scholarly journals Financial Impact of Incentive Spirometry

2018 ◽  
Vol 55 ◽  
pp. 004695801879499
Author(s):  
Adam E. M. Eltorai ◽  
Grayson L. Baird ◽  
Joshua Pangborn ◽  
Ashley Szabo Eltorai ◽  
Valentin Antoci ◽  
...  
Keyword(s):  
Online Survey ◽  
Unit Cost ◽  
The United States ◽  
Financial Impact ◽  
Total Annual Cost ◽  
Patient Cost ◽  
Is Implementation ◽  
Step Down ◽  
The Cost ◽  
Incentive Spirometry

Despite largely unproven clinical effectiveness, incentive spirometry (IS) is widely used in an effort to reduce postoperative pulmonary complications. The objective of the study is to evaluate the financial impact of implementing IS. The amount of time nurses and RTs spend each day doing IS-related activities was assessed utilizing an online survey distributed to the relevant national nursing and respiratory therapists (RT) societies along with questionnaire that was prospectively collected every day for 4 weeks at a single 10-bed cardiothoracic surgery step-down unit. Cost of RT time to teach IS use to patients and cost of nurse time spent reeducating and reminding patients to use IS were used to calculate IS implementation cost estimates per patient. Per-patient cost of IS implementation ranged from $65.30 to $240.96 for a mean 9-day step-down stay. For the 566 patients who stayed in the 10-bed step-down in 2016, the total estimated cost of implementing IS ranged from $36 959.80 to $136 383.36. Using national survey workload data, per-patient cost of IS implementation costed $107.36 (95% confidence interval [CI], $97.88-$116.98) for a hospital stay of 4.5 days. For the 9.7 million inpatient surgeries performed annually in the United States, the total annual cost of implementing postoperative IS is estimated to be $1.04 billion (95% CI, $949.4 million-$1.13 billion). The cost of implementing IS is substantial. Further efficacy studies are necessary to determine whether the cost is justifiable.

scholarly journals Financial burden and impact of atopic dermatitis out-of-pocket healthcare expenses among black individuals in the United States

2021 ◽  
Author(s):  
Raj Chovatiya ◽  
Wendy Smith Begolka ◽  
Isabelle J. Thibau ◽  
Jonathan I. Silverberg
Keyword(s):  
Atopic Dermatitis ◽  
Online Survey ◽  
Financial Burden ◽  
The United States ◽  
Healthcare Resource Utilization ◽  
Self Report ◽  
Financial Impact ◽  
Black Race ◽  
Targeted Interventions ◽  
Healthcare Expenses

AbstractBlack race is associated with increased atopic dermatitis (AD) severity and healthcare resource utilization. However, the burden of out-of-pocket (OOP) expenses among black individuals with AD is not well understood. We sought to characterize the categories and impact of OOP healthcare expenses associated with AD management among black individuals. A 25-question voluntary online survey was administered to National Eczema Association members (N = 113,502). Inclusion criteria (US residents age ≥ 18 years; self-report of AD or primary caregivers of individuals with AD) was met by 77.3% (1118/1447) of respondents. Black individuals with AD were younger, had lower household income, Medicaid, urban residence, poor AD control and frequent skin infections (P ≤ 0.02). Blacks vs. non-blacks reported more OOP costs for prescription medications covered (74.2% vs. 63.6%, P = 0.04) and not covered (65.1% vs. 46.5%, P = 0.0004) by insurance, emergency room visits (22.1% vs. 11.8%, P = 0.005), and outpatient laboratory testing (33.3% vs. 21.8%, P = 0.01). Black race was associated with increased household financial impact from OOP expenses (P = 0.0009), and predictors of financial impact included minimally controlled AD (adjusted OR [95% CI] 13.88 [1.63–117.96], P = 0.02), systemic therapy (4.34 [1.63–11.54], 0.003), > $200 monthly OOP expenses (14.28 [3.42–59.60], P = 0.0003), and Medicaid (4.02 [1.15–14.07], P = 0.03). Blacks with Medicaid had higher odds of harmful financial impact (3.32 [1.77–6.24], P = 0.0002) than those of black race (1.81 [1.04–3.15], P = 0.04) or with Medicaid (1.39 [1.02–1.88], P = 0.04) alone. Black race is associated with increased OOP costs for AD and significant household financial impact. Targeted interventions are needed to address financial disparities in AD.

scholarly journals Financial Impact of MRI in Treatment of Foot and Ankle Osteomyelitis

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0001
Author(s):  
Srikanth Divi ◽  
Kelly Hynes ◽  
Douglas Dirschl ◽  
Cody Lee
Keyword(s):  
Lower Extremity ◽  
Clinical Decision Making ◽  
Tertiary Care ◽  
The United States ◽  
Operative Procedures ◽  
Financial Impact ◽  
Foot And Ankle ◽  
Plain Radiographs ◽  
Significant Difference ◽  
The Cost

Category: Ankle, Diabetes, Hindfoot, Lesser Toes, Midfoot/Forefoot, Infection Introduction/Purpose: Osteomyelitis of the foot and ankle is a common condition with a high economic burden in the United States, particularly in the context of diabetes mellitus. The timely and accurate diagnosis of osteomyelitis is important to initiate treatment and possibly reduce overall healthcare costs. Plain radiographs are the initial study of choice given their widespread availability and low cost. Magnetic resonance imaging (MRI) is generally considered the most sensitive imaging modality for detecting osteomyelitis, however it is associated with significant cost and may not change overall treatment as compared to plain radiographs. The purpose of our retrospective study is to determine whether the use of MRI at our institution changed clinical decision making and calculate the financial impact in patients with foot and ankle osteomyelitis. Methods: We retrospectively identified patients at our tertiary care, academic center treated for a diagnosis of osteomyelitis using ICD-9 codes 730.07, 730.17, and 730.27. Demographic data including age, sex, race and ethnicity and patient comorbidities was collected. The use of plain radiographs, MRI, and any operative procedures up to 2 years after the index encounter for each patient were identified. An impact MRI was defined as an MRI that led to an operative procedure within the same admission encounter. The cost of an impact MRI was estimated using the equation: (average MRI cost)*(total MRIs/impact MRIs). Chi- squared test was used to statistically compare patients that underwent procedures in the MRI group vs. those in non-MRI group. Results: 619 patients undergoing osteomyelitis treatment between January 2009 and September 2015 at our institution were identified, of which 40.4% were female and 59.6% were male. 151 patients had a total of 227 MRIs of the lower extremity performed vs. 468 patients that did not have MRIs performed. Of the MRI cohort, 104/151 patients (68.9%) had subsequent operative procedures, whereas in the non-MRI cohort 299/468 patients (63.9%) had subsequent operative procedures (p = 0.26). Of the 227 MRIs performed, 85 were deemed impactful MRIs and 142 were deemed non-impactful MRIs. Average MRI cost at our institution for the lower extremity with and without contrast was $5069.75. Using our previous definition, the cost of an impact MRI was calculated to be effectively $13,539.21. Conclusion: MRI can be an effective modality in aiding the clinical diagnosis of osteomyelitis, however, it can be an unnecessary cost when not used to guide treatment. In our study, we did not find a significant difference in the operative rate between patients undergoing MRIs vs. those that did not. We also found that the effective cost of an MRI that led to a change in treatment was $13,539, almost 2.7 times higher than the average cost of an MRI at our institution.

PIPELINES AND PIPEDREAMS

1974 ◽  
Vol 14 (1) ◽  
pp. 145
Author(s):  
A. E. Ranson
Keyword(s):  
Low Cost ◽  
Unit Cost ◽  
The United States ◽  
Direct Function ◽  
North West ◽  
Remote Areas ◽  
The North ◽  
The Status ◽  
Australian Experience ◽  
The Cost

There is little Australian experience to work on but the available evidence indicates that the capital cost of installing pipelines in Australia is well in excess of the cost of building similar size lines in the United States. The terrain in which the line is being laid is an important factor in total cost.The costs of operating a gas pipeline are essentially determined by the cost of installation of the line and the cost of the funds used. The first of these factors is largely outside the control of the operator although it does have some discretion in areas such as the source of the pipe to be used. The cost of the funds used in a project is dependent on the status of the owner and while private pipeline owners have tended to be low cost borrowers, government bodies should be able to obtain better rates of interest. However, the source of government funds is limited and the allocation of these funds should be determined by suitable tests of social and economic benefits.Given the capital and financial costs of a pipeline the unit cost of transporting gas is a direct function of throughput and the variation in that throughput.Even under generous usage assumptions, the pipe which is projected to join the North West Shelf to the East Coast will not be economic for many years. Provision of funds from consolidated revenue and other devices will not reduce the costs but merely divert them to taxpayers. Pipelines to some of the more remote areas will probably never be economic.

Underresourced Hospital Infection Control and Prevention Programs: Penny Wise, Pound Foolish?

2007 ◽  
Vol 28 (7) ◽  
pp. 767-773 ◽  
Author(s):  
Deverick J. Anderson ◽  
Kathryn B. Kirkland ◽  
Keith S. Kaye ◽  
Paul A. Thacker ◽  
Zeina A. Kanafani ◽  
...  
Keyword(s):  
Infection Control ◽  
Annual Cost ◽  
Blood Stream Infection ◽  
The United States ◽  
Total Annual Cost ◽  
Community Hospitals ◽  
Control Programs ◽  
Successful Infection ◽  
Hospital Infection Control ◽  
The Cost

Objectives.To estimate the cost of healthcare-associated infections (HAIs) in a network of 28 community hospitals and to compare this sum to the amount budgeted for infection control programs at each institution and for the entire network.Design.We reviewed literature published since 1985 to estimate costs for specific HAIs. Using these estimates, we determined the costs attributable to specific HAIs in a network of 28 hospitals during a 1-year period (January 1 through December 31, 2004). Cost-saving models based on reductions in HAIs were calculated.Setting.Twenty-eight community hospitals in the southeastern region of the United States.Results.The weight-adjusted mean cost estimates for HAIs were $25,072 per episode of ventilator-associated pneumonia, $23,242 per nosocomial blood stream infection, $10,443 per surgical site infection, and $758 per catheter-associated urinary tract infection. The median annual cost of HAIs per hospital was $594,683 (interquartile range [IQR], $299,057-$l,287,499). The total annual cost of HAIs for the 28 hospitals was greater than $26 million. Hospitals budgeted a median of $129,000 (IQR, $92,500-$200,000) for infection control; the median annual cost of HAIs was 4.6 (IQR, 3.4-8.0) times the amount budgeted for infection control. An annual reduction in HAIs of 25% could save each hospital a median of $148,667 (IQR, $74,763-$296,861) and could save the group of hospitals more than $6.5 million.Conclusions.The economic cost of HAIs in our group of 28 study hospitals was enormous. In the modern age of infection control and patient safety, the cost-control ratio will become the key component of successful infection control programs.

Financial impact of cancer care on survivors: Results from the 2015 LIVESTRONG survey.

2017 ◽  
Vol 35 (5_suppl) ◽  
pp. 10-10
Author(s):  
Aditi Narayan
Keyword(s):  
Cancer Care ◽  
Daily Living ◽  
Online Survey ◽  
Financial Impact ◽  
Retirement Savings ◽  
Foreseeable Future ◽  
Doctor Visit ◽  
Survey Results ◽  
The Cost ◽  
Out Of Pocket Costs

10 Background: The cost of cancer care in the U.S. was $124.5 billion in 2010, and is projected to increase by 27% to $158 billion in 2020. With an estimated 1.7 million new cancer cases every year, it is imperative to understand the financial impact of cancer care on survivors’ decision-making and daily living. Methods: In August of 2015, LIVESTRONG conducted an online survey to learn more about the financial impact of treatment on cancer survivors and their loved ones. Two similar surveys were distributed for survivors (n = 1,704) and loved ones (n = 739). Our analyses focus on the results from the survivor survey. Results: Fifty-nine percent of survivors reported that they experienced a lot of or some financial problems as a result of cancer. Eighty-five percent of survivors reported that their provider did not discuss the costs of care with them, and 12% reported that they would have altered decisions about treatment if they had known then what they know now about the financial impact of cancer. Most survivors (59%) reported that they spent less than $10,000 on out-of-pocket costs while 27% reported that they spent between $10,000 and $24,999 on out-of-pocket costs. The majority of respondents reported that they paid out-of-pocket for doctor visit co-pays (77%), transportation (60%) and medications (51%) (Table 1). Additionally, 61% of survivors reported that they had to make financial sacrifices such as using retirement savings and spending less on day-to-day living expenses. Conclusions: With costs of cancer care expected to continue rising for the foreseeable future, there is a need for more and better communication between patients and healthcare teams related to the potential financial impact of cancer care prior to treatment. Cancer institutions should consider including financial counselors as a part of care teams to inform patients of costs based on insurance status and type, and help them make educated and well-informed decisions related to their care. [Table: see text]

Financial impact of spinal cord stimulation on the healthcare budget: a comparative analysis of costs in Canada and the United States

2009 ◽  
Vol 10 (6) ◽  
pp. 564-573 ◽  
Author(s):  
Krishna Kumar ◽  
Sharon Bishop
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Stimulation ◽  
Unit Cost ◽  
The United States ◽  
Maintenance Cost ◽  
Healthcare Budget ◽  
The Us ◽  
Initial Implantation ◽  
The Individual ◽  
The Cost

Object Many institutions with spinal cord stimulation (SCS) programs fail to realize that besides the initial implantation cost, budgetary allocation must be made to address annual maintenance costs as well as complications as they arise. Complications remain the major contributing factor to the overall expense of SCS. The authors present a formula that, when applied, provides a realistic representation of the actual costs necessary to implant and maintain SCS systems in Canada and the US. Methods The authors performed a retrospective analysis of 197 cases involving SCS (161 implanted and 36 failed trial stimulations) between 1995 and 2006. The cost of patient workup, initial implantation, annual maintenance, and resources necessary to resolve complications were assessed for each case and a unit cost applied. The total cost allocated for each case was determined by summing across healthcare resource headings. Using the same parameters, the unit cost was calculated in both Canadian (CAD) and US dollars (USD) at 2007 prices. Results The cost of implanting a SCS system in Canada is $21,595 (CAD), in US Medicare $32,882 (USD), and in US Blue Cross Blue Shield (BCBS) $57,896 (USD). The annual maintenance cost of an uncomplicated case in Canada is $3539 (CAD), in US Medicare $5071 (USD), and in BCBS $7277 (USD). The mean cost of a complication was $5191 in Canada (range $136–18,837 [CAD]). In comparison, in the US the figures were $9649 (range $381–28,495) for Medicare and $21,390 (range $573–54,547) for BCBS (both USD). Using these calculations a formula was derived as follows: the annual maintenance cost (a) was added to the average annual cost per complication per patient implanted (b); the sum was then divided by the implantation cost (c); and the result was multiplied by 100 to obtain a percentage (a + b ÷ c × 100). To make this budgetary cap universally applicable, the results from the application of the formula were averaged, resulting in an 18% premium. Conclusions For budgeting purposes the institution should first calculate the initial implantation costs that then can be “grossed up” by 18% per annum. This amount of 18% should be in addition to the implantation costs for the individual institution for new patients, as well as for each actively managed patient. This resulting amount will cover the costs associated with annual maintenance and complications for every actively managed patient. As the initial cost of implantation in any country reflects their current economics, the formula provided will be applicable to all implanters and policy makers alike.

Speech-Language Pathologists' Perceptions of Their Preparation and Confidence for Providing Dysphagia Services

2020 ◽  
Vol 5 (6) ◽  
pp. 1666-1682
Author(s):  
Lena G. Caesar ◽  
Merertu Kitila
Keyword(s):  
Service Delivery ◽  
Graduate School ◽  
Online Survey ◽  
The United States ◽  
Academic Preparation ◽  
Speech Language Pathologists ◽  
Confidence Levels ◽  
Graduate School Preparation ◽  
Graduate Preparation ◽  
Significant Relationships

Purpose The purpose of this study was to investigate the perceptions of speech-language pathologists (SLPs) regarding their academic preparation and current confidence levels for providing dysphagia services, and the relationship between their perceptions of graduate school preparation and their current levels of confidence. Method This study utilized an online survey to gather information from 374 American Speech-Language-Hearing Association–certified SLPs who currently provide dysphagia services in the United States. Surveys were primarily distributed through American Speech-Language-Hearing Association Special Interest Group forums and Facebook groups. The anonymous survey gathered information regarding SLPs' perceptions of academic preparation and current confidence levels for providing dysphagia services in 11 knowledge and skill areas. Results Findings indicated that more than half of respondents did not feel prepared following their graduate academic training in five of the 11 knowledge and skill areas related to dysphagia service delivery. However, about half of respondents indicated they were currently confident about their ability to provide services in eight of the 11 knowledge and skill areas. Findings also indicated that their current confidence levels to provide dysphagia services were significantly higher than their perceptions of preparation immediately following graduate school. However, no significant relationships were found between respondents' self-reported current confidence levels and their perceptions of the adequacy of their academic preparation. Conclusions Despite SLPs' low perceptions of the adequacy of their graduate preparation for providing dysphagia services in specific knowledge and skill areas immediately following graduation, they reported high confidence levels with respect to their actual service delivery. Implications of these findings are discussed.

School-Based Speech-Language Pathologists' Perceived Self-Efficacy in Conducting Multidimensional Treatment With Children Who Stutter

2020 ◽  
Vol 51 (4) ◽  
pp. 1172-1186
Author(s):  
Carolina Beita-Ell ◽  
Michael P. Boyle
Keyword(s):  
Self Efficacy ◽  
Clinical Training ◽  
Online Survey ◽  
The United States ◽  
Comfort Level ◽  
Social Emotional ◽  
Speech Language Pathologists ◽  
Fluency Disorders ◽  
Cognitive Components ◽  
School Based

Purpose The purposes of this study were to examine the self-efficacy of school-based speech-language pathologists (SLPs) in conducting multidimensional treatment with children who stutter (CWS) and to identify correlates of self-efficacy in treating speech-related, social, emotional, and cognitive domains of stuttering. Method Three hundred twenty randomly selected school-based SLPs across the United States responded to an online survey that contained self-efficacy scales related to speech, social, emotional, and cognitive components of stuttering. These ratings were analyzed in relation to participants' beliefs about stuttering treatment and their comfort level in treating CWS, perceived success in therapy, and empathy levels, in addition to their academic and clinical training in fluency disorders as well as demographic information. Results Overall, SLPs reported moderate levels of self-efficacy on each self-efficacy scale and on a measure of total self-efficacy. Significant positive associations were observed between SLPs' self-efficacy perceptions and their comfort level in treating CWS, self-reported success in treatment, beliefs about the importance of multidimensional treatment, and self-reported empathy. There were some discrepancies between what SLPs believed was important to address in stuttering therapy and how they measured success in therapy. Conclusions Among school-based SLPs, self-efficacy for treating school-age CWS with a multidimensional approach appears stronger than previously reported; however, more progress in training and experience is needed for SLPs to feel highly self-efficacious in these areas. Continuing to improve clinician self-efficacy for stuttering treatment through improved academic training and increased clinical experiences should remain a high priority in order to enhance outcomes for CWS. Supplemental Material https://doi.org/10.23641/asha.12978194

Demonstrating Nutrient Cost Gradients: A Brooklyn Case Study

2014 ◽  
Vol 84 (5-6) ◽  
pp. 244-251 ◽  
Author(s):  
Robert J. Karp ◽  
Gary Wong ◽  
Marguerite Orsi
Keyword(s):  
Low Income ◽  
Energy Content ◽  
Food Selection ◽  
The United States ◽  
United States Department ◽  
Micronutrient Deficiencies ◽  
Caloric Density ◽  
Low Income Families ◽  
The Cost ◽  
The Impact

Abstract. Introduction: Foods dense in micronutrients are generally more expensive than those with higher energy content. These cost-differentials may put low-income families at risk of diminished micronutrient intake. Objectives: We sought to determine differences in the cost for iron, folate, and choline in foods available for purchase in a low-income community when assessed for energy content and serving size. Methods: Sixty-nine foods listed in the menu plans provided by the United States Department of Agriculture (USDA) for low-income families were considered, in 10 domains. The cost and micronutrient content for-energy and per-serving of these foods were determined for the three micronutrients. Exact Kruskal-Wallis tests were used for comparisons of energy costs; Spearman rho tests for comparisons of micronutrient content. Ninety families were interviewed in a pediatric clinic to assess the impact of food cost on food selection. Results: Significant differences between domains were shown for energy density with both cost-for-energy (p < 0.001) and cost-per-serving (p < 0.05) comparisons. All three micronutrient contents were significantly correlated with cost-for-energy (p < 0.01). Both iron and choline contents were significantly correlated with cost-per-serving (p < 0.05). Of the 90 families, 38 (42 %) worried about food costs; 40 (44 %) had chosen foods of high caloric density in response to that fear, and 29 of 40 families experiencing both worry and making such food selection. Conclusion: Adjustments to USDA meal plans using cost-for-energy analysis showed differentials for both energy and micronutrients. These differentials were reduced using cost-per-serving analysis, but were not eliminated. A substantial proportion of low-income families are vulnerable to micronutrient deficiencies.

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