Expansion of activity-based hospital payment in Israel: evaluation of effects on inpatient activity

Abstract Background In 2013-14, Israel stepped up the replacement of per-diem payments by Procedure-Related Group (PRG) based hospital payments, a local version of Diagnosis-Related groups (DRGs). PRGs were created for selected procedures in urology, general surgery, gynecology and ophthalmology. We analyzed how did this change affect inpatient activities, measured by the number of discharges, average length of stay (ALoS), and the case-severity Charlson Comorbidity Index (CCI). Methods We investigated the impacts of the PRG-payment reform on 15 procedures. Observations covered groups of inpatients, by age and gender, who underwent these procedures in 2005-2016 at all non-profit hospitals. We examined the effect of the payment change on the number of discharges, ALoS and CCI using a multivariable analysis of Ordinary Least Squares controlling for patients, hospital characteristics, and year fixed-effects. Results Data on 89,533 patients were examined. During the study period, the ALoS decreased except for one procedure, the number of inpatients increased for most procedures, and case severity remained stable. The multivariable analysis suggests that the transition to PRG-payments contributed to changes in ALoS or case severity for only 3 out of 15 procedures examined. The PRG-reform contributed to changes of 10%-45% in the number of patients, but there was no clear trend: it increased in 9, and decreased in 5. The changes did not follow a clear pattern according to procedures’ price changes after the reform. Conclusions Factors that may have hampered the effects of the PRG-reform are conflicting incentives created by other co-existing hospital-payment components, such as revenue caps and retrospective subsidies, and the lack of resources to increase productivity. Key messages Provider payment reforms should carefully coordinate the entire payment system, otherwise the incentives may be blurred. Uncoordinated reforms may miss their goals.

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The use of various genetically engineered biological drugs and selective immunosuppressants within the current provider-payment model of russian diagnosis-related groups

PHARMACOECONOMICS Modern pharmacoeconomics and pharmacoepidemiology ◽

10.17749/2070-4909/farmakoekonomika.2020.058 ◽

2020 ◽

Vol 13 (3) ◽

pp. 225-239

Author(s):

E. V. Derkach ◽

E. A. Pyadushkina ◽

M. V. Avxentyeva ◽

T. V. Boyarskaya ◽

E. E. Yagnenkova ◽

...

Keyword(s):

Biological Therapy ◽

Diagnosis Related Groups ◽

Genetically Engineered ◽

Pharmaceutical Treatment ◽

Biological Drugs ◽

Payment Model ◽

Federal Level ◽

Input Intensity ◽

Number Of Patients ◽

Provider Payment

Diagnosis-Related Groups (DRG) for the payment for biological therapy were created at the stage of the pilot project and their coefficients of input intensity were not revised since then. The expansion of the range of genetically-engineered biological drugs (GEBD) and the development of new indications for biological therapy and new groups of expensive drugs (like selective immunodepressants, SI) determine the necessity in the differentiated payment for the therapy with GEBD and SI. However, at the federal level, this will be possible only after the approval of the clinical recommendations.Aim. The study aimed to identify possible applications of different GEBD and SI within the current provider-payment model of the Russian diagnosis-related group in terms of bronchial asthma (BA) and inflammatory bowel disease (IBD) - Crohn's disease and ulcerative colitis.Materials and methods. The expenses on GEBD and SI for one case of hospitalization were calculated and compared with the imposed tariffs. For the evaluation of the possibility of the provision of an expensive treatment within the existing DRG model, the authors modeled the distribution of patients with BA and IBD by different pharmaceutical treatment plans in the current practice and cases of an increase in the share of indications of more expensive therapy. The authors identified the number of patients that could have been treated without an increase in the costs of compulsory medical insurance (CHI). The authors proposed the subgroups for the differentiated payment for the treatment of BA and IBD with GEBD and SI.Results. Few variants of treatment with GEBD and SI were characterized by the costs of drugs that would exceed an average payment rate for DRG st36.003 and ds36.004 in 2020. In the model, an increase in the share of patients that received the most expensive drugs of all the registered GEBD and SI in the RF for the treatment of BA and IBD did not lead to an increase in the costs for CHI. It is possible to maintain the initial volume of the financing and increase the number of patients that receive GEBD and SI due to a decrease in the number of hospitalizations. The authors identified approximate values of the coefficient of input intensity (CII) for the subgroups that can be formed for the differentiated payment for pharmaceutical treatment with GEBD and SI.Conclusion. Despite the fact that without the recalculation of CII, there were numerous changed introduced into DRGs st36.003 and ds36.004 “Treatment with GEBD and SI” and the spectrum of the associated clinical situations expanded, it was possible to maintain the possibility of the payment for the therapy with different drugs, including the most expensive ones without an increase in the costs for the CHI system. Still, the results of the present study indicate the necessity in the optimization of the system of payment for medical care with genetically-engineered biologic drugs and selective immunodepressants through the implementation of a differentiated approach to the payment at the federal level.

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The antecedents of corporate social and environmental responsibility discourse in Pakistan: Multiple theoretical perspectives

10.34091/ajss.13.1.01 ◽

2019 ◽

Author(s):

Muhammad Farhan Basheer ◽

Saqib Muneer ◽

Muhammad Atif ◽

Zubair Ahmad

Keyword(s):

Institutional Theory ◽

Least Squares ◽

Agency Theory ◽

Stakeholder Theory ◽

Fixed Effects ◽

Ordinary Least Squares ◽

Environmental Responsibility ◽

Legitimacy Theory ◽

Discourse Practices ◽

Corporate Social

The primary purpose of the study is to explore the antecedents of corporate social and environmental responsibilities discourse practices in Pakistan. The industry sensitivity, government shareholding, block holder ownership, print media coverage, environmental monitoring programs, and strategic posture are examined as antecedents of corporate social and environmental responsibility practices. A multidimensional theoretical perspective namely stakeholder theory (ST), institutional theory (IT), agency theory (PAT), and legitimacy theory (LT) is used to conceptualize the phenomena. All the four of perspective theories (positive accounting theory, legitimacy theory, stakeholder theory, and institutional theory) claim that there are ‘pressures’ that impact the organization. How much ‘pressures’ are recognized, managed or satisfied differs from one perspective of theory to the other. To estimate the data, this study uses three sets of panel data models, i.e., the pooled ordinary least squares model (POLS) or constant coefficients model, fixed effects (FEM or least squares dummy variable/LSDV model) and random-effects models. The final sample is comprising of 173 firms over eight years from 2011 to 2017. The firms listed in PSX are included in the sample. Overall the findings of the study have shown agreement with the proposed results. However, the study has provided more support to the institutional theory and stakeholder theory. Keywords: Corporate Social Responsibility, Stakeholders Theory, Agency Theory, Pakistan

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Analysis of the New Kuznets Relationship: Considering Emissions of Carbon, Methanol, and Nitrous Oxide Greenhouse Gases—Evidence from EU Countries

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18062907 ◽

2021 ◽

Vol 18 (6) ◽

pp. 2907

Author(s):

Mara Madaleno ◽

Victor Moutinho

Keyword(s):

Nitrous Oxide ◽

Least Squares ◽

Fixed Effects ◽

Ghg Emissions ◽

Ordinary Least Squares ◽

Kuznets Curve ◽

Ekc Hypothesis ◽

Long Run ◽

Short Run ◽

The Eu

Decreased greenhouse gas emissions (GHG) are urgently needed in view of global health threat represented by climate change. The goal of this paper is to test the validity of the Environmental Kuznets Curve (EKC) hypothesis, considering less common measures of environmental burden. For that, four different estimations are done, one considering total GHG emissions, and three more taking into account, individually, the three main GHG gases—carbon dioxide (CO2), nitrous oxide (N2O), and methane gas (CH4)—considering the oldest and most recent economies adhering to the EU27 (the EU 15 (Old Europe) and the EU 12 (New Europe)) separately. Using panel dynamic fixed effects (DFE), dynamic ordinary least squares (DOLS), and fully modified ordinary least squares (FMOLS) techniques, we validate the existence of a U-shaped relationship for all emission proxies considered, and groups of countries in the short-run. Some evidence of this effect also exists in the long-run. However, we were only able to validate the EKC hypothesis for the short-run in EU 12 under DOLS and the short and long-run using FMOLS. Confirmed is the fact that results are sensitive to models and measures adopted. Externalization of problems globally takes a longer period for national policies to correct, turning global measures harder and local environmental proxies more suitable to deeply explore the EKC hypothesis.

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Crohn’s disease: a population-based study of surgery in the age of biological therapy

International Journal of Colorectal Disease ◽

10.1007/s00384-021-03930-w ◽

2021 ◽

Author(s):

Christian Stöss ◽

Maximilian Berlet ◽

Stefan Reischl ◽

Ulrich Nitsche ◽

Marie-Christin Weber ◽

...

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Minimally Invasive ◽

Biological Therapy ◽

Hospital Admissions ◽

Diagnosis Related Groups ◽

Age Distribution ◽

Considerable Proportion ◽

Discharge Data ◽

Number Of Patients

Abstract Purpose Despite primary conservative therapy for Crohn’s disease, a considerable proportion of patients ultimately needs to undergo surgery. Presumably, due to the increased use of biologics, the number of surgeries might have decreased. This study aimed to delineate current case numbers and trends in surgery in the era of biological therapy for Crohn’s disease. Methods Nationwide standardized hospital discharge data (diagnosis-related groups statistics) from 2010 to 2017 were used. All patients who were admitted as inpatient Crohn’s disease cases in Germany were included. Time-related development of admission numbers, rate of surgery, morbidity, and mortality of inpatient Crohn’s disease cases were analyzed. Results A total number of 201,165 Crohn’s disease cases were included. Within the analyzed time period, the total number of hospital admissions increased by 10.6% (n = 23,301 vs. 26,069). While gender and age distribution remained comparable, patients with comorbidities such as stenosis formation (2010: 10.1%, 2017: 13.4%) or malnutrition (2010: 0.8%, 2017: 3.2%) were increasingly admitted. The total number of all analyzed operations for Crohn’s disease increased by 7.5% (2010: n = 1567; 2017: n = 1694). On average, 6.8 ± 0.2% of all inpatient patients received ileocolonic resections. Procedures have increasingly been performed minimally invasive (2010: n = 353; 2017: n = 687). The number of postoperative complications remained low. Conclusion Despite the development of novel immunotherapeutics, the number of patients requiring surgery for Crohn’s disease remains stable. Interestingly, patients have been increasingly hospitalized with stenosis and malnutrition. The trend towards more minimally invasive operations has not relevantly changed the rate of overall complications.

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P17 An audit of Trakcare discharge times for Laparoscopic Cholecystectomy

BJS Open ◽

10.1093/bjsopen/zrab032.016 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

Author(s):

Jacob Rapier ◽

Steven Hornby ◽

Jacob Rapier

Keyword(s):

Laparoscopic Cholecystectomy ◽

Length Of Stay ◽

Initial Data ◽

Best Practice ◽

Average Length ◽

Accurate Data ◽

Day Case ◽

Average Length Of Stay ◽

Number Of Patients ◽

Elective Laparoscopic Cholecystectomy

Abstract Introduction Nationally 61,220 Laparoscopic Cholecystectomies are carried out annually. Those carried out as day-cases reduce providers’ costs and increase income through the best practice tariff. The system in our trust to record discharges is ‘Trakcare’. The aim of this audit was to accurately measure the discharge times of patients undergoing elective Laparoscopic Cholecystectomies, to try and reduce the number of patients recorded as having an overnight stay by accurate data collection. Methods Initial data was collected for all elective Laparoscopic Cholecystectomy discharge times on Trakcare, over a 1 month period. This data was then re-audited prospectively both from Trakcare and discharges reported by nurses/patients. A comparison was then made of Trakcare against reported discharge times. Results Initially 54 operations were recorded, with 30 completed as day cases (55.6%). The re-audited data (on Trakcare) recorded 47 operations, with 15 completed as day cases (37.91%). Of these discharges we were able to capture 26 (55.32%) manually, and 11 were completed as day cases (42.31%). Measuring these 26 with the same operations on Trakcare we were unable to show a difference in the number of cases completed as a day case (11 vs 11), with only a 33 minute decrease in the average length of stay. Conclusion Trakcare is a reliable tool for measuring the date of discharge for patients. The recommendations in are: scheduling surgery for a time pre-13:00 shows a higher proportion of patients discharged the same day, and continue to use Trakcare to record discharge times.

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138 Effects of Increasing Soybean Meal in Corn-based Diets on Growth Performance of Late-finishing Pigs

Journal of Animal Science ◽

10.1093/jas/skab054.115 ◽

2021 ◽

Vol 99 (Supplement_1) ◽

pp. 70-71

Author(s):

Julia P Holen ◽

Robert D Goodband ◽

Mike D Tokach ◽

Jason C Woodworth ◽

Joel M DeRouchey

Keyword(s):

Amino Acids ◽

Growth Performance ◽

Soybean Meal ◽

Fixed Effects ◽

Average Length ◽

Average Daily Gain ◽

Random Effect ◽

Finishing Pigs ◽

Distillers Grains With Solubles ◽

Dietary Treatments

Abstract Two experiments were conducted to determine the effects of increasing levels of soybean meal (SBM) replacing feed grade amino acids in corn or corn-dried distillers grains with solubles (DDGS)-based diets on growth performance of late finishing pigs. In both experiments, there were 22 to 27 pigs per pen and 14 pens per treatment. Average length of the experiments was 35 (Exp. 1) and 29 days (Exp. 2). Diets were balanced to contain 0.70% SID Lys and 2,667 or 2,610 kcal NE/kg for Exp. 1 and 2, respectively. Minimum amino acid ratios relative to Lys were: Ile, 55; Met&Cys, 60; Thr, 65; Trp, 19.5, and Val, 70. Dietary crude protein ranged from 10.1 to 15.2 for Exp. 1 and 13.6 to 19.4 for Exp. 2. The statistical model considered fixed effects of treatment, linear and quadratic contrasts, and random effect of block. In Exp.1, 1,793 pigs (L337×1050, PIC; initially 104.9 ± 1.4 kg) were fed corn-based diets and pens of pigs were assigned to 1 of 5 dietary treatments with increasing SBM from 5 to 20%. Overall, average daily gain (ADG) and gain-to-feed (G:F) increased (linear; P < 0.05) as SBM increased with the greatest improvement observed as SBM increased from 5 to 8.75%, with little improvement thereafter. In Exp. 2, 1,827 pigs (L337×1050, PIC; initially 97.9 ± 1.1 kg) were used in a similar study as Exp. 1, but all diets contained 25% DDGS and SBM levels increased from 0 to 16%. Overall, G:F and final bodyweight of pigs marginally improved (linear and quadratic, respectively; P < 0.10) as SBM increased, with the greatest performance observed when diets contained 8% SBM. These results suggest that increasing SBM up to 8% at the expense of feed grade amino acids in corn or corn-DDGS-based diets improved ADG or G:F in late-finishing pigs.

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Critical illness myopathy in intensive care setting

QJM ◽

10.1093/qjmed/hcab086.044 ◽

2021 ◽

Vol 114 (Supplement_1) ◽

Author(s):

Mostafa K Fouad ◽

Ashraf M Hazem ◽

Kareem M Elnaghy

Keyword(s):

Critical Illness ◽

Mortality Rate ◽

Usual Care ◽

Usual Care Group ◽

Fixed Effects ◽

Meta Analysis ◽

Care Group ◽

Fixed Effects Model ◽

Analysis Study ◽

Number Of Patients

Abstract Aim of the Work to provide cumulative data about the efficacy and safety of neuro-muscular electrical stimulation (NMES) combined with usual care (UC) versus usual care alone in ICU patients with Critical Illness Myopathy (CIM). Methodology The current systematic review was done on studies published between 2009 and 2019. The total number of patients in all the included studies was 1259 patients; 652 in NMES group, and 607 in UC group. Our data were divided into two groups: NMES (652 patients), and UC (607 patients). Metaanalysis study was done on 11 studies which described and compared the 2 different techniques for treatment of CIM; with overall number of patients (N = 1259). Results Regarding 1ry outcome measures, we found 8 studies reported critical Critical illness myopathy (CIM), critical illness polyneuropathy (CIP), and the overlap, critical care setting MRC scale for muscle strength, with total number of patients (N = 968). The random-effects model of the meta-analysis study showed non-significant difference in mean MRC scale in NMES group compared to usual care group (p > 0.05). We also found 11 studies reported ICU stay with total number of patients (N = 1259). The random-effects model of the meta-analysis study showed nonsignificant difference in mean ICU stay in NMES group compared to usual care group (p > 0.05). We also found only 2 studies reported SF-36 scale for quality of life, with total number of patients (N = 270). The fixed-effects model of the metaanalysis study showed highly significant decrease in mean SF-36 scale in NMES group compared to usual care group (p = 0.003). Regarding 2ry outcome measure, we found 3 studies reported CIM incidence with total number of patients (N = 394). The fixed-effects model of the meta-analysis study showed marked decrease in CIM incidence in NMES group compared to usual care group, but not reaching statistical significance (p > 0.05). We also found 9 studies reported mortality rate with total number of patients (N = 1044). The fixed-effects model of the meta-analysis study showed non-significant difference in mortality rate in NMES group compared to usual care. Our systematic review and meta-analysis showed that NMES combined with usual care was not associated with significant differences in global muscle strength, ICU stay, quality of life score, CIM incidence and mortality rate in comparison with usual care alone in critically ill patients. Conclusion NMES is not superior to usual care in management of CIM. Usual care remains the mainstay of management of CIM with significant better outcomes, in addition to preventive measures as early aggressive treatment of sepsis and MOF, blood glucose control, optimizing certain drugs use, early enteral nutrition, maintaining water, electrolyte and acidbase balance.

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Is active sacroiliitis on MRI associated with radiographic damage in axial spondyloarthritis? Real-life data from the ASAS and DESIR cohorts

Rheumatology ◽

10.1093/rheumatology/key387 ◽

2018 ◽

Vol 58 (5) ◽

pp. 798-802 ◽

Cited By ~ 2

Author(s):

Alexandre Sepriano ◽

Sofia Ramiro ◽

Robert Landewé ◽

Maxime Dougados ◽

Désirée van der Heijde ◽

...

Keyword(s):

Bone Marrow ◽

Odds Ratio ◽

Structural Damage ◽

Axial Spondyloarthritis ◽

Multivariable Analysis ◽

Real Life ◽

Daily Practice ◽

Bone Marrow Oedema ◽

Number Of Patients ◽

Structural Progression

Abstract Objective To assess any association between bone marrow oedema on MRI of the sacroiliac joints (MRI-SIJ) according to local readings in daily practice and the development of structural damage on radiographs of the SIJ (X-SIJ) in axial spondyloarthritis (axSpA). Methods Patients with axSpA from the Assessment of the SpondyloArthritis international Society (ASAS) and DEvenir des Spondylarthopathies Indifférenciées Récentes (DESIR) multicentre cohorts were included. MRI-SIJ and X-SIJ were obtained at baseline, and X-SIJ at follow-up after a mean 4.6 years (ASAS) and 5.1 years (DESIR). All images were scored by local readers. Structural damage in the X-SIJ was defined according to the modified New York criteria. The percentage of structural net progression (number of ‘progressors’ minus the number of ‘regressors’ divided by the total number of patients) was assessed and the effect of bone marrow oedema on MRI-SIJ on X-SIJ damage evaluated by multivariable logistic regression. Results In total, 125 (ASAS-cohort) and 415 (DESIR-cohort) patients had baseline MRI-SIJ and complete X-SIJ data available. According to local readings, progression and ‘improvement’ in X-SIJ was seen in both the ASAS- and DESIR-cohort, yielding a net progression that was higher in the former than in the latter (19.2% and 6.3%). In multivariable analysis, baseline bone marrow oedema on MRI-SIJ was strongly associated with X-SIJ structural progression in both ASAS (odds ratio = 3.2 [95% CI: 1.3; 7.9]), and DESIR (odds ratio = 7.6 [95% CI: 4.3; 13.2]). Conclusion Inflammation on MRI-SIJ is associated with future radiographic progression according to local readings despite an expected increased imprecision invoked by local readings.

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Fixed Effects Vector Decomposition: A Magical Solution to the Problem of Time-Invariant Variables in Fixed Effects Models?

Political Analysis ◽

10.1093/pan/mpq034 ◽

2011 ◽

Vol 19 (2) ◽

pp. 135-146 ◽

Cited By ~ 83

Author(s):

William Greene

Keyword(s):

Fixed Effects ◽

Ordinary Least Squares ◽

Fe Model ◽

Real World Data ◽

Problem Of Time ◽

Dummy Variable ◽

Vector Decomposition ◽

Step Procedure ◽

Time Invariant ◽

Subsequent Literature

Plümper and Troeger (2007) propose a three-step procedure for the estimation of a fixed effects (FE) model that, it is claimed, “provides the most reliable estimates under a wide variety of specifications common to real world data.” Their fixed effects vector decomposition (FEVD) estimator is startlingly simple, involving three simple steps, each requiring nothing more than ordinary least squares (OLS). Large gains in efficiency are claimed for cases of time-invariant and slowly time-varying regressors. A subsequent literature has compared the estimator to other estimators of FE models, including the estimator of Hausman and Taylor (1981) also (apparently) with impressive gains in efficiency. The article also claims to provide an efficient estimator for parameters on time-invariant variables (TIVs) in the FE model. None of the claims are correct. The FEVD estimator simply reproduces (identically) the linear FE (dummy variable) estimator then substitutes an inappropriate covariance matrix for the correct one. The consistency result follows from the fact that OLS in the FE model is consistent. The “efficiency” gains are illusory. The claim that the estimator provides an estimator for the coefficients on TIVs in an FE model is also incorrect. That part of the parameter vector remains unidentified. The “estimator” relies upon a strong assumption that turns the FE model into a type of random effects model.

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Teacher-principal race and teacher satisfaction over time, region

Journal of Educational Administration ◽

10.1108/jea-10-2016-0122 ◽

2017 ◽

Vol 55 (6) ◽

pp. 624-639

Author(s):

Samantha L. Viano ◽

Seth B. Hunter

Keyword(s):

Job Satisfaction ◽

Fixed Effects ◽

White Teachers ◽

Ordinary Least Squares ◽

Teacher Job Satisfaction ◽

Southern Region ◽

Content Type ◽

Black Principals ◽

The Relationship ◽

Over Time

Purpose The purpose of this paper is to replicate prior findings on teacher-principal race congruence and teacher job satisfaction and extend the literature by investigating trends over time and if the relationship between race congruence and teacher job satisfaction differs by principal race and region. Design/methodology/approach The study sample comes from four waves of cross-sectional data, the nationally representative Schools and Staffing Survey, administered between 2000 and 2012. The analysis is conducted using ordinary least squares and school-year fixed effects with a comprehensive set of covariates. Findings The relationship between race congruence and teacher job satisfaction is attenuating over time and is likely explained by the lower job satisfaction of white teachers who work for black principals. Some evidence indicates teacher-principal race congruence has greater salience in the Southern region of the country. Find evidence that teachers with race-congruent principals report more workplace support than their non-race congruent colleagues. Research limitations/implications Future studies should investigate why racial congruence has more salience in the Southern region of the country and for white teachers who work with black principals. At the same time, results indicate that teacher-principal race congruence might no longer be a determinant of teacher job satisfaction, although further studies should continue investigating this relationship. Originality/value Findings on the changing nature of the relationship between principal-teacher race congruence and teacher job satisfaction over time as well as the differing nature of race congruence in the Southern region of the country are both novel findings in the literature.

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