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1.
PLoS One ; 16(1): e0244867, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33449940

RESUMO

In light of the ongoing coronavirus disease (COVID-19) pandemic, this study aims to examine the relationship between the availability of public health resources and the mortality rate of this disease. We conducted empirical analyses using linear regression, a time-varying effect model, and a regression discontinuity design to investigate the association of medical resources with the mortality rate of the COVID-19 patients in Hubei, China. The results showed that the numbers of hospital beds, healthcare system beds, and medical staff per confirmed cases all had significant negative effects on the coronavirus disease mortality rate. Furthermore, in the context of the severe pandemic currently being experienced worldwide, the present study summarized the experience and implications in pandemic prevention and control in Hubei province from the perspective of medical resource integration as follows: First, hospitals' internal medical resources were integrated, breaking interdepartmental barriers. Second, joint pandemic control was realized by integrating regional healthcare system resources. Finally, an external medical resource allocation system was developed.


Assuntos
/mortalidade , /epidemiologia , China/epidemiologia , Demografia/estatística & dados numéricos , Recursos em Saúde/estatística & dados numéricos , Humanos , Mortalidade/tendências
2.
PLoS One ; 15(11): e0240651, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33147213

RESUMO

The general public is subject to triage policies that allocate scarce lifesaving resources during the COVID-19 pandemic, one of the worst public health emergencies in the past 100 years. However, public attitudes toward ethical principles underlying triage policies used during this pandemic are not well understood. Three experiments (preregistered; online samples; N = 1,868; U.S. residents) assessed attitudes toward ethical principles underlying triage policies. The experiments evaluated assessments of utilitarian, egalitarian, prioritizing the worst-off, and social usefulness principles in conditions arising during the COVID-19 pandemic, involving resource scarcity, resource reallocation, and bias in resource allocation toward at-risk groups, such as the elderly or people of color. We found that participants agreed with allocation motivated by utilitarian principles and prioritizing the worst-off during initial distribution of resources and disagreed with allocation motivated by egalitarian and social usefulness principles. At reallocation, participants agreed with giving priority to those patients who received the resources first. Lastly, support for utilitarian allocation varied when saving the greatest number of lives resulted in disadvantage for at-risk or historically marginalized groups. Specifically, participants expressed higher levels of agreement with policies that shifted away from maximizing benefits to one that assigned the same priority to members of different groups if this mitigated disadvantage for people of color. Understanding these attitudes can contribute to developing triage policies, increase trust in health systems, and assist physicians in achieving their goals of patient care during the COVID-19 pandemic.


Assuntos
Atitude , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/psicologia , Recursos em Saúde/estatística & dados numéricos , Pandemias , Pneumonia Viral/epidemiologia , Pneumonia Viral/psicologia , Adolescente , Adulto , Idoso , Emergências/psicologia , Feminino , Alocação de Recursos para a Atenção à Saúde/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Saúde Pública/estatística & dados numéricos , Opinião Pública , Triagem/estatística & dados numéricos , Adulto Jovem
3.
PLoS One ; 15(10): e0240348, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33052956

RESUMO

Coronavirus disease 2019 (COVID-19) was first identified in December 2019 in Wuhan, China as an infectious disease, and has quickly resulted in an ongoing pandemic. A data-driven approach was developed to estimate medical resource deficiencies due to medical burdens at county level during the COVID-19 pandemic. The study duration was mainly from February 15, 2020 to May 1, 2020 in the U.S. Multiple data sources were used to extract local population, hospital beds, critical care staff, COVID-19 confirmed case numbers, and hospitalization data at county level. We estimated the average length of stay from hospitalization data at state level, and calculated the hospitalized rate at both state and county level. Then, we developed two medical resource deficiency indices that measured the local medical burden based on the number of accumulated active confirmed cases normalized by local maximum potential medical resources, and the number of hospitalized patients that can be supported per ICU bed per critical care staff, respectively. Data on medical resources, and the two medical resource deficiency indices are illustrated in a dynamic spatiotemporal visualization platform based on ArcGIS Pro Dashboards. Our results provided new insights into the U.S. pandemic preparedness and local dynamics relating to medical burdens in response to the COVID-19 pandemic.


Assuntos
Infecções por Coronavirus/epidemiologia , Alocação de Recursos para a Atenção à Saúde/estatística & dados numéricos , Recursos em Saúde/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Análise Espaço-Temporal , Infecções por Coronavirus/economia , Efeitos Psicossociais da Doença , Humanos , Pandemias/economia , Pneumonia Viral/economia , Estados Unidos
5.
Int J Health Geogr ; 19(1): 36, 2020 09 14.
Artigo em Inglês | MEDLINE | ID: mdl-32928236

RESUMO

BACKGROUND: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), causing the coronavirus disease 2019 (COVID-19) pandemic, has infected millions of people and caused hundreds of thousands of deaths. While COVID-19 has overwhelmed healthcare resources (e.g., healthcare personnel, testing resources, hospital beds, and ventilators) in a number of countries, limited research has been conducted to understand spatial accessibility of such resources. This study fills this gap by rapidly measuring the spatial accessibility of COVID-19 healthcare resources with a particular focus on Illinois, USA. METHOD: The rapid measurement is achieved by resolving computational intensity of an enhanced two-step floating catchment area (E2SFCA) method through a parallel computing strategy based on cyberGIS (cyber geographic information science and systems). The E2SFCA has two major steps. First, it calculates a bed-to-population ratio for each hospital location. Second, it sums these ratios for residential locations where hospital locations overlap. RESULTS: The comparison of the spatial accessibility measures for COVID-19 patients to those of population at risk identifies which geographic areas need additional healthcare resources to improve access. The results also help delineate the areas that may face a COVID-19-induced shortage of healthcare resources. The Chicagoland, particularly the southern Chicago, shows an additional need for resources. This study also identified vulnerable population residing in the areas with low spatial accessibility in Chicago. CONCLUSION: Rapidly measuring spatial accessibility of healthcare resources provides an improved understanding of how well the healthcare infrastructure is equipped to save people's lives during the COVID-19 pandemic. The findings are relevant for policymakers and public health practitioners to allocate existing healthcare resources or distribute new resources for maximum access to health services.


Assuntos
Área Programática de Saúde/estatística & dados numéricos , Infecções por Coronavirus/epidemiologia , Recursos em Saúde/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Betacoronavirus , Acesso aos Serviços de Saúde/organização & administração , Número de Leitos em Hospital/estatística & dados numéricos , Humanos , Illinois , Unidades de Terapia Intensiva/estatística & dados numéricos , Pandemias , Fatores Socioeconômicos , Análise Espacial , Ventiladores Mecânicos/provisão & distribução
7.
Rev Epidemiol Sante Publique ; 68(5): 302-305, 2020 Sep.
Artigo em Francês | MEDLINE | ID: mdl-32948360

RESUMO

Following the onset of the global COVID-19 pandemic and the alerts issued by the World Health Organization, for several months attention has been focused on Africa as a potentially severely endangered continent. A sizable number of African countries, mainly low and middle income, suffer from limited available resources, especially in critical care, and COVID-19 is liable to overwhelm their already fragile health systems. To effectively manage what is shaping up as a multidimensional crisis, the challenge unquestionably goes beyond the necessary upgrading of public health infrastructures. It is also a matter of anticipating and taking timely action with regard to factors that may mitigate the propagation of SARS-CoV2 and thereby cushion the shock of the pandemic on the African continent. While some of these factors are largely unmanageable (climate, geography…), several others (socio-cultural, religious, audio-visual, and potentially political…) could be more or less effectively dealt with by African governments and populations.


Assuntos
Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , África/epidemiologia , Vacina BCG/uso terapêutico , Betacoronavirus/fisiologia , Clima , Infecções por Coronavirus/economia , Infecções por Coronavirus/terapia , Recursos em Saúde/organização & administração , Recursos em Saúde/estatística & dados numéricos , Recursos em Saúde/provisão & distribução , História do Século XX , História do Século XXI , Humanos , Controle de Infecções/economia , Controle de Infecções/história , Controle de Infecções/organização & administração , Controle de Infecções/normas , Pandemias/economia , Pandemias/estatística & dados numéricos , Pneumonia Viral/economia , Pneumonia Viral/terapia , Áreas de Pobreza , Papel Profissional , Saúde Pública/economia , Saúde Pública/história , Saúde Pública/estatística & dados numéricos , Mídias Sociais , Responsabilidade Social , Fatores Socioeconômicos , Organização Mundial da Saúde
8.
PLoS One ; 15(9): e0238843, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32915863

RESUMO

OBJECTIVE: The economic burden of commercially insured patients in the United States with treatment-resistant depression and patients with non-treatment-resistant major depressive disorder was compared using data from the Optum Clinformatics™ claims database. METHODS: Patients 18-63 years on antidepressant treatment between 1/1/13 and 9/30/13, who had no treatment claims for depression 6 months before the index date (first antidepressant dispensing), and who had a major depressive disorder or depression diagnosis within 30 days of the index date, were included. Treatment-resistant depression was defined as receiving 3 antidepressant regimens during 1 major depressive disorder episode. Patients with treatment-resistant depression were matched with patients with non-treatment-resistant major depressive disorder at a 1:4 ratio using propensity score matching. The study consisted of 1-year baseline (pre-index) and 2-year follow-up (post index) periods. Cost outcomes were compared using a generalized linear model. RESULTS: 2,370 treatment-resistant depression and 9,289 non-treatment-resistant major depressive disorder patients were included. In year 1 of the follow-up period, compared with non-treatment-resistant major depressive disorder, patients with treatment-resistant depression had: more emergency department visits (odds ratio = 1.39, 95% confidence interval = 1.24-1.56); more inpatient hospitalizations (odds ratio = 1.73, 95% confidence interval = 1.46-2.05); longer hospital stays (mean difference vs non-treatment-resistant major depressive disorder = 2.86, 95% confidence interval = 0.86-4.86 days); and more total healthcare costs (mean difference vs non-treatment-resistant major depressive disorder = US$3,846, 95% confidence interval = $2,855-$4,928). These patterns remained consistent in year 2 of the follow-up period. CONCLUSION: Treatment-resistant depression was associated with higher healthcare resource utilization and costs versus non-treatment-resistant major depressive disorder in this commercially insured cohort of patients in the United States.


Assuntos
Antidepressivos/economia , Assistência à Saúde/estatística & dados numéricos , Transtorno Depressivo Maior/tratamento farmacológico , Transtorno Depressivo Resistente a Tratamento/tratamento farmacológico , Custos de Cuidados de Saúde , Recursos em Saúde/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Adolescente , Adulto , Antidepressivos/uso terapêutico , Bases de Dados Factuais , Assistência à Saúde/economia , Transtorno Depressivo Maior/economia , Transtorno Depressivo Maior/epidemiologia , Transtorno Depressivo Resistente a Tratamento/economia , Transtorno Depressivo Resistente a Tratamento/epidemiologia , Feminino , Humanos , Revisão da Utilização de Seguros , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Estados Unidos/epidemiologia , Adulto Jovem
9.
Aliment Pharmacol Ther ; 52(4): 655-668, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32902894

RESUMO

BACKGROUND: There are limited data on population-wide assessment of cost in Crohn's disease (CD) and ulcerative colitis (UC). AIM: To estimate the societal cost of actively treated CD and UC in Sweden. METHODS: We identified 10 117 prevalent CD and 19 762 prevalent UC patients, aged ≥18 years on 1 January 2014 and 4028 adult incident CD cases and 8659 adult incident UC cases (2010-2013) from Swedish Patient Register. Each case was matched to five population comparators. Healthcare costs were calculated from medications, outpatient visits, hospitalisations and surgery. Cost of productivity losses was derived from disability pension and sick leave. RESULTS: The mean annual societal costs per working-age patient (18-64 years) with CD and UC were $22 813 (vs $7533 per comparator) and $14 136 (vs $7351 per comparator), respectively. In patients aged ≥65 years, the mean annual costs of CD and UC were $9726 and $8072 vs $3875 and $4016 per comparator, respectively. The majority of cost for both CD (56%) and UC (59%) patients originated from productivity losses. Higher societal cost of working-age CD patients as compared to UC patients was related to greater utilisation of anti-TNF (22.2% vs 7.4%) and increased annual disability pension (44 days vs 25 days). Among incident CD and UC patients, the mean total cost over the first year per patient was over three times higher than comparators. CONCLUSION: In Sweden, the societal cost of incident and prevalent CD and UC patients was consistently two to three times higher than the general population.


Assuntos
Colite Ulcerativa , Doença de Crohn , Custos de Cuidados de Saúde , Recursos em Saúde , Licença Médica , Absenteísmo , Adolescente , Adulto , Colite Ulcerativa/economia , Colite Ulcerativa/epidemiologia , Colite Ulcerativa/terapia , Doença de Crohn/economia , Doença de Crohn/epidemiologia , Doença de Crohn/terapia , Feminino , Custos de Cuidados de Saúde/estatística & dados numéricos , Recursos em Saúde/economia , Recursos em Saúde/estatística & dados numéricos , Hospitalização/economia , Hospitalização/estatística & dados numéricos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Prevalência , Licença Médica/economia , Licença Médica/estatística & dados numéricos , Suécia/epidemiologia , Fator de Necrose Tumoral alfa/uso terapêutico , Trabalho/economia , Trabalho/estatística & dados numéricos , Adulto Jovem
10.
PLoS One ; 15(8): e0238067, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32866165

RESUMO

AIMS: To determine the out-of-hospital cardiac arrest (OHCA) rates and occurrences at municipality level through a novel statistical model accounting for temporal and spatial heterogeneity, space-time interactions and demographic features. We also aimed to predict OHCAs rates and number at municipality level for the upcoming years estimating the related resources requirement. METHODS: All the consecutive OHCAs of presumed cardiac origin occurred from 2005 until 2018 in Canton Ticino region were included. We implemented an Integrated Nested Laplace Approximation statistical method for estimation and prediction of municipality OHCA rates, number of events and related uncertainties, using age and sex municipality compositions. Comparisons between predicted and real OHCA maps validated our model, whilst comparisons between estimated OHCA rates in different yeas and municipalities identified significantly different OHCA rates over space and time. Longer-time predicted OHCA maps provided Bayesian predictions of OHCA coverages in varying stressful conditions. RESULTS: 2344 OHCAs were analyzed. OHCA incidence either progressively reduced or continuously increased over time in 6.8% of municipalities despite an overall stable spatio-temporal distribution of OHCAs. The predicted number of OHCAs accounts for 89% (2017) and 90% (2018) of the yearly variability of observed OHCAs with prediction error ≤1OHCA for each year in most municipalities. An increase in OHCAs number with a decline in the Automatic External Defibrillator availability per OHCA at region was estimated. CONCLUSIONS: Our method enables prediction of OHCA risk at municipality level with high accuracy, providing a novel approach to estimate resource allocation and anticipate gaps in demand in upcoming years.


Assuntos
Recursos em Saúde/estatística & dados numéricos , Modelos Estatísticos , Parada Cardíaca Extra-Hospitalar/epidemiologia , Idoso , Teorema de Bayes , Feminino , Geografia , Humanos , Masculino , Sistema de Registros , Análise Espaço-Temporal
13.
Lancet Respir Med ; 8(9): 853-862, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32735842

RESUMO

Background Nationwide, unbiased, and unselected data of hospitalised patients with COVID-19 are scarce. Our aim was to provide a detailed account of case characteristics, resource use, and outcomes of hospitalised patients with COVID-19 in Germany, where the health-care system has not been overwhelmed by the pandemic. METHODS: In this observational study, adult patients with a confirmed COVID-19 diagnosis, who were admitted to hospital in Germany between Feb 26 and April 19, 2020, and for whom a complete hospital course was available (ie, the patient was discharged or died in hospital) were included in the study cohort. Claims data from the German Local Health Care Funds were analysed. The data set included detailed information on patient characteristics, duration of hospital stay, type and duration of ventilation, and survival status. Patients with adjacent completed hospital stays were grouped into one case. Patients were grouped according to whether or not they had received any form of mechanical ventilation. To account for comorbidities, we used the Charlson comorbidity index. FINDINGS: Of 10 021 hospitalised patients being treated in 920 different hospitals, 1727 (17%) received mechanical ventilation (of whom 422 [24%] were aged 18-59 years, 382 [22%] were aged 60-69 years, 535 [31%] were aged 70-79 years, and 388 [23%] were aged ≥80 years). The median age was 72 years (IQR 57-82). Men and women were equally represented in the non-ventilated group, whereas twice as many men than women were in the ventilated group. The likelihood of being ventilated was 12% for women (580 of 4822) and 22% for men (1147 of 5199). The most common comorbidities were hypertension (5575 [56%] of 10 021), diabetes (2791 [28%]), cardiac arrhythmia (2699 [27%]), renal failure (2287 [23%]), heart failure (1963 [20%]), and chronic pulmonary disease (1358 [14%]). Dialysis was required in 599 (6%) of all patients and in 469 (27%) of 1727 ventilated patients. The Charlson comorbidity index was 0 for 3237 (39%) of 8294 patients without ventilation, but only 374 (22%) of 1727 ventilated patients. The mean duration of ventilation was 13·5 days (SD 12·1). In-hospital mortality was 22% overall (2229 of 10 021), with wide variation between patients without ventilation (1323 [16%] of 8294) and with ventilation (906 [53%] of 1727; 65 [45%] of 145 for non-invasive ventilation only, 70 [50%] of 141 for non-invasive ventilation failure, and 696 [53%] of 1318 for invasive mechanical ventilation). In-hospital mortality in ventilated patients requiring dialysis was 73% (342 of 469). In-hospital mortality for patients with ventilation by age ranged from 28% (117 of 422) in patients aged 18-59 years to 72% (280 of 388) in patients aged 80 years or older. INTERPRETATION: In the German health-care system, in which hospital capacities have not been overwhelmed by the COVID-19 pandemic, mortality has been high for patients receiving mechanical ventilation, particularly for patients aged 80 years or older and those requiring dialysis, and has been considerably lower for patients younger than 60 years. FUNDING: None.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Recursos em Saúde/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Hospitais/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Infecções por Coronavirus/terapia , Infecções por Coronavirus/virologia , Feminino , Alemanha/epidemiologia , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde , Pandemias , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Pneumonia Viral/terapia , Pneumonia Viral/virologia , Respiração Artificial/estatística & dados numéricos , Adulto Jovem
14.
Am Surg ; 86(9): 1113-1118, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32830522

RESUMO

BACKGROUND: To study the relationship between race and outcomes of patients with firearm injuries hospitalized in the United States. METHODS: The 2016 National Inpatient Sample was used. Patients were included if they had a principal diagnosis of firearm injury. Exclusion criteria were age <16 years and elective admissions. The primary outcome was in-hospital mortality. Secondary outcomes were morbidity (traumatic shock, prolonged mechanical ventilation, acute respiratory distress syndrome [ADRS], and ventilator-associated pneumonia [VAP]), and resource utilization (length of stay and total hospitalization charges and costs). RESULTS: The sample included 31 335 patients; 52% were Black and 29% were Caucasian. The mean age was 32 years and 88% were male. Black patients had lower odds of mortality (adjusted odds ratio (aOR): 0.41 (95% CI: 0.32-0.53), P < .01). However, compared with Caucasians, Blacks had higher mean total hospitalization charges (adjusted mean difference (aMD) : $14 052 (CI: $1469-$26 635), P = .03) and costs (aMD: $3248 (CI: $654-$5842), P = .01) despite similar mean length of stay (aMD: 0.70 (CI: -0.05-1.45), P = .07). Both racial groups had similar rates of traumatic shock (aOR: 0.91 (0.72-1.15), P = .44), prolonged mechanical ventilation (aOR: 0.82 (0.63-1.09), P = .17), ARDS (aOR: 1.18 (0.45-3.07), P = .74) and VAP (aOR: 1.27 (0.47-3.41), P = .63). DISCUSSION: Black patients with firearm injuries had a lower adjusted odds of in-hospital mortality compared with other races. However, despite having a similar hospital length of stay and in-hospital morbidity, -Black patients had higher total hospitalization costs and charges.


Assuntos
Grupos de Populações Continentais , Hospitalização/estatística & dados numéricos , Pacientes Internados , Sistema de Registros , Ferimentos por Arma de Fogo/etnologia , Adulto , Recursos em Saúde/estatística & dados numéricos , Mortalidade Hospitalar/tendências , Humanos , Incidência , Morbidade/tendências , Estudos Retrospectivos , Fatores de Tempo , Estados Unidos/epidemiologia
15.
Can J Surg ; 63(5): E383-E390, 2020 08 28.
Artigo em Inglês | MEDLINE | ID: mdl-32856887

RESUMO

Background: The care of rural trauma patients in northern Alberta can be extremely challenging because of the vast geographic area, the limited access to health care facilities and the lack of adequate resources to manage severe injuries. Identifying gaps in equipment and personnel in rural centres can provide opportunities for improving the care of injured patients in these environments. We conducted a survey based on Canadian Accreditation Council quality indicators to evaluate trauma infrastructure and human resources in rural centres across northern Alberta. Methods: A standardized survey was developed to assess the availability of trauma-specific equipment and personnel across the prehospital and emergency department (ED) settings. The survey was distributed to 50 peripheral hospitals biannually from January 2017 to September 2018. Two-tailed paired t tests were used to evaluate changes in survey responses; a p value of less than 0.05 was considered statistically significant. Results: The survey response rate was 100%. By the end of the study period, there were significant improvements in the number of providers (p = 0.04), nurses (p = 0.01) and dedicated trauma resuscitation bays (p = 0.04) in the ED for managing injured patients. There were also significant increases in the availability of equipment, including advanced airway management tools (p = 0.02), rapid infusion devices (p = 0.02) and warmers (p = 0.04). Access to x-ray equipment (p = 0.03) and computed tomography (CT) scanners (p = 0.04) as well as equipment to support telehealth and teleconferencing (p = 0.04) increased during the study period. Access to, and supply of, blood products also increased significantly (p = 0.02) during the study period. Conclusion: Our study demonstrates that the trauma resources of rural health care centres may be evaluated in a standardized fashion centres, and the results point to opportunities to remedy gaps in equipment and personnel. Our methods may be applied to any trauma network that serves geographically large areas with a sparse distribution of health care facilities, to provide critical information for the optimization of resources in rural trauma.


Assuntos
Equipamentos e Provisões Hospitalares/provisão & distribução , Recursos em Saúde/estatística & dados numéricos , Mão de Obra em Saúde/estatística & dados numéricos , Serviços de Saúde Rural/estatística & dados numéricos , Centros de Traumatologia/estatística & dados numéricos , Alberta , Pesquisas sobre Serviços de Saúde , Humanos , Estudos Prospectivos
16.
Artigo em Inglês | MEDLINE | ID: mdl-32806775

RESUMO

In South Korea, 4.5% patients of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) were readmitted to hospitals after discharge. However, there is insufficient research on risk factors for readmission and management of patients after discharge is poor. In this study, 7590 confirmed coronavirus disease (COVID-19) patients were defined as a target for analysis using nationwide medical claims data. The demographic characteristics, underlying diseases, and the use of medical resources were used to examine the association with readmission through the chi-square test and then logistic regression analysis was performed to analyze factors affecting readmission. Of the 7590 subjects analyzed, 328 patients were readmitted. The readmission rates of men, older age and patients with medical benefits showed a high risk of readmission. The Charlson Comorbidity Index score was also related to COVID-19 readmission. Concerning requiring medical attention, there was a higher risk of readmission for the patients with chest radiographs, computed tomography scans taken and lopinavir/ritonavir at the time of their first admission. Considering the risk factors presented in this study, classifying patients with a high risk of readmission and managing patients before and after discharge based on priority can make patient management and medical resource utilization more efficient. This study also indicates the importance of lifestyle management after discharge.


Assuntos
Infecções por Coronavirus/epidemiologia , Readmissão do Paciente/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Adolescente , Adulto , Fatores Etários , Idoso , Betacoronavirus , Distribuição de Qui-Quadrado , Criança , Pré-Escolar , Comorbidade , Coronavirus , Feminino , Gastos em Saúde/estatística & dados numéricos , Recursos em Saúde/estatística & dados numéricos , Humanos , Lactente , Revisão da Utilização de Seguros/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Pandemias , República da Coreia/epidemiologia , Fatores de Risco , Fatores Sexuais , Fatores Socioeconômicos , Adulto Jovem
17.
Updates Surg ; 72(3): 693-700, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32816284

RESUMO

BACKGROUND: Observing cyclic patterns in surgical outcome is a common experience. We aimed to measure this phenomenon and to hypothesize possible causes using the experience of a high-volume pancreatic surgery department. METHODS: Outcomes of 2748 patients who underwent a Whipple procedure at a single high-volume center from January 2000 to December 2018 were retrospectively analyzed. Three different hypotheses were tested: the effect of climate changes, the "July effect" and the effect of vacations. RESULTS: Clavien-Dindo ≥ 3 morbidity was similar during warm vs. cold months (22.5% vs. 19.8%, p = 0.104) and at the beginning of activity of new trainees vs. the rest of the year (23.5 vs. 22.5%, p = 0.757). Patients operated when a high percentage of staff is on vacation showed an increased Clavien-Dindo ≥ 3 morbidity (22.3 vs. 18.5%, p = 0.022), but similar mortality (2.3 vs. 1.8%, p = 0.553). The surgical waiting list was also significantly longer during these periods (37 vs. 27 days, p = 0.037). Being operated in such a period of the year was an independent predictor of severe morbidity (OR 1.271, CI 95% 1.086-1.638, p = 0.031). CONCLUSION: Being operated when more staff is on vacation significantly affects severe morbidity rate. Future healthcare system policies should prevent the relative shortage of resources during these periods.


Assuntos
Pancreatectomia/métodos , Pancreatectomia/estatística & dados numéricos , Estações do Ano , Absenteísmo , Idoso , Feminino , Recursos em Saúde/estatística & dados numéricos , Humanos , Masculino , Corpo Clínico/estatística & dados numéricos , Pessoa de Meia-Idade , Morbidade , Pancreatectomia/mortalidade , Estudos Retrospectivos , Resultado do Tratamento
18.
Am Surg ; 86(5): 486-492, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32684040

RESUMO

BACKGROUND: Extended hospital length of stay (LOS) is widely associated with significant healthcare costs. Since LOS is a known surrogate for cost, we sought to evaluate outliers. We hypothesized that particular characteristics are likely predictive of trauma high resource consumers (THRC) and can be used to more effectively manage care of this population. METHODS: The Pennsylvania Trauma Outcome Study database was retrospectively queried from 2003-2017 for all adult (age ≥15) trauma patients admitted to accredited trauma centers in Pennsylvania. THRC were defined as patients with hospital LOS two standard deviations above the population mean or ≥22 days (p<0.05). Patient demographics, comorbid conditions and clinical variables were compared between THRC and non-THRC to identify potential predictor variables. A multilevel mixed-effects logistic regression model controlling for age, gender, injury severity, admission Glasgow coma score, systolic blood pressure, and injury year assessed the adjusted impact of clinical factors in predicting THRC status. The National Trauma Data Bank (NTDB) was retrospectively queried from 2014-2016 for all adult (age ≥15) trauma patients admitted to state-accredited trauma centers and likewise were assessed for factors associated with THRC. RESULTS: A total of 465,601 patients met inclusion criteria [THRC: 16,818 (3.6%); non-THRC 448,783 (96.4%)]. Compared to non-THRC counterparts, THRC patients were significantly more severely injured (median ISS: 9 vs. 22, p<0.001). In adjusted analysis, gunshot wound (GSW) to the abdomen, undergoing major surgery and reintubation along with injury to the spine, upper or lower extremities were significantly associated with THRC. From the NTDB, 2 323 945 patients met inclusion criteria. In adjusted analysis, GSW to the abdomen was significantly associated with THRC. Penetrating injury overall was associated with decreased risk of being a THRC in the NTDB dataset. Those who had either GSW to abdomen, surgery, or reintubation required significantly longer LOS (p<0.001). CONCLUSIONS: Reintubation, major surgery, gunshot wound to abdomen, along with injury to the spine, upper or lower extremities are all strongly predictive of THRC. Understanding the profile of the THRC will allow clinicians and case management to proactively put processes in place to streamline care and potentially reduce costs and LOS.


Assuntos
Tempo de Internação/estatística & dados numéricos , Ferimentos e Lesões , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Previsões , Recursos em Saúde/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Centros de Traumatologia , Ferimentos e Lesões/terapia , Adulto Jovem
19.
Public Health ; 185: 324-331, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32726729

RESUMO

OBJECTIVES: Social needs interventions in medical settings aim to mitigate the effects of adverse social circumstances on health outcomes by connecting vulnerable patients with resources. This study examined the relationship between intervention dosage and the success of resource connections using data from a social needs intervention in multiple clinical settings across the US. STUDY DESIGN: The intervention uses a case management approach to connect patients with unmet needs to resources and services in the community. Intervention dosage was conceptualized as the number of contacts between the navigator and the patient, categorized as direct contact (phone vs. in person) and indirect contact (initiated by the navigator vs. patient). Success of the intervention was conceptualized as 'none,' 'partial,' or 'optimal' for each patient, based on the number of social needs the resource connections addressed. METHODS: Administrative data were extracted for 38,404 unique patients who screened positive for unmet resource needs between 2012 and 2017. Owing to the large sample size, statistical corrections were made to reduce type I error. RESULTS: Multinomial logistic regression analyses showed that higher intervention dosage was related to greater success of resource connections, after adjusting for the patient and site characteristics, and the number of needs (odds ratios ranged from 1.62 to 2.89). In-person contact, although received by only 25% of the patients, was associated with the highest probability of optimal success. CONCLUSIONS: This study demonstrates a feasible way to conceptualize an intervention dose for a social needs intervention that uses a case management approach and has implications for how intervention delivery may improve success of resource connections.


Assuntos
Administração de Caso/estatística & dados numéricos , Recursos em Saúde/estatística & dados numéricos , Apoio Social , Adulto , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Telefone , Estados Unidos , Populações Vulneráveis
20.
Pediatrics ; 146(1)2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32591437

RESUMO

Clinicians in the United States today regularly face dilemmas about health disparities. Many patients and families cannot afford the medical care that doctors recommend. These problems are most stark when the medical care that is needed is lifesaving and expensive and involves scarce resources. Transplants are the best example of this. The most ethically disturbing situations occur when an undocumented immigrant child needs a transplant. We present such a case and analyze the ethical, legal, and policy issues that arise.


Assuntos
Emigrantes e Imigrantes , Recursos em Saúde/estatística & dados numéricos , Transplante de Rim/métodos , Síndrome Nefrótica/cirurgia , Transplantados , Imigrantes Indocumentados , Pré-Escolar , Humanos , Masculino , Síndrome Nefrótica/etnologia , Estados Unidos/epidemiologia
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