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1.
J Ment Health Policy Econ ; 23(3): 101-109, 2020 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-32853159

RESUMO

BACKGROUND: Since June 2017, the Primary Health Care Integrated Geriatric Services Initiative (PHC IGSI) has been implemented in Alberta, Canada to, among other aims, reduce costs of unplanned health service utilization while maximizing the utilization of available community resources to support people living with dementia living in communities. AIM OF THE STUDY: We performed an economic evaluation of this initiative to inform policy regarding sustainability, scale up and spread. METHODS: We used a cohort design together with a difference-in-difference approach and a propensity score matching technique to calculate impacts of the intervention on patient's health service utilization, including inpatient, outpatient and physician services, as well as prescription drugs. We then used a decision tree to compare between benefits and costs of the intervention and reported net benefits (NB) and return on investment ratios (ROI). We used a health system perspective and a time horizon of 1 year. Both deterministic and probabilistic sensitivity analyses were performed for the uncertainty of parameters. We analyzed real-world data extracted from the Alberta Health Administrative Databases. All costs/savings were inflated to 2019 CAD (CAD 1 \sim = USD 0.75) using the Canadian Consumer Price Index. RESULTS: The intervention reduced the use of hospital (inpatient, emergency, and outpatient) services by increasing the use of community services (physician and prescription drug). As hospital services are expensive, the PHC IGSI community intervention resulted in a NB from CAD 554 to 4,046 per patient-year for the health system, and a ROI from 1.3 to 3.1 meaning that every CAD invested in PHC IGSI would bring CAD 1.3 to 3.1 in return. The probability of PHC IGSI to be cost-saving was 56.4% to 69.3%. IMPLICATIONS FOR HEALTH CARE PROVISION AND USE: The PHC IGSI is cost-effective in Alberta. IMPLICATIONS FOR HEALTH POLICY: The savings would be larger if the initiative is sustained, scaled up and spread because of not only a reduced cost of intervention in the sustainability phase, but also because of the increased number of patients that would be impacted. IMPLICATIONS FOR FURTHER RESEARCH: Future studies taking a societal perspective to also include costs for families and health and social sectors at the community level, would be desirable. Additionally, future works to determine how wellbeing is impacted by the PHC IGSI as vertical and horizontal integration interventions are implemented at the community level, are essential to undertake. Finally, in addition to people living with dementia, the PHC IGSI also supports people living in the community with frailty and other geriatric syndromes, therefore, the cost-savings estimated in this study are likely underestimated.


Assuntos
Prestação Integrada de Cuidados de Saúde/economia , Serviços de Saúde para Idosos/economia , Atenção Primária à Saúde/economia , Idoso , Alberta , Redução de Custos , Análise Custo-Benefício , Serviços de Saúde , Humanos
3.
J Am Acad Orthop Surg ; 28(15): e642-e650, 2020 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-32732655

RESUMO

Trigger finger (TF) is one of the most common causes of hand disability. Immobilization of TF with a joint-blocking orthosis has been demonstrated to effectively relieve pain and improve function. The efficacy of steroid injections for TF varies based on the number of affected digits and the clinical severity of the condition. Up to three repeat steroid injections are effective in most patients. When conservative interventions are unsuccessful, open surgical release of the A1 pulley effectively alleviates the subjective and objective manifestations of TF and currently remains the benchmark procedure for addressing TF. Although several studies have emerged suggesting that a percutaneous approach may result in improved outcomes, this technique demands a learning curve that may predispose patients to higher risk of procedure-related complications. There is no role for preoperative antibiotics in patients who undergo elective soft-tissue procedures of the hand. WALANT anesthesia has gained popularity because it has been associated with improved patient outcomes and a clear cost savings; however, proper patient selection is critical. Similar to other soft-tissue hand procedures, TF surgery rarely necessitates a postoperative opioid prescription.


Assuntos
Procedimentos Ortopédicos/métodos , Dedo em Gatilho/cirurgia , Corticosteroides/administração & dosagem , Adulto , Anestesia Local/economia , Anestesia Local/métodos , Anti-Inflamatórios não Esteroides/uso terapêutico , Tratamento Conservador , Redução de Custos , Mãos/cirurgia , Humanos , Imobilização/métodos , Injeções Intralesionais , Curva de Aprendizado , Procedimentos Ortopédicos/economia , Procedimentos Ortopédicos/educação , Dedo em Gatilho/diagnóstico , Dedo em Gatilho/terapia
4.
Ann R Coll Surg Engl ; 102(8): 611-615, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32735121

RESUMO

INTRODUCTION: Laparoscopic anti-reflux surgery is the standard surgical treatment for gastro-oesophageal reflux disease in patients for who long-term pharmacotherapy is intolerable or ineffective. Advances in anaesthesia and minimally invasive surgery have led to day case treatment being adopted by some centres. The objective of this study is to describe our day case pathway and peri- and postoperative outcomes. MATERIALS AND METHODS: This is a single centre, retrospective case series review of a prospectively collected database from October 2014 to August 2019 performed in a tertiary centre for upper gastrointestinal surgery. Data collected included demographics, comorbidities, indications, complications, length of stay and readmission. RESULTS: A total of 362 patients underwent laparoscopic anti-reflux surgery with or without hiatus hernia repair of up to 10cm, with day case rates of 59%. Unplanned admission following day surgery was 5.1% (13/225) and 30-day readmission was 2.2% (8/362); 90.6% of patients remained in hospital for less than 24 hours. There was one intraoperative complication and one patient required revisional surgery within 30 days. The rate of all postoperative complications was 1.38% (5/362) with one postoperative mortality. DISCUSSION: The inclusion of larger hernias is unusual, as most studies limit size to 5cm or less. Our results show the safety and feasibility of the procedure even when applied to hiatus hernias up to 10cm. Success was multifactorial and based on standardisation of procedures and support from dedicated specialist nursing staff. CONCLUSION: Laparoscopic anti-reflux surgery can be performed safely as a day case procedure even in larger hiatus hernias, with a dedicated care pathway and specialist nurse practitioners to support it.


Assuntos
Hérnia Hiatal/epidemiologia , Hérnia Hiatal/cirurgia , Herniorrafia , Adulto , Idoso , Idoso de 80 Anos ou mais , Redução de Custos/estatística & dados numéricos , Refluxo Gastroesofágico/etiologia , Hérnia Hiatal/complicações , Herniorrafia/efeitos adversos , Herniorrafia/economia , Herniorrafia/métodos , Herniorrafia/estatística & dados numéricos , Humanos , Pessoa de Meia-Idade , Readmissão do Paciente/estatística & dados numéricos , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Resultado do Tratamento , Reino Unido , Adulto Jovem
5.
Value Health ; 23(8): 994-1002, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32828227

RESUMO

OBJECTIVES: To evaluate the outbreak size and hospital cost effects of bacterial whole-genome sequencing availability in managing a large-scale hospital outbreak. METHODS: We built a hybrid discrete event/agent-based simulation model to replicate a serious bacterial outbreak of resistant Escherichia coli in a large metropolitan public hospital during 2017. We tested the 3 strategies of using whole-genome sequencing early, late (actual outbreak), or not using it and assessed their associated outbreak size and hospital cost. The model included ward dynamics, pathogen transmission, and associated hospital costs during a 5-month outbreak. Model parameters were determined using data from the Queensland Hospital Admitted Patient Data Collection (N = 4809 patient admissions) and local clinical knowledge. Sensitivity analyses were performed to address model and parameter uncertainty. RESULTS: An estimated 197 patients were colonized during the outbreak, with 75 patients detected. The total outbreak cost was A$460 137 (US$317 117), with 6.1% spent on sequencing. Without sequencing, the outbreak was estimated to result in 352 colonized patients, costing A$766 921 (US$528 547). With earlier detection from use of routine sequencing, the estimated outbreak size was 3 patients and cost A$65 374 (US$45 054). CONCLUSIONS: Using whole-genome sequencing in hospital outbreak management was associated with smaller outbreaks and cost savings, with sequencing costs as a small fraction of total hospital costs, supporting the further investigation of the use of routine whole-genome sequencing in hospitals.


Assuntos
Escherichia coli/genética , Administração Hospitalar/economia , Sequenciamento Completo do Genoma/economia , Redução de Custos , Infecção Hospitalar/microbiologia , Infecção Hospitalar/prevenção & controle , Surtos de Doenças , Hospitais com mais de 500 Leitos , Custos Hospitalares , Humanos , Queensland , Centros de Atenção Terciária
6.
Contemp Clin Trials ; 96: 106106, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32781230

RESUMO

BACKGROUND: The Covid-19 pandemic has caused fear and panic worldwide, forcing healthcare systems to disregard conventional practices and adopt innovation to contain the infection and death. Globally, there has been a rapid proliferation of research studies and clinical trials assessing risks, infectivity and treatment. METHODS: This review assesses the opportunities and challenges in the Middle East North Africa (MENA) region to engage in the conduct of high quality clinical trials during the Covid-19 pandemic. RESULTS: Opportunities are abundant for conducting clinical trials in MENA countries, including substantial cost savings, academic health centers, integrated health information systems, international accreditation, and international collaborations. Yet, the MENA region has missed out on opportunities to advance patient research during prior infectious disease outbreaks caused by the Severe Acute Respiratory Syndrome, Ebola, and the Middle East Respiratory Syndrome, as evidenced by the lack of concerted research and clinical trials from the region. A large vulnerable population, especially the poor expatriate work force, the current isolation of the health centers, and the lack of an expert network or field trained task force, all contribute to challenges preventing the formation of a pan Arab research enterprise for epidemics. CONCLUSION: Quality clinical research is critical during public health emergencies to identify treatments and solutions. The efficient conduct of clinical trials requires innovative strategies in research design, approval, and dissemination. Many countries in the MENA region have an opportunity to quickly ramp up research capacity and contribute significantly to the fight against the Covid-19 global threat.


Assuntos
Pesquisa Biomédica , Ensaios Clínicos como Assunto , Infecções por Coronavirus , Pandemias , Pneumonia Viral , Centros Médicos Acadêmicos , África do Norte , Betacoronavirus , Redução de Custos , Doença pelo Vírus Ebola , Humanos , Consentimento Livre e Esclarecido , Cooperação Internacional , Oriente Médio , Pesquisadores , Síndrome Respiratória Aguda Grave , Populações Vulneráveis
7.
PLoS One ; 15(7): e0235040, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32628684

RESUMO

The objective of this analysis was to evaluate and report on the economic impact of implementing an integrated, quality, and operational improvement program on chronic obstructive pulmonary disease (COPD) care from acute through post-acute care settings. This initiative was established in a cohort of 12 hospitals in Alabama and sought to address COPD readmission through improved workflows pertaining to early diagnosis, efficient care transitions, and patient visibility across the entire care episode. Implementation of the initiative was influenced by lean principles, particularly cross-functional agreement of workflows to improve COPD care delivery and outcomes. A budget impact model was developed to calculate cost savings directly from objective data collected during this initiative. The model estimated payer annual savings over 5 years. Patients were classified for analysis based on whether or not they received noninvasive ventilation. Scenario analyses calculated savings for payers covering different COPD cohort sizes. The base case revealed annual per patient savings of $11,263 for patients treated through the quality improvement program versus traditional care. The model projected cumulative savings of $52 million over a 5-year period. Clinical incorporation of non-invasive ventilation (NIV) resulted in $20,535 annual savings per patient and projected $91 million over 5 years. We conclude that an integrated management program for COPD patients across the care continuum is associated with substantial cost savings and significantly reduced hospital readmissions.


Assuntos
Redução de Custos/estatística & dados numéricos , Análise Custo-Benefício/estatística & dados numéricos , Modelos Econômicos , Doença Pulmonar Obstrutiva Crônica/economia , Melhoria de Qualidade/economia , Doença Aguda , Adulto , Idoso , Idoso de 80 Anos ou mais , Alabama/epidemiologia , Orçamentos/estatística & dados numéricos , Gerenciamento Clínico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ventilação não Invasiva/economia , Readmissão do Paciente/economia , Readmissão do Paciente/estatística & dados numéricos , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Doença Pulmonar Obstrutiva Crônica/terapia
8.
Recenti Prog Med ; 111(7): 404-410, 2020.
Artigo em Italiano | MEDLINE | ID: mdl-32658879

RESUMO

Lockdown and self-isolation are to date the only solution to limit the spread of recent outbreak of coronavirus disease (CoViD-19), highlighting the great advantage of home dialysis in a patient otherwise forced to travel from / to the dialysis center to receive this "life-saving" treatment. Indeed, to prevent spreading of CoViD-19 infection among extremely fragile dialysis patients, as well as among dialysis workers, hemodialysis (HD) centers are adopting specific procedures ("dedicated" dialysis facilities, portable osmosis, etc.) with a great economic and organizational commitment. Peritoneal dialysis (PD) represents a type of home dialysis therapy not yet adequately implemented to date, in spite of safe and simple practice, as well as similar dialytic efficiency vs in-center hemodialysis. Remote patient monitoring (RPM) systems have been developed in automated PD (APD) cyclers in order to improve the acceptance of this dialysis method, to increase the compliance to the prescribed therapy and to control treatment adequacy. In this review we assess the potential advantages of RPM in APD, that are the chance for patients to acquire greater independence and safety in the home treatment, to allow better access to care for residents in remote areas, faster resolution of problems, reduction in hospitalizations and mortality rates, as well as time and cost saving for both the patient and the staff. The use of medical devices (sphygmomanometer, glucometer, balance, etc.), connected by wireless to the clinician's portal, might also allow a wider diffusion of incremental dialysis, an integrated therapy that combines conservative management of ESKD patients with a soft dialysis based on the residual kidney function and symptomatology, with potential prognosis and economic benefits. Although the majority of the studies are small and observational, a wider use of RPM systems is desirable to broaden the spread of home dialysis, as we learnt from Coronavirus pandemic.


Assuntos
Betacoronavirus , Infecções por Coronavirus , Hemodiálise no Domicílio , Monitorização Fisiológica/métodos , Pandemias , Pneumonia Viral , Automação , Infecções por Coronavirus/prevenção & controle , Redução de Custos , Suscetibilidade a Doenças , Acesso aos Serviços de Saúde , Hemodiálise no Domicílio/economia , Hemodiálise no Domicílio/métodos , Humanos , Falência Renal Crônica/psicologia , Falência Renal Crônica/terapia , Monitorização Fisiológica/instrumentação , Pandemias/prevenção & controle , Cooperação do Paciente , Diálise Peritoneal/instrumentação , Diálise Peritoneal/métodos , Pneumonia Viral/prevenção & controle , Medicina de Precisão , Isolamento Social , Telemedicina
11.
Yakugaku Zasshi ; 140(7): 937-941, 2020.
Artigo em Japonês | MEDLINE | ID: mdl-32612059

RESUMO

Studies on the drug saxagliptin (marketed in Japan since 2013) suggest favorable efficacy in hemodialysis patients, but included small sample sizes. Noting that some hemodialysis patients at our medical institution had been switched to saxagliptin 2.5 mg from treatment with other dipeptidyl peptidase-4 inhibitors, we decided to evaluate the effects of switching to saxagliptin on blood glucose control in these patients. The study included 11 patients. Before switching drugs, six of the patients used teneligliptin 20 mg and five used linagliptin 5 mg. Mean glycated albumin (GA) from before to 4 months after switching tended to increase in the previous users of teneligliptin 20 mg (18.4±3.0% to 19.5±2.7%) and tended to decrease in the previous users of linagliptin 5 mg (18.8±3.3% to 17.7±1.4%). Lack of a substantial change in GA when the previous users of teneligliptin 20 mg and linagliptin 5 mg were switched to saxagliptin 2.5 mg indicates that these three agents might have comparable antihyperglycemic profiles when used in patients on hemodialysis. Future research following from this pilot study must evaluate the risk of cardiac failure and incidences of adverse events in a larger population, to investigate the long-term efficacy and safety of switching to saxagliptin.


Assuntos
Adamantano/análogos & derivados , Glicemia/metabolismo , Diabetes Mellitus/tratamento farmacológico , Dipeptídeos/administração & dosagem , Substituição de Medicamentos , Diálise Renal , Adamantano/administração & dosagem , Adamantano/efeitos adversos , Adamantano/economia , Idoso , Idoso de 80 Anos ou mais , Redução de Custos , Diabetes Mellitus/sangue , Dipeptídeos/efeitos adversos , Dipeptídeos/economia , Feminino , Humanos , Linagliptina , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Pirazóis , Albumina Sérica/metabolismo , Tiazolidinas
12.
Lancet Gastroenterol Hepatol ; 5(10): 927-939, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32730786

RESUMO

WHO has set global targets for the elimination of hepatitis B and hepatitis C as a public health threat by 2030. However, investment in elimination programmes remains low. To help drive political commitment and catalyse domestic and international financing, we have developed a global investment framework for the elimination of hepatitis B and hepatitis C. The global investment framework presented in this Health Policy paper outlines national and international activities that will enable reductions in hepatitis C incidence and mortality, and identifies potential sources of funding and tools to help countries build the economic case for investing in national elimination activities. The goal of this framework is to provide a way for countries, particularly those with minimal resources, to gain the substantial economic benefit and cost savings that come from investing in hepatitis C elimination.


Assuntos
Erradicação de Doenças/métodos , Saúde Global/economia , Hepatite B/prevenção & controle , Hepatite C/prevenção & controle , Redução de Custos/economia , Erradicação de Doenças/economia , Feminino , Saúde Global/normas , Política de Saúde/economia , Política de Saúde/legislação & jurisprudência , Hepatite B/epidemiologia , Hepatite C/epidemiologia , Humanos , Incidência , Lactente , Recém-Nascido , Período Periparto , Gravidez , Saúde Pública/economia , Saúde Pública/normas , Vacinação/normas , Organização Mundial da Saúde/organização & administração
14.
J Environ Manage ; 271: 110975, 2020 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-32579527

RESUMO

China has launched pilot carbon emissions permit trading schemes (ETS) in seven regions since 2013/2014 and has established a nationwide ETS in the power industry by the end of 2017. Recent literature has evaluated China's seven pilot regions on design aspects of the ETS, and yet little is known about the potential recovery of economic output loss through introducing the ETS. This study considers the recovery of industrial value added loss and thus measures the abatement cost savings from trading to evaluate the necessity and feasibility of China's pilot ETSs. The analysis develops a parametric and nonparametric combined technique to calculate the opportunity abatement cost savings (i.e., potential abatement cost savings and unrealized abatement cost savings) and marginal abatement cost savings (i.e., changes on carbon shadow prices) in China's pilot ETSs during 2011-2015. It additionally provides an estimation of potential carbon emissions reduction from ETS. Both cross-industrial trading and intertemporal trading are considered, and three simulations, defined as no trading, cross-industrial trading, and cross-industrial and intertemporal trading, are conducted. We found that, i) 1-16% potential abatement cost savings and 2-12% unrealized abatement cost savings would be identified in China's pilot ETS regions. ii) 0.5-33% and 1.6-25% carbon emissions reduction potential would be realized respectively by introducing ETS and eliminating the operational inefficiency of the ETS. iii) Marginal abatement cost savings would both exist in almost all regions if the ETS were implemented and if the ETS were fully operational.


Assuntos
Carbono/análise , Gases de Efeito Estufa , China , Redução de Custos , Indústrias
15.
Value Health ; 23(6): 812-823, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32540239

RESUMO

OBJECTIVES: Implementation of value-based initiatives depends on cost-assessment methods that can provide high-quality cost information. Time-driven activity-based costing (TDABC) is increasingly being used to solve the cost-information gap. This study aimed to review the use of the TDABC methodology in real-world settings and to estimate its impact on the value-based healthcare concept for inpatient management. METHODS: This systematic review was conducted by screening PubMed/MEDLINE and Scopus databases following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, including all studies up to August 2019. The use of TDABC for inpatient management was the main eligibility criterion. A qualitative approach was used to analyze the different methodological aspects of TDABC and its effective contribution to the implementation of value-based initiatives. RESULTS: A total of 1066 studies were retrieved, and 26 full-text articles were selected for review. Only studies focused on surgical inpatient conditions were identified. Most of the studies reported the types of activities on a macrolevel. Professional and structural cost variables were usually assessed. Eighteen studies reported that TDABC contributed to value-based initiatives, especially cost-saving findings. TDABC was satisfactorily applied to achieve value-based contributions in all the studies that used the method for this purpose. CONCLUSIONS: TDABC could be a strategy for increasing cost accuracy in real-world settings, and the method could help in the transition from fee-for-service to value-based systems. The results could provide a clearer idea of the costs, help with resource allocation and waste reduction, and might support clinicians and managers in increasing value in a more accurate and transparent way.


Assuntos
Custos e Análise de Custo/métodos , Assistência à Saúde/economia , Custos de Cuidados de Saúde , Redução de Custos , Planos de Pagamento por Serviço Prestado/economia , Humanos , Pacientes Internados , Alocação de Recursos/economia , Fatores de Tempo
17.
South Med J ; 113(6): 320-324, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32483643

RESUMO

OBJECTIVE: To evaluate pharmacist involvement in the inpatient transition of care (TOC) process for patients hospitalized with type 1 diabetes mellitus, type 2 diabetes mellitus, or chronic obstructive pulmonary disease. METHODS: A pharmacist screened patients admitted with one or more of the qualifying conditions within 48 hours of admission to perform medication reconciliation. During medication reconciliation, the pharmacist removed any duplicate or nonindicated medications and added any omitted medications. The pharmacist also reviewed the discharge summary to ensure medication optimization upon discharge. RESULTS: Pharmacist involvement in the admission and discharge reconciliation processes of the 50 identified patients was 100% and 44%, respectively. A medication-related problem was identified in 96% (n = 48) of patients, representing 338 pharmacist-mediated interventions with an average of 6.8 ± 4.0 (range 0-16) interventions per patient. Of those 338 interventions, 298 drug discrepancies were identified and corrected, with an average of 6.0 ± 3.7 (range 0-15) discrepancies per patient. Average time spent was 66 ± 22 (range 30-130) minutes with each patient. Of the 50 patients enrolled, 12 were readmitted within 30 days. CONCLUSIONS: This pilot study demonstrated an improved medication reconciliation process with pharmacist involvement, expanding the body of evidence that pharmacists can enhance TOC management in an inpatient setting. These results highlight the utility of a pharmacist in the implementation and refinement of TOC services and provides impetus for a team-based approach when patients experience a TOC.


Assuntos
Diabetes Mellitus Tipo 1/tratamento farmacológico , Diabetes Mellitus Tipo 2/tratamento farmacológico , Hospitalização , Reconciliação de Medicamentos , Transferência de Pacientes , Serviço de Farmácia Hospitalar , Doença Pulmonar Obstrutiva Crônica/tratamento farmacológico , Adulto , Idoso , Idoso de 80 Anos ou mais , Redução de Custos , Registros Eletrônicos de Saúde , Feminino , Humanos , Ciência da Implementação , Masculino , Pessoa de Meia-Idade , Alta do Paciente , Readmissão do Paciente , Farmacêuticos , Projetos Piloto , Papel Profissional , Adulto Jovem
18.
J Surg Educ ; 77(5): 999-1004, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32507697

RESUMO

OBJECTIVE: To evaluate the effect of COVID-19 on the costs of the surgical fellowship interview process. DESIGN: A literature review of the historical costs of surgical fellowship interviews and a summary of how the shift to virtual interviews has unintended positive and negative effects on costs for applicants and training programs. RESULTS: Transitioning fellowship interviews to virtual platforms affects expenditures of finances and time. Each fellowship candidate saves close to $6,000 in interview travel expenses. Applicants require less time off from their residency programs during this critical time of need for frontline healthcare workers. However, applicants miss some of the live aspects of interviewing, and training programs invest more effort upfront altering their interviews to virtual formats. CONCLUSIONS: The COVID-19 public health crisis has had a significant impact on surgical education, including how selection is conducted. Virtual recruitment has the potential for cost savings but should continue to be refined. This is an opportune time to innovate and rethink how to recruit prospective surgical residency and fellowship candidates during the current and forthcoming interview seasons.


Assuntos
Infecções por Coronavirus/epidemiologia , Redução de Custos , Educação de Pós-Graduação em Medicina/métodos , Bolsas de Estudo/economia , Cirurgia Geral/educação , Entrevistas como Assunto/métodos , Pneumonia Viral/epidemiologia , Adulto , Análise Custo-Benefício , Feminino , Humanos , Internato e Residência/organização & administração , Masculino , Pandemias , Telecomunicações/economia , Estados Unidos
19.
Pediatrics ; 145(6)2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32366609

RESUMO

BACKGROUND: Improvement initiatives promote safe and efficient care for hospitalized children. However, these may be associated with limited cost savings. In this article, we sought to understand the potential financial benefit yielded by improvement initiatives by describing the inpatient allocation of costs for common pediatric diagnoses. METHODS: This study is a retrospective cross-sectional analysis of pediatric patients aged 0 to 21 years from 48 children's hospitals included in the Pediatric Health Information System database from January 1, 2017, to December 31, 2017. We included hospitalizations for 8 common inpatient pediatric diagnoses (seizure, bronchiolitis, asthma, pneumonia, acute gastroenteritis, upper respiratory tract infection, other gastrointestinal diagnoses, and skin and soft tissue infection) and categorized the distribution of hospitalization costs (room, clinical, laboratory, imaging, pharmacy, supplies, and other). We summarized our findings with mean percentages and percent of total costs and used mixed-effects models to account for disease severity and to describe hospital-level variation. RESULTS: For 195 436 hospitalizations, room costs accounted for 52.5% to 70.3% of total hospitalization costs. We observed wide hospital-level variation in nonroom costs for the same diagnoses (25%-81% for seizure, 12%-51% for bronchiolitis, 19%-63% for asthma, 19%-62% for pneumonia, 21%-78% for acute gastroenteritis, 21%-63% for upper respiratory tract infection, 28%-69% for other gastrointestinal diagnoses, and 21%-71% for skin and soft tissue infection). However, to achieve a cost reduction equal to 10% of room costs, large, often unattainable reductions (>100%) in nonroom cost categories are needed. CONCLUSIONS: Inconsistencies in nonroom costs for similar diagnoses suggest hospital-level treatment variation and improvement opportunities. However, individual improvement initiatives may not result in significant cost savings without specifically addressing room costs.


Assuntos
Redução de Custos/economia , Preços Hospitalares , Hospitalização/economia , Hospitais Pediátricos/economia , Quartos de Pacientes/economia , Controle de Qualidade , Adolescente , Criança , Criança Hospitalizada , Pré-Escolar , Estudos de Coortes , Redução de Custos/tendências , Estudos Transversais , Feminino , Preços Hospitalares/tendências , Hospitalização/tendências , Hospitais Pediátricos/tendências , Humanos , Lactente , Recém-Nascido , Masculino , Quartos de Pacientes/tendências , Estudos Retrospectivos , Adulto Jovem
20.
N Z Med J ; 133(1514): 16-32, 2020 05 08.
Artigo em Inglês | MEDLINE | ID: mdl-32379736

RESUMO

AIMS: To evaluate the clinical and cost impacts of the All New Zealand Acute Coronary Syndrome Quality Improvement programme (ANZACS-QI) specifically for Maori with acute coronary syndrome (ACS). METHODS: Decision analytic Markov models were used to estimate the effectiveness and costs of the ANZACS-QI programme over four years of full coverage (2013 to 2016), against a hypothetical scenario in which the registry did not exist. The estimated return on investment (ROI) and incremental cost-effectiveness ratios (ICERs) are reported. RESULTS: The ROI ratio for the ANZACS-QI programme for Maori over the four-year period of full coverage was 1.51; that is, every dollar spent on the programme resulted in a return of NZD $1.51. The estimated ICER was NZD $114,786 per year of life saved (YoLS) over a one-year time horizon, but extending the benefits accrued to five years reduced the ICER to NZD $20,173 per YoLS. CONCLUSIONS: The ANZACS-QI programme represents a sound investment for improving outcomes in the setting of ACS for Maori in New Zealand. Using highly conservative assumptions, the programme would be cost-saving based on an annual ROI ratio of 1.5.


Assuntos
Síndrome Coronariana Aguda/economia , Custos de Cuidados de Saúde/estatística & dados numéricos , Grupo com Ancestrais Oceânicos/estatística & dados numéricos , Melhoria de Qualidade , Sistema de Registros , Síndrome Coronariana Aguda/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Redução de Custos , Análise Custo-Benefício , Feminino , Humanos , Expectativa de Vida , Masculino , Pessoa de Meia-Idade , Nova Zelândia , Avaliação de Programas e Projetos de Saúde , Melhoria de Qualidade/economia , Resultado do Tratamento
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