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6.
Medicine (Baltimore) ; 98(37): e17131, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31517851

RESUMO

Unexplained fever is one of the most common and difficult diagnostic problems faced daily by clinicians. This study evaluated the differences in health service utilization, health care expenditures, and quality of care provided to patients with unexplained fever before and after global budget (GB) implementation in Taiwan.The National Health Insurance Research Database was used for analyzing the health care expenditures and quality of care before and after implementation of the GB system. Patients diagnosed as having unexplained fever during 2000-2001 were recruited; their 2000-2001 and 2004-2005 data were considered baseline and postintervention data, respectively.Data of 259 patients with unexplained fever were analyzed. The mean lengths of stay (LOSs) before and after GB system implementation were 4.22 ±â€Š0.35 days and 5.29 ±â€Š0.70 days, respectively. The mean costs of different health care expenditures before and after implementation of the GB system were as follows: the mean diagnostic, drug, therapy, and total costs increased respectively from New Taiwan Dollar (NT$) 1440.05 ±â€ŠNT$97.43, NT$3249.90 ±â€ŠNT$1108.27, NT$421.03 ±â€ŠNT$100.03, and NT$13,866.77 ±â€ŠNT$2,114.95 before GB system implementation to NT$2224.34 ±â€ŠNT$238.36, NT$4272.31 ±â€ŠNT$1466.90, NT$2217.03 ±â€ŠNT$672.20, and NT$22,856.41 ±â€ŠNT$4,196.28 after implementation. The mean rates of revisiting the emergency department within 3 days and readmission within 14 days increased respectively from 10.5% ±â€Š2.7% and 8.3% ±â€Š2.4% before implementation to 6.3% ±â€Š2.2% and 4.0% ±â€Š1.7% after implementation.GB significantly increased LOS and incremental total costs for patients with unexplained fever; but improved the quality of care.


Assuntos
Orçamentos , Febre/economia , Febre/terapia , Hospitalização/economia , Medicina Estatal/economia , Adolescente , Feminino , Febre/epidemiologia , Febre/etiologia , Custos de Cuidados de Saúde , Humanos , Pacientes Internados , Masculino , Qualidade da Assistência à Saúde/economia , Fatores de Risco , Taiwan , Adulto Jovem
9.
BMC Health Serv Res ; 19(1): 485, 2019 Jul 16.
Artigo em Inglês | MEDLINE | ID: mdl-31307442

RESUMO

BACKGROUND: Non-communicable diseases are the leading cause of death in England, and poor diet and physical inactivity are two of the principle behavioural risk factors. In the context of increasingly constrained financial resources, decision makers in England need to be able to compare the potential costs and health outcomes of different public health policies aimed at improving these risk factors in order to know where to invest so that they can maximise population health. This paper describes PRIMEtime CE, a multistate life table cost-effectiveness model that can directly compare interventions affecting multiple disease outcomes. METHODS: The multistate life table model, PRIMEtime Cost Effectiveness (PRIMEtime CE), is developed from the Preventable Risk Integrated ModEl (PRIME) and the PRIMEtime model. PRIMEtime CE uses routinely available data to estimate how changing diet and physical activity in England affects morbidity and mortality from heart disease, stroke, diabetes, liver disease, and cancers either directly or via raised blood pressure, cholesterol, and body weight. RESULTS: Model outcomes are change in quality adjusted life years, and change in English National Health Service and social care costs. CONCLUSION: This paper describes PRIMEtime CE and highlights its main strengths and limitations. The model can be used to compare any number of public policies affecting diet and physical activity, allowing decision makers to understand how they can maximise population health with limited financial resources.


Assuntos
Dieta , Exercício , Promoção da Saúde/economia , Tábuas de Vida , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Análise Custo-Benefício , Inglaterra , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Programas Nacionais de Saúde/economia , Política Pública , Anos de Vida Ajustados por Qualidade de Vida , Fatores de Risco , Medicina Estatal/economia , Adulto Jovem
10.
BMC Health Serv Res ; 19(1): 489, 2019 Jul 16.
Artigo em Inglês | MEDLINE | ID: mdl-31307459

RESUMO

BACKGROUND: PRIMEtime CE is a multistate life table model that can directly compare the cost effectiveness of public health interventions affecting diet and physical activity levels, helping to inform decisions about how to spend finite resources. This paper estimates the costs and health outcomes in England of two scenarios: reformulating salt and expanding subsidised access to leisure centres. The results are used to help validate PRIMEtime CE, following the steps outlined in the Assessment of the Validation Status of Health-Economic decision models (AdViSHE) tool. METHODS: The PRIMEtime CE model estimates the difference in quality adjusted life years (QALYs) and difference in NHS and social care costs of modelled interventions compared with doing nothing. The salt reformulation scenario models how salt consumption would change if food producers met the 2017 UK Food Standards Agency salt reformulation targets. The leisure centre scenario models change in physical activity levels if the Birmingham Be Active scheme (where swimming pools and gym access is free to residents during defined periods) was rolled out across England. The AdViSHE tool was developed by health economic modellers and divides model validation into five parts: validation of the conceptual model, input data validation, validation of computerised model, operational validation, and other validation techniques. PRIMEtime CE is discussed in relation to each part. RESULTS: Salt reformulation was dominant compared with doing nothing, and had a 10-year return on investment of £1.44 (£0.50 to £2.94) for every £1 spent. By contrast, over 10 years the Be Active expansion would cost £727,000 (£514,000 to £1,064,000) per QALY. PRIMEtime CE has good face validity of its conceptual model and has robust input data. Cross-validation produces mixed results and shows the impact of model scope, input parameters, and model structure on cost-per-QALY estimates. CONCLUSIONS: This paper illustrates how PRIMEtime CE can be used to compare the cost-effectiveness of two different public health measures affecting diet and physical activity levels. The AdViSHE tool helps to validate PRIMEtime CE, identifies some of the key drivers of model estimates, and highlights the challenges of externally validating public health economic models against independent data.


Assuntos
Alimentos/normas , Atividades de Lazer/economia , Modelos Econômicos , Saúde Pública/economia , Sódio na Dieta/normas , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Análise Custo-Benefício , Inglaterra , Exercício , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Programas Nacionais de Saúde/economia , Anos de Vida Ajustados por Qualidade de Vida , Reprodutibilidade dos Testes , Sódio na Dieta/administração & dosagem , Medicina Estatal/economia , Adulto Jovem
11.
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
12.
Ann R Coll Surg Engl ; 101(7): 463-471, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31155919

RESUMO

INTRODUCTION: Surgical site infections are associated with increased morbidity and mortality in patients. The Getting It Right First Time surgical site infection programme set up a national survey to review surgical site infection rates in surgical units in England. The objectives were for frontline clinicians to assess the rates of infection following selected procedures, to examine the risk of significant complications and to review current practice in the prevention of surgical site infection. METHODS: A national survey was launched in April 2017 to assess surgical site infections within 13 specialties: breast surgery, cardiothoracic surgery, cranial neurosurgery, ear, nose and throat surgery, general surgery, obstetrics and gynaecology, ophthalmology, oral and maxillofacial surgery, orthopaedic surgery, paediatric surgery, spinal surgery, urology and vascular surgery. All participating trusts prospectively identified and collected supporting information on surgical site infections diagnosed within the six-month study period. RESULTS: Data were received from 95 NHS trusts. A total of 1807 surgical site infection cases were reported. There were variations in rates reported by trusts across specialties and procedures. Reoperations were reported in 36.2% of all identified cases, and surgical site infections are associated with a delayed discharge rate of 34.1% in our survey. CONCLUSION: The Getting It Right First Time surgical site infection programme has introduced a different approach to infection surveillance in England. Results of the survey has demonstrated variation in surgical site infection rates among surgical units, raised the importance in addressing these issues for better patient outcomes and to reduce the financial burden on the NHS. Much work remains to be done to improve surgical site infection surveillance across surgical units and trusts in England.


Assuntos
Hospitais Estaduais/estatística & dados numéricos , Medicina Estatal/estatística & dados numéricos , Procedimentos Cirúrgicos Operatórios/efeitos adversos , Infecção da Ferida Cirúrgica/epidemiologia , Antibioticoprofilaxia/normas , Efeitos Psicossociais da Doença , Inglaterra/epidemiologia , Feminino , Hospitais Estaduais/normas , Humanos , Masculino , Guias de Prática Clínica como Assunto , Avaliação de Programas e Projetos de Saúde , Estudos Prospectivos , Medicina Estatal/economia , Medicina Estatal/normas , Procedimentos Cirúrgicos Operatórios/normas , Infecção da Ferida Cirúrgica/economia , Infecção da Ferida Cirúrgica/etiologia , Infecção da Ferida Cirúrgica/prevenção & controle
13.
J R Soc Med ; 112(7): 292-303, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31170358

RESUMO

OBJECTIVES: To examine the impact of NHS-funded private provision on NHS provision, access and inequalities. DESIGN: Ecological study using routinely collected NHS inpatient data. SETTING: England. PARTICIPANTS: All individuals undergoing an NHS-funded elective hip arthroplasty in England from 2003/2004 to 2012/2013. MAIN OUTCOME MEASURES: Annual crude and standardised rates of hip arthroplasties per 100,000 population performed by NHS and private providers between 2004/2005 and 2012/2013. RESULTS: Age standardised rates of hip arthroplasty increased from 116.4 (95% CI 115.4-117.4) to 148.7 (147.6-149.8) per 100,000 between 2004/2005 and 2012/2013. Provision shifted from NHS providers to private providers from 2007/2008; NHS provision decreased 8.6% and private provision increased 188% between 2007/2008 and 2012/2013. There is evidence of risk selection; private sector hip arthroplasties on NHS patients from the most affluent areas increased 228% from 10.8 (10.2-11.5) to 35.4 (34.3-36.5) per 100,000 compared to an increase of 186% from 8.8 (8.1-9.4) to 25.2 (24.1-26.4) per 100,000 among patients from the least affluent areas between 2007/2008 and 2012/2013. There was no statistically significant (p > 0.05) widening in any measure of inequality (absolute, relative difference and slope and relative slope of index inequality) in hip arthroplasty rates between 2004/2005 and 2012/2013. CONCLUSION: Private provision substituted for NHS provision and did not add to overall provision favouring patients living in the most affluent area. Continuing the trend towards private provision and reducing NHS provision is likely to result in risk selection and widening inequalities in provision of elective hip arthroplasty in England.


Assuntos
Artroplastia de Quadril/economia , Custos de Cuidados de Saúde , Política de Saúde , Setor Privado/economia , Medicina Estatal/economia , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Inglaterra , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto Jovem
15.
Med Leg J ; 87(2): 85-88, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31179881

RESUMO

The National Health Service in UK is facing grave financial crisis. Recently, 65% of Acute Trusts have reported a collective deficit of £2.5 billion. This financial crunch has had significant impact on patient care and sustenance of essential healthcare services. In order to thrive, the National Health Service has begun significant rationing of treatment which has become increasingly apparent in recent times, exposing the National Health Service to legal challenges. This article reviews the current state of the National Health Service from a legal perspective.


Assuntos
Alocação de Recursos para a Atenção à Saúde/legislação & jurisprudência , Acesso aos Serviços de Saúde/normas , Medicina Estatal/normas , Alocação de Recursos para a Atenção à Saúde/normas , Acesso aos Serviços de Saúde/economia , Humanos , Qualidade da Assistência à Saúde/normas , Qualidade da Assistência à Saúde/tendências , Medicina Estatal/economia , Medicina Estatal/legislação & jurisprudência
18.
Br J Nurs ; 28(10): 619-627, 2019 May 23.
Artigo em Inglês | MEDLINE | ID: mdl-31116591

RESUMO

BACKGROUND: nurse-led telephone advice line (TAL) services have been endorsed by the Royal College of Nursing (RCN) and provide patients and their carers with expert advice and self-management strategies. Identified helpline shortfalls in one rheumatology TAL included a high number of inappropriate calls, calls not recorded in patients' records, and no formal process for assigning calls to nurses. Using RCN guidelines, the service was redesigned by specialist rheumatology nurses to address these issues. METHOD: troubleshooting sessions were used to identify solutions to shortcomings in the helpline processes. Following service redesign, nurse/user feedback was collated, and efficiency savings achieved from reducing face-to-face appointments were calculated. RESULTS: the new TAL received fewer inappropriate calls, was received positively by staff and patients, and saved approximately £354 890 a year for the local clinical commissioning group. CONCLUSION: rheumatology nurses successfully improved a TAL using RCN guidance. The approach could be used by other trusts to improve patient helplines and contribute to the NHS drive for efficiency.


Assuntos
Consulta Remota , Doenças Reumáticas/enfermagem , Medicina Estatal/organização & administração , Telefone , Eficiência Organizacional/estatística & dados numéricos , Humanos , Pesquisa em Avaliação de Enfermagem , Satisfação do Paciente/estatística & dados numéricos , Medicina Estatal/economia , Reino Unido
19.
Value Health ; 22(5): 518-526, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-31104729

RESUMO

BACKGROUND: Health inequalities can be partially addressed through the range of treatments funded by health systems. Nevertheless, although health technology assessment agencies assess the overall balance of health benefits and costs, no quantitative assessment of health inequality impact is consistently undertaken. OBJECTIVES: To assess the inequality impact of technologies recommended under the NICE single technology appraisal process from 2012 to 2014 using an aggregate distributional cost-effectiveness framework. METHODS: Data on health benefits, costs, and patient populations were extracted from the NICE website. Benefits for each technology were distributed to social groups using the observed socioeconomic distribution of hospital utilization for the targeted disease. Inequality measures and estimates of cost-effectiveness were compared using the health inequality impact plane and combined using social welfare indices. RESULTS: Twenty-seven interventions were evaluated. Fourteen interventions were estimated to increase population health and reduce health inequality, 8 to reduce population health and increase health inequality, and 5 to increase health and increase health inequality. Among the latter 5, social welfare analysis, using inequality aversion parameters reflecting high concern for inequality, indicated that the health gain outweighs the negative health inequality impact. CONCLUSIONS: The methods proposed offer a way of estimating the health inequality impacts of new health technologies. The methods do not allow for differences in technology-specific utilization and health benefits, but require less resources and data than conducting full distributional cost-effectiveness analysis. They can provide useful quantitative information to help policy makers consider how far new technologies are likely to reduce or increase health inequalities.


Assuntos
Análise Custo-Benefício , Equidade em Saúde , Disparidades nos Níveis de Saúde , Medicina Estatal/economia , Avaliação da Tecnologia Biomédica/economia , Humanos , Anos de Vida Ajustados por Qualidade de Vida , Reino Unido
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