RESUMO
OBJECTIVES: Healthcare-associated infections (HAIs) represent a major threat to patient safety and are associated with significant economic burden. Calculating the costs attributable to HAIs is challenging given the various sources of bias. Although HAIs as a reasonably preventable medical harm should have been closely linked to medical insurance incentives, there was little linkage between HAIs and medicare in western China owing to the lack of economic evaluation data. The present study aimed to generate estimates of the attributable costs associated with HAIs and the magnitude of costs growth. METHODS: In this cohort study designed horizontally and vertically from 2016 to 2022, we compared outcomes of randomly sampling patients with HAIs and individually matched patients without HAIs in two cohorts at a 6-year interval at 34 hospitals in western China. The primary outcome was the direct medical cost for the entire hospital stay, converted to US dollars ($ for the benchmark year), discounted at 3% annually, and estimated separately in the full analysis set (FAS) and the per protocol set (PPS). We used multiple linear regression to adjust the discounted costs and to assess subgroups effects within each cohort. We nested a dynamic vertical comparison of costs attributable to HAIs between the front and rear cohorts. RESULTS: A total of 230 patients with HAIs in 2016 and 204 patients with HAIs in 2022 were enrolled. After a 1:1 match, all 431 pairs were recruited as FAS, of which 332 pairs as PPS met all matching restrictions. Compared to the 2016 cohort in FAS, the patients with HAIs in 2022 had a significantly older age (64.40 ± 16.45 years), higher repeat hospitalization rate (65 [32.02%] of 203), and lower immune function (69 [33.99%] of 203). The discounted costs and adjusted-discounted costs for patients with HAIs in the 2022 cohort were found to be significantly higher than those of patients without HAIs (discounted costs: $5484.60 [IQR 8426.03] vs $2554.04(4530.82), P < 0.001; adjusted-discounted costs: $5235.90 [3772.12] vs $3040.21(1823.36), P < 0.001, respectively), and also higher than those of patients with HAIs in the 2016 cohort (discounted costs: $5484.60 [8426.03] vs $3553.00 [6127.79], P < 0.001; adjusted-discounted costs: $5235.90 [3772.12] vs $3703.82 [3159.14], P < 0.001, respectively). In vertical comparison of PPS, the incremental costs of the 2022 cohort are 1.48 times higher than those of the 2016 cohort ($964.63(4076.15) vs $652.43 [2533.44], P = 0.084). CONCLUSIONS: This meticulously designed study in western China has successfully and accurately examined the economic burden attributable to HAIs. Their rapidly increasing tendency poses a serious challenge to patients, hospitals, and the medical insurance. A closer linkage between HAIs and ongoing motivating system changes is urgently needed in western China.
Assuntos
Infecção Hospitalar , Estresse Financeiro , Estados Unidos , Humanos , Idoso , Estudos de Coortes , Estudos Prospectivos , Medicare , Infecção Hospitalar/epidemiologia , Hospitais , China/epidemiologia , Atenção à SaúdeRESUMO
Ensuring bird diversity can secure key ecosystem services within cities. Building ecological corridors into urban planning is an effective way to protect urban birds, but existing corridor construction methods often ignore locality and diversity of species, leading to homogenization of corridor construction results and orientation. We proposed a corridor construction model that combines local bird surveys and bird threat levels. After constructing differentiated corridors for each bird species by assessing their habits and flight abilities, we used three weighted scenarios (original, weighted abundance, weighted abundance, and phylogeny) to assess the conservation priorities of birds and overlaid them to derive a comprehensive bird corridor model. Our results show significant differences in conservation priority and corridor pattern among different bird species, thus demonstrating the importance of local bird surveys and knowledge of threat levels in accurate corridor simulations. This study provides differential simulation of corridors for each bird species and the identification of important conservation species, and uses these to extend the theory of ecological corridor planning to urban bird populations. These results can be applied to guide biodiversity management, evaluate green space policies, and provide practical assistance for sustainable urban development and management.
Assuntos
Conservação dos Recursos Naturais , Ecossistema , Animais , Conservação dos Recursos Naturais/métodos , Biodiversidade , Cidades , Desenvolvimento Sustentável , AvesRESUMO
As an emerging form of agriculture, urban facility agriculture is an important supplement to traditional agriculture and one of the ways to alleviate the urban food crisis, but it may generate a high carbon footprint. A comprehensive assessment of urban facility agriculture is a necessity for promoting its low-carbon development. In this study, the carbon footprint of urban facility agriculture under four different technological innovation models was simulated by life cycle assessment and a system dynamics model for a carbon footprint accounting without considering economic risk. Case 1, as the basic case, is Household farm facility agriculture. Case 2 is the introduction of vertical hydroponic technology based on Case 1, Case 3 is the introduction of distributed hybrid renewable energy micro-grid technology based on Case 2, and Case 4 is the introduction of automatic composting technology based on Case 3. These four cases demonstrate the gradual optimization of the food-energy-water-waste nexus in urban facility agriculture. This study further uses the system dynamics model for carbon reduction potential considering economic risk to simulate the diffusion (promotion) scale and carbon reduction potential of different technological innovations. Research results show that with the superposition of technologies, the carbon footprint per unit land area is gradually reduced, and the carbon footprint of Case 4 is the lowest at 4.78e+06 kg CO2eq. However, the gradual superposition of technologies will further limit the diffusion scale of technological innovation, thereby reducing the carbon reduction potential of technological innovation. In Chongming District, Shanghai, under theoretical circumstances, the carbon reduction potential of Case 4 is the highest at 1.6e+09 kg CO2eq, but the actual carbon reduction potential is only 1.8e+07 kg CO2eq due to excessive economic risks. By contrast, the actual carbon reduction potential of Case 2 is the highest with 9.6e+08 kg CO2eq. To fully achieve the carbon reduction potential of technology innovation, it is necessary to promote the scale diffusion of Urban facility agricultural technology innovation by raising the sales price of agricultural products and the grid connection price of renewable electricity.