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Background: An external vendor providing off-the-shelf spinal orthoses to inpatients created significant costs and barriers to quality care for spinal surgery patients. A nursing leadership team initiated a quality improvement project to reduce the cost of providing off-the-shelf spinal orthoses and improve the care provided to spinal patients. Objective: To develop and evaluate a nursing-led process for providing off-the-shelf orthoses to spinal surgery patients and eliminate high costs. Design: Quality improvement project evaluated as a retrospective interrupted time-series. Setting: Post Surgery Inpatient Unit Level II Trauma Center in a United States hospital located in Florida. Participants: Vendor Program: 134 patients; Centralized Program: 155 patients. Methods: The nursing leadership team developed a centralized spinal orthoses program where the bedside nurse fitted the patient with a spinal orthosis, eliminating the need for an external orthotist. The study quantifies changes in study metrics by comparing patients identified through chart review who received care in the vendor program to those who received care in the centralized program utilizing nonparametric statistical techniques. Results: The centralized nursing-led spinal orthosis program allowed the unit to mobilize patients more quickly than patients managed under the vendor program (3.85 hr. [95 % CI: 1.27 to 7.26 hrs] reduction; p = 0.004). The overall length of stay was reduced by 0.78 days ([1.34 - 0.02 days]; p = 0.063) or 18.72 h. While the statistical test did not indicate significance, the 18.72-hour reduction in length of stay represents a potential clinically relevant finding. Evaluating patients that suffered a primary spinal injury and no complications (vendor program: 54 patients; centralized program: 86 patients) showed a similar reduction in time to mobilization (4.5 hr reduction [0.53 to 12.93 hrs]; p = 0.025), but the length of stay reduction increased to 1.02 days [0.12 to 1.97 days], a difference determined to be statistically significant (p = 0.014). Centralizing the process for providing off-the-shelf spinal orthoses reduced the cost of a thoracic-lumbar sacral orthosis by $1,483 and the price of a lumbar-sacral orthosis by $1,327. Throughout the study, the new program reduced the cost of providing spinal orthoses by $175,319. Conclusions: The results demonstrate that the nursing-led centralized spinal orthosis program positively impacted the quality of care provided to our patients while also reducing the cost of delivering the orthoses. Tweetable abstract: A nursing-led centralized spinal orthosis program reduces the cost of care while reducing time to mobilization and length of stay.
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Clinical research faces complex and unpredictable budgetary challenges, despite its central role in the development of healthcare products. This retrospective study examines the estimated and actual costs of 13 trials managed by the Clinical Trials Coordinating Pharmacy at the University Hospital of Toulouse. It aims to assess the accuracy of estimates, identify trial-influencing events and identify budget adjustment variables. The results show that only two of the 13 studies stay within their initial estimates, with most exceeding their projected margins. Costs vary by area, with shipping and packaging in particular exceeding the initial budget, while distribution costs are more accurately estimated. Several factors influence costs, including study duration, centre locations, number of enrolments, product stability and protocol amendments. Extending the study duration leads to increased costs in all areas, while reducing the number of inclusions tends to be in line with the original budget. In conclusion, budget management in clinical trials is complex due to numerous influencing variables. Careful planning and consideration of the specifics of each trial are crucial for more accurate estimates and budget adherence. This study enhances the understanding of the financial challenges faced by institutional sponsors of clinical trials and contributes to the refinement of budgeting methods for future clinical trials.
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Objective: To select high-quality and cost-effective dural (spinal) membrane repair materials, in order to reduce the cost of consumables procurement, save medical insurance funds, and optimize hospital operation and management. Methods: Taking the BS06B disease group (spinal cord and spinal canal surgery without extremely severe or severe complications and comorbidities, mainly diagnosed as congenital tethered cord syndrome) as an example, a retrospective analysis was conducted on the relevant data of surgical treatment for congenital tethered cord syndrome conducted in our hospital from January 2021 to June 2023. Safety and efficacy indicators in clinical application (incidence of postoperative epidural hemorrhage, incidence of postoperative purulent cerebrospinal meningitis, incidence of cerebrospinal fluid leakage, surgical duration, and postoperative hospital stay) were compared. Results: There was no difference in safety and effectiveness between different brands of dura mater repair materials. Conclusion: For the repair of small incisions in dura mater surgery, high-quality and cost-effective dura mater repair materials can be selected to reduce hospital costs and control expenses for the disease group.
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Duramadre , Duramadre/cirugía , Estudios Retrospectivos , Humanos , Defectos del Tubo Neural/cirugía , Médula Espinal/cirugíaRESUMEN
AIM: This study aimed to critically review the methods used to control the significantly increasing costs of dental care. METHODS: Through a comprehensive search of the available literature, the cost control (CC) mechanisms for health services were identified from a healthcare system perspective. The probable applicability of each CC method was evaluated mainly based on its potential contribution to oral health promotion. Each mechanism was then classified and discussed under any of the two headings of financing and service provision. An operational guide was finally presented for policy-making in each of the three main models of healthcare systems, including National Health Services, social/public health insurance and private insurance. RESULTS: From a total of 142 articles/reports retrieved in PubMed, 73 in Scopus and 791 in Google Scholar, 35 were included in the final review after eliminating the duplicates and screening process. Totally ten mechanisms were identified for CC of dental care. Seven were discussed under the financing function, including cost sharing, preauthorization, mixed payment method and an evidence-based approach to benefit package definition, among others. Three further methods were classified under the service provision function, including workforce skill mix with emphasis on primary oral healthcare providers, development of primary healthcare (PHC) network and an appropriate use of tele-dentistry. CONCLUSION: Painless control of dental expenditures requires a smart integration of prevention into the CC plans. The suggested policy guide emphasizes organizational factors; particularly including the development of PHC-based networks with midlevel providers (desirably extended-duty dental hygienists) as the frontline oral healthcare providers.
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PURPOSE: Intensive care requires extensive resources. The ICUs' resource use can be compared using standardized resource use ratios (SRURs). We assessed the effect of mortality prediction models on the SRURs. MATERIALS AND METHODS: We compared SRURs using different mortality prediction models: the recent Finnish Intensive Care Consortium (FICC) model and the SAPS-II model (n = 68,914 admissions). We allocated the resources to severity of illness strata using deciles of predicted mortality. In each risk and year stratum, we calculated the expected resource use per survivor from our modelling approaches using length of ICU stay and Therapeutic Intervention Scoring System (TISS) points. RESULTS: Resource use per survivor increased from one length of stay (LOS) day and around 50 TISS points in the first decile to 10 LOS-days and 450 TISS in the tenth decile for both risk scoring systems. The FICC model predicted mortality risk accurately whereas the SAPS-II grossly overestimated the risk of death. Despite this, SRURs were practically identical and consistent. CONCLUSIONS: SRURs provide a robust tool for benchmarking resource use within and between ICUs. SRURs can be used for benchmarking even if recently calibrated risk scores for the specific population are not available.
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Benchmarking , Mortalidad Hospitalaria , Unidades de Cuidados Intensivos , Tiempo de Internación , Humanos , Unidades de Cuidados Intensivos/estadística & datos numéricos , Tiempo de Internación/estadística & datos numéricos , Masculino , Femenino , Persona de Mediana Edad , Anciano , Finlandia/epidemiología , Medición de Riesgo , Índice de Severidad de la Enfermedad , Puntuación Fisiológica Simplificada Aguda , Recursos en Salud/estadística & datos numéricosRESUMEN
This study presents a solution to the challenges of tracking consensus and guarantee-cost H∞ control in a specific set of second-order multi-agent systems with external disturbances. A proposed event-triggered control method based on periodic sampling data is presented for second-order multi-agent systems that include external disturbances. In contrast to the real-time monitoring of system state information used in the previous event-triggered mechanism, this approach collects system state information through periodic sampling. This ensures that the interval between two consecutive triggering moments is at least one sampling cycle, thereby preventing the controller from triggering infinitely within a finite time frame. A finite-time controller based on the sampled-data event-triggered mechanism is designed, and sufficient conditions to ensure the finite-time stability of the closed-loop system at a specified attenuation level are established using theoretical methods such as matrix analysis. For the given sampled-data event-triggered control protocol with a finite-time controller, a quadratic guarantee-cost function is introduced, and by designing control inputs and determining the parameters such as the finite-time upper bound T∗ and the H∞ performance index γ , the exact value of the upper bound of the system's guarantee-cost function under the action of the designed controller is derived. Finally, the feasibility of the proposed control scheme is verified through numerical simulation.
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Consenso , Simulación por ComputadorRESUMEN
Insufficient emphasis on planning and control is one of the major causes of several delayed and cost-overrun construction projects. To improve such performances, many studies have been conducted on project control techniques such as Earned Value Analysis (EVA) and its modifications: fuzzy EVA and grey EVA. Since there is no analytical model integrating fuzzy theory and grey theory simultaneously with EVA, this research aimed at predicting construction cost under uncertainty using grey-fuzzy EVA. Consequently, simple and valid project cost control grey-fuzzy EVA algorithms were developed to ensure continuous project cost performance improvement in the presence of imprecise data. In addition, an analysis result interpretation scheme was presented. Grey-fuzzy EVA was compared with fuzzy EVA and grey EVA to check its validity. Then, a case study of a road project in Addis Ababa, Ethiopia, was presented to demonstrate the application of grey-fuzzy EVA. This research contributes determinations of the lower limit, median, and upper limit of predicted costs and degree of greyness using grey-fuzzy EVA, which simplifies cost analysis, requires only a small number of data points (BAC, PV, AC, and Progress), needs no experts to create a membership function, and is comprehensible for practitioners as compared to fuzzy EVA and grey EVA used separately.
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BACKGROUND: Better cost-awareness is a prerogative in achieving the best benefit/risk/cost ratio in the care. We aimed to assess the cost-awareness of intensivists in their daily clinical practice and to identify factors associated with accurate estimate of cost (50-150% of the real cost). METHODS: We performed a prospective observational study in seven French ICUs. We compared the estimate of intensivists of the daily costs of caring with the real costs on a given day. The estimates covered five categories (drugs, laboratory tests, imaging modalities, medical devices, and waste) whose sum represented the overall cost. RESULTS: Of the 234 estimates made by 65 intensivists, 70 (29.9%) were accurate. The median overall cost estimate (330 [170; 620]) was significantly higher than the real cost (178 [124; 239], p < 0.001). This overestimation was found in four categories, in particular for waste (40 [15; 100] vs. 1.1 [0.6; 2.3], p < 0.001). Only the laboratory tests were underestimated (65 [30; 120] vs. 106 [79; 138], p < 0.001). Being aware of the financial impact of prescriptions was factor associated with accurate estimate (OR: 5.05, 95%CI:1.47-17.4, p = 0.01). However, feeling able to accurately perform estimation was factor negatively associated with accurate estimate (OR: 0.11, 95%CI: 0.02-0.71, p = 0.02). CONCLUSION: French intensivists have a poor awareness of costs in their daily clinical practice. Raising awareness of the financial impact of prescriptions, and of the cost of laboratory tests and waste are the main areas for improvement that could help achieve the objective of the best care at the best cost.
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OBJECTIVES: To evaluate the comparative effectiveness and cost-effectiveness of peripherally inserted central catheters (PICCs) compared with centrally inserted central catheters (CICCs). METHODS: Prospective cohort study was followed by an economic analysis over a 30-day time horizon. Propensity score matching was used to select hospitalized adults with similar indications for PICC or CICC. The composite outcome was device removal or replacement because of complications before the end of treatment. The economic evaluation was based on a decision tree model for cost-effectiveness analysis, with calculation of the incremental cost-effectiveness ratio (ICER) per catheter removal avoided. All costs are presented in Brazilian reais (BRL) (1 BRL = 0.1870 US dollar). RESULTS: A total of 217 patients were followed in each group; 172 (79.3%) of those receiving a PICC and 135 (62.2%) of those receiving a CICC had no device-related complication, respectively. When comparing the events leading to device removal, the risk of composite endpoint was significantly higher in the CICC group (hazard ratio 0.20; 95% CI 0.11-0.35). The cost of PICC placement was BRL 1290.98 versus BRL 467.16 for a CICC. In the base case, the ICER for placing a PICC instead of a CICC was BRL 3349.91 per removal or replacement avoided. On univariate sensitivity analyses, the model proved to be robust within an ICER range of 2500.00 to 4800.00 BRL. CONCLUSIONS: PICC placement was associated with a lower risk of complications than CICC placement. Although the cost of a PICC is higher, its use avoided complications and need for catheter replacement before the end of treatment.
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Cateterismo Venoso Central , Cateterismo Periférico , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Brasil , Cateterismo Venoso Central/economía , Cateterismo Venoso Central/instrumentación , Cateterismo Periférico/economía , Cateterismo Periférico/instrumentación , Análisis de Costo-Efectividad , Puntaje de Propensión , Estudios ProspectivosRESUMEN
In response to the EU ETS, we propose a cost model considering carbon emissions for container shipping, calculating fuel consumption, carbon emissions, EUA cost, and total cost of container shipping. We take a container ship operating on a route from the Far East to Northwest Europe as a case study. Environmental and economic impacts of including maritime transport activities in the EU ETS on container shipping are assessed. Results show that carbon emissions from the selected container ship using methanol are the smallest, and total cost of the selected container ship using methanol is the lowest. Among MGO, HFO, LNG, and methanol, methanol is the most environmentally and cost-effective option. Using LNG has greater environmental benefit, while using HFO has greater economic benefit. Compared to MGO, carbon reduction effects of LNG and methanol are 14.2% and 57.1%, and their cost control effects are 7.8% and 26.5%. Compared to HFO, carbon reduction effects of LNG and methanol are 11.7% and 55.8%, and the cost control effect of methanol is 9.3%. Speed reduction is effective in achieving carbon reduction and cost control of container shipping only when the sailing speed of the selected container ship is greater than 8.36 knots. Once the sailing speed is less than this threshold, speed reduction will increase carbon emissions and total cost of container shipping. This model can assess the environmental and economic impacts of including maritime transport activities in the EU ETS on container shipping and explore the measures to achieve carbon reduction and cost control of container shipping in response to the EU ETS.
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Óxido de Magnesio , Metanol , Unión Europea , Navíos , Control de Costos , CarbonoRESUMEN
This paper investigates the adaptive guaranteed cost stabilization (AGCS) problems for two classes of high-order nonlinear systems with unknown parameters (vector) and time delays. Firstly, based on the high-order fully actuated (HOFA) system approaches, the Lyapunov-Krasovskii functional (LKF) and the guaranteed cost control (GCC), a new AGCS strategy is proposed for HOFA nonlinear system with unknown parameter vector and time delays. Then, based on the above result, another AGCS controller for a class of strict-feedback systems (SFSs) with unknown parameters and time delays is obtained. Two designed controllers ensure that all of the states of two closed-loop systems are global boundedness, and preset arbitrarily the upper bound of cost functions (UBCFs) characterizing the output performance. More importantly, the UBCFs are independent of system initial values, unknown parameters (vector), and even time delays, which is difficult to achieve by using existing control methods. To do this, this paper introduces a local smooth nonlinear function (LSNF), and gives its corresponding lemma, which provide an important mathematical tool. Finally, three simulation examples, including an application in the electromechanical system, are given to prove the effectiveness and the practicability of our proposed control method.
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This paper aims to investigate the guaranteed cost control via dynamic output feedback for nonlinear networked control systems (NCSs) with consideration of hybrid communication mechanism, data dropout and bounded disturbance. Interval type-2 (IT2) Takagi-Sugeno (T-S) fuzzy model is utilized to describe the nonlinear system with parameter uncertainties. To enhance bandwidth utilization and improve control performance, a hybrid communication mechanism involving both event-triggered mechanism (ETM) and time-triggered mechanism (TTM) is proposed. Two Bernoulli processes are invoked to describe the switching between two triggering mechanisms, and the data dropout phenomenon in communication network, respectively. The quadratic boundedness (QB) technique is employed to specify the closed-loop stability of a bounded disturbance networked system. The sufficient conditions for the stability of the system and the presence of a dynamic output feedback guaranteed cost controller are presented. In addition, the problem of controller design is converted to a convex optimization problem that can be tackled by linear matrix inequalities (LMIs) technique. At last, simulation experiment is carried out to explicate the availability and usefulness of the designed controller.
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A microbial fuel cell (MFC), which is a new type of energy source, utilises electrogenic bacteria in sewage or soil to convert chemical energy into electrical energy. MFCs typically require an external controller to provide a stable output voltage to the external load. This study develops a non-fragile guaranteed cost (NFGC) controller to suppress the interference of the controller of an MFC and ensure that the quadratic cost function of the system satisfies certain performance indexes. First, for the convenience of controller design, a Takagi-Sugeno fuzzy model is established to approximate a single-chamber single-population MFC model. Subsequently, the linear matrix inequality method is used to design the NFGC controller. This control scheme can reduce the influence of controller disturbances on the system and ensure asymptotic stability of the closed-loop system under the specified upper bound of the provided cost function. The simulation results demonstrate that the developed control method has a shorter adjustment time and smaller steady-state error than traditional control methods such as sliding mode control (SMC), backstepping control, and fuzzy SMC.
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Fuentes de Energía Bioeléctrica , Lógica Difusa , Simulación por Computador , Algoritmos , ElectricidadRESUMEN
Objetivo : Determinar el impacto del aseguramiento en salud en la economía de los hogares peruanos en el periodo 2010-2019. Materiales y Métodos : Estudio analítico transversal, que utilizó la base de datos de la Encuesta Nacional de Hogares de los años 2010, 2014 y 2019 para analizar el impacto del aseguramiento en salud en términos de gasto de bolsillo en salud, gasto catastrófico y empobrecimiento de los hogares peruanos, así como determinar qué otros factores se encuentran asociados. Resultados : Durante el periodo de estudio se observó que los hogares peruanos presentaron una disminución del gasto de bolsillo en salud promedio mensual (S/.119,9 en 2010 a S/.107,9 en 2019), así como del porcentaje de hogares con gasto catastrófico en salud (4,06 % en 2010 a 3,47 % en 2019) y del porcentaje de hogares que empobrecen por gastos de bolsillo en salud (1,78 % en 2010 a 1,51 % en 2019). Los factores asociados al gasto catastrófico en salud y al empobrecimiento fueron el menor nivel de escolaridad del jefe del hogar, la presencia de miembros con enfermedad crónica y el área de residencia rural. La ausencia de aseguramiento en salud se asoció significativamente a un mayor riesgo de gasto de bolsillo en salud catastrófico, mas no al empobrecimiento. Conclusiones : El aumento de la cobertura de aseguramiento en salud contribuye a la protección financiera de los hogares peruanos frente al gasto de bolsillo en salud; sin embargo, las barreras para el acceso efectivo a los servicios de salud y otros factores socioeconómicos pueden limitar significativamente su impacto.
Objective : To determine the impact of health insurance in the economy of Peruvian households during the 2010-2019 period. Material and Methods : This is a cross-sectional analytical study that used the database of the National Peruvian Household Surveys from years 2010, 2014, and 2019, aiming to analyze the impact of health insurance in terms of pocket money spending for health issues, catastrophic healthcare spending, and impoverishment in Peruvian households, and also to determine the presence of other associated factors. Results : During the study period, it was observed that Peruvian households reduced their monthly average pocket money spending for health issues (119.9 PEN in 2010 and 107.9 PEN in 2029), as well as the percentage of household with catastrophic healthcare expenses (4.06% in 2010 to 3.47% in 2019), and the percentage of households who became impoverished because of pocket money expenses for health issues (1.78% in 2020 to 1.51% in 2019). Factors associated to catastrophic healthcare expenses and to impoverishment were lower educational level for the household leader, the presence of family members with chronic diseases, and living in a rural area. The absence of health insurance was significantly associated to a greater risk for catastrophic healthcare expenses, but not to impoverishment. Conclusions : Increased healthcare insurance coverage contributes to financial protection of Peruvian households against pocket money spending for health issues; however, barriers for effective access to healthcare services, and other socioeconomical factors may significantly limit this impact.
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With the impact of the COVID-19 pandemic, global container freights have increased dramatically since the second half of 2020, which has significantly hampered the booking activities of fragmented transportation space for small and medium-sized import and export enterprises (SMIEEs). To provide SMIEEs with an effective tool for controlling shipping costs, we propose the design principles of index microinsurance under fragmented scenarios and design the container freight index microinsurance (CFIM) based on a comprehensive analysis of the term, compensation and share structures. We further establish the pricing model for the CFIM and selection procedure for product optimization, and illustrate the framework with a case study based on the data of the China Containerized Freight Index Europe Service, which demonstrates the good performance of the designed product even under extreme market conditions. The design principles proposed can shed light on the innovation of index microinsurance product that meets fragmented needs and the newly designed CFIM, along with the pricing and optimization procedure, provides practitioners with useful tools for cost control.
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In-patient service is a crucial link in the whole medical chain,how to construct an economical and efficient inpatient service model,so as to let patients spend the least amount of money,get the best quality medical service,and effectively improve their sense of well-being and sense of acquisition is a social problem that needs to be solved urgently.From the perspective of economics and combined with practical experience,a new inpatient service model(pre-hospitalization and pre-discharge model)is constructed,which is an upgrading and transformation of the original model on the basis of the existing business system,simplifies the existing service process of hospitalization and discharge,effectively reduces the average hospitalization day and the subperiod average hospitalization cost,and significantly improves the evaluation indexes of inpatient service compared with the traditional inpatient service model.
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Objective:To construct a comprehensive performance evaluation model based on Shapley value weighting method to improve the clinical service level of large medical equipment in hospitals.Methods:The performance evaluation index system of large medical equipment was developed from the three indicators of cost control,social gain and development potential at the criterion level and 22 indicators at the indicator level.The evaluation model was constructed by Shapley value weighting,and the comprehensive performance level was divided into four evaluation levels:high quality,relatively high quality,medium quality and poor quality.Performance management strategies were developed for equipment operating technicians,equipment managers and medical engineers.Thirty-one large medical equipment in clinical use in the hospital were selected and divided into control group and observation group according to different evaluation and management methods.The control group adopted cost-benefit evaluation management,and the observation group adopted comprehensive performance evaluation management.The comprehensive performance scores,evaluation levels of performance indicators and recognition degree of management quality of the two groups were compared.Results:The comprehensive performance scores of diagnostic equipment,treatment equipment and scientific research equipment in the observation group were(0.85±0.04)points,(0.87±0.06)points and(0.84±0.05)points,respectively,which were higher than those in the control group,the difference was statistically significant(t=2.836,t=2.354,t=3.879;P<0.05).The proportion of high quality and relatively high quality in cost performance,social performance and development performance of large medical equipment in the observation group were 77.42%and 19.35%,58.06%and 35.48%,41.94%and 51.61%,respectively,the overall proportions were higher than those in the control group,the difference was statistically significant(x2=4.026,x2=4.292,x2=5.415;P<0.05).The recognition of equipment management quality by medical staff,medical engineers,scientific researcher and equipment managers of the observation group were(91.79±3.93)%,(90.09±4.46)%,(93.48±2.03)%and(90.65±4.43)%,which were higher than those of the control group,the difference was statistically significant(t=2.564,t=2.271,t=6.210,t=4.353;P<0.05).Conclusion:The comprehensive performance evaluation model of large medical equipment in hospitals based on Shapley value weighting can improve the comprehensive performance level of large medical equipment,increase the proportion of indicators of high quality and relatively higher quality evaluation grade,and improve the management quality and clinical service capabilities of large medical equipment.
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Aim: This study aimed to investigate the key points in the transformation of the functions of the Drug and Therapeutics Committee (DTC) of the Shandong Provincial Third Hospital and how to provide full authority to its role in the control of rational drug use, especially in the management of antibiotic use. Method: A prescription review management group, antimicrobial stewardship group, and rational drug use service group were established under the DTC. From January 2016 to December 2021, each group played a role in promoting rational drug use and antimicrobial stewardship. In addition, we performed statistics on typical management cases, irrational drug use, bacterial resistance rate, and drug costs from 2015 to 2021 to evaluate the effect of management by the DTC. Results: Intervention by the DTC led to a significant reduction in prescribing errors (71.43%, p < 0.05), the intervention acceptance rate increased by 16.03%, and the problem solved rate increased by 32.41% (p < 0.05). Resistance rates of general spectrum antibiotics were reduced remarkably after the intervention. The quality of drug treatment was improved and patient drug expenses was continuously reduced. Conclusion: Giving full play to the functions of the DTC can significantly improve the level of drug treatment and reduce unreasonable drug use to save unnecessary drug expenses and slow the development of drug resistance.
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PURPOSE: The resource use of cardiac surgery and neurosurgery patients likely differ from other ICU patients. We evaluated the relevance of these patient groups on overall ICU resource use. METHODS: Secondary analysis of 69,862 patients in 17 ICUs in Finland, Estonia, and Switzerland in 2015-2017. Direct costs of care were allocated to patients using daily Therapeutic Intervention Scoring System (TISS) scores and ICU length of stay (LOS). The ratios of observed to severity-adjusted expected resource use (standardized resource use ratios; SRURs), direct costs and outcomes were assessed before and after excluding cardiac surgery or cardiac and neurosurgery. RESULTS: Cardiac surgery and neurosurgery, performed only in university hospitals, represented 22% of all ICU admissions and 15-19% of direct costs. Cardiac surgery and neurosurgery were excluded with no consistent effect on SRURs in the whole cohort, regardless of cost separation method. Excluding cardiac surgery or cardiac surgery plus neurosurgery had highly variable effects on SRURs of individual university ICUs, whereas the non-university ICU SRURs decreased. CONCLUSIONS: Cardiac and neurosurgery have major effects on the cost structure of multidisciplinary ICUs. Extending SRUR analysis to patient subpopulations facilitates comparison of resource use between ICUs and may help to optimize resource allocation.
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Procedimientos Quirúrgicos Cardíacos , Neurocirugia , Estudios de Cohortes , Mortalidad Hospitalaria , Humanos , Unidades de Cuidados Intensivos , Tiempo de InternaciónRESUMEN
Spain has become one of the countries most affected by coronavirus disease 2019 (COVID-19), with the highest testing rates, and one of the worst-performing countries in the fight against the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. There are no studies related to the consumption of health resources and the economic cost of the SARS-CoV-2 virus. We present a retrospective analysis of 9,811 (Primary Care and Hospital) patients which aimed to estimate public health expenditure by the consumption of health resources due to COVID-19. According to the results, the gender distribution of patients has a similar rate in both groups, with slightly higher rates in women. Similarly, age is the same in both groups, with a median of 62 years in the case of hospitalizations and 61 years in the case of primary care; using a weighted average of these rates and costs, we can estimate that the average cost of care per patient infected with the SARS-CoV-2 virus, regardless of the course is 2373.24. We conclude that a patient with COVID-19 without hospitalization costs 729.79, while the expenses of a hospitalized patient are between 4294.36 and 14440.68, if there is ICU admission.