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1.
Arch. argent. pediatr ; 119(4): 270-273, agosto 2021. tab, ilus
Artigo em Inglês, Espanhol | LILACS, BINACIS | ID: biblio-1280932

RESUMO

En pacientes con infección por SARS-CoV-2 la intubación endotraqueal es un procedimiento con riesgo elevado de contagio. La videolaringoscopia complementa la protección del profesional, pero los videolaringoscopios comerciales son caros y no siempre están disponibles en las terapias intensivas pediátricas argentinas. El objetivo fue describir la práctica de intubación en un modelo de cabeza de simulación de lactante con un videolaringoscopio artesanal de bajo costo.Quince pediatras sin experiencia previa con el dispositivo participaron de una práctica de intubación en una cabeza de simulación con un videolaringoscopio artesanal. El tiempo promedio del primer intento fue de 116,4 segundos (intervalo de confianza del 95 % [IC95 %]: 84,8-148,0) y, el del siguiente fue de 44,2 segundos (IC95 %: 27,7­60,6). El tiempo disminuyó de forma significativa en el segundo intento (p : 0,0001). El dispositivo permitió la intubación exitosa en todos los intentos acortando la duración del procedimiento en la segunda práctica


In patients with SARS-CoV-2 infection, endotracheal intubation is a procedure with a high risk for transmission. A videolaryngoscopy is a supplementary level of health care provider protection, but commercial videolaryngoscopes are expensive and not always available in pediatric intensive care units in Argentina. Our objective was to describe intubation practice using an infant head mannequin with a low-cost, handcrafted videolaryngoscope.Fifteen pediatricians with no prior experience using the device participated in an intubation practice in a head mannequin with a handcrafted videolaryngoscope. The average time for the first attempt was 116.4 seconds (95 % confidence interval [CI]: 84.8-148.0) and, for the second one, 44.2 seconds (95 % CI: 27.7-60.6). Time decreased significantly for the second attempt (p: 0.0001).A successful intubation was achieved with the device in all attempts, and the procedure duration decreased with the second practice


Assuntos
Humanos , Lactente , Pediatria/educação , Laringoscópios/economia , Treinamento por Simulação/métodos , COVID-19/prevenção & controle , Intubação Intratraqueal/instrumentação , Laringoscopia/economia , Pediatria/economia , Fatores de Tempo , Gravação em Vídeo , Custos de Cuidados de Saúde , Competência Clínica/estatística & dados numéricos , Educação Médica Continuada/métodos , Curva de Aprendizado , COVID-19/transmissão , Internato e Residência/métodos , Intubação Intratraqueal/economia , Intubação Intratraqueal/métodos , Laringoscopia/educação , Laringoscopia/instrumentação , Laringoscopia/métodos , Manequins
2.
J Glob Health ; 11: 04024, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34326989

RESUMO

Background: Short-term surgical missions facilitated by non-governmental organizations (NGOs) may be a possible platform for cost-effective international global surgical efforts. The objective of this study is to determine if short-term surgical mission trips provided by the non-governmental organization (NGO) Esperança to Nicaragua from 2016 to 2020 are cost-effective. Methods: Using a provider perspective, the costs of implementing the surgical trips were collected via Esperança's previous trip reports. The reports and patient data were analyzed to determine disability-adjusted life years averted from each surgical procedure provided in Nicaragua from 2016-2020. Average cost-effectiveness ratios for each surgical trip specialty were calculated to determine the average cost of averting one disability-adjusted life year. Results: Esperança's surgical missions' program in Nicaragua from 2016 to 2020 was found to be cost-effective, with pediatric and gynecology surgical specialties being highly cost-effective and general and orthopedic surgical specialties being moderately cost-effective. These results were echoed in both scenarios of the sensitivity analysis, except for the orthopedic specialty which was found to not be cost-effective when testing an increased discount rate. Conclusions: The cost-effectiveness of short-term surgical missions provided by NGOs can be cost-effective, but limitations include inconsistent data from a societal perspective and lack of an appropriate counterfactual. Future studies should examine the capacity for NGOs to collect adequate data and conduct rigorous economic evaluations.


Assuntos
Missões Médicas , Procedimentos Cirúrgicos Operatórios , Adulto , Criança , Análise Custo-Benefício , Feminino , Cirurgia Geral/economia , Procedimentos Cirúrgicos em Ginecologia/economia , Humanos , Masculino , Missões Médicas/economia , Pessoa de Meia-Idade , Nicarágua , Procedimentos Ortopédicos/economia , Pediatria/economia , Procedimentos Cirúrgicos Operatórios/economia
3.
Arch Argent Pediatr ; 119(4): 270-272, 2021 08.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-34309304

RESUMO

In patients with SARS-CoV-2 infection, endotracheal intubation is a procedure with a high risk for transmission. A videolaryngoscopy is a supplementary level of health care provider protection, but commercial videolaryngoscopes are expensive and not always available in pediatric intensive care units in Argentina. Our objective was to describe intubation practice using an infant head mannequin with a low-cost, handcrafted videolaryngoscope. Fifteen pediatricians with no prior experience using the device participated in an intubation practice in a head mannequin with a handcrafted videolaryngoscope. The average time for the first attempt was 116.4 seconds (95 % confidence interval [CI]: 84.8- 148.0) and, for the second one, 44.2 seconds (95 % CI: 27.7-60.6). Time decreased significantly for the second attempt (p: 0.0001). A successful intubation was achieved with the device in all attempts, and the procedure duration decreased with the second practice.


Assuntos
COVID-19/prevenção & controle , Intubação Intratraqueal/instrumentação , Laringoscópios/economia , Laringoscopia/educação , Pediatria/educação , Treinamento por Simulação/métodos , Argentina , COVID-19/transmissão , Competência Clínica/estatística & dados numéricos , Educação Médica Continuada/métodos , Custos de Cuidados de Saúde , Humanos , Lactente , Internato e Residência/métodos , Intubação Intratraqueal/economia , Intubação Intratraqueal/métodos , Laringoscopia/economia , Laringoscopia/instrumentação , Laringoscopia/métodos , Curva de Aprendizado , Manequins , Pediatria/economia , Fatores de Tempo , Gravação em Vídeo
4.
Pediatrics ; 148(4)2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34330864

RESUMO

The coronavirus disease 2019 pandemic significantly impacted undergraduate and graduate medical education and created challenges that prevented a traditional approach to residency and fellowship recruitment and interviews. Early in the pandemic, the pediatric education community came together to support applicants and training programs and to foster an equitable recruitment process. We describe many of our community's innovations, including the use of virtual cafés to educate programs and highlight best practices for virtual recruitment and the use of regional webinars to highlight residency programs and provide information to applicants. Surveys of applicants and programs suggest that the virtual interview process worked well overall, with applicants and programs saving both time and money and programs maintaining a high rate of filling their positions. On the basis of this experience, we highlight the strengths and weaknesses of 3 potential models for future interview seasons. We close with a series of questions that need further investigation to create an effective and equitable recruitment process for the future.


Assuntos
Bolsas de Estudo , Internet , Internato e Residência , Entrevistas como Assunto/métodos , Pediatria/educação , Seleção de Pessoal/métodos , COVID-19/epidemiologia , Criança , Humanos , Candidatura a Emprego , Pandemias , Pediatria/economia , SARS-CoV-2 , Estados Unidos
5.
Pediatr Clin North Am ; 68(3): 573-581, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-34044986

RESUMO

Integrated behavioral health care (IBHC) improves patient outcomes, decreases cost, and increases patient satisfaction. It has become increasingly evident that IBHC must be incorporated into the US health care system. Although most health care providers agree that IBHC is beneficial, there is great debate regarding financial sustainability. Some studies have shown that incorporating BHCs into primary care clinics allows providers to see more patients, thus generating more revenue indirectly. In this article, the authors discuss funding and billing for IBHC. The authors truly believe that once properly implemented, IBHC will lower costs and improve patient care in the long run.


Assuntos
Seguro Saúde/economia , Serviços de Saúde Mental/economia , Pediatria/economia , Criança , Codificação Clínica/economia , Análise Custo-Benefício , Organização do Financiamento/economia , Humanos , Satisfação do Paciente
6.
Pediatr Clin North Am ; 68(3): 651-658, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-34044991

RESUMO

The integrated behavioral health care model in primary care has the potential to reduce barriers to care experienced by children and families from ethnic minorities and low socioeconomic status. Limited access to pediatric behavioral health care is a significant problem, with up to 40% of children and adolescents with identified mental disorders and only 30% of them receiving care. Barriers include transportation, insurance, and shortage of specialists. Primary care provider bias, decreased knowledge and feelings of competence, and cultural beliefs and stigma also affect earlier diagnosis and treatment, particularly for Hispanic families with low English proficiency and African Americans.


Assuntos
Assistência Integral à Saúde , Acesso aos Serviços de Saúde , Serviços de Saúde Mental , Pediatria , Adolescente , Afro-Americanos , Criança , Assistência Integral à Saúde/economia , Assistência Integral à Saúde/normas , Competência Cultural , Grupos Étnicos , Acesso aos Serviços de Saúde/economia , Acesso aos Serviços de Saúde/normas , Disparidades em Assistência à Saúde , Hispano-Americanos , Humanos , Serviços de Saúde Mental/economia , Serviços de Saúde Mental/normas , Pediatria/economia , Pediatria/normas , Atenção Primária à Saúde/economia , Atenção Primária à Saúde/organização & administração , Atenção Primária à Saúde/normas , Racismo , Classe Social , Fatores Socioeconômicos
7.
JAMA Netw Open ; 4(4): e213927, 2021 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-33792730

RESUMO

Importance: Parental smoking adversely affects parents' and children's health. There are effective interventions delivered in pediatric settings to help parents quit smoking. The cost-effectiveness of this type of intervention is not known. Objective: To evaluate the cost-effectiveness of a parental smoking cessation intervention, the Clinical Effort Against Secondhand Smoke Exposure (CEASE) program, delivered in pediatric primary care, compared with usual care from a health care organization's perspective. Design, Setting, and Participants: This economic evaluation used data on intervention costs and parental smoking cessation collected prospectively as part of the CEASE randomized clinical trial. Data were collected at pediatric offices in 5 US states from April 2015 to October 2017. Participants included parents of children attending 10 pediatric primary care practices (5 control, 5 intervention). Data analysis was performed from October 2019 to August 2020. Exposures: The trial compared CEASE (practice training and support to address family tobacco use) vs usual care. Main Outcomes and Measures: The overall cost and incremental cost per quit of the CEASE intervention were calculated using microcosting methods. CEASE effectiveness was estimated using 2 trial outcomes measures assessed in repeated cross-sections: (1) change in smoking prevalence assessed by parental report for intervention vs usual care practices at 2 weeks after program initiation (baseline) and at 2-year follow-up and (2) changes in the proportion of smokers who achieved cotinine-confirmed smoking cessation in the previous 2 years at baseline vs follow-up. Monte Carlo analyses were used to provide 95% CIs. Results: The study included a total of 3054 participants (1523 at baseline and 1531 at follow-up); 2163 (70.8%) were aged 25 to 44 years old, and 2481 (81.2%) were women. Over 2 years, the total cost of implementing and sustaining CEASE across 5 intervention practices was $115 778. The incremental cost per quit for CEASE compared with usual care was $1132 (95% CI, $653-$3603), according to the change in parent-reported smoking prevalence, and $762 (95% CI, $418-$2883), according to cotinine-confirmed cessation. CEASE was cost-effective at a willingness-to-pay threshold of $2000 per quit in 88.0% of simulations based on the parent-reported smoking prevalence and 94.6% of simulations based on cotinine-confirmed smoking cessation measures. Conclusions and Relevance: These findings suggest that the CEASE intervention was associated with an incremental cost per quit that compared favorably with those of other clinical smoking cessation interventions. CEASE is inexpensive to initiate and maintain in the clinical pediatric setting, suggesting that it has the potential for a high impact on population health.


Assuntos
Terapia Comportamental/economia , Relações Pais-Filho , Atenção Primária à Saúde/economia , Abandono do Hábito de Fumar/economia , Adulto , Terapia Comportamental/métodos , Criança , Análise Custo-Benefício , Feminino , Seguimentos , Comportamentos Relacionados com a Saúde , Humanos , Pais , Pediatria/economia , Atenção Primária à Saúde/métodos , Abandono do Hábito de Fumar/métodos
8.
Pediatrics ; 147(4)2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33685988

RESUMO

OBJECTIVES: Our 2011 report, reflecting data from 2007-2008, demonstrated that, for many pediatric subspecialties, pursuing fellowship training was a negative financial decision when compared with practicing as a general pediatrician. We provide an updated analysis on the financial impact of pediatric fellowship training and model interventions that can influence the results. METHODS: We estimated the financial returns a graduating pediatric resident might anticipate from fellowship training followed by a career as a pediatric subspecialist and compared them with the returns expected from starting a career as a general pediatrician immediately after residency. We evaluated the potential effects of eliminating medical school debt, shortening the length of fellowship training, and implementing a federal loan repayment program for pediatric subspecialists. We compared the financial returns of subspecialty training in 2018-2019 to those from our previous report. RESULTS: Pursuing fellowship training generated widely variable financial returns when compared with general pediatrics that ranged from +$852 129 for cardiology to -$1 594 366 for adolescent medicine. Twelve of 15 subspecialties analyzed yielded negative financial returns. The differences have become more pronounced over time: the spread between the highest and lowest earning subspecialties widened from >$1.4 million in 2007-2008 to >$2.3 million in 2018-2019. The negative financial impact of fellowship training could be partially ameliorated by shortening the length of training or by implementing pediatric subspecialist specific loan repayment programs. CONCLUSIONS: This report can be used to help guide trainees, educators, and policy makers. The interventions discussed could help maintain an adequate and balanced pediatric workforce.


Assuntos
Renda , Pediatras/economia , Especialização/economia , Bolsas de Estudo/economia , Humanos , Internato e Residência/economia , Pediatria/economia , Estados Unidos
11.
An. pediatr. (2003. Ed. impr.) ; 94(2): 92-98, feb. 2021. tab
Artigo em Espanhol | IBECS | ID: ibc-201819

RESUMO

INTRODUCCIÓN: Son pocas las intervenciones de eSalud dirigidas a padres que analizan sus costes y el ahorro potencial que pueden generar. Los objetivos de este trabajo consistieron en calcular los costes de desarrollo y mantenimiento de una web de pediatría para padres, el coste por visita y por visitante, y el ahorro potencial generado en función de las visitas médicas evitadas como consecuencia de su uso. MÉTODOS: Para los costes de la web se consideraron los costes tecnológicos y del trabajo de los profesionales. El cálculo del coste de los profesionales y de ahorro potencial se basó en los honorarios oficiales y en los precios públicos del Sistema Sanitario Público de Andalucía. RESULTADOS: Durante los 5 años y 6 meses del estudio el coste total de la web fue de 45.201,56 (Euro). El coste por visita recibida fue de 0,0155 (Euro), y por cada visitante único, de 0,0186 (Euro). Entre los 516 usuarios que participaron en el estudio se evitaron visitas presenciales a las consultas de pediatría de atención primaria y a los servicios de urgencias de pediatría por un valor de 22.263,89 (Euro). CONCLUSIONES: Los costes de desarrollo de una web de eSalud de pediatría para padres escrita en español, usando tecnología existente y gratuita, son bajos en comparación a otras formas de desarrollo de eSalud. Además, los costes son considerablemente bajos si se dividen entre el número de visitas totales o el número de visitantes. También existe un potencial considerable de ahorro económico al contribuir a evitar visitas presenciales


INTRODUCTION: There are few studies on e-Health interventions directed at parents that analyse their costs and any potential savings that may occur. The aims of this study consisted of calculating the costs of the development and maintenance of paediatric web site for parents, including the costs per visit and per visitor, and the potentially savings made as regards medical visits avoided as a result of its use. METHODS: The technology costs as well as the work of the professionals were considered as costs of the web site. The calculation of the cost of the professionals and the potential savings were based on the official fees and public prices of the Andalusian Public Health Service. RESULTS: During 5 years and 6 months of the study, the total cost of the web site was (Euro)45,201.56. The cost per visit received was (Euro) 0.0155(Euro), and (Euro) 0.0186 for each single visitor. Among the 516 users that took part in the study, face-to-face visits to Primary Care paediatric clinics were avoided, as well as those to Paediatric Emergency Department, at a savings of (Euro) 22,263.89. CONCLUSIONS: The costs of developing a paediatric e-Health website for parents written in Spanish, using existing and free technologies, are low compared to other forms of e-Health development. Furthermore, the costs are considerably low if they are divided by the total number of visits or the number of visitors. There is also a considerable potential financial saving on contributing to avoid face-to-face visits


Assuntos
Humanos , Masculino , Feminino , Lactente , Pré-Escolar , Criança , Adulto , Telemedicina/economia , Pediatria/economia , Pais , Pediatria/métodos , Análise Custo-Benefício , Inquéritos e Questionários , Consulta Remota/economia , Atenção Primária à Saúde/economia , Espanha , Redes de Comunicação de Computadores/economia
14.
Ann Surg ; 273(2): 379-386, 2021 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-30907755

RESUMO

OBJECTIVE: To determine the cost-effectiveness of building and maintaining a dedicated pediatric operating room (OR) in Uganda from the societal perspective. BACKGROUND: Despite the heavy burden of pediatric surgical disease in low-income countries, definitive treatment is limited as surgical infrastructure is inadequate to meet the need, leading to preventable morbidity and mortality in children. METHODS: In this economic model, we used a decision tree template to compare the intervention of a dedicated pediatric OR in Uganda for a year versus the absence of a pediatric OR. Costs were included from the government, charity, and patient perspectives. OR and ward case-log informed epidemiological and patient outcomes data, and measured cost per disability adjusted life year averted and cost per life saved. The incremental cost-effectiveness ratio (ICER) was calculated between the intervention and counterfactual scenario. Costs are reported in 2015 US$ and inflated by 5.5%. FINDINGS: In Uganda, the implementation of a dedicated pediatric OR has an ICER of $37.25 per disability adjusted life year averted or $3321 per life saved, compared with no existing operating room. The ICER is well below multiple cost-effectiveness thresholds including one times the country's gross domestic product per capita ($694). The ICER remained robust under 1-way and probabilistic sensitivity analyses. CONCLUSION: Our model ICER suggests that the construction and maintenance of a dedicated pediatric operating room in sub-Saharan Africa is very-cost effective if hospital space and personnel pre-exist to staff the facility. This supports infrastructure implementation for surgery in sub-Saharan Africa as a worthwhile investment.


Assuntos
Salas Cirúrgicas/economia , Pediatria/economia , Saúde Pública/economia , Criança , Análise Custo-Benefício , Humanos , Modelos Econômicos , Uganda
17.
Pak J Pharm Sci ; 33(3(Special)): 1389-1395, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-33361028

RESUMO

Antibiotics are widely prescribed and often used irrationally in Chinese hospitals. This study aimed to evaluate the pharmacist's influence on antibiotic use in the pediatric ward. We conducted this pre-to-post intervention study in the pediatrics of a Chinese tertiary hospital. The patients hospitalized from April to June 2018 were assigned to the pre-intervention group and those from April to June 2019 were distributed to post-intervention group. In the post-intervention stage, the pharmacist took measures to promote rational use of antibiotics and their effects were assessed. This study analyzed data of 1408 patients totally, 671 and 737 in the pre-intervention and post-intervention group respectively. The interventions of clinical pharmacist significantly reduced the rate of using antibiotics without indications (from 33.55% to 15.82%, p<0.01), percentage of inappropriate antibiotic choice (from 24.79% to 16.58%, p p<0.01), dose (from 8.55% to 4.34%, p p<0.05), combination (from 11.75% to 5.10%, p p<0.01) and prolonged duration (from 14.53% to 10.46%, p p<0.05). The mean antibiotic cost and cost/patient-day were also significantly reduced after the intervention. The ratio of average antibiotic cost saving to pharmacist time cost was 16.77:1. The pharmacist could play vital roles in optimizing antibiotic use, thus resulting in favorable clinical and economic outcomes in pediatric ward.


Assuntos
Antibacterianos/uso terapêutico , Gestão de Antimicrobianos , Prescrição Inadequada , Pediatria , Farmacêuticos , Serviço de Farmácia Hospitalar , Antibacterianos/efeitos adversos , Antibacterianos/economia , Gestão de Antimicrobianos/economia , Criança , Pré-Escolar , Redução de Custos , Análise Custo-Benefício , Custos de Medicamentos , Feminino , Custos Hospitalares , Humanos , Prescrição Inadequada/efeitos adversos , Prescrição Inadequada/economia , Lactente , Masculino , Pediatria/economia , Farmacêuticos/economia , Serviço de Farmácia Hospitalar/economia , Papel Profissional , Estudos Retrospectivos , Centros de Atenção Terciária , Fatores de Tempo
18.
JAMA Netw Open ; 3(10): e2021201, 2020 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-33064137

RESUMO

Importance: Health care organizations are increasingly incorporating social risk screening into patient care. Studies have reported wide variations in patients' interest in receiving health care-based assistance for identified social risks. However, no study to date has examined the factors associated with patients' interest in receiving assistance, including whether interest in receiving assistance varies based on specific patient demographic characteristics. Targeted research on this topic could improve the success of health care-based programs that offer social care services. Objective: To identify participant characteristics associated with interest in receiving health care-based social risk assistance. Design, Setting, and Participants: This cross-sectional study was conducted in 7 primary care clinics and 4 emergency departments in 9 US states between July 2, 2018, and February 13, 2019. A convenience sample of adult patients and adult caregivers of pediatric patients completed a screening survey that measured social risk factors and participants' interest in receiving assistance for identified social risks. Participants were randomly selected to receive 1 of 2 versions of the survey, which differed based on the order in which questions about social risks and interest in receiving assistance were presented. Multivariable logistic regression analyses were used to evaluate the associations between covariates and participants' interest in receiving assistance, stratified by social risk screening results. Data were analyzed from September 8, 2019, to July 30, 2020. Exposures: Social risk screening questions assessed risk factors comprising housing, food, transportation, utilities, and exposure to interpersonal violence. Additional questions assessed participants' interest in receiving assistance and their perspectives on health care-based social risk screening. Main Outcomes and Measures: Participant interest in receiving health care-based social risk assistance. Results: A total of 1021 adult participants with complete survey responses were included in the analysis. Of those, 709 of 1004 participants (70.6%) were female, and 544 of 1007 participants (54.0%) were aged 18 to 44 years. Overall, 353 of 662 participants (53.3%) with positive screening results for 1 or more social risk factors were interested in receiving assistance, whereas 31 of 359 participants (8.6%) with negative screening results for all social risks were interested in receiving assistance. Participants with positive screening results for 1 or more social risk factors had a higher likelihood of being interested in receiving assistance if they answered the question about interest in receiving assistance before they answered the questions about social risk factors (adjusted odds ratio [aOR], 1.48; 95% CI, 1.05-2.07), had positive screening results for a higher number of social risk factors (aOR, 2.40; 95% CI, 1.68-3.42), reported lower household income levels (aOR, 7.78; 95% CI, 2.96-20.44), or self-identified as having non-Hispanic Black ancestry (aOR, 2.22; 95% CI, 1.37-3.60). Among those with negative screening results for all social risk factors, the interest in receiving assistance was higher if the participants reported lower household income levels (aOR, 12.38; 95% CI, 2.94-52.15), previous exposure to health care-based social risk screening (aOR, 2.35; 95% CI, 1.47-3.74), higher perceived appropriateness of social risk screening (aOR, 3.69; 95% CI, 1.08-12.55), or worse health status (aOR, 4.22; 95% CI, 1.09-16.31). Conclusions and Relevance: In this study, multiple factors were associated with participants' interest in receiving social risk assistance. These findings may have implications for how and when social risk assistance is offered to patients. As the health care system's role in addressing social risk factors evolves, an understanding of patients' perspectives regarding screening and their interest in receiving assistance may be important to implementing patient-centered interventions.


Assuntos
Cuidadores/psicologia , Custos de Cuidados de Saúde/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Pacientes/psicologia , Serviço Social/normas , Adolescente , Adulto , Cuidadores/estatística & dados numéricos , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Pacientes/estatística & dados numéricos , Pediatria/economia , Pediatria/métodos , Fatores de Risco , Serviço Social/métodos , Estados Unidos
19.
J Pediatr Orthop ; 40(10): e952-e957, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32796210

RESUMO

BACKGROUND: Increased enrollment in government-based insurance plans has been reported. With youth sports injuries on the rise, increased ordering of advanced imaging such as magnetic resonance imaging (MRI) has occurred. This study sought to report on the impact of insurance type on access to and results of knee MRI in pediatric sports medicine patients. METHODS: A retrospective review of 178 consecutive pediatric sports medicine clinics was completed. INCLUSION CRITERIA: patients younger than 18 years, routine knee MRI ordered, sports medicine diagnosis, and insurance. Data included basic demographics, injury date, date and location (urgent care vs. clinic) of the first presentation, details of MRI ordering and approval, date and location of MRI follow-up, MRI results (negative, minor findings, major findings), and eventual treatment required. RESULTS: A total of 168 charts underwent a complete review. The patients' average age was 14±3 years and 54% (N=90) were female. Ninety-eight had government insurance and 70 had commercial insurance. The time between injury and MRI completion was significantly longer with government insurance (34 vs. 67 d, P<0.01). Government insurance had increased wait time between the first visit and MRI completion (11 vs. 40 d, P<0.001) as well as MRI order and completion (9 vs. 16.5 d, P<0.001). There was no significant difference in positive findings on MRI between insurance groups, including both major and minor findings nor in the proportion receiving eventual operative treatment. CONCLUSION: Pediatric sports medicine patients with government insurance have delays in obtaining knee MRI, despite there being no difference in the rate of positive findings and subsequent operative treatments. LEVEL OF EVIDENCE: Level III-case-control study.


Assuntos
Traumatismos em Atletas/diagnóstico por imagem , Cobertura do Seguro , Traumatismos do Joelho/diagnóstico por imagem , Imageamento por Ressonância Magnética/economia , Adolescente , Estudos de Casos e Controles , Criança , Feminino , Humanos , Seguro , Masculino , Pediatria/economia , Estudos Retrospectivos , Medicina Esportiva/economia
20.
Med Decis Making ; 40(5): 596-605, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32613894

RESUMO

Background. Intensive multidisciplinary intervention (IMI) represents a well-established treatment for pediatric feeding disorders (PFDs), but program availability represents an access care barrier. We develop an economic analysis of IMI for weaning from gastronomy tube (G-tube) treatment for children diagnosed with PFDs from the Medicaid programs' perspective, where Medicaid programs refer to both fee-for-service and managed care programs. Methods. The 2010-2012 Medicaid Analytic eXtract claims provided health care data for children aged 13 to 72 months. An IMI program provided data on average admission costs. We employed a finite-horizon Markov model to simulate PFD treatment progression assuming 2 treatment arms: G-tube only v. IMI targeting G-tube weaning. We compared the expenditure differential between the 2 arms under varying time horizons and treatment effectiveness. Results. Overall Medicaid expenditure per member per month was $6814, $2846, and $1550 for the study population of children with PFDs and G-tube treatment, the control population with PFDs without G-tube treatment, and the no-PFD control population, respectively. The PFD-diagnosed children with G-tube treatment only had the highest overall expenditures across all health care settings except psychological services. The expenditure at the end of the 8-year time horizon was $405,525 and $208,218 per child for the G-tube treatment only and IMI arms, respectively. Median Medicaid expenditure was between 1.7 and 2.2 times higher for the G-tube treatment arm than for the IMI treatment arm. Limitations. Data quality issues could cause overestimates or underestimates of Medicaid expenditure. Conclusions. This study demonstrated the economic benefits of IMI to treat complex PFDs from the perspective of Medicaid programs, indicating this model of care not only holds benefit in terms of improving overall quality of life but also brings significant expenditure savings in the short and long term.


Assuntos
Análise Custo-Benefício/métodos , Transtornos da Alimentação e da Ingestão de Alimentos/economia , Comunicação Interdisciplinar , Medicaid/estatística & dados numéricos , Criança , Pré-Escolar , Análise Custo-Benefício/tendências , Transtornos da Alimentação e da Ingestão de Alimentos/terapia , Feminino , Humanos , Lactente , Masculino , Medicaid/economia , Pediatria/economia , Pediatria/métodos , Estados Unidos
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