scholarly journals What are the financial implications of an open right hemicolectomy to hospital trusts within NHS England? A cost analysis

BMJ Open ◽  
2021 ◽  
Vol 11 (12) ◽  
pp. e053187
Author(s):  
Ian Daniels ◽  
Richard Tuson ◽  
Judith Hargreaves
Keyword(s):  
Average Length ◽  
Right Hemicolectomy ◽  
Cost Of Care ◽  
Care Hospital ◽  
Total Cost ◽  
Average Length Of Stay ◽  
Group 4 ◽  
High Dependency ◽  
Resource Group ◽  
The Cost

ObjectiveThis study aimed to quantify the actual costs to National Health Service (NHS) England of open right/extended right hemicolectomy (ORH) patient episodes compared with national tariffs to determine whether the total cost of care for these patients is adequately reimbursed to NHS Trusts.Design2017–2018 NHS Improvement reference cost data for elective and non-elective ORH Healthcare Resource Group 4+ (HRG4+)-coded procedures were used to calculate the actual mean initial admission costs of ORH and compare with corresponding 2017–2018 national tariffs. Costs of postoperative complications were estimated based on 2017–2018 Hospital Episode Statistics (intensive care unit (ICU)/high-dependency unit (HDU) stay and surgical site infection (SSI)) or further associated HRG4+-coded procedures (anastomotic leakage, SSI or hernia).Setting and patient cohortData were analysed for all ORH inpatients reported as treated at 140 secondary care Hospital Trusts in England during the 2017–2018 financial year.Results9812 ORH HRG4+-coded procedures were reported across 140 Hospital Trusts (74.0% elective; 26.0% non-elective). A total 1-year deficit of £993 335 was estimated between actual initial admission costs incurred and tariffs reimbursed for all patient episodes, 93.7% of which was associated with elective admissions. The cost of the average length of stay (LoS) in ICU/HDU after an ORH was £6818. The additional cost of an extended LoS in ICU/HDU due to an SSI was £45 316.ConclusionThe total cost of delivering care for these patients declared by NHS England was far higher than the tariff provided, which may be significantly underestimating the true cost of an ORH, leading to inadequate national tariff-setting by NHS Improvement.

The Cost of Hospital Stay for Operable Breast Cancer

1992 ◽  
Vol 78 (6) ◽  
pp. 359-362 ◽  
Author(s):  
Stefano Capri ◽  
Edoardo Majno ◽  
Maurizio Mauri
Keyword(s):  
Breast Cancer ◽  
Length Of Stay ◽  
Hospital Stay ◽  
Average Length ◽  
Operable Breast Cancer ◽  
Cost Component ◽  
Homogeneous Groups ◽  
Total Cost ◽  
Average Length Of Stay ◽  
The Cost

The cost of the first hospital stay for operable breast cancer was deducted by analysing a random sample of 100 admissions to the National Institute of Cancer during the period January-December 1989. The aims of the study were: (1) to describe and calculate the cost component of the stay; (2) to analyse whether any procedure, service rended or stage of the pathology might explain differences in the total costs of the stay; and (3) to acquire a better knowledge of the organizational aspects to be improved. With an average length of stay of 14.1 days, the overall total cost observed was 4.9 million lira (US $ 3.800, 1989 US dollars). A significant correlation between total cost and duration of stay was found (R2 = 0.982), while no or very little correlation was found between cost and the anatomical extent of disease (TNM stage) and different cost items (laboratory, imaging tests, operating room, etc.). Two homogeneous groups of cases were found: patients with quadrantectomy and patients with mastectomy. The cost of the latter was 40% greater than that of the former (P < 0.001) with a length of stay 52% longer (p < 0.001). This study does not concern the costs immediately following the stay, which namely are higher for the quadrantectomy because the radiotherapy outpatient procedures. Attention should be paid to reducing the length of stay, keeping waiting time for organizational procedures to a minimum during the stay.

scholarly journals Colonization and Infection With MRSA and CRKP and Its Result in an Increased Mortality Rate Within the Intensive Care and High-Dependency Units in Barbados

2020 ◽  
Vol 41 (S1) ◽  
pp. s173-s174
Author(s):  
Keisha Gustave
Keyword(s):  
Intensive Care ◽  
Length Of Stay ◽  
High Mortality ◽  
Average Length ◽  
Cohort Analysis ◽  
Health Concern ◽  
Queen Elizabeth Hospital ◽  
Surveillance Program ◽  
Average Length Of Stay ◽  
High Dependency

Background: Methicillin-resistant Staphylococcus aureus(MRSA) and carbapenem-resistant Klebsiella pneumoniae (CRKP) are a growing public health concern in Barbados. Intensive care and critically ill patients are at a higher risk for MRSA and CRKP colonization and infection. MRSA and CRKP colonization and infection are associated with a high mortality and morbidly rate in the intensive care units (ICUs) and high-dependency units (HDUs). There is no concrete evidence in the literature regarding MRSA and CRKP colonization and infection in Barbados or the Caribbean. Objectives: We investigated the prevalence of MRSA and CRKP colonization and infection in the patients of the ICU and HDU units at the Queen Elizabeth Hospital from 2013 to 2017. Methods: We conducted a retrospective cohort analysis of patients admitted to the MICU, SICU, and HDU from January 2013 through December 2017. Data were collected as part of the surveillance program instituted by the IPC department. Admissions and weekly swabs for rectal, nasal, groin, and axilla were performed to screen for colonization with MRSA and CRKP. Follow-up was performed for positive cultures from sterile isolates, indicating infection. Positive MRSA and CRKP colonization or infection were identified, and patient notes were collected. Our exclusion criteria included patients with a of stay of <48 hours and patients with MRSA or CRKP before admission. Results: Of 3,641 of persons admitted 2,801 cases fit the study criteria. Overall, 161 (5.3%) were colonized or infected with MRSA alone, 215 (7.67%) were colonized or infected with CRKP alone, and 15 (0.53%) were colonized or infected with both MRSA and CRKP. In addition, 10 (66.6%) of patients colonized or infected with MRSA and CRKP died. Average length of stay of patients who died was 50 days. Conclusions: The results of this study demonstrate that MRSA and CRKP cocolonization and coinfection is associated with high mortality in patients within the ICU and HDU units. Patients admitted to the ICU and HDU with an average length of stay of 50 days are at a higher risk for cocolonization and coinfection with MRSA and CRKP. Stronger IPC measures must be implemented to reduce the spread and occurrence of MRSA and CRKP.Funding: NoneDisclosures: None

scholarly journals Temporal Changes in Central-Line–Associated Bloodstream Infection Time Between Events, 2017–2018 Versus 2015–2016

2020 ◽  
Vol 41 (S1) ◽  
pp. s403-s404
Author(s):  
Jonathan Edwards ◽  
Katherine Allen-Bridson ◽  
Daniel Pollock
Keyword(s):  
Length Of Stay ◽  
Patient Care ◽  
Average Length ◽  
Bloodstream Infections ◽  
Central Line ◽  
Significant Shift ◽  
Care Hospital ◽  
Average Length Of Stay ◽  
Period 2 ◽  
Hospital Bed

Background: The CDC NHSN surveillance coverage includes central-line–associated bloodstream infections (CLABSIs) in acute-care hospital intensive care units (ICUs) and select patient-care wards across all 50 states. This surveillance enables the use of CLABSI data to measure time between events (TBE) as a potential metric to complement traditional incidence measures such as the standardized infection ratio and prevention progress. Methods: The TBEs were calculated using 37,705 CLABSI events reported to the NHSN during 2015–2018 from medical, medical-surgical, and surgical ICUs as well as patient-care wards. The CLABSI TBE data were combined into 2 separate pairs of consecutive years of data for comparison, namely, 2015–2016 (period 1) and 2017–2018 (period 2). To reduce the length bias, CLABSI TBEs were truncated for period 2 at the maximum for period 1; thereby, 1,292 CLABSI events were excluded. The medians of the CLABSI TBE distributions were compared over the 2 periods for each patient care location. Quantile regression models stratified by location were used to account for factors independently associated with CLABSI TBE, such as hospital bed size and average length of stay, and were used to measure the adjusted shift in median CLABSI TBE. Results: The unadjusted median CLABSI TBE shifted significantly from period 1 to period 2 for the patient care locations studied. The shift ranged from 20 to 75.5 days, all with 95% CIs ranging from 10.2 to 32.8, respectively, and P < .0001 (Fig. 1). Accounting for independent associations of CLABSI TBE with hospital bed size and average length of stay, the adjusted shift in median CLABSI TBE remained significant for each patient care location that was reduced by ∼15% (Table 1). Conclusions: Differences in the unadjusted median CLABSI TBE between period 1 and period 2 for all patient care locations demonstrate the feasibility of using TBE for setting benchmarks and tracking prevention progress. Furthermore, after adjusting for hospital bed size and average length of stay, a significant shift in the median CLABSI TBE persisted among all patient care locations, indicating that differences in patient populations alone likely do not account for differences in TBE. These findings regarding CLABSI TBEs warrant further exploration of potential shifts at additional quantiles, which would provide additional evidence that TBE is a metric that can be used for setting benchmarks and can serve as a signal of CLABSI prevention progress.Funding: NoneDisclosures: None

Total Population Estimate of Newborn Special-Care Bed Needs

PEDIATRICS ◽  
1985 ◽  
Vol 75 (6) ◽  
pp. 993-996
Author(s):  
August L. Jung ◽  
Nan Sherman Streeter
Keyword(s):  
Length Of Stay ◽  
Total Population ◽  
Average Length ◽  
Special Care ◽  
Care Hospital ◽  
Total Hospital ◽  
Live Births ◽  
Average Length Of Stay ◽  
Study Results ◽  
Hospital Days

In 1977, 7% of the 38,855 infants born in Utah were estimated to have required a total of 27,439 special-care hospital days. About half (53%) were mildly ill; their average length of stay was 4.6 days, or 24% of the total hospital-days. Another 20% of the infants had intermediate illness, with a 12-day average stay, or 23% of the total hospital-days. The remaining 27% of the infants required intensive care and used 53% of the total hospital-days; their average length of stay was 20 days. As a total population, the state's 38,855 births generated a need for two beds per 1,000 annual live births in special-care facilities. The estimated bed need was: mild illness (Level I), 0.5 beds per 1,000 annual live births; intermediate illness (Level II), 0.5 beds per 1,000 annual live births; and intense illness (Level III), one bed per 1,000 annual live births. Results are based on the assumption that nonstudy births, 30% of the total, have needs proportionate to study births. The following considerations are necessary to extrapolate these bed needs to other populations: (1) convalescence of intensely ill babies may require that up to 50% of their bed needs may be shifted to intermediate care; (2) compliance with criteria for transport to the next level of care may not be 100% as assumed in the study, thus redistributing bed needs; (3) census characteristically fluctuates in special-care nurseries (study results are reported for an unchanging daily census); and (4) the low birth rate of a population is intimately related to the bed needs.

scholarly journals Proposal of resources optimization in the hospital treatment of heart failure by an increased utilization of cardiac rehabilitation

2016 ◽  
Vol 66 (4) ◽  
Author(s):  
Tommaso Diaco ◽  
Geremia Milanesi ◽  
Daniela Zaniboni ◽  
Massimo Gritti ◽  
Gianna Zavatteri ◽  
...  
Keyword(s):  
Cardiac Rehabilitation ◽  
Average Length ◽  
Mean Value ◽  
Hospital Treatment ◽  
Utilization Rate ◽  
Average Length Of Stay ◽  
Use Of Resources ◽  
Acute Patient ◽  
The Cost ◽  
Acute Patients

weight on social cost. An improved resources utilization could promote a reduction of the new hospitalization and a of medical costs. Working hypotesis: To analyze a model of increased utilization of our Cardiac Rehabilitation (CR) Unit, aiming at improving the cost/profit ratio through a better use of resources and a better assignment of care. With a reduction of average length of stay in the Operative Units for acute patients, we could promote a demand of post-acute hospitalization of 950.7 days of hospitalization that could be assigned to Cardiologic Rehabilitation Unit. Results: With the transfer of patients the utilization rate of CR would increase to 97%. With a mean period in bed of 15.3 days we could hospitalize 62 additional patients and the total margin of contribution would became positive: 69.817 euro. The break even analysis applied to costs and returns of the Unit shows a further indication to increase the hospitalization number in CR Unit with patients transfered from acute patient units. Under the same costs the recovery of efficiency leads to a reduction of variable costs. In the same time there is an increase of returns due to an increase of mean value for case and an increase of services. Conclusion: The increase in the efficiency in the utilization of CR Unit leads to an increase of the Hospital efficiency. The transfer of patients from acute units to CR Unit would allow an increased hospitalization rate for acute patients without requiring additional resources.

Cost-Consequence Analysis of Single-Dose Dalbavancin Versus Standard of Care for the Treatment of Acute Bacterial Skin and Skin Structure Infections in a Multisite Healthcare System

2020 ◽  
Author(s):  
Julia Gonzalez ◽  
Diana Carolina Andrade ◽  
JianLi Niu
Keyword(s):  
Healthcare System ◽  
Treatment Success ◽  
Standard Of Care ◽  
Cost Of Care ◽  
Secondary Outcome ◽  
Total Cost ◽  
Skin Structure ◽  
Cost Consequence ◽  
The Difference ◽  
The Cost

Abstract Background Acute bacterial skin and skin structure infections (ABSSSIs) are common infectious diseases that cause a significant economic burden on the healthcare system. This study aimed to compare the cost-effectiveness of dalbavancin vs standard of care (SoC) in the treatment of ABSSSI in a community-based healthcare system. Methods This was a retrospective study of adult patients with ABSSSI treated with dalbavancin or SoC during a 27-month period. Patients were matched based on age and body mass index. The primary outcome was average net cost of care to the healthcare system per patient, calculated as the difference between reimbursement payments and the total cost to provide care to the patient. The secondary outcome was proportion of cases successfully treated, defined as no ABSSSI-related readmission within 30 days after the initiation of treatment. Results Of the 418 matched patients, 209 received SoC and 209 received dalbavancin. The average total cost of care per patient was greater with dalbavancin vs SoC ($4770 vs $2709, P &lt; .0001). The average reimbursement per patient was $3084 with dalbavancin vs $2633 SoC (P = .527). The net cost, calculated as revenue minus total cost, was $1685 with dalbavancin vs $75 with SoC (P = .013). The overall treatment success rate was 74% with dalbavancin vs 85% with SoC (P = .004). Conclusions Dalbavancin was more costly than SoC for the treatment of ABSSSI, with a higher 30-day readmission rate. Dalbavancin does not offer an economic or efficacy advantage.

Abstract WP382: The Cost of Ischemic Stroke: The Superiority of Marginal over Total Cost Estimation and Its Impact on National Cost Estimates

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Annie N Simpson ◽  
Charles Ellis ◽  
Abby S Kazley ◽  
Heather S Bonilha ◽  
James S Zoller
Keyword(s):  
South Carolina ◽  
Ischemic Stroke ◽  
Cost Of Illness ◽  
Cost Of Care ◽  
Control Group ◽  
Medicare Beneficiaries ◽  
Comorbid Conditions ◽  
Total Cost ◽  
Economic Decision Making ◽  
The Cost

Introduction Cost of illness for ischemic stroke has historically been reported as mean cost per case over a time period. Such cost include expenditures made for comorbid conditions, and may result in an over-estimation of the economic burden of stroke on the nation. Without accurate estimates, policymakers cannot plan appropriately for the ageing US population. Hypothesis The 1-year marginal cost of stroke is less than the 1-year total cost of stroke for South Carolina (SC) Medicare beneficiaries. Methods A cost of illness analysis was performed from the Medicare perspective. SC Medicare billing files for 2004 and 2005 were used to estimate the mean 12 month cost of stroke for 2,976 Medicare beneficiaries hospitalized for ischemic Stroke in 2004. Using nearest neighbor propensity score matching, a control group of 5,952 non-stroke beneficiaries were matched on age, race, gender and comorbid conditions. Results The total cost estimated for stroke patients for 1 year was $81.3 million. The cost for the matched comparison group without stroke, but with similar age, gender, race and comorbid conditions was significantly less at $54.4 million (p<0.0001). Thus, the 2004 marginal costs to Medicare due to ischemic stroke in SC are estimated to be $26.9 million. If this difference is inflated to 2012 dollars and projected to estimate the 2012 one year burden of ischemic stroke nationally, total annual stroke costs would be overestimated by $4.89 billion. Conclusions Accurate estimates of cost of care for conditions, such as stroke, that are common in older patients with a high rate of comorbid conditions require the use of a marginal costing approach. Overestimation of cost of care for stroke may lead to erroneous funding allocation and prediction of larger savings than realizable from stroke treatment and prevention programs. Given the trend of policies based on cost savings, overestimation poses a danger of limiting services that patients may receive. Thus, it is important to use marginal costing for stroke program estimates, especially with the increasing public focus on evidence-based economic decision making to be expected with health reform.

A Single-Institution's Experience With the CMS Noncervical Spine Fusion Bundle Payments

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Abraham Schlauderaff ◽  
Neel T Patel ◽  
G Timothy Reiter
Keyword(s):  
Healthcare Costs ◽  
Chart Review ◽  
Average Length ◽  
Skilled Nursing Facility ◽  
Retrospective Chart Review ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
Average Length Of Stay ◽  
Cost Metrics ◽  
The Cost

Abstract INTRODUCTION To reign in escalating healthcare costs, multiple cost-containment methodologies have been proposed. CMS has recently initiated bundle payments for certain DRGs during a 90 d global period. These include DRG codes 459 and 460: spinal fusion except cervical with and without major complications or comorbidity, respectively. METHODS The investigators reviewed patients who have been included in the CMS dataset for the aforementioned CMS trial. The data were utilized to analyze our performance in both quality and estimated cost metrics. Data not included in the CMS dataset were obtained via a retrospective chart review. RESULTS A total of 29 patients were included (25 with DRG 460 and 4 with DRG 459). Currently, there are no complete episodes, and final net episode payments are not known. Mean age was 68.9 (SD 9.7) yr. There were 17 males and 12 females. A total of 25 cases were elective and 4 were traumatic. Average length of stay (LOS) was 6 d (2-16 d) with a mean estimated cost of $30,631 (SD $6332). Six patients went to an inpatient rehab for a mean of 14 d (6-21 d) at a mean estimated cost of $28,089 (SD $7372). Two patients went to a skilled nursing facility for 8 and 23 d at a mean estimated cost of $21,906 (5091 and 38,721). Only 1 traumatic case went to rehab/SNF (25%) compared to 7 elective cases (32%). The estimated net episode payment (ENEP) for discharge to home was $36,726 versus that for discharge to facility of $73,100. CONCLUSION From these preliminary data, we conclude that being discharged to Rehab/SNF approximately doubled the ENEP. Of interest, being admitted as a trauma did not increase the risk of being discharged to Rehab/SNF. As patient data mature, we will be able to analyze the cost and expense relationship to obtain a variance to target in our population.

Physician data review to reduce cost per case and ALOS.

2013 ◽  
Vol 31 (31_suppl) ◽  
pp. 268-268
Author(s):  
Susan Schreiner ◽  
Theresa Franco
Keyword(s):  
Average Length ◽  
Communication Strategy ◽  
Net Income ◽  
Average Length Of Stay ◽  
Cancer Services ◽  
Reduction Methods ◽  
Critical Feedback ◽  
Reducing Costs ◽  
The Cost ◽  
Time Frames

268 Background: Reducing costs in health care is critical due to declining reimbursement. Physicians are often unaware of how their practices affect the cost of patient care and may have difficulty in making changes. The leadership of the Cancer Service Line believed a more targeted approach in sharing data would improve physician understanding and engagement to assist in greater standardization and cost reduction. Methods: An education and communication strategy was developed that involves the leadership of each specialty section of oncology. A dashboard was created with metrics such as clinic visits, surgical volume, cost per case, average length of stay, and net income. The data is presented in monthly, quarterly and annual time frames with trends to highlight progress and identify areas for improvement. Monthly meetings are conducted with key stakeholders to obtain critical feedback. Results: Consistent data has increased physician understanding of clinical businesses the business is doing and has prompted them to optimize clinical schedules and improve operational efficiencies. Outpatient and inpatient data regarding cost per case, ancillary costs, pharmaceutical usage, blood product utilization, and drug exchanges has driven practice changes. The ALOS is at almost an entire day below benchmarks and direct cost per case is at budgeted target. Standardization has occurred in the use of blood products and there has been an intentional shift of some interventions to the outpatient arena. Conclusions: The implementation of a robust education and communication strategy have resulted in active engagement and participation of physicians, significant practice changes in cancer care and heightened understanding of the relationship of practice to cost. A dashboard that trends relevant metrics shared at regular intervals with key providers impact the cost of cancer services without affecting the quality.

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