scholarly journals Do discontinuities in marginal reimbursement affect inpatient psychiatric care in Germany?

2020 ◽  
Author(s):  
Clara Pott ◽  
Tom Stargardt ◽  
Udo Schneider ◽  
Simon Frey
Keyword(s):  
Length Of Stay ◽  
Health Care Providers ◽  
Psychiatric Hospitals ◽  
Care Providers ◽  
Duration Of Treatment ◽  
Inpatient Psychiatric Care ◽  
Logistic Regression Models ◽  
Payment Incentives ◽  
Tariff Rates ◽  
Discharge Behaviour

Abstract This paper examines the behaviour of mental health care providers in response to marginal payment incentives induced by a discontinuous per diem reimbursement schedule with varying tariff rates over the length of stay. The analyses use administrative data on 12,627 cases treated in 82 psychiatric hospitals and wards in Germany. We investigate whether substantial reductions in marginal reimbursement per inpatient day led to strategic discharge behaviour once a certain length of stay threshold is exceeded. The data do not show gaps and bunches at the duration of treatment when marginal reimbursement decreases. Using logistic regression models, we find that providers did not react to discontinuities in marginal reimbursement by significantly reducing inpatient length of stay around the threshold. These findings are robust in terms of different model specifications and subsamples. The results indicate that if regulators aim to set incentives to decrease LOS, this might not be achieved by cuts in reimbursement over LOS.

Association between religious beliefs and discussions regarding advance care planning: A nationwide survey

2021 ◽  
pp. 026921632110295
Author(s):  
Jun Miyashita ◽  
Sayaka Shimizu ◽  
Shunichi Fukuhara ◽  
Yosuke Yamamoto
Keyword(s):  
Health Care Providers ◽  
Advance Care Planning ◽  
Religious Beliefs ◽  
Nationwide Survey ◽  
Care Planning ◽  
Care Providers ◽  
Logistic Regression Models ◽  
Japanese Buddhism ◽  
Advance Care ◽  
Quota Sampling

Background: The relationship between advance care planning and religious beliefs, which are important for palliative care, is controversial in Western countries and has not been verified in Asian countries. Aim: To investigate the association between advance care planning discussions and religious beliefs in Japan. Design: A nationwide survey conducted in 2016 using a quota sampling method to obtain a representative sample of Japan’s general population. Setting/participants: We analyzed responses from 3167 adults aged 20–84 years (mean age ± standard deviation, 50.9 ± 16.8 years). The outcome was measured by asking whether the respondents had ever discussed advance care planning, and the main exposure by whether they had any religious beliefs or affiliations, and if so, their degree of devoutness. We analyzed religious beliefs, affiliations, and devoutness in relation to the occurrence of discussions using multivariable logistic regression models adjusted for possible sociodemographic covariates. Results: Compared with respondents without, those with religious beliefs had significantly higher odds of having had discussions (adjusted odds ratio: 1.45, 95% confidence interval: 1.22–1.73). The devoutness of religious belief was proportional to the propensity of the occurrence of discussions ( p for trend < 0.001). In addition, Buddhists and Christians had higher odds of having had discussions than did nonbelievers. Conclusion: The results suggest that holding religious beliefs, especially in Japanese Buddhism and Christianity, facilitates advance care planning discussions among Japanese adults, and thus, may help health-care providers identify those prioritized for facilitating engagement in advance care planning, especially in palliative and spiritual care settings.

scholarly journals Opioid Tolerance – A Predictor of Increased Length of Stay and Higher Readmission Rates

2014 ◽  
Vol 4;17 (4;7) ◽  
pp. E503-E507 ◽  
Author(s):  
Padma Gulur
Keyword(s):  
Health Care ◽  
Length Of Stay ◽  
Health Care Providers ◽  
Massachusetts General Hospital ◽  
The United States ◽  
Opioid Tolerance ◽  
Control Group ◽  
Care Providers ◽  
Readmission Rates ◽  
Expected Length

The increasing use of opioids to manage pain in the United States over the last decade has resulted in a subset of our population developing opioid tolerance. While the management of opioid tolerant patients during acute episodes of care is well known to be a challenge amongst health care providers, there is little in the literature that has studied opioid tolerance as a predictor of outcomes. We conducted a review on all admissions to Massachusetts General Hospital over a period of 6 months, from January 2013 to June 2013, and identified opioid tolerant patients at admission using the FDA definition of opioid tolerance. To compare risk adjusted groups, we placed opioid tolerant patients and control patients into groups determined by expected length of stay of less than 2 days, 2 to 5 days, 5 to 10 days, and greater than 10 days. Opioid tolerant patients were then compared to the control for outcomes measures including observed length of stay and readmission rates. Our results show that all opioid tolerant patients have a significantly longer length of stay and a greater 30 day all cause readmission rate than the control group (P < 0.01). This trend was found in the first 3 risk adjusted groups, but not in the fourth group where expected length of stay was greater than 10 days. The opioid tolerant population is at risk given the poorer outcomes and higher health care costs associated with their care. It is imperative that we identify opportunities for improvement and delineate specific pathways for the care of these patients. Key words: Opioid tolerance, opioid tolerant patient population, opioid tolerant patients, readmission rates, length of stay

The Effect of Diagnosis-Related Groups on the Shift of Medical Services From Inpatient to Outpatient Settings: A National Claims-Based Analysis

2019 ◽  
Vol 31 (6) ◽  
pp. 499-509
Author(s):  
Changwoo Lee ◽  
Ji Man Kim ◽  
Ye-Soon Kim ◽  
Euichul Shin
Keyword(s):  
Length Of Stay ◽  
Hospital Discharge ◽  
Health Care Providers ◽  
Outpatient Visit ◽  
Diagnosis Related Groups ◽  
Medical Services ◽  
Care Providers ◽  
Economic Interests ◽  
Medical Institutions ◽  
Outpatient Settings

The purpose of this study was to determine whether the introduction of diagnosis-related groups (DRGs) shifted the medical services from inpatient to outpatient settings. Using a difference-in-difference analysis, the changes in length of stay, outpatient visit days within 30 days before hospitalization, and outpatient visit days within 30 days after hospital discharge were evaluated. The length of stay was reduced after the DRG policy, consistent with previous studies. Outpatient visit days within 30 days before a hospital admission increased significantly after the policy change. In addition, outpatient visit days within 30 days after a hospital discharge increased in all the medical institutions excluding hospitals. The study findings are consistent with the expectation that providers respond to changes in the payment system to protect or enhance their economic interests. Health care providers in Korea responded to the DRG policy by reducing the intensity of inpatient treatment and transferring costs to outpatient settings.

scholarly journals The challenge of improving evidence-based therapy adherence in the secondary prevention of coronary artery disease: the next frontier of cardiac rehabilitation

2016 ◽  
Vol 72 (2) ◽  
Author(s):  
Sabino Scardi ◽  
Carmine Mazzone ◽  
Paolo Umari
Keyword(s):  
Health Care Providers ◽  
Drug Regimen ◽  
Medical Problem ◽  
Care Providers ◽  
Duration Of Treatment ◽  
Improve Medication Adherence ◽  
Factors Affecting ◽  
Physician Compliance ◽  
Increased Risk ◽  
Artery Disease

Non-adherence to prescribed drug regimens is an increasing medical problem affecting physicians and patients and contribute to negative outcomes, such as the increased risk of subsequent cardiovascular events. Analysis of various patient populations shows that the choice of drug, its tolerability and the duration of treatment influence the non-adherence. Intervention is required toward patients and health-care providers to improve medication adherence. This review deals about the prevalence of non-adherence to therapy after medical and surgical cardiac event, the risk factors affecting non-adherence and the strategies to implement it. Interventions that may successfully improve adherence should include improved physician compliance with guidelines, patient education and patient reminders, frequent visits or telephone calls from staff, simplification of the patient’s drug regimen by reducing the number of pills and daily doses. Since single interventions do not appear efficaceous, it is necessary to establish multiple interventions simultaneously addressing a number of barriers to adherence.

DOZ047.83: Coordination of care through implementation of a multidisciplinary clinic for patients with esophageal atresia and tracheoesophageal fistula

2019 ◽  
Vol 32 (Supplement_1) ◽  
Author(s):  
J Platt ◽  
I Mitchell ◽  
C Bjornson ◽  
J A M Bailey
Keyword(s):  
Health Care ◽  
Length Of Stay ◽  
Esophageal Atresia ◽  
Health Care Providers ◽  
Hospital Admissions ◽  
Study Cohort ◽  
Coordination Of Care ◽  
Care Providers ◽  
Coordinated Care ◽  
Multidisciplinary Clinic

Abstract Introduction Esophageal atresia/tracheoesophageal atresia (EA/TEF) is a multisystem congenital anomaly. Initial treatment is complex and ongoing complications are numerous. Coordination of care has been shown to reduce costs and hospitalizations in complex populations. A previous study at our center demonstrated that children with EA/TEF lacked coordinated care. A multidisciplinary clinic was established to provide coordinated care, screen for complications, provide anticipatory guidance, and improve outpatient access. Methods This single-center retrospective cohort study included children with EA/TEF born between March 2005 and March 2011 and enrolled in the clinic. Patients with EA alone were excluded. A chart review was completed to identify demographics, hospitalizations, emergency visits, clinic visits, coordination of outpatient care, and adherence to the intended clinic schedule. Results Twenty-five patients were included; 84% had a C-type EA/TEF. Multidisciplinary clinics had an average of 4.3 health care providers (1.75 physicians) per visit. Adherence to the visit schedule was 91.4%. The average length of stay (46.2 + 37.9 days) for the initial hospital admission was similar to the previous study cohort. Subsequent hospital admissions were reduced in number and length of stay, most notably in the first two years of life (0–1 year: 1.28 + 1.2 admissions/patient; 10.7 + 19.1 days/admission; 1–2 years: 0.6 + 0.76 admissions/patient; 3.7 + 3.2 days/admission). Conclusions Multidisciplinary care clinics for medically complex children such as those with EA/TEF can improve care through coordination of visits with multiple health care providers and may contribute to reduced use of acute care services.

scholarly journals Get Yourself Tested (GYT) Campaign: Investigating Campaign Awareness and Behaviors Among High School and College Students

2018 ◽  
Vol 46 (1) ◽  
pp. 63-71 ◽  
Author(s):  
Heather P. Eastman-Mueller ◽  
Melissa A. Habel ◽  
Sara B. Oswalt ◽  
Nicole Liddon
Keyword(s):  
College Students ◽  
High School ◽  
Sexual Health ◽  
Hiv Testing ◽  
Health Care Providers ◽  
Romantic Partners ◽  
Care Providers ◽  
Chi Square ◽  
Logistic Regression Models ◽  
Std Testing

Adolescents and young adults are disproportionately affected by sexually transmitted diseases (STDs). This study examined the association of GYT: Get Yourself Tested (GYT), a sexual health social marketing campaign, with several sexual health behaviors on a nationally representative sample of high school (HS) and college students ( n = 2,329) recruited through an online panel survey. Behaviors examined were STD testing, HIV testing, and whether students had communication with health care providers and their romantic partners about STDs and STD testing. Rao-Scott chi-square tests and multivariable logistic regression models were conducted. The results indicated college students were more aware of GYT than HS students. Awareness of GYT was significantly associated with STD testing ( p < .05), HIV testing ( p < .01), and talking with romantic partners ( p < .01) for college students but only with STD testing ( p < .05) and talking to a provider ( p < .05) for HS students. The differences between HS and college students provide insight for those developing and implementing interventions across such a broad age range of youth.

scholarly journals A betegbiztonságot támogató szervezeti kultúra változása a hazai akkreditációs programot tesztelő intézményekben

2016 ◽  
Vol 157 (42) ◽  
pp. 1667-1673 ◽  
Author(s):  
Judit Lám ◽  
Gergő Merész ◽  
Gyula Bakacsi ◽  
Éva Belicza ◽  
Cecília Surján ◽  
...  
Keyword(s):  
Patient Safety ◽  
Health Care Providers ◽  
Regression Models ◽  
Organisational Culture ◽  
Three Dimensions ◽  
Care Providers ◽  
Logistic Regression Models ◽  
Accreditation Program ◽  
Validated Questionnaire ◽  
The Impact

Introduction: The accreditation system for health care providers was developed in Hungary aiming to increase safety, efficiency, and efficacy of care and optimise its organisational operation. Aim: The aim of this study was to assess changes of organisational culture in pilot institutes of the accreditation program. Method: 7 volunteer pilot institutes using an internationally validated questionnaire were included. The impact study was performed in 2 rounds: the first before the introduction of the accreditation program, and the second a year later, when the standards were already known. Data were analysed using descriptive statistics and logistic regression models. Results: Statistically significant (p<0.05) positive changes were detected in hospitals in three dimensions: organisational learning – continuous improvement, communication openness, teamwork within the unit while in outpatient clinics: overall perceptions of patient safety, and patient safety within the unit. Conclusions: Organisational culture in the observed institutes needs improvement, but positive changes already point to a safer care. Orv. Hetil., 2016, 157(42), 1667–1673.

scholarly journals Patients’ perspectives on the experience of absconding from a psychiatric hospital: a qualitative study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Mark Mohan Kaggwa ◽  
Anita Acai ◽  
Godfrey Zari Rukundo ◽  
Sheila Harms ◽  
Scholastic Ashaba
Keyword(s):  
Mental Illness ◽  
Health Care Providers ◽  
Psychiatric Hospitals ◽  
Psychiatric Ward ◽  
Care Providers ◽  
Psychiatric Facility ◽  
Mixed Emotions ◽  
History Of ◽  
Basic Services ◽  
Depth Interviews

Abstract Background Absconding (i.e., escaping) is common among patients with mental illness admitted to psychiatric hospitals. Patients use various strategies to make absconding successful due to the experiences faced during admission. We conducted a study to identify patients’ perspectives on the experience of absconding from the psychiatry facility. Methods We conducted 10 in-depth interviews with patients with a history of absconding from the hospital who were accessing care at the Mbarara Regional Referral Hospital in Mbarara city Uganda. Interviews were audio-recorded, translated when required, transcribed into English, and analyzed thematically to identify relevant themes. Results Participants ranged in age from 18 to 55 and the majority (n = 9) were male. Most had absconded at least twice from a psychiatric facility. We identified different experiences that influenced patients’ engagement in absconding from the psychiatry hospital ward. These included: (1) stigma, (2) experiences with caregivers: mixed emotions, (3) poor resources and services, and (4) the influence of mental illness symptoms. The loneliness of stigma, negative emotions associated with the loss of important roles given the nature and framework of caregiving on the psychiatric ward, as well as the stress of limited resources were a salient part of the patient experience as it relates to absconding. Conclusion Our findings indicate that absconding is a symptom of a larger problem with a mental health system that perpetuates stigma in its design, isolates patients and makes them feel lonely, and forces patients to rely on caregivers who infantilize them and take away all their freedom in a facility with no basic services. For many patients, this makes absconding the only option. Within such a system, all stakeholders (policymakers, health-care providers, caregivers, and patients) should be involved in rethinking how psychiatric facilities should be operated to make the journey of patient recovery more positive.

scholarly journals A Study of Factors Affecting on Patients’ Length of Stay in a Surgical Ward: Toward Optimization by Technology-based Solutions

2019 ◽  
Author(s):  
Tayebeh Baniasadi ◽  
Marjan Ghazisaeedi ◽  
Mehdi Hassaniazad ◽  
Sharareh R. Niakan Kalhori ◽  
Mehraban Shahi
Keyword(s):  
Information Technology ◽  
Length Of Stay ◽  
Health Information Technology ◽  
Health Information ◽  
Health Care Providers ◽  
Influential Factors ◽  
Care Providers ◽  
Factors Affecting ◽  
Surgical Ward ◽  
Hospital Resources

Abstract Background: Understanding each of the factors affecting the length of hospitalization especially in surgery wards can play a major role in planning for the optimal use of hospital resources. This study aims to determine factors affecting the length of stay (LOS) in a surgical ward and then provide technology-based solutions .Methods: In this cross-sectional study, 310 records were selected by systematic random sampling from hospitalized patients in surgery ward of a general teaching hospital in Bandar Abbas, situated in sought of Iran. In order to determine the association of 26 variables (demographic, clinical, and non-clinical) with LOS, analytical and descriptive statistics were used. Then, the researchers reviewed relevant literature in PubMed, Scopus, and Google Scholar to introduce solutions based on health information technology (HIT) toward LOS optimization.Results: Mean and median of patients’ LOS in surgery ward were 3.30±3.71 and 2 days respectively. According to multivariate regression model, factors that exerted higher influence on length of stay includes number of para-clinical tests, surgeries, and consultation as well as type of referral and months of admission(p<0.05). Regarding HIT-based intervention, eleven general categories of suggestions were provided. Based on the findings, more accessible technologies such as hospital information system, picture archiving and communication system, telemedicine especially tele-consultation or tele-visit as well as electronic consultation and discharge planning tools alongside smart dashboards for institutions like the center under study in order to expedite the process of diagnosis and treatment, then optimizing LOS seem appropriate. Conclusions: It is important to move toward optimized LOS though understanding and control influential factors; standardize LOS along with continuous monitoring of performance indicators may help to utilize hospital resources more efficiently. HIT-based interventions may support health care providers and administrators to manage patients` admission, hospitalization, transfer, and discharge processes more properly. Keywords: Index; length of Stay; Hospital; Health Information Technology; Surgery_ward

scholarly journals An Exploration and Forecast of COVID-19 in Mexico with Machine Learning

2020 ◽  
Author(s):  
Daniela A. Gomez-Cravioto ◽  
Ramon E. Diaz-Ramos ◽  
Francisco J. Cantu-Ortiz ◽  
Hector G. Ceballos
Keyword(s):  
Machine Learning ◽  
Time Series ◽  
Health Care Providers ◽  
Machine Learning Techniques ◽  
Future Research ◽  
Logistic Growth ◽  
Care Providers ◽  
Modern Approach ◽  
Logistic Regression Models ◽  
Feature Importance

Abstract Background: To understand and approach the COVID-19 spread, Machine Learning offers fundamental tools. This study presents the use of machine learning techniques for the projection of COVID-19 infections and deaths in Mexico. The research has three main objectives: first, to identify which function adjusts the best to the infected population growth in Mexico; second, to determine the feature importance of climate and mobility; third, to compare the results of a traditional time series statistical model with a modern approach in machine learning. The motivation for this work is to support health care providers in their preparation and planning. Methods: The methods used are linear, polynomial, and generalized logistic regression models to evaluate the growth of the COVID-19 incidents in the country. Additionally, machine learning and time-series techniques are used to identify feature importance and perform forecasting for daily cases and fatalities. The study uses the publicly available data sets from the John Hopkins University of Medicine in conjunction with mobility rates obtained from Google’s Mobility Reports and climate variables acquired from Weather Online. Results: The results suggest that the logistic growth model fits best the behavior of the pandemic in Mexico, that there is a significant correlation of climate and mobility variables with the disease numbers, and that LSTM is a more suitable approach for the prediction of daily cases. Conclusion: We hope that this study can make some contributions to the world’s response to this epidemic as well as give some references for future research.

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