[Calculation of standardised unit costs from a societal perspective for health economic evaluation]. / Ermittlung standardisierter Bewertungssätze aus gesellschaftlicher Perspektive für die gesundheitsökonomische Evaluation.

PURPOSE: Due to demographic aging, economic evaluation of health care technologies for the elderly becomes more important. A standardised questionnaire to measure the health-related resource utilisation has been designed. The monetary valuation of the resource use documented by the questionnaire is a central step towards the determination of the corresponding costs. The aim of this paper is to provide unit costs for the resources in the questionnaire from a societal perspective. METHODS: The unit costs are calculated pragmatically based on regularly published sources. Thus, an easy update is possible. RESULTS: This paper presents the calculated unit costs for outpatient medical care, inpatient care, informal and formal nursing care and pharmaceuticals from a societal perspective. CONCLUSION: The calculated unit costs can serve as a reference case in health economic evaluations and hence help to increase their comparability.

Condition Code 44 or Condition Code W2?

When hospitals determine after discharge that a patient did not meet inpatient criteria, they can file a provider liable claim using Condition Code W2 and be reimbursed for all services as if the patient were an outpatient, according to Deborah Hale, CCS, CCDS. The claims must be filed within 12 months after discharge. The medical record must be reviewed by the physician advisor and the utilization review committee before the claim is submitted. It is still advantageous to get the patient status right up front.

Comparing diagnosis-related group systems to identify design improvements.

The objective of this research was to compare the casemix systems used in the United Kingdom (UK), Australia and the United States of America (USA) to identify possible improvements in the design of the UK Healthcare Resource Groups. The data consisted of over 12 million inpatient and day case discharge records from 574 National Health Service acute hospitals in England for 2001-2002. These data were grouped into four casemix systems, namely Versions 3.1 and 3.5 of Healthcare Resource Groups, the United States-based All Patient Diagnosis Related Groups, and the Australian Refined Diagnosis Related Groups. The statistical performance of the groups was measured using the reduction in variance (RIV) statistic. The Australian Refined Diagnosis Related Groups produced the best RIV overall but this grouper had the advantage of more groups than the others. The comparison of the performance of the chapters within each grouper showed that each had some chapters with a better RIV than the other groupers. Comparing the performance of these groupers was successful in identifying changes to the Healthcare Resource Groups that improved its performance. Further revision of the Healthcare Resource Groups should be focused on the chapters with the best potential for improved performance.

Unmeasured improvement work: the lack of routinely collected, service-related data in NHS endoscopy units in England involved in "modernisation".

BACKGROUND: The availability of routinely collected service-related endoscopy data from NHS endoscopy units has never been quantified. METHODS: This retrospective observational study asked 19 endoscopy units to submit copies of all in-house, service-related endoscopy data that had been routinely collected by the unit - Referral numbers, Activity, Number of patients waiting and Number of lost slots. Nine of the endoscopy units had previously participated in the Modernising Endoscopy Services (MES) project during 2003 to redesign their endoscopy services. These MES sites had access to additional funding and data collection software. The other ten (Control sites) had modernised independently. All data was requested in two phases and corresponded to eight specific time points between January 2003 and April 2006. RESULTS: Only eight of 19 endoscopy units submitted routinely collected, service-related data. Another site's data was collected specifically for the study. A further two units claimed to routinely collect service-related data but did not submit any to the study. The remaining eight did not collect any service-related endoscopy data routinely and liaised with their Trust for data. Of the eight sites submitting service-related data, only three were MES project sites. Of these three, the data variables collected were limited and none collected the complete set of endoscopy data variables requested. Of the other five sites, two collected all four endoscopy data types. Data for the three MES project sites went back as far as January 2003, whilst the five Control sites were only able to submit data from December 2003 onwards. CONCLUSION: There was a lack of service-related endoscopy data routinely collected by the study sites, especially those who had participated in the MES project. Without this data, NHS endoscopy services cannot have a true understanding of their services, cannot identify problems and cannot measure the impact of any changes. With the increasing pressures placed on NHS endoscopy services, the need to effectively inform redesign plans is paramount. We recommend the compulsory collection of service-related endoscopy data by all NHS endoscopy units using a standardised format with rigorous guidelines.

Emergency department visits in Wisconsin 1998-2002: trends in usage and accuracy of reported data.

INTRODUCTION: There is a paucity of data regarding the utilization of emergency departments (EDs) across Wisconsin. It is unknown if national trends in increased utilization are consistent within our state. Several years ago, mandatory reporting of ED visits to the Department of Health and Family Services was instituted and, if accurate, may provide a method for tracking ED usage. METHODS: We conducted a survey of existing EDs to study the trend in patient visits for the 5-year time period 1998-2003. Data reported in the surveyed departments were compared to those reported to the state database. RESULTS: On average, all EDs reported a consistent yearly increase in patient visits over the time period (an average overall increase of 10%). On average, this increase was larger for smaller hospitals. Growth was consistent over the time period, but the yearly rate steadily slowed down. Data reported to the state consistently underreported the actual census. CONCLUSION: All sizes of EDs across Wisconsin continue to show increases in ED utilization. The growth rate is consistent but may be slowing. This has implications for planning for ED resources. Reported data have many discrepancies and need to be independently checked before they can be utilized in any research or planning.

Application and Outcomes of Treatment Guidelines in a Utilization Review Program.

The value of treatment guidelines in improving outcomes for patients and controlling costs is significantly enhanced in Washington by incorporating guidelines into a structured UR program. This article describes: (1) how the Washington Department of Labor and Industries (L&I) UR program uses guidelines; and (2) the impact of the UR program on costs and outcomes. The impact of guideline implementation in the Washington program is considerable. In 2014, the L&I program produced net savings of $7,519,823, and the return on investment was approximately $2.00. The impact on clinical outcomes includes an overarching effect from use of best practices.

Usability and Safety of Software Medical Devices: Need for Multidisciplinary Expertise to Apply the IEC 62366: 2007.

Software medical devices must now comply with the "ergonomics" essential requirement of the Medical Device Directive. However, the usability standard aiming to guide the manufacturers is very difficult to understand and apply. Relying on a triangulation of methods, this study aims to highlight the need to combine various expertises to be able to grasp the standard. To identify the areas of expertise on which the usability standard relies, an analytical review of this document was performed as well as an analysis of a discussion forum dedicated to it and an analysis of a case study of its application for CE marking. The results show that the IEC 62366 is a usability standard structured as a risk management one. It obviously requires Human Factors/Ergonomics expertise to be able to correctly identify and prevent risks of use errors, but it also requires risk management expertise to be able to grasp the issues of the risk analysis and master the related methods.

Assessment of prolonged hospital stay attributable to surgical site infections using appropriateness evaluation protocol.

BACKGROUND: The accepted standard in estimating the stay prolongation attributable to surgical site infections is the matched-cohort study method (MCS), which is associated with selection bias. The Appropriateness Evaluation Protocol (AEP) has been used to estimate stay prolongation attributable to nosocomial infections but has not been validated specifically for surgical site infections. AIM OF THE STUDY: To compare estimates of stay prolongation attributable to surgical site infections after digestive surgery, obtained by AEP and by MCS. METHODS: Sixty-five surgical site infections after digestive tract surgery were analyzed by AEP and MCS. AEP stay prolongation was the number of days judged specifically appropriate for the care of surgical site infections. MCS stay prolongation was the difference of stay duration in surgical site infection cases and two controls matched by age, sex, and diagnosis-related groups. Sensitivity and specificity of AEP, and agreement between both methods, were calculated. RESULTS: The mean AEP stay prolongation was 3.5 days vs 7.2 days for MCS. The sensitivity of AEP was 58% and the specificity was 75%. The agreement between the two methods was poor. CONCLUSION: Surgical site infections after digestive tract surgery increased the hospital stay. Accurate estimations of a prolongation of stay will vary according to the method selected.

Pediatric length of stay guidelines and routine practice: the case of Milliman and Robertson.

BACKGROUND: Guidelines for inpatient length of stay (LOS) have been developed by Milliman and Robertson (M&R) and are widely applied by health plans. This study was designed to compare LOS for several pediatric conditions with the M&R LOS criteria using recent data and to determine if concordance of actual practice with M&R LOS criteria varied between children and adults. DESIGN: Administrative data from Pennsylvania hospitals from 1996 through 1998 were used to examine LOS for hospital discharges for 12 selected diagnoses for which M&R published guidelines for children and adults. PATIENTS: Discharge data for all patients discharged from public and private hospitals in Pennsylvania for which 1 of 12 selected diagnoses were examined. MAIN OUTCOME MEASURE: Length of stay. RESULTS: In Pennsylvania hospitals from 1996 through 1998, pediatric LOS was divergent for all conditions examined, although not to the extent found in a previous study examining data from New York State. Of note, median LOS for some conditions was shorter than M&R LOS criteria. The percentage of pediatric hospital discharges that exceeded the M&R LOS criteria ranged from 25% for pneumonia to 84% for meningitis. Adult hospital discharges exceeded M&R LOS criteria to a greater extent than did pediatric discharges for all conditions except for sickle cell crisis and meningitis. CONCLUSIONS: The M&R LOS criteria were divergent from routine practice for both children and adults. Greater divergence of adult discharges illustrates the need to consider comorbid conditions when implementing these guidelines. Thus, patient care may suffer if guidelines are implemented in an uninformed way. These findings emphasize the importance of using the best possible science when producing guidelines such as these.