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1.
Medicine (Baltimore) ; 99(6): e19027, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32028413

RESUMO

To evaluate disparities in the National Institute of Health (NIH) trauma research funding.Traumatic injury has increased in both prevalence and cost over the last decade. In the event of a traumatic injury, patients in the United States (US) rely on the trauma system to provide high-quality care. The current trauma research funding is not commensurate with the extent of the burden of trauma on the US population.In this qualitative study, the National Institutes of Health's Estimates of Funding for Various Research, Condition, and Disease Categories (RCDC) data were reviewed. The burden of traumatic injury on the US and the NIH trauma research funding was examined and compared with other diseases.In 2018, the NIH funded an estimated $639 million to traumatic injury research projects, <2% of the NIH budget. Comparatively, the NIH funded an estimated $6.3 billion towards cancer research in 2018. Cancer research receives extensively more funding than trauma research despite that trauma accounts for 24.1% of all years of potential life lost (YPLL) before age 75 compared with 21.3% for cancer.In the event of traumatic injury, trauma systems in the US should be able to provide high-quality care to patients yet cannot do so without adequate research funding. The federal funding contributed towards trauma research deserves a re-evaluation.


Assuntos
Pesquisa Biomédica/economia , National Institutes of Health (U.S.) , Ferimentos e Lesões/terapia , Pesquisa Biomédica/estatística & dados numéricos , Humanos , National Institutes of Health (U.S.)/economia , National Institutes of Health (U.S.)/estatística & dados numéricos , Apoio à Pesquisa como Assunto , Estados Unidos/epidemiologia , Ferimentos e Lesões/economia , Ferimentos e Lesões/epidemiologia
2.
Medicine (Baltimore) ; 98(39): e17330, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31574869

RESUMO

The aim of this study was to investigate the experiences of medical transportation of Korean travelers who suffered accidents abroad and then transferred home by our aeromedical team.We collected demographic and clinical data on patients injured while traveling abroad from January 2013 to July 2017. Descriptive analyses based on 4 different transportation methods and transport time since hospitalization were performed.A total of 33 patients were repatriated during the study period. Of these, 28 (84.8%) were trauma cases with pedestrian injuries being the most common (11 cases; 39.3%). Twenty patients were repatriated by flight-stretchers, 6 by flight-prestige, 2 by ship, and 5 by air ambulance. The air ambulance was the most expensive (average 61,124 US Dollars) mode of transportation (P = .001) and the ship took the longest time (14 hours) to transport patients back to Korea from regions with similar distance (P = .0023).We experienced medical repatriation of 33 seriously injured Korean travelers back to South Korea. Transfer time should be an important considering factor and directly contacting and communicating with the specialized staff of foreign hospitals could also be very important to reduce unnecessary overseas hospital stay and cost incidence.


Assuntos
Transporte de Pacientes , Viagem/estatística & dados numéricos , Ferimentos e Lesões , Acidentes/economia , Acidentes/estatística & dados numéricos , Adulto , Resgate Aéreo , Feminino , Humanos , Incidência , Seguro Saúde , Internacionalidade , Masculino , República da Coreia , Macas (Leitos) , Transporte de Pacientes/economia , Transporte de Pacientes/métodos , Transporte de Pacientes/estatística & dados numéricos , Ferimentos e Lesões/economia , Ferimentos e Lesões/epidemiologia
3.
Zhonghua Yu Fang Yi Xue Za Zhi ; 53(9): 900-906, 2019 Sep 06.
Artigo em Chinês | MEDLINE | ID: mdl-31474071

RESUMO

Objective: To study the distribution and related factors of curative care expenditure (CCE) of injury in Gansu Province in 2017. Methods: Based on the "A System of Health Accounts 2011 (SHA 2011)", the curative care expenditure of injury in Gansu Province was calculated and analyzed. The five-stage stratified cluster sampling method was adopted to extract 149 medical and health institutions, 120 township hospitals (including community health service centers), 150 individual clinics and 600 village clinics (including community health service stations). The top-down allocation method was used to calculate the cost of injury treatment in Gansu Province, and the influencing factors were analyzed by multiple linear regression. Results: In 2017, the CCE of injury in Gansu province was 3.831 billion yuan, and the expense in general hospitals was 2.708 billion yuan. Among them, the cost of lower limb injury and head injury were 1.090 and 0.847 billion yuan. People aged 40 to 69 years old spent 1.901 billion yuan on injury treatment, and the CCE of injury treatment for men and women were 2.422 and 1.409 billion yuan respectively. The results of multiple linear regression showed that hospitalization expenditure was significantly associated with length of stay, operation, hospital grade, age, payment method and gender (P<0.001). Conclusion: The economic burden of injury in Gansu Province is relatively heavy, so it is necessary to focus on preventions for different groups and costly injury sites.


Assuntos
Gastos em Saúde , Hospitalização , Ferimentos e Lesões/epidemiologia , Adulto , Idoso , China , Serviços de Saúde Comunitária , Feminino , Hospitalização/economia , Hospitalização/estatística & dados numéricos , Hospitais/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Ferimentos e Lesões/economia
5.
Public Health ; 174: 145-153, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31376684

RESUMO

OBJECTIVES: To assess the extent that the presence of severe injuries among rural and urban household members is associated with household catastrophic expenditure. STUDY DESIGN: Vietnam's Household Living Standard Survey of 2014 was used for this study. METHODS: A two-level (household and community) logistic regression analysis was used to identify factors associated with catastrophic health expenditure. RESULTS: The incidence of catastrophic health expenditure was significantly higher in rural areas (3.1-11.7%) than in urban areas (1.4-6.1%). Households with members with severe injuries were significantly more likely to incur catastrophic health expenditure than those without severe injuries, and the increase was more pronounced for the rural poor and near poor (5.5-8.7 times) than for the rural rich (1.5-2.5 times). Having at least one inpatient contact at a higher level public hospital increased the risk of catastrophic health expenditure significantly for both rural and urban residents, and the increase was significantly greater among the rural residents than the urban residents. Having more household members with health insurance had little effect on the incidence of catastrophic health expenditure faced by urban residents, while it increased the incidence of catastrophic health expenditure faced by rural residents. CONCLUSION: The presence of severe injuries among household members was strongly associated with catastrophic health expenditure. To protect households against the financial consequences of severe injuries, efforts should be directed at injury prevention and strengthening the quality of primary and trauma care at the lower level public health facilities as well as extending the breadth and depths of insurance coverage.


Assuntos
Doença Catastrófica/economia , Características da Família , Gastos em Saúde/estatística & dados numéricos , Índices de Gravidade do Trauma , Ferimentos e Lesões/economia , Doença Catastrófica/epidemiologia , Feminino , Humanos , Incidência , Seguro Saúde/estatística & dados numéricos , Masculino , População Rural/estatística & dados numéricos , Fatores Socioeconômicos , Inquéritos e Questionários , População Urbana/estatística & dados numéricos , Vietnã/epidemiologia , Ferimentos e Lesões/epidemiologia
6.
Br J Hosp Med (Lond) ; 80(7): 387-390, 2019 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-31283388

RESUMO

The costs of litigation are large and increasing, to a level that places a drain on precious health-care resources and affects the way medicine is practised. This article examines whether a change to a no-fault legal system would lead to reduced costs and improved patient care.


Assuntos
Imperícia/economia , Imperícia/legislação & jurisprudência , Erros Médicos/economia , Erros Médicos/legislação & jurisprudência , Humanos , Responsabilidade Legal/economia , Procedimentos Ortopédicos/economia , Melhoria de Qualidade/organização & administração , Medicina Estatal/economia , Medicina Estatal/legislação & jurisprudência , Reino Unido , Ferimentos e Lesões/economia
7.
J Wound Care ; 28(6): 324-330, 2019 Jun 02.
Artigo em Inglês | MEDLINE | ID: mdl-31166856

RESUMO

OBJECTIVE: To estimate the cost of wound care to the Irish health-care system. METHODS: A bottom-up, prevalence-based analysis was undertaken using a decision analytic model to estimate costs. Health-care resource activity was identified from a recently published study from the UK and was valued using unit cost data for Ireland. RESULTS: The base case analysis estimated the total annual healthcare cost of wound care to be €629,064,198 (95% Confidence interval (CI): €452,673,358 to €844,087,124), accounting for 5% (95% CI: 3% to 6%) of total public health expenditure in Ireland in 2013. The average cost per patient was €3,941 (95% CI: €2,836 to €5,287). However, this study is subject to many limitations and plausible changes in the model's inputs showed that the total annual health-care cost of wound care could range from €281,438,970 to €844,316,912. CONCLUSION: Caring for wounds places a substantial burden on the Irish health-care system. In light of growing pressures to finance an already resource-constrained health-care system, these results provide useful information for those charged with future wound care service design and provision in Ireland and elsewhere.


Assuntos
Custos de Cuidados de Saúde , Gastos em Saúde , Ferimentos e Lesões/economia , Assistência Ambulatorial/economia , Enfermagem em Saúde Comunitária/economia , Custos e Análise de Custo , Técnicas de Apoio para a Decisão , Equipamentos e Provisões/economia , Hospitalização/economia , Visita Domiciliar/economia , Humanos , Irlanda/epidemiologia , Prevalência , Ferimentos e Lesões/epidemiologia , Ferimentos e Lesões/terapia
11.
PLoS One ; 14(4): e0215152, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30973920

RESUMO

Direct road mortality and the barrier effect of roads are typically identified as one of the greatest threats to wildlife. In addition, collisions with large mammals are also a threat to human safety and represent an economic cost to society. We documented and explored the effects of animal-vehicle crashes on human safety in São Paulo State, Brazil. We estimated the costs of these crashes to society, and we summarized the legal perspectives. On average, the Military Highway Police of São Paulo reported 2,611 animal-vehicle crashes per year (3.3% of total crashes), and 18.5% of these resulted in human injuries or fatalities. The total annual cost to society was estimated at R$ 56,550,642 (US $ 25,144,794). The average cost for an animal-vehicle crash, regardless of whether human injuries and fatalities occurred, was R$ 21,656 (US $ 9,629). The Brazilian legal system overwhelmingly (91.7% of the cases) holds the road administrator liable for animal-vehicle collisions, both with wild and domestic species. On average, road administrators spent R$ 2,463,380 (US $ 1,005,051) per year compensating victims. The logical conclusion is that the Brazilian legal system expects road administrators to keep animals, both wild and domestic species, off the road. We suggest an improved coordination between the laws that relate to animal-vehicle collisions and human safety, and the process for environmental licenses that focusses on reducing collisions with wildlife and providing habitat connectivity. In addition, we suggest better management practices, raising awareness and social change with regard to abandoned domesticated animals including horses, cattle, and dogs. This should ultimately result in a road system with improved human safety, reduced unnatural mortality for both domestic and wild animal species, safe crossing opportunities for wildlife, and reduced monetary costs to society.


Assuntos
Acidentes de Trânsito/economia , Acidentes de Trânsito/legislação & jurisprudência , Animais Selvagens/lesões , Automóveis/estatística & dados numéricos , Segurança/normas , Ferimentos e Lesões/economia , Ferimentos e Lesões/prevenção & controle , Acidentes de Trânsito/prevenção & controle , Acidentes de Trânsito/estatística & dados numéricos , Animais , Automóveis/legislação & jurisprudência , Ambiente Construído , Humanos , Fatores de Risco
14.
J Pediatr Surg ; 54(5): 968-974, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30826118

RESUMO

PURPOSE: Given limited resources, it is essential to determine which Mechanisms of Injury (MOIs) to prioritize for injury prevention policy and research. We developed objective, evidence-based Injury Prevention Priority Scores (IPPSs) for Canadian children across three prevention perspectives: mortality, injury severity, and resource utilization. METHODS: We performed a retrospective cohort study of all injuries in Canada in individuals aged 0 to 19 years old from 2009 to 2014. For each MOI, an IPPS was calculated as a balanced measure of frequency and either mortality rate, median ICD-10 derived Injury Severity Score (ICISS), or median cost per hospitalization. RESULTS: Of 87,017 injuries, 83,112 were nonfatal hospitalizations, and 3905 were deaths. Overall mortality rate was 0.04 deaths/injury, median ICISS was 0.994 (IQR 0.75-0.996), and median cost per hospitalization was CAD$3262 (IQR $2118-$5001). The top three mechanisms were falls (IPPS 72), intentional self-harm (IPPS 68), and drowning (IPPS 65) for mortality, falls (IPPS73), drowning (IPPS 61), and suffocation (IPPS 61) for injury severity and falls (IPPS 70), fires (IPPS 65), and intentional self-harm (IPPS 60) for resource utilization. CONCLUSION: Falls, if prevented, would provide the most benefit to the largest proportion of the Canadian pediatric population and should be targeted for injury prevention. LEVEL OF EVIDENCE: Level III.


Assuntos
Custos de Cuidados de Saúde/estatística & dados numéricos , Conhecimentos, Atitudes e Prática em Saúde , Recursos em Saúde/estatística & dados numéricos , Ferimentos e Lesões/etiologia , Ferimentos e Lesões/mortalidade , Acidentes por Quedas/mortalidade , Acidentes por Quedas/estatística & dados numéricos , Adolescente , Asfixia/mortalidade , Canadá/epidemiologia , Criança , Pré-Escolar , Afogamento/mortalidade , Fogo/estatística & dados numéricos , Hospitalização/economia , Humanos , Lactente , Recém-Nascido , Escala de Gravidade do Ferimento , Estudos Retrospectivos , Comportamento Autodestrutivo/complicações , Comportamento Autodestrutivo/epidemiologia , Ferimentos e Lesões/economia , Ferimentos e Lesões/prevenção & controle , Adulto Jovem
17.
Wounds ; 31(2): E9-E11, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30730299

RESUMO

INTRODUCTION: Patient nonadherence to home care treatment poses an obstacle to wound healing that can lead to additional costs and prolong care. OBJECTIVE: This retrospective pilot study examines the potential time and cost savings associated with a remote therapy monitoring (RTM) program designed to improve negative pressure wound therapy (NPWT) adherence in the home care setting. MATERIALS AND METHODS: Payor claims data of patients receiving NPWT with (n = 199) or without (n = 232) RTM between January 1 and June 30, 2017 were analyzed. RESULTS: The RTM patients were significantly older (P = .0401), had a higher percentage of Medicare Advantage plans (P = .0015), and had a higher mean Charleston Comorbidity Index score (P = .0115) than non-RTM patients. For both groups, chronic wounds had higher 90-day wound-related costs than acute wounds. The median length of treatment for RTM patients was shorter than non-RTM patients (P = .0394). Mean 90-day wound-related costs for RTM and non-RTM patients were $10 515 and $12 158, respectively. CONCLUSIONS: These results build upon previous studies of RTM-assisted outpatient NPWT and suggest an opportunity for wound care cost savings.


Assuntos
Tratamento de Ferimentos com Pressão Negativa , Cooperação do Paciente/estatística & dados numéricos , Tecnologia de Sensoriamento Remoto , Autocuidado/métodos , Cicatrização/fisiologia , Ferimentos e Lesões/terapia , Redução de Custos , Serviços de Assistência Domiciliar , Humanos , Revisão da Utilização de Seguros , Tratamento de Ferimentos com Pressão Negativa/economia , Educação de Pacientes como Assunto , Projetos Piloto , Tecnologia de Sensoriamento Remoto/economia , Estudos Retrospectivos , Resultado do Tratamento , Estados Unidos , Ferimentos e Lesões/economia , Ferimentos e Lesões/patologia
18.
Wounds ; 31(2 Suppl): S1-S17, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30741645

RESUMO

Use of ultra-portable, mechanically powered disposable negative pressure wound therapy (dNPWT) has grown as an adjunctive modality to manage wounds in outpatient care and to expedite transition of inpatients to an outpatient setting. This technology has demonstrated similar efficacy and usability for mobile outpatients when compared with electrically powered negative pressure wound therapy devices. It was designed for patients with smaller, low to moderately exudating wounds and does not require batteries or a power source. However, very few studies address best practices for using dNPWT in a variety of wound types. There is a need for comprehensive clinical recommendations to better direct clinicians and patients in using this therapy. In addition, it is critical that providers are knowledgeable about processes for obtaining reimbursement for placement of dNPWT since codes and procedures differ drastically from standard NPWT. A panel meeting of experts with a high level of experience with dNPWT in varied wound types was convened to develop clinical recommendations and summarize current US reimbursement coding guidelines for the use of dNPWT. This publication summarizes the recommendations from panel members, in addition to supporting evidence, to help guide appropriate use of dNPWT. Panel recommendations regarding optimal patient and wound selection, wound preparation, proper patient training, and use of dNPWT in various wound types are included as well as clinical techniques for dressing application, bridging under offloading devices and compression, maintaining a seal, and protecting intact skin. Processes and codes for obtaining reimbursement for dNPWT are reviewed by care setting. Clinical recommendations and reimbursement guidelines summarized in this publication are meant to provide direction to clinicians in using dNPWT that potentially could translate into improved clinical and economic value.


Assuntos
Equipamentos Descartáveis , Tratamento de Ferimentos com Pressão Negativa , Ferimentos e Lesões/terapia , Equipamentos Descartáveis/economia , Exsudatos e Transudatos , Humanos , Tratamento de Ferimentos com Pressão Negativa/economia , Tratamento de Ferimentos com Pressão Negativa/instrumentação , Pacientes Ambulatoriais , Seleção de Pacientes , Guias de Prática Clínica como Assunto , Mecanismo de Reembolso , Índices de Gravidade do Trauma , Cicatrização , Ferimentos e Lesões/economia , Ferimentos e Lesões/patologia
19.
Accid Anal Prev ; 125: 207-216, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30772676

RESUMO

Most light-duty vehicle crashes occur due to human error. Many of these crashes could be avoided or made less severe with the aid of crash avoidance technologies. These technologies can assist the driver in maintaining control of the vehicle when a possibly dangerous situation arises by issuing alerts to the driver and in a few cases, responding to the situation itself. This paper estimates the societal and private benefits and costs associated with three crash avoidance technologies, blind-spot monitoring, lane departure warning, and forward-collision warning, for all light duty passenger vehicles in the U.S. for the year 2015. The three technologies could collectively prevent up to 1.6 million crashes each year including 7200 fatal crashes. In this paper, the authors estimated the net-societal benefits to the overall society from avoiding the cost of the crashes while also estimating the private share of those benefits that are directly affecting the crash victims. For the first generation warning systems, net-societal benefits and net-private benefits are positive. Moreover, the newer generation of improved warning systems and active braking should make net benefits even more advantageous.


Assuntos
Prevenção de Acidentes/economia , Prevenção de Acidentes/métodos , Acidentes de Trânsito/economia , Acidentes de Trânsito/prevenção & controle , Automóveis , Equipamentos de Proteção/economia , Prevenção de Acidentes/estatística & dados numéricos , Acidentes de Trânsito/estatística & dados numéricos , Automóveis/economia , Análise Custo-Benefício , Humanos , Ferimentos e Lesões/economia , Ferimentos e Lesões/prevenção & controle
20.
Inj Prev ; 25(1): 4-12, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30670560

RESUMO

OBJECTIVE: China's population is ageing and fall-related injury in older Chinese people is a growing public health concern. This review aims to synthesise existing evidence on the incidence, risk factors and economic burden of fall-related injury among older Chinese people to inform health service planning. METHODS: A systematic search of literature on falls and injury among older people living in China was performed in six electronic databases including both English and Chinese databases. Results were combined using narrative synthesis due to the heterogeneity of included studies. RESULTS: A total of 93 studies from Mainland China, Taiwan and Hong Kong were included in this review. Most of these studies were descriptive; 82 reported the incidence of fall-related injury among older Chinese people, 7 studies examined the risk factors for fall-related injury and 22 studies described the economic burden of fall-related injury. The incidence of fall-related injury reported among older Chinese people ranged from 0.6% to 19.5%. Risk factors significantly associated with fall-related injury among older Chinese included older age, female sex, walking aid use, living environments, chronic disease, medication usage, visual impairment and a fall direction other than forward. The cost of fall-related injury among older Chinese people ranged from US$16 to US$3812 per person per fall. CONCLUSION: Falls-related injuries are a significant public health issue for older Chinese people. Further studies using prospective design to identify risk factors and the economic burden of fall-related injuries are needed.


Assuntos
Acidentes por Quedas/economia , Acidentes por Quedas/estatística & dados numéricos , Gastos em Saúde/estatística & dados numéricos , Ferimentos e Lesões/economia , Ferimentos e Lesões/epidemiologia , Fatores Etários , Idoso , China/epidemiologia , Efeitos Psicossociais da Doença , Humanos , Incidência , Vida Independente , Estilo de Vida , Fatores de Risco
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