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1.
J Surg Res ; 273: 132-137, 2022 05.
Artículo en Inglés | MEDLINE | ID: mdl-35085940

RESUMEN

INTRODUCTION: Ownership may influence trauma center (TC) location. For-profit (FP) TCs require a favorable payor mix to thrive, whereas not-for-profit (NFP) centers may rely on government funding, grants, and patient volume. We hypothesized that the demographics of trauma patients would be different for NFP and FP TCs due to ownership type. We also hypothesized that these demographic differences might be associated with outcomes such as length of stay, reported complications, and mortality. METHODS: We used the Florida Agency for Health Care Administration (AHCA) 2016-2017 inpatient dataset to examine differences in outcomes by trauma center ownership type. Negative binomial and logistical regression was used to compare trauma ownership, length of stay (LOS), reported complications, and mortality of severely injured nonelderly adult trauma patients. RESULTS: Our study analyzed risk factors and outcomes for 10,700 trauma alert patients. Patients treated at FP TCs were less likely to be Black (OR 0.70, 95% CI: 0.62-0.78), to be uninsured (OR 0.40, 95% CI 0.36-0.45), have Medicare (OR 0.53, 95% CI 0.43-0.66), or Medicaid (OR 0.57, 95% CI 0.50-0.65) (all P < 0.001). Patients treated at FP centers were less likely to have comorbidities (OR 0.89, 95% CI 0.82-0.96) and were associated with a longer LOS (0.10, 95% 0.05-0.15, P < 0.001) in nonelderly adult trauma patients. FP TCs were associated with fewer reported complications (OR 0.83, 95% CI 0.74-0.94) and were associated with a higher likelihood of mortality in nonelderly adults (OR 1.70, 95% CI 1.35-2.12, P < 0.001). CONCLUSIONS: Among this cohort of severe International Classification of Diseases-based injury severity score (ICISS) patients, complications were less likely, but LOS and mortality were increased among FP TC patients. FP centers cared for fewer patients who were Black, uninsured, or who were Medicare/Medicaid/noncommercial insurance.


Asunto(s)
Centros Traumatológicos , Heridas y Lesiones , Adulto , Anciano , Demografía , Humanos , Puntaje de Gravedad del Traumatismo , Medicare , Propiedad , Estudios Retrospectivos , Estados Unidos/epidemiología , Heridas y Lesiones/terapia
2.
J Appl Gerontol ; 41(4): 1120-1130, 2022 04.
Artículo en Inglés | MEDLINE | ID: mdl-34404255

RESUMEN

OBJECTIVE: This study assessed affordability of care in a diverse sample of Floridians aged ≥ 65 to ascertain concerns about health care costs. METHODS: We surveyed 170 adults (40.6% white, 27.6% black, and 31.8% Hispanic) and conducted three race/ethnic-stratified focus groups (n = 27). RESULTS: Most participants had Medicare (97.1%). Among whites, 11.6% reported problems paying medical bills in the past 12 months versus 14.9% of blacks and 24.1% of Hispanics. In addition, 13% of whites, 19.2% of blacks, and 20.4% of Hispanics reported not getting needed prescription drugs because of costs. The most frequently identified concerns from the focus groups were the cost of prescription drugs, out-of-pocket expenses, and medical billing. Concerns about medical billing included understanding bills, transparency, timely postings, and uncertainty about who to contact about problems. DISCUSSION: Our findings suggest that practices that help older adults effectively manage medical bills and costs may alleviate their concerns and guard against financial burdens.


Asunto(s)
Medicamentos bajo Prescripción , Población Blanca , Negro o Afroamericano , Anciano , Florida , Costos de la Atención en Salud , Humanos , Medicare , Estados Unidos
3.
Health Serv Res ; 56(3): 464-473, 2021 06.
Artículo en Inglés | MEDLINE | ID: mdl-33393668

RESUMEN

BACKGROUND: The Hospital Value-Based Purchasing Program (HVBP) is a pay for performance system that impacts traditional Medicare fee-for-service payments to hospitals through rewards and penalties. OBJECTIVES: To explore variation in overall and individual-hospital total performance score (TPS) and embedded domains for hospitals during 2014-2018. DATA SOURCE: Hospital data were retrieved from the publicly available HOSArchive dataset. STUDY DESIGN: Distribution of annual TPS and HVBP domain scores for 2014-2018 was evaluated using descriptive statistics. Transitional probabilities were analyzed to evaluate annual movement in the TPS ranking for outlier hospitals in the Top and Bottom 5%. PRINCIPAL FINDINGS: TPS scores are positively skewed while the distribution of domain scores vary with patient experience, (clinical) outcome, and efficiency domains having a large number of (positive) outliers. Mean TPS score decreased from 40.54 in 2014 to 38.04 by 2018. Improvement was shown in mean domain scores for clinical process of care and clinical outcome using 95% confidence intervals, with hospitals gaining 10 points over the study period in clinical outcome. Changes in the mean scores for other domains did not show consistent increases or decreases. Chi-square analyses of hospital ranking categories showed some evidence that, as a group, hospitals initially ranked in the Bottom 5% are making consistent annual movements to higher categories. In contrast, over half of the hospitals ranking in the initial Top 5% remained in the top category across all study years. CONCLUSIONS: It may be time for CMS to redesign the HVBP incentive program to assure the measures accurately demonstrate sustained improvement, the domain weights appropriately reflect the level of importance, and the TPS comparative ranking methodology does not discourage lower-performing hospitals from actively improving the care they deliver and achieving top ranks.


Asunto(s)
Compra Basada en Calidad/organización & administración , Compra Basada en Calidad/estadística & datos numéricos , Centers for Medicare and Medicaid Services, U.S. , Economía Hospitalaria/estadística & datos numéricos , Humanos , Estados Unidos , Compra Basada en Calidad/normas
4.
Violence Vict ; 35(5): 741-750, 2020 10 01.
Artículo en Inglés | MEDLINE | ID: mdl-33060254

RESUMEN

Interpersonal violence is known to lead to both short- and long-term health effects. Victims of sexual abuse tend to have higher healthcare costs and higher rates of physical and mental health issues than nonvictims. In this study, we investigate whether the comorbidity of mental illness and a personal history of adult physical and sexual abuse (HAPSA) results in higher healthcare costs and length of emergency department (ED) stay among Florida residents. A Negative Binomial and Log-Linear Regression Analysis suggest increased ED visit duration for those with a history of abuse, Hispanics, the uninsured, and those with multiple comorbidities. In addition, increased costs were found to be associated with White race, the uninsured, those with multiple comorbidities, and the facility type (for-profit hospitals).


Asunto(s)
Servicio de Urgencia en Hospital/economía , Violencia de Pareja/psicología , Tiempo de Internación , Adulto , Etnicidad , Femenino , Florida , Humanos , Violencia de Pareja/etnología , Masculino , Persona de Mediana Edad
5.
AIMS Public Health ; 7(2): 274-286, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32617355

RESUMEN

Healthcare affordability is a worry for many Americans. We examine whether the relationship between having problems paying medical bills and mental health problems changed as the Affordable Care Act (ACA) was implemented, which increased health insurance coverage. Data from the 2013-2016 Health Reform Monitoring Survey, a survey of Americans aged 18-64, were used. Using zero-inflated negative binomial regression, adjusted for predisposing, enabling, and need factors, we examined differences in days of mental health symptoms by problems paying medical bills (n = 85,430). From 2013 to 2016, the rates of uninsured and problems paying medical bills decreased from 15.1% to 9.0% and 22.0% to 18.6%, respectively. Having one or more days of mental health symptoms increased from 39.3% to 42.9%. Individuals who reported problems paying medical bills had more days of mental health symptoms (Beta = 0.133, p < 0.001) than those who did not have this problem. Insurance was not significantly associated with days of mental health symptoms. Over the 4-year period, there were not significant differences in days of mental health symptoms by problems paying medical bills or insurance status. Despite improvements in coverage, the relationship between problems paying medical bills and mental health symptoms was not modified.

6.
BMJ Open Sport Exerc Med ; 5(1): e000491, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31191961

RESUMEN

OBJECTIVE: To analyse the financial costs from sports injuries among inpatients and emergency department (ED) patients aged 5-18 with a focus on Medicaid patients. METHODS: Fixed-effects linear regression was used to assess the association of patient factors with cost of injury from sports. Florida Agency for Health Care Administration data from 2010 to 2014 were used, which included all inpatient and ED patients aged 5-18 years who had a sports injury. RESULTS: Over 5 years, sports injuries in Florida youth cost $24 million for inpatient care and $87 million for ED care. Youth averaged $6039 for an inpatient visit and $439 for an ED visit in costs from sports injuries. Sports injuries for Medicaid-insured youth cost $10.8 million for inpatient visits and $44.2 million for ED visits. CONCLUSION: Older athletes and males consistently have higher healthcare costs from sports. Baseball, basketball, bike riding, American football, roller-skating/skateboarding and soccer are sports with high costs for both ED patients and inpatients and would benefit from prevention programmes. Injuries from non-contact sport participants are few but can have high costs. These athletes could benefit from prevention programmes as well.

7.
Stat Methods Med Res ; 28(2): 569-588, 2019 02.
Artículo en Inglés | MEDLINE | ID: mdl-28936916

RESUMEN

In longitudinal AIDS studies, it is of interest to investigate the relationship between HIV viral load and CD4 cell counts, as well as the complicated time effect. Most of common models to analyze such complex longitudinal data are based on mean-regression, which fails to provide efficient estimates due to outliers and/or heavy tails. Quantile regression-based partially linear mixed-effects models, a special case of semiparametric models enjoying benefits of both parametric and nonparametric models, have the flexibility to monitor the viral dynamics nonparametrically and detect the varying CD4 effects parametrically at different quantiles of viral load. Meanwhile, it is critical to consider various data features of repeated measurements, including left-censoring due to a limit of detection, covariate measurement error, and asymmetric distribution. In this research, we first establish a Bayesian joint models that accounts for all these data features simultaneously in the framework of quantile regression-based partially linear mixed-effects models. The proposed models are applied to analyze the Multicenter AIDS Cohort Study (MACS) data. Simulation studies are also conducted to assess the performance of the proposed methods under different scenarios.


Asunto(s)
Síndrome de Inmunodeficiencia Adquirida/inmunología , Teorema de Bayes , Recuento de Linfocito CD4 , Humanos , Límite de Detección , Modelos Lineales , Estudios Longitudinales , Carga Viral/inmunología
8.
Trauma Surg Acute Care Open ; 4(1): e000300, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31922017

RESUMEN

BACKGROUND: Trauma alert criteria include physiologic and anatomic criteria, although field triage based on injury mechanism is common. This analysis evaluates injury mechanisms associated with pediatric trauma alert overtriage and estimates the effect of overtriage on patient care costs. METHODS: Florida's Agency for Health Care Administration inpatient and financial data for 2012-2014 were used. The study population included mildly and moderately injured patients aged 5-15 years brought to a trauma center and had an International Classification of Diseases-based Injury Severity Score survival probability ≥0.90, a recorded mechanism of injury, no surgery, a hospital stay less than 24 hours, and discharged to home. Overtriaged patients were those who had a trauma alert. Logistic regression was used to analyze the odds of overtriage relative to mechanism of injury and multivariable linear regression was used to analyze cost of overtriage. RESULTS: Twenty percent of patients were overtriaged; yet these patients accounted for 37.2% of total costs. The mechanisms of injury related to firearms (OR 11.99) and motor vehicle traffic (2.25) were positively associated with overtriage as a trauma alert. Inpatient costs were 131.8% higher for overtriaged patients. DISCUSSION: Firearm injuries and motor vehicle injuries can be associated with severe injuries. However, in this sample, a proportion of patients with this mechanism suffered minimal injuries. It is possible that further identifying relevant anatomic and physiologic criteria in youth may help decrease overtriage without compromising outcomes. LEVEL OF EVIDENCE: Economic, level IV.

9.
Health Serv Res Manag Epidemiol ; 5: 2333392818797793, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-30225273

RESUMEN

OBJECTIVE: The purpose was to analyze the association of trauma volume and hospital trauma center (TC) ownership type with trauma alert (TA) response charges, which are billed for activation of the trauma team to the emergency department (ED). METHODS: All Florida ED and inpatients who were billed a TA charge from 2012 to 2014 were included (62 974 observations). Multiple linear regression, controlling for patient and hospital factors, was used to identify associations between TA charges and trauma volume and hospital ownership type. Severity elasticity of trauma response charges was calculated by ownership type. RESULTS: Trauma volume had a significant, inverse relationship with TA charges. For-profit (FP) hospitals had significantly higher TA charges and government-owned hospitals had significantly lower TA charges relative to private not-for-profits. For-profit trauma response charges were inelastic to severity, that is, charges did not change with changes in severity. CONCLUSION: Higher TA charges were associated with lower patient volumes, as well as at FP TCs. Further, only FP TCs used alert charges that were not associated with injury severity. Adding new TCs that reduce volume at existing TCs is expected to increase TA charges, especially if they are FP TCs.

10.
J Dermatol ; 45(7): 799-804, 2018 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-29667763

RESUMEN

Treatment with 5α-reductase inhibitors has been associated with sexual adverse events such as impotence (erectile dysfunction) and decreased libido. The primary objective of this study was to evaluate adverse events related to sexual function, based on their frequency, duration, persistence and associated treatment discontinuations, in men treated with dutasteride for androgenetic alopecia. Participants were randomized to receive double-blind dutasteride 0.5 mg or placebo once daily for 24 weeks, followed by open-label dutasteride 0.5 mg for an additional 24 weeks. Sexual adverse events were followed up until resolution or for up to 24 weeks after the last dose. Overall, 117 men, 23-50 years of age, were randomized. The incidence of sexual adverse events was approximately twofold higher in the dutasteride group (16%) than the placebo group (8%) during the double-blind period; the overall incidence of sexual adverse events was lower (5%) during the open-label period. All adverse events were mild to moderate in severity and considered treatment-related. The adverse events resolved while on study treatment or after the end of treatment and did not lead to treatment discontinuation. A limitation of this study was the small sample size. The sexual adverse events of impotence, decreased libido and ejaculation disorders reported in this study were expected and reversible.


Asunto(s)
Inhibidores de 5-alfa-Reductasa/efectos adversos , Alopecia/tratamiento farmacológico , Dutasterida/efectos adversos , Disfunciones Sexuales Psicológicas/epidemiología , Adulto , Factores de Edad , Método Doble Ciego , Humanos , Incidencia , Libido/efectos de los fármacos , Masculino , Persona de Mediana Edad , Placebos/efectos adversos , Estudios Prospectivos , Disfunciones Sexuales Psicológicas/inducido químicamente , Resultado del Tratamiento , Adulto Joven
11.
Health Serv Res ; 53(1): 35-48, 2018 02.
Artículo en Inglés | MEDLINE | ID: mdl-28074471

RESUMEN

OBJECTIVE: To corroborate anecdotal evidence with systematic evidence of a lower threshold for admission among for-profit hospitals. DATA SOURCES: The study used Florida emergency department and hospital discharge datasets for 2012 to 2014. The treatment variable of interest was for-profit-designated trauma center status. The dependent variable indicated whether a patient with mild-to-moderate injuries was admitted after presenting as a trauma alert and then discharged to home. A separate analysis was conducted of discharges that had a 1-day length of stay. STUDY DESIGN: Generalized estimation equations with logistic distribution models were used to control for the confounding influences and developed for four groups of patients: ICISS = 1 (no probability of mortality), ICISS ≥ 0.99, ICISS ≥ 0.95, and ICISS ≥ 0.85 (zero to 15 percent probability of mortality, which includes all mild and moderate injury patients). PRINCIPAL FINDINGS: For the ICISS = 1 and ICISS ≥ 0.99 models, the centers' for-profit status was the most important predictor. In the ICISS ≥ 0.95 and ICISS ≥ 0.85 models, injury type played a more important role, but for-profit status remained important. For patients with a 1-day stay, for-profit status was associated with an even higher probability of hospitalization. CONCLUSIONS: Considerable differences exist between for-profit and not-for-profit trauma centers concerning hospitalization among the study population, which may be explained by supplier-induced demand.


Asunto(s)
Servicio de Urgencia en Hospital/estadística & datos numéricos , Hospitalización/estadística & datos numéricos , Propiedad/estadística & datos numéricos , Centros Traumatológicos/estadística & datos numéricos , Índices de Gravedad del Trauma , Heridas y Lesiones/terapia , Factores de Edad , Florida , Capacidad de Camas en Hospitales/estadística & datos numéricos , Humanos , Cobertura del Seguro/estadística & datos numéricos , Seguro de Salud/estadística & datos numéricos , Grupos Raciales , Factores Sexuales , Factores Socioeconómicos , Heridas y Lesiones/mortalidad
12.
Eur Spine J ; 26(3): 698-707, 2017 03.
Artículo en Inglés | MEDLINE | ID: mdl-27154167

RESUMEN

PURPOSE: The objective of this study is to identify the demographic and payer factors that are associated with lumbar fusion surgery. METHODS: A case-control study was conducted utilizing a population of 38,092 patients from the 2010 Florida Agency for Health Care Administration (AHCA), USA hospital discharge data. The case population included 16,236 records with any of five ICD-9-CM principal procedure codes for initial lumbar fusion. The control group was comprised of 21,856 patients who were admitted for the same principal diagnoses as the cases, but who did not have initial fusion surgery. Logistic regression was used to analyze the association of age, gender, race and principal payer type with initial lumbar fusions. The interaction between age and payer was also examined, as payer type may moderate the association between age and lumbar fusion surgery. RESULTS: Gender, race, principal payer and age were all found to be significantly associated with lumbar fusion surgery. The interaction of payer and age was also found to be significant. Being female was significantly associated with having a fusion (OR = 1.11, 95 % CI 1.07-1.16). The association between age and receiving surgery was greatest for the less than 20 age group (OR = 10.43, 95 % CI 8.74-12.45). Employees and dependents of Federal government agencies (Tricare, etc.) and patients with commercial insurance were significantly associated with surgery (OR = 1.48, 95 % CI 1.29-1.70 and OR = 1.12, 95 % CI 1.04-1.20, respectively). Patients insured through Medicaid (a social health care program for those with low incomes and limited resources), and the uninsured were negatively associated with surgery (OR = 0.53, 95 % CI 0.47-0.60 and OR = 0.52, 95 % CI 0.46-0.58, respectively). CONCLUSIONS: Lumbar fusion surgery is not recommended in clinical practice guidelines for the top four principal diagnoses in this study. Yet, patients covered by certain types of insurance were found to be significantly associated with fusion surgery.


Asunto(s)
Vértebras Lumbares/cirugía , Fusión Vertebral/estadística & datos numéricos , Adulto , Factores de Edad , Anciano , Estudios de Casos y Controles , Bases de Datos Factuales , Femenino , Florida/epidemiología , Humanos , Cobertura del Seguro/estadística & datos numéricos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Grupos Raciales/estadística & datos numéricos , Factores Sexuales , Adulto Joven
13.
Psychiatr Serv ; 67(11): 1169-1174, 2016 11 01.
Artículo en Inglés | MEDLINE | ID: mdl-27364809

RESUMEN

OBJECTIVE: Length of stay (LOS) and boarding in the emergency department (ED) for psychiatric patients have been the subject of concern, given the problems with crowding and excessive wait times in EDs. This investigation examined correlates of LOS and boarding in Florida EDs for patients presenting with psychiatric complaints from 2010 to 2013. METHODS: Utilizing the Florida ED discharge database, the authors examined the association of LOS and boarding with hospital and encounter factors for adult patients presenting with a primary psychiatric diagnosis (N=597,541). RESULTS: The mean LOS was 7.77 hours. Anxiety disorders were the most frequent psychiatric complaint and were associated with the lowest mean LOS compared with other diagnoses (p<.05). Patient encounters resulting in a presentation of intentional self-harm and suicidality or schizophrenia were associated with significantly longer stays compared with other psychiatric diagnoses. Commercial insurance was associated with the shortest average LOS. African Americans, Hispanics, and patients age 45 and older were associated with a longer average LOS. Smaller hospital size, for-profit ownership, and rural designation were associated with a shorter average LOS. Teaching status was not associated with LOS. Furthermore, 73% of encounters resulting in transfers qualified as episodes of boarding (a stay of more than six or more hours in the ED). CONCLUSIONS: Extended LOS was endemic for psychiatric patients in Florida EDs.


Asunto(s)
Servicio de Urgencia en Hospital/estadística & datos numéricos , Tiempo de Internación/estadística & datos numéricos , Trastornos Mentales/terapia , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Florida , Humanos , Masculino , Persona de Mediana Edad , Adulto Joven
14.
Eval Health Prof ; 39(2): 226-44, 2016 06.
Artículo en Inglés | MEDLINE | ID: mdl-25007792

RESUMEN

Evaluations of red light camera (RLC) traffic safety programs have produced mixed results. Some conclude RLCs were associated with significant increases in motor vehicle crashes and injury crashes, whereas other research reports safety benefits. To understand the difference in findings, the present analysis assessed whether standards required for internal validity in quasi-experimental public health program evaluations were adhered to in frequently cited RLC analyses. Four evaluation standards were identified and used to assess the RLC analyses: lack of bias in the selection of both (a) treated sites and (b) comparison sites, (c) integration of relevant control variables in the analysis, and (d) full disclosure of results of the statistical analysis. Six leading RLC studies were then critiqued. Only two of the six studies adhered to the four standards and both concluded RLCs were associated with significant increases in crashes and injury or possible injury crashes. A third study reported an increase in fatal/injury crashes but did not test for statistical significance. Three studies reported equivocal findings; however, each failed to adhere to most standards. Differences in findings were attributed to the evaluation methods used. If implementing an RLC program, communities should use sound public health evaluation methods to assess effectiveness.


Asunto(s)
Accidentes de Tránsito/estadística & datos numéricos , Proyectos de Investigación , Heridas y Lesiones/epidemiología , Accidentes de Tránsito/mortalidad , Interpretación Estadística de Datos , Humanos , Evaluación de Programas y Proyectos de Salud , Factores de Tiempo , Heridas y Lesiones/mortalidad
15.
Inquiry ; 522015.
Artículo en Inglés | MEDLINE | ID: mdl-26294267

RESUMEN

Medicare Advantage was implemented in 2004 and the Recovery Audit Contractor (RAC) program was implemented in Florida during 2005. Both increase surveillance of medical necessity and deny payments for improper admissions. The purpose of the present study was to determine their potential impact on for-profit (FP) and not-for-profit (NFP) hospital operating margins in Florida. FP hospitals were expected to be more adversely affected as admissions growth has been one strategy to improve stock performance, which is not a consideration at NFPs. This study analyzed Florida community hospitals from 2000 through 2010, assessing changes in pre-tax operating margin (PTOM). Florida Agency for Health Care Administration data were analyzed for 104 community hospitals (62 FPs and 42 NFPs). Academic, public, and small hospitals were excluded. A mixed-effects model was used to assess the association of RAC implementation, organizational and payer type variables, and ownership interaction effects on PTOM. FP hospitals began the period with a higher average PTOM, but converged with NFPs during the study period. The average Medicare Advantage effect was not significant for either ownership type. The magnitude of the RAC variable was significantly negative for average PTOM at FPs (-4.68) and positive at NFPs (0.08), meaning RAC was associated with decreasing PTOM at FP hospitals only. RAC complements other Medicare surveillance systems that detect medically unnecessary admissions, coding errors, fraud, and abuse. Since its implementation in Florida, average FP and NFP operating margins have been similar, such that the higher margins reported for FP hospitals in the 1990s are no longer evident.


Asunto(s)
Administración Financiera de Hospitales/economía , Hospitales Comunitarios/economía , Medicare/economía , Propiedad/economía , Administración Financiera de Hospitales/organización & administración , Florida , Capacidad de Camas en Hospitales , Hospitales Comunitarios/organización & administración , Hospitales Filantrópicos/organización & administración , Humanos , Administración de Personal en Hospitales , Estados Unidos
16.
J Trauma Acute Care Surg ; 79(2): 263-8, 2015 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-26218695

RESUMEN

BACKGROUND: A regional trauma system must establish and monitor acceptable overtriage and undertriage rates. Although diagnoses from discharge data sets can be used with mortality prediction models to define high-risk injury, retrospective analyses introduce methodological errors when evaluating real-time triage processes. The purpose of this study was to determine if major trauma patients identified using field criteria correlated with those retrospectively labeled high risk and to assess system performance by measuring triage accuracy and trauma center utilization. METHODS: A statewide database was queried for all injury-related International Classification of Diseases, 9th Revision, code discharges from designated trauma centers and nontrauma centers for 2012. Children and burn patients were excluded. Patients assigned a trauma alert fee were considered field-triage(+). The International Classification Injury Severity Score methodology was used to estimate injury-related survival probabilities, with an International Classification Injury Severity Score less than 0.85 considered high risk. Triage rates were expressed relative to the total population; the proportion of low- and high-risk patients discharged from trauma centers defined trauma center utilization. RESULTS: There were 116,990 patients who met study criteria, including 11,368 (10%) high-risk, 70,741 field-triage(-) patients treated in nontrauma centers and 28,548 field-triage(-) and 17,791 field-triage(+) patients treated in trauma centers. Field triage was 86% accurate, with 10% overtriage and 4% undertriage. System triage was 66% accurate, with 32% overtriage and 2% undertriage. Overtriage patients more often, and undertriage patients less often, had severe injury characteristics than appropriately triaged patients. CONCLUSION: Trauma system performance assessed using retrospective administrative data provides a convenient measure of performance but must be used with caution. Residual mistriage can partly be attributed to error introduced by retrospective high-risk definitions, whereas differences between field and system triage accuracy can be attributed to the trauma center's role as a large community hospital. Given the limitations of the data and methods, these results may represent optimal patient distribution within this mature system.


Asunto(s)
Atención a la Salud/normas , Centros Traumatológicos/normas , Triaje/normas , Heridas y Lesiones/terapia , Adulto , Bases de Datos Factuales , Femenino , Florida/epidemiología , Humanos , Masculino , Centros Traumatológicos/estadística & datos numéricos , Índices de Gravedad del Trauma , Heridas y Lesiones/diagnóstico
17.
Appl Health Econ Health Policy ; 13(1): 69-80, 2015 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-25403718

RESUMEN

BACKGROUND: The relationship of antiretroviral therapy (ART) adherence to total healthcare expenditures for Medicaid-insured people living with HIV or AIDS (PLWHA) is not well understood, especially among asymptomatic HIV-positive patients. OBJECTIVE: This study examined Medicaid-insured HIV-positive and AIDS-diagnosed patient groups to determine the association of ART adherence to mean monthly total healthcare expenditures in the 24-month measurement period, controlling for demographic, geographic, insurance, and clinical factors. The present study extends the existing literature by analyzing the relationship of ART adherence to total healthcare costs for asymptomatic HIV-positive patients separately from those patients with AIDS-defining conditions. METHODS: This retrospective study utilized claims data from Florida Medicaid claims from July 2006 through June 2011. All patients (n = 502) were HIV-positive, aged 18-64 years, non-pregnant, and ART naïve for at least 12 months prior to the measurement period. Each patient was categorized, based on medication possession ratios, as adherent (≥90 %) or non-adherent (<90 %), and were divided into two groups: HIV positive (n = 232) and AIDS diagnosed (n = 270). Generalized linear models predicted the mean monthly total expenditures for the non-adherence group versus the adherence group. RESULTS: For the HIV-positive group, the adjusted mean monthly expenditures for the non-adherent group were US$1,291; the adherent group adjusted mean monthly expenditures were US$1,926. The HIV-positive non-adherent group adjusted mean monthly expenditures were significantly less than the adherent group (-40 %, p < 0.001). However, for the AIDS-diagnosed group, there was not a statistically significant association of ART adherence to total healthcare expenditures (p = 0.29). CONCLUSION: The results show that the relationship of ART adherence to healthcare costs is more complex than previously reported.


Asunto(s)
Síndrome de Inmunodeficiencia Adquirida/tratamiento farmacológico , Antirretrovirales/economía , Infecciones por VIH/tratamiento farmacológico , Costos de la Atención en Salud/estadística & datos numéricos , Gastos en Salud/estadística & datos numéricos , Medicaid/economía , Cumplimiento de la Medicación/estadística & datos numéricos , Síndrome de Inmunodeficiencia Adquirida/economía , Adolescente , Adulto , Antirretrovirales/uso terapéutico , Femenino , Florida , Infecciones por VIH/economía , Humanos , Modelos Lineales , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Estados Unidos , Adulto Joven
18.
Spine (Phila Pa 1976) ; 39(23): 1990-5, 2014 Nov 01.
Artículo en Inglés | MEDLINE | ID: mdl-25365714

RESUMEN

STUDY DESIGN: A mixed-effects model was used to evaluate the effects specific surgical procedure by International Classification of Diseases, Ninth Revision, Clinical Modification, procedure code, patient age, sex, ethnic group, payers for the inpatient hospital stay, and number of additional diagnoses beyond the principal diagnosis that led to the procedure (as a proxy for severity of illness) on the charges for lumbar fusion surgery. OBJECTIVE: The present research examined the charges and the predictors of the charges for lumbar fusion surgery in Florida hospitals in 2010. SUMMARY OF BACKGROUND DATA: The number of spinal fusion surgical procedures in the United States has grown exponentially in recent years despite the procedure's high costs and questionable efficacy for many of the principal diagnoses associated with it. METHODS: All records with any of the 5 International Classification of Diseases, Ninth Revision, Clinical Modification, principal procedure codes for lumbar fusion were extracted (cases) from the Florida Agency for Health Care Administration (AHCA) hospital discharge data for the year 2010. A control group was obtained by taking all patients who had the same principal diagnoses as the cases, but who did not have fusion surgery. This produced 16,236 cases and 21,856 controls. RESULTS: The total hospital charges for lumbar fusion surgery in Florida in 2010 were $2,095,413,584. Despite having the same principal diagnoses and a similar number of additional diagnoses, patients who underwent a fusion surgery had 3 times the charges as those incurred by the controls. The number of additional diagnoses, sex, age, payer, and principal procedure, were all found to be statistically significant predictors of charges. Ethnicity was not significant. Of all the predictors, the number of additional diagnoses was the most significant in the model (F=2577, P<0.0001). CONCLUSION: The high incidence and charges for fusion surgical procedures shown in this study emphasize the need for a better understanding of when these surgical procedures are justified and for which patients. LEVEL OF EVIDENCE: N/A.


Asunto(s)
Precios de Hospital , Vértebras Lumbares/cirugía , Fusión Vertebral/economía , Adulto , Anciano , Femenino , Florida/epidemiología , Predicción , Precios de Hospital/tendencias , Hospitales/tendencias , Humanos , Masculino , Persona de Mediana Edad , Alta del Paciente/economía , Alta del Paciente/tendencias , Adulto Joven
19.
Surgery ; 154(2): 291-8, 2013 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-23889955

RESUMEN

BACKGROUND: Injury remains a public health challenge despite advances in trauma care. Periodic survey of injury epidemiology is essential to the trauma system's continuous performance improvement. We undertook this study to characterize the changes in Florida injury rates during the past 15 years. METHODS: Injured patients were identified with the use of a statewide database over 15 years ending in 2010. Population data were obtained from the U.S. Census. Severe injury was defined by International Classification Injury Severity Scores less than 0.85. Injury rates were expressed in discharges per 100,000 residents. Trends were analyzed by linear regression. RESULTS: The 1.5 million patient discharges consisted of 5.2% children, 39.7% adults, and 55.1% elderly. The overall injury rate decreased in children by 18% but increased in adults by 2% and in the elderly by 17% during the study period. The proportion of severe injuries decreased in children and the elderly but did not change in adults. Injury patterns changed in all age groups. CONCLUSION: Injury in the elderly is increasing at a rate seven times that of adults. In 2010, the elderly accounted for only 17% of the population but 55% of injury-related discharges. These trends have dramatic implications for the design of future trauma systems and health care resource use.


Asunto(s)
Heridas y Lesiones/epidemiología , Adolescente , Adulto , Anciano , Niño , Preescolar , Florida/epidemiología , Humanos , Lactante , Recién Nacido , Puntaje de Gravedad del Traumatismo , Persona de Mediana Edad
20.
J Am Coll Surg ; 216(4): 687-95; discussion 695-8, 2013 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-23415551

RESUMEN

BACKGROUND: Trauma systems are designed to deliver timely and appropriate care. Prehospital triage regulations and interfacility transfer guidelines are the primary determinants of system efficacy. We analyzed the effectiveness of the Florida trauma system in delivering trauma patients to trauma centers over time. STUDY DESIGN: Injured patients were identified by ICD-9 codes from a statewide discharge dataset, and they were categorized as children (less than 16 years old), adult (16 to 65 years old), or elderly (over 65 years old). Severe injury was defined by International Classification Injury Severity Scores (ICISS) < 0.85. Residence ZIP codes were used as a surrogate for injury location. RESULTS: Severe injury discharges increased at designated trauma centers (DTCs) and decreased at nontrauma centers (NTCs). The proportion of patients with severe injuries discharged from DTCs increased for all age groups, capturing nearly all severely injured children and adults. Access to DTCs was dependent on proximity for severely injured elderly but not for severely injured children and adults. CONCLUSIONS: Triage improved over time, enabling near complete capture of at-risk children and adults independent of DTC proximity. Because distance from a DTC does not limit access for children and adults, existing trauma system resources are sufficient to meet the current demands. Efforts are needed to determine the trauma resource and triage needs of the severely injured elderly.


Asunto(s)
Puntaje de Gravedad del Traumatismo , Centros Traumatológicos/estadística & datos numéricos , Centros Traumatológicos/normas , Triaje/estadística & datos numéricos , Triaje/normas , Adulto , Anciano , Niño , Humanos , Factores de Tiempo , Poblaciones Vulnerables
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