scholarly journals Impact of deprivation on hospital efficiency and financial balance in paediatrics

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
M Michel ◽  
C Alberti ◽  
J C Carel ◽  
K Chevrel
Keyword(s):  
Diagnosis Related Groups ◽  
Hospital Efficiency ◽  
Production Costs ◽  
Hospital Funding ◽  
Payment Methods ◽  
Paediatric Patients ◽  
Hospital Payment ◽  
The Difference ◽  
Financial Balance ◽  
The Impact

Abstract Background In healthcare systems where hospital tariffs are based on average national length of stay (LOS), deprived patients may be a source of inefficiency for hospitals as deprivation has been shown to be associated with increased LOS. They may also negatively impact hospitals’ financial balance as few hospital payment methods include deprivation. Our objective was to study the impact of deprivation on hospital efficiency and financial balance. Methods A study was carried out using an exhaustive national hospital discharge database. All inpatient stays in mainland France between 2012 and 2014 by children over 28 days and under 18 in hospitals with a paediatric ward were included. Deprivation was estimated with an ecological deprivation index divided into national quintiles. Efficiency was assessed by variations in patients’ LOS compared to different mean national LOS (paediatric LOS, LOS of admissions for a similar condition...). Financial balance was assessed at the admission level through the ratio of production costs and revenues and at the hospital level with the difference between all revenues and production costs for said hospital. Multivariate models assessed the association between those indicators and deprivation. Results 4,124,510 inpatient stays were included. LOS was shorter than national means for less deprived patients and longer for the more deprived, and the difference was higher for diagnosis-related groups (DRGs) that included both adult and paediatric patients compared to paediatric-only DRGs. The multivariate model confirmed those significant associations. Deprivation also had a significant impact on hospitals’ financial balance, especially for hospitals with a percentage of paediatric patients in the two most deprived quintiles between 20% and 60%. Conclusions Measures to reform hospital payment methods must be encouraged to improve resource allocation efficiency and equity in access to good paediatric care. Key messages A reform of hospital funding to better account for deprivation is needed. A modulation of tariffs using an allocation key at the patient level must be considered to mitigate the effect of deprivation. DRGs specific to children should be encouraged to become the norm rather the exception to provide an adequate picture of resources used during admission and therefore an appropriate tariff.

Consider the Option Value Model on the Optimal Investment of the Recycle Economy Projects

2011 ◽  
Vol 474-476 ◽  
pp. 271-276
Author(s):  
Hua Wang ◽  
Ling Ling Chen
Keyword(s):  
Optimal Investment ◽  
Production Costs ◽  
Option Value ◽  
Project Investment ◽  
Document Code ◽  
Recycle Economy ◽  
Project Cycle ◽  
The Difference ◽  
Value Model ◽  
The Impact

In this paper, We apply option game theory methods to compensate for the inherent limitations of traditional NPV, study Timing Decision of recycle economy investment in monopoly situation, in best time to invest the recycle project, not only brought a lot of cash flow, better profitability, and implemented the project cycle of production, reduce production costs. Finally ,analyze the parameters of affecting investment , which can reduce the impact on investment；And analysis the difference in critical belief value between the project investment of recycle economic and non-recycle economy. <b>CLC</b><b>：</b>F424.7 <b>Document code</b><b>：</b>A

scholarly journals Importance of coding co-morbidities for APR-DRG assignment: Focus on cardiovascular and respiratory diseases

2019 ◽  
Vol 49 (1) ◽  
pp. 47-57 ◽  
Author(s):  
Julio Souza ◽  
João Vasco Santos ◽  
Veronica Bolon Canedo ◽  
Amparo Betanzos ◽  
Domingos Alves ◽  
...  
Keyword(s):  
Respiratory Diseases ◽  
Diagnosis Related Groups ◽  
Severity Of Illness ◽  
Support Vector ◽  
Hospital Funding ◽  
Co Morbidity ◽  
Key Factor ◽  
Hospital Payment ◽  
The Individual ◽  
Inpatient Database

Background: The All Patient-Refined Diagnosis-Related Groups (APR-DRGs) system has adjusted the basic DRG structure by incorporating four severity of illness (SOI) levels, which are used for determining hospital payment. A comprehensive report of all relevant diagnoses, namely the patient’s underlying co-morbidities, is a key factor for ensuring that SOI determination will be adequate. Objective: In this study, we aimed to characterise the individual impact of co-morbidities on APR-DRG classification and hospital funding in the context of respiratory and cardiovascular diseases. Methods: Using 6 years of coded clinical data from a nationwide Portuguese inpatient database and support vector machine (SVM) models, we simulated and explored the APR-DRG classification to understand its response to individual removal of Charlson and Elixhauser co-morbidities. We also estimated the amount of hospital payments that could have been lost when co-morbidities are under-reported. Results: In our scenario, most Charlson and Elixhauser co-morbidities did considerably influence SOI determination but had little impact on base APR-DRG assignment. The degree of influence of each co-morbidity on SOI was, however, quite specific to the base APR-DRG. Under-coding of all studied co-morbidities led to losses in hospital payments. Furthermore, our results based on the SVM models were consistent with overall APR-DRG grouping logics. Conclusion and implications: Comprehensive reporting of pre-existing or newly acquired co-morbidities should be encouraged in hospitals as they have an important influence on SOI assignment and thus on hospital funding. Furthermore, we recommend that future guidelines to be used by medical coders should include specific rules concerning coding of co-morbidities.

scholarly journals Socioeconomic Status of Newborns and Hospital Efficiency: Implications for Hospital Payment Methods

2020 ◽  
Vol 23 (3) ◽  
pp. 335-342
Author(s):  
Morgane Michel ◽  
Corinne Alberti ◽  
Jean-Claude Carel ◽  
Karine Chevreul
Keyword(s):  
Socioeconomic Status ◽  
Hospital Efficiency ◽  
Payment Methods ◽  
Hospital Payment

Evaluation of the impact of public investment programs on social and economic performance of territories

2019 ◽  
pp. 109-123
Author(s):  
I. E. Limonov ◽  
M. V. Nesena
Keyword(s):  
Bayesian Modeling ◽  
Positive Impact ◽  
Public Investment ◽  
Difference In Differences ◽  
The Public ◽  
Export Activity ◽  
Regional Investment ◽  
The Difference ◽  
The Impact ◽  
Development Institution

The purpose of this study is to evaluate the impact of public investment programs on the socio-economic development of territories. As a case, the federal target programs for the development of regions and investment programs of the financial development institution — Vnesheconombank, designed to solve the problems of regional development are considered. The impact of the public interventions were evaluated by the “difference in differences” method using Bayesian modeling. The results of the evaluation suggest the positive impact of federal target programs on the total factor productivity of regions and on innovation; and that regional investment programs of Vnesheconombank are improving the export activity. All of the investments considered are likely to have contributed to the reduction of unemployment, but their implementation has been accompanied by an increase in social inequality.

The Use of Multimedia and its Impact on Bangladeshi EFL Learners at Tertiary Level

2020 ◽  
Vol 4 (2) ◽  
pp. 150
Author(s):  
Farzana Sharmin Pamela Islam
Keyword(s):  
Language Learning ◽  
Academic Writing ◽  
Teaching And Learning ◽  
English Language ◽  
Capital City ◽  
Tertiary Level ◽  
Language Classroom ◽  
The Difference ◽  
The Government ◽  
The Impact

As 21st century is the era of modern technologies with different aspects, it offers us to make the best use of them. After tape recorder and overhead projector (OHP), multimedia has become an important part of language classroom facilities for its unique and effective application in delivering and learning lesson. Although in many parts of Bangladesh, a South Asian developing country, where English enjoys the status of a foreign language, the use of multimedia in teaching and learning is viewed as a matter of luxury. However, nowadays the usefulness and the necessity of it are well recognized by the academics as well as the government. The study aims to focus on the difference between a traditional classroom void of multimedia and multimedia equipped classrooms at university level by explaining how multimedia support the students with enhanced opportunity to interact with diverse texts that give them more in-depth comprehension of the subject. It also focuses on audio-visual advantage of multimedia on the students’ English language learning. The study has followed a qualitative method to get an in-depth understanding of the impact of using multimedia in an English language classroom at tertiary level. For this purpose, the data have been collected from two different sources. Firstly, from students’ written response to  an open ended question as to their comparative experience of learning  lessons with and without multimedia facilities; and secondly, through  observation of English language classes at a private university of Dhaka, the capital city of Bangladesh. The discussion of the study is limited to  the use of multimedia in English language classroom using cartoons, images and music with a view to enhance students’ skills in academic writing, critical analysis of image and critical appreciation of music. For this purpose, cartoons in English language, images from Google and music from You Tube have got focused discussion in this paper.

Case study: Prediction and field tests of railway noise and effects of a low-height noise barrier

2020 ◽  
Vol 68 (4) ◽  
pp. 303-314
Author(s):  
Yuna Park ◽  
Hyo-In Koh ◽  
University of Science and Technology, Transpo ◽  
University of Science and Technology, Transpo ◽  
University of Science and Technology, Transpo ◽  
...  
Keyword(s):  
High Speed ◽  
Field Tests ◽  
Residential Areas ◽  
Railway Systems ◽  
Railway Noise ◽  
Sound Levels ◽  
Noise Barrier ◽  
The Difference ◽  
Reduction Effect ◽  
The Impact

Railway noise is calculated to predict the impact of new or reconstructed railway tracks on nearby residential areas. The results are used to prepare adequate counter- measures, and the calculation results are directly related to the cost of the action plans. The calculated values were used to produce noise maps for each area of inter- est. The Schall 03 2012 is one of the most frequently used methods for the production of noise maps. The latest version was released in 2012 and uses various input para- meters associated with the latest rail vehicles and track systems in Germany. This version has not been sufficiently used in South Korea, and there is a lack of standard guidelines and a precise manual for Korean railway systems. Thus, it is not clear what input parameters will match specific local cases. This study investigates the modeling procedure for Korean railway systems and the differences between calcu- lated railway sound levels and measured values obtained using the Schall 03 2012 model. Depending on the location of sound receivers, the difference between the cal- culated and measured values was within approximately 4 dB for various train types. In the case of high-speed trains, the value was approximately 7 dB. A noise-reducing measure was also modeled. The noise reduction effect of a low-height noise barrier system was predicted and evaluated for operating railway sites within the frame- work of a national research project in Korea. The comparison of calculated and measured values showed differences within 2.5 dB.

SELISIH BIAYA PRODUKSI SEBAGAI ALAT PENGENDALIAN MANAJEMEN PT INDO PUSAKA BERAU

2019 ◽  
Vol 3 (02) ◽  
pp. 397
Author(s):  
SAFITRI NURHIDAYATI ◽  
RIZKI AMELYA SYAM
Keyword(s):  
Raw Materials ◽  
Field Research ◽  
Analytical Tool ◽  
Production Costs ◽  
Raw Material ◽  
Labor Costs ◽  
Material Costs ◽  
Library Research ◽  
The Difference ◽  
The Cost

This study aims to analyze whether the difference that occurs in the cost of raw materials, direct labor, and factory overhead costs between the standard costs and the actual costs in PLTU LATI is a difference that is favorable or unfavorable. Data collection techniques with field research and library research. The analytical tool used is the analysis of the difference in raw material costs, the difference in direct labor costs and the difference in factory overhead costs. The hypothesis in this study is that the difference allegedly occurs in the cost of raw materials, direct labor costs, and factory overhead costs at PT Indo Pusaka Berau Tanjung Redeb is a favorable difference. The results showed that the difference in the cost of producing MWh electricity at PT Indo Pusaka Berau Tanjung Redeb in 2018, namely the difference in the price of raw material costs Rp. 548,029.80, - is favorable, the difference in quantity of raw materials is Rp. 957,216,602, - is (favorable) , the difference in direct labor costs Rp 2,602,642,084, - is (unfavorable), and the difference in factory overhead costs Rp 8,807,051,422, - is (favorable) This shows that the difference in the overall production cost budget is favorable or profitable. This beneficial difference shows that the company is really able to reduce production costs optimally in 2018.  

The Impact of Plant Protection Systems on the Productivity of Soybean Varieties under Irrigated Conditions

2019 ◽  
pp. 109-117
Keyword(s):  
Plant Protection ◽  
Crop Protection ◽  
Production Costs ◽  
Protection System ◽  
Average Weight ◽  
The South ◽  
Biological Origin ◽  
Chemical Protection ◽  
Protection Systems ◽  
The Impact

The application of preparations of biological origin in the protection system of soybean grown under conditions of intensive irrigated crop rotations conforms to the modern tendencies of science and production development. The use of them contributes to solving ecological, production and social-economic problems. The study presents the three-year research on the efficiency of systems protecting soybean from pests and diseases based on biological and chemical preparations. The research was conducted in typical soil and climate conditions of the South of Ukraine. Zonal agricultural methods and generally accepted research methodology were used. The purpose of the research was to create a soybean protection system based on preparations of biological origin, ensuring high productivity of high-quality products reducing a negative impact of the crop production on the environment. The study emphasizes that, under irrigated conditions of the South of Ukraine, the application of biological preparations has a positive impact on the indexes of growth, development and formation of the elements of soybean yield structure. There was an increase in the crop biological weight by 13.8 % and 22.1 % and the number of seeds per plant rose by 11.6 and 14.6 % as a consequence of eliminating harmful organisms with the plant protection systems. The larger ground mass was formed by medium-ripe varieties Danai and Svyatogor, on which the increase from protection measures was higher. Weight 1000 pcs. the seeds did not undergo significant changes. It is established that the larger seeds were formed by Danaya and Svyatogor varieties, in which the average weight is 1000 pcs. seeds were 142 and 136 g, respectively, while in the variety Diona this figure was 133 g. There was an increase in the height of the lowest pod when the total plant height rose. For medium-ripe varieties was characterized by a higher attachment of beans, where the highest values of this indicator acquired in the variety Svyatogor. The medium maturing soybean variety Danaia formed the maximum yield of 3.23 and 3.35 t/ha respectively, when biological and chemical protection systems were applied. The research establishes that the application of the bio-fungicide Psevdobakterin 2 (2.0 l/ha) in the crop protection system at the beginning of soybean flowering and the bio-fungicide Baktofit (2.5 l/ha) with the bio-insecticide Lepidotsid-BTU (10.0 l/ha) at the beginning of pod formation does not reduce the productivity of the soybean varieties under study considerably, when compared to the application of chemical preparations. The research determines that the soybean protection system under study ensures a decrease in the coefficient of soybean water uptake by 7.2-13.0 %, increasing the total water intake to an inconsiderable degree. Biologization of the soybean crop protection system leads to a reduction in production costs compared to the chemical protection system. Taking into account the needs for the collection of additional products, costs increase by an average of 1 thousand UAH/ha, while for chemical protection systems by 1.8 thousand UAH/ha. At the same time, the cost is reduced by 220-360 UAH/t and the profitability of growing crops is increased by 3.8-7.8 %. There has been a reduction in the burden of pesticides on the environment and the production of cleaner products. This indicates the prospect of using the biofungicides Pseudobacterin 2 and Bactophyte and the bioinsecticide Lepidocid-BTU on soybeans to protect plants from pests.

scholarly journals Soil Moisture Dynamics in Response to Precipitation and Thinning in a Semi-Dry Forest in Northern Mexico

Water ◽  
2021 ◽  
Vol 13 (1) ◽  
pp. 105
Author(s):  
Argelia E. Rascón-Ramos ◽  
Martín Martínez-Salvador ◽  
Gabriel Sosa-Pérez ◽  
Federico Villarreal-Guerrero ◽  
Alfredo Pinedo-Alvarez ◽  
...  
Keyword(s):  
Soil Moisture ◽  
Forest Management ◽  
Water Availability ◽  
Dry Forest ◽  
Rainfall Events ◽  
Rainfall Characteristics ◽  
Northern Mexico ◽  
The Difference ◽  
The Impact ◽  
Moisture Dynamics

Understanding soil moisture behavior in semi-dry forests is essential for evaluating the impact of forest management on water availability. The objective of the study was to analyze soil moisture based in storm observations in three micro-catchments (0.19, 0.20, and 0.27 ha) with similar tree densities, and subject to different thinning intensities in a semi-dry forest in Chihuahua, Mexico. Vegetation, soil characteristics, precipitation, and volumetric water content were measured before thinning (2018), and after 0%, 40%, and 80% thinning for each micro-catchment (2019). Soil moisture was low and relatively similar among the three micro-catchments in 2018 (mean = 8.5%), and only large rainfall events (>30 mm) increased soil moisture significantly (29–52%). After thinning, soil moisture was higher and significantly different among the micro-catchments only during small rainfall events (<10 mm), while a difference was not noted during large events. The difference before–after during small rainfall events was not significant for the control (0% thinning); whereas 40% and 80% thinning increased soil moisture significantly by 40% and 53%, respectively. Knowledge of the response of soil moisture as a result of thinning and rainfall characteristics has important implications, especially for evaluating the impact of forest management on water availability.

scholarly journals 216. Are Automatic Antimicrobial Stop Orders an Effective Stewardship Tool for Urinary Tract and Intra-Abdominal Infections?

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S110-S110
Author(s):  
Christina Maguire ◽  
Dusten T Rose ◽  
Theresa Jaso
Keyword(s):  
Urinary Tract ◽  
Antimicrobial Therapy ◽  
Source Control ◽  
Clostridioides Difficile ◽  
Days Of Therapy ◽  
Before And After ◽  
The Difference ◽  
Tract Infections ◽  
Length Of Therapy ◽  
The Impact

Abstract Background Automatic antimicrobial stop orders (ASOs) are a stewardship initiative used to decrease days of therapy, prevent resistance, and reduce drug costs. Limited evidence outside of the perioperative setting exists on the effects of ASOs on broad spectrum antimicrobial use, discharge prescription duration, and effects of missed doses. This study aims to evaluate the impact of an ASO policy across a health system of adult academic and community hospitals for treatment of intra-abdominal (IAI) and urinary tract infections (UTI). ASO Outcome Definitions ASO Outcomes Methods This multicenter retrospective cohort study compared patients with IAI and UTI treated before and after implementation of an ASO. Patients over the age of 18 with a diagnosis of UTI or IAI and 48 hours of intravenous (IV) antimicrobial administration were included. Patients unable to achieve IAI source control within 48 hours or those with a concomitant infection were excluded. The primary outcome was the difference in sum length of antimicrobial therapy (LOT). Secondary endpoints include length and days of antimicrobial therapy (DOT) at multiple timepoints, all cause in hospital mortality and readmission, and adverse events such as rates of Clostridioides difficile infection. Outcomes were also evaluated by type of infection, hospital site, and presence of infectious diseases (ID) pharmacist on site. Results This study included 119 patients in the pre-ASO group and 121 patients in the post-ASO group. ASO shortened sum length of therapy (LOT) (12 days vs 11 days respectively; p=0.0364) and sum DOT (15 days vs 12 days respectively; p=0.022). This finding appears to be driven by a decrease in outpatient LOT (p=0.0017) and outpatient DOT (p=0.0034). Conversely, ASO extended empiric IV LOT (p=0.005). All other secondary outcomes were not significant. Ten patients missed doses of antimicrobials due to ASO. Subgroup analyses suggested that one hospital may have influenced outcomes and reduction in LOT was observed primarily in sites without an ID pharmacist on site (p=0.018). Conclusion While implementation of ASO decreases sum length of inpatient and outpatient therapy, it may not influence inpatient length of therapy alone. Moreover, ASOs prolong use of empiric intravenous therapy. Hospitals without an ID pharmacist may benefit most from ASO protocols. Disclosures All Authors: No reported disclosures

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