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1.
Rev Saude Publica ; 53: 104, 2019.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31800915

RESUMO

OBJECTIVE: To verify if the Melhor em Casa program can actually reduce hospitalization costs. METHODS: We use as an empirical strategy a Regression Discontinuity Design, which reduces endogeneity problems of our model. We also performed tests of heterogeneous responses and robustness. Data on the dependent variable, namely hospitalization costs, were collected in the Department of Informatics of the Unified Health System (DATASUS), using the microdata set from the Hospital Admissions System of the Unified Health System (SUS) from 2010 to 2013, totaling 3,609,384 observations. The covariates or control variables used were age and costs with patients in the intensive care unit, also from DATASUS. RESULTS: The results point out that the Melhor em Casa program effectively reduced hospitalization costs by approximately 4.7% in 2011, 5.8% in 2012 and 10.2% in 2013. CONCLUSIONS: Based on the analyses, we observed that maintaining the program can effectively improve the management of public resources, since it reduced the hospitalization costs in the three years studied. The program reduced hospitalization costs of risk groups and also in situations that usually increase hospital costs such as lack of equipment and elective hospitalizations. Thus, it can be affirmed that the program can reduce hospitalization costs, especially in risk and more vulnerable groups, showing efficiency as a public policy.


Assuntos
Custos de Cuidados de Saúde/estatística & dados numéricos , Custos Hospitalares/estatística & dados numéricos , Hospitalização/economia , Visita Domiciliar/economia , Fatores Etários , Brasil , Cidades/economia , Feminino , Humanos , Masculino , Programas Nacionais de Saúde/economia , Avaliação de Programas e Projetos de Saúde , Valores de Referência , Fatores Sexuais , Fatores de Tempo
2.
J Cardiothorac Surg ; 14(1): 192, 2019 Nov 08.
Artigo em Inglês | MEDLINE | ID: mdl-31703606

RESUMO

BACKGROUND: Chest tubes are routinely used to evacuate shed mediastinal blood in the critical care setting in the early hours after heart surgery. Inadequate evacuation of shed mediastinal blood due to chest tube clogging may result in retained blood around the heart and lungs after cardiac surgery. The objective of this study was to compare if active chest tube clearance reduces the incidence of retained blood complications and associated hospital resource utilization after cardiac surgery. METHODS: Propensity matched analysis of 697 consecutive patients who underwent cardiac surgery at a single center. 302 patients served as a baseline control (Phase 0), 58 patients in a training and compliance verification period (Phase 1) and 337 were treated prospectively using active tube clearance (Phase 2). The need to drain retained blood, pleural effusions, postoperative atrial fibrillation, ICU resource utilization and hospital costs were assessed. RESULTS: Propensity matched patients in Phase 2 had a reduced need for drainage procedures for pleural effusions (22% vs. 8.1%, p < 0.001) and reduced postoperative atrial fibrillation (37 to 25%, P = 0.011). This corresponded with fewer hours in the ICU (43.5 [24-79] vs 30 [24-49], p = < 0.001), reduced median postoperative length of stay (6 [4-8] vs 5 [4-6.25], p < 0.001) median costs reduced by $1831.45 (- 3580.52;82.38, p = 0.04) and the mean costs reduced by an average of $2696 (- 6027.59;880.93, 0.116). CONCLUSIONS: This evidence supports the concept that efforts to actively maintain chest tube patency in early recovery is useful in improving outcomes and reducing resource utilization and costs after cardiac surgery. TRIAL REGISTRATION: Clinicaltrial.gov, NCT02145858, Registered: May 23, 2014.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Tubos Torácicos , Drenagem/métodos , Custos Hospitalares/estatística & dados numéricos , Complicações Pós-Operatórias/prevenção & controle , Idoso , Drenagem/economia , Drenagem/instrumentação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , New Hampshire , Complicações Pós-Operatórias/economia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Pontuação de Propensão , Estudos Prospectivos , Estudos Retrospectivos , Resultado do Tratamento
3.
Rev Esc Enferm USP ; 53: e03486, 2019 Aug 19.
Artigo em Português, Inglês | MEDLINE | ID: mdl-31433016

RESUMO

OBJECTIVE: To evaluate the impact of Healthcare-Associated Infections on the hospitalization cost of children. METHOD: A prospective, quantitative cohort study involving children admitted to the Inpatient and Pediatric Intensive Care Units of a public university hospital. The data were analyzed through SPSS software by frequency distribution, central tendency measures and dispersion. The level of statistical significance was set at p<0.05 for all analyzes. RESULTS: The sample consisted of 173 children, of whom 18.5% developed Healthcare-Associated Infections, which increased the hospitalization costs 4.2 times (p<0.001). A greater cost impact was observed among patients with two or more infectious sites (R$81,037.57; p=0.010) and sepsis (R$46,315.63; p<0.001). Children colonized by multiresistant microorganisms with a prevalence of E. coli and A. baumannii ESBL also generated higher costs of R$35,206.15 and R$30,692.52, respectively. CONCLUSION: Healthcare-Associated Infections significantly increased the hospitalization costs for children, especially among those with more than two infectious sites, who developed sepsis or were colonized by multiresistant microorganisms.


Assuntos
Infecção Hospitalar/epidemiologia , Custos Hospitalares/estatística & dados numéricos , Hospitalização/economia , Sepse/epidemiologia , Adolescente , Brasil , Criança , Pré-Escolar , Estudos de Coortes , Infecção Hospitalar/economia , Infecção Hospitalar/microbiologia , Farmacorresistência Bacteriana Múltipla , Hospitais Universitários , Humanos , Lactente , Recém-Nascido , Estudos Prospectivos , Sepse/economia
4.
Am J Health Syst Pharm ; 76(8): 551-553, 2019 Apr 08.
Artigo em Inglês | MEDLINE | ID: mdl-31420984

RESUMO

PURPOSE: A cost-reduction strategy for isoproterenol use in radiofrequency catheter ablation procedures was evaluated. SUMMARY: A medication-use evaluation at a 454-bed tertiary medical center revealed that the cardiac catheterization laboratory was the highest user of isoproterenol. Isoproterenol was removed from all AcuDose-Rx machines Omnicell, Mountain View, CA, and compounding was performed by pharmacy personnel. It was initially provided to the cardiac catheterization laboratory as an 8-µg/mL concentration in 20-mL 0.9% sodium chloride injection syringes with a 24-hour beyond-use date. This resulted in an initial cost savings but with an unacceptably high rate of wastage. Isoproterenol was then compounded as a 4-µg/mL concentration in 30 mL 5% dextrose in water syringes with a 9-day beyond-use date after a thorough literature search supported longer stability with this admixture. After 12 months of our current process, isoproterenol use during radio frequency catheter ablations (RFCAs) in the cardiac catheterization laboratory was reduced by 85%, decreasing the number of ampules used from 11.15 to 1.66 per week. CONCLUSION: A pharmacy-initiated process to mitigate an extraordinary increase in isoproterenol acquisition cost resulted in a reduction in usage in a tertiary care community hospital. Isoproterenol usage was reduced 85% after two different interventions were implemented, which is estimated to save $1,839 per procedure.


Assuntos
Ablação por Cateter/métodos , Redução de Custos , Composição de Medicamentos/métodos , Isoproterenol/economia , Serviço de Farmácia Hospitalar/economia , Ablação por Cateter/economia , Ablação por Cateter/instrumentação , Composição de Medicamentos/economia , Custos de Medicamentos/estatística & dados numéricos , Estabilidade de Medicamentos , Armazenamento de Medicamentos/economia , Registros Eletrônicos de Saúde/estatística & dados numéricos , Custos Hospitalares/estatística & dados numéricos , Humanos , Isoproterenol/administração & dosagem , Estudos Retrospectivos , Centros de Atenção Terciária/economia , Centros de Atenção Terciária/estatística & dados numéricos , Fatores de Tempo
5.
World Neurosurg ; 131: e606-e613, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31408751

RESUMO

OBJECTIVE: In the present study, we sought to evaluate the timing and outcomes in patients with hemorrhagic stroke who received tracheostomy. METHODS: A retrospective database search was undertaken to identify patients with hemorrhagic stroke between January 2010 and December 2018. Clinical data on basic demographics, clinical features, and outcomes were extracted. The primary outcome was in-hospital mortality and secondary outcomes were hospital stays and hospital costs. Univariate and multivariate analyses were used to compare the characteristics and outcomes between patients with hemorrhagic stroke who underwent tracheostomy early (days 1-6) and late (days 7 or later). RESULTS: A total of 425 patients were identified, 74.4% (n = 316) received an early tracheostomy during the hospitalization. Patients with hemorrhagic stroke who received early tracheostomy had a higher rate of neurosurgical operation (odds ratio, 2.77; 95% confidence interval, 1.54-4.99; P = 0.001) and different types of hemorrhagic stroke (P = 0.001) in comparison with the late tracheostomy patients. In addition, early tracheostomy was associated with shorter hospital stays (odds ratio, 1.02; 95% confidence interval, 1.01-1.03; P = 0.003) and reduced hospital costs (P < 0.001) than with late tracheostomy. However, no significant difference was observed with regard to in-hospital mortality between early and late tracheostomy groups (P = 0.744). CONCLUSIONS: In our cohort, early tracheostomy in patients with hemorrhagic stroke may help reduce hospital stays and hospital costs, but not in-hospital mortality. Future prospective multicenter studies are warranted to validate these findings.


Assuntos
Mortalidade Hospitalar , Hemorragias Intracranianas/terapia , Acidente Vascular Cerebral/terapia , Traqueostomia/métodos , Idoso , Feminino , Custos Hospitalares/estatística & dados numéricos , Humanos , Hemorragias Intracranianas/economia , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos , Respiração Artificial/economia , Respiração Artificial/métodos , Estudos Retrospectivos , Acidente Vascular Cerebral/economia , Fatores de Tempo , Traqueostomia/economia , Resultado do Tratamento
6.
Artigo em Inglês | MEDLINE | ID: mdl-31374945

RESUMO

OBJECTIVE: The China Center for Disease Control and Prevention (CDC) introduced an innovative financing model of tuberculosis (TB) care and control with the aim of standardizing TB treatment and reducing the financial burden associated with patients with TB. This is a study of the pilot implementation of new financing mechanism in Zhenjiang, between 2014-2015. We compared TB hospitalization rates and inpatient service costs before and after implementation to examine the factors associated with hospital admissions. Our goal is to provide evidence-based recommendations for improving TB service provision and cost control. METHODS: We reviewed new policy documents on TB financing. We conducted a patient survey to investigate the utilization of inpatient services, and patients' out-of-pocket payment for inpatient care. We extracted total medical expenditures of inpatient services from inpatient records of TB designated hospitals. FINDINGS: 63.6% (n = 159) of the surveyed patients with TB were admitted for treatment in 2015, which was higher than that in 2013 (54.8%, n = 144). The number of hospital admission was slightly lower in 2015 (1.16 per patient) than in 2013 (1.26 per patient), while the length of hospital stay was longer in 2015 (24 days) than in 2013 (16 days). In 2015, patients from families with low incomes were more likely to be admitted than those from higher income groups (OR = 3.06, 95% CI: 1.12-8.33). The average inpatient service cost in 2015 (3345 USD) was 1.7 times the cost in 2013 (1952 USD). It was found that 96.2% of patients with TB who were from low-income households spent more than 20% of their household income on inpatient care in 2013, versus 100% in 2015. CONCLUSION: The TB hospital admission rate and total inpatient service cost increased over the study period. The majority of patients with TB, particularly poor patient who used inpatient care, continue to suffer from heavy financial burden.


Assuntos
Custos Hospitalares/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Pacientes Internados , Tuberculose/terapia , Adulto , China , Feminino , Gastos em Saúde/estatística & dados numéricos , Humanos , Masculino , Inquéritos e Questionários
7.
Medicine (Baltimore) ; 98(27): e16054, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31277099

RESUMO

The aim of the study was to determine the financial burden of complications and examine the cost differentials between complicated and uncomplicated hospital stays, including the differences in cost due to extent of resection and operative technique.Liver resection carries a high financial cost. Despite improvements in perioperative care, postoperative morbidity remains high. The contribution of postoperative complications to the cost of liver resection is poorly quantified, and there is little data to help guide cost containment strategies.Complications for 317 consecutive adult patients undergoing liver resection were recorded using the Clavien-Dindo classification. Patients were stratified based on the grade of their worst complication to assess the contribution of morbidity to resource use of specific cost centers. Costs were calculated using an activity-based costing methodology.Complications dramatically increased median hospital cost ($22,954 vs $15,593, P < .001). Major resection cost over $10,000 more than minor resection and carried greater morbidity (82% vs 59%, P < .001). Similarly, open resection cost more than laparoscopic resection ($21,548 vs $15,235, P < .001) and carried higher rates of complications (72% vs 41.5%, P < .001). Hospital cost increased with increasing incidence and severity of complications. Complications increased costs across all cost centers. Minor complications (Clavien-Dindo Grade I and II) were shown to significantly increase costs compared with uncomplicated patients.Liver resection continues to carry a high incidence of complications, and these result in a substantial financial burden. Hospital cost and length of stay increase with greater severity and number of complications. Our findings provide an in-depth analysis by stratifying total costs by cost centers, therefore guiding future economic studies and strategies aimed at cost containment for liver resection.


Assuntos
Hepatectomia/economia , Custos Hospitalares/estatística & dados numéricos , Tempo de Internação/economia , Complicações Pós-Operatórias/economia , Análise Custo-Benefício , Feminino , Hepatectomia/efeitos adversos , Hepatectomia/classificação , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/classificação , Período Pós-Operatório , Estudos Retrospectivos , Estatísticas não Paramétricas
8.
Anesthesiology ; 131(3): 534-542, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31283739

RESUMO

BACKGROUND: In addition to payments for services, anesthesia groups in the United States often receive revenue from direct hospital payments. Understanding the magnitude of these payments and their association with the hospitals' payer mixes has important policy implications. METHODS: Using a dataset of financial reports from 240 nonacademic California hospitals between 2002 and 2014, the authors characterized the prevalence and magnitude of direct hospital payments to anesthesia groups, and analyzed the association between these payments and the fraction of anesthesia revenue derived from public payers (e.g., Medicaid). RESULTS: Of hospitals analyzed, 69% (124 of 180) made direct payments to an anesthesia group in 2014, compared to 52% (76 of 147) in 2002; the median payment increased from $242,351 (mean, $578,322; interquartile range, $72,753 to $523,861; all dollar values in 2018 U.S. dollars) to $765,128 (mean, $1,295,369; interquartile range, $267,006 to $1,503,163) during this time period. After adjusting for relevant covariates, hospitals where public insurers accounted for a larger fraction of anesthesia revenues were more likely to make direct payments to anesthesia groups (ß = 0.45; 95% CI, 0.10 to 0.81; P = 0.013), so that a 10-percentage point increase in the fraction of anesthesia revenue derived from public payers would be associated with a 4.5-percentage point increase in the probability of receiving any payment. Among hospitals making payments, our results (ß = 2.10; 95% CI, 0.74 to 3.45; P = 0.003) suggest that a 1-percentage point increase in the fraction of anesthesia revenue derived from public payers would be associated with a 2% relative increase in the amount paid. CONCLUSIONS: Direct payments from hospitals are becoming a larger financial consideration for anesthesia groups in California serving nonacademic hospitals, and are larger for groups working at hospitals serving publicly insured patients.


Assuntos
Anestesiologia/economia , Economia Hospitalar/estatística & dados numéricos , Prática de Grupo/economia , Custos Hospitalares/estatística & dados numéricos , Seguro Saúde/economia , Seguro Saúde/estatística & dados numéricos , California , Estudos de Coortes , Humanos , Prática Privada/economia , Estudos Retrospectivos , Estados Unidos
9.
Med Care ; 57(8): 615-624, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31268953

RESUMO

BACKGROUND: Children with complex chronic conditions (CCCs) utilize a disproportionate share of hospital resources. OBJECTIVE: We asked whether some hospitals display a significantly different pattern of resource utilization than others when caring for similar children with CCCs admitted for medical diagnoses. RESEARCH DESIGN: Using Pediatric Health Information System data from 2009 to 2013, we constructed an inpatient Template of 300 children with CCCs, matching these to 300 patients at each hospital, thereby performing a type of direct standardization. SUBJECTS: Children with CCCs were drawn from a list of the 40 most common medical principal diagnoses, then matched to patients across 40 Children's Hospitals. MEASURES: Rate of intensive care unit admission, length of stay, resource cost. RESULTS: For the Template-matched patients, when comparing resource use at the lower 12.5-percentile and upper 87.5-percentile of hospitals, we found: intensive care unit utilization was 111% higher (6.6% vs. 13.9%, P<0.001); hospital length of stay was 25% higher (2.4 vs. 3.0 d/admission, P<0.001); and finally, total cost per patient varied by 47% ($6856 vs. $10,047, P<0.001). Furthermore, some hospitals, compared with their peers, were more efficient with low-risk patients and less efficient with high-risk patients, whereas other hospitals displayed the opposite pattern. CONCLUSIONS: Hospitals treating similar patients with CCCs admitted for similar medical diagnoses, varied greatly in resource utilization. Template Matching can aid chief quality officers benchmarking their hospitals to peer institutions and can help determine types of their patients having the most aberrant outcomes, facilitating quality initiatives to target these patients.


Assuntos
Doença Crônica/epidemiologia , Hospitalização/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Criança , Doença Crônica/terapia , Feminino , Custos Hospitalares/estatística & dados numéricos , Hospitais/estatística & dados numéricos , Humanos , Unidades de Terapia Intensiva Pediátrica/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Masculino , Fatores de Risco
10.
J Am Acad Dermatol ; 81(3): 767-774, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31150700

RESUMO

BACKGROUND: Single-institution studies show that frozen section Mohs micrographic surgery (MMS) is an effective treatment modality for cutaneous melanoma, but no multi-institutional studies have been published. OBJECTIVE: To characterize the use of MMS in the treatment of melanoma at 3 academic and 8 private practices throughout the United States, to recommend excision margins when 100% histologic margin evaluation is not used, and to compare actual costs of tumor removal with MMS vs standard surgical excision. METHODS: Prospective, multicenter, cohort study of 562 melanomas treated with MMS with melanoma antigen recognized by T cells 1 immunostaining. RESULTS: Primary trunk and extremity melanomas (noninvasive and invasive melanoma) achieved histologically negative margins in 97% of tumors with 10-mm margins, whereas 12-mm margins were necessary to achieve histologically negative margins in 97% of head and neck melanomas. Overall average cost per tumor treated was $1328.46. LIMITATIONS: Nonrandomized and noncontrolled study. CONCLUSIONS: MMS with melanoma antigen recognized by T cells 1 immunostaining safely provides tissue conservation and same-day reconstruction of histologically verified tumor-free margins in a convenient, single-day procedure. When comprehensive margin evaluation is not used, initial surgical margins of at least 10 mm for primary trunk/extremity and 12 mm for head/neck melanomas should be used to achieve histologically negative margins 97% of the time.


Assuntos
Biomarcadores Tumorais/análise , Antígeno MART-1/análise , Melanoma/cirurgia , Cirurgia de Mohs/métodos , Neoplasias Cutâneas/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Custos Hospitalares/estatística & dados numéricos , Humanos , Masculino , Margens de Excisão , Melanoma/economia , Melanoma/patologia , Pessoa de Meia-Idade , Cirurgia de Mohs/economia , Estudos Prospectivos , Pele/patologia , Neoplasias Cutâneas/economia , Neoplasias Cutâneas/patologia , Resultado do Tratamento , Estados Unidos , Adulto Jovem
11.
Asia Pac J Clin Nutr ; 28(2): 252-259, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31192554

RESUMO

BACKGROUND AND OBJECTIVES: Malnutrition has high prevalence among hospitalized patients but goes unrecognized in many patients. Early detection of malnutrition using an effective screening tool is required. This study aimed to examine the effects of nutritional status determined by the Nutrition Alert Form (NAF) and its individual sections on length of stay (LOS) and hospital costs in hospitalized patients, to investigate their associated factors, and to determine hospital malnutrition prevalence. METHODS AND STUDY DESIGN: This retrospective cohort study enrolled 2,906 hospitalized patients aged >=15 years in Ramathibodi Hospital between January and September 2016. At admission, nutritional status was screened using NAF. Nutrition status was defined as: NAF-A (normal/mild malnutrition; scores of 0-5), NAF-B (moderate malnutrition; 6-10), and NAF-C (severe malnutrition; >=11). Information regarding LOS and hospital costs during patients' hospitalization was also collected. RESULTS: The prevalence of malnutrition was 15.3%. After adjusting for age, sex and primary diagnosis, we found significantly longer LOS and higher hospital costs among those with NAF-B and NAF-C, in comparison with patients having NAF-A. The highest increase in LOS was in male patients aged >=60 years with NAF-C. The highest increase in LOS and hospital costs was associated with higher scores for functional capacity. CONCLUSIONS: Higher levels of malnutrition screened using the NAF were significantly associated with longer LOS and higher hospital costs. Older adult patients had the highest risk of being malnourished and developing negative consequences. A prospective study of nutritional support by a nutrition care team is underway.


Assuntos
Custos Hospitalares/estatística & dados numéricos , Tempo de Internação/economia , Tempo de Internação/estatística & dados numéricos , Desnutrição/epidemiologia , Estado Nutricional , Centros de Atenção Terciária , Adolescente , Adulto , Estudos de Coortes , Feminino , Humanos , Masculino , Desnutrição/economia , Pessoa de Meia-Idade , Avaliação Nutricional , Estudos Retrospectivos , Tailândia/epidemiologia , Adulto Jovem
12.
J Surg Oncol ; 120(3): 397-406, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31236957

RESUMO

BACKGROUND AND OBJECTIVE: Financial hardship occurring as a result of cancer treatment has been termed financial toxicity and is an established side effect of the cancer treatment. We investigated the risk of financial toxicity among patients undergoing surgery for gastrointestinal cancers. METHODS: All uninsured and privately insured patients who underwent surgery for a gastrointestinal cancer were identified from the National Inpatient Sample. Publicly available government data were used estimate income, food expenditure, and average maximum out-of-pocket expenditure. Risk of financial toxicity was defined as health expenditure ≥ 40% of postsubsistence income. RESULTS: Among the 78 545 patients in the analytic cohort, 73 305 individuals had private insurance while 5240 patients were uninsured. Overall median hospital charges were $58 651 (IQR: $37 912-$95 379). Approximately 90% of uninsured and 10% of privately insured patients were at risk of financial toxicity. At the subpopulation level, patients in the lowest income quartile, undergoing emergency surgery, black or hispanic individuals, and those undergoing surgery for esophageal or colon cancer were more likely to experience catastrophic costs following surgery (P < .001). CONCLUSION: Approximately 9 in 10 uninsured and 1 in 10 privately insured patients with cancer were at risk of financial toxicity after the surgery. Targeted interventions are needed to provide financial protection to patients undergoing the cancer treatment.


Assuntos
Procedimentos Cirúrgicos de Citorredução/economia , Procedimentos Cirúrgicos do Sistema Digestório/economia , Neoplasias Gastrointestinais/economia , Neoplasias Gastrointestinais/cirurgia , Adolescente , Adulto , Idoso , Estudos de Coortes , Feminino , Financiamento Pessoal/estatística & dados numéricos , Gastos em Saúde/estatística & dados numéricos , Custos Hospitalares/estatística & dados numéricos , Humanos , Pacientes Internados , Seguro Saúde/estatística & dados numéricos , Masculino , Pessoas sem Cobertura de Seguro de Saúde/estatística & dados numéricos , Pessoa de Meia-Idade , Estados Unidos , Adulto Jovem
13.
Gynecol Oncol ; 154(2): 411-419, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31176554

RESUMO

OBJECTIVE: The majority of cost-studies related to robotic surgery has a short follow-up and primarily report the costs from the index surgery. The aim of this study was to evaluate the long-term resource consequences of introducing robotic surgery for early stage endometrial cancer in Denmark. METHODS: The study included all women with early stage endometrial cancer who underwent robotic, laparoscopic and open access surgery from January 2008 to June 2015. Data was linked from national databases to determine resource consumption and costs from hospital treatments, outpatient contacts, primary health care sector visits, labor market affiliation and prescription of medication. Each patient was observed in a period of 12 months before- and after surgery. The key exposure variable was women who were exposed to robotic surgery compared to those who were not. RESULTS: A total of 4133 women underwent surgery for early stage endometrial cancer. The study found additional costs of $7309 (95% confidence interval [CI] 2100-11,620, P = 0.001) per patient in the group exposed to robotic surgery including long-term costs post-surgery compared to the non-exposed group (non-robotic group). When controlling for time trends, the introduction of robotic surgery did not reduce the number of bed days (mean diff -0.42, 95% CI -3.03-2.19, P = 0.752). CONCLUSIONS: The introduction of robotic surgery for early stage endometrial cancer did not generate any long-term cost savings. The additional costs of robotic surgery were primarily driven by the index surgery. Any reduction in bed days could be explained by time trends.


Assuntos
Neoplasias do Endométrio/cirurgia , Custos Hospitalares/estatística & dados numéricos , Procedimentos Cirúrgicos Robóticos/economia , Idoso , Estudos de Casos e Controles , Análise Custo-Benefício , Dinamarca/epidemiologia , Neoplasias do Endométrio/economia , Neoplasias do Endométrio/epidemiologia , Feminino , Humanos , Tempo de Internação/economia , Pessoa de Meia-Idade , Duração da Cirurgia , Período Pós-Operatório , Estudos Retrospectivos , Procedimentos Cirúrgicos Robóticos/estatística & dados numéricos
14.
Bone Joint J ; 101-B(5): 573-581, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-31038999

RESUMO

AIMS: The purpose of this study was to compare outcomes of combined total joint arthroplasty (TJA) (total hip arthroplasty (THA) and total knee arthroplasty (TKA) performed during the same admission) versus bilateral THA, bilateral TKA, single THA, and single TKA. Combined TJAs performed on the same day were compared with those staged within the same admission episode. PATIENTS AND METHODS: Data from the National (Nationwide) Inpatient Sample recorded between 2005 and 2014 were used for this retrospective cohort study. Postoperative in-hospital complications, total costs, and discharge destination were reviewed. Logistic and linear regression were used to perform the statistical analyses. p-values less than 0.05 were considered statistically significant. RESULTS: Combined TJA was associated with increased risk of deep vein thrombosis, prosthetic joint infection, irrigation and debridement procedures, revision arthroplasty, length of stay (LOS), and in-hospital costs compared with bilateral THA, bilateral TKA, single THA, and single TKA. Combined TJA performed on separate days of the same admission showed no statistically significant differences when compared with same-day combined TJA, but trended towards decreased total costs and total complications despite increased LOS. CONCLUSION: Combined TJA is associated with increased in-hospital complications, LOS, and costs. We do not recommend performing combined TJA during the same hospital stay. Cite this article: Bone Joint J 2019;101-B:573-581.


Assuntos
Artroplastia de Quadril/efeitos adversos , Artroplastia do Joelho/efeitos adversos , Custos Hospitalares/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Complicações Pós-Operatórias/etiologia , Idoso , Idoso de 80 Anos ou mais , Artroplastia de Quadril/economia , Artroplastia de Quadril/métodos , Artroplastia do Joelho/economia , Artroplastia do Joelho/métodos , Estudos de Coortes , Bases de Dados Factuais , Feminino , Hospitalização/economia , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Alta do Paciente/estatística & dados numéricos , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento
15.
Surgery ; 165(6): 1234-1242, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31056199

RESUMO

BACKGROUND: Congenital anomalies are the leading cause of infant death and pediatric hospitalization, but existing estimates of the associated costs of health care are either cross-sectional surveys or economic projections. We sought to determine the percent of total hospital health care expenditures attributable to major anomalies requiring surgery within the first year of life. METHODS: Utilizing comprehensive California statewide data from 2008 to 2012, cohorts of infants undergoing major surgery, with birth defects and with surgical anomalies, were constructed alongside a referent group of newborns with no anomalies or operations. Cost-to-charge and physician fee ratios were used to estimate hospital and professional costs, respectively. For each cohort, costs were broken down according to admission, birth episode, and first year of life, with additional stratifications by birth weight, gestational age, and organ system. RESULTS: In total, 68,126 of 2,205,070 infants (3.1%) underwent major surgery (n = 32,614) or had a diagnosis of a severe congenital anomaly (n = 57,793). These accounted for $7.7 billion of the $18.9 billion (40.7%) of the total health care costs/expenditures of the first-year-of-life hospitalizations, $7.0 billion (48.6%) of the costs for infants with comparatively long birth episodes, and $5.2 billion (54.7%) of the total neonatal intensive care unit admission costs. Infants with surgical anomalies (n = 21,264) totaled $4.1 billion (21.7%) at $80,872 per infant. Cardiovascular and gastrointestinal diseases accounted for most admission costs secondary to major surgery or congenital anomalies. CONCLUSION: In a population-based cohort of infant births compared with other critically ill neonates, surgical congenital anomalies are disproportionately costly within the United States health care system. The care of these infants, half of whom are covered by Medi-Cal or Medicaid, stands as a particular focus in an age of reform of health care payments.


Assuntos
Anormalidades Congênitas/economia , Anormalidades Congênitas/cirurgia , Utilização de Instalações e Serviços/economia , Gastos em Saúde/estatística & dados numéricos , Custos Hospitalares/estatística & dados numéricos , California , Utilização de Instalações e Serviços/estatística & dados numéricos , Feminino , Disparidades em Assistência à Saúde/economia , Disparidades em Assistência à Saúde/estatística & dados numéricos , Hospitalização/economia , Hospitalização/estatística & dados numéricos , Humanos , Lactente , Recém-Nascido , Armazenamento e Recuperação da Informação , Unidades de Terapia Intensiva Neonatal/economia , Unidades de Terapia Intensiva Neonatal/estatística & dados numéricos , Terapia Intensiva Neonatal/economia , Terapia Intensiva Neonatal/estatística & dados numéricos , Masculino
16.
Cien Saude Colet ; 24(4): 1527-1536, 2019 Apr.
Artigo em Português, Inglês | MEDLINE | ID: mdl-31066854

RESUMO

This study estimated the costs of vaginal delivery and elective cesarean section without clinical indication, for usual risk pregnant women from the perspective of the Brazilian Unified Health System. Data was collected from three public maternity hospitals located in the southeast region of Brazil through visits and interviews with professionals. The cost components were human resources, hospital supplies, capital cost and overhead, which were identified, quantified and valued through the micro-costing method. The costs with vaginal delivery, elective cesarean section and daily hospital charge in rooming for the three maternity hospitals were identified. The mean cost of a vaginal delivery procedure was R$ 808.16 and ranged from R$ 585.74 to R$ 916.14 between hospitals. The mean cost of elective cesarean section was R$ 1,113.70, ranging from R$ 652.69 to R$ 1,516.02. The main cost component was human resources for both procedures. When stay in rooming was included, the mean costs of vaginal delivery and cesarean were R$ 1,397.91 (R$ 1,287.50 - R$ 1,437.87) and R$ 1,843.87 (R$ 1,521.54 - R$ 2,161.98), respectively. Cost analyses of perinatal care contribute to the management of health services and are essential for cost-effectiveness analysis.


Assuntos
Cesárea/economia , Parto Obstétrico/economia , Custos Hospitalares/estatística & dados numéricos , Programas Nacionais de Saúde/economia , Brasil , Cesárea/estatística & dados numéricos , Parto Obstétrico/métodos , Feminino , Maternidades/economia , Humanos , Gravidez , Gravidez de Alto Risco , Alojamento Conjunto/economia , Alojamento Conjunto/estatística & dados numéricos
17.
Health Serv Res ; 54(4): 739-751, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31070263

RESUMO

OBJECTIVE: To estimate the effects of the health insurance exchange and Medicaid coverage expansions on hospital inpatient and emergency department (ED) utilization rates, cost, and patient illness severity, and also to test the association between changes in outcomes and the size of the uninsured population eligible for coverage in states. DATA SOURCES: Healthcare Cost and Utilization Project State Inpatient and Emergency Department Databases, 2011-2015, Nielsen Demographic Data, and the American Community Survey. STUDY DESIGN: Retrospective study using fixed-effects regression to estimate the effects in expansion and nonexpansion states by age/sex demographic groups. FINDINGS: In Medicaid expansion states, rates of uninsured inpatient discharges and ED visits fell sharply in many demographic groups. For example, uninsured inpatient discharge rates across groups, except young females, decreased by ≥39 percent per capita on average in expansion states. In nonexpansion states, uninsured utilization rates remained unchanged or increased slightly (0-9.2 percent). Changes in all-payer and private insurance rates were more muted. Changes in inpatient costs per discharge were negative, and all-payer inpatient costs per discharge declined <6 percent in most age/sex groups. The size of the uninsured population eligible for coverage was strongly associated with changes in outcomes. For example, among males aged 35-54 years in expansion states, there was a 0.793 percent decrease in the uninsured discharge rate per unit increase in the coverage expansion ratio (the ratio of the size of the population eligible for coverage to the size of the previously covered population within an age/sex/payer/geographic group). CONCLUSIONS: Significant shifts in cost per discharge and patient severity were consistent with selective take-up of insurance. The "treatment intensity" of expansions may be useful for anticipating future effects.


Assuntos
Serviço Hospitalar de Emergência/economia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Custos Hospitalares/estatística & dados numéricos , Patient Protection and Affordable Care Act/legislação & jurisprudência , Adulto , Fatores Etários , Feminino , Acesso aos Serviços de Saúde/estatística & dados numéricos , Humanos , Cobertura do Seguro/estatística & dados numéricos , Seguro Saúde/estatística & dados numéricos , Masculino , Medicaid/estatística & dados numéricos , Pessoas sem Cobertura de Seguro de Saúde/estatística & dados numéricos , Pessoa de Meia-Idade , Alta do Paciente/estatística & dados numéricos , Estudos Retrospectivos , Índice de Gravidade de Doença , Fatores Sexuais , Fatores Socioeconômicos , Estados Unidos , Adulto Jovem
18.
J Urol ; 202(5): 959-963, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31112102

RESUMO

PURPOSE: The typical mean length of stay following robot-assisted laparoscopic prostatectomy is 24 to 48 hours. We began routinely offering same day discharge from the hospital after robot-assisted laparoscopic prostatectomy. We evaluated the success rate, safety and cost implications in what is to our knowledge the only large series of same day discharge to date. MATERIALS AND METHODS: Beginning in September 2016 all patients were given the option of same day discharge without it being mandated. After allowing 3 months to solidify the protocol we evaluated our prospective database for the next 500 patients. RESULTS: Of the 500 consecutive men who underwent robot-assisted laparoscopic prostatectomy performed by 1 surgeon in 18 months 246 (49.2%) were discharged home the day of surgery and all of the remaining 254 were discharged the next day for a mean 0.51-day length of stay. Mean patient age was 62 years (range 42 to 81) and mean body mass index was 29.7 kg/m2 (range 20 to 53). Of the patients 34 (6.8%) had a Clavien-Dindo grade I-III complication within 90 days but there were no grade IV-V complications. Only 5 patients (1%) required an emergency department visit and only 8 (1.6%) required readmission. Only 1 of the patients who elected same day discharge was rehospitalized and only 1 presented to the emergency department. The estimated charge for an overnight stay at our institution is $2,109. The approximate reduction in charges was $518,814 during 18 months ($345,876 per year) with no increased cost due to emergency department visits or hospital readmissions compared with that of overnight patients. In the most recent 100 patients the rate of same day discharge improved to 65%. CONCLUSIONS: Same day discharge following robot-assisted laparoscopic prostatectomy can be safely routinely offered with no increase in readmissions or emergency visits. It may lead to significant savings in health care costs.


Assuntos
Procedimentos Cirúrgicos Ambulatórios/métodos , Alta do Paciente/estatística & dados numéricos , Prostatectomia/métodos , Procedimentos Cirúrgicos Robóticos/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Procedimentos Cirúrgicos Ambulatórios/economia , Serviço Hospitalar de Emergência/economia , Utilização de Instalações e Serviços/economia , Utilização de Instalações e Serviços/estatística & dados numéricos , Estudos de Viabilidade , Custos Hospitalares/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Ohio , Alta do Paciente/economia , Readmissão do Paciente/economia , Readmissão do Paciente/estatística & dados numéricos , Complicações Pós-Operatórias/economia , Complicações Pós-Operatórias/epidemiologia , Prostatectomia/economia , Procedimentos Cirúrgicos Robóticos/economia
19.
J Am Acad Dermatol ; 81(3): 740-748, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31102603

RESUMO

BACKGROUND: Readmissions for skin disease, particularly for the same diagnosis and over time, have not been well studied. OBJECTIVE: To characterize hospital readmissions for skin disease. METHODS: A cross-sectional observational study examined the Nationwide Readmissions Database from 2010 to 2014, a national sample of hospital discharges in the United States. RESULTS: Of the patients in 3,602,599 dermatologic hospitalizations from 2010 to 2014, 9.8% were readmitted for any cause, 3.3% were admitted for the same diagnosis within 30 days, and 7.8% were readmitted for the same diagnosis within the calendar year (CY). The cost of all CY same-cause readmissions was $508 million per year. Mycosis fungoides had the highest 30-day all-cause readmission rate (32%), vascular hamartomas and dermatomyositis had the highest 30-day same-cause readmission rates (21% and 18%, respectively), and dermatomyositis and systemic lupus erythematosus had the highest CY same-cause readmission rates (31% and 24%, respectively). Readmission rates stayed stable from 2010 to 2014. Readmission for the same diagnosis was strongly associated with Medicaid and morbid obesity. LIMITATIONS: This study is a broad description of hospitalizations for skin disease. Conclusions for individual diseases are not intended. CONCLUSION: The rates and costs of readmissions for skin diseases remained high from 2010 to 2014. This study identifies diseases associated with high risk of hospital readmission, but disease-specific studies are needed. The diseases and risk factors presented should guide additional studies focused on strategies to reduce readmissions in specific skin diseases.


Assuntos
Custos Hospitalares/estatística & dados numéricos , Readmissão do Paciente/estatística & dados numéricos , Dermatopatias/terapia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Estudos Transversais , Bases de Dados Factuais/estatística & dados numéricos , Feminino , Custos Hospitalares/tendências , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Readmissão do Paciente/economia , Readmissão do Paciente/tendências , Fatores de Risco , Dermatopatias/economia , Estados Unidos , Adulto Jovem
20.
Bull Hosp Jt Dis (2013) ; 77(2): 136-139, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31128584

RESUMO

INTRODUCTION: Hip and knee arthroplasty are high volume, clinically successful, but costly orthopedic surgical procedures. There is significant variation in volume, outcomes, and cost at various hospitals. METHODS: Using the Statewide Planning and Research Cooperative System (SPARCS) database to determine readmission rates and the New York State Department of Health (NYSDoH) hospital cost transparency database to obtain costs, we reviewed this data for hip and knee replacements to determine if there was a relationship between volume of procedures performed and cost or readmission rates. RESULTS: The readmission rate increased with increasing cost for facilities performing total knee arthroplasty (p = 0.02). Readmission rate did not change significantly with volume of procedures performed. Similarly, the readmission rate increased with increasing cost for facilities performing total hip arthroplasty but did not change significantly with respect to volume (p < 0.01). CONCLUSION: Spending more money to perform total hip and knee arthroplasty in New York State does not ensure lower readmission rates. Readmission rates vary independent of volume of procedures performed. Total hip and knee arthroplasty are two of the most successful and commonly performed orthopedic surgical procedures. Outcome investigations demonstrate reliable pain relief and consistently good or excellent functional outcomes.1-3 However, there is significant variability in both cost and quality of these procedures, resulting in a wide difference in their value. Porter defines value as outcomes divided by cost.4 One metric that reflects both the cost as well as the quality of care is the unplanned readmission rate. Whether readmission occurs as a result of thromboembolic disease, surgical site infection, or cardiopulmonary complications in the postoperative period, it represents a deterioration of outcome at a significant cost burden to the treating institution. The New York State Department of Health's Statewide Planning and Research Cooperative System (SPARCS) database was established in 1979. Licensed hospitals in the state are mandated to report data on all discharges, including inpatient and outpatient surgery procedures and emergency department admissions.5 On December 5, 2013, the New York State Department of Health made hospital-specific average costs for over 300 diagnosis-related groups (DRGs) available publicly on its website.6 Among the selected DRGs were total hip (301) and total knee (302) arthroplasty. The purpose of this study was to determine if there was a relationship between quality (as indicated by readmission rate) and either volume of procedures performed or cost of performing those procedures.


Assuntos
Artroplastia de Quadril , Artroplastia do Joelho , Custos Hospitalares/estatística & dados numéricos , Idoso , Artroplastia de Quadril/efeitos adversos , Artroplastia de Quadril/economia , Artroplastia de Quadril/métodos , Artroplastia do Joelho/efeitos adversos , Artroplastia do Joelho/economia , Artroplastia do Joelho/métodos , Análise Custo-Benefício , Bases de Dados Factuais , Feminino , Humanos , Masculino , Medicare/economia , Pessoa de Meia-Idade , Readmissão do Paciente/economia , Readmissão do Paciente/estatística & dados numéricos , Estados Unidos
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