Resource Utilization Among Patients With Sepsis Syndrome

2003 ◽  
Vol 24 (1) ◽  
pp. 62-70 ◽  
Author(s):  
David W. Bates ◽  
D. Tony Yu ◽  
Edgar Black ◽  
Kenneth E. Sands ◽  
J. Sanford Schwartz ◽  
...  
Keyword(s):  
Resource Utilization ◽  
Tertiary Care ◽  
Sepsis Syndrome ◽  
Hospital Charges ◽  
Linear Regression Models ◽  
Academic Medical ◽  
The Mean ◽  
Tertiary Care Centers ◽  
Post Onset ◽  
Total Charges

AbstractObjective:To assess the resource utilization associated with sepsis syndrome in academic medical centers.Design:Prospective cohort study.Setting:Eight academic, tertiary-care centers.Patients:Stratified random sample of 1,028 adult admissions with sepsis syndrome and all 248,761 other adult admissions between January 1993 and April 1994. The main outcome measures were length of stay (LOS) in total and after onset of sepsis syndrome (post-onset LOS) and total hospital charges.Results:The mean LOS for patients with sepsis was 27.7 ± 0.9 days (median, 20 days), with sepsis onset occurring after a mean of 8.1 ± 0.4 days (median, 3 days). For all patients without sepsis, the LOS was 7.2 ± 0.03 days (median, 4 days). In multiple linear regression models, the mean for patients with sepsis syndrome was 18.2 days, which was 11.0 days longer than the mean for all other patients (P < .0001), whereas the mean difference in total charges was $43,000 (both P < .0001). These differences were greater for patients with nosocomial as compared with community-acquired sepsis, although the groups were similar after adjusting for pre-onset LOS. Eight independent correlates of increased post-onset LOS and 12 correlates of total charges were identified.Conclusions:These data quantify the resource utilization associated with sepsis syndrome, and demonstrate that resource utilization is high in this group. Additional investigation is required to determine how much of the excess post-onset LOS and charges are attributable to sepsis syndrome rather than the underlying medical conditions.

Healthcare Resource Utilization and Healthcare Costs of COVID-19 Patients in A Tertiary Care Public Hospital: A Retrospective Cohort Study in Thailand

2021 ◽  
Vol 104 (12) ◽  
pp. 1953-1958
Keyword(s):  
Linear Regression ◽  
Resource Utilization ◽  
Healthcare Costs ◽  
Healthcare Resource ◽  
Tertiary Care ◽  
Patient Characteristics ◽  
Healthcare Resource Utilization ◽  
Linear Regression Models ◽  
Personal Protection Equipment ◽  
Objective Health

Objective: Health care costs (HCCs) are a significant concern in developing countries. The authors investigated the healthcare resource utilization (HCRU) and HCCs for patients with COVID-19 based on disease severity and infection site. Materials and Methods: The authors reviewed data from the electronic medical records of COVID-19 patients admitted to the present study hospital between January 2020 and April 2020. The authors used comorbidities and patient characteristics as covariates. Analyses were conducted using simple linear regression and generalized linear regression models with a log-link and gamma distribution. Results: Two hundred two patients had confirmed SARS-CoV-2 infection. Total costs per patient were 6,626 USD (756 to 45,586). Personal protection equipment costs were the most significant cost for COVID-19 patients with a mean of 3,778 USD. The mean treatment cost per patient was 326 USD. Patients with severe symptoms and lower respiratory tract infection (LRI) had a higher cost and resource utilization value before and after adjusting for covariates. Conclusion: COVID-19 patients with severe symptoms and LRI had higher HCRU. Length of stay, severity of symptoms, and LRI were associated with higher cost of treatment. Keywords: SARS-CoV-2; COVID-19; Healthcare resource utilization; Healthcare costs; Thailand

scholarly journals Late diagnosis of pseudohypoparathyroidism in adulthood. Case series

2018 ◽  
Vol 66 (4) ◽  
pp. 643-649
Author(s):  
Maria Camila Trejo ◽  
Alejandro Roman-Gonzalez ◽  
Sebastian Ruiz ◽  
Catalina Tobón ◽  
Pablo Castaño ◽  
...  
Keyword(s):  
Tertiary Care ◽  
Peripheral Resistance ◽  
Case Series ◽  
Hereditary Disease ◽  
Primary Diagnosis ◽  
Inclusion Criteria ◽  
Mean Values ◽  
The Mean ◽  
Tertiary Care Centers ◽  
Adequate Management

Introduction: Pseudohypoparathyroidism (PHP) is a rare hereditary disease, characterized by hypocalcemia/hyperphosphatemia secondary to peripheral resistance to parathyroid hormone (PTH). PHP diagnosis is usually precluded since hypocalcemia is considered as the primary diagnosis, thus delaying further diagnostic studies and preventing an adequate management of this clinical condition.Materials and methods: Retrospective review of the databases of the Endocrinology departments of two tertiary care centers of Medellin, Colombia from January 2012 to December 2016. Patients diagnosed with PHP based on clinical presentation and confirmatory laboratory values were included.Results: Four patients met the inclusion criteria. All PHP cases were diagnosed in adulthood despite strong early clinical and laboratory evidence of the disease. Three patients were diagnosed with Fahr’s syndrome and two with Albright’s hereditary osteodystrophy. The mean values obtained were PTH of 376.8 pg/mL, calcium of 6.17 mg/dL and phosphorus of 6.55 mg/dL.Conclusions: PHP is a rare disorder. This paper describes four PHP cases diagnosed during adulthood. Emphasis should be placed on the judicious approach to the patient with hypocalcemia and hyperphosphatemia with increased PTH and normal renal function, since these symptoms strongly suggest a diagnosis of PHP.

Immediate Unilateral Breast Reconstruction using Abdominally Based Flaps: Analysis of 3,310 Cases

2018 ◽  
Vol 35 (01) ◽  
pp. 074-082 ◽  
Author(s):  
Andrew Simpson ◽  
Xiangyang Ye ◽  
Eric Tatro ◽  
Jayant Agarwal ◽  
Alvin Kwok
Keyword(s):  
Breast Reconstruction ◽  
Hospital Charges ◽  
Vascular Anastomosis ◽  
Lengths Of Stay ◽  
Epigastric Artery ◽  
Nationwide Inpatient Sample Database ◽  
Aesthetic Results ◽  
Siea Flap ◽  
The Mean ◽  
Total Charges

Background The abdomen is the most common area from which tissue is harvested for autologous breast reconstruction. We sought to examine national data to determine the differences in total hospital charges, length of stay (LOS), and early postoperative complications following pedicled transverse rectus abdominis myocutaneous flap (pTRAM), free TRAM (fTRAM), deep-inferior epigastric perforator (DIEP), and superficial inferior epigastric artery perforator (SIEA) flaps. Methods The 2009–2013 Nationwide Inpatient Sample Database was used to identify patients who underwent a unilateral mastectomy and only one type of abdominally based autologous flap (pTRAM, fTRAM, DIEP, and SIEA) during the same hospital admission. Outcomes of interest included total charges, LOS, and complications including revision of vascular anastomosis and hematoma. Results A total of 3,310 cases were identified, corresponding to 15,991 abdominally based unilateral immediate breast reconstructions after standard weighting was applied; 5,079 (31.8%) were pTRAM flaps, 4,461 (27.9%) were fTRAM flaps, 6,206 (38.8%) were DIEP flaps, and 245 (1.5%) were SIEA flaps. The mean total charges for pTRAM, fTRAM, DIEP, and SIEA flaps were $17,765.5, $22,637.6, $25,814.6, and $26,605.2, respectively (p < 0.0001). The mean LOS for pTRAM, fTRAM, DIEP, and SIEA flaps were 96.5, 106.5, 106.7, and 108.9 hours, respectively (p = 0.002). The rates for return to the OR for the revision of a vascular anastomosis for pTRAM, fTRAM, DIEP, and SIEA were 0.0%, 1.72%, 2.66%, and 5.64%, respectively (p < 0.0001). Conclusions There is variation in the total charges, LOS, and early complications between pTRAM, fTRAM, DIEP, and SIEA flap-based breast reconstruction. fTRAM, DIEP, and SIEA flaps incur higher hospital total charges, have longer lengths of stay, and experience more immediate complications compared with pTRAM. Well-designed prospective trials are required to better understand the findings from this study with the inclusion of other critical outcomes such as patient satisfaction, aesthetic results, and long-term outcomes such as abdominal wall morbidity.

scholarly journals Small-incision cataract surgery in patients with Fuch’s heterochromic iridocyclitis

2014 ◽  
Vol 6 (2) ◽  
pp. 153-161 ◽  
Author(s):  
R Bhargava ◽  
P Kumar ◽  
SK Sharma ◽  
S Ranjan ◽  
M Kumar ◽  
...  
Keyword(s):  
Cataract Surgery ◽  
Tertiary Care ◽  
Secondary Outcome ◽  
Small Incision Cataract Surgery ◽  
Small Incision ◽  
Vitreous Opacities ◽  
The Mean ◽  
Tertiary Care Centers ◽  
Preoperative Factors

Introduction: Fuch’s heterochromic iridocyclitis (FHI) is often complicated by cataract formation.Objective: To assess the results of small-incision cataract surgery (SICS) in FHI and to study the effect of preoperative factors on postoperative vision.Materials and methods: Sixty-three eyes of 59 patients with Fuchs heterochromic iridocyclitis who had SICS with in-the-bag implantation of intraocular lens (IOL) were evaluated retrospectively; and the primary and secondary outcome measures evaluated were the postoperative vision and complication rate.Results: The mean age was 39.22 ± 4.95 years. The mean pre-operative vision was 0.75 ± 0.24 Log MAR units. The mean final vision was 0.27 ± 0.10 Log MAR units (P = < 0.001). At the final follow-up, 84.1 % of the patients had a final Snellen’s vision of 6/12 or better. The mean follow-up period was 12.06 ± 2.06 months. The causes of corrected distance visual acuity (CDVA) worse than 6/60 were vitreous opacities, posterior keratic precipitates (KPs), glaucoma, persistent uveitis and cystoid macular edema (CME). Preoperative factors like iris atrophy (P = 0.973), heterochromia (P = 0.10) and vessels in angle (P = 0.074) did not have a significant effect on the final vision. On the contrary, vitreous opacities (P = 0.002) and posterior KPs (P = 0.009) had a significant effect on the final visual outcome.Conclusion: SICS with in-the-bag implantation of IOL in patients with Fuch’s heterochromic iridocyclitis resulted in good visual outcomes. SICS in complicated cataracts can be performed in rural settings and eye camps with minimal instrumentation, obviating the need for referral to tertiary care centers. Pre-operative factors like vitreous opacities and posterior KPs have a significant effect on the final vision.DOI: http://dx.doi.org/10.3126/nepjoph.v6i2.11705Nepal J Ophthalmol 2014: 6 (12): 153-161

Prospective Pricing Model for Neonatologists and Obstetricians in Tertiary Care Centers

PEDIATRICS ◽  
1988 ◽  
Vol 82 (3) ◽  
pp. 442-446
Author(s):  
Michael B. Resnick ◽  
Mario Ariet ◽  
Randolph L. Carter ◽  
Richard L. Bucciarelli ◽  
Robert R. Furlough ◽  
...  
Keyword(s):  
Tertiary Care ◽  
Classification Systems ◽  
Hospital Charges ◽  
Fee For Service ◽  
Drg System ◽  
Goods And Services ◽  
Care Groups ◽  
Intensity Of Care ◽  
The Government ◽  
Tertiary Care Centers

According to the new federal diagnosis-related group (DRG) system, hospitals are reimbursed fixed sums based on discharge diagnoses, rather than variable sums that depend on specific goods and services consumed and number of days hospitalized. The government is now exploring DRGs as a potential mechanism for reimbursing physicians. In Florida, two DRG-type reimbursement systems were developed for neonatal and obstetrical hospitalizations in tertiary care settings, as departures from the federal DRG system. Called neonatal care groups (NCGs) and obstetrical care groups (OBCGs), both classification systems predicted hospital charges in these settings more accurately than did federal DRGs. The feasibility of a prospective pricing system for neonatologists and obstetricians based on NCGs and OBCGs was investigated. The data showed that neonatologists' charges had a high correlation with hospital charges (r = .90) and that increasing levels of intensity of care as defined by the NCGs were reflected by consistent increases in reimbursement to neonatologists. If the NCG system were to be applied, neonatologists would receive compensation equivalent to that which they currently earn according to the fee-for-service system. In contrast, obstetricians' charges bore almost no relationship to hospital charges. However, modest differences in obstetrician's charges did emerge as a reflection of number of complications, which are incorporated into the OBCG categories; this suggests that a reimbursement system based on hospital OBCG categories might be applied to obstetricians.

scholarly journals Healthcare Resource Utilization and Healthcare costs of patients infected with the SARS-CoV-2 virus in a tertiary care public hospital: A cross-sectional study in Thailand

2020 ◽  
Author(s):  
Jirapong Leeyaphan ◽  
Charussri Leeyaphan ◽  
Patama Sutha ◽  
Suthira Taychakhoonavudh ◽  
Nattanichcha Kulthanachairojana
Keyword(s):  
Linear Regression ◽  
Resource Utilization ◽  
Healthcare Resource ◽  
Tertiary Care ◽  
Patient Characteristics ◽  
Healthcare Resource Utilization ◽  
Linear Regression Models ◽  
Cross Sectional ◽  
Personal Protection Equipment ◽  
Medication Costs

Abstract Background: Health care costs (HCCs) are a significant concern in developing countries. We investigated the healthcare resource utilization (HCRU) and HCCs for patients with COVID-19 concerning disease-severity and infection site.Methods: We reviewed the data from electronic medical records of COVID-19 patients. We used comorbidity conditions and patient characteristics as covariates. Analyses were conducted using simple linear regression and generalized linear regression models with a log–link and gamma distribution. Results: A total of 202 patients were confirmed to have a SARS-CoV-2 infection. Total costs per patient were USD 6,626 (USD 5,901–7,350). Personal protection equipment costs were the most significant cost for COVID-19 patients (USD 3,777). Mean medication costs per patient were USD 300 (USD 182–419). Patients with severe symptoms and a lower respiratory tract infection (LRI) had a higher cost and resource utilization value both before and after adjusting for covariates.Conclusions: COVID-19 patients with severe symptoms and LRI were associated with higher HCRU. length of stay, severe symptoms, and LRI were associated with a higher cost of treatment.

Pre-operative Plasma Levels of Thrombin-Antithrombin III Complexes Correlate with the Development of Venous Thrombosis after Major Hip or Knee Surgery

1995 ◽  
Vol 74 (02) ◽  
pp. 602-605 ◽  
Author(s):  
Jeffrey S Ginsberg ◽  
Patrick Brill-Edwards ◽  
Akbar Panju ◽  
Ameen Patel ◽  
Joanne McGinnis ◽  
...  
Keyword(s):  
Antithrombin Iii ◽  
Tertiary Care ◽  
Knee Surgery ◽  
Referral Centre ◽  
Study Objective ◽  
Cut Points ◽  
Vein Thrombosis ◽  
Major Orthopedic Surgery ◽  
The Mean ◽  
Deep Vein

SummaryStudy objective. To determine whether levels of thrombin-antithrombin III (TAT) in plasma, taken two weeks pre-operatively, predict the development of deep vein thrombosis (DVT) in patients undergoing major hip or knee surgery.Design. Prospective cohort.Setting. Tertiary-care referral centre, university-affiliated hospital.Patients. Ninety eight consecutive patients undergoing elective hip or knee surgery.Intervention. All eligible consenting patients were seen in a preoperative clinic two weeks prior to surgery and had blood taken for measurement of plasma TAT level. After surgery, they received a combination of unfractionated heparin 5000 Units 12-hourly subcutaneously, and antiembolism stockings (TEDS), as prophylaxis against DVT. Contrast venography was performed prior to discharge, and according to the results, patients were classified as having proximal (popliteal and/or more proximal) DVT (n = 12), calf DVT (n = 7) or no DVT (n = 79).Measurements and Results. The mean TAT level was significantly higher in patients who developed DVT (5.7 μg/l) than in those who did not (4.1 μg/l), p = 0.035. Using cut-points of 3.5 and 5.5 μg/l for the TAT level, patients could be categorized as high, intermediate, and low risk for the development of DVT. The proportion of patients with TAT levels of ≥3.5μg/l who developed calf or proximal DVT was significantly higher than the proportion of patients with TAT levels of <3.5 μg/l who developed calf or proximal DVT (p = 0.02). The proportion of patients with TAT levels >5.5 μg/l who developed proximal DVT was significantly higher than the proportion of patients with TAT levels of ≤5.5 μg/l who developed proximal DVT (p = 0.03).Conclusions. This study demonstrates that pre-operative TAT levels correlate with the risk of developing DVT after major orthopedic surgery. Further studies are needed to determine the reason(s) for this observation and whether rational recommendations about prophylaxis and screening for DVT can be made based on the results of a pre-operative TAT level.

scholarly journals Clinical Team Distribution and Antibiotic Use Patterns at a Tertiary-Care Academic Medical Center

2020 ◽  
Vol 41 (S1) ◽  
pp. s168-s169
Author(s):  
Rebecca Choudhury ◽  
Ronald Beaulieu ◽  
Thomas Talbot ◽  
George Nelson
Keyword(s):  
Medical Center ◽  
Academic Medical Center ◽  
Tertiary Care ◽  
Antibiotic Use ◽  
Care Hospital ◽  
Hospital Units ◽  
Antibiotic Utilization ◽  
Academic Medical ◽  
Level Data ◽  
Utilization Data

Background: As more US hospitals report antibiotic utilization to the CDC, standardized antimicrobial administration ratios (SAARs) derived from patient care unit-based antibiotic utilization data will increasingly be used to guide local antibiotic stewardship interventions. Location-based antibiotic utilization surveillance data are often utilized given the relative ease of ascertainment. However, aggregating antibiotic use data on a unit basis may have variable effects depending on the number of clinical teams providing care. In this study, we examined antibiotic utilization from units at a tertiary-care hospital to illustrate the potential challenges of using unit-based antibiotic utilization to change individual prescribing. Methods: We used inpatient pharmacy antibiotic use administration records at an adult tertiary-care academic medical center over a 6-month period from January 2019 through June 2019 to describe the geographic footprints and AU of medical, surgical, and critical care teams. All teams accounting for at least 1 patient day present on each unit during the study period were included in the analysis, as were all teams prescribing at least 1 antibiotic day of therapy (DOT). Results: The study population consisted of 24 units: 6 ICUs (25%) and 18 non-ICUs (75%). Over the study period, the average numbers of teams caring for patients in ICU and non-ICU wards were 10.2 (range, 3.2–16.9) and 13.7 (range, 10.4–18.9), respectively. Units were divided into 3 categories by the number of teams, accounting for ≥70% of total patient days present (Fig. 1): “homogenous” (≤3), “pauciteam” (4–7 teams), and “heterogeneous” (>7 teams). In total, 12 (50%) units were “pauciteam”; 7 (29%) were “homogeneous”; and 5 (21%) were “heterogeneous.” Units could also be classified as “homogenous,” “pauciteam,” or “heterogeneous” based on team-level antibiotic utilization or DOT for specific antibiotics. Different patterns emerged based on antibiotic restriction status. Classifying units based on vancomycin DOT (unrestricted) exhibited fewer “heterogeneous” units, whereas using meropenem DOT (restricted) revealed no “heterogeneous” units. Furthermore, the average number of units where individual clinical teams prescribed an antibiotic varied widely (range, 1.4–12.3 units per team). Conclusions: Unit-based antibiotic utilization data may encounter limitations in affecting prescriber behavior, particularly on units where a large number of clinical teams contribute to antibiotic utilization. Additionally, some services prescribing antibiotics across many hospital units may be minimally influenced by unit-level data. Team-based antibiotic utilization may allow for a more targeted metric to drive individual team prescribing.Funding: NoneDisclosures: None

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