RESUMO
To determine the costs of the three types of delivery in the maternity department of the Tiznit Provincial Hospital Center. This quantitative study analyzed costs for the year 2016 by the activity-based costing method. The total maternity ward costs were 6 269 922.31 MAD, of which 5 781 409,09 MAD (92.21%) were attributed to the three types of delivery studied. Human resources accounted for 53.56% of maternity department expenses, pharmaceutical expenses for 16.22%, and administrative expenses for 11.40%. The average costs of a normal delivery were 1257,76 MAD, for a dystocic delivery 1258,00 MAD, and for cesarean delivery 3004.87 MAD. This type of study is the first of its kind to be conducted in a Moroccan hospital. It demonstrates the feasibility of this approach, on the one hand, and on the other it provides managers with a much more accurate idea of the cost of the services offered and the information needed for decision-making.
Assuntos
Parto Obstétrico/economia , Parto Obstétrico/estatística & dados numéricos , Custos de Cuidados de Saúde , Unidade Hospitalar de Ginecologia e Obstetrícia/economia , Unidade Hospitalar de Ginecologia e Obstetrícia/estatística & dados numéricos , Feminino , Humanos , Marrocos , GravidezRESUMO
OBJECTIVE: The objective of this study was to compare midwife-led and consultant-led obstetrical care for women with uncomplicated low-risk pregnancies. We estimated costs and maternal outcomes in both units to achieve a cost-effectiveness ratio. DESIGN: The cost-analysis was made according to the "intention to treat" concept in order to minimize bias associated with the non-randomization of participants. At the obstetric-led unit, women received care from both midwives and medical staff while those in the alternative structure called 'Le Cocon' only received care from midwives. SETTING: The obstetric-led unit of the Erasme University-Hospital in Brussels and its alongside midwife-led unit. PARTICIPANTS: The study population included all low-risk pregnant women from 1 March 2014 until 31 October 2015 who were affiliated to the MLOZ (Mutualités Libres-Onafhankelijke Ziekenfondsen; third Belgian statutory health care insurer). INTERVENTIONS: The cost calculation involved a bottom-up approach. The health care consumption of each participant was obtained from MLOZ's data. The study included costs occurred the beginning of pregnancy until 3 months post-partum. Clinical data were extracted from the patient medical records. FINDINGS: Compared to the traditional obstetric-led unit, the alternative midwife-led unit was associated with a cost reduction for the national payer (∆ = -397.39, pâ¯=â¯0.046) and for the patient (∆ = - 44.19, pâ¯=â¯0.016). There were no significant differences in rates of caesarean, instrumental birth and epidural analgesia between MLU and OLU. A sensitivity analysis was performed (Appendix C) but does not change the overall results and conclusions. KEY CONCLUSIONS: Due to the small size of the samples, no statistical differences were found. More analysis is needed to evaluate the cost-effectiveness regarding the use of epidural analgesia, caesarean and instrumental birth rates in the midwife-led unit. IMPLICATIONS FOR PRACTICE: Given the economical findings, this could contribute to reduce health expenditures for both women (out of pocket) and state (public payer via health care insurers).
Assuntos
Enfermeiros Obstétricos/economia , Unidade Hospitalar de Ginecologia e Obstetrícia/economia , Padrões de Prática em Enfermagem/economia , Adulto , Bélgica , Análise Custo-Benefício , Feminino , Humanos , Enfermeiros Obstétricos/estatística & dados numéricos , Unidade Hospitalar de Ginecologia e Obstetrícia/organização & administração , Unidade Hospitalar de Ginecologia e Obstetrícia/estatística & dados numéricos , Assistência Perinatal/economia , Assistência Perinatal/métodos , Assistência Perinatal/estatística & dados numéricos , Padrões de Prática em Enfermagem/organização & administração , Padrões de Prática em Enfermagem/estatística & dados numéricos , Gravidez , Estudos RetrospectivosRESUMO
WHAT WE ALREADY KNOW ABOUT THIS TOPIC: WHAT THIS ARTICLE TELLS US THAT IS NEW: BACKGROUND:: The Malignant Hyperthermia Association of the United States recommends that dantrolene be available for administration within 10 min. One approach to dantrolene availability is a malignant hyperthermia cart, stocked with dantrolene, other drugs, and supplies. However, this may not be of cost benefit for maternity units, where triggering agents are rarely used. METHODS: The authors performed a cost-benefit analysis of maintaining a malignant hyperthermia cart versus a malignant hyperthermia cart readily available within the hospital versus an initial dantrolene dose of 250 mg, on every maternity unit in the United States. A decision-tree model was used to estimate the expected number of lives saved, and this benefit was compared against the expected costs of the policy. RESULTS: We found that maintaining a malignant hyperthermia cart in every maternity unit in the United States would reduce morbidity and mortality costs by $3,304,641 per year nationally but would cost $5,927,040 annually. Sensitivity analyses showed that our results were largely driven by the extremely low incidence of general anesthesia. If cesarean delivery rates in the United States remained at 32% of all births, the general anesthetic rate would have to be greater than 11% to achieve cost benefit. The only cost-effective strategy is to keep a 250-mg dose of dantrolene on the unit for starting therapy. CONCLUSIONS: It is not of cost benefit to maintain a fully stocked malignant hyperthermia cart with a full supply of dantrolene within 10 min of maternity units. We recommend that hospitals institute alternative strategies (e.g., maintain a small supply of dantrolene on the maternity unit for starting treatment).
Assuntos
Análise Custo-Benefício/métodos , Dantroleno/economia , Árvores de Decisões , Hipertermia Maligna/economia , Relaxantes Musculares Centrais/economia , Unidade Hospitalar de Ginecologia e Obstetrícia/economia , Dantroleno/administração & dosagem , Relação Dose-Resposta a Droga , Feminino , Humanos , Hipertermia Maligna/tratamento farmacológico , Relaxantes Musculares Centrais/administração & dosagem , Gravidez , Resultado do TratamentoRESUMO
BACKGROUND: In Gujarat, India, a state led public private partnership scheme to promote facility birth named Chiranjeevi Yojana (CY) was implemented in 2005. Institutional birth is provided free of cost at accredited private health facilities to women from socially disadvantaged groups (eligible women). CY has contributed in increasing facility birth and providing substantially subsidized (but not totally free) birth care; however, the retention of mothers in this scheme in subsequent child birth is unknown. Therefore, we conducted a study aimed to determine the effect of previous utilization of the scheme and previous out of pocket expenditure on subsequent child birth among multiparous eligible women in Gujarat. METHODS: This was a retrospective cohort study of multiparous eligible women (after excluding abortions and births at public facility). A structured questionnaire was administered by trained research assistant to those with recent delivery between Jan and Jul 2013. Outcome of interest was CY utilization in subsequent child birth (Jan-Jul 2013). Explanatory variables included socio-demographic characteristics (including category of eligibility), pregnancy related characteristics in previous child birth, before Jan 2013, (including CY utilization, out of pocket expenditure) and type of child birth in subsequent birth. A poisson regression model was used to assess the association of factors with CY utilization in subsequent child birth. RESULTS: Of 997 multiparous eligible women, 289 (29%) utilized and 708 (71%) did not utilize CY in their previous child birth. Of those who utilized CY (n = 289), 182 (63%) subsequently utilized CY and 33 (11%) gave birth at home; whereas those who did not utilize CY (n = 708) had four times higher risk (40% vs. 11%) of subsequent child birth at home. In multivariable models, previous utilization of the scheme was significantly associated with subsequent utilization (adjusted Relative Risk (aRR): 2.7; 95% CI: 2.2-3.3), however previous out of pocket expenditure was not found to be associated with retention in the CY scheme. CONCLUSION: Women with previous CY utilization were largely retained; therefore, steps to increase uptake of CY are expected to increase retention of mothers within CY in their subsequent child birth. To understand the reasons for subsequent child birth at home despite previous CY utilization and previous zero/minimal out of pocket expenditure, future research in the form of systematic qualitative enquiry is recommended.
Assuntos
Parto Obstétrico/estatística & dados numéricos , Gastos em Saúde/estatística & dados numéricos , Serviços de Saúde Materna/estatística & dados numéricos , Parcerias Público-Privadas/estatística & dados numéricos , Adulto , Parto Obstétrico/economia , Feminino , Instalações de Saúde/estatística & dados numéricos , Acessibilidade aos Serviços de Saúde/economia , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Parto Domiciliar/economia , Parto Domiciliar/estatística & dados numéricos , Humanos , Índia , Serviços de Saúde Materna/economia , Mães/estatística & dados numéricos , Unidade Hospitalar de Ginecologia e Obstetrícia/economia , Unidade Hospitalar de Ginecologia e Obstetrícia/estatística & dados numéricos , Gravidez , Parcerias Público-Privadas/economia , Estudos Retrospectivos , Populações Vulneráveis/estatística & dados numéricosRESUMO
BACKGROUND: Increasingly couples are travelling overseas to access assisted reproductive technology, known as cross border reproductive care, although the incidence, pregnancy outcomes and healthcare costs are unknown. AIMS: To determine obstetric and neonatal outcomes for multiple pregnancies conceived through fertility treatment overseas, and estimate cost of these pregnancies to the health system. MATERIALS AND METHODS: Retrospective study of women receiving care for a multiple gestation between July 2013 and June 2015 at Western Australia's sole tertiary obstetric hospital, where conception was by overseas fertility treatment. Obstetric and neonatal outcomes were recorded and cost estimates calculated. RESULTS: Of 11 710 births, 422 were multiple pregnancies. Thirty-seven pregnancies were conceived with fertility treatment, with 11 (29.7%) conceived overseas. Median antenatal clinic attendances, ultrasound examinations, and fetal assessments for the overseas fertility cases were six, 10, and nine, respectively. The gestational age at delivery ranged from 30 to 38 weeks (median 34 + 1). Median neonatal admission duration was 18 days (range 0-47). Cost for obstetric care was estimated between $170 000 and $216 000, and cost of neonatal care was estimated as $810 000, giving a combined total cost of between $980 000 and $1 026 000. CONCLUSION: At the sole tertiary obstetric centre in WA, approximately one-third of all multiple pregnancies conceived with fertility treatment resulted from treatment overseas. The Australian healthcare cost for these 11 women and their infants exceeded $1 000 000. This study suggests that overseas fertility treatment has a significant health-related cost to the mother and infant, and the local healthcare system.
Assuntos
Custos de Cuidados de Saúde/estatística & dados numéricos , Turismo Médico/economia , Unidade Hospitalar de Ginecologia e Obstetrícia/economia , Gravidez Múltipla , Técnicas de Reprodução Assistida , Adulto , Feminino , Idade Gestacional , Custos Hospitalares/estatística & dados numéricos , Humanos , Recém-Nascido , Doenças do Recém-Nascido/economia , Pessoa de Meia-Idade , Gravidez , Técnicas de Reprodução Assistida/economia , Estudos Retrospectivos , Centros de Atenção Terciária , Austrália OcidentalAssuntos
Centros de Assistência à Gravidez e ao Parto , Parto Obstétrico , Obstetrícia , Acreditação , Centros de Assistência à Gravidez e ao Parto/economia , Centros de Assistência à Gravidez e ao Parto/organização & administração , Centros de Assistência à Gravidez e ao Parto/normas , Custos e Análise de Custo , Parto Obstétrico/economia , Parto Obstétrico/normas , Feminino , Humanos , Tocologia/economia , Tocologia/organização & administração , Tocologia/normas , Modelos Organizacionais , Obstetrícia/economia , Obstetrícia/organização & administração , Obstetrícia/normas , Unidade Hospitalar de Ginecologia e Obstetrícia/economia , Unidade Hospitalar de Ginecologia e Obstetrícia/organização & administração , Unidade Hospitalar de Ginecologia e Obstetrícia/normas , Afiliação Institucional , Segurança do Paciente/normas , Admissão e Escalonamento de Pessoal , Gravidez , Resultado da Gravidez , Risco , Estados UnidosRESUMO
OBJECTIVE: To provide a model for conducting cost-effectiveness analyses in medical education. The model was based on a randomised trial examining the effects of training midwives to perform cervical length measurement (CLM) as compared with obstetricians on patients' waiting times. (CLM), as compared with obstetricians. METHODS: The model included four steps: (i) gathering data on training outcomes, (ii) assessing total costs and effects, (iii) calculating the incremental cost-effectiveness ratio (ICER) and (iv) estimating cost-effectiveness probability for different willingness to pay (WTP) values. To provide a model example, we conducted a randomised cost-effectiveness trial. Midwives were randomised to CLM training (midwife-performed CLMs) or no training (initial management by midwife, and CLM performed by obstetrician). Intervention-group participants underwent simulation-based and clinical training until they were proficient. During the following 6 months, waiting times from arrival to admission or discharge were recorded for women who presented with symptoms of pre-term labour. Outcomes for women managed by intervention and control-group participants were compared. These data were then used for the remaining steps of the cost-effectiveness model. RESULTS: Intervention-group participants needed a mean 268.2 (95% confidence interval [CI], 140.2-392.2) minutes of simulator training and a mean 7.3 (95% CI, 4.4-10.3) supervised scans to attain proficiency. Women who were scanned by intervention-group participants had significantly reduced waiting time compared with those managed by the control group (n = 65; mean difference, 36.6 [95% CI 7.3-65.8] minutes; p = 0.008), which corresponded to an ICER of 0.45 EUR minute(-1) . For WTP values less than EUR 0.26 minute(-1) , obstetrician-performed CLM was the most cost-effective strategy, whereas midwife-performed CLM was cost-effective for WTP values above EUR 0.73 minute(-1) . CONCLUSION: Cost-effectiveness models can be used to link quality of care to training costs. The example used in the present study demonstrated that different training strategies could be recommended as the most cost-effective depending on administrators' willingness to pay per unit of the outcome variable.
Assuntos
Análise Custo-Benefício/métodos , Educação de Graduação em Medicina/economia , Ocupações em Saúde/educação , Qualidade da Assistência à Saúde , Medida do Comprimento Cervical , Feminino , Humanos , Tocologia/economia , Tocologia/educação , Unidade Hospitalar de Ginecologia e Obstetrícia/economia , GravidezRESUMO
OBJECTIVE: to compare the cost of maternity care between two midwife-led units, and their linked consultant-led units, following a large randomised trial in Ireland. DESIGN: ethical approval was received for this unblinded, pragmatic randomised trial (MidU) funded by the Health Service Executive (Dublin North-East, Ireland), conducted 2004-2009. A comparison of costs analysis was conducted on the outcomes from the trial. SETTING: two maternity units in Ireland, with 'alongside' midwife-led units. PARTICIPANTS: all women without risk factors for labour and birth who booked at the two maternity units before 24 weeks׳ gestation were assessed for inclusion. Consenting women (n=1653) were centrally randomised on a 2:1 ratio (1101:552) to midwife-led or consultant-led care. INTERVENTIONS: women randomised to consultant-led care received standard care. Women randomised to the midwife-led arm received midwife-led care provided by a small group of midwives in two units, situated ׳alongside׳ the consultant-led units, throughout pregnancy, birth and postnatal. MEASUREMENTS: mean difference in clinician salaries, cost of care based on managers׳ data, known costs of postnatal bed days and costs of key interventions were measured. FINDINGS: the average cost of caring for a woman allocated to the midwife-led units was 2598, compared to 2780 in the consultant-led units (average difference 182 per woman, analysed by 'intention to treat'). KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: care in these two midwife-led units costs less than care provided by the consultant-led units. Given the clinical findings, which showed that care provided in the midwife-led units is as safe as that in the consultant-led units and results in less intervention, more midwife-led units should be incorporated into maternity care in Ireland so that scarce resources can be used more effectively.
Assuntos
Parto Obstétrico/economia , Serviços de Saúde Materna/economia , Tocologia/economia , Feminino , Custos Hospitalares , Humanos , Irlanda , Unidade Hospitalar de Ginecologia e Obstetrícia/economia , Avaliação de Resultados em Cuidados de Saúde , Período Pós-Parto , GravidezRESUMO
INTRODUCTION AND OBJECTIVES: Recent changes to the Polish healthcare system have forced healthcare managers and administrators to implement modern instruments for strategic and operations management. The main aim of the study was to analyze the effect of managerial decisions in the area of human resources, resulting from the adopted restructuring program, on the economic situation of the OGCH, PUMS. MATERIAL AND METHODS: The research material comprised of secondary sources on finance, accounting and human resources data: financial statements, analysis of costs incurred by individual hospital departments, reports on the implementation of NHF contracts for providing health services and on hospital workforce at the time of the study, as well as the results of patient satisfaction survey at the OGCH, PUMS. RESULTS: After implementation of the restructuring program all clinics apart from one - Surgical Gynecology Clinic - reached better beds occupancy rates in 2012 as compared to 2009, as well as significantly improved profit/per hospital bed. Over the course of three years, since the launch of the hospital restructuring program, a significant (20%) increase in the revenues from selling healthcare services and a simultaneous decrease (2%) of the operating cost was observed. CONCLUSIONS: Inclusion of department heads into the decision making processes of managerial accounting seems to be necessary to improve the overall financial condition of a hospital. However, it requires a more flexible hospital structure, what can be achieved by implementing a divisional organizational structure, which grants individual organizational units a certain autonomy in the process of making medical-financial decisions.
Assuntos
Reestruturação Hospitalar/organização & administração , Hospitais Universitários/organização & administração , Unidade Hospitalar de Ginecologia e Obstetrícia/organização & administração , Administração de Recursos Humanos em Hospitais , Reestruturação Hospitalar/economia , Hospitais Universitários/economia , Unidade Hospitalar de Ginecologia e Obstetrícia/economia , PolôniaRESUMO
Begun in 2003, the Yale-New Haven Hospital comprehensive obstetric safety program consisted of measures to standardize care, improve teamwork and communication, and optimize oversight and quality review. Prior publications have demonstrated improvements in adverse outcomes and safety culture associated with this program. In this analysis, we aimed to assess the impact of this program on liability claims and payments at a single institution. We reviewed liability claims at a single, tertiary-care, teaching hospital for two 5-year periods (1998-2002 and 2003-2007), before and after implementing the safety program. Connecticut statute of limitations for professional malpractice is 36 months from injury. Claims/events were classified by event-year and payments were adjusted for inflation. We analyzed data for trends as well as differences between periods before and after implementation. Forty-four claims were filed during the 10-year study period. Annual cases per 1000 deliveries decreased significantly over the study period (P < .01). Claims (30 vs 14) and payments ($50.7 million vs $2.9 million) decreased in the 5-years after program inception. Compared with before program inception, median annual claims dropped from 1.31 to 0.64 (P = .02), and median annual payments per 1000 deliveries decreased from $1,141,638 to $63,470 (P < .01). Even estimating the monetary awards for the 2 remaining open cases using the median payments for the surrounding 5 years, a reduction in the median monetary amount per case resulting in payment to the claimant was also statistically significant ($632,262 vs $216,815, P = .046). In contrast, the Connecticut insurance market experienced a stable number of claims and markedly increased cost per claim during the same period. We conclude that an obstetric safety initiative can improve liability claims exposure and reduce liability payments.
Assuntos
Compensação e Reparação/legislação & jurisprudência , Hospitais de Ensino/normas , Responsabilidade Legal/economia , Imperícia/legislação & jurisprudência , Unidade Hospitalar de Ginecologia e Obstetrícia/normas , Segurança do Paciente/normas , Traumatismos do Nascimento/economia , Traumatismos do Nascimento/etiologia , Connecticut , Parto Obstétrico/efeitos adversos , Parto Obstétrico/economia , Parto Obstétrico/legislação & jurisprudência , Feminino , Hospitais de Ensino/economia , Hospitais de Ensino/legislação & jurisprudência , Hospitais de Ensino/tendências , Humanos , Recém-Nascido , Imperícia/economia , Imperícia/estatística & dados numéricos , Imperícia/tendências , Unidade Hospitalar de Ginecologia e Obstetrícia/economia , Unidade Hospitalar de Ginecologia e Obstetrícia/legislação & jurisprudência , Unidade Hospitalar de Ginecologia e Obstetrícia/tendências , Segurança do Paciente/economia , Segurança do Paciente/legislação & jurisprudência , Gravidez , Avaliação de Programas e Projetos de Saúde , Melhoria de Qualidade/economiaRESUMO
OBJECTIVE: To evaluate a policy of routine versus selective postpartum complete blood count (CBC). STUDY DESIGN: Historic case control design with matched subjects from 1 year periods bracketing the policy change (n = 800). Our primary outcome was postpartum transfusion rate. Univariable and multivariable analyses were performed. Total hospital costs were estimated. RESULTS: Eliminating routine postpartum CBC testing was associated with decreased transfusion rates (5.5% vs 1.8%, P = .007) despite similar transfusion risks. CBC utilization decreased from 59% to 22.2% (P < .0001). No adverse bleeding outcomes occurred. Multivariable modeling suggested that the occurrence of postpartum hemorrhage was the best clinical predictors of transfusion n risk. Tachycardia, oliguria, and symptoms were also effective at identifying transfusion candidates. Elimination of routine CBC was independently associated with a reduced risk of transfusion (odds ratio, 0.30; 95% confidence interval, 0.12-0.72). Annual cost savings were estimated at $58,000. CONCLUSION: Targeted CBC testing results in fewer transfusions, lower costs and improved quality of patient care.
Assuntos
Contagem de Células Sanguíneas/estatística & dados numéricos , Transfusão de Sangue/estatística & dados numéricos , Hemoglobinas/análise , Custos Hospitalares/estatística & dados numéricos , Unidade Hospitalar de Ginecologia e Obstetrícia/estatística & dados numéricos , Cuidado Pós-Natal/métodos , Adulto , Contagem de Células Sanguíneas/economia , Transfusão de Sangue/economia , Estudos de Casos e Controles , Custos e Análise de Custo/métodos , Feminino , Humanos , Modelos Logísticos , Unidade Hospitalar de Ginecologia e Obstetrícia/economia , Segurança do Paciente , Cuidado Pós-Natal/economia , Guias de Prática Clínica como Assunto , Gravidez , Estudos RetrospectivosRESUMO
OBJECTIVE: To examine the relationship between nurse-to-patient staffing ratios and perinatal outcomes in women receiving oxytocin during labor. STUDY DESIGN: A retrospective analysis of perinatal outcomes in women receiving oxytocin for induction or augmentation of labor during 2010. Outcomes examined were fetal distress, birth asphyxia, primary cesarean delivery, chorioamnionitis, endomyometritis, and a composite of adverse events. Frequency of 1:1 nurse-to-patient staffing was determined for each hospital. Outcomes were compared between hospitals categorized into quartiles of staffing ratios. RESULTS: In 208,033 women delivering during 2010, there was no relation between frequency of 1:1 nurse-to-patient staffing ratio and improved perinatal outcomes. Adoption of universal 1:1 staffing in the United States would result in the need for an additional 27,000 labor nurses and a cost of $1.6 billion. CONCLUSION: Available data do not support the imposition of mandatory 1:1 nurse-to-patient staffing ratios for women receiving oxytocin in all U.S. facilities.
Assuntos
Trabalho de Parto Induzido/enfermagem , Recursos Humanos de Enfermagem Hospitalar/normas , Unidade Hospitalar de Ginecologia e Obstetrícia , Ocitocina/uso terapêutico , Admissão e Escalonamento de Pessoal/normas , Asfixia Neonatal/epidemiologia , Custos e Análise de Custo , Feminino , Humanos , Trabalho de Parto Induzido/economia , Trabalho de Parto , Recursos Humanos de Enfermagem Hospitalar/economia , Unidade Hospitalar de Ginecologia e Obstetrícia/economia , Unidade Hospitalar de Ginecologia e Obstetrícia/normas , Gravidez , Resultado da Gravidez , Estudos Retrospectivos , Estados Unidos , Recursos Humanos , Carga de TrabalhoAssuntos
Ginecologia , Reforma dos Serviços de Saúde , Unidade Hospitalar de Ginecologia e Obstetrícia , Obstetrícia , Bulgária , Técnicas de Diagnóstico Obstétrico e Ginecológico , Ginecologia/economia , Ginecologia/educação , Ginecologia/métodos , Ginecologia/normas , Obstetrícia/economia , Obstetrícia/educação , Obstetrícia/métodos , Obstetrícia/normas , Unidade Hospitalar de Ginecologia e Obstetrícia/economia , Unidade Hospitalar de Ginecologia e Obstetrícia/normas , Sociedades MédicasAssuntos
Ginecologia/educação , Ginecologia/métodos , Obstetrícia/educação , Obstetrícia/métodos , Bulgária , Ginecologia/economia , Ginecologia/normas , Reforma dos Serviços de Saúde , Obstetrícia/economia , Obstetrícia/normas , Unidade Hospitalar de Ginecologia e Obstetrícia/economia , Unidade Hospitalar de Ginecologia e Obstetrícia/normas , Sociedades MédicasAssuntos
Compensação e Reparação/legislação & jurisprudência , Unidade Hospitalar de Ginecologia e Obstetrícia , Feminino , Humanos , Recém-Nascido , Japão , Unidade Hospitalar de Ginecologia e Obstetrícia/economia , Unidade Hospitalar de Ginecologia e Obstetrícia/legislação & jurisprudência , Guias de Prática Clínica como Assunto , Gravidez , Melhoria de Qualidade/economia , Padrão de Cuidado/economiaRESUMO
Hospitals and health care systems are already seeing the effect of health care reform with declining dollars. Hospital services, which had narrow financial margins in the past, will have further challenges. This article will review definitions, challenges, and potential financial solutions for labor and delivery units. Improving quality, efficiency, and cost requires substantial physician cooperation in the changing paradigm from physician-centric care to the transparent safety of teams. The financial contribution margin should increase the net revenue, but significant volumes are also needed. The challenge of this model for obstetrics is the slowing birth rate with the ultimate limitation for growth. Therefore, cost containment is imperative for sustainability. Standardization of hospital policies and procedures can improve quality and cost-savings with new incentive models. Examples include decreasing expensive pharmaceuticals, minimizing elective inductions of labor, and encouraging breast-feeding. As providers of health care to women, we all must engage in the triple aim of (1) improving the experience of care, (2) improving the health of populations, and (3) reducing per capita costs of health care. Although accountable care organizations presently are focused on Medicare populations for cost containment, all health care providers and institutions must be vigilant on both quality cost-effective care for sustainability, especially in obstetrics.
Assuntos
Redução de Custos , Trabalho de Parto Induzido/economia , Unidade Hospitalar de Ginecologia e Obstetrícia/economia , Melhoria de Qualidade/organização & administração , Organizações de Assistência Responsáveis/organização & administração , Análise Custo-Benefício , Feminino , Humanos , Tempo de Internação/economia , Unidade Hospitalar de Ginecologia e Obstetrícia/organização & administração , Gravidez , Estados UnidosRESUMO
OBJECTIVE: to investigate the cost-effectiveness in birth care for low-risk women, in an alongside midwife-led unit (MU) compared to a standard obstetric unit (SCU) within the same hospital. DESIGN: economic evaluation based on the findings of a randomised trial, randomising participants either into the MU or SCU. The hospital's activity-based costing system CPP was used to estimate costs, as no data on complete resource use exists. SETTING: the Department of Obstetrics and Gynaecology, Østfold Hospital Trust, Norway. PARTICIPANTS: the study population consists of 1,110 consenting healthy women, assessed to be at low-risk at spontaneous onset of labour. MEASUREMENTS: effect measures; avoided caesarean sections, instrumental vaginal deliveries, complications requiring treatment in the operating room, epidural analgesia and oxytocin augmentation. Costs () were calculated by costs per day multiplied with length of stay, added costs for procedures performed outside the units. The results are expressed in incremental cost-effectiveness ratios (ICER) with SCU as comparator. FINDINGS: total costs per stay were significantly lower for women at the MU (1,672) compared to the SCU (1,950, p<0.001). The ICER showed that MU was a dominant strategy (lower costs and reduction in clinical procedures) for all effect measures. Based on the sensitivity analysis, allocating low-risk women to MU significantly reduced costs, but was not a dominant strategy for all outcomes. KEY CONCLUSIONS: the MU is more cost-effective than the SCU for low-risk women without prelabour preference for level of birth care provided equal capacity at the units. IMPLICATIONS FOR PRACTICE: it is cost-effective to organise birth care for low-risk women in a separate midwife-led unit.
Assuntos
Parto Obstétrico/economia , Serviços de Saúde Materna/economia , Tocologia/economia , Relações Enfermeiro-Paciente , Unidade Hospitalar de Ginecologia e Obstetrícia/economia , Adulto , Feminino , Custos de Cuidados de Saúde , Humanos , Noruega , Papel do Profissional de Enfermagem , Pesquisa Metodológica em Enfermagem , Avaliação de Resultados em Cuidados de Saúde/economia , Gravidez , Adulto JovemRESUMO
OBJECTIVE: to compare cost-effectiveness of two models of maternity service delivery: Midwifery Group Practice (MGP) at a birth centre and standard care (SC). DESIGN: a prospective non-randomised trial. SETTING: an Australian metropolitan hospital. METHOD: women at 36 weeks gestation were approached in the birth centre or hospital antenatal clinics between March and December 2008. Of 170 consecutive women who met birth centre eligibility criteria, 70% (n=119) were recruited to the study. Women (MGP n=52 or standard care n=50) were followed through to 6 weeks postpartum. Publically funded care costs were collected from women's diaries, handheld pregnancy health records, medical records and the hospital accounting system. MAIN OUTCOME MEASURES: health-care costs to the hospital and government. ANALYSIS: generalised linear models with covariates of age, nulliparity, private health insurance (yes/no) and household income category. FINDINGS: women receiving MGP care were less likely to experience induction of labour, required fewer antenatal visits, received more postnatal care, and neonates were less likely to be admitted to special care nursery than those receiving standard care. Statistically significant lower costs were found for women and babies receiving MGP care compared with women receiving standard care during pregnancy, labour and birth and postpartum to 6 weeks. MGP resulted in lower costs for the hospital ($AUD4,696 vs. $AUD5,521 p<0.001) and the government ($AUD4,722 vs. $AUD5,641 p<0.001). When baby costs were excluded MGP care remained statistically significantly cheaper than standard care. CONCLUSION: for women at low-risk of birth complications, Midwifery Group Practice was cost effective, and women experienced fewer obstetric interventions compared with standard maternity care. The evidence suggests Midwifery Group Practice is safe and economically viable.
Assuntos
Parto Obstétrico/economia , Prática de Grupo/economia , Tocologia/economia , Papel do Profissional de Enfermagem , Unidade Hospitalar de Ginecologia e Obstetrícia/economia , Adulto , Austrália , Continuidade da Assistência ao Paciente/economia , Feminino , Custos de Cuidados de Saúde , Humanos , Masculino , Serviços de Saúde Materna/economia , Relações Enfermeiro-Paciente , Avaliação de Resultados em Cuidados de Saúde/economia , Gravidez , Resultado da Gravidez , Estudos Prospectivos , Adulto JovemRESUMO
OBJECTIVE: To investigate the patterns of medication errors in the obstetric emergency ward in a low resource setting. MATERIAL AND METHODS: This prospective observational study included 10,000 women who presented at the obstetric emergency ward, department of Obstetrics and Gynecology, Menofyia University Hospital, Egypt between March and December 2010. All medications prescribed in the emergency ward were monitored for different types of errors. The head nurse in each shift was asked to monitor each pharmacologic order from the moment of prescribing till its administration. Retrospective review of the patients' charts and nurses' notes was carried out by the authors of this paper. Results were tabulated and statistically analyzed. RESULTS: A total of 1976 medication errors were detected. Administration errors were the commonest error reported. Omitted errors ranked second followed by unauthorized and prescription errors. Three administration errors resulted in three Cesareans were performed for fetal distress because of wrong doses of oxytocin infusion. The rest of errors did not cause patients harm but may have lead to an increase in monitoring. Most errors occurred during night shifts. CONCLUSION: The availability of automated infusion pumps will probably decrease administration errors significantly. There is a need for more obstetricians and nurses during the nightshifts to minimize errors resulting from working under stressful conditions.