, DRG version, injury severity, intensive care unit admission status, mechanical ventilation, payer, exceeding GMLOS, and the interaction between payer and exceeding the GMLOS were regressed on contribution margin to determine significant predictors of positive contribution margin. RESULTS Among 2,449 insured trauma patients, the distribution of payers was Medicaid (54.6%), Medicare (24.0%), and commercial (21.4%). Thirty-five percent (n = 867) of patient LOS exceeded GMLOS. Exceeding GMLOS by 10 or more days was significantly more likely for Medicaid and Medicare patients in stepwise fashion (commercial, 2.7%; Medicaid, 4.5%; Medicare, 6.0%; p = 0.030). Median contribution margin was positive for commercially insured patients ($16,913) and negative for Medicaid (-$8,979) and Medicare (-$2,145) patients. Adjusted multivariate modeling demonstrated that when exceeding GMLOS, Medicare and Medicaid cases were less likely than commercial payers to have a positive contribution margin (p < 0.001 and p < 0.001). CONCLUSION Government-insured patients, despite having a payer source, are a financial burden to a trauma center. Excess LOS among government insured patients, but not the commercially insured, exacerbates financial loss. A shift toward a greater proportion of government insured patients may result in a significant fiscal liability for a trauma center. LEVEL OF EVIDENCE Economic and Value-Based Evaluation, Level III.
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Affiliation(s)
- Marin A Chavez
- From the Department of Surgery (M.A.C., J.N.B., H.S.-L., J.V.J., K.M.C., J.A.W.), St. Joseph's Hospital and Medical Center, Phoenix; and Creighton University School of Medicine (M.A.C., J.N.B., H.S.-L., J.V.J., K.M.C., J.A.W.), Phoenix Regional Campus, Phoenix, Arizona
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22
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Yusefi AR, Mehralian G, Khodamoradi A, Abbasi R, Vatankhah F, Heaidari F, Bastani P. Out-of-pocket payments for treatment of COVID-19 in Iran. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2022; 20:12. [PMID: 35305664 PMCID: PMC8934129 DOI: 10.1186/s12962-022-00350-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 03/10/2022] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Out-of-pocket (OOP) is among the payment methods in Iran's health system. The present study aimed to examine the OOP treatment costs for patients with COVID-19 in Iran. METHODS A descriptive-analytical, cross-sectional study was conducted in 2021. In this study, the cost records of 550 patients with COVID-19 hospitalized in a referral center of COVID-19 were selected using the stratified random sampling method. The required data were collected using a researcher-made questionnaire. Data were analyzed by t-test, ANOVA, and Pearson's correlation coefficient in SPSS software version 23 at p = 0.05. RESULTS The total direct costs were 1,037,992.15 US $. Moreover, the shares of patients (OOP), basic insurance, government subsidy, supplementary insurance, discounts, and out-of-government subsidy in the total direct costs were US $ 92,231.21, 746,932.99 US $, 155,127.08 US $, 39,690.25 US $ and 4010.61 US $, respectively. In addition, the results confirmed that there was a positive and significant relationship between the patients' OOP payments and the length of stay. It also found that the patients' OOP payments are subject to the type of insurance program and discharge method. CONCLUSION According to the results, 8.89% of the total direct costs were directly paid out of the patients' pockets. The research findings confirm the urgent need to make decisions and implement effective interventions for COVID-19 disease by controlling risk factors and exploiting other countries' successful experiences and international organizations' recommendations to decrease the prevalence of the infected and consequently reduce the financial pressure of the disease on patients by approving the expansion of the insurance organizations' role.
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Affiliation(s)
- Ali Reza Yusefi
- Department of Public Health, School of Health, Jiroft University of Medical Sciences, Jiroft, Iran
| | | | - Abdolvahed Khodamoradi
- Department of Health Policy and Economics, Social Security Research Institute, Tehran, Iran
| | - Roghaye Abbasi
- Student Research Committee, School of Health, Jiroft University of Medical Sciences, Jiroft, Iran
| | - Fatemeh Vatankhah
- Student Research Committee, School of Health, Jiroft University of Medical Sciences, Jiroft, Iran
| | - Fatemeh Heaidari
- Student Research Committee, School of Health, Jiroft University of Medical Sciences, Jiroft, Iran
| | - Peivand Bastani
- Faculty of Health and Behavioral Sciences, School of Dentistry, University of Queensland, Brisbane, QLD 4072 Australia
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23
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Farkas A, Kostic M, Huang CC, Gummin D. Poison center consultation reduces hospital length of stay. Clin Toxicol (Phila) 2022; 60:863-868. [PMID: 35261300 DOI: 10.1080/15563650.2022.2039686] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
CONTEXT Prior studies have observed shorter lengths of stay when practitioners consult a US poison control center (PCC) regarding hospitalized toxicology patients, but the most recent study used data from 2010. Since then, the implementation of the Affordable Care Act, a trend toward shorter hospitalizations and substantial adjustments in hospital charges have occurred. METHODS This is a retrospective study of administrative hospital data and poison center data obtained from the Wisconsin Hospital Association and Wisconsin Poison Center for patients treated from 2010 to 2017. Stratified analysis was used to investigate the potential effects of PCC consultation on hospitalization. Univariate and multivariable regression analysis was used to characterize which factors were associated with an increased rate of PCC consultation. DISCUSSION 127,224 hospitalized cases were found, of which 44,628 were entered into a stratified hospital charge and length of stay analysis. PCC consultation was associated with an 11.6 h (95% CI 10.4-13.0 h) shorter mean length of stay overall, with children aged 0-6 having a larger reduction of 1.18 days. While total charges were higher by $600 in PCC consultation cases in the overall analysis (95% CI $390-$777), mean charges in patients aged 0-6 were $6695 lower when the PCC was consulted. PCC consultation was more likely to occur in cases involving children and adolescents, intentional overdoses (versus accidental or unknown intent), and women. CONCLUSIONS Our findings suggest that PCC consultation should be encouraged to potentially shorten hospitalizations of poisoned patients, and for pediatric patients in particular. Intentionality and demographic factors affect the rate of PCC consultation for overdose, but the nature of these relationships is unclear.
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Affiliation(s)
- Andrew Farkas
- Medical College of Wisconsin Department of Emergency Medicine, Milwaukee, WI, USA.,Wisconsin Poison Center, Children's Wisconsin, Milwaukee, WI, USA
| | - Mark Kostic
- Medical College of Wisconsin Department of Emergency Medicine, Milwaukee, WI, USA.,Wisconsin Poison Center, Children's Wisconsin, Milwaukee, WI, USA
| | - Chiang-Chin Huang
- Joseph J. Zilber School of Public Health, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - David Gummin
- Medical College of Wisconsin Department of Emergency Medicine, Milwaukee, WI, USA.,Wisconsin Poison Center, Children's Wisconsin, Milwaukee, WI, USA
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24
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Karunakaran M, Jonnada PK, Chandrashekhar SH, Vinayachandran G, Kaambwa B, Barreto SG. Enhancing the cost-effectiveness of surgical care in pancreatic cancer: a systematic review and cost meta-analysis with trial sequential analysis. HPB (Oxford) 2022; 24:309-321. [PMID: 34848126 DOI: 10.1016/j.hpb.2021.11.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 10/21/2021] [Accepted: 11/07/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Clinical pathways (CP) based on Enhanced recovery after surgery (ERAS®) are increasingly utilised in patients undergoing pancreatoduodenectomy (PD). This systematic review aimed to compare the impact of CPs versus conventional care (CC) on peri-PD costs. METHODS A systematic review of major reference databases was undertaken. Quality assessment was performed using the CHEERS checklist. Incremental cost-effectiveness ratios were calculated as part of the cost-effectiveness analysis. A meta-analysis was performed using random-effects models and Trial sequential analysis (TSA) was used to assess the precision and conclusiveness of the results. RESULTS 14 studies meeting inclusion criteria were included for full qualitative synthesis. All studies reported a reduction in overall costs, length of stay and overall complication rates for CPs when compared to CC. Meta-analysis performed on nine studies demonstrated significantly reduced costs in the CP group, with considerable heterogeneity (Pooled mean difference of $ 4.28 × 103, p < 0.01, I2 = 95%). Cost-effectiveness analysis in relation to complications demonstrated dominance of CPs over CC in being cheaper as well as more effective. TSA supported the cost benefit of enhanced-recovery CPs, displaying minimal type 1 error. CONCLUSION Peri-PD CPs result in significant cost-reduction in comparison to CC.
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Affiliation(s)
- Monish Karunakaran
- Department of Surgical Gastroenterology, SK Hospital, Thiruvananthapuram, India
| | - Pavan K Jonnada
- Department of Surgical Oncology, Basavatarakam Indo-American Cancer Hospital & Research Institute, Hyderabad, India
| | - Sagar H Chandrashekhar
- Department of Gastrointestinal Surgery, Gastrointestinal Oncology, and Bariatric Surgery, Medanta- The Medicity, Gurgaon, India
| | | | - Billingsley Kaambwa
- College of Medicine and Public Health, Flinders University, South Australia, Australia
| | - Savio G Barreto
- College of Medicine and Public Health, Flinders University, South Australia, Australia; Division of Surgery and Perioperative Medicine, Flinders Medical Center, Bedford Park, Adelaide, South Australia, Australia.
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25
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Krajewski S, Furtak J, Zawadka-Kunikowska M, Kachelski M, Birski M, Harat M. Comparison of the Functional State and Motor Skills of Patients after Cerebral Hemisphere, Ventricular System, and Cerebellopontine Angle Tumor Surgery. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:2308. [PMID: 35206503 PMCID: PMC8871731 DOI: 10.3390/ijerph19042308] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 02/08/2022] [Accepted: 02/15/2022] [Indexed: 01/27/2023]
Abstract
Brain tumor location is an important factor determining the functional state after brain tumor surgery. We assessed the functional state and course of rehabilitation of patients undergoing surgery for brain tumors and assessed the location-dependent risk of loss of basic motor skills and the time needed for improvement after surgery. There were 835 patients who underwent operations, and 139 (16.6%) required rehabilitation during the inpatient stay. Karnofsky Performance Scale, Barthel Index, and the modified Rankin scale were used to assess functional status, whereas Gait Index was used to assess gait efficiency. Motor skills, overall length of stay (LOS) in hospital, and LOS after surgery were recorded. Patients were classified into four groups: cerebral hemisphere (CH), ventricular system (VS), and cerebellopontine angle (CPA) tumors; and a control group not requiring rehabilitation. VS tumor patients had the lowest scores in all domains compared with the other groups before surgery (p < 0.001). Their performance further deteriorated after surgery and by the day of discharge. They most often required long-lasting postoperative rehabilitation and had the longest LOS (35 days). Operation was most often required for CH tumors (77.7%), and all metrics and LOS parameters were better in these patients (p < 0.001). Patients with CPA tumors had the best outcomes (p < 0.001). Most patients (83.4%) with brain tumors did not require specialized rehabilitation, and LOS after surgery in the control group was on average 5.1 days after surgery. VS tumor patients represent a rehabilitation challenge. Postoperative rehabilitation planning must take the tumor site and preoperative condition into account.
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Affiliation(s)
- Stanisław Krajewski
- Department of Physiotherapy, University of Bydgoszcz, Unii Lubelskiej 4, 85-059 Bydgoszcz, Poland
- Department of Neurosurgery, 10th Military Research Hospital and Polyclinic, 85-681 Bydgoszcz, Poland; (J.F.); (M.K.); (M.B.); (M.H.)
| | - Jacek Furtak
- Department of Neurosurgery, 10th Military Research Hospital and Polyclinic, 85-681 Bydgoszcz, Poland; (J.F.); (M.K.); (M.B.); (M.H.)
- Franciszek Łukaszczyk Oncology Center, Department of Neurooncology and Radiosurgery, 85-796 Bydgoszcz, Poland
| | - Monika Zawadka-Kunikowska
- Department of Human Physiology, LudwikRydygier Collegium Medicum in Bydgoszcz Nicolaus Copernicus University in Torun, Karłowicza 24, 85-092 Bydgoszcz, Poland;
| | - Michał Kachelski
- Department of Neurosurgery, 10th Military Research Hospital and Polyclinic, 85-681 Bydgoszcz, Poland; (J.F.); (M.K.); (M.B.); (M.H.)
| | - Marcin Birski
- Department of Neurosurgery, 10th Military Research Hospital and Polyclinic, 85-681 Bydgoszcz, Poland; (J.F.); (M.K.); (M.B.); (M.H.)
| | - Marek Harat
- Department of Neurosurgery, 10th Military Research Hospital and Polyclinic, 85-681 Bydgoszcz, Poland; (J.F.); (M.K.); (M.B.); (M.H.)
- Department of Neurosurgery and Neurology, LudwikRydygier Collegium Medicum in Bydgoszcz Nicolaus Copernicus University in Torun, M. Sklodowskiej-Curie 9, 85-094 Bydgoszcz, Poland
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26
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Yan Y, Cheng J, Chen K, Liu TF, Ning G. Better clinical benefits and potential cost saving of an enhanced recovery pathways for laparoscopic adrenalectomy. Gland Surg 2022; 11:23-34. [PMID: 35242666 PMCID: PMC8825523 DOI: 10.21037/gs-21-504] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 12/18/2021] [Indexed: 01/03/2025]
Abstract
BACKGROUND Enhanced recovery pathways (ERPs) have been demonstrated to be clinically and economically effective for colorectal surgery. However, data are lacking to support the cost-effectiveness of ERPs for laparoscopic adrenalectomy, as well as potential economic loss. This study aims to determine the cost-effectiveness of ERPs vs. conventional care (CC) for patients undergoing laparoscopic adrenalectomy. METHODS A single centered retrospective case-control study was performed. Patients undergoing laparoscopic adrenalectomy from January 2018 to June 2021 were enrolled. One inpatient ward used ERPs, whereas the other did not. Case control was used for matching (53 patients for each group). Postoperative outcomes were recorded up to 30 days after surgery. ERPs-specific costs were integrated into the model. Preoperative, intraoperative and postoperative real costs were collected for each patient via the hospital administration, which were reported in Renminbi. A bootstrap independent t-test was used for comparison. RESULTS The two groups were matched in terms of demographics and surgical details. Hospital stay was significantly shorter in the ERPs group (2.54 days, P<0.001). The rate of complications was lower in the ERPs group (1 vs. 7 patients, P=0.031), there was no severe complications or morbidity. ERPs-specific costs were ¥656 per patient. The self-payment cost difference per patient between the two groups was ¥3,154.52 in favor of the ERPs group, but this was not statistically significant (P=0.113). The mean direct saving per patient in the ERPs group was ¥8,326.00, the total costs saving including indirect and potential overhead per patient was ¥18,247.60. CONCLUSIONS Enhanced recovery is cost-effective compared with conventional perioperative management for laparoscopic adrenalectomy. Savings were noted in disposable materials, medicine and medical services, radiology and laboratory costs, with no increase in morbidity or duration.
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Affiliation(s)
- Yue Yan
- Dean’s Office, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Institute for Hospital Management, Tsinghua University, Tsinghua Shenzhen International Graduate School, Beijing, China
| | - Jie Cheng
- Dean’s Office, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Kang Chen
- Dean’s Office, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ting-Fang Liu
- Institute for Hospital Management, Tsinghua University, Tsinghua Shenzhen International Graduate School, Beijing, China
| | - Guang Ning
- Dean’s Office, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Institute for Hospital Management, Tsinghua University, Tsinghua Shenzhen International Graduate School, Beijing, China
- Department of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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27
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Agri F, Hübner M, Demartines N, Grass F. Economic considerations of a connected tracking device after colorectal surgery. Br J Surg 2021; 108:e407-e408. [PMID: 34738102 DOI: 10.1093/bjs/znab377] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 09/30/2021] [Indexed: 12/15/2022]
Affiliation(s)
- Fabio Agri
- Department of Visceral Surgery, Lausanne University Hospital (CHUV), University of Lausanne (UNIL), Lausanne, Switzerland.,Department of Administration and Finance, Lausanne University, Lausanne, Switzerland
| | - Martin Hübner
- Department of Visceral Surgery, Lausanne University Hospital (CHUV), University of Lausanne (UNIL), Lausanne, Switzerland
| | - Nicolas Demartines
- Department of Visceral Surgery, Lausanne University Hospital (CHUV), University of Lausanne (UNIL), Lausanne, Switzerland
| | - Fabian Grass
- Department of Visceral Surgery, Lausanne University Hospital (CHUV), University of Lausanne (UNIL), Lausanne, Switzerland
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28
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Ludbrook GL. The Hidden Pandemic: the Cost of Postoperative Complications. CURRENT ANESTHESIOLOGY REPORTS 2021; 12:1-9. [PMID: 34744518 PMCID: PMC8558000 DOI: 10.1007/s40140-021-00493-y] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/14/2021] [Indexed: 12/17/2022]
Abstract
Purpose of Review Population-based increases in ageing and medical co-morbidities are expected to substantially increase the incidence of expensive postoperative complications. This threatens the sustainability of essential surgical care, with negative impacts on patients' health and wellbeing. Recent Findings Identification of key high-risk areas, and implementation of proven cost-effective strategies to manage both outcome and cost across the end-to-end journey of the surgical episode of care, is clearly feasible. However, good programme design and formal cost-effectiveness analysis is critical to identify, and implement, true high value change. Summary Both outcome and cost need to be a high priority for both fundholders and clinicians in perioperative care, with the focus for both groups on delivering high-quality care, which in itself, is the key to good cost management.
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Affiliation(s)
- Guy L. Ludbrook
- The University of Adelaide, and Royal Adelaide Hospital, C/O Royal Adelaide Hospital, 3G395, 1 Port Road, Adelaide, South Australia 5000 Australia
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29
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Biffl WL, Lu N, Schultz PR, Wang J, Castelo MR, Schaffer KB. Improving length of stay on a trauma service. Trauma Surg Acute Care Open 2021; 6:e000744. [PMID: 34527812 PMCID: PMC8395366 DOI: 10.1136/tsaco-2021-000744] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 08/02/2021] [Indexed: 11/04/2022] Open
Abstract
Background Reducing length of stay (LOS) is a major healthcare initiative. While LOS is closely linked to the diagnosis and procedure in elective surgery, many additional factors influence LOS on a trauma service. We hypothesized that more standardized patient management would lead to decreased LOS. Methods Retrospective analysis of Trauma Registry data compared LOS before (PRE) and after (POST) implementation of standardized processes on a trauma service. Patients were subdivided by age (over and under 65 years). Data were compared using unpaired t-test, χ2 test and analysis of variance tests, where appropriate. Results 1613 PRE and 1590 POST patients were compared. Although age and Injury Severity Score were similar, median LOS decreased by 1 day for the group overall (p<0.0001), and for subgroups over and under the age of 65 years (p<0.0001). Older patients were discharged home 13% more often in POST, compared with 4% more for younger patients. Conclusions Improved standardization of processes on a trauma service reduced LOS in patients of all ages. A prospective study may identify specific factors associated with prolonged LOS, to allow further improvement. Level of evidence III. Study type Therapeutic/Care management.
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Affiliation(s)
- Walter L Biffl
- Trauma, Scripps Memorial Hospital La Jolla, La Jolla, California, USA
| | - Ning Lu
- Trauma, Scripps Memorial Hospital La Jolla, La Jolla, California, USA
| | - Peter R Schultz
- Trauma, Scripps Memorial Hospital La Jolla, La Jolla, California, USA
| | - Jiayan Wang
- Trauma, Scripps Memorial Hospital La Jolla, La Jolla, California, USA
| | - Matthew R Castelo
- Trauma, Scripps Memorial Hospital La Jolla, La Jolla, California, USA
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30
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Peloza JH, Millgram MA, Jacobian E, Kolsky DE, Guyer RD, Le Huec JC, Ashkenazi E. Economic Analysis of Transforaminal Lumbar Interbody Fusion Surgery Utilizing a Curved Bone Removal Device. PHARMACOECONOMICS - OPEN 2021; 5:519-531. [PMID: 33462767 PMCID: PMC8333172 DOI: 10.1007/s41669-020-00256-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 12/31/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND Transforaminal lumbar interbody fusion (TLIF) represents a commonly performed spinal procedure that poses a significant financial burden on patients, hospitals and insurers. Reducing these costs, while maintaining efficacy, may be assisted by a new powered endplate preparation device, designed to shorten procedural time while offering positive impacts on other elements that contribute to the cost of care. OBJECTIVE The aim of the study was to assess and compare the individual cost elements of TLIF procedures with and without the use of the device, to determine whether application of this technology translated into any material procedural savings. METHODS The records of 208 single-level TLIF procedures in a single hospital were reviewed. Surgical time, length of hospital stay, blood loss, infection rate, and other parameters were compared for the cases where the device was used (device group; n = 143) and cases which used standard tools (control group; n = 65). The cost per unit of each element was derived from the literature, online resources, and the hospital's financial department. RESULTS The analysis revealed a shorter surgery duration in the device group (23 min, after controlling for procedure year and patient characteristics; statistically significant at p < 0.001) and lower complication and readmission rates (p = 0.67 and p = 0.21, respectively) associated with the use of the device, leading to a statistically significant cost reduction of approximately 2060 US dollars (US$) (p < 0.01). CONCLUSION The study suggests that use of the device may lead to a cost reduction and shorter procedure without deteriorating the clinical outcome.
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Affiliation(s)
| | - Michael A Millgram
- Israel Spine Center, Assuta Hospital, Assuta Medical Centers, 69710, Tel Aviv, Israel.
| | - Erel Jacobian
- Israel Spine Center, Assuta Hospital, Assuta Medical Centers, 69710, Tel Aviv, Israel
| | - Daniel E Kolsky
- Israel Spine Center, Assuta Hospital, Assuta Medical Centers, 69710, Tel Aviv, Israel
| | | | | | - Ely Ashkenazi
- Israel Spine Center, Assuta Hospital, Assuta Medical Centers, 69710, Tel Aviv, Israel
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31
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LaHue SC, Maselli J, Rogers S, Casatta J, Chao J, Croci R, Gonzales R, Holt B, Josephson SA, Lama S, Lau C, McCulloch C, Newman JC, Terrelonge M, Yeager J, Douglas VC. Outcomes Following Implementation of a Hospital-Wide, Multicomponent Delirium Care Pathway. J Hosp Med 2021; 16:397-403. [PMID: 34197303 PMCID: PMC9621338 DOI: 10.12788/jhm.3604] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Accepted: 01/21/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Delirium is associated with poor clinical outcomes that could be improved with targeted interventions. OBJECTIVE To determine whether a multicomponent delirium care pathway implemented across seven specialty nonintensive care units is associated with reduced hospital length of stay (LOS). Secondary objectives were reductions in total direct cost, odds of 30-day hospital readmission, and rates of safety attendant and restraint use. METHODS This retrospective cohort study included 22,708 hospitalized patients (11,018 preintervention) aged ≥50 years encompassing seven nonintensive care units: neurosciences, medicine, cardiology, general and specialty surgery, hematology-oncology, and transplant. The multicomponent delirium care pathway included a nurse-administered delirium risk assessment at admission, nurse-administered delirium screening scale every shift, and a multicomponent delirium intervention. The primary study outcome was LOS for all units combined and the medicine unit separately. Secondary outcomes included total direct cost, odds of 30-day hospital readmission, and rates of safety attendant and restraint use. RESULTS Adjusted mean LOS for all units combined decreased by 2% post intervention (proportional change, 0.98; 95% CI, 0.96-0.99; P = .0087). Medicine unit adjusted LOS decreased by 9% (proportional change, 0.91; 95% CI, 0.83-0.99; P = .028). For all units combined, adjusted odds of 30-day readmission decreased by 14% (odds ratio [OR], 0.86; 95% CI, 0.80-0.93; P = .0002). Medicine unit adjusted cost decreased by 7% (proportional change, 0.93; 95% CI, 0.89-0.96; P = .0002). CONCLUSION This multicomponent hospital-wide delirium care pathway intervention is associated with reduced hospital LOS, especially for patients on the medicine unit. Odds of 30-day readmission decreased throughout the entire cohort.
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Affiliation(s)
- Sara C LaHue
- Department of Neurology, School of Medicine, University of California, San Francisco, California
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, California
- Corresponding Author: Sara C LaHue, MD;
| | - Judy Maselli
- Department of Medicine, School of Medicine, University of California, San Francisco, California
| | - Stephanie Rogers
- Department of Medicine, School of Medicine, University of California, San Francisco, California
| | - Julie Casatta
- Department of Neurological Surgery, University of California, San Francisco, California
| | - Jessica Chao
- Clinical Innovation Center, University of California, San Francisco, California
| | - Rhiannon Croci
- Department of Medicine, School of Medicine, University of California, San Francisco, California
| | - Ralph Gonzales
- Department of Medicine, School of Medicine, University of California, San Francisco, California
- Clinical Innovation Center, University of California, San Francisco, California
| | - Brian Holt
- Continuous Improvement Department, University of California, San Francisco, California
| | - S Andrew Josephson
- Department of Neurology, School of Medicine, University of California, San Francisco, California
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, California
| | - Sudha Lama
- Department of Medicine, School of Medicine, University of California, San Francisco, California
| | - Catherine Lau
- Department of Medicine, School of Medicine, University of California, San Francisco, California
| | - Charles McCulloch
- Epidemiology & Biostatistics, University of California, San Francisco, California
| | - John C Newman
- Department of Medicine, School of Medicine, University of California, San Francisco, California
- Buck Institute for Research on Aging, Novato, California
| | - Mark Terrelonge
- Department of Neurology, School of Medicine, University of California, San Francisco, California
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, California
| | - Jan Yeager
- Clinical Innovation Center, University of California, San Francisco, California
| | - Vanja C Douglas
- Department of Neurology, School of Medicine, University of California, San Francisco, California
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, California
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32
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Harris CM, Wright SM. Severe vision impairment and blindness in hospitalized patients: a retrospective nationwide study. BMC Ophthalmol 2021; 21:263. [PMID: 34158004 PMCID: PMC8220710 DOI: 10.1186/s12886-021-02021-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 06/08/2021] [Indexed: 11/30/2022] Open
Abstract
Background Outcomes among hospitalized patients with severe vision impairment or blindness have not been extensively explored. This study sought to determine clinical and resource utilization outcomes in patients with severe vision impairment/blindness (SVI/B). Because obesity is very common among those who are hospitalized, we also sought to understand its impact among patients with SVI/B. Methods We conducted a retrospective study using the National Inpatient Sample for the year 2017; hospitalized adults with and without SVI/B were compared. In addition, for all patients with SVI/B, we compared those with and without obesity. Multiple logistic regression and linear analysis were used to evaluate mortality, disposition, length of stay, and hospital charges; the analyses were adjusted for multiple variables including age, sex, and race. Results 30,420,907 adults were hospitalized, of whom 37,200 had SVI/B. Patients with SVI/B were older (mean age ± SEM: 66.4 ± 0.24 vs. 57.9 ± 0.09 years, p < 0.01), less likely to be female (50 % vs. 57.7 %, p < 0.01), more frequently insured by Medicare (75.7 % vs. 49.2 %, p < 0.01), and had more comorbidities (Charlson comorbidity score ≥ 3: 53.2 % vs. 27.8 %, p < 0.01). Patients with SVI/B had a higher in-hospital mortality rate (3.9 % vs. 2.2 %; p < 0.01), and had lower odds to be discharged home after hospital discharge (adjusted Odds Ratio {aOR} =0.54, [Confidence Interval (CI) 0.51–0.58]; p < 0.01) compared to those without SVI/B. Hospital charges were not significantly different (adjusted Mean Difference {aMD} = $247 CI [-$2,474-2,929]; p = 0.85) but length of stay was longer (aMD = 0.5 days CI [0.3–0.7]; p < 0.01) for those with SVI/B. Patients with vision impariment who were also obese had higher total hospital charges compared to those without obesity (mean difference: $9,821 [CI $1,375-$18,268]; p = 0.02). Conclusions Patients admitted to American hospitals in 2017 who had SVI/B had worse clinical outcomes and greater resources utilization than those without SVI/B. Hospital-based healthcare providers who understand that those with SVI/B may be at risk for worse outcomes may be optimally positioned to help them to receive the best possible care. Supplementary Information The online version contains supplementary material available at 10.1186/s12886-021-02021-2.
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Affiliation(s)
- Ché Matthew Harris
- Department of Medicine, Johns Hopkins School of Medicine, Johns Hopkins Bayview Medical Center, Baltimore, Maryland, United States of America.
| | - Scott Mitchell Wright
- Department of Medicine, Johns Hopkins School of Medicine, Johns Hopkins Bayview Medical Center, Baltimore, Maryland, United States of America
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Khan B, Haqqani U, Ullah S, Hamayun S, Bibi Z, Khanzada K. Duration of In-hospital Stay for Elective Neurosurgical Procedures in a Tertiary Care Hospital. Cureus 2021; 13:e15745. [PMID: 34285851 PMCID: PMC8286779 DOI: 10.7759/cureus.15745] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2021] [Indexed: 12/05/2022] Open
Abstract
Objective: Public hospitals have fixed days with allotted time slots during which to perform neurosurgical elective cases. If emergency operations or other events preempt these scheduled time slots, the patient remains hospitalized, waiting in queue for a new time slot. We conducted this study to determine the number of days patients remained admitted waiting for elective cases in a tertiary care public hospital, which operates on fixed days. Materials and methods: This cross-sectional study was conducted in the Department of Neurosurgery Unit B, Medical Teaching Institution (MTI) - Lady Reading Hospital (LRH), Peshawar. We reviewed the admission charts and discharge slips of all patients who were admitted and underwent operations between September 2018 and August 2019. A form was made and was completed with each patients' records like age, gender, number of days spent preoperatively and postoperatively and the total duration of stay, indication for surgery (spinal, cranial, peripheral nerve), etc. Patients who had undergone elective neurosurgical procedures were included while those who had undergone emergency surgeries or had expired during the hospital stay, had been discharged or referred to other centers were excluded from the study. All the data were entered into the statistical software SPSS version 22 (IBM Corp., Armonk, NY) and were converted into tables and charts. Results: A total of 1818 patients were admitted/discharged during the study period, and of them, 823 patients were admitted for elective neurosurgical procedures. There were 601 (73.7%) males and 222 (26.3%) females with a male to female ratio of approximately 3:1. The age range was from 09 days to 72 years and was further subdivided into six groups. The procedures were broadly divided into cranial, spinal, related to hydrocephalus (HCP)-related, and miscellaneous. Cranial procedures comprised of surgeries for brain tumors, transsphenoidal operations, vascular procedures for aneurysms, and nerve decompressions, and they comprised about 29.43% (n=244) while spinal procedures accounted for 317 (36.63%) procedures, the rest were related to HCP and miscellaneous. Preoperative and postoperative stay durations were calculated and then added to determine the total stay durations and were further stratified for the specific procedures and categorized into days and weeks. About 58.26% (n=143) of cranial cases, and 156 (49.36%) of spinal cases, 37.57% (n=65) of HCP-related cases, and 36.66% (n=41) of cases in the miscellaneous group had a duration of stay between eight days to more than three weeks.
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Affiliation(s)
- Bilal Khan
- Neurosurgery, Medical Teaching Institution/Lady Reading Hospital, Peshawar, PAK
| | - Usman Haqqani
- Neurosurgery, Qazi Hussain Ahmed Medical Complex, Nowshehra, PAK
| | - Sajjad Ullah
- Neurosurgery, Medical Teaching Institution/Khyber Teaching Hospital, Peshawar, PAK
| | | | - Zohra Bibi
- Psychiatry, Medical Teaching Institution/Lady Reading Hospital, Peshawar, PAK
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Wondmagegn BY, Xiang J, Dear K, Williams S, Hansen A, Pisaniello D, Nitschke M, Nairn J, Scalley B, Xiao A, Jian L, Tong M, Bambrick H, Karnon J, Bi P. Increasing impacts of temperature on hospital admissions, length of stay, and related healthcare costs in the context of climate change in Adelaide, South Australia. THE SCIENCE OF THE TOTAL ENVIRONMENT 2021; 773:145656. [PMID: 33592481 DOI: 10.1016/j.scitotenv.2021.145656] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Revised: 01/21/2021] [Accepted: 02/01/2021] [Indexed: 05/22/2023]
Abstract
BACKGROUND A growing number of studies have investigated the effect of increasing temperatures on morbidity and health service use. However, there is a lack of studies investigating the temperature-attributable cost burden. OBJECTIVES This study examines the relationship of daily mean temperature with hospital admissions, length of hospital stay (LoS), and costs; and estimates the baseline temperature-attributable hospital admissions, and costs and in relation to warmer climate scenarios in Adelaide, South Australia. METHOD A daily time series analysis using distributed lag non-linear models (DLNM) was used to explore exposure-response relationships and to estimate the aggregated burden of hospital admissions for conditions associated with temperatures (i.e. renal diseases, mental health, diabetes, ischaemic heart diseases and heat-related illnesses) as well as the associated LoS and costs, for the baseline period (2010-2015) and different future climate scenarios in Adelaide, South Australia. RESULTS During the six-year baseline period, the overall temperature-attributable hospital admissions, LoS, and associated costs were estimated to be 3915 cases (95% empirical confidence interval (eCI): 235, 7295), 99,766 days (95% eCI: 14,484, 168,457), and AU$159 million (95% eCI: 18.8, 269.0), respectively. A climate scenario consistent with RCP8.5 emissions, and including projected demographic change, is estimated to lead to increases in heat-attributable hospital admissions, LoS, and costs of 2.2% (95% eCI: 0.5, 3.9), 8.4% (95% eCI: 1.1, 14.3), and 7.7% (95% eCI: 0.3, 13.3), respectively by mid-century. CONCLUSIONS There is already a substantial temperature-attributable impact on hospital admissions, LoS, and costs which are estimated to increase due to climate change and an increasing aged population. Unless effective climate and public health interventions are put into action, the costs of treating temperature-related admissions will be high.
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Affiliation(s)
- Berhanu Y Wondmagegn
- School of Public Health, The University of Adelaide, North Terrace, Adelaide, South Australia, Australia; College of Health and Medical Sciences, Haramaya University, Dire Dawa, Ethiopia.
| | - Jianjun Xiang
- School of Public Health, The University of Adelaide, North Terrace, Adelaide, South Australia, Australia.
| | - Keith Dear
- School of Public Health, The University of Adelaide, North Terrace, Adelaide, South Australia, Australia
| | - Susan Williams
- School of Public Health, The University of Adelaide, North Terrace, Adelaide, South Australia, Australia.
| | - Alana Hansen
- School of Public Health, The University of Adelaide, North Terrace, Adelaide, South Australia, Australia.
| | - Dino Pisaniello
- School of Public Health, The University of Adelaide, North Terrace, Adelaide, South Australia, Australia.
| | - Monika Nitschke
- South Australian Department of Health and Wellbeing, Adelaide, South Australia, Australia.
| | - John Nairn
- Australian Bureau of Meteorology, South Australia, Australia.
| | - Ben Scalley
- Metropolitan Communicable Disease Control, Department of Health WA, Perth, Western Australia, Australia.
| | - Alex Xiao
- Epidemiology Branch, Department of Health WA, Perth, Western Australia, Australia.
| | - Le Jian
- Epidemiology Branch, Department of Health WA, Perth, Western Australia, Australia.
| | - Michael Tong
- School of Public Health, The University of Adelaide, North Terrace, Adelaide, South Australia, Australia.
| | - Hilary Bambrick
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia.
| | - Jonathan Karnon
- College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia.
| | - Peng Bi
- School of Public Health, The University of Adelaide, North Terrace, Adelaide, South Australia, Australia.
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Linzey JR, Foshee R, Moriguchi F, Adapa AR, Koduri S, Kahn EN, Williamson CA, Sheehan K, Rajajee V, Thompson BG, Muraszko KM, Pandey AS. Length of Stay Beyond Medical Readiness in a Neurosurgical Patient Population and Associated Healthcare Costs. Neurosurgery 2021; 88:E259-E264. [PMID: 33370820 DOI: 10.1093/neuros/nyaa535] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Accepted: 09/28/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Length of stay beyond medical readiness (LOS-BMR) leads to increased expenses and higher morbidity related to hospital-acquired conditions. OBJECTIVE To determine the proportion of admitted neurosurgical patients who have LOS-BMR and associated risk factors and costs. METHODS We performed a prospective, cohort analysis of all neurosurgical patients admitted to our institution over 5 mo. LOS-BMR was assessed daily by the attending neurosurgeon and neuro-intensivist with a standardized criterion. Univariate and multivariate logistic regressions were performed. RESULTS Of the 884 patients admitted, 229 (25.9%) had a LOS-BMR. The average LOS-BMR was 2.7 ± 3.1 d at an average daily cost of $9 148.28 ± $12 983.10, which resulted in a total cost of $2 076 659.32 over the 5-mo period. Patients with LOS-BMR were significantly more likely to be older and to have hemiplegia, dementia, liver disease, renal disease, and diabetes mellitus. Patients with a LOS-BMR were significantly more likely to be discharged to a subacute rehabilitation/skilled nursing facility (40.2% vs 4.1%) or an acute/inpatient rehabilitation facility (22.7% vs 1.7%, P < .0001). Patients with Medicare insurance were more likely to have a LOS-BMR, whereas patients with private insurance were less likely (P = .048). CONCLUSION The most common reason for LOS-BMR was inefficient discharge of patients to rehabilitation and nursing facilities secondary to unavailability of beds at discharge locations, insurance clearance delays, and family-related issues.
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Affiliation(s)
- Joseph R Linzey
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan
| | - Rachel Foshee
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan
| | | | - Arjun R Adapa
- School of Medicine, University of Michigan, Ann Arbor, Michigan
| | - Sravanthi Koduri
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan
| | - Elyne N Kahn
- Saint Joseph Mercy Health System, Ypsilanti, Michigan
| | | | - Kyle Sheehan
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan
| | | | | | - Karin M Muraszko
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan
| | - Aditya S Pandey
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan
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Xu Z, Xue C, Zhao F, Hu C, Wu Y, Zhang L. Hospitalization Costs and Length of Stay in Chinese Naval Hospitals Between 2008 and 2016 Based on Influencing Factors: A Longitudinal Comparison. Mil Med 2021; 185:e282-e289. [PMID: 31287875 DOI: 10.1093/milmed/usz170] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 06/10/2019] [Accepted: 06/14/2019] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION A retrospective review conducted in three hospitals of Guangdong and Hainan, China. To analyze the variation tendency of mean hospitalization costs and length of stay (LOS) in naval hospitals over nine years, paying special attention to the factors affecting hospitalization costs and LOS to provide a reference base for health resource allocation in naval hospitals. MATERIALS AND METHODS A total of 21,375 cases of military patients who were hospitalized and treated in three naval hospitals between January 2008 to December 2016 were extracted from the military health system. There were 16,278 complete and effective cases during those nine years. The situation, trends, and factors influencing hospitalization costs and LOS were analyzed using descriptive statistics, Mann-Whitney U test, Kruskal-Wallis H test, and multiple linear regressions. RESULTS The following factors showed statistically significant differences in hospitalization costs: special care, primary care, year, military rank, critical illness, allergies, and condition (p < 0.0001); and number of hospitalizations, gender, and age (p < 0.01). The following factors showed statistically significant differences in hospital LOS: year, number of hospitalizations, outcomes, military rank, special care, severity of illness, and condition (p < 0.0001); allergy (p < 0.01); and service and gender (p < 0.05). LOS between 2008-2016 showed a decreasing tendency, while hospitalization costs showed an increasing trend. There were 6 factors that affected Abstract (or Structured Summary) both the cost of hospitalization and LOS: special care, year, military rank, condition, allergy, and gender. CONCLUSIONS The results suggest that improving efficiency of military hospital require strengthening hierarchical referrals and controlling hospital LOS. Shortening LOS, optimizing clinical pathways, and reasonably controlling the costs associated with medicines and surgery can help reduce hospitalization costs for military patients. Controlling the growth of hospitalization costs can help avoid the physical and psychological burden of medical over-treatment on patients and may also optimize the allocation of military health resources.
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Affiliation(s)
- Zhenqing Xu
- Department of Military Health Management, College of Health Service, Second Military Medical University, Shanghai 100433, China.,952nd Hospital of PLA, Glomud, Qinghai, China
| | - Chen Xue
- Department of Military Health Management, College of Health Service, Second Military Medical University, Shanghai 100433, China
| | - Fangjie Zhao
- Department of Military Health Management, College of Health Service, Second Military Medical University, Shanghai 100433, China
| | - Chaoqun Hu
- Department of Military Health Management, College of Health Service, Second Military Medical University, Shanghai 100433, China
| | - Yaomin Wu
- Department of Military Health Management, College of Health Service, Second Military Medical University, Shanghai 100433, China
| | - Lulu Zhang
- Department of Military Health Management, College of Health Service, Second Military Medical University, Shanghai 100433, China
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Joliat GR, Hübner M, Roulin D, Demartines N. Cost Analysis of Enhanced Recovery Programs in Colorectal, Pancreatic, and Hepatic Surgery: A Systematic Review. World J Surg 2020; 44:647-655. [PMID: 31664495 DOI: 10.1007/s00268-019-05252-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Enhanced recovery programs (ERPs) have been shown to improve postoperative outcomes after abdominal surgery. This study aimed to review the current literature to assess if ERPs in colorectal, pancreas, and liver surgery induce cost savings. METHODS A systematic review was performed including prospective and retrospective studies comparing conventional management versus ERP in terms of costs. All kinds of ERP were considered (fast-track, ERAS®, or home-made protocols). Studies with no mention of a clear protocol and no reporting of protocol compliance were excluded. RESULTS Thirty-seven articles out of 144 identified records were scrutinized as full articles. Final analysis included 16 studies. In colorectal surgery, two studies were prospective (1 randomized controlled trial, RCT) and six retrospective, totaling 1277 non-ERP patients and 2078 ERP patients. Three of the eight studies showed no difference in cost savings between the two groups. The meta-analysis found a mean cost reduction of USD3010 (95% CI: 5370-650, p = 0.01) in favor of ERP. Among the five included studies in pancreas surgery (all retrospective, 552 non-ERP vs. 348 ERP patients), the mean cost reduction in favor of the ERP group was USD7020 (95% CI: 11,600-2430, p = 0.003). In liver surgery, only three studies (two retrospective and 1 RCT, 180 non-ERP vs. 197 ERP patients) were found, which precluded a sound cost analysis. CONCLUSIONS The present systematic review suggests that ERPs in colorectal and pancreas surgery are associated with cost savings compared to conventional perioperative management. Cost data in liver surgery are scarce.
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Affiliation(s)
- Gaëtan-Romain Joliat
- Department of Visceral Surgery, Lausanne University Hospital CHUV, Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Martin Hübner
- Department of Visceral Surgery, Lausanne University Hospital CHUV, Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Didier Roulin
- Department of Visceral Surgery, Lausanne University Hospital CHUV, Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Nicolas Demartines
- Department of Visceral Surgery, Lausanne University Hospital CHUV, Rue du Bugnon 46, 1011, Lausanne, Switzerland.
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Nonhome Discharge as an Independent Risk Factor for Adverse Events and Readmission in Patients Undergoing Anterior Cervical Discectomy and Fusion. Clin Spine Surg 2020; 33:E454-E459. [PMID: 32101991 DOI: 10.1097/bsd.0000000000000961] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
STUDY DESIGN A retrospective study of a prospectively collected cohort. OBJECTIVE To characterize a cohort of patients who underwent anterior cervical discectomy and fusion (ACDF) and examine whether nonhome discharge (NHD) is associated with postdischarge adverse events (AEs) and readmission. SUMMARY OF THE BACKGROUND DATA Predictors of NHD have been elucidated in the spine surgery literature, and NHD has been tied to poor outcomes in the joint arthroplasty literature, but no such analysis exists for patients undergoing ACDF. MATERIALS AND METHODS All patients who underwent ACDF from 2012 to 2015 in the National Surgical Quality Improvement Program were identified. Those who underwent concomitant posterior cervical operations were excluded. Patients who were discharged to home were compared with those discharged to nonhome destinations on the basis of demographics and outcomes. Multivariable models were created to assess whether NHD was an independent risk factor for postdischarge AEs and readmission. RESULTS NHD patients were significantly older (63.96 vs. 53.57 y; P<0.0001), more functionally dependent (13.87% vs. 1.09%; P<0.0001), more likely to have body mass index >40 (9.38% vs. 7.51%; P=0.004), and more likely to have ASA Class >2 (77.89% vs. 39.57%; P<0.0001). Patients who underwent NHD were significantly more likely to suffer severe AEs (14.44% vs. 0.93%; P<0.0001), minor AEs (7.22% vs. 0.24%; P<0.0001), and infectious complications (3.58% vs. 0.13%; P<0.0001) before discharge. When examining AEs after discharge, patients who underwent NHD were more likely to suffer severe AEs (6.37% vs. 1.34%; P<0.0001), minor AEs (4.09% vs. 0.74%; P<0.0001), death (1.25% vs. 0.07%; P<0.0001), and unplanned readmission (10.12% vs. 3.06%; P<0.0001). In adjusted analysis, NHD was found to independently predict severe AEs after discharge (odds ratio, 2.40; 95% confidence interval, 1.87-3.07; P<0.0001) and readmission (odds ratio, 1.77; 95% confidence interval, 1.46-2.14; P<0.0001). CONCLUSIONS NHD patients were significantly sicker than those discharged home. In addition, NHD is associated with higher rates of postdischarge complications.
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Khanijow AN, Wood LN, Xie R, Theiss LM, Hollis RH, Hardiman KM, Gunnells DJ, Kennedy GD, Morris MS, Cannon JA, Chu DI. The impact of an enhanced recovery program (ERP) on the costs of colorectal surgery. Am J Surg 2020; 222:186-192. [PMID: 33246551 DOI: 10.1016/j.amjsurg.2020.11.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 11/15/2020] [Accepted: 11/16/2020] [Indexed: 01/03/2023]
Abstract
BACKGROUND Enhanced Recovery Programs (ERPs) benefit patients but their effects on healthcare costs remain unclear. This study aimed to investigate the costs associated with a colorectal ERP in a large academic health system. METHODS Patients who underwent colorectal surgery from 2012 to 2014 (pre-ERP) and 2015-2017 (ERP) were propensity score matched based on patient and operative-level characteristics. Primary outcomes were median variable, fixed, and total costs. Secondary outcomes included length-of-stay (LOS), readmissions, and postoperative complications (POCs). RESULTS 616 surgical cases were included. Patient and operative-level characteristics were similar between the cohorts. Variable costs were $1028 less with ERP. ERP showed savings in nursing, surgery, anesthesiology, pharmacy, and laboratory costs, but had higher fixed costs. Total costs between the two groups were similar. ERP patients had significantly shorter LOS (-1 day, p < 0.01), but similar 30-day readmission rates and overall POCs. CONCLUSIONS Implementation of an ERP for colorectal surgery was associated with lower variable costs compared to pre-ERP.
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Affiliation(s)
- Anisha N Khanijow
- Division of Gastrointestinal Surgery, Department of Surgery, 1720 2nd Avenue South, KB427, University of Alabama at Birmingham, Birmingham, 35294, AL, USA
| | - Lauren N Wood
- Division of Gastrointestinal Surgery, Department of Surgery, 1720 2nd Avenue South, KB427, University of Alabama at Birmingham, Birmingham, 35294, AL, USA
| | - Rongbing Xie
- Division of Gastrointestinal Surgery, Department of Surgery, 1720 2nd Avenue South, KB427, University of Alabama at Birmingham, Birmingham, 35294, AL, USA
| | - Lauren M Theiss
- Division of Gastrointestinal Surgery, Department of Surgery, 1720 2nd Avenue South, KB427, University of Alabama at Birmingham, Birmingham, 35294, AL, USA
| | - Robert H Hollis
- Division of Gastrointestinal Surgery, Department of Surgery, 1720 2nd Avenue South, KB427, University of Alabama at Birmingham, Birmingham, 35294, AL, USA
| | - Karin M Hardiman
- Division of Gastrointestinal Surgery, Department of Surgery, 1720 2nd Avenue South, KB427, University of Alabama at Birmingham, Birmingham, 35294, AL, USA
| | - Drew J Gunnells
- Division of Gastrointestinal Surgery, Department of Surgery, 1720 2nd Avenue South, KB427, University of Alabama at Birmingham, Birmingham, 35294, AL, USA
| | - Gregory D Kennedy
- Division of Gastrointestinal Surgery, Department of Surgery, 1720 2nd Avenue South, KB427, University of Alabama at Birmingham, Birmingham, 35294, AL, USA
| | - Melanie S Morris
- Division of Gastrointestinal Surgery, Department of Surgery, 1720 2nd Avenue South, KB427, University of Alabama at Birmingham, Birmingham, 35294, AL, USA
| | - Jamie A Cannon
- Division of Gastrointestinal Surgery, Department of Surgery, 1720 2nd Avenue South, KB427, University of Alabama at Birmingham, Birmingham, 35294, AL, USA
| | - Daniel I Chu
- Division of Gastrointestinal Surgery, Department of Surgery, 1720 2nd Avenue South, KB427, University of Alabama at Birmingham, Birmingham, 35294, AL, USA.
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Ren Y, Zhou Z, Liu G, Shen C, Cao D, Xu T, Fry JM, Nawaz R, Zhao D, Su M, Ge T, Si Y, Chen G. Does inpatient health services utilization vary by remoteness in the medical financial assistance population? Evidence from Shaanxi province, China. BMC Health Serv Res 2020; 20:1051. [PMID: 33213451 PMCID: PMC7678078 DOI: 10.1186/s12913-020-05907-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 11/09/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Medical Financial Assistance (MFA) provides health insurance and financial support for millions of low income and disabled Chinese people, yet there has been little systematic analysis focused on this vulnerable population. This study aims to advance our understanding of MFA recipients' access to health care and whether their inpatient care use varies by remoteness. METHODS Data were collected from the Surveillance System of Civil Affairs of Shaanxi province in 2016. To better proxy remoteness (geographic access), drive time from the respondent's village to the nearest county-level or city-level hospital was obtained by a web crawler. Multilevel models were used to explore the impacts of remoteness on inpatient services utilization by MFA recipients. Furthermore, the potential moderating role of hospital grade (i.e. the grade of medical institution where recipient's latest inpatient care services were taken in the previous year) on the relationship between geographic access and inpatient care use was explored. RESULTS The analytical sample consisted of 9516 inpatient claims within 73 counties of Shaanxi province in 2016. We find that drive time to the nearest hospital and hospital grade are salient predictors of inpatient care use and there is a significant moderation effect of hospital grade. Compared to those with shortest drive time to the nearest hospital, longer drive time is associated with a longer inpatient stay but fewer admissions and lower annual total and out-of-pocket (OOP) inpatient costs. In addition, these associations are lower when recipients are admitted to a tertiary hospital, for annual total and OOP inpatient expenditures, but higher for length of the most recent inpatient stay no matter what medical treatments are taken in secondary or tertiary hospitals for the most remote recipients. CONCLUSION Our results suggest that remoteness has a significant and negative association with the frequency of inpatient care use. These findings advance our understanding of inpatient care use of the extremely poor and provide meaningful insights for further MFA program development as well as pro-poor health strategies.
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Affiliation(s)
- Yangling Ren
- School of Public Policy and Administration, Xi’an Jiaotong University, No. 28 Xianning West Road, Xi’an, 710049 Shaanxi China
| | - Zhongliang Zhou
- School of Public Policy and Administration, Xi’an Jiaotong University, No. 28 Xianning West Road, Xi’an, 710049 Shaanxi China
| | - Guanping Liu
- School of Public Policy and Administration, Xi’an Jiaotong University, No. 28 Xianning West Road, Xi’an, 710049 Shaanxi China
| | - Chi Shen
- School of Public Policy and Administration, Xi’an Jiaotong University, No. 28 Xianning West Road, Xi’an, 710049 Shaanxi China
| | - Dan Cao
- School of Public Policy and Administration, Xi’an Jiaotong University, No. 28 Xianning West Road, Xi’an, 710049 Shaanxi China
| | - Tiange Xu
- School of Public Policy and Administration, Xi’an Jiaotong University, No. 28 Xianning West Road, Xi’an, 710049 Shaanxi China
| | - Jane M. Fry
- Centre for Health Economics, Monash University, 900 Dandenong Road, Caulfield East, VIC 3145 Australia
| | - Rashed Nawaz
- School of Public Policy and Administration, Xi’an Jiaotong University, No. 28 Xianning West Road, Xi’an, 710049 Shaanxi China
| | - Dantong Zhao
- School of Public Policy and Administration, Xi’an Jiaotong University, No. 28 Xianning West Road, Xi’an, 710049 Shaanxi China
| | - Min Su
- School of Public Administration, Inner Mongolia University, Inner Mongolia, 010021 China
| | - Tingshuai Ge
- School of Public Policy and Administration, Xi’an Jiaotong University, No. 28 Xianning West Road, Xi’an, 710049 Shaanxi China
| | - Yafei Si
- ARC Centre of Excellence in Population Ageing Research (CEPAR), The University of New South Wales, 223 Anzac Parade, Sydney, NSW 2052 Australia
| | - Gang Chen
- Centre for Health Economics, Monash University, 900 Dandenong Road, Caulfield East, VIC 3145 Australia
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Orthosis in Thoracolumbar Fractures: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Spine (Phila Pa 1976) 2020; 45:E1523-E1531. [PMID: 32858744 DOI: 10.1097/brs.0000000000003655] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Systematic review and meta-analysis of randomized controlled trial (RCT). OBJECTIVE The aim of this study was to evaluate radiological and clinical outcomes of acute traumatic thoracolumbar fractures in skeletally mature patients treated with orthosis, versus no immobilization. SUMMARY OF BACKGROUND DATA Orthosis is traditionally used in conservative treatment of thoracolumbar fractures. However, recent studies suggest no benefit, and a possible negative impact in recovery. METHODS Databases were searched from inception to June 2019. Studies were selected in two phases by two blinded reviewers; disagreements were solved by consensus. Inclusion criteria were: RCT; only patients with acute traumatic thoracolumbar fractures; primary conservative treatment; comparison between orthosis and no orthosis. Exclusion criteria were inclusion of nonacute fractures, patients with other significant known diseases and comparison of groups different than use of an orthosis. Two independent reviewers performed data extraction and quality assessment. Fixed-effects models were used upon no heterogeneity, and random-effects model in the remaining cases. A previous plan for extraction of radiological (kyphosis progression; loss of anterior height) and clinical (pain; disability; length of stay) outcomes was applied. PRISMA guidelines were followed. RESULTS Eight articles/five studies were included (267 participants). None reported significant differences in pain, kyphosis progression, and loss of anterior height. One reported a better ODI with orthosis at 12 but not at 24 weeks. No other study reported differences in disability. All authors concluded an equivalence between treatments.Meta-analysis showed a significant increase of 3.47days (95% confidence interval 1.35-5.60) in mean admission time in orthosis group. No differences were found in kyphosis at 6 and 12 months; kyphosis progression between 0 to 6 and 0 to 12 months; loss of anterior height 0 to 6 months; VAS for pain at 6 months; VAS change 0 to 6 months. CONCLUSION Orthosis seems to add no benefit in conservative treatment of acute thoracolumbar fractures. This should be considered in guidelines and reviews of health care policies. LEVEL OF EVIDENCE 3.
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Whitley HP, Smith WD, Hanson C, Parton JM. Interdisciplinary speed dating augments diabetes self-management education and support to improve health outcomes. PATIENT EDUCATION AND COUNSELING 2020; 103:2305-2311. [PMID: 32475712 DOI: 10.1016/j.pec.2020.05.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 04/30/2020] [Accepted: 05/11/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To determine if a novel interdisciplinary "speed-dating" clinic augments Diabetes Self-Management Education and Support (DSMES). METHODS Adult patients with diabetes attended a DSMES class. Two weeks later patients attended an interdisciplinary clinic utilizing a "speed-dating" format during which they progressed through 5 stations hosted by different healthcare disciplines at 30-minute increments: physician, pharmacist, nurse/dietitian, case manager, and psychologist. Shared decision-making was utilized to identify mutually agreeable recommendations. Change in clinical outcomes were compared for DSMES-only attenders versus Dual-attendees; utilization of emergency department and hospital services were measured 12 months before and after attending the Speed Dating clinic. This analysis represents patients attending the program during 2016. RESULTS Sixty-nine attended the DSMES class, 40 of whom followed-up in the "speed-dating" clinic (58% return rate). Attending the Speed Dating clinic improved A1C (p = 0.003) and LDL-C (p = 0.003) compared to the DSMES class alone. Comparatively, after attending the speed-dating clinic, patients had fewer emergency department (p = 0.366) and hospital admissions (p = 0.036), and shorter lengths of hospital stay (p = 0.030). CONCLUSIONS The interdisciplinary "speed-dating" approach improved diabetes outcomes beyond DSMES alone and reduced utilization of hospital services. PRACTICE IMPLICATIONS Patients should attend DSMES but also participate in an Interdisciplinary Speed Dating follow-up to further improve outcomes.
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Affiliation(s)
- Heather P Whitley
- Department of Pharmacy Practice, Auburn University Harrison School of Pharmacy, Auburn, USA; Montgomery Family Medicine Residency Program, Baptist Health System, 4371 Narrow Lane Rd, Suite #100 / Montgomery, Alabama, 36116, USA.
| | - Warren D Smith
- Department of Drug Discovery and Development, Auburn University Harrison School of Pharmacy, Auburn, USA
| | - Courtney Hanson
- Culverhouse College of Business Institute of Business Analytics, The University of Alabama, Tuscaloosa, USA
| | - Jason M Parton
- Culverhouse College of Business Institute of Business Analytics, The University of Alabama, Tuscaloosa, USA
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Matsuzaki S, Bonnin M, Fournet-Fayard A, Bazin JE, Botchorishvili R. Effects of Low Intraperitoneal Pressure on Quality of Postoperative Recovery after Laparoscopic Surgery for Genital Prolapse in Elderly Patients Aged 75 Years or Older. J Minim Invasive Gynecol 2020; 28:1072-1078.e3. [PMID: 32979535 DOI: 10.1016/j.jmig.2020.09.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 09/04/2020] [Accepted: 09/19/2020] [Indexed: 11/24/2022]
Abstract
STUDY OBJECTIVE Previous clinical trials for laparoscopic surgery have included few elderly patients aged ≥75 years. We aimed to evaluate the quality of postoperative recovery after laparoscopic surgery using low intraperitoneal pressure (IPP) (6 mm Hg) and warmed, humidified carbon dioxide gas for genital prolapse in elderly patients aged ≥75 years. DESIGN Prospective consecutive case series. SETTING University hospital. PATIENTS Consecutive patients (n = 30) aged ≥75 years planning to undergo laparoscopic surgery for genital prolapse by the same surgeon were recruited from October 2016 through December 2019. INTERVENTIONS Laparoscopic promontofixation for the treatment of genital prolapse was performed using low IPP and warmed, humidified carbon dioxide gas. When a promontory could not be easily identified, laparoscopic pectopexy was alternatively performed. MEASUREMENTS AND MAIN RESULTS The primary outcome was the Quality of Recovery-40 (QoR-40) score at 24 hours postoperatively. The secondary outcomes were postoperative pain using a 100-mm visual analog scale and the length of hospital stay after surgery (LHSS). For the global QoR-40 score and for 4 dimensions of the QoR-40, "emotional state," "physical comfort," "psychologic support," and "pain," no differences were observed between the baseline score and the score at 24 hours. The score for the "physical independence" dimension at 24 hours was significantly lower than the baseline score (p <.001). No patient had visual analog scale pain scores >30 out of 100 at 12 hours or later. LHSS was <48 hours in 22 patients (73.3%) and <72 hours in 8 patients (26.7%). Multivariable analysis showed that the odds of an LHSS >48 hours were more than 8 times higher in patients who were discharged from the operating room in the afternoon compared with those with a morning discharge. CONCLUSION The use of a low IPP is feasible, safe, and has clinical benefits for elderly patients aged ≥75 years who undergo laparoscopic surgery for genital prolapse.
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Affiliation(s)
- Sachiko Matsuzaki
- Department of Gynecologic Surgery, CHU Clermont-Ferrand (Drs. Matsuzaki and Botchorishvili); UMR6602, CNRS/UCA/SIGMA, Institute Pascal, University of Clermont Auvergne (Drs. Matsuzaki and Botchorishvili).
| | - Martine Bonnin
- Department of Perioperative Medicine, CHU Clermont-Ferrand (Drs. Bonnin, Fournet-Fayard, and Bazin), Clermont-Ferrand, France
| | - Aurelie Fournet-Fayard
- Department of Perioperative Medicine, CHU Clermont-Ferrand (Drs. Bonnin, Fournet-Fayard, and Bazin), Clermont-Ferrand, France
| | - Jean-Etienne Bazin
- Department of Perioperative Medicine, CHU Clermont-Ferrand (Drs. Bonnin, Fournet-Fayard, and Bazin), Clermont-Ferrand, France
| | - Revaz Botchorishvili
- Department of Gynecologic Surgery, CHU Clermont-Ferrand (Drs. Matsuzaki and Botchorishvili); UMR6602, CNRS/UCA/SIGMA, Institute Pascal, University of Clermont Auvergne (Drs. Matsuzaki and Botchorishvili)
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Forner D, Noel CW, Guttman MP, Haas B, Enepekides D, Rigby MH, Nathens AB, Eskander A. Blunt Versus Penetrating Neck Trauma: A Retrospective Cohort Study. Laryngoscope 2020; 131:E1109-E1116. [PMID: 32894596 DOI: 10.1002/lary.29088] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 07/23/2020] [Accepted: 08/19/2020] [Indexed: 01/21/2023]
Abstract
OBJECTIVES/HYPOTHESIS Despite being common, neck injuries have received relatively little attention for important quality of care metrics. This study sought to determine the association between blunt and penetrating neck injuries on mortality and length of stay, and to identify additional patient and hospital-level characteristics that impact these outcomes. STUDY DESIGN Retrospective cohort study utilizing the American College of Surgeons Trauma Quality Improvement Program database. METHODS Adult patients (≥18) who sustained traumatic injuries involving the soft tissues of the neck between 2012 and 2016 were eligible. Multiple imputation was used to account for missing data. Logistic regression and negative binomial models were used to analyze 1) in-hospital mortality and 2) length of stay respectively while adjusting for potential confounders and accounting for clustering at the hospital level. RESULTS In a cohort of 20,285 patients, the crude mortality rate was lower in those sustaining blunt neck injuries compared to penetrating injuries (4.9% vs. 6.0%, P < .01), while length of hospital stay was similar (median 9.9 vs. 10.2, P = 0.06). In adjusted analysis, blunt neck injuries were associated with a reduced odds of mortality during hospital admission (odds ratio: 0.66, 95% confidence intervals [0.564, 0.788]), as well as significant reductions in length of stay (rate ratio: 0.92, 95% confidence intervals [0.880, 0.954]). CONCLUSIONS Blunt neck injuries are associated with lower mortality and length of stay compared to penetrating injuries. Areas of future study have been identified, including elucidation of processes of care in specific organs of injury. LEVEL OF EVIDENCE Level 3 Laryngoscope, 131:E1109-E1116, 2021.
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Affiliation(s)
- David Forner
- Division of Otolaryngology - Head & Neck Surgery, Dalhousie University, Halifax, Nova Scotia, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Christopher W Noel
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Department of Otolaryngology - Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Matthew P Guttman
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Barbara Haas
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.,Division of General Surgery, Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Danny Enepekides
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Department of Otolaryngology - Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada.,Department of Otolaryngology - Head & Neck Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Matthew H Rigby
- Division of Otolaryngology - Head & Neck Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Avery B Nathens
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.,Division of General Surgery, Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Antoine Eskander
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Department of Otolaryngology - Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada.,Department of Otolaryngology - Head & Neck Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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De la Plaza Llamas R, Ramia JM. Cost of postoperative complications: How to avoid calculation errors. World J Gastroenterol 2020; 26:2682-2690. [PMID: 32550746 PMCID: PMC7284181 DOI: 10.3748/wjg.v26.i21.2682] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 03/27/2020] [Accepted: 05/20/2020] [Indexed: 02/06/2023] Open
Abstract
Postoperative complications (PC) are a basic health outcome, but no surgery service in the world records and/or audits the PC associated with all the surgical procedures it performs. Most studies that have assessed the cost of PC suffer from poor quality and a lack of transparency and consistency. The payment system in place often rewards the volume of services provided rather than the quality of patients' clinical outcomes. Without a thorough registration of PC, the economic costs involved cannot be determined. An accurate, reliable appraisal would help identify areas for investment in order to reduce the incidence of PC, improve surgical results, and bring down the economic costs. This article describes how to quantify and classify PC using the Clavien-Dindo classification and the comprehensive complication index, discusses the perspectives from which economic evaluations are performed and the minimum postoperative follow-up established, and makes various recommendations. The availability of accurate and impartially audited data on PC will help reduce their incidence and bring down costs. Patients, the health authorities, and society as a whole are sure to benefit.
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Affiliation(s)
- Roberto De la Plaza Llamas
- Department of General and Digestive Surgery, Hospital Universitario de Guadalajara, Guadalajara 19002, Spain
| | - José M Ramia
- Department of General and Digestive Surgery, Hospital Universitario de Guadalajara, Guadalajara 19002, Spain
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Weyh A, Nocella R, Abdelmalik M, Pucci R, Quimby A, Bunnell A, Fernandes R. An analysis of unplanned readmissions after head and neck microvascular reconstructive surgery. Int J Oral Maxillofac Surg 2020; 49:1559-1565. [PMID: 32475708 DOI: 10.1016/j.ijom.2020.04.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 03/08/2020] [Accepted: 04/28/2020] [Indexed: 10/24/2022]
Abstract
The 30-day readmission rate is a highly scrutinized metric of quality surgical care, because readmission is costly and perceived to be avoidable with planning and patient education. Head and neck surgery patients generally have multiple risk factors for readmission, as readmitted patients are generally older, with more co-morbidities, lower socio-economic status, and a history of multiple emergency department visits and readmissions. A retrospective cohort study was implemented to determine the incidence and etiology of 30-day readmission after microvascular head and neck reconstructive surgery, focusing on social risk factors. Data were analyzed by χ2 test, analysis of variance, t-test, and logistic regression, with statistical significance set at P<0.05. Of 209 patients included in this study, 35 (16.7%) had a 30-day readmission. Increased needs at discharge were associated with increased readmission, while other social risk factors were less significant for a readmission in this study.
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Affiliation(s)
- A Weyh
- Department of Oral and Maxillofacial Surgery, University of Florida Jacksonville, Jacksonville, FL, USA.
| | - R Nocella
- Department of Oral and Maxillofacial Surgery, University of Florida Jacksonville, Jacksonville, FL, USA.
| | - M Abdelmalik
- Department of Oral and Maxillofacial Surgery, University of Florida Jacksonville, Jacksonville, FL, USA.
| | - R Pucci
- Department of Maxillofacial Surgery, Sapienza University of Rome, Rome, Italy.
| | - A Quimby
- Department of Oral and Maxillofacial Surgery, University of Florida Jacksonville, Jacksonville, FL, USA.
| | - A Bunnell
- Department of Oral and Maxillofacial Surgery, University of Florida Jacksonville, Jacksonville, FL, USA.
| | - R Fernandes
- Department of Oral and Maxillofacial Surgery, University of Florida Jacksonville, Jacksonville, FL, USA.
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Hemmige V, David MZ. Effects of Including Variables Such as Length of Stay in a Propensity Score Analysis With Costs as Outcome. Clin Infect Dis 2020; 69:2039-2040. [PMID: 31044231 DOI: 10.1093/cid/ciz347] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Vagish Hemmige
- Division of Infectious Diseases, Albert Einstein College of Medicine, Bronx, New York
| | - Michael Z David
- Division of Infectious Diseases, Department of Medicine, University of Pennsylvania, Philadelphia
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Shepard J, Frederick J, Wong F, Madison S, Tompkins L, Hadhazy E. Could the prevention of health care-associated infections increase hospital cost? The financial impact of health care-associated infections from a hospital management perspective. Am J Infect Control 2020; 48:255-260. [PMID: 32089192 DOI: 10.1016/j.ajic.2019.08.035] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 08/30/2019] [Accepted: 08/31/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND The financial burden health care-associated infections (HAIs) have on patients, payers, and hospitals is not clear. Although patient safety is the highest priority, administrators require data to justify the expense of HAI reduction programs. METHODS Chart review was performed to identify HAIs for patients discharged from Stanford Hospital. Using a t test, we tested whether patients with an HAI will have a different daily total hospital cost and length of stay than patients without an HAI. We calculated the change in hospital profit related to HAIs by comparing patients with and without an HAI in the same admit All-Patient Refined Diagnosis Related Group and complexity score. RESULTS Between October 1, 2015 and September 30, 2018, there were 78,551 inpatient discharges and 1,541 HAIs identified. Daily total hospital cost and length of stay for patients with an HAI versus patients without an HAI was $6,433 ($6,251, $6,615) versus $6,604 ($6,557, $6,651) (P = .073), and 26.30 days (24.89, 27.71) versus 5.69 (5.64, 5.74) (P < .001). DISCUSSION For each HAI eliminated, data suggests that hospital's cost and revenue would increase $25,008 and $1,518,682, respectively, by backfilling beds with new patients at a 4.62:1 ratio. The reduction of HAIs is profitable for hospitals. CONCLUSIONS Data from this study suggest that the more HAIs you eliminate and the more capacity you build for the hospital, the higher the total hospital costs will go. This is an essential shift to the current paradigm that will allow for the accurate and continued funding of HAI reduction programs. Although hospital cost appears to increase as HAIs are reduced, hospital profits rise even more.
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Variations in Revenue Generation for the Care of Orthopaedic Trauma Patients. J Am Acad Orthop Surg 2020; 28:e151-e157. [PMID: 31219971 DOI: 10.5435/jaaos-d-17-00871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND In the background of increasing competition between trauma centers, this study investigated the relative reimbursement of trauma care provided in an urban trauma setting, comparing patients previously unknown (new) to the system, representing potential sources of new revenue, and those who were known (established), having received medical care previously in the same system. METHODS A retrospective review of 440 patients with high-energy fractures at a single level 1 trauma center was conducted. Payment to charge (P/C) ratios for professional and facilities services within 6 months of injury were calculated. RESULTS Mean professional charges per patient were $35,522 and $30,639 (P = 0.11), between new and established patients, respectively, whereas mean professional payments were statistically different, $7,894 and $4,365 (P < 0.001). Mean differences in P/C for facilities payments for new and established patients were not statistically significant, but professional P/C was higher in new patients (P < 0.001), consistent with better insured patients. DISCUSSION Insurance companies reimburse for professional or facilities services with statistically different P/C ratios. Treating new patients at our institution likely benefits our institution by offering exposure to a more favorable payer mix and more complex patients. LEVEL OF EVIDENCE Retrospective level III.
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50
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Hersh DS, Smith LGF, Jones TL, Fraser BD, Kumar R, Vaughn B, Klimo P. Predictors of an Extended Length of Stay following an Elective Craniotomy in Children and Young Adults. Pediatr Neurosurg 2020; 55:259-267. [PMID: 33099552 DOI: 10.1159/000511090] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 08/24/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Length of stay (LOS) is now a generally accepted clinical metric within the USA. An extended LOS following an elective craniotomy can significantly impact overall costs. Few studies have evaluated predictors of an extended LOS in pediatric neurosurgical patients. OBJECTIVE The aim of the study was to determine predictors of an extended hospital LOS following an elective craniotomy in children and young adults. METHODS All pediatric patients and young adults undergoing an elective craniotomy between January 1, 2010, and April 1, 2019, were retrospectively identified using a prospectively maintained database. Demographic, clinical, radiological, and surgical data were collected. The primary outcome was extended LOS, defined as a postsurgical stay greater than 7 days. Bivariate and multivariable analyses were performed. RESULTS A total of 1,498 patients underwent 1,720 elective craniotomies during the study period over the course of 1,698 hospitalizations with a median LOS of 4 days (interquartile range 3-6 days). Of these encounters, 218 (12.8%) had a prolonged LOS. Multivariable analysis demonstrated that non-Caucasian race (OR = 1.9 [African American]; OR = 1.6 [other]), the presence of an existing shunt (OR = 1.8), the type of craniotomy (OR = 0.3 [vascular relative to Chiari]), and the presence of a postoperative complication (OR = 14.7) were associated with an extended LOS. CONCLUSIONS Inherent and modifiable factors predict a hospital stay of more than a week in children and young adults undergoing an elective craniotomy.
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Affiliation(s)
- David S Hersh
- Division of Neurosurgery, Connecticut Children's, Hartford, Connecticut, USA, .,Department of Surgery, UConn School of Medicine, Farmington, Connecticut, USA,
| | - Luke G F Smith
- Department of Neurosurgery, The Ohio State University, Columbus, Ohio, USA
| | - Tamekia L Jones
- Departments of Pediatrics and Preventive Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA.,Children's Foundation Research Institute, Le Bonheur Children's Hospital, Memphis, Tennessee, USA
| | - Brittany D Fraser
- Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Rahul Kumar
- College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Brandy Vaughn
- Neuroscience Institute, Le Bonheur Children's Hospital, Memphis, Tennessee, USA
| | - Paul Klimo
- Neuroscience Institute, Le Bonheur Children's Hospital, Memphis, Tennessee, USA.,Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA.,Semmes Murphey, Memphis, Tennessee, USA
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