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1.
Acta otorrinolaringol. esp ; 69(6): 331-338, nov.-dic. 2018. tab, graf
Artículo en Inglés | IBECS | ID: ibc-180496

RESUMEN

Objective: Epistaxis is the most common rhinological emergency seen in the emergency department. The purpose of this study was to evaluate epidemiological data of epistaxis in a southern European tertiary care hospital. Methods: A retrospective study was conducted during the period between January 2009 and December 2015. We analyzed the distribution by cross-referencing the demographic variables, destination after medical discharge, inpatient characteristics (major comorbid diseases, medication, bleeding localization and treatment) and health-care costs with the disease. Results: Epistaxis accounted for approximately 1 in 30 visits to the ED and 77 out of a population of 100,000 was served by that ED. Overall, 71,624 patients were treated and 2371 patients presented with epistaxis (3.31%). One-thousand three-hundred and twenty-seven cases were male and 1044 female (p <.001). The mean age was 56 years (±26). Age distribution was bimodal, with peaks among those <10 years and >70 (p <.001). Epistaxis was more common in the winter months (p < 0.001). The main referral destinations (6.8%) included outpatient (2.9%) and inpatient (1.9%) services. Hospitalization was more frequent between the ages of 60 and 80 years (p =.029), and the major comorbidity was hypertension (47.8%). Medication interfering with haemostasis was documented in 30.4%. Most inpatient epistaxis was managed in a non-interventional manner and only. 5% of patients needed surgery. The mean total health-care cost was 69.8 Euros per episode. Conclusion: Emergency epistaxis was more frequent in men, the elderly, patients with underlying comorbidities, during the winter months, and showed a higher risk of referral and hospitalization with increasing age (as a result of an aging population in western countries). The main hospital expenses for epistaxis are related to hospitalization and health care costs


Objetivo: La epistaxis es la urgencia rinológica más comúnmente observada en el servicio de urgencias (SU). El objetivo de este estudio es evaluar los datos epidemiológicos de la epistaxis en un hospital de atención terciaria del sur de Europa. Métodos: Se realizó un estudio retrospectivo durante el periodo comprendido entre enero de 2009 y diciembre de 2015. Analizamos la distribución entrecruzando las variables demográficas, el destino tras el alta médica, las características hospitalarias (enfermedades comórbidas mayores, medicación, localización del sangrado y tratamiento) y los costes sanitarios con la enfermedad. Resultados: La presentación con epistaxis supuso aproximadamente una de 30 visitas al SU, donde se atendió a una población de 77 de cada 100.000 habitantes. En general se trataron 71.624 pacientes, de los cuales 2.371 se presentaron con epistaxis (3,31%). Mil trescientos veintisiete casos eran varones y 1.044 mujeres (p < 0,001). La edad media fue de 56 años (± 26). La distribución de la edad fue bimodal, con valores máximos entre ellos < 10 años y >70 (p < 0,001). La epistaxis fue más común durante los meses invernales (p < 0,001). Los principales destinos de derivación (6,8%) incluyeron los servicios ambulatorios (2,9%) y hospitalarios (1,9%). Las hospitalizaciones fueron más frecuentes entre los 60 y 80 años (p = 0,029), siendo la hipertensión la mayor comorbilidad (47,8%). La medicación que interfirió con la hemostasia se documentó en el 30,4%. A la mayoría de pacientes hospitalarios con epistaxis se les trató de manera no intervencionista, y únicamente el 0,5% de los casos precisó cirugía. Los costes sanitarios totales medios fueron del 69,8 Euros por episodio. Conclusión: La epistaxis de urgencia fue más frecuente en varones, personas mayores, pacientes con comorbilidades subyacentes, durante los meses invernales, y reflejó un mayor riesgo de derivación y hospitalización con el incremento de la edad (como resultado del envejecimiento de la población en los países occidentales). Los principales gastos hospitalarios en los casos de epistaxis guardan relación con la hospitalización y los costes de la atención sanitaria


Asunto(s)
Humanos , Masculino , Femenino , Persona de Mediana Edad , Epistaxis/epidemiología , Servicios Médicos de Urgencia/estadística & datos numéricos , Atención Terciaria de Salud , Centros de Atención Terciaria , Atención Terciaria de Salud/economía , Estudios Retrospectivos , Costo de Enfermedad
3.
J Arthroplasty ; 33(7): 2047-2049, 2018 07.
Artículo en Inglés | MEDLINE | ID: mdl-29615376

RESUMEN

BACKGROUND: Orthopedic surgeons utilize the 22-modifier when billing for complex procedures under the American Medical Association's Current Procedural Terminology (CPT) for reasons such as excessive blood loss, anatomic abnormality, and morbid obesity, cases that would ideally be reimbursed at a higher rate to compensate for additional physician work and time. We investigated how the 22-modifier affects physician reimbursement in knee and hip arthroplasty. METHODS: We queried hospital billing data from 2009 to 2016, identifying all cases performed at our urban tertiary care orthopedic center for knee arthroplasty (CPT codes 27438, 27447, 27487, and 27488) and hip arthroplasty (CPT codes 27130, 27132, 27134, 27236). We extracted patient insurance status and reimbursement data to compare the average reimbursement between cases with and without the 22-modifier. RESULTS: We analyzed data from 2605 procedures performed by 10 providers. There were 136 cases with 22-modifiers. For knee arthroplasty (n = 1323), the 22-modifier did not significantly increase reimbursement after adjusting for insurer, provider, and fiscal year (4.2% dollars higher on average, P = .159). For hip arthroplasty (n = 1282), cases with a 22-modifier had significantly higher reimbursement than those without the 22-modifier (6.2% dollars more, P = .049). For hip arthroplasty cases with a 22-modifier, those noting morbid obesity were reimbursed 29% higher than those cases with other etiology. CONCLUSIONS: The effect of the 22-modifier on reimbursement amount is differential between knee and hip arthroplasty. Hip arthroplasty procedures coded as 22-modifier are reimbursed more than those without the 22-modifier. Providers should consider these potential returns when considering submitting a 22-modifier.


Asunto(s)
Artroplastia de Reemplazo de Cadera/economía , Artroplastia de Reemplazo de Rodilla/economía , Current Procedural Terminology , Reembolso de Seguro de Salud , Ortopedia/economía , Hospitales , Humanos , Medicare , Obesidad Mórbida , Médicos , Atención Terciaria de Salud/economía , Estados Unidos
4.
Expert Rev Pharmacoecon Outcomes Res ; 18(3): 315-320, 2018 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-29022830

RESUMEN

BACKGROUND: Chronic pancreatitis (CP) is a leading cause of hospitalization among gastrointestinal diseases resulting in considerable financial burden to patients. However the direct costs for nonsurgical management in CP remains unexplored. METHODS: A cross sectional study was carried out (2011-14) in the Department of Gastroenterology, Kasturba Hospital, Manipal, India. Demographic and clinical data on laboratory investigations, interventions and follow up were obtained from the medical records department. Item costs were derived from the hospital electronic billing section. Cost was expressed as median annual cost per patient. RESULTS: 65 (male 48; 73.8%) patients were included. Their median age was 31 (range 12-68) years. The annual median (IQR) total cost per patient was INR 88,892 (70,550.5-116,004); [USD 1410(1119-1841); € 1155(916-1507)], comprising of INR 61,089 (39,102.5-90,360.5) [USD 970 (621-1434); € 793(508-1174)] for outpatient management and INR 32,450 (11,016-46,958) [USD 515 (175-745); €421(143-610)] for hospitalization. 69.5% of the treatment cost was attributed to outpatient treatment. Drugs contributed to 54%, hospitalization incurred 30.5%, investigations 12% and professional fees (3.5%) of the total cost. Pancreatic enzyme replacement therapy (PERT) cost contributed to three-quarters of drug therapy. Use of rabeprazole as against pantoprazole reduced the overall annual cost of therapy by 4%. CONCLUSIONS: This study depicts the first nonsurgical management of accrued direct costs associated with CP due to expensive medications. Due to the high cost for PERT, its usefulness needs proper validation by cost benefit analysis.


Asunto(s)
Atención Ambulatoria/economía , Costos de la Atención en Salud , Hospitalización/economía , Pancreatitis Crónica/terapia , 2-Piridinilmetilsulfinilbencimidazoles/economía , 2-Piridinilmetilsulfinilbencimidazoles/uso terapéutico , Adolescente , Anciano , Niño , Análisis Costo-Beneficio , Estudios Transversales , Terapia de Reemplazo Enzimático/economía , Femenino , Hospitales de Enseñanza/economía , Humanos , India , Masculino , Persona de Mediana Edad , Pancreatitis Crónica/economía , Pantoprazol , Rabeprazol/economía , Rabeprazol/uso terapéutico , Estudios Retrospectivos , Atención Terciaria de Salud/economía , Adulto Joven
5.
J Infect Public Health ; 11(4): 507-513, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-29113779

RESUMEN

BACKGROUND: Data on the economic burden of hospital-acquired lower respiratory tract infection (LRTI) among high risk hospitalized patients are lacking in China. This study aims to fill this knowledge gap. METHODS: We used a prospective matched cohort design, comparing patients with LRTIs and 1:1 matched patients without LRTIs. Study period was from January 2013 to December 2015 analyzing inpatients from high risk wards - intensive care unit (ICU), dialysis, hematology, etc. - in a tertiary hospital. Hospital information system and hospital infection surveillance system were applied to extract necessary information. The primary outcome was incidence of hospital-acquired LRTIs, and the secondary was economic burden outcomes, including incremental medical costs and prolonged length of stay (LOS). Wilcoxon's signed rank test was used to explore the differences in the economic burden. RESULTS: Among 5990 hospital visitors over the period of time, 895 (14.94%) had hospital-acquired LRTIs. We analyzed 340 patients with LRTIs and 340 respective controls without infections. The median hospital costs for patients with ICU-acquired LRTIs were significantly higher than those without LRTIs in other wards ($12,301.17 vs. $4674.64, P<0.01). The average attributable cost per patient was $2853.93 ($6916.48 vs. $4062.55, P<0.01). Patients from hematology department had the longest LOS, at 15days (25days vs. 10 days, P<0.01). An LRTI led to an attributable increase in LOS by 8days on average (P<0.01). Western medicine, treatment and laboratory test were the dominant contributors to the growth in overall medical costs in hospital-acquired LRTIs. CONCLUSIONS: Hospital-acquired LRTI imposed considerable economic burden on patients hospitalized in high risk wards in China. This study provides the first data for economic evaluation of LRTI, highlighting the urgent need to establish targeted preventive strategies to minimize the occurrence of this complication to reduce economic burden.


Asunto(s)
Costo de Enfermedad , Infección Hospitalaria/economía , Costos de la Atención en Salud , Hospitalización/economía , Infecciones del Sistema Respiratorio/economía , Infecciones del Sistema Respiratorio/epidemiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Estudios de Cohortes , Infección Hospitalaria/epidemiología , Femenino , Hospitales de Enseñanza/estadística & datos numéricos , Humanos , Incidencia , Control de Infecciones/economía , Unidades de Cuidados Intensivos/economía , Tiempo de Internación/economía , Tiempo de Internación/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Infecciones del Sistema Respiratorio/microbiología , Atención Terciaria de Salud/economía , Atención Terciaria de Salud/normas , Adulto Joven
6.
Soc Sci Med ; 196: 131-141, 2018 01.
Artículo en Inglés | MEDLINE | ID: mdl-29175702

RESUMEN

What is the role of spatial peers in diffusion of information about health care? We use the implementation of a health insurance program in Karnataka, India that provided free tertiary care to poor households to explore this issue. We use administrative data on location of patient, condition for which the patient was hospitalized and date of hospitalization (10,507 observations) from this program starting November 2009 to June 2011 for 19 months to analyze spatial and temporal clustering of tertiary care. We find that the use of healthcare today is associated with an increase in healthcare use in the same local area (group of villages) in future time periods and this association persists even after we control for (1) local area fixed effects to account for time invariant factors related to disease prevalence and (2) local area specific time fixed effects to control for differential trends in health and insurance related outreach activities. In particular, we find that 1 new hospitalization today results in 0.35 additional future hospitalizations for the same condition in the same local area. We also document that these effects are stronger in densely populated areas and become pronounced as the insurance program becomes more mature suggesting that word of mouth diffusion of information might be an explanation for our findings. We conclude by discussing implications of our results for healthcare policy in developing economies.


Asunto(s)
Difusión de la Información , Grupo Paritario , Atención Terciaria de Salud/estadística & datos numéricos , Cobertura Universal del Seguro de Salud , Composición Familiar , Hospitalización/estadística & datos numéricos , Humanos , India , Programas Nacionales de Salud , Pobreza , Evaluación de Programas y Proyectos de Salud , Análisis Espacial , Atención Terciaria de Salud/economía
7.
Proc Natl Acad Sci U S A ; 114(43): 11368-11373, 2017 10 24.
Artículo en Inglés | MEDLINE | ID: mdl-29073058

RESUMEN

Maintaining a robust blood product supply is an essential requirement to guarantee optimal patient care in modern health care systems. However, daily blood product use is difficult to anticipate. Platelet products are the most variable in daily usage, have short shelf lives, and are also the most expensive to produce, test, and store. Due to the combination of absolute need, uncertain daily demand, and short shelf life, platelet products are frequently wasted due to expiration. Our aim is to build and validate a statistical model to forecast future platelet demand and thereby reduce wastage. We have investigated platelet usage patterns at our institution, and specifically interrogated the relationship between platelet usage and aggregated hospital-wide patient data over a recent consecutive 29-mo period. Using a convex statistical formulation, we have found that platelet usage is highly dependent on weekday/weekend pattern, number of patients with various abnormal complete blood count measurements, and location-specific hospital census data. We incorporated these relationships in a mathematical model to guide collection and ordering strategy. This model minimizes waste due to expiration while avoiding shortages; the number of remaining platelet units at the end of any day stays above 10 in our model during the same period. Compared with historical expiration rates during the same period, our model reduces the expiration rate from 10.5 to 3.2%. Extrapolating our results to the ∼2 million units of platelets transfused annually within the United States, if implemented successfully, our model can potentially save ∼80 million dollars in health care costs.


Asunto(s)
Modelos Estadísticos , Transfusión de Plaquetas/estadística & datos numéricos , Atención Terciaria de Salud , California , Registros Electrónicos de Salud , Costos de la Atención en Salud , Humanos , Transfusión de Plaquetas/economía , Atención Terciaria de Salud/economía
8.
Health Econ ; 26(12): e81-e102, 2017 12.
Artículo en Inglés | MEDLINE | ID: mdl-28147440

RESUMEN

One of the main concerns about capitation-based reimbursement systems is that tertiary institutions may be underfunded due to insufficient reimbursements of more complicated cases. We test this hypothesis with a data set from New Zealand that, in 2003, introduced a capitation system where public healthcare provider funding is primarily based on the characteristics of the regional population. Investigating the funding for all cases from 2003 to 2011, we find evidence that tertiary providers are at a disadvantage compared with secondary providers. The reasons are that tertiary providers not only attract the most complicated, but also the highest number of cases. Our findings suggest that accurate risk adjustment is crucial to the success of a capitation-based reimbursement system. Copyright © 2017 John Wiley & Sons, Ltd.


Asunto(s)
Capitación/estadística & datos numéricos , Personal de Salud/economía , Sistema de Pago Prospectivo/economía , Atención Terciaria de Salud/economía , Adulto , Humanos , Persona de Mediana Edad , Nueva Zelanda
10.
J Clin Neurosci ; 38: 114-117, 2017 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-27887977

RESUMEN

Myasthenia gravis (MG) requires lifelong treatment. The cost of management MG is very high in developed countries but there is no information on the cost of management of MG in the developing countries. This study reports the direct and indirect cost and predictors of cost of MG in a tertiary care teaching hospital in India. In a prospective hospital based study, from a tertiary hospital in India 66 consecutive patient during 2014-2015 were included. The age of the patients ranged between 6 and 75years. The severity of MG was assessed by myasthenia gravis foundation association (MGFA) class (MGFA) I-V. The patient data was collected s and their direct cost was calculated from the computerized Hospital information system. The indirect cost was calculated from patient's memory, checking the bills of transportation and wages loss by the patient or the care giver. Total annual cost of MG ranged between INR (4560-532227) with median INR 61390.5 (US$911.64). The median cost of outpatient department (OPD) consultation of 16 patients was INR 20439.9 (US$303.53), of 50 admitted patients was INR 44311.8 (US$658.03) and 21 intensive care unit (ICU) patients was INR 59574.3 (US$ 884.6) and the direct cost of thymectomy was INR 45000 (US$ 668.25). Direct cost was related to indirect cost (r=0.55; p=0.0001). Predictors of patient outcome were severity of MG, ICU admission, and thymectomy. The total median cost for management of myasthenia gravis was INR 61390.5 (4560-532227, US$911.64) per year, and the cost was mainly determined by the severity of MG.


Asunto(s)
Países en Desarrollo/economía , Costos de la Atención en Salud , Hospitales de Enseñanza/economía , Miastenia Gravis/economía , Miastenia Gravis/epidemiología , Atención Terciaria de Salud/economía , Adolescente , Adulto , Anciano , Niño , Femenino , Costos de la Atención en Salud/tendencias , Hospitalización/economía , Hospitalización/tendencias , Hospitales de Enseñanza/tendencias , Humanos , India/epidemiología , Masculino , Persona de Mediana Edad , Miastenia Gravis/terapia , Estudios Prospectivos , Atención Terciaria de Salud/tendencias , Timectomía/economía , Timectomía/métodos , Resultado del Tratamiento , Adulto Joven
11.
Neurosurgery ; 79(4): 541-8, 2016 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-27489167

RESUMEN

BACKGROUND: Thousands of neurosurgical emergencies are transferred yearly to tertiary care facilities to assume a higher level of care. Several studies have examined how neurosurgical transfers influence patient outcomes, but characteristics of potentially avoidable transfers have yet to be investigated. OBJECTIVE: To identify whether potentially avoidable transfers represent a significant portion of transfers to a tertiary neurosurgical facility. METHODS: In this cohort study, we evaluated 916 neurosurgical patients transferred to a tertiary care facility over a 2-year period. Transfers were classified as potentially avoidable when no neurosurgical diagnostic test, intervention, or intensive monitoring was deemed necessary (n = 180). The remaining transfers were classified as justifiable (n = 736). The main outcomes and measures were age, sex, diagnosis, insurance status, intervention, distance of transfer, length of hospital and intensive care unit stay, mortality, discharge disposition, and cost. RESULTS: Nearly 20% of transfers were identified as being potentially avoidable. Although some of these patients had suffered devastating, irrecoverable neurological insults, many had innocuous conditions that did not require transfer to a higher level of care. Justifiable transfers tend to involve patients with nontraumatic intracranial hemorrhage and cranial neoplasm. Both groups were admitted to the intensive care unit at the same rate (approximately 70% of patients). Finally, the direct transportation cost of potentially avoidable transfers was $1.46 million over 2 years. CONCLUSION: This study identified the frequency and expense of potentially avoidable transfers. There is a need for closer examination of the clinical and financial implications of potentially avoidable transfers. ABBREVIATIONS: CI, confidence intervalIQR, interquartile rangeJT, justifiable transferOR, odds ratioPAT, potentially avoidable transferUAB, University of Alabama at Birmingham.


Asunto(s)
Neurocirugia , Transferencia de Pacientes/economía , Atención Terciaria de Salud , Procedimientos Innecesarios , Adulto , Anciano , Estudios de Cohortes , Femenino , Humanos , Masculino , Persona de Mediana Edad , Neurocirugia/economía , Proyectos Piloto , Atención Terciaria de Salud/economía , Procedimientos Innecesarios/economía
12.
PLoS Negl Trop Dis ; 10(2): e0004448, 2016 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-26919606

RESUMEN

BACKGROUND: Rabies is a uniformly fatal disease, but preventable by timely and correct use of post exposure prophylaxis (PEP). Unfortunately, many health care facilities in Pakistan do not carry modern life-saving vaccines and rabies immunoglobulin (RIG), assuming them to be prohibitively expensive and unsafe. Consequently, Emergency Department (ED) health care professionals remain untrained in its application and refer patients out to other hospitals. The conventional Essen regimen requires five vials of cell culture vaccine (CCV) per patient, whereas Thai Red Cross intradermal (TRC-id) regimen requires only one vial per patient, and gives equal seroconversion as compared with Essen regimen. METHODOLOGY/PRINCIPAL FINDINGS: This study documents the cost savings in using the Thai Red Cross intradermal regimen with cell culture vaccine instead of the customary 5-dose Essen intramuscular regimen for eligible bite victims. All patients presenting to the Indus Hospital ED between July 2013 to June 2014 with animal bites received WHO recommended PEP. WHO Category 2 bites received intradermal vaccine alone, while Category 3 victims received vaccine plus wound infiltration with Equine RIG. Patients were counseled, and subsequent doses of the vaccine administered on days 3, 7 and 28. Throughput of cases, consumption utilization of vaccine and ERIG and the cost per patient were recorded. CONCLUSIONS/SIGNIFICANCE: Government hospitals in Pakistan are generally underfinanced and cannot afford treatment of the enormous burden of dog bite victims. Hence, patients are either not treated at all, or asked to purchase their own vaccine, which most cannot afford, resulting in neglect and high incidence of rabies deaths. TRC-id regimen reduced the cost of vaccine to 1/5th of Essen regimen and is strongly recommended for institutions with large throughput. Training ED staff would save lives through a safe, effective and affordable technique.


Asunto(s)
Profilaxis Posexposición/economía , Rabia/economía , Rabia/prevención & control , Atención Terciaria de Salud/economía , Adolescente , Adulto , Animales , Niño , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pakistán , Rabia/epidemiología , Vacunas Antirrábicas/administración & dosificación , Vacunas Antirrábicas/economía , Adulto Joven
13.
Trials ; 16: 215, 2015 May 13.
Artículo en Inglés | MEDLINE | ID: mdl-25968303

RESUMEN

BACKGROUND: Missed injury is commonly used as a quality indicator in trauma care. The trauma tertiary survey (TTS) has been proposed to reduce missed injuries. However a systematic review assessing the effect of the TTS on missed injury rates in trauma patients found only observational studies, only suggesting a possible increase in early detection and reduction in missed injuries, with significant potential biases. Therefore, more robust methods are necessary to test whether implementation of a formal TTS will increase early in-hospital injury detection, decrease delayed diagnosis and decrease missed injuries after hospital discharge. METHODS/DESIGN: We propose a cluster-randomised, controlled trial to evaluate trauma care enhanced with a formalised TTS procedure. Currently, 20 to 25% of trauma patients routinely have a TTS performed. We expect this to increase to at least 75%. The design is for 6,380 multi-trauma patients in approximately 16 hospitals recruited over 24 months. In the first 12 months, patients will be randomised (by hospital) and allocated 1:1 to receive either the intervention (Group 1) or usual care (Group 2). The recruitment for the second 12 months will entail Group 1 hospitals continuing the TTS, and the Group 2 hospitals beginning it to enable estimates of the persistence of the intervention. The intervention is complex: implementation of formal TTS form, small group education, and executive directive to mandate both. Outcome data will be prospectively collected from (electronic) medical records and patient (telephone follow-up) questionnaires. Missed injuries will be adjudicated by a blinded expert panel. The primary outcome is missed injuries after hospital discharge; secondary outcomes are maintenance of the intervention effect, in-hospital missed injuries, tertiary survey performance rate, hospital and ICU bed days, interventions required for missed injuries, advanced diagnostic imaging requirements, readmissions to hospital, days of work and quality of life (EQ-5D-5 L) and mortality. DISCUSSION: The findings of this study may alter the delivery of international trauma care. If formal TTS is (cost-) effective this intervention should be implemented widely. If not, where already partly implemented, it should be abandoned. Study findings will be disseminated widely to relevant clinicians and health funders. TRIAL REGISTRATION: ANZCTR: ACTRN12613001218785, prospectively registered, 5 November 2013.


Asunto(s)
Errores Diagnósticos/prevención & control , Traumatismo Múltiple/diagnóstico , Atención Terciaria de Salud/métodos , Traumatología/métodos , Australia , Análisis Químico de la Sangre , Protocolos Clínicos , Análisis Costo-Beneficio , Diagnóstico por Imagen , Registros Electrónicos de Salud , Costos de Hospital , Humanos , Traumatismo Múltiple/economía , Traumatismo Múltiple/terapia , Examen Físico , Valor Predictivo de las Pruebas , Estudios Prospectivos , Indicadores de Calidad de la Atención de Salud , Proyectos de Investigación , Centros de Atención Terciaria , Atención Terciaria de Salud/economía , Atención Terciaria de Salud/normas , Factores de Tiempo , Traumatología/economía , Traumatología/normas , Resultado del Tratamiento
14.
Diabetes Metab Syndr ; 8(3): 129-32, 2014.
Artículo en Inglés | MEDLINE | ID: mdl-25087885

RESUMEN

BACKGROUND: Worldwide, diabetic foot infections are one of the most serious complications resulting in long term hospitalization among the diabetic patients. AIM: The aim of this study was to determine the microbial profile and the antibiogram pattern of the patients with diabetic foot infections. METHODS: Pus samples were taken from 50 patients presenting with diabetic foot infections over a period of 10 months. The samples were processed by standard microbiological methods. RESULTS: A total of 51 bacterial isolates were obtained from 50 patients with diabetic foot infections. The age group of these patients ranged from 30 to 80 years and the maximum number of patients were in the age group of 51-60 years. Gram negative (51%) were more prevalent than Gram positive (49%) organisms in this study. The commonest isolate was Staphylococcus aureus (41%) followed by Pseudomonas aeruginosa (35%), Enterococcus spp., (4%), Escherichia coli, (4%), Salmonella spp., (4%), Bacillus spp., (4%), Micrococcus spp., (2%), Listeria spp., (2%), Shigella spp., (2%) and Proteus spp., (2%). The antibiotic sensitivity pattern showed Meropenem, Piperacillin, Cefoperazone/Sulbactam, Piperacillin/Tazobactam and Amikacin as the most effective antimicrobial agents for the gram positive and Gram negative bacterial species. In this study, 8(44%) isolates of Gram negative bacilli were ESBL producers and 4 (19%) isolates were MRSA strains. CONCLUSION: The results of the study indicate that effective planning of therapy is very essential for the prevention of drug resistant organisms.


Asunto(s)
Antibacterianos/uso terapéutico , Pie Diabético/microbiología , Infecciones por Bacterias Gramnegativas/microbiología , Infecciones por Bacterias Grampositivas/microbiología , Hospitalización/estadística & datos numéricos , Atención Terciaria de Salud , Adulto , Anciano , Anciano de 80 o más Años , Pie Diabético/epidemiología , Diagnóstico Precoz , Femenino , Infecciones por Bacterias Gramnegativas/epidemiología , Infecciones por Bacterias Grampositivas/epidemiología , Humanos , India/epidemiología , Masculino , Persona de Mediana Edad , Prevalencia , Atención Terciaria de Salud/economía
15.
Intern Med J ; 44(9): 865-72, 2014 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-24893971

RESUMEN

BACKGROUND: Ascites, the most frequent complication of cirrhosis, is associated with poor prognosis and reduced quality of life. Recurrent hospital admissions are common and often unplanned, resulting in increased use of hospital services. AIMS: To examine use of hospital services by patients with cirrhosis and ascites requiring paracentesis, and to investigate factors associated with early unplanned readmission. METHODS: A retrospective review of the medical chart and clinical databases was performed for patients who underwent paracentesis between October 2011 and October 2012. Clinical parameters at index admission were compared between patients with and without early unplanned hospital readmissions. RESULTS: The 41 patients requiring paracentesis had 127 hospital admissions, 1164 occupied bed days and 733 medical imaging services. Most admissions (80.3%) were for management of ascites, of which 41.2% were unplanned. Of those eligible, 69.7% were readmitted and 42.4% had an early unplanned readmission. Twelve patients died and nine developed spontaneous bacterial peritonitis. Of those eligible for readmission, more patients died (P = 0.008) and/or developed spontaneous bacterial peritonitis (P = 0.027) if they had an early unplanned readmission during the study period. Markers of liver disease, as well as haemoglobin (P = 0.029), haematocrit (P = 0.024) and previous heavy alcohol use (P = 0.021) at index admission, were associated with early unplanned readmission. CONCLUSION: Patients with cirrhosis and ascites comprise a small population who account for substantial use of hospital services. Markers of disease severity may identify patients at increased risk of early readmission. Alternative models of care should be considered to reduce unplanned hospital admissions, healthcare costs and pressure on emergency services.


Asunto(s)
Ascitis/etiología , Costo de Enfermedad , Recursos en Salud/estadística & datos numéricos , Hospitalización/economía , Cirrosis Hepática/complicaciones , Paracentesis/economía , Readmisión del Paciente/economía , Atención Terciaria de Salud/economía , Ascitis/economía , Ascitis/epidemiología , Australia/epidemiología , Femenino , Estudios de Seguimiento , Recursos en Salud/economía , Hospitalización/estadística & datos numéricos , Humanos , Cirrosis Hepática/economía , Cirrosis Hepática/epidemiología , Masculino , Persona de Mediana Edad , Paracentesis/estadística & datos numéricos , Readmisión del Paciente/estadística & datos numéricos , Calidad de Vida , Estudios Retrospectivos , Factores de Riesgo , Factores de Tiempo
16.
Antimicrob Agents Chemother ; 58(8): 4470-5, 2014 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-24867975

RESUMEN

Piperacillin-tazobactam (PTZ) is frequently used as empirical and targeted therapy for Gram-negative sepsis. Time-dependent killing properties of PTZ support the use of extended-infusion (EI) dosing; however, studies have shown inconsistent benefits of EI PTZ treatment on clinical outcomes. We performed a retrospective cohort study of adult patients who received EI PTZ treatment and historical controls who received standard-infusion (SI) PTZ treatment for presumed sepsis syndromes. Data on mortality rates, clinical outcomes, length of stay (LOS), and disease severity were obtained. A total of 843 patients (662 with EI treatment and 181 with SI treatment) were available for analysis. Baseline characteristics of the two groups were similar, except for fewer female patients receiving EI treatment. No significant differences between the EI and SI groups in inpatient mortality rates (10.9% versus 13.8%; P = 0.282), overall LOS (10 versus 12 days; P = 0.171), intensive care unit (ICU) LOS (7 versus 6 days; P = 0.061), or clinical failure rates (18.4% versus 19.9%; P = 0.756) were observed. However, the duration of PTZ therapy was shorter in the EI group (5 versus 6 days; P < 0.001). Among ICU patients, no significant differences in outcomes between the EI and SI groups were observed. Patients with urinary or intra-abdominal infections had lower mortality and clinical failure rates when receiving EI PTZ treatment. We did not observe significant differences in inpatient mortality rates, overall LOS, ICU LOS, or clinical failure rates between patients receiving EI PTZ treatment and patients receiving SI PTZ treatment. Patients receiving EI PTZ treatment had a shorter duration of PTZ therapy than did patients receiving SI treatment, and EI dosing may provide cost savings to hospitals.


Asunto(s)
Antibacterianos/uso terapéutico , Infecciones por Bacterias Gramnegativas/tratamiento farmacológico , Infusiones Intravenosas/métodos , Ácido Penicilánico/análogos & derivados , Sepsis/tratamiento farmacológico , Anciano , Antibacterianos/economía , Análisis Costo-Beneficio , Femenino , Bacterias Gramnegativas/efectos de los fármacos , Bacterias Gramnegativas/patogenicidad , Bacterias Gramnegativas/fisiología , Infecciones por Bacterias Gramnegativas/microbiología , Infecciones por Bacterias Gramnegativas/mortalidad , Infecciones por Bacterias Gramnegativas/patología , Humanos , Tiempo de Internación/economía , Masculino , Ácido Penicilánico/economía , Ácido Penicilánico/uso terapéutico , Piperacilina/economía , Piperacilina/uso terapéutico , Combinación Piperacilina y Tazobactam , Estudios Retrospectivos , Sepsis/microbiología , Sepsis/mortalidad , Sepsis/patología , Análisis de Supervivencia , Síndrome , Atención Terciaria de Salud/economía
18.
Pediatr Emerg Care ; 29(12): 1255-9, 2013 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-24257586

RESUMEN

OBJECTIVES: When measuring physicians' competencies, there is no consensus as to what would constitute an optimum exposure in unintentional pediatric poisoning. In the absence of universal protocols and poison centers' support, the behavior responses of the physicians can vary depending on their exposure to cases. We sought to determine if there was a correlation between the case exposure and physicians' behavior choices that could affect quality and cost of care. METHODS: A cross-sectional study was conducted in 2010, and a self-reporting survey questionnaire was given to the physicians in the pediatric emergency departments and primary care centers in the city of Al Ain. The physicians' responses were plotted against (a) the number of cases the physicians have had managed in the preceding 12 months and (b) the number of years the physicians have had been in practice RESULTS: One hundred seven physicians partook in the survey. We found that the physicians who had managed more than 2 cases of childhood poisoning in the preceding year chose significantly more positive behavior responses when compared with those who had managed 2 cases or less. There was no significant difference when the responses were measured against the physicians' number of years of practice. CONCLUSIONS: Physicians' practice effectiveness may improve if they manage at least 3 cases of childhood poisoning in a year. Physicians training modules could be developed for those physicians who do not get the optimum exposure necessary in improving physicians' behaviors associated with effective quality and cost efficiency.


Asunto(s)
Servicios de Salud del Niño , Competencia Clínica , Servicio de Urgencia en Hospital , Pediatría , Envenenamiento , Pautas de la Práctica en Medicina/estadística & datos numéricos , Atención Primaria de Salud , Atención Secundaria de Salud , Atención Terciaria de Salud , Adulto , Actitud del Personal de Salud , Niño , Servicios de Salud del Niño/economía , Conducta de Elección , Competencia Clínica/economía , Estudios Transversales , Servicio de Urgencia en Hospital/economía , Femenino , Adhesión a Directriz , Encuestas de Atención de la Salud , Humanos , Curva de Aprendizaje , Masculino , Persona de Mediana Edad , Padres , Admisión del Paciente , Pediatría/economía , Envenenamiento/diagnóstico , Envenenamiento/economía , Envenenamiento/terapia , Guías de Práctica Clínica como Asunto , Pautas de la Práctica en Medicina/economía , Atención Primaria de Salud/economía , Relaciones Profesional-Familia , Atención Secundaria de Salud/economía , Encuestas y Cuestionarios , Atención Terciaria de Salud/economía , Factores de Tiempo , Emiratos Árabes Unidos
19.
BMC Fam Pract ; 14: 138, 2013 Sep 17.
Artículo en Inglés | MEDLINE | ID: mdl-24044374

RESUMEN

BACKGROUND: Frequently attending patients to primary care (FA) are likely to cost more in primary care than their non-frequently attending counterparts. But how much is spent on specialist care of FAs? We describe the healthcare expenditures of frequently attending patients during 1, 2 or 3 years and test the hypothesis that additional costs can be explained by FAs' combined morbidity and primary care physicians' characteristics. METHODS: Record linkage study. Pseudonymised clinical data from the medical records of 16 531 patients from 39 general practices were linked to healthcare insurer's reimbursements data. Main outcome measures were all reimbursed primary and specialist healthcare costs between 2007 and 2009. Multilevel linear regression analysis was used to quantify the effects of the different durations of frequent attendance on three-year total healthcare expenditures in primary and specialist care, while adjusting for age, sex, morbidities and for primary care physicians characteristics. Primary care physicians' characteristics were collected through administrative data and a questionnaire. RESULTS: Unadjusted mean 3-year expenditures were 5044 and 15 824 Euros for non-FAs and three-year-FAs, respectively. After adjustment for all other included confounders, costs both in primary and specialist care remained substantially higher and increased with longer duration of frequent attendance. As compared to non-FAs, adjusted mean expenditures were 1723 and 5293 Euros higher for one-year and three-year FAs, respectively. CONCLUSIONS: FAs of primary care give rise to substantial costs not only in primary, but also in specialist care that cannot be explained by their multimorbidity. Primary care physicians' working styles appear not to explain these excess costs. The mechanisms behind this excess expenditure remain to be elucidated.


Asunto(s)
Comorbilidad , Gastos en Salud/estadística & datos numéricos , Médicos de Atención Primaria/estadística & datos numéricos , Atención Primaria de Salud/economía , Adolescente , Adulto , Anciano , Estudios de Cohortes , Femenino , Costos de la Atención en Salud/estadística & datos numéricos , Humanos , Modelos Lineales , Masculino , Persona de Mediana Edad , Análisis Multinivel , Análisis Multivariante , Países Bajos , Estudios Retrospectivos , Atención Secundaria de Salud/economía , Atención Terciaria de Salud/economía , Adulto Joven
20.
Otol Neurotol ; 34(7): 1311-5, 2013 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-23921939

RESUMEN

OBJECTIVE: Estimate the available direct cost of cholesteatoma care in a university practice. STUDY DESIGN: Retrospective review of both physician and hospital financial data during a recent 3-year period. SETTING: University-based tertiary referral medical system. PATIENTS: Adults (≥ 18 yr old) with cholesteatoma. INTERVENTION(S): Financial information associated with both physician and hospital encounters were analyzed in a deidentified manner. MAIN OUTCOME MEASURE(S): Frequency and type of encounter, charges, collections, and payers were tabulated. RESULTS: Approximately 949 physician encounters (817 clinic, 130 surgical, and 2 inpatient) among 344 patients resulted in greater than $700, 000 in charges and greater than $211,000 in receipts (≈ 30% rate of collection). The average physician charge per patient per year was approximately $1,600. About 259 hospital encounters among 171 patients resulted in greater than $1.8 million in charges and greater than $520,000 in receipts (≈ 28% collection rate). The average hospital charge per patient per year was ∼$10,000. For physician encounters, managed care (37%) and Medicare (25%) were the most common payers, whereas 17% were uninsured. For hospital encounters, managed care (28%) and Medicare (14%) were the most common payers, whereas 24% were uninsured. CONCLUSION: The direct cost of care for patients with cholesteatoma is significant. The current treatment paradigm for this chronic disorder results in repeated health care system access and associated direct (and unmeasured indirect) expenses. Future treatment paradigms should be designed to improve disease-specific quality of life while mitigating this financial impact.


Asunto(s)
Colesteatoma/economía , Colesteatoma/terapia , Atención Terciaria de Salud/economía , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Costos y Análisis de Costo , Femenino , Hospitalización/economía , Hospitales Universitarios/economía , Humanos , Pacientes Internos , Clasificación Internacional de Enfermedades , Masculino , Programas Controlados de Atención en Salud/economía , Medicare/economía , Persona de Mediana Edad , Médicos , Estudios Retrospectivos , Estados Unidos , Adulto Joven
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