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1.
Gesundheitswesen ; 82(1): 100-106, 2020 Jan.
Artigo em Alemão | MEDLINE | ID: mdl-29758573

RESUMO

BACKGROUND: Prospective analysis of assessment reports in otorhinolaryngology for the period 01-03-2011 to 31-03-2017 by the Health Advisory Boards in Lower Saxony and Bremen, Germany in relation to coding in the G-DRG-System. MATERIAL AND METHODS: The assessment reports were documented using a standardized database system developed on the basis of the electronic data exchange (DTA) by the Health Advisory Board in Lower Saxony. In addition, the documentation of the assessment reports according to the G-DRG system was used for assessment. Furthermore, the assessment of a case was evaluated once again on the basis of the present assessment documents and presented as an example in detail. RESULTS: During the period from 01-03-2011 to 31-03-2017, a total of 27,424 cases of inpatient assessments of DRGs according to the G-DRG system were collected in the field of otorhinolaryngology. In 7,259 cases, the DRG was changed, and in 20,175 cases, the suspicion of a DRG-relevant coding error was not justified in the review; thus, a DRG change rate of 26% of the assessments was identified over the time period investigated. CONCLUSIONS: There were different kinds of coding errors. In order to improve the coding quality in otorhinolaryngology, in addition to the special consideration of the presented "hit list" by the otorhinolaryngology departments, there should be more intensive cooperation between hospitals and the Health Advisory Boards of the federal states.


Assuntos
Grupos Diagnósticos Relacionados , Otolaringologia , Documentação , Alemanha , Otolaringologia/estatística & dados numéricos , Estudos Prospectivos
2.
BMC Health Serv Res ; 19(1): 988, 2019 Dec 23.
Artigo em Inglês | MEDLINE | ID: mdl-31870354

RESUMO

BACKGROUND: The United Kingdom aortic aneurysms (AA) services have undergone reconfiguration to improve outcomes. The National Health Service collects data on all hospital admissions in England. The complex administrative datasets generated have the potential to be used to monitor activity and outcomes, however, there are challenges in using these data as they are primarily collected for administrative purposes. The aim of this study was to develop standardised algorithms with the support of a clinical consensus group to identify all AA activity, classify the AA management into clinically meaningful case mix groups and define outcome measures that could be used to compare outcomes among AA service providers. METHODS: In-patient data about aortic aneurysm (AA) admissions from the 2002/03 to 2014/15 were acquired. A stepwise approach, with input from a clinical consensus group, was used to identify relevant cases. The data is primarily coded into episodes, these were amalgamated to identify admissions; admissions were linked to understand patient pathways and index admissions. Cases were then divided into case-mix groups based upon examination of individually sampled and aggregate data. Consistent measures of outcome were developed, including length of stay, complications within the index admission, post-operative mortality and re-admission. RESULTS: Several issues were identified in the dataset including potential conflict in identifying emergency and elective cases and potential confusion if an inappropriate admission definition is used. Ninety six thousand seven hundred thirty-five patients were identified using the algorithms developed in this study to extract AA cases from Hospital episode statistics. From 2002 to 2015, 83,968 patients (87% of all cases identified) underwent repair for AA and 12,767 patients (13% of all cases identified) died in hospital without any AA repair. Six thousand three hundred twenty-nine patients (7.5%) had repair for complex AA and 77,639 (92.5%) had repair for infra-renal AA. CONCLUSION: The proposed methods define homogeneous clinical groups and outcomes by combining administrative codes in the data. These methodologically robust methods can help examine outcomes associated with previous and current service provisions and aid future reconfiguration of aortic aneurysm surgery services.


Assuntos
Aneurisma Aórtico/cirurgia , Medicina Estatal , Estudos de Coortes , Conjuntos de Dados como Assunto , Grupos Diagnósticos Relacionados , Inglaterra , Hospitalização/estatística & dados numéricos , Humanos , Resultado do Tratamento
3.
BMC Health Serv Res ; 19(1): 776, 2019 Oct 30.
Artigo em Inglês | MEDLINE | ID: mdl-31666066

RESUMO

BACKGROUND: In 2002, a voluntary diagnosis-related groups (DRGs) payment system was introduced in South Korea for seven disease groups, and participation in the DRGs was mandated for all hospitals beginning in 2013. The primary aim of this study was to compare results reflective of patient care between voluntary participation hospitals (VPHs) and mandatory participation hospitals (MPHs) governed by either the DRGs or fee-for-service (FFS) payment system. METHODS: We collected DRGs and FFS inpatient records (n=3,038,006) from the Health Insurance Review and Assessment for the period of July 2011 to July 2014 and compared length-of-stay, total medical costs, shifting services to an outpatient setting, and readmission rates according to payment system, time of DRGs implementation, and hospital type. We analyzed the effects of mandatory introduction in DRGs payment system on results for patient care and used generalized estimating equations with difference-in-difference methodology. RESULTS: Most notably, patients at MPHs had significantly shorter LOS and lower readmission rates than VPH patients after mandatory introduction of the DRGs. Shifting services to an outpatient setting was similar between the groups. CONCLUSIONS: Our findings suggest that the DRGs payment policy in Korea has decreased LOS and readmission rates. These findings support the continued implementation and enlargement of the DRGs payment system for other diseases in South Korea, given its potential for curbing unnecessary resource usage encouraged by FFS. If the Korean government deliberates on expansion of the DRGs to include other diseases with higher rates of complications, policymakers need to monitor deterioration of health care quality caused by fixed pricing.


Assuntos
Grupos Diagnósticos Relacionados/economia , Hospitais , Programas Obrigatórios , Qualidade da Assistência à Saúde/estatística & dados numéricos , Adulto , Idoso , Planos de Pagamento por Serviço Prestado/economia , Feminino , Humanos , Revisão da Utilização de Seguros , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Readmissão do Paciente/estatística & dados numéricos , Avaliação de Programas e Projetos de Saúde , República da Coreia , Adulto Jovem
4.
BMC Health Serv Res ; 19(1): 877, 2019 Nov 21.
Artigo em Inglês | MEDLINE | ID: mdl-31752866

RESUMO

BACKGROUND: In the move toward value-based care, bundled payments are believed to reduce waste and improve coordination. Some commercial insurers have addressed this through the use of bundled payment, the provision of one fee for all care associated with a given index procedure. This system was pioneered by Medicare, using a population generally over 65 years of age, and despite its adoption by mainstream insurers, little is known of bundled payments' ability to reduce variation or cost in a working-age population. This study uses a universally-insured, nationally-representative population of adults aged 18-65 to examine the effect of bundled payments for five high-cost surgical procedures which are known to vary widely in Medicare reimbursement: hip replacement, knee replacement, coronary artery bypass grafting (CABG), lumbar spinal fusion, and colectomy. METHODS: Five procedures conducted on adults aged 18-65 were identified from the TRICARE database from 2011 to 2014. A 90-day period from index procedure was used to determine episodes of associated post-acute care. Data was sorted by Zip code into hospital referral regions (HRR). Payments were determined from TRICARE reimbursement records, they were subsequently price standardized and adjusted for patient and surgical characteristics. Variation was assessed by stratifying the HRR into quintiles by spending for each index procedure. RESULTS: After adjusting for case mix, significant inter-quintile variation was observed for all procedures, with knee replacement showing the greatest variation in both index surgery (107%) and total cost of care (75%). Readmission was a driver of variation for colectomy and CABG, with absolute cost variation of $17,257 and $13,289 respectively. Other post-acute care spending was low overall (≤$1606, for CABG). CONCLUSIONS: This study demonstrates significant regional variation in total spending for these procedures, but much lower spending for post-acute care than previously demonstrated by similar procedures in Medicare. Targeting post-acute care spending, a common approach taken by providers in bundled payment arrangements with Medicare, may be less fruitful in working aged populations.


Assuntos
Gastos em Saúde/estatística & dados numéricos , Programas de Assistência Gerenciada/economia , Mecanismo de Reembolso , Procedimentos Cirúrgicos Operatórios/economia , Adolescente , Adulto , Idoso , Artroplastia de Quadril/economia , Artroplastia do Joelho/economia , Colectomia/economia , Ponte de Artéria Coronária/economia , Grupos Diagnósticos Relacionados , Feminino , Reforma dos Serviços de Saúde/legislação & jurisprudência , Humanos , Masculino , Pessoa de Meia-Idade , Militares , Fusão Vertebral/economia , Cuidados Semi-Intensivos/economia , Estados Unidos , Veteranos , Adulto Jovem
6.
Asia Pac J Public Health ; 31(6): 499-509, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31516035

RESUMO

The purpose of this study was to determine whether the introduction of diagnosis-related groups (DRGs) shifted the medical services from inpatient to outpatient settings. Using a difference-in-difference analysis, the changes in length of stay, outpatient visit days within 30 days before hospitalization, and outpatient visit days within 30 days after hospital discharge were evaluated. The length of stay was reduced after the DRG policy, consistent with previous studies. Outpatient visit days within 30 days before a hospital admission increased significantly after the policy change. In addition, outpatient visit days within 30 days after a hospital discharge increased in all the medical institutions excluding hospitals. The study findings are consistent with the expectation that providers respond to changes in the payment system to protect or enhance their economic interests. Health care providers in Korea responded to the DRG policy by reducing the intensity of inpatient treatment and transferring costs to outpatient settings.


Assuntos
Assistência Ambulatorial/estatística & dados numéricos , Grupos Diagnósticos Relacionados , Hospitalização/estatística & dados numéricos , Humanos , Revisão da Utilização de Seguros , Tempo de Internação/estatística & dados numéricos , República da Coreia
7.
Klin Padiatr ; 231(6): 313-319, 2019 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-31525782

RESUMO

BACKGROUND: Pediatrics are often regarded as a "victim" of the German Diagnosis related Groups (G-DRG) system because the economic situation of many pediatric hospitals has deteriorated since the introduction of the G-DRG system in 2004. This is often attributed to an insufficient case mix of pediatric diagnoses. It is unknown if revenues are lost due to an insufficient qualification of coding staff. METHODS: All members of the German Society of Pediatric Hospitals and Departments (GKinD) were invited to an online survey by e-mail. RESULTS: 177 (52%) of the 340 german children's hospitals delivered complete questionnaires. 52% of the hospitals employed codings staff that had no additional clinical duties. Coding staff had no specific professional training and did not undergo specific ongoing education in 47 and 32% of the hospitals, respectively. During absence, 35% of coding staff a no substitute or a non-pediatric substitute. 2,8% of the senior physicians judged the established structures as "bad" or "very bad". DISCUSSION: In many german children's hospitals, diagnoses are documented by coding staff with an insufficient qualification. This is associated with the risk of inaccurate or incomplete coding and can threaten the economic success of the hospital. The senior physicians are satisfied with the established coding structures, thus they might be unaware of the great economic potenzial of improvements of the coding quality. CONCLUSION: The economic situation of german children's hospitals could be significantly improved by recruitment of qualified, full-time coding staff.


Assuntos
Grupos Diagnósticos Relacionados/economia , Grupos Diagnósticos Relacionados/estatística & dados numéricos , Administração Hospitalar/economia , Administração Hospitalar/estatística & dados numéricos , Hospitais Pediátricos , Médicos/economia , Criança , Alemanha , Humanos , Mecanismo de Reembolso , Inquéritos e Questionários
8.
BMC Health Serv Res ; 19(1): 630, 2019 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-31484551

RESUMO

BACKGROUND: This work aims to apply data-detection algorithms to predict the possible deductions of reimbursement from Taiwan's Bureau of National Health Insurance (BNHI), and to design an online dashboard to send alerts and reminders to physicians after completing their patient discharge summaries. METHODS: Reimbursement data for discharged patients were extracted from a Taiwan medical center in 2016. Using the Rasch model of continuous variables, we applied standardized residual analyses to 20 sets of norm-referenced diagnosis-related group (DRGs), each with 300 cases, and compared these to 194 cases with deducted records from the BNHI. We then examine whether the results of prediction using the Rasch model have a high probability associated with the deducted cases. Furthermore, an online dashboard was designed for use in the online monitoring of possible deductions on fee items in medical settings. RESULTS: The results show that 1) the effects deducted by the NHRI can be predicted with an accuracy rate of 0.82 using the standardized residual approach of the Rasch model; 2) the accuracies for drug, medical material and examination fees are not associated among different years, and all of those areas under the ROC curve (AUC) are significantly greater than the randomized probability of 0.50; and 3) the online dashboard showing the possible deductions on fee items can be used by hospitals in the future. CONCLUSION: The DRG-based comparisons in the possible deductions on medical fees, along with the algorithm based on Rasch modeling, can be a complementary tool in upgrading the efficiency and accuracy in processing medical fee applications in the discernable future.


Assuntos
Computação em Nuvem , Grupos Diagnósticos Relacionados , Reembolso de Seguro de Saúde/estatística & dados numéricos , Programas Nacionais de Saúde/estatística & dados numéricos , Alta do Paciente/estatística & dados numéricos , Grupos Diagnósticos Relacionados/economia , Honorários Médicos , Hospitais , Humanos , Programas Nacionais de Saúde/economia , Taiwan
9.
Int J Med Inform ; 129: 248-252, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31445263

RESUMO

BACKGROUND AND PROJECT AIM: The American British Cowdray Medical Center is a private healthcare institution in Mexico City. One of the many tools that we use and help us to achieve a high standard of quality and recognition worldwide is the clinical coding and Diagnosis Related Groups (DRG). To help the readers to improve the process of clinical coding, we will share the challenges, changes and different applications of the generation of DRG in the private healthcare institution. METHODS AND RESULTS: A retrospective, descriptive study to demonstrate the changes on the process of coding and measure the outcome of clinical coding, precision of data and better quality in the generations of DRGs. Initially, less than 2 diagnoses and 1 procedure were coded per discharge, using partial medical records. By the second half of 2007, a different coding procedure was implemented, and the complete medical records started being used; also, comorbid conditions were included in coding. Nowadays, the average number of coded diagnoses is 5.4 and the average number of coded procedures is 4.2, with a coding error rate of 0.68% and a DRG outliers' rate of 0.45%. DISCUSSION AND CONCLUSIONS: While many countries use DRG for reimbursement, we exploit the clinical data registration and the DRGs for the economic and organizational. Through more efficient and accurate coding, DRGs are useful within the institution to generate indicators on resources, cost, length of stay and goals for each service. Having better quality clinical data has allowed for improved service line management, which has translated into patient-oriented services. Prospective studies are necessary to keep evaluating in a objective way the utilities of the DRG in healthcare private institutions.


Assuntos
Codificação Clínica , Custos e Análise de Custo , Grupos Diagnósticos Relacionados , Hospitais , Humanos , Registros Médicos , Alta do Paciente/economia , Estudos Prospectivos , Estudos Retrospectivos , Fatores de Tempo
10.
Stud Health Technol Inform ; 264: 1706-1707, 2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31438303

RESUMO

Diagnosis Related Groups (DRGs) and the Tenth Revision of the International Statistical Classification of Disease and Related Health Problems (ICD-10) were implemented to Taiwan in 2010 and 2016 respectively. New rules related to the medical costs reimbursement were great challenges facing medical institutions. One of the medical centers in north Taiwan introduced an ICD e-dictionary, DRGs cloud computing system, and integrated them into the hospital information system. Further, developing a medical coder specialization work model optimized the workflow, coding quality, and efficiency, which defeated the adverse effects of DRGs and ICD-10 implementation successfully.


Assuntos
Codificação Clínica , Classificação Internacional de Doenças , Grupos Diagnósticos Relacionados , Especialização , Taiwan
11.
Med Care ; 57(10): 822-829, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31415339

RESUMO

OBJECTIVE: In 2012 Centers for Medicare and Medicaid Services (CMS) launched a multifaceted initiative aimed at reducing the unnecessary use of antipsychotic medications in nursing facilities due to evidence these medications are associated with little or uncertain benefit and substantial risk. Yet, little is known about whether efforts to reduce antipsychotic medication should be focused on residents with targeted characteristics, or on nursing facility regulation (eg, staffing levels). Our objective was to identify the relative contribution of resident and facility characteristics to potentially inappropriate antipsychotic use. METHODS: We examined 1,156,875 long stay residents in 14,699 US nursing facilities in 2014 and predicted resident antipsychotic use controlling sequentially for resident and facility characteristics and calculated the incremental variation explained. RESULTS: We found significant variability in unadjusted rates of potentially inappropriate antipsychotic use among nursing facilities (mean=18.0%; interquartile range: 11.3%-23.7%; SD: 11.1). Regression results indicated that 93% of the explained variation in antipsychotic use was attributed to resident characteristics and 7% was attributed to facility-level factors. At the facility level, worker hours per resident day was not significantly associated with antipsychotic use. Simulations indicated that applying the effect sizes achieved by the best performing facilities to the existing case mix across all nursing facilities would result in no more than a 1 percentage point change in population-level antipsychotic use. CONCLUSIONS: Efforts to reduce antipsychotic use may have greater impact by developing new clinical strategies to address specific diagnoses rather than regulations related to facility-level attributes.


Assuntos
Antipsicóticos/uso terapêutico , Prescrições de Medicamentos/estatística & dados numéricos , Prescrição Inadequada/estatística & dados numéricos , Casas de Saúde/estatística & dados numéricos , Adulto , Idoso , Grupos Diagnósticos Relacionados/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estados Unidos
12.
Am Surg ; 85(6): 611-619, 2019 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-31267902

RESUMO

The Medicare Severity Diagnosis Related Group (MS-DRG) weight, as derived from the MS-DRG assigned at discharge, is in part determined by the physician-documented diagnoses. However, the terminology associated with MS-DRG determination is often not aligned with typical physician language, leading to inaccurate coding and decreased hospital reimbursements. The goal of this study was to evaluate the impact of a diagnosis picklist within a paper-based history and physical examination (H&P) on the average MS-DRG weight and the Case-mix index (CMI). Our trauma center implemented a paper H&P form for trauma patients featuring picklist diagnoses aligned with the MS-DRG terminology and arranged by the physiologic system. To evaluate its impact, we conducted a cohort study using data from our trauma registry between July 2015 and November 2017. Our cohort included 442 (26.0%) paper and 1,261 (74.0%) dictated H&Ps. Average CMI (2.56 vs 2.15) and expected patients ($25,057 vs $19,825) were higher for the paper group (P < 0.001, P = 0.002). Adjusted regression models demonstrated paper coding to be associated with 0.265 CMI points, translating to an average increase in expected payment of 6.5 per cent per patient. Utilization of a standardized, paper-based H&P template with picklist diagnoses was associated with a higher trauma service CMI and higher expected payments. Preprinted diagnoses that align with the MS-DRG terminology lead to clinical documentation improvement.


Assuntos
Grupos Diagnósticos Relacionados/tendências , Documentação/tendências , Alta do Paciente/tendências , Melhoria de Qualidade , Centros de Traumatologia/organização & administração , Ferimentos e Lesões/diagnóstico , Centros Médicos Acadêmicos/organização & administração , Arizona , Intervalos de Confiança , Bases de Dados Factuais , Grupos Diagnósticos Relacionados/normas , Documentação/métodos , Feminino , Humanos , Masculino , Medicare/economia , Admissão do Paciente/normas , Admissão do Paciente/tendências , Alta do Paciente/normas , Alta do Paciente/estatística & dados numéricos , Exame Físico/normas , Exame Físico/tendências , Sistema de Pagamento Prospectivo/normas , Sistema de Pagamento Prospectivo/tendências , Análise de Regressão , Estudos Retrospectivos , Estados Unidos , Ferimentos e Lesões/classificação
13.
Otolaryngol Head Neck Surg ; 161(4): 629-634, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31307271

RESUMO

OBJECTIVES: (1) To evaluate whether admission volume and case complexity are associated with mortality rates and (2) evaluate whether admission volume and case complexity are associated with cost per admission. STUDY DESIGN: Retrospective case series. SETTING: Tertiary academic hospital. SUBJECTS AND METHODS: The Vizient database was queried for inpatient admissions between July 2015 and March 2017 to an otolaryngology-head and neck surgery service. Data collected included admission volume, length of stay, intensive care unit (ICU) status, complication rates, case mix index (CMI), and cost data. Regression analysis was performed to evaluate the relationship between cost, CMI, admission volume, and mortality rate. RESULTS: In total, 338 hospitals provided data for analysis. Mean hospital admission volume was 182 (range, 1-1284), and mean CMI was 1.69 (range, 0.66-6.0). A 1-point increase in hospital average CMI was associated with a 40% increase in odds for high mortality. Admission volume was associated with lower mortality, with 1% lower odds for each additional case. A 1-point increase in CMI produces a $4624 higher total cost per case (95% confidence interval, $4550-$4700), and for each additional case, total cost per case increased by $6. CONCLUSION: For otolaryngology inpatient services at US academic medical centers, increasing admission volume is associated with decreased mortality rates, even after controlling for CMI and complication rates. Increasing CMI levels have an anticipated correlation with higher total costs per case, but admission volume is unexpectedly associated with a significant increase in average cost per case.


Assuntos
Centros Médicos Acadêmicos/estatística & dados numéricos , Grupos Diagnósticos Relacionados , Custos de Cuidados de Saúde , Hospitalização/estatística & dados numéricos , Procedimentos Cirúrgicos Otorrinolaringológicos/economia , Procedimentos Cirúrgicos Otorrinolaringológicos/mortalidade , Centros Médicos Acadêmicos/economia , Economia Hospitalar , Cabeça/cirurgia , Mortalidade Hospitalar , Hospitais com Alto Volume de Atendimentos , Humanos , Tempo de Internação , Pescoço/cirurgia , Análise de Regressão , Estudos Retrospectivos , Estados Unidos
14.
PLoS One ; 14(7): e0219672, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31339906

RESUMO

BACKGROUND: The national Epithor database was initiated in 2003 in France. Fifteen years on, a quality assessment of the recorded data seemed necessary. This study examines the completeness of the data recorded in Epithor through a comparison with the French PMSI database, which is the national medico-administrative reference database. The aim of this study was to demonstrate the influence of data quality with respect to identifying 30-day mortality hospital outliers. METHODS: We used each hospital's individual FINESS code to compare the number of pulmonary resections and deaths recorded in Epithor to the figures found in the PMSI. Centers were classified into either the good-quality data (GQD) group or the low-quality data (LQD) group. To demonstrate the influence of case-mix quality on the ranking of centers with low-quality data, we used 2 methods to estimate the standardized mortality rate (SMR). For the first (SMR1), the expected number of deaths per hospital was estimated with risk-adjustment models fitted with low-quality data. For the second (SMR2), the expected number of deaths per hospital was estimated with a linear predictor for the LQD group using the coefficients of a logistic regression model developed from the GQD group. RESULTS: Of the hospitals that use Epithor, 25 were classified in the GQD group and 75 in the LQD group. The 30-day mortality rate was 2.8% (n = 300) in the GQD group vs. 1.9% (n = 181) in the LQD group (P <0.0001). The between-hospital differences in SMR1 appeared substantial (interquartile range (IQR) 0-1.036), and they were even higher in SMR2 (IQR 0-1.19). SMR1 identified 7 hospitals as high-mortality outliers. SMR2 identified 4 hospitals as high-mortality outliers. Some hospitals went from non-outlier to high mortality and vice-versa. Kappa values were roughly 0.46 and indicated moderate agreement. CONCLUSION: We found that most hospitals provided Epithor with high-quality data, but other hospitals needed to improve the quality of the information provided. Quality control is essential for this type of database and necessary for the unbiased adjustment of regression models.


Assuntos
Bases de Dados Factuais , Grupos Diagnósticos Relacionados , Administração Hospitalar , Hospitais , Discrepância de GDH , Feminino , Mortalidade Hospitalar , Humanos , Modelos Logísticos , Masculino , Modelos Teóricos , Risco Ajustado
15.
Medwave ; 19(6): e7668, 2019 Jul 23.
Artigo em Espanhol | MEDLINE | ID: mdl-31348768

RESUMO

Introduction: Stroke is the leading cause of death and disability in Chile. Objective: To analyze the epidemiological characteristics of hospitalized patients with a diagnosis of stroke in our hospital unit (Complejo Asistencial Víctor Ríos Ruiz). Methods: We performed an observational, cross-sectional study. We included patients who were discharged from our hospital with a diagnosis of stroke between 2014 and 2017. We extracted data on stroke-related ICD codes, demographic variables, types of stroke, case fatality rates, and hospital stay. Quantitative variables were expressed as averages with standard deviation (± SD), and categorical variables were expressed as absolute and relative frequencies. Differences were analyzed using Student t-distribution and ANOVA. We defined a p-value of < 0.05 as statistically significant. Results: In total, 1856 patients were discharged of which 58.6% were male, with an average age of 66.9 (± 13.9) years, and an average stay of 10.4 (± 16.7) days. In the female population, the average age was 69.9 (± 16), and the average hospitalization was 11.1 (± 16.5) days. 55.5% of stroke cases was ischemic, and 17.4% was hemorrhagic. The main risk factors were hypertension (72%) and type 2 diabetes (33%). We found an overall in-hospital case fatality rate of 10.6%. Both the case fatality rate and prolonged in-hospital stay were associated with subarachnoid hemorrhage and hemorrhagic stroke (p < 0.05). Conclusions: Prevalence of stroke is similar in both men and women. Hypertension was the leading risk factor associated with acute stroke. Although ischemic stroke was the most frequent diagnosis, both subarachnoid hemorrhage and hemorrhagic stroke were related to an increased case fatality rate and a more extended hospital stay.


Assuntos
Diabetes Mellitus Tipo 2/epidemiologia , Hospitalização , Hipertensão/epidemiologia , Acidente Vascular Cerebral/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Chile , Estudos Transversais , Grupos Diagnósticos Relacionados , Feminino , Humanos , Hemorragias Intracranianas/epidemiologia , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/etiologia , Hemorragia Subaracnóidea/epidemiologia
16.
Epidemiol Prev ; 43(2-3): 177-184, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31293137

RESUMO

OBJECTIVES: a blended training programme combining residential meetings (de visu) and distance training course (DTC) have been developed in order to provide the key elements for prevention, individuation, and care of women victims of violence. DESIGN: the Project involved the identification and testing of a systematic methodology of blended training addressed to social and health operators of 28 Emergency Room (ER) Units in 4 Italian regions (Lombardy - Northern Italy, Lazio - Central Italy, Campania and Sicily - Southern Italy). Tuscany region (Central Italy) collaborated through experts in the field from the Grosseto Task Force. This training approach specifically aimed to increase the professional competences for diagnosis, management and treatment of gender-based violence, as well as to strengthen multidisciplinary territorial networks against violence. SETTING AND PARTICIPANTS: in this Project, 28 ERs in the four Italian regions mentioned above were selected because of their involvement in managing gender-based violence. This selection was performed by a coordinator, one for each region, who also coordinated the recruitment of personnel to be involved in the training programme. The programme has therefore been proposed to social and health operators and police officers in the ERs recruited. In each ER, two referents were identified (a doctor and a nurse) in order to ensure a constant connection between the course participants and the experts involved in the management of the Project and the DTC platform. MAIN OUTCOME MEASURES: evaluation of the increase of knowledge relatively to gender-based violence issue in the ER professionals who have concluded the blended training programme. A systematic analysis and comparison of all accesses concerning women aged ≥14 years in the period 1 July-31 December 2014 (before the blended training programme) and in the period 1 July-31 December 2016 (after the blended training program). RESULTS: among the 866 registered professionals, 636 participants (73.5%) completed the course, 202 (23.3%) professionals did not complete it, 21 (2.4%) did not pass the certification test, and 7 (0.8%) participated as Auditors. Among the participants who completed the course, most of them (70.8%) were females; the average age was 45 for both males and females. The most represented professional role was the nurse (61%), followed by the medical doctor (27.2%). Based on our data, in the post-training period, an increased number of cases of violence were correctly recorded in comparison to the pre-training period. CONCLUSION: the Project allowed to define a training strategy for health professionals of the ERs who respond daily to the health needs of women who are victims of violence. The blended training programme combining residential meetings (de visu) and distance training course has been developed in order to provide the key elements for prevention, individuation, and care of women victims of violence. The observed improvement in the recording and management of cases of gender-based violence is probably due to a greater competence in the awareness and use of specific diagnostic codes by ER professionals.


Assuntos
Educação a Distância/organização & administração , Serviço Hospitalar de Emergência , Violência de Gênero/prevenção & controle , Pessoal de Saúde/educação , Adulto , Atitude do Pessoal de Saúde , Diagnóstico , Grupos Diagnósticos Relacionados , Feminino , Pessoal de Saúde/psicologia , Humanos , Comunicação Interdisciplinar , Masculino , Pessoa de Meia-Idade , Competência Profissional , Avaliação de Programas e Projetos de Saúde
17.
BMC Health Serv Res ; 19(1): 374, 2019 Jun 13.
Artigo em Inglês | MEDLINE | ID: mdl-31196075

RESUMO

BACKGROUND: Switzerland recently introduced Acute and Transitional Care (ATC) as a new financing option and a preventive measure to mitigate potential side effects of Swiss Diagnosis Related Group (SwissDRG). The goal of ATC was to support patients who after acute treatment at a hospital require temporary increased professional care. However, evidence is lacking as to the practicality of ATC. METHODS: Using qualitative focus group methodology, we sought to understand the implementation and use of ATC. A purposive sample of forty-two professionals from five Swiss cantons participated in this study. We used a descriptive thematic approach to analyse the data. RESULTS: Our findings first reveal that ATC's implementation differs in the five cantons (i.e. federal states). In two cantons, only ambulatory variant of ATC is used; in one canton only stationary ATC has been created, and two cantons had both ambulatory and stationary ATC but preferred the latter. Second, there are intrinsic practical challenges associated with ATC, which include physicians' lack of familiarity with ATC and its regulatory limitations. Finally, participants felt that due to shorter hospital stays because of SwissDRG, premature discharge of patients with complex care needs to stationary ATC takes place. This development does not fit the nursing home concept of care tailored to long-term patients. CONCLUSION: This empirical study underscores that there is a strong need to improve ATC so that it is uniformly implemented throughout the country and its application is streamlined. In light of the newness of ATC as well as SwissDRG, their impact on the quality of care received by patients is yet to be fully understood. Empirical evidence is necessary to improve these two measures.


Assuntos
Grupos Diagnósticos Relacionados/estatística & dados numéricos , Serviços Médicos de Emergência , Cuidado Transicional , Serviços Médicos de Emergência/organização & administração , Serviços Médicos de Emergência/normas , Estudos de Avaliação como Assunto , Grupos Focais , Humanos , Estudos Prospectivos , Suíça/epidemiologia , Cuidado Transicional/organização & administração , Cuidado Transicional/normas
18.
Rev Epidemiol Sante Publique ; 67(4): 213-221, 2019 Jul.
Artigo em Francês | MEDLINE | ID: mdl-31196581

RESUMO

BACKGROUND: Since 2008, in France, hospital funding is determined by the nature of activities provided (activity-based funding). Quality control of hospital activity coding is essential to optimize hospital remuneration. There is a need for reliable tools to allocate human resources wisely in order to improve these controls. METHODS: The main objective of this study was to identify the determinants of time needed by medical information technicians to control hospital activity coding in a Regional Hospital Center. From March 2016 to the beginning of January 2017, medical information technicians reported the time they spent on each quality control, and the time they needed when they had to code the entire stay. Multiple linear regressions were performed to identify the determinants of quality control or coding duration. A split sample validation was used: model was created on one half of the sample and validated on the remaining half. RESULTS: Among the controls, 5431 were included in the analysis of determinants of control duration (2715 kept aside for model validation). Seven determinants have been identified (stay duration, level of complexity, month of control, type of control, medical information technician, rank of classing information, and major diagnostic category). The correlation coefficient between predicted and real control duration was 0.71 (P<10-4); 808 stays were included in the analysis of determinants of coding duration (404 kept aside for model validation). Two determinants have been identified. The correlation coefficient, between predicted and real coding duration, was 0.47 (P<10-3). We performed the same multiple regression, on 2017 activity data, to estimate the weight of each hospital activity pole, regarding quality control of hospital activity coding. CONCLUSION: We succeeded in modeling time needed for quality control of hospital stays. These results helped to estimate human resources required for quality control of each hospital pole. Nevertheless, the second analysis did not give satisfactory results: we failed in modeling time needed to code hospital stays.


Assuntos
Codificação Clínica , Medicina Geral , Cirurgia Geral , Tempo de Internação , Informática Médica , Obstetrícia , Controle de Qualidade , Estudos de Casos e Controles , Codificação Clínica/organização & administração , Codificação Clínica/normas , Grupos Diagnósticos Relacionados/organização & administração , Grupos Diagnósticos Relacionados/normas , Registros Eletrônicos de Saúde/organização & administração , Registros Eletrônicos de Saúde/normas , Honorários Médicos , Feminino , França , Medicina Geral/organização & administração , Medicina Geral/normas , Cirurgia Geral/organização & administração , Cirurgia Geral/normas , Humanos , Tempo de Internação/economia , Tempo de Internação/estatística & dados numéricos , Masculino , Informática Médica/métodos , Informática Médica/organização & administração , Informática Médica/normas , Obstetrícia/organização & administração , Obstetrícia/normas , Indicadores de Qualidade em Assistência à Saúde/normas , Qualidade da Assistência à Saúde , Programas Médicos Regionais/organização & administração , Programas Médicos Regionais/normas , Fatores de Tempo , Carga de Trabalho
19.
Acta Med Port ; 32(5): 348-354, 2019 May 31.
Artigo em Inglês | MEDLINE | ID: mdl-31166895

RESUMO

INTRODUCTION: Peripheral arterial disease has an important impact on morbidity/mortality. The objective of this study was to quantify the impact of this disease in Portugal during the last eight years, expressed by the volume of admissions, treatment strategies and associated morbidity and mortality. MATERIAL AND METHODS: We collected data from the Diagnosis Related Group national database on primary diagnosis, procedures codes, demographic variables, a number of risk factors, and mortality of all cases admitted from 2009 to 2016 with a primary diagnosis of peripheral arterial disease coded according to the 9th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-9). RESULTS: In this study, peripheral arterial disease led to 27 684 hospitalisations, which corresponded to 26.7% of all admissions for vascular disease in this period. Approximately 49.9% of patients were admitted to the emergency department. The volume of procedures in patients with claudication decreased over the eight years, unlike patients with critical ischaemia, in which the number of procedures increased. DISCUSSION: Age and the presence of cardiovascular risk factors have been associated with the severity of disease, as observed in our series. Overall hospital mortality varied, being significantly higher in patients with more advanced severity of the disease. CONCLUSION: Peripheral arterial disease represents an important burden in the overall volume of admissions in Portuguese public hospitals. A large number of patients was admitted in the context of emergency.


Assuntos
Hospitalização/estatística & dados numéricos , Doença Arterial Periférica/epidemiologia , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Análise de Variância , Bases de Dados Factuais/estatística & dados numéricos , Grupos Diagnósticos Relacionados , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Gangrena/epidemiologia , Mortalidade Hospitalar , Hospitalização/tendências , Humanos , Claudicação Intermitente/epidemiologia , Úlcera da Perna/epidemiologia , Masculino , Pessoa de Meia-Idade , Dor/epidemiologia , Doença Arterial Periférica/mortalidade , Doença Arterial Periférica/cirurgia , Portugal/epidemiologia , Prevalência , Fatores de Risco , Fatores de Tempo , Adulto Jovem
20.
GMS J Med Educ ; 36(3): Doc30, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31211225

RESUMO

Background: During clinical clerkships students experience complex and challenging clinical situations related to problems beyond the domain of the "Medical Expert". Workplace routine may leave little opportunity to reflect on these situations. The University of Zurich introduced a mandatory course directly after the clinical clerkship year (CCY) to work up these situations. Prior to the course each student submitted a vignette on a case he or she had perceived challenging during the CCY and which was not related to the domain of the "Medical Expert" role. In this paper we want to characterize these cases in respect to most prominent themes and related CanMEDS roles. The goal was to inform clinical supervisors about potential teaching demands during the CCY. Methods: All case vignettes submitted by a years' cohort were analysed by three researchers in two ways: for the clinical characteristics and the main theme of the underlying problem and the most prominent CanMEDS roles involved. Themes of the underlying problem were aggregated to overarching topics and subsequently to main categories by pragmatic thematic analysis. Results: 254 case vignettes covered the whole spectrum of clinical disciplines. A wide range of underlying themes could be assigned to five main categories: "communication within team" (23.2%), "communication with patients and relatives" (24.8%), "patient behavior and attitudes" (18.5%), "clinical decision making" (24.0%), and "social and legal issues" (9.4%). Most frequent CanMEDS roles were "Communicator" (26.9%) and "Professional" (23.5%). Conclusions: Cases students perceived as challenging beyond the "Medical Expert" were reported from all clinical disciplines. These were mainly related to communicational and professional issues, mirrored by the CanMEDS roles "Communicator" and "Professional". Therefore, supervisors in clinical clerkships should put an additional teaching focus on communication and professionalism.


Assuntos
Estágio Clínico/normas , Currículo/normas , Estudantes de Medicina/psicologia , Adulto , Atitude do Pessoal de Saúde , Estágio Clínico/métodos , Competência Clínica/normas , Currículo/estatística & dados numéricos , Grupos Diagnósticos Relacionados/normas , Educação de Graduação em Medicina/métodos , Educação de Graduação em Medicina/normas , Feminino , Humanos , Masculino , Treinamento por Simulação/métodos , Treinamento por Simulação/normas
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