RESUMO
Hospitals are penalized financially for high 30-day readmission rates for specific diagnoses, including heart failure. The economic imperative exists to better manage the heart-failure population and acute care providers are in need of appropriate tools to aid in their efforts. This study was conducted to determine if the Rothman Index score may be useful to prospectively identify patients with heart failure at risk for extended hospitalization, high inpatient cost of care, and 30-day readmission. Results from this study suggest the Rothman Index score can be a useful adjunct to current clinical assessment methods in helping multidisciplinary teams better manage patient care and limited resources.
Assuntos
Insuficiência Cardíaca/economia , Insuficiência Cardíaca/terapia , Custos Hospitalares/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Readmissão do Paciente/estatística & dados numéricos , Medição de Risco , Idoso , Gerenciamento Clínico , Feminino , Insuficiência Cardíaca/epidemiologia , Humanos , Masculino , Estudos Retrospectivos , Estados Unidos/epidemiologiaRESUMO
BACKGROUND: Tracheotomy patients are a small portion of hospitalizations, but account for disproportionately high risk and costs. There are many complex decisions that go into the care of these patients, and practice variation is expected to be compounded in a health system. This study sought to characterize the medical economic impact of tracheotomy patients on the hospital system. METHODS: A retrospective review of the health system's hospital billing software was performed for 2013, and pertinent outcomes measures were tabulated. RESULTS: There were 829 tracheotomies performed in the health system of seven hospitals, with total costs of $128,883,865. Average length of stay was 36.74 days for principal procedures, and 43.36 days for tracheotomy as secondary procedures. Mortality was â¼ 18% overall, and re-admissions were 10.93% for primary, and 14.36% for secondary procedures. A fairly wide variation in each category among the different hospitals was observed. CONCLUSIONS: There are potentially many factors that impact variations of care and outcomes in patients with tracheotomy. Due to their large economic impact and risks for morbidity and mortality, a formalized care pathway is warranted. Goals of the pathway should include understanding medical decisions surrounding these complex patients, monitoring pertinent outcomes, reducing practice variation, and improving the efficiency of compassionate care.
Assuntos
Custos Hospitalares , Mortalidade Hospitalar , Tempo de Internação/economia , Avaliação de Processos e Resultados em Cuidados de Saúde/economia , Readmissão do Paciente/economia , Traqueotomia/economia , Contas a Pagar e a Receber , Tomada de Decisões , Humanos , Tempo de Internação/estatística & dados numéricos , New York , Avaliação de Processos e Resultados em Cuidados de Saúde/estatística & dados numéricos , Readmissão do Paciente/estatística & dados numéricos , Estudos RetrospectivosRESUMO
BACKGROUND AIMS: Stem cell collection can be a major component of overall cost of autologous stem cell transplantation (ASCT). Plerixafor is an effective agent for mobilization; however, it is often reserved for salvage therapy because of its high cost. We present data on the pharmacoeconomic impact of the use of plerixafor as an up-front mobilization in patients with multiple myeloma (MM). METHODS: Patients with MM who underwent ASCT between January 2008 and April 2011 at the Mount Sinai Medical Center were reviewed retrospectively. In April 2010, practice changes were instituted for patients with MM to delay initiation of granulocyte-colony-stimulating factor (G-CSF) support from day 0 to day +5 and to add plerixafor to G-CSF as an up-front autologous mobilization. Targets of collection were 5-10 × 10(6) CD34(+) cells/kg. RESULTS: Of 50 adults with MM who underwent ASCT, 25 received plerixafor/filgrastim and 25 received G-CSF alone as an up-front mobilization. Compared with the control, plerixafor mobilization yielded higher CD34(+) cell content (16.1 versus 8.4 × 10(6) CD34(+) cells/kg; P = 0.0007) and required fewer sessions of apheresis (1.9 versus 3.1; P = 0.0001). In the plerixafor group, the mean number of plerixafor doses required per patient was 1.8. Although the overall cost of medications was higher in the plerixafor group, the cost for blood products and overall cost of hospitalization were similar between the two groups. CONCLUSIONS: Up-front use of plerixafor is an effective mobilization strategy in patients with MM and does not have a substantial pharmacoeconomic impact in overall cost of hospitalization combined with the apheresis procedure.