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2.
Z Evid Fortbild Qual Gesundhwes ; 161: 19-27, 2021 Apr.
Artigo em Alemão | MEDLINE | ID: mdl-33642252

RESUMO

BACKGROUND: The quality assurance directive for very low birthweight preterm infants (QFR-RL) by the German Federal Joint Committee calls for fixed nurse-to-patient ratios (NPRs) in neonatal intensive care, leading to considerable difficulties for staff planners, especially in smaller hospitals, as an extensive pool of nursing staff is required to ensure compliance with guidelines. Reliable parameters are therefore needed to provide a valid basis for staff planning. OBJECTIVE: To calculate the number of nurse full-time equivalents (FTE) required to meet the demands of the QFR-RL for individual diagnosis-related groups (FTE-debit) and in relation to relative caseweight (FTE-debit / RW); to compare the calculated estimates with real hospital expenses (FTE-real) with nurse-relevant DRG proportions calculated by the Institute for the Hospital Remuneration System (FTE-norm). METHODS: We included all very low birthweight infants (VLBW, <1,500 g) treated between 08/2013 and 07/2018. FTE-debit was determined on the basis of shifts with 1 : 1, 1 :2, and 1 : 4 NPR using the time infants underwent invasive or non-invasive mechanical ventilation, had a birthweight below 1,000 g, or with imminent death. FTE-real was extracted from hospital cost accounting, and FTE-norm was determined as nurse-relevant DRG proportions calculated by the Institute for the Hospital Remuneration System. RESULTS: 856 (50.1 % female) VLBW preterm infants were analysed. Calculated FTEs varied from 0.02 (95% confidence interval (CI) 0.02-0.02) to 1.16 (95%-CI 0.96-1.37) between individual DRGs. Calculated estimates (FTE-debit) were consistent with real expenses (FTE-real) and calculated nurse-relevant DRG-proportions (FTE-norm). In relation to the relative caseweight, an average demand of nurse FTE of about 0.02 FTE / relative weight point (FTE-debit / RW) was identified. CONCLUSIONS: This approach facilitates prospective planning which is in line with the FTEs required by the QFR-RL and based on remunerated DRGs; however, it is not supposed to replace shift-specific documentation.


Assuntos
Recém-Nascido Prematuro , Recém-Nascido de muito Baixo Peso , Grupos Diagnósticos Relacionados , Feminino , Alemanha , Humanos , Lactente , Recém-Nascido , Masculino , Estudos Prospectivos
3.
Ther Umsch ; 78(3): 129-135, 2021 Apr.
Artigo em Alemão | MEDLINE | ID: mdl-33775132

RESUMO

Inpatient treatment of Breast Cancer - the essentials Abstract. The treatment of breast cancer patients in the inpatient setting has dramatically changed over the last decades. Modern operative techniques resulted in tremendous reductions of morbidity and complication rates. New breast conserving surgical techniques and the consequent reduction of unnecessary extensive lymph node surgery resulted in a significantly shorter length of stay. This in combination with the system of lump compensations and diagnosis related groups (DRG) led to the fact that the inpatient treatment is just another part of a complex multidisciplinary diagnostic and therapeutic algorithm. Most of the steps are being organized and performed in the outpatient setting. The overall effort has increased nevertheless due to modern quality standards and certification of breast centers.


Assuntos
Neoplasias da Mama , Neoplasias da Mama/diagnóstico , Neoplasias da Mama/cirurgia , Grupos Diagnósticos Relacionados , Hospitalização , Humanos , Pacientes Internados , Pacientes Ambulatoriais
4.
Spine (Phila Pa 1976) ; 46(6): 391-400, 2021 Mar 15.
Artigo em Inglês | MEDLINE | ID: mdl-33620184

RESUMO

STUDY DESIGN: Retrospective cohort study. OBJECTIVE: The aim of this study was to analyze how a Current Procedural Terminology (CPT)-based categorization method can predict cost variation in surgical spine procedures. SUMMARY OF BACKGROUND DATA: Neck and back disorders affect a majority of the adult population and account for tens of billions of dollars in health care spending each year. In the era of bundled payments and value-based reimbursement, it is imperative for surgeons to identify sources of cost variability across surgical spine procedures. Historically, this has been accomplished using Medicare Severity Diagnosis Related Group (MS-DRG) codes, but they utilize an overly simplistic categorization of surgical procedures. The specificity and familiarity of the CPT coding structure makes it a better option for categorizing differences in surgical decision making and technique. METHODS: Hospital billing data for patients undergoing a surgical spine procedure requiring an overnight, in-patient stay was retrospectively collected over 4 fiscal years (2012-2016) from a single health care system. Linear regression analysis was performed to assess the correlation between cost variation and: spine-specific MS-DRG codes; a novel CPT-based categorization method; and the combination of MS-DRG codes and CPT-based categorization. RESULTS: There were 5020 surgical procedures were analyzed with respect to 16 different MS-DRG codes and 30 distinct CPT-based surgical categories (CSCs). Linear regression results were: MS-DRG R2 = 0.6545 (P < 0.001); CSC R2 = 0.5709 (P < 0.001); and R2 = 0.744 for the combined MS-DRG and CSC methods (P < 0.05). Median difference between the actual and predicted cost for the combined model was -$261.00, compared with -$727.50 for the CSC model and -$478.70 for the MS-DRG model. CONCLUSION: Addition of the CPT-based categorization method to MS-DRG coding provides an enhanced method to evaluate the association between predicted and actual cost when using linear regression analysis to assess cost variation in spine surgery.Level of Evidence: 3.


Assuntos
Current Procedural Terminology , Medicare/economia , Índice de Gravidade de Doença , Doenças da Coluna Vertebral/economia , Doenças da Coluna Vertebral/cirurgia , Adulto , Idoso , Estudos de Coortes , Grupos Diagnósticos Relacionados , Feminino , Previsões , Humanos , Masculino , Medicare/tendências , Estudos Retrospectivos , Estados Unidos/epidemiologia
5.
Injury ; 52(3): 395-401, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33627252

RESUMO

PURPOSE: The aim of this study was to evaluate changes in both mechanism and diagnoses of injuries presenting to the orthopaedic department during this lockdown period, as well as to observe any changes in operative case-mix during this time. METHODS: A study period of twelve weeks following the introduction of the nationwide "lockdown period", March 23rd - June 14th, 2020 was identified and compared to the same time period in 2019 as a "baseline period". A retrospective analysis of all emergency orthopaedic referrals and surgical procedures performed during these time frames was undertaken. All data was collected and screened using the 'eTrauma' management platform (Open Medical, UK). The study included data from a five NHS Foundation Trusts within North West London. A total of 6695 referrals were included for analysis. RESULTS: The total number of referrals received during the lockdown period fell by 35.3% (n=2631) compared to the same period in 2019 (n=4064). Falls remained proportionally the most common mechanism of injury across all age groups in both time periods. The proportion sports related injuries compared to the overall number of injuries fell significantly during the lockdown period (p<0.001), however, the proportion of pushbike related accidents increased significantly (p<0.001). The total number of operations performed during the lockdown period fell by 38.8% (n=1046) during lockdown (n=1732). The proportion of patients undergoing operative intervention for Neck of Femur (NOF) and ankle fractures remained similar during both study periods. A more non-operative approach was seen in the management of wrist fractures, with 41.4% of injuries undergoing an operation during the lockdown period compared to 58.6% at baseline (p<0.001). CONCLUSION: In conclusion, the nationwide lockdown has led to a decrease in emergency orthopaedic referrals and procedure numbers. There has been a change in mechanism of injuries, with fewer sporting injuries, conversely, there has been an increase in the number of pushbike or scooter related injuries during the lockdown period. NOF fractures remained at similar levels to the previous year. There was a change in strategy for managing distal radius fractures with more fractures being treated non-operatively.


Assuntos
Acidentes por Quedas/estatística & dados numéricos , Acidentes de Trânsito/tendências , Ciclismo/lesões , Procedimentos Ortopédicos/tendências , Encaminhamento e Consulta/tendências , Ferimentos e Lesões/epidemiologia , Adolescente , Adulto , Idoso , Traumatismos do Braço/epidemiologia , Traumatismos do Braço/etiologia , Traumatismos do Braço/terapia , Traumatismos em Atletas/epidemiologia , Traumatismos em Atletas/terapia , Criança , Pré-Escolar , Grupos Diagnósticos Relacionados , Feminino , Fraturas do Colo Femoral/epidemiologia , Fraturas do Colo Femoral/cirurgia , Fraturas Ósseas/epidemiologia , Fraturas Ósseas/etiologia , Fraturas Ósseas/terapia , Fraturas Expostas/epidemiologia , Fraturas Expostas/etiologia , Fraturas Expostas/terapia , Humanos , Lactente , Recém-Nascido , Traumatismos da Perna/epidemiologia , Traumatismos da Perna/etiologia , Traumatismos da Perna/terapia , Londres/epidemiologia , Masculino , Pessoa de Meia-Idade , Centros de Traumatologia , Ferimentos e Lesões/etiologia , Ferimentos e Lesões/terapia , Traumatismos do Punho/epidemiologia , Traumatismos do Punho/etiologia , Traumatismos do Punho/terapia , Adulto Jovem
6.
Handchir Mikrochir Plast Chir ; 53(1): 7-18, 2021 Feb.
Artigo em Alemão | MEDLINE | ID: mdl-33588487

RESUMO

BACKGROUND: Hand surgery in Germany has been subject to structural changes that strongly affect the balance between medicine and economics. On the one hand there is a shift of elective hand surgery from the inpatient to the outpatient sector. On the other hand - so our observations - emergency hand trauma cases are more concentrated in bigger hospitals. Given this background there is a lack of statistical data on the management of hand trauma care and treatment of patients with hand injuries. This article discusses a 10-year-analysis of hand traumatological cases treated at a maximum care hospital regarding epidemiological, structural and economic aspects. MATERIAL AND METHODS: Using a database query using ICD codes, inpatient hand trauma cases were identified between 2009-2018 and analyzed with regard to epidemiological and economic indicators (age, gender, comorbidities, case-mix-index (CMI), revenue, length of stay, length of surgery) using PIVOT tables. Patients under the age of 16 years, forearm fractures and intensive care patients were excluded. RESULTS: In the study period the typical hand surgical trauma patient was male with an average age of 44 years. The Patient-Clinical-Complexity-Level (PCCL) was 0 in 80 % of all cases. The proportion of work-related injuries averaged around 25 %. The three top diagnose related groups (DRG) were the I32F (18.5 %), X01B (11.3 %) and the I32A (7.2 %). A striking point was the massive increase in the overall number of trauma cases over the years from approx. 300 cases in 2009 to over 1000 cases per year in 2018 with a shift of the main workload to on-call and night-shift hours away from core working times. In the study period 4 of 5 others hospitals located in a distance of 100 km reduced and stopped treatment of emergency hand cases. The average length of a hospital stay was approx. 4-5 days, the average cut/suture time less than 60 minutes and the average CMI 1.23. Those cases generate an average proceed of € 4370 in 2018, whereby the cases generated by the work-related injuries averaged € 387 less. DISCUSSION: On the assumption that the number of emergency hand trauma cases did not really increase in the study period we think that there was a concentration of such cases in a few centres still providing extensive treatment for hand injuries while in smaller hospitals care for emergency hand trauma cases is progressively reduced. However, hand injuries may be worth a second thought for economic reasons because they can create reasonable revenues with rather little effort.If a critical number of patients is exceeded, costs of service provisions can be significantly amortized by the proceed generated by treatment. In those hospitals still taking care for acute hand injuries the workload especially in standby duty increased. What may have a negative input on the numbers of treated elective hand surgery cases.


Assuntos
Traumatologia , Adolescente , Adulto , Custos e Análise de Custo , Grupos Diagnósticos Relacionados , Alemanha , Humanos , Tempo de Internação , Masculino
7.
Cad Saude Publica ; 37(1): e00149019, 2021.
Artigo em Espanhol | MEDLINE | ID: mdl-33440410

RESUMO

Tobacco is the leading modifiable cause of cardiovascular disease, cancer, and respiratory diseases and is thus a serious global public health problem. In 2006, Uruguay implemented the World Health Organization Framework Convention on Tobacco Control (WHO-FCTC) and achieved a decrease in the smoking rate and improvements in cardiovascular and respiratory health. We analyzed the clinical and economic impacts of tobacco control measures on the healthcare costs for acute myocardial infarction, which was reduced by 17%. The costs avoided for other diseases were not included. The study examined the trend in a healthcare institution and projected the result to the country's population. The cost analysis used the diagnosis-related groups (DRG) methodology, combined with the institution's accounting reports. Besides the hospitalization costs, the analysis included patient transportation, invasive cardiovascular procedures, and healthcare costs for the 12 months following the acute myocardial infarction. The cost per patient was USD 12,037. Considering a decrease of 500 acute myocardial infarctions per year, the estimated annual savings are USD 6 million in medical care costs for the averted acute myocardial infarctions, besides savings from averted work absenteeism, subsequent disability, and disability adjusted life years. This successful tobacco control policy has been the leading public health intervention in the last 30 years in Uruguay. The study aims to contribute to the guidelines determined by the World Health Organization (WHO).


Assuntos
Infarto do Miocárdio , Tabaco , Brasil , Grupos Diagnósticos Relacionados , Custos de Cuidados de Saúde , Humanos , Uruguai
8.
Endocrinol. diabetes nutr. (Ed. impr.) ; 67(8): 500-508, oct. 2020. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-196882

RESUMO

INTRODUCCIÓN: Las herramientas para analizar la casuística en consultas externas son escasas e insatisfactorias. El objetivo de este trabajo de la Sociedad Castellano Manchega de Endocrinología, Nutrición y Diabetes (SCAMEND) fue el desarrollo de una herramienta que permita analizar la casuística de las consultas externas de Endocrinología y Nutrición teniendo en cuenta la complejidad de la patología atendida. MATERIAL Y MÉTODOS: Se definió el Índice SCAMEND de Complejidad en Consultas Externas de Endocrinología y Nutrición (ISCCE-EyN) mediante método Delphi con dos rondas entre especialistas en Endocrinología y Nutrición, comparando la complejidad de cada patología con la de una revisión de hipotiroidismo primario. RESULTADOS: Las primeras visitas fueron consideradas más complejas que las visitas sucesivas. La patología tiroidea no neoplásica y el sobrepeso/obesidad sin complicaciones fueron consideradas las patologías menos complejas, mientras que las metabolopatías, los síndromes de neoplasias endocrinas múltiples y el carcinoma suprarrenal fueron consideradas las más complejas. El grado de consenso fue elevado en la mayoría de las patologías analizadas. CONCLUSIONES: Presentamos una herramienta que permite analizar la casuística de las consultas externas de Endocrinología y Nutrición teniendo en cuenta la complejidad inherente a la patología del paciente atendido. Esta herramienta puede servir para realizar comparaciones entre centros, para asignar mejores recursos dentro de un determinado servicio o para la autoevaluación


INTRODUCTION: The tools for analyzing the case-mix in outpatient clinics are scarce few and unsatisfactory. The objective of this study conducted by Sociedad Castellano Manchega de Endocrinología, Nutrición y Diabetes (SCAMEND) was to develop a tool that allows for analyzing the case-mix in outpatient endocrinology and nutrition clinics, considering bearing in mind the complexity of the conditions seen. MATERIAL AND METHODS: Using the Delphi method, the SCAMEND index of complexity in outpatient endocrinology and nutrition clinics (ISCCE-EyN) was developed by endocrinologists in two rounds, comparing the complexity of each condition being compared with that of a review visit of primary hypothyroidism. RESULTS: The first visits were considered more complex than the subsequent visits. Non-neoplastic thyroid disease and uncomplicated overweight/obesity were considered as the least complex diseases, while metabolic diseases, multiple endocrine neoplasia syndromes, and adrenal carcinoma were considered as the most complex. The degree of agreement was high in most of the diseases analyzed. CONCLUSIONS: This tool allows for analyzing the case-mix in outpatient endocrinology and nutrition clinics, based on the inherent complexity of the disease of the patient is reported. This tool may be used for comparisons between centers, to better allocate resources within a given service, or for self-evaluation


Assuntos
Humanos , Masculino , Feminino , Grupos Diagnósticos Relacionados/classificação , Ambulatório Hospitalar , Sociedades Médicas/normas , Hipotireoidismo/epidemiologia , Ciências da Nutrição/organização & administração , Endocrinologia/normas , Técnica Delfos , Técnicas de Diagnóstico Endócrino/normas , Doenças do Sistema Endócrino/epidemiologia , Assistência Ambulatorial/normas
9.
Surgery ; 168(5): 968-974, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32888714

RESUMO

BACKGROUND: Infectious airborne and surface pathogens constitute a substantial and poorly explored source of patient subclinical illness and infections. With that in mind, a system of advanced air purification technology was designed to destroy the DNA and RNA of all bacteria, fungi, and viruses. This study compares the effects of advanced air purification technology versus high efficiency particulate air filtration with respect to certain metrics of health care economics and resource utilization at a large, community-based, urban hospital. Our hypothesis was that the use of the advanced air purification technology would decrease health care durations of stay, lead to fewer nonhome discharges, and decrease hospital charges. METHODS: After the installation of advanced air purification technology, 3 resultant air purification "zones" were established: zone C, a control floor with high efficiency particulate air filtration; zone B, a mixed high efficiency particulate air and advanced air purification technology floor; and zone A, a comprehensive advanced air purification technology remediation. This study included nonbariatric surgical patients admitted to any zone between December 2017 and December 2018, with reported case mix index on discharge. We analyzed hospital duration of stays, discharge destination, and hospital charges with adjustment for severity of illness using the case mix index. The likelihood of mortality, health care-associated infection, and readmission for each study zone was examined using logistic regression adjusting for case mix index, age, sex, and source of admission. RESULTS: The study included 1,002 patients across the 3 zones, with mean age of 55.8 years (53.7% female), average case mix index of 1.98, and mortality of 1.7%. Compared with zone C, patients in zones A and B demonstrated decreased hospital stays, a greater percentage of home discharges (86.5-87.8% vs 64.7%), and less hospital charges. In addition, logistic regression modeling performed on 999 study patients showed that the likelihood of mortality, hospital-acquired infections, and readmissions did not differ among the 3 zones. A trend toward a lesser incidence of hospital-acquired infections was noted in zones A and B (0.40% and 0.48%, respectively) when compared with zone C (0.63%). CONCLUSION: Patients in the advanced air purification technology zones demonstrated statistically significant improvements in durations of stay, discharge to home, and costs after adjusting for case mix index. In addition, a trend toward fewer hospital-acquired infections in advanced air purification technology zones was noted. These findings suggest that environmental factors may affect key clinical and economic outcomes, supporting further research in this important and largely unexplored area.


Assuntos
Filtros de Ar , Infecção Hospitalar/prevenção & controle , Custos Hospitalares , Tempo de Internação , Adulto , Idoso , Microbiologia do Ar , Grupos Diagnósticos Relacionados , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Alta do Paciente , Estudos Retrospectivos
10.
Int J Infect Dis ; 100: 67-74, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32950738

RESUMO

OBJECTIVE: We aimed to document data on the epidemiology and factors associated with clinical course leading to death of patients hospitalised with COVID-19. METHODS: Prospective observational cohort study on patients hospitalised with COVID-19 disease in February-24th/May-17th 2020 in Milan, Italy. Uni-multivariable Cox regression analyses were performed. Death's percentage by two-weeks' intervals according to age and disease severity was analysed. RESULTS: A total of 174/539 (32.3%) patients died in hospital over 8228 person-day follow-up; the 14-day Kaplan-Meier probability of death was 29.5% (95%CI: 25.5-34.0). Older age, burden of comorbidities, COVID-19 disease severity, inflammatory markers at admission were independent predictors of increased risk, while several drug-combinations were predictors of reduced risk of in-hospital death. The highest fatality rate, 36.5%, occurred during the 2nd-3rd week of March, when 55.4% of patients presented with severe disease, while a second peak, by the end of April, was related to the admission of older patients (55% ≥80 years) with less severe disease, 30% coming from long-term care facilities. CONCLUSIONS: The unusual fatality rate in our setting is likely to be related to age and the clinical conditions of our patients. These findings may be useful to better allocate resources of the national healthcare system, in case of re-intensification of COVID-19 epidemics.


Assuntos
Betacoronavirus , Infecções por Coronavirus/mortalidade , Grupos Diagnósticos Relacionados , Pneumonia Viral/mortalidade , Adulto , Idoso , Feminino , Mortalidade Hospitalar , Humanos , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Pandemias , Estudos Prospectivos , Adulto Jovem
12.
Z Gastroenterol ; 58(9): 855-867, 2020 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-32947631

RESUMO

BACKGROUND: The economic effects of spontaneous bacterial peritonitis (SBP), nosocomial infections (nosInf) and acute-on-chronic liver failure (ACLF) have so far been poorly studied. We analyzed the impact of these complications on treatment revenues in hospitalized patients with decompensated cirrhosis. METHODS: 371 consecutive patients with decompensated liver cirrhosis, who received a paracentesis between 2012 and 2016, were included retrospectively. DRG (diagnosis-related group), "ZE/NUB" (additional charges/new examination/treatment methods), medication costs, length of hospital stay as well as different kinds of specific treatments (e. g., dialysis) were considered. Exclusion criteria included any kind of malignancy, a history of organ transplantation and/or missing accounting data. RESULTS: Total treatment costs (DRG + ZE/NUB) were higher in those with nosInf (€â€Š10,653 vs. €â€Š5,611, p < 0.0001) driven by a longer hospital stay (23 d vs. 12 d, p < 0.0001). Of note, revenues per day were not different (€â€Š473 vs. €â€Š488, p = 0.98) despite a far more complicated treatment with a more frequent need for dialysis (p < 0.0001) and high-complex care (p = 0.0002). Similarly, SBP was associated with higher total revenues (€â€Š10,307 vs. €â€Š6,659, p < 0.0001). However, the far higher effort for the care of SBP patients resulted in lower daily revenues compared to patients without SBP (€â€Š443 vs. €â€Š499, p = 0.18). ACLF increased treatment revenues to €â€Š10,593 vs. €6,369 without ACLF (p < 0.0001). While treatment of ACLF was more complicated, revenue per day was not different to no-ACLF patients (€â€Š483 vs. €â€Š480, p = 0.29). CONCLUSION: SBP, nosInf and/or ACLF lead to a significant increase in the effort, revenue and duration in the treatment of patients with cirrhosis. The lower daily revenue, despite a much more complex therapy, might indicate that these complications are not yet sufficiently considered in the German DRG system.


Assuntos
Insuficiência Hepática Crônica Agudizada/economia , Infecções Bacterianas/economia , Infecção Hospitalar/economia , Grupos Diagnósticos Relacionados/economia , Custos de Cuidados de Saúde/estatística & dados numéricos , Peritonite/economia , Insuficiência Hepática Crônica Agudizada/terapia , Infecções Bacterianas/terapia , Infecção Hospitalar/complicações , Infecção Hospitalar/terapia , Grupos Diagnósticos Relacionados/estatística & dados numéricos , Alemanha/epidemiologia , Humanos , Tempo de Internação , Cirrose Hepática/complicações , Peritonite/tratamento farmacológico , Estudos Retrospectivos
13.
Br J Anaesth ; 125(4): 450-455, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32773215

RESUMO

Coronavirus disease 2019 (COVID-19; severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2] has dislocated clinical services and postgraduate training. To better understand and to document these impacts, we contacted anaesthesia trainees and trainers across six continents and collated their experiences during the pandemic. All aspects of training programmes have been affected. Trainees report that reduced caseload, sub-specialty experience, and supervised procedures are impairing learning. Cancelled educational activities, postponed examinations, and altered rotations threaten progression through training. Job prospects and international opportunities are downgraded. Work-related anxieties about provision of personal protective equipment, and risks to self and to colleagues are superimposed on concerns for family and friends and domestic disruption. These seismic changes have had consequences for well-being and mental health. In response, anaesthetists have developed innovations in teaching and trainee support. New technologies support trainer-trainee interactions, with a focus on e-learning. National training bodies and medical regulators that specify training and oversee assessment of trainees and their progression have provided flexibility in their requirements. Within anaesthesia departments, support transcends grades and job titles with lessons for the future. Attention to wellness, awareness of mental health issues and multimodal support can attenuate but not eliminate trainee distress.


Assuntos
Anestesiologia/educação , Anestesistas/educação , Infecções por Coronavirus , Pandemias , Pneumonia Viral , Atitude do Pessoal de Saúde , Currículo , Grupos Diagnósticos Relacionados , Educação de Pós-Graduação em Medicina , Humanos , Saúde Mental , Equipamento de Proteção Individual , Estudantes de Medicina/psicologia , Ensino
14.
PLoS One ; 15(8): e0236695, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32785282

RESUMO

The goal of this study is to investigate the effectiveness of the neonatal diagnosis-related group scheme in patients affected by respiratory distress syndrome. The variable costs of individual patients in the same group are examined. This study uses the data of infants (N = 243) hospitalized in the Neonatal Intensive Care Unit of the Gaslini Children's Hospital in Italy in 2016. The care unit's operating and management costs are employed to estimate the average cost per patient. Operating costs include those related to personnel, drugs, medical supplies, treatment tools, examinations, radiology, and laboratory services. Management costs relate to administration, maintenance, and depreciation cost of medical equipment. Cluster analysis and Tobit regression are employed, allowing for the assessment of the total cost per patient per day taking into account the main cost determinants: birth weight, gestational age, and discharge status. The findings highlight great variability in the costs for patients in the same diagnosis-related group, ranging from a minimum of €267 to a maximum of €265,669. This suggests the inefficiency of the diagnosis-related group system. Patients with very low birth weight incurred costs approximately twice the reimbursement set by the policy; a loss of €36,420 is estimated for every surviving baby with a birth weight lower than 1,170 grams. On the contrary, at term, newborns cost about €20,000 less than the diagnosis-related group reimbursement. The actual system benefits hospitals that mainly treat term infants with respiratory distress syndrome and penalizes hospitals taking care of very low birth weight patients. As a result, strategic behavior and "up-coding" might occur. We conduct a cluster analysis that suggests a birth weight adjustment to determine new fees that would be fairer than the current costs.


Assuntos
Grupos Diagnósticos Relacionados/economia , Unidades de Terapia Intensiva Neonatal/economia , Síndrome do Desconforto Respiratório do Recém-Nascido/economia , Feminino , Idade Gestacional , Custos Hospitalares/estatística & dados numéricos , Humanos , Lactente , Recém-Nascido , Recém-Nascido de muito Baixo Peso/fisiologia , Itália/epidemiologia , Tempo de Internação/economia , Masculino , Síndrome do Desconforto Respiratório do Recém-Nascido/diagnóstico , Síndrome do Desconforto Respiratório do Recém-Nascido/fisiopatologia , Fatores de Risco
15.
Praxis (Bern 1994) ; 109(13): 1039-1049, 2020.
Artigo em Alemão | MEDLINE | ID: mdl-32787532

RESUMO

Care Management for Polytrauma Patients in a Level-1 Trauma Centre Abstract. In our level-1 trauma institution, polytrauma patients with an Injury Severity Score of 16 or higher are facing waiting times for transfer to a rehabilitation facility, causing a negative financial outcome for our institution. The purpose of this study is to stimulate rapid transfer to a rehabilitation facility. In a single-centre case study, care management for (poly)trauma patients was started to ensure time-directed treatment for trauma patients related to Diagnosis-Related Groups (DRG). In the period of 2013-2018 there was an increase in trauma admissions up to 14 % (n = 16 157) with a mean length of hospital stay of 6.4 days, together with a reduction in the number of trauma bed capacity from 50 to 42. In relation to the DRGs, regular trauma patients who were not in need of a stationary rehabilitation facility stayed in line with the expected time of hospital stay. But (poly)trauma patients (n = 1831) with the need of a stationary stay in a rehabilitation centre were faced with waiting times before they could be transferred. The average excess waiting time in relation to DRG for polytrauma patients was 5.1 days. Trauma patients for a rehabilitation centre have a higher Case Mix Index (CMI) compared to those who do not require inpatient rehabilitation (4.22 versus 1.04, p <0.0001). With about 280 trauma patients annually waiting an extra 5.1 days for transfer to a rehabilitation facility, the financial burden for our department amounts to Swiss francs 885,360 without reimbursement. Since no extra bed capacities in rehabilitation facilities are available in our area, it may be advised to set up an early in-hospital trauma rehabilitation program in a level-1 trauma centre in order to reduce financial loss.


Assuntos
Traumatismo Múltiplo , Centros de Traumatologia , Grupos Diagnósticos Relacionados , Hospitalização , Humanos , Tempo de Internação , Traumatismo Múltiplo/diagnóstico , Traumatismo Múltiplo/terapia
16.
J Oral Maxillofac Surg ; 78(11): 2009.e1-2009.e7, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32798454

RESUMO

PURPOSE: A relative paucity of literature exists analyzing rural-urban differences in Medicare insurance claims by oral and maxillofacial surgeons (OMSs). The purpose of this study is to compare Medicare utilization, billing practices, and reimbursement rates between rural OMSs and their urban counterparts. METHODS: This cross-sectional study examines Medicare claims data from the 2017 Medicare Provider Utilization and Payment Data: Physician and Other Supplier Public Use File. The primary predictor variable was the provider Rural-Urban Commuting Area Code (rural vs urban). The primary outcome variable was the total Medicare standardized payment amount per OMS. Additional variables include total number of services provided, total unique Healthcare Common Procedure Coding System codes submitted, total submitted charge amount for all services, mean beneficiary hierarchical condition category, and the total Medicare allowed/payment amount for all services. Descriptive statistics were calculated and continuous variables were compared using nonparametric Mann-Whitney U tests. RESULTS: The analysis cohort had 921 OMSs who recorded 114,169 Part B services in 2017. Urban OMSs billed more services compared to rural OMSs, saw patients with a higher average hierarchical condition category score, and submitted more claims per beneficiary. The mean reimbursement-to-charge ratio was higher among rural OMSs, although the mean payment per service was higher among urban surgeons. CONCLUSIONS: Rural OMSs bill fewer unique codes and treat less medically complex patients compared with their urban counterparts. Rural surgeons were reimbursed proportionally higher for their total submitted charges than urban surgeons; however, they were reimbursed less for each individual service provided. These differences may be attributable to the Centers for Medicare & Medicaid Services Multiple Procedure Payment Reduction policy and provider case mix.


Assuntos
Cirurgiões Bucomaxilofaciais , Cirurgiões , Idoso , Estudos Transversais , Grupos Diagnósticos Relacionados , Humanos , Medicare , Estados Unidos
18.
Emergencias ; 32(4): 242-252, 2020.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-32692001

RESUMO

OBJECTIVES: The primary objective was to describe the clinical characteristics and 30-day mortality rates in emergency department patients with coronavirus disease 2019 (COVID-19) in different diagnostic groupings. MATERIAL AND METHODS: Secondary analysis of the COVID-19 registry compiled by the emergency department of Hospital Clínico San Carlos in Madrid, Spain. We selected suspected COVID-19 cases treated in the emergency department between February 28 and March 31, 2020. The cases were grouped as follows: 1) suspected, no polymerase chain reaction (PCR) test (S/no-PCR); 2) suspected, negative PCR (S/PCR-); 3) suspected, positive PCR (S/PCR+); 4) highly suspected, no PCR, or negative PCR (HS/no or PCR-); and 5) highly suspected, positive PCR (HS/PCR+). We collected clinical, radiologic, and microbiologic data related to the emergency visit. The main outcome was 30-day all-cause mortality. Secondary outcomes were hospitalization and clinical severity of the episode. RESULTS: A total of 1993 cases (90.9%) were included as follows: S/no-PCR, 17.2%; S/PCR-, 11.4%; S/PCR+, 22.1%; HS/no PCR or PCR-, 11.7%; and HS/PCR+, 37.6%. Short-term outcomes differed significantly in the different groups according to demographic characteristics; comorbidity and clinical, radiographic, analytical, and therapeutic variables. Thirty-day mortality was 11.5% (56.5% in hospitalized cases and 19.6% in cases classified as severe). The 2 HS categories and the S/PCR+ category had a greater adjusted risk for 30-day mortality and for having a clinically severe episode during hospitalization in comparison with S/PCR- cases. Only the 2 HS categories showed greater risk for hospitalization than the S/PCR- cases. CONCLUSION: COVID-19 diagnostic groups differ according to clinical and laboratory characteristics, and the differences are associated with the 30-day prognosis.


Assuntos
Betacoronavirus , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/mortalidade , Pneumonia Viral/diagnóstico , Pneumonia Viral/mortalidade , Adulto , Causas de Morte , Comorbidade , Intervalos de Confiança , Infecções por Coronavirus/complicações , Infecções por Coronavirus/terapia , Grupos Diagnósticos Relacionados , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/complicações , Pneumonia Viral/terapia , Reação em Cadeia da Polimerase/estatística & dados numéricos , Sistema de Registros/estatística & dados numéricos , Espanha/epidemiologia , Avaliação de Sintomas , Fatores de Tempo , Resultado do Tratamento
19.
Med J Aust ; 213(8): 359-363, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32720326

RESUMO

OBJECTIVE: To develop a casemix classification to underpin a new funding model for residential aged care in Australia. DESIGN, SETTING: Cross-sectional study of resident characteristics in thirty non-government residential aged care facilities in Melbourne, the Hunter region of New South Wales, and northern Queensland, March 2018 - June 2018. PARTICIPANTS: 1877 aged care residents and 1600 residential aged care staff. MAIN OUTCOME MEASURES: The Australian National Aged Care Classification (AN-ACC), a casemix classification for residential aged care based on the attributes of aged care residents that best predict their need for care: frailty, mobility, motor function, cognition, behaviour, and technical nursing needs. RESULTS: The AN-ACC comprises 13 aged care resident classes reflecting differences in resource use. Apart from the class that included palliative care patients, the primary branches were defined by the capacity for mobility; further classification is based on physical capacity, cognitive function, mental health problems, and behaviour. The statistical performance of the AN-ACC was good, as measured by the reduction in variation statistic (RIV; 0.52) and class-specific coefficients of variation. The statistical performance and clinical acceptability of AN-ACC compare favourably with overseas casemix models, and it is better than the current Australian aged care funding model, the Aged Care Funding Instrument (64 classes; RIV, 0.20). CONCLUSIONS: The care burden associated with frailty, mobility, function, cognition, behaviour and technical nursing needs drives residential aged care resource use. The AN-ACC is sufficiently robust for estimating the funding and staffing requirements of residential aged care facilities in Australia.


Assuntos
Grupos Diagnósticos Relacionados/classificação , Serviços de Saúde para Idosos/economia , Instituição de Longa Permanência para Idosos , Casas de Saúde , Atividades Cotidianas , Austrália , Disfunção Cognitiva/economia , Disfunção Cognitiva/enfermagem , Fragilidade/economia , Fragilidade/enfermagem , Necessidades e Demandas de Serviços de Saúde , Financiamento da Assistência à Saúde , Humanos , Transtornos Mentais/economia , Transtornos Mentais/enfermagem , Limitação da Mobilidade , New South Wales , Serviços de Enfermagem/economia , Queensland , Vitória
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