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1.
Z Gastroenterol ; 58(4): 364-372, 2020 Apr.
Artículo en Alemán | MEDLINE | ID: mdl-32353889

RESUMEN

INTRODUCTION: Short-bowel-syndrome (SBS) is an often chronic disease with high morbidity. The aim of this study was to evaluate the complexity of SBS treatment and the economic burden on a treating hospital. METHODS: Anonymized data of eleven consecutive SBS patients from the University Hospital of Bonn were included. Parameters of medical resources were considered for year of diagnosis (YOD) and a follow-up (FU) period of three years. Subsequently, costs were evaluated according to the corresponding catalogues. RESULTS: Median inpatient days were 96 days in YOD and decreased to three days in the third year of FU. Median cost of inpatient treatment decreased from approximately 84 500 € auf 3200 €. While major visceral surgery was usually required in the YOD, catheter-associated interventions dominated during further FU. Actual reimbursement according to the G-DRG covered approximately 50 % of inpatient treatment cost, for outpatient care only est. 16.5 % of costs were covered. Annual costs for medication, parenteral nutrition and GLP-2-analogon treatment added up to 6752 €, 48 485 € and 138 442 €, respectively. CONCLUSIONS: The interdisciplinary medical care of SBS-patients is resource-intensive and expensive. The required treatment shifts from the in- to the outpatient sector. Both settings are at present not adequately reimbursed. Hence, this imbalance may endanger adequate care for SBS-patients in the future in times of economic rationale. In concordance with other rare disease management programs, additional measures are needed to provide and improve interdisciplinary treatment of SBS.


Asunto(s)
Atención Ambulatoria/economía , Costos de la Atención en Salud/normas , Hospitalización/economía , Grupo de Atención al Paciente , Síndrome del Intestino Corto , Atención Ambulatoria/estadística & datos numéricos , Costo de Enfermedad , Alemania , Hospitalización/estadística & datos numéricos , Humanos
2.
Nat Med ; 26(5): 665-671, 2020 05.
Artículo en Inglés | MEDLINE | ID: mdl-32405058

RESUMEN

The current COVID-19 pandemic challenges oncologists to profoundly re-organize oncological care in order to dramatically reduce hospital visits and admissions and therapy-induced immune-related complications without compromising cancer outcomes. Since COVID-19 is a novel disease, guidance by scientific evidence is often unavailable, and impactful decisions are inevitably made on the basis of expert opinions. Here we report how the seven comprehensive cancer centers of Cancer Core Europe have organized their healthcare systems at an unprecedented scale and pace to make their operations 'pandemic proof'. We identify and discuss many commonalities, but also important local differences, and pinpoint critical research priorities to enable evidence-based remodeling of cancer care during the COVID-19 pandemic. Also, we discuss how the current situation offers a unique window of opportunity for assessing the effects of de-escalating anticancer regimens, which may fast-forward the development of more-refined and less-toxic treatments. By sharing our joint experiences, we offer a roadmap for proceeding and aim to mobilize the global research community to generate the data that are critically needed to offer the best possible care to patients.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/epidemiología , Neoplasias , Neumonía Viral/epidemiología , Atención Ambulatoria/estadística & datos numéricos , Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/prevención & control , Prestación de Atención de Salud , Humanos , Neoplasias/complicaciones , Neoplasias/terapia , Pandemias/prevención & control , Neumonía Viral/complicaciones , Neumonía Viral/prevención & control
4.
Rev Cardiovasc Med ; 21(1): 1-7, 2020 03 30.
Artículo en Inglés | MEDLINE | ID: mdl-32259899

RESUMEN

Approximately 90 days of the SARS-CoV-2 (COVID-19) spreading originally from Wuhan, China, and across the globe has led to a widespread chain of events with imminent threats to the fragile relationship between community health and economic health. Despite near hourly reporting on this crisis, there has been no regular, updated, or accurate reporting of hospitalizations for COVID-19. It is known that many test-positive individuals may not develop symptoms or have a mild self-limited viral syndrome consisting of fever, malaise, dry cough, and constitutional symptoms. However some individuals develop a more fulminant syndrome including viral pneumonia, respiratory failure requiring oxygen, acute respiratory distress syndrome requiring mechanical ventilation, and in substantial fractions leading to death attributable to COVID-19. The pandemic is evolving in a clustered, non-inform fashion resulting in many hospitals with preparedness but few or no cases, and others that are completely overwhelmed. Thus, a considerable risk of spread when personal protection equipment becomes exhausted and a large fraction of mortality in those not offered mechanical ventilation are both attributable to a crisis due to maldistribution of resources. The pandemic is amenable to self-reporting through a mobile phone application that could obtain critical information on suspected cases and report on the results of self testing and actions taken. The only method to understand the clustering and the immediate hospital resource needs is mandatory, uniform, daily reporting of hospital censuses of COVID-19 cases admitted to hospital wards and intensive care units. Current reports of hospitalizations are delayed, uncertain, and wholly inadequate. This paper urges all the relevant stakeholders to take up self-reporting and reporting of hospitalizations of COVID-19 as an urgent task in combating this devastating pandemic.


Asunto(s)
Infecciones por Coronavirus/epidemiología , Recursos en Salud/provisión & distribución , Recursos en Salud/estadística & datos numéricos , Notificación Obligatoria , Aplicaciones Móviles/estadística & datos numéricos , Pandemias/estadística & datos numéricos , Neumonía Viral/epidemiología , Atención Ambulatoria/estadística & datos numéricos , Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/terapia , Cuidados Críticos/estadística & datos numéricos , Hospitalización/estadística & datos numéricos , Hospitales/estadística & datos numéricos , Humanos , Unidades de Cuidados Intensivos/estadística & datos numéricos , Neumonía Viral/complicaciones , Neumonía Viral/terapia , Características de la Residencia/estadística & datos numéricos , Autoinforme/estadística & datos numéricos
5.
Medicine (Baltimore) ; 99(16): e19603, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-32311928

RESUMEN

Hepatic encephalopathy (HE) is a complication occurring in patients with cirrhosis and is associated with neuropsychiatric and motor abnormalities. Symptomatic HE episodes almost always require hospitalization and the frequent recurrence of episodes is associated with poor prognosis and increased medical costs. The utilization of existing therapies for management of HE and adherence to them has yet to be evaluated using real-world claims data.The aim of this study was to evaluate HE drug regimens and adherence and their association with hospital readmissions in Medicare Advantage plan patients.This was a retrospective cohort study of patients discharged from a HE-related hospitalization or emergency room visit. Based on subsequent enrollment in the plan they were categorized into cohorts of 1 month, 3, and 6 months follow-up, and medication regimen was evaluated within the first month. The drugs evaluated included lactulose, rifaximin, and neomycin. Multivariable logistic regression was conducted to evaluate the association of drug regimen and medication adherence measured as proportion of days covered with HE readmissions.There were 347 patients hospitalized for HE with 184 patients having 30-day enrollment and either a drug refill or an outpatient visit in this duration. Medications were not refilled by 67 (36.4%) patients. Various drug regimens had different adherence with mean (standard deviation) proportion of days covered ranging from 0.56 (0.29) to 0.82 (0.16) at 3 months and 0.48 (0.3) to 0.77 (0.15) at 6 months. The results of logistic regression at 3 and 6 months did not show a significant association of medication use or medication adherence with hospital readmissions.Despite availability of therapy, medication utilization was alarmingly low after discharge of patients from HE-related hospitalization. Medication adherence was also low, which may affect the rate of recurrence and costs associated with readmissions. Efforts are needed in both care coordination of these patients to ensure they are prescribed appropriate medications and to enhance adherence to them.


Asunto(s)
Prescripciones de Medicamentos/estadística & datos numéricos , Encefalopatía Hepática/tratamiento farmacológico , Cumplimiento de la Medicación/estadística & datos numéricos , Readmisión del Paciente/estadística & datos numéricos , Reclamos Administrativos en el Cuidado de la Salud , Anciano , Anciano de 80 o más Años , Atención Ambulatoria/estadística & datos numéricos , Antibacterianos/uso terapéutico , Quimioterapia Combinada , Femenino , Estudios de Seguimiento , Fármacos Gastrointestinales/uso terapéutico , Humanos , Lactulosa/uso terapéutico , Masculino , Medicare Part C , Persona de Mediana Edad , Neomicina/uso terapéutico , Recurrencia , Estudios Retrospectivos , Rifaximina/uso terapéutico , Estados Unidos
6.
Otolaryngol Head Neck Surg ; 162(6): 800-803, 2020 06.
Artículo en Inglés | MEDLINE | ID: mdl-32286910

RESUMEN

Coronavirus disease 2019 (COVID-19) is a novel coronavirus resulting in high mortality in the adult population but low mortality in the pediatric population. The role children and adolescents play in COVID-19 transmission is unclear, and it is possible that healthy pediatric patients serve as a reservoir for the virus. This article serves as a summary of a single pediatric institution's response to COVID-19 with the goal of protecting both patients and health care providers while providing ongoing care to critically ill patients who require urgent interventions. A significant limitation of this commentary is that it reflects a single institution's joint effort at a moment in time but does not take into consideration future circumstances that could change practice patterns. We still hope dissemination of our overall response at this moment, approximately 8 weeks after our region's first adult case, may benefit other pediatric institutions preparing for COVID-19.


Asunto(s)
Control de Enfermedades Transmisibles/organización & administración , Infecciones por Coronavirus/prevención & control , Hospitales Pediátricos/organización & administración , Otolaringología/organización & administración , Pandemias/prevención & control , Pediatría/normas , Neumonía Viral/prevención & control , Adolescente , Atención Ambulatoria/estadística & datos numéricos , Niño , Preescolar , Infección Hospitalaria/prevención & control , Procedimientos Quirúrgicos Electivos/estadística & datos numéricos , Servicio de Urgencia en Hospital/estadística & datos numéricos , Femenino , Humanos , Masculino , Evaluación de Resultado en la Atención de Salud , Pandemias/estadística & datos numéricos , Prevención Primaria/métodos , Estudios Retrospectivos , Planes Estatales de Salud/organización & administración , Washingtón
8.
MMWR Morb Mortal Wkly Rep ; 69(11): 298-302, 2020 Mar 20.
Artículo en Inglés | MEDLINE | ID: mdl-32191686

RESUMEN

In 2017, prescription opioids were involved in 36% of opioid-involved overdose deaths in the United States (1). Prescription opioids can be obtained by prescription or through diversion (the channeling of regulated drugs from legal to illegal sources) (2). Among new heroin users, 66%-83% reported that their opioid use began with the misuse of a prescription opioid (3). "Misuse" is generally defined as drugs taken for a purpose other than that directed by the prescribing physician, in greater amounts, more often, or for a longer duration than prescribed (2). Exposure to prescription opioids can be lessened by ensuring recommended prescribing, thereby potentially reducing the risk for misuse, opioid use disorder, and overdose (4). Sex and age groups with high exposure to prescription opioids are not well defined. Using a retail pharmaceutical database from IQVIA,* nationwide trends in opioid prescription fill rates for adult outpatients by age and sex were examined during 2008-2018. Opioid prescription fill rates were disproportionately higher among men and women aged ≥65 years and women of all ages. For reasons not well understood, these disparities persisted over 11 years even as the opioid fill rate declined for each age group and sex. Interventions to improve prescribing practices by following evidence-based guidelines that include weighing the benefits and risks for using prescription opioids for each patient and adopting a multimodal approach to pain management could improve patient safety while ameliorating pain. These efforts might need to consider the unique needs of women and older adults, who have the highest opioid prescription fill rates.


Asunto(s)
Atención Ambulatoria/estadística & datos numéricos , Analgésicos Opioides/uso terapéutico , Prescripciones de Medicamentos/estadística & datos numéricos , Disparidades en Atención de Salud/estadística & datos numéricos , Adulto , Factores de Edad , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Factores Sexuales , Estados Unidos , Adulto Joven
9.
Medicine (Baltimore) ; 99(11): e19009, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-32176029

RESUMEN

Quick diagnosis units (QDU) have become an alternative hospital-based ambulatory medicine strategy to inpatient hospitalization for potentially serious illnesses in Spain. Whether diagnosis of pancreatic cancer is better accomplished by an ambulatory or inpatient approach is unknown. The main objective of this retrospective study was to examine and compare the diagnostic effectiveness of a QDU or inpatient setting in patients with pancreatic cancer.Patients with a diagnosis of pancreatic adenocarcinoma who had been referred to a university, tertiary hospital-based QDU or hospitalized between 2005 and 2018 were eligible. Presenting symptoms and signs, risk and prognostic factors, and time to diagnosis were compared. The costs incurred during the diagnostic assessment were analyzed with a microcosting method.A total of 1004 patients (508 QDU patients and 496 inpatients) were eligible. Admitted patients were more likely than QDU patients to have weight loss, asthenia, anorexia, abdominal pain, jaundice, and palpable hepatomegaly. Time to diagnosis of inpatients was similar to that of QDU patients (4.1 [0.8 vs 4.3 [0.6] days; P = .163). Inpatients were more likely than QDU patients to have a tumor on the head of the pancreas, a tumor size >2 cm, a more advanced nodal stage, and a poorer histological differentiation. No differences were observed in the proportion of metastatic and locally advanced disease and surgical resections. Microcosting revealed a cost of &OV0556;347.76 (48.69) per QDU patient and &OV0556;634.36 (80.56) per inpatient (P < .001).Diagnosis of pancreatic cancer is similarly achieved by an inpatient or QDU clinical approach, but the latter seems to be cost-effective. Because the high costs of hospitalization, an ambulatory diagnostic assessment may be preferable in these patients.


Asunto(s)
Adenocarcinoma/diagnóstico , Atención Ambulatoria/métodos , Hospitalización/estadística & datos numéricos , Neoplasias Pancreáticas/diagnóstico , Adenocarcinoma/economía , Anciano , Atención Ambulatoria/economía , Atención Ambulatoria/estadística & datos numéricos , Costos de la Atención en Salud , Hospitalización/economía , Humanos , Persona de Mediana Edad , Neoplasias Pancreáticas/economía , Pronóstico , Estudios Retrospectivos , Factores de Riesgo , España , Listas de Espera
10.
Environ Pollut ; 261: 114205, 2020 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-32113107

RESUMEN

Clinical or pathological evidence demonstrated that air pollution could undermine other organ systems of human body besides respiratory and circulation systems. Investigations that directly relate hospital outpatient visits for endocrine (ENDO), digestive (DIGE), urological (UROL), and dermatological (DERM) diseases categories with ambient particulate matter (PM) are still lacking, particularly in heavily polluted cities. Here, we conducted a time-series analysis using 812,624, 1,111,342, 539,803, and 741,662 hospital visits for ENDO, DIGE, UROL, and DERM, respectively, in Nanjing, China from 2013 to 2019. A generalized additive model was applied to estimate the exposure-response associations. Results showed that a 10 µg/m3 increase in PM2.5 concentration on lag 0 day was significantly associated with 0.59% (95% CI: 0.30%, 0.88%), 0.43% (0.15%, 0.70%), 0.36% (0.06%, 0.66%), and 0.65% (0.42%, 0.87%) increase for ENDO, DIGE, UROL, and DERM hospital visits, respectively. The estimated effects of PM10 were slightly smaller but still statistically significant. The magnitude and significance of the associations between PM and four health outcomes were sensitive to additional adjustment for co-pollutants. Exposure-response relationships were linear for PM concentrations lower than 100 µg/m3 but the curves became nonlinear across the full range of exposures due to a flatten slope at higher concentrations. We also explored the effect modifications by season (cold or warm), age (5-18, 18-64, 65-74, or 75+ years), and sex (male or female). Results showed that the DERM-related population aged 65 years or older was more vulnerable to PM exposure, compared with the 5 to 17-year age group; the DERM-related population aged 75 years or older and 65 years or older was more vulnerable to PM2.5 and PM10 exposure, respectively, compared with the 18 to 64-year age group. Our study provided suggestive evidence that ambient PM pollution was associated with ENDO, DIGE, UROL, and DERM outpatient hospital visits in Nanjing, China.


Asunto(s)
Contaminación del Aire , Atención Ambulatoria , Enfermedades del Sistema Digestivo , Enfermedades del Sistema Endocrino , Material Particulado , Enfermedades de la Piel , Enfermedades Urológicas , Anciano , Contaminación del Aire/análisis , Contaminación del Aire/estadística & datos numéricos , Atención Ambulatoria/estadística & datos numéricos , China/epidemiología , Ciudades/estadística & datos numéricos , Enfermedades del Sistema Digestivo/epidemiología , Enfermedades del Sistema Endocrino/epidemiología , Exposición a Riesgos Ambientales , Femenino , Humanos , Masculino , Enfermedades de la Piel/epidemiología , Enfermedades Urológicas/epidemiología
11.
Medicine (Baltimore) ; 99(5): e18532, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-32000362

RESUMEN

Fever is one of the most common symptoms seen in patients. The work-up and follow-up of fever in an outpatient-only setting is a reasonable option for stable patients referred for unexplained fever; however, the safety and efficacy of outpatient follow-up for those patients remain unclear. We conducted this study to evaluate the safety and efficacy of outpatient follow-up for referred patients with unexplained fever.This study was a retrospective cohort study. We included patients referred to the outpatient department of the diagnostic medicine of our university hospital for unexplained fever between October 2016 and September 2017. Exclusion criteria were recurrent fever or admission for fever evaluation prior to referral. Main outcomes of interest were the rate of admission without diagnosis, rate of remission of fever, and the total duration of fever in undiagnosed patients.Among 84 patients included in this study, 17 (20%) were diagnosed during outpatient follow-up, 6 (7%) were admitted due to worsened condition, 5 (6%) were lost to follow-up, and 56 (67%) were followed up as outpatients without a diagnosis. Among the 56 undiagnosed patients, fever resolved in 53 during outpatient follow-up with or without treatment (95%). The total duration of resolved fever in undiagnosed patients was within 8 weeks.Follow-up of patients referred for unexplained fever in an outpatient setting is safe and effective.


Asunto(s)
Cuidados Posteriores/estadística & datos numéricos , Atención Ambulatoria/estadística & datos numéricos , Fiebre de Origen Desconocido , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos
12.
Pneumologie ; 74(4): 201-209, 2020 Apr.
Artículo en Alemán | MEDLINE | ID: mdl-32053838

RESUMEN

BACKGROUND: The aim of this study was to evaluate the effects of an outpatient medical rehabilitation (OMR) mainly composed of exercise therapy and sports for patients with asbestosis and focused on keeping up sustainability effects. METHODS: 157 male patients aged 65.2 ±â€Š5.7 years suffering from asbestosis carried out over a period of three weeks 5 times weekly 6 h at a time phase 1 of the OMR consisting of evidence-based contents of the pulmonary rehabilitation. In the immediately following phase 2, the patients completed once a week for 3 hours over 12 weeks further therapeutic applications with the main focus on exercise therapy and sports and were subsequently transferred to health sports groups near to residence (phase 3). The effects of the OMR were evaluated at the beginning (T1), at the end of phase 1 (T2) and phase 2 (T3) as well as 6 (T4) and 20 months (T5) after T3. 61 patients (73.5 years ±â€Š5.6) were re-examined 6 years after T5 (T6) without any interim care. RESULTS: 72.1 % of the 61 patients (n = 44) carried out health sports twice a week in T5 as well as in T6 eight years after T1 and were able to maintain their physical performance (6-minute walk test, hand force, PWC test) as well as the perceived quality of life (SF-36, baseline/transition dyspnea index) according to age, while the rehab effects of the 17 patients breaking off any sporting activities after T3 fell significantly (p < .01) below the starting condition in T1. CONCLUSIONS: In spite of a restrictive pulmonary disease specific exercise therapy and sports are able to mobilize physical reserves of performance and induce an increasing quality of life as well as a higher resilience in activities of daily living. These positive effects could be stabilized in the long term by a regular training. The results underline the necessity of integrating aftercare strategies into the concept of rehabilitation with special consideration of perceived self-efficacy.


Asunto(s)
Atención Ambulatoria/estadística & datos numéricos , Asbestosis/rehabilitación , Terapia por Ejercicio/métodos , Actividades Cotidianas , Anciano , Asbestosis/diagnóstico , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Pacientes Ambulatorios , Calidad de Vida , Resultado del Tratamiento
13.
Med. clín (Ed. impr.) ; 154(3): 86-93, feb. 2020. graf, tab
Artículo en Español | IBECS | ID: ibc-189060

RESUMEN

ANTECEDENTES Y OBJETIVO: Evaluar el malestar emocional y el nivel de complejidad de pacientes presentados al Comité de Atención Psicosocial. MATERIALES Y MÉTODOS: Estudio pre-post con un solo grupo en pacientes con cáncer. De los 144 pacientes, 27 fueron derivados por el comité a especialistas del área psicosocial, y sus niveles de malestar emocional y de complejidad fueron revisados un mes después. RESULTADOS: Tras ser atendidos según indicaciones del comité, los pacientes mostraron un descenso significativo de los valores en malestar emocional: la media inicial de 8 puntos en la escala visual analógica de malestar emocional descendía a 5,8 puntos. El descenso se reflejó también en los niveles de complejidad: antes de ser revisados, el 70,4% de los pacientes mostraban un alto nivel de complejidad y el 7,4%, un nivel bajo. Después de ser atendidos, los porcentajes de pacientes con alta complejidad se redujeron al 48,1% en los enfermos con alta complejidad, y aumentaron al 22,3% en los de baja complejidad. CONCLUSIONES: El comité ofrece un instrumento para derivar los casos de mayor complejidad que requieren atención preferente y multidisciplinar, permitiendo optimizar recursos, por su eficacia en la resolución de casos complejos


BACKGROUND AND AIM: To assess emotional distress and complexity of patients referred to the Psychosocial Committee. MATERIAL AND METHODS: A pre-post single group study was performed in a sample of oncological patients. From the 144 patients referred to the committee, 27 were attended by psychosocial specialists. The patients' levels of emotional distress and psychosocial complexity were reviewed one month later. RESULTS: After having been attended according to the committee's indications, the patients showed significant decreases in emotional distress. The initial mean of 8 points on the emotional distress scale decreased to 5.81 points after having been referred to the specialist. This decline was also observed in psychosocial complexity. Before attendance, 70.4% patients showed high levels of complexity, and 7.4% showed low levels. After attendance, the percentages of patients with high levels of psychosocial complexity reduced to 48.1% and patients with low complexity increased to 22.2%. CONCLUSIONS: The committee provides an instrument to refer patients who show high levels of psychosocial complexity and require preferential and multidisciplinary attention. The committee optimizes resources due to its efficiency in resolving complex cases


Asunto(s)
Humanos , Persona de Mediana Edad , Psicooncología/métodos , Neoplasias/psicología , Agotamiento Psicológico/psicología , Vulnerabilidad Social , Impacto Psicosocial , Familia/psicología , Atención Ambulatoria/estadística & datos numéricos , Técnica Delfos , Análisis de Vulnerabilidad , Comité de Profesionales/organización & administración
14.
Cancer Causes Control ; 31(4): 353-363, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-32086673

RESUMEN

PURPOSE: Cancer treatment may be affected by comorbidities; however, studies are limited. The purpose of this study is to examine the frequency of comorbidities at visits by patients with breast, prostate, colorectal, and lung cancer and to estimate frequency of a prescription for antineoplastic drugs being included in the treatment received at visits by patients with cancer and concomitant comorbidities. METHODS: We used nationally representative data on visits to office-based physicians from the 2010-2016 National Ambulatory Medical Care Survey and selected visits by adults with breast, prostate, colorectal, or lung cancer (n = 4,672). Nineteen comorbid conditions were examined. Descriptive statistics were calculated for visits by cancer patients with 0, 1, and ≥ 2 comorbidities. RESULTS: From 2010-2016, a total of 10.2 million physician office visits were made annually by adult patients with breast, prostate, colorectal, or lung cancer. Among US visits by adult patients with breast, prostate, colorectal, or lung cancer, 56.3% were by patients with ≥ 1 comorbidity. Hypertension was the most frequently observed comorbidity (37.7%), followed by hyperlipidemia (19.0%) and diabetes (12.3%). Antineoplastic drugs were prescribed in 33.5% of the visits and prescribed at a lower percentage among visits by cancer patients with COPD (21.3% versus 34.3% of visits by cancer patients without COPD) and heart disease (22.7% versus 34.2% of visits by cancer patients without heart disease). CONCLUSION: Our study provides information about comorbidities in cancer patients being treated by office-based physicians in an ambulatory setting.


Asunto(s)
Antineoplásicos/administración & dosificación , Neoplasias/tratamiento farmacológico , Neoplasias/epidemiología , Anciano , Atención Ambulatoria/estadística & datos numéricos , Comorbilidad , Femenino , Encuestas de Atención de la Salud , Humanos , Masculino , Persona de Mediana Edad , Visita a Consultorio Médico/estadística & datos numéricos , Prescripciones/estadística & datos numéricos , Estados Unidos/epidemiología
15.
Bone Joint J ; 102-B(1): 82-89, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31888355

RESUMEN

AIMS: The aim of this study was to report our experience at 3.5 years with outpatient total hip arthroplasty (THA). METHODS: In this prospective cohort study, we included all patients who were planned to receive primary THA through the anterior approach between 1 April 2014 and 1 October 2017. Patient-related data and surgical information were recorded. Patient reported outcome measures (PROMs) related to the hip and an anchor question were taken preoperatively, at six weeks, three months, and one year after surgery. All complications, readmissions, and reoperations were registered. RESULTS: Of the 647 THA patients who had surgery in this period through the anterior approach, 257 patients (39.7%) met the inclusion criteria and were scheduled for THA in an outpatient setting. Of these, 40 patients (15.6%) were admitted to the hospital, mainly because of postoperative nausea and/or dizziness. All other 217 patients were able to go home on the day of surgery. All hip-related PROMs improved significantly up to 12 months after surgery, compared with the scores before surgery. There were three readmissions and two reoperations in the outpatient cohort. There were no complications related to the outpatient THA protocol. CONCLUSION: These study results confirm that outpatient THA can be performed safe and successfully in a selected group of patients, with satisfying results up to one year postoperatively, and without outpatient-related complications, readmissions, and reoperations. Cite this article: Bone Joint J 2020;102-B(1):82-89.


Asunto(s)
Atención Ambulatoria/estadística & datos numéricos , Artroplastia de Reemplazo de Cadera/estadística & datos numéricos , Actividades Cotidianas , Anciano , Estudios de Casos y Controles , Femenino , Fracturas de Cadera/cirugía , Hospitalización/estadística & datos numéricos , Humanos , Masculino , Persona de Mediana Edad , Readmisión del Paciente/estadística & datos numéricos , Medición de Resultados Informados por el Paciente , Satisfacción del Paciente , Fracturas Periprotésicas/cirugía , Estudios Prospectivos , Reoperación/estadística & datos numéricos , Índice de Severidad de la Enfermedad , Encuestas y Cuestionarios
16.
Plast Reconstr Surg ; 145(2): 303-311, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31985608

RESUMEN

BACKGROUND: The authors compared long-term health care use and cost in women undergoing immediate autologous breast reconstruction and implant-based breast reconstruction. METHODS: This study was conducted using the OptumLabs Data Warehouse, which contains deidentified retrospective administrative claims data, including medical claims and eligibility information from a large U.S. health insurance plan. Women who underwent autologous or implant-based breast reconstruction between January of 2004 and December of 2014 were included. The authors compared 2-year use rates and predicted costs of care. Comparisons were tested using the t test. RESULTS: Overall, 12,296 women with immediate breast reconstruction were identified; 4257 with autologous (35 percent) and 8039 with implant-based (65 percent) breast reconstruction. The proportion of autologous breast reconstruction decreased from 47.2 percent in 2004 to 32.7 percent in 2014. The mean predicted reconstruction cost of autologous reconstruction was higher than that of implant-based reconstruction in both unilateral and bilateral surgery. Similar results for mean predicted 2-year cost of care were seen in bilateral procedures. However, in unilateral procedures, the 2-year total costs were higher for implant-based than for autologous reconstruction. Two-year health care use rates were higher for implant-based reconstruction than for autologous reconstruction for both unilateral and bilateral procedures. Women undergoing unilateral implant-based reconstruction had higher rates of hospital admissions (30.3 versus 23.1 per 100; p < 0.01) and office visits (2445.1 versus 2283.6 per 100; p < 0.01) than those who underwent autologous reconstruction. Emergency room visit rates were similar between the two methods. Bilateral procedures yielded similar results. CONCLUSION: Although implant-based breast reconstruction is a less expensive index operation than autologous breast reconstruction, it was associated with higher health care use, resulting in similar total cost of care over 2 years.


Asunto(s)
Implantación de Mama/métodos , Neoplasias de la Mama/cirugía , Mamoplastia/métodos , Adolescente , Adulto , Atención Ambulatoria/economía , Atención Ambulatoria/estadística & datos numéricos , Implantación de Mama/economía , Implantes de Mama/economía , Implantes de Mama/estadística & datos numéricos , Neoplasias de la Mama/economía , Costos y Análisis de Costo , Servicio de Urgencia en Hospital/economía , Servicio de Urgencia en Hospital/estadística & datos numéricos , Utilización de Instalaciones y Servicios , Femenino , Hospitalización/economía , Hospitalización/estadística & datos numéricos , Humanos , Mamoplastia/economía , Persona de Mediana Edad , Estudios Retrospectivos , Trasplante Autólogo/economía , Trasplante Autólogo/estadística & datos numéricos , Estados Unidos , Adulto Joven
17.
Med Care ; 58(5): 468-473, 2020 05.
Artículo en Inglés | MEDLINE | ID: mdl-31934953

RESUMEN

BACKGROUND: Health care costs and utilization for those with an intellectual or developmental disability (IDD) have been shown to be higher than the general population. OBJECTIVE: To investigate the services that contribute to higher costs and utilization among noninstitutionalized children with an IDD. DESIGN: Matched case-control secondary analysis of the 2000-2017 Medical Expenditure Panel Survey. Pediatric (age 0-21) patients with an IDD were matched to non-IDD subjects. Health care utilization and costs were evaluated with zero-inflated negative binomial regressions and generalized linear models, respectively. MEASURES: Outcome measures included high-acuity health care utilization [ie, emergency department (ED) visits and hospital admissions], and cost outcomes for total spending, ED use, hospitalization, medications, office visits, home health, and physical therapy. RESULTS: There was no statistical difference in utilization of EDs among the 2 groups though subjects with an IDD showed more hospitalizations than their matched cohort (incidence rate ratios=1.63, P=0.00). Total health care spending was higher among patients with an IDD (coefficient=$5831, P=0.00). Pediatric spending was higher in all measures except for ED. The biggest discrepancies in spending were seen in home health (coefficient=$2558, P=0.00) and outpatient visits (coefficient=$1180, P=0.00). CONCLUSIONS: Pediatric patients with an IDD had higher health care spending and utilization than non-IDD subjects in all categories except for ED use.


Asunto(s)
Discapacidades del Desarrollo/economía , Gastos en Salud/estadística & datos numéricos , Discapacidad Intelectual/economía , Atención Ambulatoria/economía , Atención Ambulatoria/estadística & datos numéricos , Estudios de Casos y Controles , Niño , Discapacidades del Desarrollo/epidemiología , Servicio de Urgencia en Hospital/economía , Servicio de Urgencia en Hospital/estadística & datos numéricos , Femenino , Encuestas Epidemiológicas , Servicios de Atención de Salud a Domicilio/economía , Servicios de Atención de Salud a Domicilio/estadística & datos numéricos , Hospitalización/economía , Hospitalización/estadística & datos numéricos , Humanos , Discapacidad Intelectual/epidemiología , Masculino , Estados Unidos/epidemiología
18.
Am J Gastroenterol ; 115(1): 128-137, 2020 01.
Artículo en Inglés | MEDLINE | ID: mdl-31895723

RESUMEN

OBJECTIVES: The prevalence of inflammatory bowel disease (IBD) is increasing. The total direct costs of IBD have not been assessed on a population-wide level in the era of biologic therapy. DESIGN: We identified all persons with IBD in Manitoba between 2005 and 2015, with each matched to 10 controls on age, sex, and area of residence. We enumerated all hospitalizations, outpatient visits and prescription medications including biologics, and their associated direct costs. Total and per capita annual IBD-attributable costs and health care utilization (HCU) were determined by taking the difference between the costs/HCU accrued by an IBD case and their controls. Generalized linear modeling was used to evaluate trends in direct costs and Poisson regression for trends in HCU. RESULTS: The number of people with IBD in Manitoba increased from 6,323 to 7,603 between 2005 and 2015. The total per capita annual costs attributable to IBD rose from $3,354 in 2005 to $7,801 in 2015, primarily driven by an increase in per capita annual anti-tumor necrosis factor costs, which rose from $181 in 2005 to $5,270 in 2015. There was a significant decline in inpatient costs for CD ($99 ± 25/yr. P < 0.0001), but not for ulcerative colitis ($8 increase ±$18/yr, P = 0.63). DISCUSSION: The direct health care costs attributable to IBD have more than doubled over the 10 years between 2005 and 2015, driven mostly by increasing expenditures on biological medications. IBD-attributable hospitalization costs have declined modestly over time for persons with CD, although no change was seen for patients with ulcerative colitis.


Asunto(s)
Productos Biológicos/economía , Colitis Ulcerosa/economía , Enfermedad de Crohn/economía , Costos Directos de Servicios/estadística & datos numéricos , Costos Directos de Servicios/tendencias , Adulto , Factores de Edad , Anciano , Atención Ambulatoria/economía , Atención Ambulatoria/estadística & datos numéricos , Productos Biológicos/uso terapéutico , Estudios de Casos y Controles , Colitis Ulcerosa/tratamiento farmacológico , Colitis Ulcerosa/epidemiología , Enfermedad de Crohn/tratamiento farmacológico , Enfermedad de Crohn/epidemiología , Prescripciones de Medicamentos/economía , Prescripciones de Medicamentos/estadística & datos numéricos , Femenino , Hospitalización/economía , Hospitalización/estadística & datos numéricos , Humanos , Estudios Longitudinales , Masculino , Manitoba/epidemiología , Persona de Mediana Edad , Aceptación de la Atención de Salud/estadística & datos numéricos , Prevalencia , Estudios Retrospectivos , Factores Sexuales
19.
PLoS One ; 15(1): e0228148, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31990930

RESUMEN

INTRODUCTION: Zimbabwe is scaling up HIV differentiated service delivery (DSD) to improve treatment outcomes and health system efficiencies. Shifting stable patients into less-intensive DSD models is a high priority in order to accommodate the large numbers of newly-diagnosed people living with HIV (PLHIV) needing treatment and to provide healthcare workers with the time and space needed to treat people with advanced HIV disease. DSD is also seen as a way to improve service quality and enhance retention in care. National guidelines support five differentiated antiretroviral treatment models (DART) for stable HIV-positive adults, but little is known about patient preferences, a critical element needed to guide DART scale-up and ensure person-centered care. We designed a mixed-methods study to explore treatment preferences of PLHIV in urban Zimbabwe. METHODS: The study was conducted in Harare, and included 35 health care worker (HCW) key informant interviews (KII); 8 focus group discussions (FGD) with 54 PLHIV; a discrete choice experiment (DCE) in which 500 adult DART-eligible PLHIV selected their preferences for health facility (HF) vs. community location, individual vs. group meetings, provider cadre and attitude, clinic operation times, visit frequency, visit duration and cost to patient; and a survey with the 500 DCE participants exploring DART knowledge and preferences. RESULTS: Patient preferences were consistent in the FGDs, DCE and survey. Participants strongly preferred respectful HCWs, HF-based services, individual DART models, and less costly services. Patients also preferred less frequent visits and shorter wait times. They were indifferent to variations in HCW cadre and distances from home to HF. These preferences were mostly homogenous, with only minor differences between male vs. female and older vs. younger patients. HCWs in the KII correctly characterized facility-based individual models as the one most favored by patients; HCWs also preferred this model, which they felt decongested HFs and reduced their workload. CONCLUSIONS: DART-eligible PLHIV in Harare found it relatively easy to access HFs, and preferred attributes associated with facility-based individual models. Prioritizing these for scale-up in urban areas may be the most efficient way to sustain positive patient outcomes and increase health system performance.


Asunto(s)
Fármacos Anti-VIH/uso terapéutico , Infecciones por VIH/tratamiento farmacológico , Población Urbana/estadística & datos numéricos , Adolescente , Adulto , Atención Ambulatoria/psicología , Atención Ambulatoria/estadística & datos numéricos , Conducta de Elección , Confidencialidad , Femenino , Grupos Focales , Infecciones por VIH/epidemiología , Infecciones por VIH/psicología , Humanos , Masculino , Encuestas y Cuestionarios , Adulto Joven , Zimbabwe/epidemiología
20.
N Engl J Med ; 382(2): 152-162, 2020 01 09.
Artículo en Inglés | MEDLINE | ID: mdl-31914242

RESUMEN

BACKGROUND: There is widespread interest in programs aiming to reduce spending and improve health care quality among "superutilizers," patients with very high use of health care services. The "hotspotting" program created by the Camden Coalition of Healthcare Providers (hereafter, the Coalition) has received national attention as a promising superutilizer intervention and has been expanded to cities around the country. In the months after hospital discharge, a team of nurses, social workers, and community health workers visits enrolled patients to coordinate outpatient care and link them with social services. METHODS: We randomly assigned 800 hospitalized patients with medically and socially complex conditions, all with at least one additional hospitalization in the preceding 6 months, to the Coalition's care-transition program or to usual care. The primary outcome was hospital readmission within 180 days after discharge. RESULTS: The 180-day readmission rate was 62.3% in the intervention group and 61.7% in the control group. The adjusted between-group difference was not significant (0.82 percentage points; 95% confidence interval, -5.97 to 7.61). In contrast, a comparison of the intervention-group admissions during the 6 months before and after enrollment misleadingly suggested a 38-percentage-point decline in admissions related to the intervention because the comparison did not account for the similar decline in the control group. CONCLUSIONS: In this randomized, controlled trial involving patients with very high use of health care services, readmission rates were not lower among patients randomly assigned to the Coalition's program than among those who received usual care. (Funded by the National Institute on Aging and others; ClinicalTrials.gov number, NCT02090426; American Economic Association registry number, AEARCTR-0000329.).


Asunto(s)
Enfermedad Crónica/terapia , Hospitalización/estadística & datos numéricos , Manejo de Atención al Paciente/métodos , Readmisión del Paciente/estadística & datos numéricos , Adulto , Anciano , Atención Ambulatoria/estadística & datos numéricos , Costos de la Atención en Salud , Visita Domiciliaria , Humanos , Modelos Lineales , Persona de Mediana Edad , New Jersey , Manejo de Atención al Paciente/organización & administración , Resumen del Alta del Paciente , Estudios Prospectivos , Factores Socioeconómicos , Estados Unidos
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