Increased risk of severe COVID-19 in pregnancy in a multicenter propensity score-matched study.

OBJECTIVES: To explore the association between COVID-19 severity and pregnancy using measures such as COVID-19 ordinal scale severity score, hospitalization, intensive care unit (ICU) admission, oxygen supplementation, invasive mechanical ventilation, and death. METHODS: We conducted a retrospective, multicenter cohort study to understand the association between COVID-19 severity and pregnancy. We reviewed consecutive charts of adult females, ages 18-45, with laboratory testing for SARS-CoV-2 infection between March 1, 2020, and August 31, 2020. Cases were patients diagnosed with COVID-19 during pregnancy, whereas controls were not pregnant at the time of COVID-19 diagnosis. Primary endpoints were the COVID-19 severity score at presentation (within four hours) and the nadir of the clinical course. The secondary endpoints were the proportion of patients requiring hospitalization, ICU admission, oxygen supplementation, invasive mechanical ventilation, and death. RESULTS: A higher proportion of pregnant women had moderate to severe COVID-19 disease at the nadir of the clinical course than non-pregnant women (25 vs. 16.1 %, p=0.04, respectively). There was a higher rate of hospitalization (25.6 vs. 17.2 %), ICU admission (8.9 vs. 4.4 %), need for vasoactive substances (5.0 vs. 2.8 %), and invasive mechanical ventilation (5.6 vs. 2.8 %) in the pregnant cohort. These differences were not significant after applying propensity score matching.We found a high rate of pregnancy complications in our population (40.7 %). The most worrisome is the rate of hypertensive disorders of pregnancy (20.1 %). CONCLUSIONS: In our propensity score-matched study, COVID-19 in pregnancy is associated with an increased risk of disease severity and pregnancy complications.

Extract BIG savings from physician preference items. Use a data-driven, team-based approach to drive down costs.

As baby boomers reach retirement age, the demand for cardiac, spine and orthopedic implants is expected to escalate rapidly. Containing spending on these physician preference items (PPI) will be crucial for hospitals, which are facing reduced revenue streams due to bundled payments and other factors. Materials managers will play a lead role in devising cost-reduction strategies. They'll need to establish benchmarking data to share with physicians to build consensus on how to best cut PPI costs without sacrificing the quality of care. Follow these steps to get started.

Preparing for the new landscape of payment reform.

A door-to-discharge analysis emphasizes a global view of care delivery to improve processes, eliminate waste, and reduce costs. Key components of this approach are identifying information sources and collecting data, engaging physicians, using techniques such as Lean and Six Sigma, and improving documentation and coding. Focusing on specific high-cost MS-DRGs, such as catheterization laboratory procedures and cardiovascular, joint replacement, and spine surgery, can produce early, significant results.