Odontologia hospitalar: uma análise crítica sobre a inserção do cirurgião dentista na atenção terciária no estado do Rio Grande do Sul, Brasil / Hospital dentistry: a critical analysis of the role of the dental surgeon in tertiary care in the state of Rio Grande do Sul, Brazil

Objetivo: analisar a inserção do cirurgião dentista na atenção terciária no estado do Rio Grande do Sul, Brasil. Método: estudo descritivo ecológico, com uso de dados secundários registrados pelo Cadastro Nacional de Estabelecimentos de Saúde no ano de 2023. A coleta de dados foi realizada em duas etapas. Na primeira etapa também foram coletados os dados do CNES referentes à presença do cirurgião dentista, tipo de vínculo contratual e especialidades ofertadas pelos serviços. Já na segunda etapa os dados coletados foram referentes aos indicadores sociodemográficos dos profissionais com habilitação em odontologia hospitalar utilizando as informações disponibilizadas pelo Sistema WSCFO do Conselho Federal de Odontologia. A análise dos dados foi realizada com o suporte do software TabWin, versão 3.6, e do software estatístico R v. 4.2.3. Os dados foram analisados por meio de análise descritiva. Resultados: apenas 6,11% das instituições são certificadas e consideradas Hospitais de Ensino. A maioria dos estabelecimentos (87,14%) oferece atendimento pelo SUS. Quanto à presença de cirurgiões dentistas nos estabelecimentos, 64,63% dos estabelecimentos relataram tê-los, enquanto 35,37% não possuem esse profissional em sua equipe. Neste estudo, constatamos que uma correlação positiva do cirurgião dentista com o número de leitos de UTI adulto e ao maior porte do hospital. Conclusão: observa-se que ainda há necessidade de estruturação da atenção terciária no Estado do Rio Grande do Sul, no que se refere à odontologia hospitalar. Há poucos os cirurgiões dentistas com uma carga horária dedicada exclusivamente ao atendimento hospitalar clínico a beira leito.(AU)

Objective: To analyze the inclusion of dental surgeons in tertiary care in the state of Rio Grande do Sul, Brazil. Method: a descriptive ecological study using secondary data recorded by the National Register of Health Establishments in 2023. Data was collected in two stages. In the first stage, data was also collected from the CNES regarding the presence of a dental surgeon, the type of contractual relationship and the specialties offered by the services. In the second stage, data was collected on the sociodemographic indicators of professionals qualified in hospital dentistry using the information provided by the WSCFO System of the Federal Council of Dentistry. The data was analyzed using TabWin software, version 3.6, and R v. 4.2.3 statistical software. The data was analyzed using descriptive analysis. Results: only 6.11% of institutions are certified and considered Teaching Hospitals. The majority of establishments (87.14%) provide care through the SUS. As for the presence of dental surgeons in the establishments, 64.63% of the establishments reported having them, while 35.37% did not have this professional on their team. In this study, we found a positive correlation between the number of adult ICU beds and the size of the hospital. Conclusion: There is still a need to structure tertiary care in the state of Rio Grande do Sul, in terms of hospital dentistry. There are few dental surgeons with a workload dedicated exclusively to bedside clinical hospital care.(AU)

Prototipo de multimedia educativa para la enseñanza-aprendizaje de los indicadores del recurso cama hospitalaria. Cuba, 2020 / Educational Multimedia Prototype for teach-learn Indicators of Hospital Bed Resource. Cuba, 2020

Introducción: En la Facultad de Tecnología de la Salud se estudia la carrera Sistemas de Información en Salud que incluye en su plan de estudios diversas asignaturas como Sistemas de Información de Estadísticas de Salud, en la que se incluye el estudio de los indicadores hospitalarios del recurso cama; materia que se imparte de forma tradicional y no tiene una herramienta tecnológica de apoyo que facilite el proceso educativo. Objetivo: Diseñar un prototipo de multimedia educativa que favorezca el auto-aprendizaje de los indicadores del recurso cama hospitalaria en la asignatura Sistemas de Información de Estadísticas de Salud de la carrera Sistemas de Información en Salud. Método: Se realizó un estudio de desarrollo tecnológico donde fueron encuestados estudiantes y se entrevistó a la profesora de la asignatura para la obtención de la información. Se utilizó la metodología de Proceso Unificado de Desarrollo y el Lenguaje Unificado de Modelado. Se emplearon las herramientas Visual Paradigm para el modelado, Axure para la creación del prototipo y Mediator para el futuro diseño de la multimedia. Resultados: Se identificaron los problemas de aprendizaje desde la visión de alumnos y profesores, lo que permitió diseñar el prototipo de multimedia educativa sobre los indicadores hospitalarios del recurso cama, que fue considerado útil y pertinente. Conclusiones: Se diseñó un prototipo de multimedia educativa que de manera combinada con el método actual de enseñanza facilitarán y efectuarán de forma dinámica las actividades en el proceso docente educativo(AU)

Introduction: Health Information Systems career is included In the Faculty of Health Technology; the career have in its curriculum subjects as Health Statistics Information Systems, in which the study of hospital resource bed indicators is carried out; the subject is taught in a traditional way and does not have a technological support tool that facilitates the educational process. Objective: To design an educational multimedia prototype that favors self-learning of the indicators of the hospital bed resource in the Health Statistics Information Systems subject of the Health Information Systems career. Method: A survey of students and interview of teachers permitted to obtain the information needed to carry out a study of technological development using Unified Development Process methodology and Unified Modeling Language; Visual Paradigm tools were used for modeling; Axure for prototyping and Mediator for future multimedia design. Results: there were identified learning problems from the perspective of students and teachers, which allowed the design of the educational multimedia prototype on hospital bed resource indicators, considering it useful and pertinent. Conclusions: The design of the educational multimedia prototype, combined with the current teaching method, will facilitate and dynamically carry out the activities in the educational teaching process(AU)

Identifying barriers to emergency department-initiated buprenorphine: A spatial analysis of treatment facility access in Michigan.

STUDY OBJECTIVES: Emergency department (ED)-initiated buprenorphine/naloxone has been shown to improve treatment retention and reduce illicit opioid use; however, its potential may be limited by a lack of accessible community-based facilities. This study compared one state's geographic distribution of EDs to outpatient treatment facilities that provide buprenorphine treatment and identified ED and geographic factors associated with treatment access. METHODS: Treatment facility data were obtained from the SAMHSA 2018 National Directory of Drug and Alcohol Abuse Treatment Facilities, and ED data were obtained from the Michigan College of Emergency Physician's 2018 ED directory. Geospatial analysis compared EDs to buprenorphine treatment facilities using 5-, 10-, and 20-mile network buffers. RESULTS: Among 131 non-exclusively pediatric EDs in Michigan, 57 (43.5%) had a buprenorphine treatment facility within 5 miles, and 66 (50.4%) had a facility within 10 miles. EDs within 10 miles of a Medicaid-accepting, outpatient buprenorphine treatment facility had higher average numbers of beds (41 vs. 15; p < 0.0001) and annual patient volumes (58,616 vs. 17,484; p < 0.0001) compared to those without. Among Michigan counties with EDs, those with at least one buprenorphine facility had larger average populations (286,957 vs. 44,757; p = 0.005) and higher annual rates of opioid overdose deaths (mean 18.3 vs. 13.0 per 100,000; p = 0.02) but were similar in terms of opioid-related hospitalizations and socioeconomic distress. CONCLUSION: Only half of Michigan EDs are within 10 miles of a buprenorphine treatment facility. Given these limitations, expanding access to ED-initiated buprenorphine in states similar to Michigan may require developing alternative models of care.

Association of COVID-19 Hospitalization Volume and Case Growth at US Hospitals with Patient Outcomes.

BACKGROUND: Whether the volume of coronavirus disease 2019 (COVID-19) hospitalizations is associated with outcomes has important implications for the organization of hospital care both during this pandemic and future novel and rapidly evolving high-volume conditions. METHODS: We identified COVID-19 hospitalizations at US hospitals in the American Heart Association COVID-19 Cardiovascular Disease Registry with ≥10 cases between January and August 2020. We evaluated the association of COVID-19 hospitalization volume and weekly case growth indexed to hospital bed capacity, with hospital risk-standardized in-hospital case-fatality rate (rsCFR). RESULTS: There were 85 hospitals with 15,329 COVID-19 hospitalizations, with a median hospital case volume was 118 (interquartile range, 57, 252) and median growth rate of 2 cases per 100 beds per week but varied widely (interquartile range: 0.9 to 4.5). There was no significant association between overall hospital COVID-19 case volume and rsCFR (rho, 0.18, P = .09). However, hospitals with more rapid COVID-19 case-growth had higher rsCFR (rho, 0.22, P = 0.047), increasing across case growth quartiles (P trend = .03). Although there were no differences in medical treatments or intensive care unit therapies (mechanical ventilation, vasopressors), the highest case growth quartile had 4-fold higher odds of above median rsCFR, compared with the lowest quartile (odds ratio, 4.00; 1.15 to 13.8, P = .03). CONCLUSIONS: An accelerated case growth trajectory is a marker of hospitals at risk of poor COVID-19 outcomes, identifying sites that may be targets for influx of additional resources or triage strategies. Early identification of such hospital signatures is essential as our health system prepares for future health challenges.

District hospital surgical capacity in Western Cape Province, South Africa: A cross-sectional survey.

BACKGROUND: The role of the district hospital (DH) in surgical care has been undervalued. However, decentralised surgical services at DHs have been identified as a key component of universal health coverage. Surgical capacity at DHs in Western Cape (WC) Province, South Africa, has not been described. OBJECTIVES: To describe DH surgical capacity in WC and identify barriers to scaling up surgical capacity at these facilities. METHODS: This was a cross-sectional survey of 33 DHs using the World Health Organization surgical situational analysis tool administered to hospital staff from June to December 2019. The survey addressed the following domains: general services and financing; service delivery and surgical volume; surgical workforce; hospital and operating theatre (OT) infrastructure, equipment and medication; and barriers to scaling up surgical care. RESULTS: Seven of 33 DHs (21%) did not have a functional OT. Of the 28 World Bank DH procedures, small WC DHs performed up to 22 (79%) and medium/large DHs up to 26 (93%). Only medium/large DHs performed all three bellwether procedures. Five DHs (15%) had a full-time surgeon, anaesthetist or obstetrician (SAO). Of DHs without any SAO specialists, 14 (50%) had family physicians (FPs). These DHs performed more operative procedures than those without FPs (p=0.005). Lack of finances dedicated for surgical care and lack of surgical providers were the most reported barriers to providing and expanding surgical services. CONCLUSIONS: WC DH surgical capacity varied by hospital size. However, FPs could play an essential role in surgery at DHs with appropriate training, oversight and support from SAO specialists. Strategies to scale up surgical capacity include dedicated financial and human resources.

Patient Mix Optimization in Admission Planning under Multitype Patients and Priority Constraints.

Hospital beds are one of the most critical medical resources. Large hospitals in China have caused bed utilization rates to exceed 100% due to long-term extra beds. To alleviate the contradiction between the supply of high-quality medical resources and the demand for hospitalization, in this paper, we address the decision of choosing a case mix for a respiratory medicine department. We aim to generate an optimal admission plan of elective patients with the stochastic length of stay and different resource consumption. We assume that we can classify elective patients according to their registration information before admission. We formulated a general integer programming model considering heterogeneous patients and introducing patient priority constraints. The mathematical model is used to generate a scientific and reasonable admission planning, determining the best admission mix for multitype patients in a period. Compared with model II that does not consider priority constraints, model I proposed in this paper is better in terms of admissions and revenue. The proposed model I can adjust the priority parameters to meet the optimal output under different goals and scenarios. The daily admission planning for each type of patient obtained by model I can be used to assist the patient admission management in large general hospitals.

Assessment of Overuse of Medical Tests and Treatments at US Hospitals Using Medicare Claims.

Importance: Overuse of health care services exposes patients to unnecessary risk of harm and costs. Distinguishing patterns of overuse among hospitals requires hospital-level measures across multiple services. Objective: To describe characteristics of hospitals associated with overuse of health care services in the US. Design, Setting, and Participants: This retrospective cross-sectional analysis used Medicare fee-for-service claims data for beneficiaries older than 65 years from January 1, 2015, to December 31, 2017, with a lookback of 1 year. Inpatient and outpatient services were included, and services offered at specialty and federal hospitals were excluded. Patients were from hospitals with the capacity (based on a claims filter developed for this study) to perform at least 7 of 12 investigated services. Statistical analyses were performed from July 1, 2020, to December 20, 2020. Main Outcomes and Measures: Outcomes of interest were a composite overuse score ranging from 0 (no overuse of services) to 1 (relatively high overuse of services) and characteristics of hospitals clustered by overuse rates. Twelve published low-value service algorithms were applied to the data to find overuse rates for each hospital, normalized and aggregated to a composite score and then compared across 6 hospital characteristics using multivariable regression. A k-means cluster analysis was used on normalized overuse rates to identify hospital clusters. Results: The primary analysis was performed on 2415 cohort A hospitals (ie, hospitals with capacity for 7 or more services), which included 1 263 592 patients (mean [SD] age, 72.4 [14] years; 678 549 women [53.7%]; 101 017 191 White patients [80.5%]). Head imaging for syncope was the highest-volume low-value service (377 745 patients [29.9%]), followed by coronary artery stenting for stable coronary disease (199 579 [15.8%]). The mean (SD) composite overuse score was 0.40 (0.10) points. Southern hospitals had a higher mean score than midwestern (difference in means: 0.06 [95% CI, 0.05-0.07] points; P < .001), northeast (0.08 [95% CI, 0.06-0.09] points; P < .001), and western hospitals (0.08 [95% CI, 0.07-0.10] points; P < .001). Nonprofit hospitals had a lower adjusted mean score than for-profit hospitals (-0.03 [95% CI, -0.04 to -0.02] points; P < .001). Major teaching hospitals had significantly lower adjusted mean overuse scores vs minor teaching hospitals (difference in means, -0.07 [95% CI, -0.08 to -0.06] points; P < .001) and nonteaching hospitals (-0.10 [95% CI, -0.12 to -0.09] points; P < .001). Of the 4 clusters identified, 1 was characterized by its low counts of overuse in all services except for spinal fusion; the majority of major teaching hospitals were in this cluster (164 of 223 major teaching hospitals [73.5%]). Conclusions and Relevance: This cross-sectional study used a novel measurement of hospital-associated overuse; results showed that the highest scores in this Medicare population were associated with nonteaching and for-profit hospitals, particularly in the South.

UTI no estado de Goiás: estudo de suficiência: relatório resumido / ICU in the state of Goiás: sufficiency study: summary report

Objetivo de propiciar aos gestores a realização de uma programação de internações/leitos mais coerente com as reais necessidades da população do estado de Goiás. Estudo exploratório, com bases de dados secundários e foco no aprofundamento da percepção de determinados cálculos/medidas não demonstrados/elucidados na portaria. Período do estudo: 2014 a 2020.Sistema de Informações/Softwares Utilizados: SIH/SUS; ANS, SCNES, SINASC, Projeção populacional do IMB. Softwares utilizados: TabWin, Microsoft Office, LibreOffice, WPS Office, Google Drive, Power BI, GitLab, Java. Indicadores previstos: nº de internações e leitos esperados, gerais e de UTI. Os dados considerados neste estudo foram coletados antes do período da pandemia da Covid-19, os leitos dedicados ao enfretamento da pandemia não foram incorporados nas análises. Apresenta os principais resultados para o período analisado no Brasil e em Goiás referentes a estabelecimentos de saúde/leitos, os resultados apurados para o Estado de Goiás em relação aos leitos gerais SUS e não SUS por especialidade, leitos de UTI SUS e não SUS por especialidade, a faixa de variação de leitos gerais e de UTI/SUS preconizados pela Portaria 1.101/2002. Os leitos gerais e UTI SUS por especialidade, para Goiânia. Após os ajustes na metodologia para a obtenção dos dados necessários à implementação das fórmulas da portaria, desenvolveu-se um protótipo de simulador para identificação dos milhares de cenários possíveis para a programação de internações e leitos, gerais e de UTI, em esfera estadual, de conformidade ao exemplo contido no item 3 deste relatório

Objective of providing managers with a schedule of admissions/beds more consistent with the real needs of the population of the state of Goiás. Exploratory study, with secondary databases and focus on deepening the perception of certain calculations/measures not demonstrated/elucidated at the gatehouse. Study period: 2014 to 2020. Information System/Software Used: SIH/SUS; ANS, SCNES, SINASC, IMB population projection. Software used: TabWin, Microsoft Office, LibreOffice, WPS Office, Google Drive, Power BI, GitLab, Java. Expected indicators: number of hospitalizations and expected beds, general and ICU. The data considered in this study were collected before the period of the Covid-19 pandemic, the beds dedicated to dealing with the pandemic were not incorporated in the analyses. It presents the main results for the period analyzed in Brazil and Goiás referring to health establishments/beds, the results obtained for the State of Goiás in relation to general SUS and non-SUS beds by specialty, SUS and non-SUS ICU beds by specialty , the range of variation of general beds and ICU/SUS recommended by Ordinance 1,101/2002. General beds and SUS ICU by specialty, for Goiânia. After adjustments in the methodology to obtain the data necessary to implement the ordinance formulas, a simulator prototype was developed to identify the thousands of possible scenarios for the programming of hospitalizations and beds, general and ICU, at the state level, of conformity to the example contained in item 3 of this report

Organizational aspects of pediatric anesthesia and surgery between two waves of Covid-19.

BACKGROUND: The initial wave of the Covid-19 pandemic has hit Italy, and Lombardy in particular, with violence, forcing to reshape all hospitals' activities; this happened even in pediatric hospitals, although the young population seemed initially spared from the disease. "Vittore Buzzi" Children's Hospital, which is a pediatric/maternal hospital located in Milan (Lombardy Region), had to stop elective procedures-with the exception of urgent/emergent ones-between February and May 2020 to leave space and resources to adults' care. We describe the challenges of reshaping the hospital's identity and structure, and restarting pediatric surgery and anesthesia, from May on, in the most hit area of the world, with the purpose to avoid and contain infections. Both patients and caregivers admitted to hospital have been tested for Sars-CoV-2 in every case. METHODS: Observational cohort study via review of clinical charts of patients undergoing surgery between 16th May and 30th September 2020, together with SARS-CoV -2 RT-PCR testing outcomes, and comparison to same period surgeries in 2019. RESULTS: An increase of approximately 70% in pediatric surgeries (OR 1.68 [1.33-2.13], P < .001) and a higher increase in the number of surgeries were reported (OR 1.75 (1.43-2.15), P < .001). Considering only urgent procedures, a significant difference in the distribution of the type of surgery was observed (Chi-squared P-value < .001). Sars-CoV-2-positive patients have been 0.8% of total number; 14% of these was discovered through caregiver's positivity. CONCLUSION: We describe our pathway for safe pediatric surgery and anesthesia and the importance of testing both patient and caregiver.

Association of Interfacility Transfer and Patient and Hospital Characteristics With Thumb Replantation After Traumatic Amputation.

Importance: Given that 40% of hand function is achieved with the thumb, replantation of traumatic thumb injuries is associated with substantial quality-of-life benefits. However, fewer replantations are being performed annually in the US, which has been associated with less surgical expertise and increased risk of future replantation failures. Thus, understanding how interfacility transfers and hospital characteristics are associated with outcomes warrants further investigation. Objective: To assess the association of interfacility transfer, patient characteristics, and hospital factors with thumb replantation attempts and success. Design, Setting, and Participants: This cross-sectional study used data from the US National Trauma Data Bank from 2009 to 2016 for adult patients with isolated traumatic thumb amputation injury who underwent revision amputation or replantation. Data analysis was performed from May 4, 2020, to July 20, 2020. Exposures: Interfacility transfer, defined as transfer of a patient from 1 hospital to another to obtain care for traumatic thumb amputation. Main Outcomes and Measures: Replantation attempt and replantation success, defined as having undergone a replantation without a subsequent revision amputation during the same hospitalization. Multilevel logistic regression models were used to assess the associations of interfacility transfer, patient characteristics, and hospital factors with replantation outcomes. Results: Of 3670 patients included in this analysis, 3307 (90.1%) were male and 2713 (73.9%) were White; the mean (SD) age was 45.8 (16.5) years. A total of 1881 patients (51.2%) were transferred to another hospital; most of these patients were male (1720 [91.4%]) and White (1420 [75.5%]). After controlling for patient and hospital characteristics, uninsured patients were less likely to have thumb replantation attempted (odds ratio [OR], 0.61; 95% CI, 0.47-0.78) or a successful replantation (OR, 0.64; 95% CI, 0.49-0.84). Interfacility transfer was associated with increased odds of replantation attempt (OR, 1.34; 95% CI, 1.13-1.59), with 13% of the variation at the hospital level. Interfacility transfer was also associated with increased replantation success (OR, 1.23; 95% CI, 1.03-1.47), with 14% of variation at the hospital level. Conclusions and Relevance: In this cross-sectional study, interfacility transfer and particularly hospital-level variation were associated with increased thumb replantation attempts and successes. These findings suggest a need for creating policies that incentivize hospitals with replantation expertise to provide treatment for traumatic thumb amputations, including promotion of centralization of replantation care.

The Impact of Halting Elective Admissions in Anticipation of a Demand Surge Due to the Coronavirus Pandemic (COVID-19).

BACKGROUND: In anticipation of a demand surge for hospital beds attributed to the coronavirus pandemic (COVID-19) many US states have mandated that hospitals postpone elective admissions. OBJECTIVES: To estimate excess demand for hospital beds due to COVID-19, the net financial impact of eliminating elective admissions in order to meet demand, and to explore the scenario when demand remains below capacity. RESEARCH DESIGN: An economic simulation to estimate the net financial impact of halting elective admissions, combining epidemiological reports, the US Census, American Hospital Association Annual Survey, and the National Inpatient Sample. Deterministic sensitivity analyses explored the results while varying assumptions for demand and capacity. SUBJECTS: Inputs regarding disease prevalence and inpatient utilization were representative of the US population. Our base case relied on a hospital admission rate reported by the Center for Disease Control and Prevention of 137.6 per 100,000, with the highest rates in people aged 65 years and older (378.8 per 100,000) and 50-64 years (207.4 per 100,000). On average, elective admissions accounted for 20% of total hospital admissions, and the average rate of unoccupied beds across hospitals was 30%. MEASURES: Net financial impact of halting elective admissions. RESULTS: On average, hospitals COVID-19 demand for hospital bed-days fell well short of hospital capacity, resulting in a substantial financial loss. The net financial impact of a 90-day COVID surge on a hospital was only favorable under a narrow circumstance when capacity was filled by a high proportion of COVID-19 cases among hospitals with low rates of elective admissions. CONCLUSIONS: Hospitals that restricted elective care took on a substantial financial risk, potentially threatening viability. A sustainable public policy should therefore consider support to hospitals that responsibly served their communities through the crisis.

Hospital bed supply and inequality as determinants of maternal mortality in China between 2004 and 2016.

BACKGROUND: Driven by the government's firm commitment to promoting maternal health, maternal mortality ratio (MMR) in China has achieved a remarkable reduction over the past 25 years. Paralleled with the decline of MMR has been the expansion of hospital bed supply as well as substantial reduction in hospital bed distribution inequalities, which were thought to be significant contributors to the reduction in MMR. However, evidences on the impact of hospital bed supply as well as how its distribution inequality has affected MMR remains scarce in China. Addressing this uncertainty is essential to understand whether efforts made on the expansion of healthcare resource supply as well as on improving its distribution inequality from a geographical perspective has the potential to produce measurable population health improvements. METHODS: Panel data of 31 provinces in China between 2004 and 2016 were extracted from the national statistical data, including China Statistical Yearbooks, China Health Statistical Yearbooks and other national publications. We firstly described the changes in hospital bed density as well as its distribution inequality from a geographical perspective. Then, a linear mixed model was employed to evaluate the impact of hospital bed supply as well as its distribution inequality on MMR at the provincial level. RESULTS: The MMR decreased substantially from 48.3 to 19.9 deaths per 100,000 live births between 2004 and 2016. The average hospital bed density increased from 2.28 per 1000 population in 2004 to 4.54 per 1000 population in 2016, with the average Gini coefficient reducing from 0.32 to 0.25. As indicated by the adjusted mixed-effects regressions, hospital bed density had a negative association with MMR (ß = - 0.112, 95% CI: - 0.210--0.013) while every 0.1-unit reduction of Gini coefficient suggested 14.50% decline in MMR on average (ß = 1.354, 95% CI: 0.123-2.584). Based on the mediation analysis, the association between hospital bed density or Gini coefficient with MMR was found to be significantly mediated by facility birth rate, especially during the period from 2004 to 2009. CONCLUSIONS: This study provided empirical evidences on China's impressive success in the aspect of reducing MMR which could be attributed to the expansion of hospital beds as well as the improvement in its distribution inequality from a geographical perspective. Such findings were expected to provide evidence-based implications for long-term policy-making procedures in order to achieve rational healthcare resource allocations as well as promoting the equity and accessibility to obtaining health care from a holistic perspective. Constant efforts should be made on improving the equity in healthcare resource allocations in order to achieve the penetration of universal healthcare coverage.

Relationship Between Psychiatric Inpatient Beds and Jail Populations in the United States.

BACKGROUND: The US criminal justice system has witnessed dramatic increases in its mentally ill population during the past 50 years. The decreasing number of psychiatric beds is one proposed cause and more psychiatric beds may be one solution. OBJECTIVE: This study examined the relationships among large changes in local psychiatric bed capacity, local jail inmate populations, and the psychiatric burden at local general hospitals. METHODS: The study used a kernel method to identify abrupt changes in psychiatric bed capacity using the American Hospital Association Survey and Medicare Provider of Services data. Data were aggregated to the hospital referral region-year level and matched to the National Inpatient Sample of hospital discharges 1988-2015 and the Annual Survey of Jails 1985-2014. Subsequent analysis by event study examined the effect of abrupt bed changes on numbers of jail inmates. RESULTS: Decreases in local psychiatric bed capacity were associated with an average increase of 256.2 jail inmates (95% confidence interval: 3.3-509.1). Increases in psychiatric bed capacity were associated with an average decrease of 199.3 jail inmates (95% confidence interval: -457.4 to 58.8). There was limited evidence for spillovers to general hospitals immediately following decreases in psychiatric beds. CONCLUSIONS: Decreases in local psychiatric bed capacity appear to be associated with subsequent increases in local jail populations. There was no clear evidence of treatment shifting from psychiatric units to local general hospitals. These findings support concerns that a consequence of reducing psychiatric inpatient bed capacity is an increase in the jail population due to more psychiatrically ill inmates, aggravating the challenge of psychiatric treatment delivery within the US criminal justice system.

COVID-19 Pandemic Planning: Simulation Models to Predict Biochemistry Test Capacity for Patient Surges.

BACKGROUND: Patient surges beyond hospital capacity during the initial phase of the COVID-19 pandemic emphasized a need for clinical laboratories to prepare test processes to support future patient care. The objective of this study was to determine if current instrumentation in local hospital laboratories can accommodate the anticipated workload from COVID-19 infected patients in hospitals and a proposed field hospital in addition to testing for non-infected patients. METHODS: Simulation models predicted instrument throughput and turn-around-time for chemistry, ion-selective-electrode, and immunoassay tests using vendor-developed software with different workload scenarios. The expanded workload included tests from anticipated COVID patients in 2 local hospitals and a proposed field hospital with a COVID-specific test menu in addition to the pre-pandemic workload. RESULTS: Instrumentation throughput and turn-around time at each site was predicted. With additional COVID-patient beds in each hospital, the maximum throughput was approached with no impact on turnaround time. Addition of the field hospital workload led to significantly increased test turnaround times at each site. CONCLUSIONS: Simulation models depicted the analytic capacity and turn-around times for laboratory tests at each site and identified the laboratory best suited for field hospital laboratory support during the pandemic.

Burden of pneumococcal pneumonia requiring ICU admission in France: 1-year prognosis, resources use, and costs.

BACKGROUND: Community-acquired pneumonia (CAP), especially pneumococcal CAP (P-CAP), is associated with a heavy burden of illness as evidenced by high rates of intensive care unit (ICU) admission, mortality, and costs. Although well-defined acutely, determinants influencing long-term burden are less known. This study assessed determinants of 28-day and 1-year mortality and costs among P-CAP patients admitted in ICUs. METHODS: Data regarding all hospital and ICU stays in France in 2014 were extracted from the French healthcare administrative database. All patients admitted in the ICU with a pneumonia diagnosis were included, except those hospitalized for pneumonia within the previous 3 months. The pneumococcal etiology and comorbidities were captured. All hospital stays were included in the cost analysis. Comorbidities and other factors effect on the 28-day and 1-year mortality were assessed using a Cox regression model. Factors associated with increased costs were identified using log-linear regression models. RESULTS: Among 182,858 patients hospitalized for CAP in France for 1 year, 10,587 (5.8%) had a P-CAP, among whom 1665 (15.7%) required ICU admission. The in-hospital mortality reached 22.8% at day 28 and 32.3% at 1 year. The mortality risk increased with age > 54 years, malignancies (hazard ratio (HR) 1.54, 95% CI [1.23-1.94], p = 0.0002), liver diseases (HR 2.08, 95% CI [1.61-2.69], p < 0.0001), and the illness severity at ICU admission. Compared with non-ICU-admitted patients, ICU survivors remained at higher risk of 1-year mortality. Within the following year, 38.2% (516/1350) of the 28-day survivors required at least another hospital stay, mostly for respiratory diseases. The mean cost of the initial stay was €19,008 for all patients and €11,637 for subsequent hospital stays within 1 year. One-year costs were influenced by age (lower in patients > 75 years old, p = 0.008), chronic cardiac (+ 11% [0.02-0.19], p = 0.019), and respiratory diseases (+ 11% [0.03-0.18], p = 0.006). CONCLUSIONS: P-CAP in ICU-admitted patients was associated with a heavy burden of mortality and costs at one year. Older age was associated with both early and 1-year increased mortality. Malignant and chronic liver diseases were associated with increased mortality, whereas chronic cardiac failure and chronic respiratory disease with increased costs. TRIAL REGISTRATION: N/A (study on existing database).

Expansion of transcatheter aortic valve replacement in the United States.

BACKGROUND: Patterns of diffusion of TAVR in the United States (U.S.) and its relation to racial disparities in TAVR utilization remain unknown. METHODS: We identified TAVR hospitals in the continental U.S. from 2012-2017 using Medicare database and mapped them to Hospital Referral Regions (HRR). We calculated driving distance from each residential ZIP code to the nearest TAVR hospital and calculated the proportion of the U.S. population, in general and by race, that lived <100 miles driving distance from the nearest TAVR center. Using a discrete time hazard logistic regression model, we examined the association of hospital and HRR variables with the opening of a TAVR program. RESULTS: The number of TAVR hospitals increased from 230 in 2012 to 540 in 2017. The proportion of the U.S. population living <100 miles from nearest TAVR hospital increased from 89.3% in 2012 to 94.5% in 2017. Geographic access improved for all racial and ethnic subgroups: Whites (84.1%-93.6%), Blacks (90.0%- 97.4%), and Hispanics (84.9%-93.7%). Within a HRR, the odds of opening a new TAVR program were higher among teaching hospitals (OR 1.48, 95% CI 1.16-1.88) and hospital bed size (OR 1.44, 95% CI 1.37-1.52). Market-level factors associated with new TAVR programs were proportion of Black (per 1%, OR 0.78, 95% CI 0.69-0.89) and Hispanic (per 1%, OR 0.82, 95% CI 0.75-0.90) residents, the proportion of hospitals within the HRR that already had a TAVR program (per 10%, OR 1.07, 95% CI 1.03-1.11), P <.01 for all. CONCLUSION: The expansion of TAVR programs in the U.S. has been accompanied by an increase in geographic coverage for all racial subgroups. Further study is needed to determine reasons for TAVR underutilization in Blacks and Hispanics.

Sex Disparities in the Choice of Cardiac Resynchronization Therapy Device: An Analysis of Trends, Predictors, and Outcomes.

BACKGROUND: There is limited evidence on the influence of sex on the decision to implant a cardiac resynchronization therapy device with pacemaker (CRT-P) or defibrillator (CRT-D) and the existence of sex-dependent differences in complications that may affect this decision. METHODS: All patients undergoing de novo CRT implantation (2004-2014) in the United States National Inpatient Sample were included and stratified by device type (CRT-P and CRT-D). Multivariable logistic regression models were conducted to assess the association of female sex with receipt of CRT-D and periprocedural complications. RESULTS: Out of 400,823 weighted CRT procedural records, the overall percentages of women undergoing CRT-P and CRT-D implantations were 41.5% and 27.8%, respectively, and these percentages increased compared with men over the study period. Women were less likely to receive CRT-D (odds ratio 0.66, 95% confidence interval 0.64-0.67), and this trend remained stable throughout the study period (P = 0.06). Furthermore, compared with men, women were associated with increased odds of procedure-related complications (bleeding, thoracic, and cardiac) in the CRT-D group but not in the CRT-P group. Factors such as atrial fibrillation, malignancies, renal failure, advanced age (> 60 years), and admission to nonurban/small hospitals favoured the receipt of CRT-P over CRT-D, whereas history of ischemic heart disease, cardiac arrest ,or ventricular arrhythmias favoured the receipt of CRT-D over CRT-P. CONCLUSIONS: Women were associated with persistently reduced odds of receipt of CRT-D compared with men over an 11-year period. This study identifies important factors that predict the choice of CRT device offered to patients in the United States.