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1.
Intern Med J ; 48(11): 1389-1392, 2018 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-30387312

RESUMEN

Palliative patients who cannot go home are placed into nursing homes. This involves moving between up to five locations in the final weeks of life. We censored all inpatients on a single day from a large tertiary centre to investigate the feasibility of a proposed extended care unit to accommodate patients with a prognosis of less than 90 days, unable to return home, and with nursing home referral process commenced. This study identifies a present demand for an extended care unit (15 patients identified), outlines admission criteria, and proposes a funding model that is predicted to save hospital costs (savings of $207.70 per patient per bed day). This patient-focused approach is a feasible economic solution to the current unmet needs of this patient demographic.


Asunto(s)
Unidades Hospitalarias/economía , Tiempo de Internación/estadística & datos numéricos , Cuidados a Largo Plazo/economía , Cuidados Paliativos/economía , Anciano , Anciano de 80 o más Años , Australia , Análisis Costo-Beneficio , Estudios de Factibilidad , Femenino , Costos de Hospital/estadística & datos numéricos , Unidades Hospitalarias/organización & administración , Humanos , Tiempo de Internación/economía , Cuidados a Largo Plazo/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Atención Dirigida al Paciente/economía , Atención Dirigida al Paciente/métodos , Mejoramiento de la Calidad , Estudios Retrospectivos , Centros de Atención Terciaria
2.
J Pediatr ; 201: 184-189.e2, 2018 10.
Artículo en Inglés | MEDLINE | ID: mdl-29961647

RESUMEN

OBJECTIVES: To assess the effect of a dedicated pediatric syncope unit on the diagnostic and therapeutic management of children with suspected syncope. We also evaluated the effectiveness of the pediatric syncope unit model in decreasing unnecessary tests and hospitalizations, minimizing social costs, and improving diagnostic yield. STUDY DESIGN: This single-center cohort observational, prospective study enrolled 2278 consecutive children referred to Bambino Gesù Children's Hospital from 2012 to 2017. Characteristics of the study population, number and type of admission examinations, and diagnostic findings before the pediatric syncope unit was implemented (2012-2013) and after the pediatric syncope unit was implemented (2014-2015 and 2016-2017) were compared. RESULTS: The proportion of undefined syncope, number of unnecessary diagnostic tests performed, and number of hospital stay days decreased significantly (P < .0001), with an overall decrease in costs. A multivariable logistic regression analysis, adjusted for confounding variables (age, sex, number of diagnostic tests), the period after pediatric syncope unit (2016-2017) resulted as the best independent predictor of effectiveness for a defined diagnosis of syncope (P < .0001). CONCLUSIONS: Pediatric syncope unit organization with fast-tracking access more appropriate diagnostic tests is effective in terms of accuracy of diagnostic yield and reduction of costs.


Asunto(s)
Técnicas de Diagnóstico Cardiovascular/economía , Costos de Hospital , Unidades Hospitalarias/economía , Síncope/diagnóstico , Adolescente , Niño , Femenino , Estudios de Seguimiento , Humanos , Incidencia , Italia/epidemiología , Tiempo de Internación/economía , Tiempo de Internación/tendencias , Masculino , Estudios Prospectivos , Síncope/economía , Síncope/epidemiología
3.
Ther Umsch ; 75(2): 127-134, 2018 Jul.
Artículo en Alemán | MEDLINE | ID: mdl-30022721

RESUMEN

Give the due value to the end of life: the systematic underfunding of specialised palliative care in the Swiss DRG system Abstract. Palliative care is an integral part of modern medicine, improving quality of life, treatment satisfaction, and reducing the costs of care in severe disease. Patients' access should be early, regardless of age, diagnosis and setting, when incurable or advanced disease has been diagnosed. The public expenditure for specialised palliative care units in hospitals can be seen as yardstick for an appropriate palliative care supply, but in Switzerland only a mere fraction of revenues is dedicated to the palliative care units. Every year, 66'000 patients die in Switzerland, 38 % of them in a hospital. Health care costs for the last year of life account for 1.9 billion Swiss francs, but palliative care units receive only estimated 51 million Swiss francs per year. Reasons are a too little number of palliative care units, a systemic underfunding of their services and a fragmentary supply chain for severely ill or dying patients. This leads to ethically conflicting situations for clinicians. They have to deal with shortage of supply and, due to economic reasons, are forced to transfer severely ill or dying patients into inadequate settings. Based on international recommendations, Switzerland is in need of further 500 beds for specialised palliative care (actually 335), and at least 11'000 patients per year need access to a specialised palliative care service (actually about 3'500). Under the actual tariffing system, units for palliative care in hospitals are endangered in their existence. Corrections of the remuneration system are urgently warranted. On the long run, a national legal basis should be elaborated to safeguard adequate palliative care supply for all patients in need and as a base for monitoring, formation and research in palliative care.


Asunto(s)
Grupos Diagnósticos Relacionados/economía , Financiación Gubernamental/economía , Necesidades y Demandas de Servicios de Salud/economía , Programas Nacionales de Salud/economía , Cuidados Paliativos/economía , Cuidado Terminal/economía , Anciano , Anciano de 80 o más Años , Enfermedad Crónica/economía , Enfermedad Crónica/terapia , Financiación Gubernamental/tendencias , Predicción , Gastos en Salud/estadística & datos numéricos , Gastos en Salud/tendencias , Accesibilidad a los Servicios de Salud/economía , Accesibilidad a los Servicios de Salud/tendencias , Necesidades y Demandas de Servicios de Salud/tendencias , Capacidad de Camas en Hospitales/economía , Unidades Hospitalarias/economía , Humanos , Programas Nacionales de Salud/tendencias , Cuidados Paliativos/tendencias , Dinámica Poblacional , Suiza , Cuidado Terminal/tendencias
4.
Australas J Ageing ; 37(2): E42-E48, 2018 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-29570236

RESUMEN

OBJECTIVES: To determine current Australian allied health rehabilitation weekend service provision and to identify perceived barriers to and facilitators of weekend service provision. METHODS: Senior physiotherapists from Australian rehabilitation units completed an online cross-sectional survey exploring current service provision, staffing, perceived outcomes, and barriers and facilitators to weekend service provision. RESULTS: A total of 179 (83%) eligible units responded, with 94 facilities (53%) providing weekend therapy. A Saturday service was the most common (97%) with the most frequent service providers being physiotherapists (90%). Rehabilitation weekend service was perceived to increase patient/family satisfaction (66%) and achieve faster goal attainment (55%). Common barriers were budgetary restraints (66%) and staffing availability (54%), with facilitators including organisational support (76%), staff availability (62%) and staff support (61%). CONCLUSION: Despite increasing evidence of effectiveness, only half of Australian rehabilitation facilities provide weekend services. Further efforts are required to translate evidence from clinical trials into feasible service delivery models.


Asunto(s)
Atención Posterior/organización & administración , Accesibilidad a los Servicios de Salud/organización & administración , Unidades Hospitalarias , Admisión y Programación de Personal/organización & administración , Fisioterapeutas/provisión & distribución , Centros de Rehabilitación , Adolescente , Adulto , Atención Posterior/economía , Anciano , Actitud del Personal de Salud , Australia , Presupuestos , Estudios Transversales , Encuestas de Atención de la Salud , Conocimientos, Actitudes y Práctica en Salud , Accesibilidad a los Servicios de Salud/economía , Costos de Hospital , Unidades Hospitalarias/economía , Humanos , Persona de Mediana Edad , Satisfacción del Paciente , Admisión y Programación de Personal/economía , Fisioterapeutas/economía , Fisioterapeutas/psicología , Recuperación de la Función , Centros de Rehabilitación/economía , Factores de Tiempo , Recursos Humanos , Carga de Trabajo , Adulto Joven
5.
Rev. neurol. (Ed. impr.) ; 66(6): 182-188, 16 mar., 2018. tab, graf
Artículo en Español | IBECS | ID: ibc-172283

RESUMEN

Introducción. La esclerosis múltiple (EM) es una enfermedad desmielinizante y autoinmune con progresión variable y alto riesgo de hospitalización. En algunos estudios, estos ingresos se utilizan como marcadores sustitutivos de la progresión de la enfermedad, pero en Portugal, debido a las asimetrías organizacionales y las opciones de seguridad clínica, esta relación no es lineal. El patrón de ingresos por EM puede proporcionar datos relevantes para el diseño de estrategias de gestión de la enfermedad y asignación de recursos. Objetivo. Caracterizar los ingresos por EM en Portugal continental entre 2002 y 2013 a través de los casos constantes en la base de datos de morbilidad hospitalaria con código de diagnóstico principal CIE-9-MC 340. Pacientes y métodos. Se utilizaron técnicas de mapeo, análisis de clusters espaciotemporales y análisis de variaciones espaciales en tendencias temporales de la tasa de ingresos por EM. Resultados. Entre 2002 y 2013, la tasa de ingreso anual por EM fue de 82,2 por 100.000 ingresos, con una tendencia decreciente anual del 3,73%. Se identificaron siete clusters espaciotemporales con tasas de ingresos por esta patología desde 2,27 a 4,23 superiores a la tasa nacional. Además, se detectaron cuatro áreas con tendencia creciente en la tasa de ingreso en este período temporal (+0,17 a +11,5%): Sintra-Cascais-Amadora, Serra da Estrela, Alentejo-Algarve y Trás-os-Montes. Conclusión. Estos resultados demuestran la asimetría esperada por las diferencias organizativas, factores ambientales, genéticos y opciones de seguridad clínica. Permite la identificación de áreas y tendencias evolutivas de las tasas de ingreso por EM, y posibilita el diseño de intervenciones en salud más enfocadas (AU)


Introduction. Multiple sclerosis (MS) is a demyelinating and autoimmune disease with variable progression and high risk of hospital admission. In some studies these hospitalizations may be used as surrogate markers of disease progression, however in Portugal, due to organizational asymmetries and clinical safety choices this relationship is not linear. The admission patterns for this pathology can provide relevant data to the design of disease’s management strategies and resource allocation. Aim. To characterize hospital admissions for MS in mainland Portugal between 2002 and 2013 through the cases included in the hospital morbidity database with the code ICD-9-CM 340 as primary diagnosis. Patients and methods. In this study mapping techniques, analysis of spatio-temporal clusters and analysis of spatial variations in temporal trends of hospital admission rates for MS were used. Results. Between 2002 and 2013 the rate of annual hospital admission for MS was 82.2/100,000 hospitalizations, with a decreasing trend of 3.73%/year. Seven spatial-temporal clusters were identified with hospital admission rates for this pathology ranging from 2.27 to 4.23 higher than the national rate. In addition, in this time period four areas with increasing trend in hospital admission rate (+ 0.17 to +11.5%) were detected: Sintra-Cascais-Amadora, Serra da Estrela, Alentejo-Algarve and Trás-os-Montes. Conclusion. These data demonstrate the expected asymmetry of organizational differences, environmental, genetic and clinical safety choices. This study allowed the identification of areas and evolutionary trends of hospital admission rates for MS, enabling the design of more focused health interventions (AU)


Asunto(s)
Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Esclerosis Múltiple/epidemiología , Planificación Hospitalaria/organización & administración , Exposición a Riesgos Ambientales , Interferón beta/uso terapéutico , Hospitalización/economía , Hospitalización/estadística & datos numéricos , Portugal/epidemiología , Agrupamiento Espacio-Temporal , Planificación Hospitalaria/estadística & datos numéricos , Actividades Cotidianas , Unidades Hospitalarias/economía , Unidades Hospitalarias/estadística & datos numéricos
6.
West J Emerg Med ; 18(4): 553-558, 2017 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-28611873

RESUMEN

INTRODUCTION: With increasing attention to the actual cost of delivering care, return-on-investment calculations take on new significance. Boarded patients in the emergency department (ED) are harmful to clinical care and have significant financial opportunity costs. We hypothesize that investment in an admissions holding unit for admitted ED patients not only captures opportunity cost but also significantly lowers direct cost of care. METHODS: This was a three-phase study at a busy urban teaching center with significant walkout rate. We first determined the true cost of maintaining a staffed ED bed for one patient-hour and compared it to alternative settings. The opportunity cost for patients leaving without being seen was then conservatively estimated. Lastly, a convenience sample of admitted patients boarding in the ED was observed continuously from one hour after decision-to-admit until physical departure from the ED to capture a record of every interaction with a nurse or physician. RESULTS: Personnel costs per patient bed-hour were $58.20 for the ED, $24.80 for an inpatient floor, $19.20 for the inpatient observation unit, and $10.40 for an admissions holding area. An eight-bed holding unit operating at practical capacity would free 57.4 hours of bed space in the ED and allow treatment of 20 additional patients. This could yield increased revenues of $27,796 per day and capture opportunity cost of $6.09 million over 219 days, in return for extra staffing costs of $218,650. Analysis of resources used for boarded patients was determined by continuous observation of a convenience sample of ED-boarded patients, which found near-zero interactions with both nursing and physicians during the boarding interval. CONCLUSION: Resource expense per ED bed-hour is more than twice that in non-critical care inpatient units. Despite the high cost of available resources, boarded non-critical patients receive virtually no nursing or physician attention. An admissions holding unit is remarkably effective in avoiding the mismatch of the low-needs patients in high-cost care venues. Return on investment is enormous, but this assumes existing clinical space for this unit.


Asunto(s)
Servicio de Urgencia en Hospital/economía , Unidades Hospitalarias/economía , Hospitales de Enseñanza/economía , Admisión del Paciente/economía , Transferencia de Pacientes/economía , Aglomeración , Servicio de Urgencia en Hospital/organización & administración , Accesibilidad a los Servicios de Salud/economía , Accesibilidad a los Servicios de Salud/organización & administración , Necesidades y Demandas de Servicios de Salud/economía , Necesidades y Demandas de Servicios de Salud/organización & administración , Hospitalización/economía , Hospitales de Enseñanza/organización & administración , Humanos , Transferencia de Pacientes/organización & administración , Factores de Tiempo , Población Urbana
8.
Med Mal Infect ; 47(4): 279-285, 2017 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-28343727

RESUMEN

OBJECTIVE: We aimed to describe the management of a carbapenemase-producing Acinetobacter baumannii (CP-AB) outbreak using the Outbreak Reports and Intervention Studies of Nosocomial Infection (ORION) statement. We also aimed to evaluate the cost of the outbreak and simulate costs if a dedicated unit to manage such outbreak had been set-up. METHODS: We performed a prospective epidemiological study. Multiple interventions were implemented including cohorting measures and limitation of admissions. Cost estimation was performed using administrative local data. RESULTS: Five patients were colonized with CP-AB and hospitalized in the neurosurgery ward. The index case was a patient who had been previously hospitalized in Portugal. Four secondary colonized patients were further observed within the unit. The strains of A. baumannii were shown to belong to the same clone and all of them produced an OXA-23 carbapenemase. The closure of the ward associated with the discharge of the five patients in a cohorting area of the Infectious Diseases Unit with dedicated staff put a stop to the outbreak. The estimated cost of this 17-week outbreak was $474,474. If patients had been managed in a dedicated unit - including specific area for cohorting of patients and dedicated staff - at the beginning of the outbreak, the estimated cost would have been $189,046. CONCLUSION: Controlling hospital outbreaks involving multidrug-resistant bacteria requires a rapid cohorting of patients. Using simulation, we highlighted cost gain when using a dedicated cohorting unit strategy for such an outbreak.


Asunto(s)
Infecciones por Acinetobacter/microbiología , Acinetobacter baumannii/enzimología , Proteínas Bacterianas/análisis , Infección Hospitalaria/microbiología , Brotes de Enfermedades , Farmacorresistencia Bacteriana Múltiple , Resistencia betalactámica , beta-Lactamasas/análisis , Infecciones por Acinetobacter/economía , Infecciones por Acinetobacter/epidemiología , Acinetobacter baumannii/efectos de los fármacos , Anciano , Anciano de 80 o más Años , Infección Hospitalaria/economía , Infección Hospitalaria/epidemiología , Francia/epidemiología , Gastos en Salud/estadística & datos numéricos , Costos de Hospital/estadística & datos numéricos , Departamentos de Hospitales , Unidades Hospitalarias/economía , Hospitales Universitarios/economía , Humanos , Infectología , Masculino , Persona de Mediana Edad , Neurocirugia , Aislamiento de Pacientes/economía , Estudios Prospectivos , Centros de Atención Terciaria/economía
9.
Pediatrics ; 138(6)2016 12.
Artículo en Inglés | MEDLINE | ID: mdl-27940716

RESUMEN

OBJECTIVE: Mental health conditions are prevalent among children hospitalized for medical conditions and surgical procedures, but little is known about their influence on hospital resource use. The objectives of this study were to examine how hospitalization characteristics vary by presence of a comorbid mental health condition and estimate the association of a comorbid mental health condition with hospital length of stay (LOS) and costs. METHODS: Using the 2012 Kids' Inpatient Database, we conducted a retrospective, nationally representative, cross-sectional study of 670 161 hospitalizations for 10 common medical and 10 common surgical conditions among 3- to 20-year-old patients. Associations between mental health conditions and hospital LOS were examined using adjusted generalized linear models. Costs of additional hospital days associated with mental health conditions were estimated using hospital cost-to-charge ratios. RESULTS: A comorbid mental health condition was present in 13.2% of hospitalizations. A comorbid mental health condition was associated with a LOS increase of 8.8% (from 2.5 to 2.7 days, P < .001) for medical hospitalizations and a 16.9% increase (from 3.6 to 4.2 days, P < .001) for surgical hospitalizations. For hospitalizations in this sample, comorbid mental health conditions were associated with an additional 31 729 (95% confidence interval: 29 085 to 33 492) hospital days and $90 million (95% confidence interval: $81 to $101 million) in hospital costs. CONCLUSIONS: Medical and surgical hospitalizations with comorbid mental health conditions were associated with longer hospital stay and higher hospital costs. Knowledge about the influence of mental health conditions on pediatric hospital utilization can inform clinical innovation and case-mix adjustment.


Asunto(s)
Enfermedad Crónica/epidemiología , Unidades Hospitalarias/estadística & datos numéricos , Hospitalización/estadística & datos numéricos , Tiempo de Internación/economía , Trastornos Mentales/epidemiología , Trastornos Mentales/terapia , Adolescente , Factores de Edad , Niño , Preescolar , Enfermedad Crónica/terapia , Comorbilidad , Análisis Costo-Beneficio , Estudios Transversales , Bases de Datos Factuales , Femenino , Cirugía General , Costos de Hospital , Unidades Hospitalarias/economía , Hospitales Pediátricos , Humanos , Medicina Interna , Masculino , Trastornos Mentales/diagnóstico , Países Bajos , Estudios Retrospectivos , Medición de Riesgo , Factores Sexuales , Resultado del Tratamiento , Adulto Joven
10.
Health Aff (Millwood) ; 35(9): 1658-64, 2016 09 01.
Artículo en Inglés | MEDLINE | ID: mdl-27605648

RESUMEN

Many hospital executives and economists have suggested that since Medicare adopted a hospital prospective payment system in 1985, prices on the hospital chargemaster (an exhaustive list of the prices for all hospital procedures and supplies) have become irrelevant. However, using 2013 nationally representative hospital data from Medicare, we found that a one-unit increase in the charge-to-cost ratio (chargemaster price divided by Medicare-allowable cost) was associated with $64 higher patient care revenue per adjusted discharge. Furthermore, hospitals appeared to systematically adjust their charge-to-cost ratios: The average ratio ranged between 1.8 and 28.5 across patient care departments, and for-profit hospitals were associated with a 2.30 and a 2.07 higher charge-to-cost ratio than government and nonprofit hospitals, respectively. We also found correlation between the proportion of uninsured patients, a hospital's system affiliation, and its regional power with the charge-to-cost ratio. These findings suggest that hospitals still consider the chargemaster price to be an important way to enhance revenue. Policy makers might consider developing additional policy tools that improve markup transparency to protect patients from unexpectedly high charges for specific services.


Asunto(s)
Administración Financiera de Hospitales/economía , Precios de Hospital/tendencias , Costos de Hospital , Unidades Hospitalarias/economía , Renta/tendencias , Cobertura del Seguro/economía , Femenino , Administración Financiera de Hospitales/tendencias , Unidades Hospitalarias/tendencias , Humanos , Masculino , Pacientes no Asegurados/estadística & datos numéricos , Medicare/economía , Sistema de Pago Prospectivo/organización & administración , Estados Unidos
11.
Clin Med (Lond) ; 16(1): 7-11, 2016 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-26833508

RESUMEN

There is little in the literature describing hospital specialist palliative care units (PCUs) within the NHS. This paper describes how specialist PCUs can be set up within and be entirely funded by the NHS, and outlines some of the challenges and successes of the units. Having PCUs within hospitals has offered patients increased choice over their place of care and death; perhaps not surprisingly leading to a reduced death rate in the acute hospital. However, since the opening of the PCUs there has also been an increased home death rate. The PCUs are well received by patients, families and other staff within the hospital. We believe they offer a model for excellence in cost-effective inpatient specialist palliative care within the NHS.


Asunto(s)
Unidades Hospitalarias/economía , Modelos Organizacionales , Programas Nacionales de Salud/economía , Cuidados Paliativos/economía , Análisis Costo-Beneficio , Humanos
12.
World J Surg ; 40(5): 1034-40, 2016 May.
Artículo en Inglés | MEDLINE | ID: mdl-26675929

RESUMEN

BACKGROUNDS: Cost-effectiveness analysis plays an important role to guide resource allocation decisions, however, information on cost per disability-adjusted life year (DALY) averted by health facilities is not available in many developing economies, including India. We estimated cost per DALY averted for 2611 patients admitted for surgical interventions in a 106-bed private for-profit hospital in northern India. METHODS: Costs were calculated using standard costing methods for the financial year 2012-2013, and effectiveness was measured in DALYs averted using risk of death/disability, effectiveness of treatment and disability weights from 2010 global burden of disease study. RESULTS: During the study period, total operating cost of the hospital for treating surgical patients was USD 1,554,406 and the hospital averted 9401 DALYs resulting in a cost per DALY averted of USD 165. CONCLUSIONS: Even though this study was based on one hospital in India, however, the hospital is a private hospital which is expected to have less surgical case load compared to government health facilities, cost per DALY averted for the surgical interventions is much lower than the cost-effectiveness threshold for India (USD 1508 in 2012). This study therefore provides evidence to re-think the common notion that surgical care is expensive and therefore of lower value than other health interventions.


Asunto(s)
Años de Vida Ajustados por Calidad de Vida , Procedimientos Quirúrgicos Operativos/economía , Análisis Costo-Beneficio , Costos de Hospital , Unidades Hospitalarias/economía , Hospitalización/economía , Hospitales Privados/economía , Humanos , India , Procedimientos Quirúrgicos Operativos/estadística & datos numéricos
13.
Nurs Econ ; 33(5): 255-62, 2015.
Artículo en Inglés | MEDLINE | ID: mdl-26625578

RESUMEN

Evidence supporting the development of Clinical Decision Units (CDUs) to impact congestive heart failure readmission rates comes from several categories of the literature. In this study, a pre-post design with comparison group was used to evaluate the impact of the CDU. Early changes in clinical and financial outcome indicators are encouraging. Nurse leaders seek ways to improve clinical outcomes while managing the current financially challenging environment. Implementation of a CDU provides many opportunities for nurse leaders to positively impact clinical care and financial performance within their institutions.


Asunto(s)
Insuficiencia Cardíaca/enfermería , Unidades Hospitalarias/economía , Readmisión del Paciente/economía , Mejoramiento de la Calidad , Eficiencia Organizacional , Insuficiencia Cardíaca/economía , Humanos , Medicare , Innovación Organizacional , Estados Unidos , Compra Basada en Calidad
15.
Rev Neurol ; 61 Suppl 1: S13-20, 2015.
Artículo en Español | MEDLINE | ID: mdl-26337642

RESUMEN

In spite that headache is, by far, the most frequent reason for neurological consultation and that the diagnosis and treatment of some patients with headache is difficult, the number of headache clinics is scarce in our country. In this paper the main arguments which should allow us, as neurologists, to defend the necessity of implementing headache clinics are reviewed. To get this aim we should first overcome our internal reluctances, which still make headache as scarcely appreciated within our specialty. The facts that more than a quarter of consultations to our Neurology Services are due to headache, that there are more than 200 different headaches, some of them actually invalidating, and the new therapeutic options for chronic patients, such as OnabotulinumtoxinA or neuromodulation techniques, oblige us to introduce specialised headache attendance in our current neurological offer. Even though there are no definite data, available results indicate that headache clinics are efficient in patients with chronic headaches, not only in terms of health benefit but also from an economical point of view.


Asunto(s)
Actitud del Personal de Salud , Cefalea/terapia , Unidades Hospitalarias , Neurología/organización & administración , Servicio Ambulatorio en Hospital , Comunicación Persuasiva , Inhibidores de la Liberación de Acetilcolina/economía , Inhibidores de la Liberación de Acetilcolina/uso terapéutico , Analgésicos/economía , Analgésicos/uso terapéutico , Toxinas Botulínicas Tipo A/economía , Toxinas Botulínicas Tipo A/uso terapéutico , Ahorro de Costo , Utilización de Medicamentos , Eficiencia Organizacional , Terapia por Estimulación Eléctrica/economía , Cefalea/economía , Cefalea/epidemiología , Necesidades y Demandas de Servicios de Salud , Administradores de Hospital/psicología , Departamentos de Hospitales/organización & administración , Unidades Hospitalarias/economía , Unidades Hospitalarias/organización & administración , Unidades Hospitalarias/provisión & distribución , Humanos , Trastornos Migrañosos/tratamiento farmacológico , Trastornos Migrañosos/economía , Trastornos Migrañosos/terapia , Bloqueo Nervioso/economía , Neurología/economía , Servicio Ambulatorio en Hospital/economía , Servicio Ambulatorio en Hospital/organización & administración , Servicio Ambulatorio en Hospital/provisión & distribución , Médicos/psicología , Prevalencia , Terapias en Investigación/economía
16.
Rev. neurol. (Ed. impr.) ; 61(supl.1): s8-s12, sept. 2015. tab
Artículo en Español | IBECS | ID: ibc-144114

RESUMEN

La cefalea constituye el motivo de consulta más frecuente en neurología. Casi la tercera parte de pacientes consultados en esta especialidad lo hace por este motivo. El gradual incremento en la complejidad de asistencia a pacientes con cefalea hace necesaria una mayor especialización por parte de los neurólogos y propicia la creación de unidades especializadas donde desarrollar esta actividad asistencial más compleja. La estructuración y coordinación de las distintas unidades asistenciales corresponde a los jefes de servicio de neurología. En este artículo se recogen los resultados de una encuesta realizado a un grupo de jefes de servicio de neurología para conocer el estado actual de las unidades de cefalea: su opinión sobre la creación, función y desarrollo de unidades de cefalea en los hospitales españoles, y los parámetros de eficacia y eficiencia de éstas (AU)


Headache is the most common reason for visiting in neurology. Almost a third of all patients surveyed in this specialty visit for this reason. The gradual increase in the complexity of the care afforded to patients with headaches requires neurologists to become more specialised and leads to the creation of specialised units where this more complex care can be implemented. The heads of the neurology department are responsible for structuring and coordinating the different care units. This article shows the findings of a survey carried out on a group of heads of neurology departments in order to determine the current state of headache units, that is, their opinion regarding the creation, functioning and development of headache units in Spanish hospitals, and the parameters of their efficacy and effectiveness (AU)


Asunto(s)
Femenino , Humanos , Masculino , Trastornos Migrañosos/metabolismo , Trastornos Migrañosos/patología , Unidades Hospitalarias/economía , Unidades Hospitalarias , Neurología/educación , Atención Primaria de Salud/métodos , Calidad de Vida/psicología , Encuestas de Atención de la Salud/instrumentación , Trastornos Migrañosos/complicaciones , Trastornos Migrañosos/diagnóstico , Unidades Hospitalarias/clasificación , Unidades Hospitalarias/normas , Neurología , Atención Primaria de Salud/normas , Encuestas de Atención de la Salud
17.
Rev. neurol. (Ed. impr.) ; 61(supl.1): s21-s26, sept. 2015. tab, ilus
Artículo en Español | IBECS | ID: ibc-144116

RESUMEN

Las unidades de cefaleas surgen ante la necesidad de abordar de forma multidisciplinar el tratamiento de pacientes con dolores de cabeza complejos. A pesar de que las cefaleas son una de las patologías médicas más prevalentes, es llamativa la poca promoción que existe para su desarrollo. Dentro de la organización multidisciplinar, el papel del neurólogo debidamente formado en este campo es crucial. Es la persona encargada de recibir, dirigir, supervisar y coordinar el tratamiento, junto con otras especialidades médicas. Se debe contar con la participación del psiquiatra, del psicólogo y del fisioterapeuta como núcleo básico. Su actuación conjunta y coordinada genera de forma objetiva una mejoría del dolor frente a cada tratamiento de forma aislada (AU)


Headache units have come into being to respond to the need to address the treatment of patients with complex headaches in a multidisciplinary manner. Although headaches are one of the most prevalent medical pathologies, it is surprising how little is being done to foster the development of such units. Within the multidisciplinary organisation, the role of the neurologist with adequate training in this field is essential. He or she is the person responsible for receiving, directing, supervising and coordinating the treatment, together with other medical specialties. The basic core of the team should consist of a psychiatrist, psychologist and physiotherapist. Their joint coordinated action generates an objective improvement in the pain over and beyond that achieved with each isolated treatment (AU)


Asunto(s)
Femenino , Humanos , Masculino , Trastornos Migrañosos/metabolismo , Trastornos Migrañosos/patología , Unidades Hospitalarias/clasificación , Unidades Hospitalarias/economía , Administración Hospitalaria/economía , Atención Dirigida al Paciente/métodos , Educación del Paciente como Asunto , Intercambio de Información en Salud/ética , Trastornos Migrañosos/complicaciones , Trastornos Migrañosos/diagnóstico , Unidades Hospitalarias , Unidades Hospitalarias , Administración Hospitalaria/ética , Atención Dirigida al Paciente/normas , Educación del Paciente como Asunto/métodos , Intercambio de Información en Salud/economía
18.
Nurs Stand ; 29(41): 8, 2015 Jun 10.
Artículo en Inglés | MEDLINE | ID: mdl-26058613

RESUMEN

Unions have cast doubt on the timetable set by the Department of Health for reducing the use of agency nurses.


Asunto(s)
Unidades Hospitalarias/economía , Sindicatos , Personal de Enfermería/economía , Admisión y Programación de Personal/economía , Salarios y Beneficios/economía , Humanos , Reino Unido
19.
BMJ Open ; 5(4): e007367, 2015 Apr 08.
Artículo en Inglés | MEDLINE | ID: mdl-25854972

RESUMEN

OBJECTIVES: Misuse of investigations, medications and hospital beds is costing the National Health Service (NHS) billions of pounds with little evidence that approaches centred on reducing overuse are sustainable. Our previous study demonstrated that twice-daily consultant ward rounds reduce inpatient length of stay and suggested a reduction in overuse of investigations and medications. This study aims to assess the impact of daily consultant ward rounds on the use of investigations and medications and estimate the potential cost benefit. SETTINGS: The study was performed on two medical wards in a major city university teaching hospital in Liverpool, UK, receiving acute admissions from medical assessment and emergency departments. PARTICIPANTS AND INTERVENTION: The total number of patients admitted, investigations performed and pharmacy costs incurred were collected for 2 years before and following a change in the working practice of consultants from twice-weekly to twice-daily consultant ward rounds on the two medical wards. OUTCOME MEASURES: We performed a cost-benefit analysis to assess the net amount of money saved by reducing inappropriate investigations and pharmacy drug use following the intervention. RESULTS: Despite a 70% increase in patient throughput (p<0.01) the investigations and pharmacy, costs per patient reduced by 50% over a 12-month period (p<0.01) and were sustained for the next 12 months. The reduction in investigations and medication use did not have any effect on the readmission or mortality rate (p=NS), whereas, the length of stay was almost halved (p<0.01). Daily senior clinician input resulted in a net cost saving of £336,528 per year following the intervention. CONCLUSIONS: Daily consultant input has a significant impact on reducing the inappropriate use of investigations and pharmacy costs saving the NHS more than £650K on the two wards over a 2-year period.


Asunto(s)
Consultores , Hospitales de Enseñanza/economía , Servicio de Farmacia en Hospital/economía , Rondas de Enseñanza , Adulto , Análisis Costo-Beneficio , Femenino , Mortalidad Hospitalaria , Unidades Hospitalarias/economía , Hospitalización/economía , Hospitalización/estadística & datos numéricos , Hospitales de Enseñanza/estadística & datos numéricos , Humanos , Prescripción Inadecuada/prevención & control , Tiempo de Internación/estadística & datos numéricos , Masculino , Readmisión del Paciente , Rondas de Enseñanza/economía
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