scholarly journals Cost of Futile ICU Care in One Ontario Hospital

2021 ◽  
Vol 58 ◽  
pp. 004695802110285
Author(s):  
Nicholas Schouela ◽  
Kwadwo Kyeremanteng ◽  
Laura H. Thompson ◽  
David Neilipovitz ◽  
Michel Shamy ◽  
...  
Keyword(s):  
Critical Care ◽  
Independent Living ◽  
Economic Cost ◽  
Medical Futility ◽  
Cost Of Care ◽  
Hospital Data ◽  
Health States ◽  
Ottawa Hospital ◽  
Costing System

Critical care is a costly and finite resource that provides the ability to manage patients with life-threatening illnesses in the most advanced forms available. However, not every condition benefits from critical care. There are unrecoverable health states in which it should not be used to perpetuate. Such situations are considered futile. The determination of medical futility remains controversial. In this study we describe the length of stay (LOS), cost, and long-term outcomes of 12 cases considered futile and that have been or were considered for adjudication by Ontario’s Consent and Capacity Board (CBB). A chart review was undertaken to identify patients admitted to the Intensive Care Unit (ICU), whose care was deemed futile and cases were considered for, or brought before the CCB. Costs for each of these admissions were determined using the case-costing system of The Ottawa Hospital Data Warehouse. All 12 patients identified had a LOS of greater than 4 months (range: 122-704 days) and a median age 83.5 years. Seven patients died in hospital, while 5 were transferred to long term or acute care facilities. All patients ultimately died without returning to independent living situations. The total cost of care for these 12 patients was $7 897 557.85 (mean: $658 129.82). There is a significant economic cost of providing resource-intensive critical care to patients in which these treatments are considered futile. Clinicians should carefully consider the allocation of finite critical care resources in order to utilize them in a way that most benefits patients.

scholarly journals What Is the Magnitude and Long-term Economic Cost of Care of the British Military Afghanistan Amputee Cohort?

2015 ◽  
Vol 473 (9) ◽  
pp. 2848-2855 ◽  
Author(s):  
D. S. Edwards ◽  
Rhodri D. Phillip ◽  
Nick Bosanquet ◽  
Anthony M. J. Bull ◽  
Jon C. Clasper
Keyword(s):  
Economic Cost ◽  
Cost Of Care ◽  
British Military

Data inputs and assumptions in calculating the non-fatal burden in burden of disease studies

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
J Haagsma ◽  
G Wyper ◽  
B Devleesschauwer
Keyword(s):  
Real Life ◽  
Disability Weight ◽  
Health States ◽  
Methodological Choices ◽  
Disability Weights ◽  
Disability Adjusted Life ◽  
Simple Step ◽  
Years Lived With Disability ◽  
Disability Adjusted Life Year

Abstract Years Lived with Disability (YLD) is a component of the Disability-Adjusted Life Year (DALY), and measures the healthy time that is lost because of living with a disease or disability. YLDs are calculated by multiplying the prevalence and/or incidence of a disorder by the short- or long-term loss of health associated with that disability (the disability weight) and disease severity (severity distribution). The process of calculating a YLD involves several components and in this presentation each step will be highlighted through a sequential walk through for each step in the YLD calculation, including counting disease occurrencethe relationship between disability weights, health states and severity distributionsadjusting for comorbiditiesdealing with uncertainty The aim of this presentation is to provide a simple step by step guide on the key components in the YLD calculation. Using the real-life example of cerebrovascular disease, the presentation will outline the key choices and assumptions that underline each data input in the YLD calculation. Participants in this session will also be provided with links to resources to help facilitate this decision-making process. The workshop will end with an interactive session where the presenters will discuss the implications of the different methodological choices with the audience.

scholarly journals Rationale, Design, and Methodology of a Prospective Cohort Study for Coping with Behavioral and Psychological Symptoms of Dementia: The RECage Project

2021 ◽  
Vol 80 (4) ◽  
pp. 1613-1627
Author(s):  
Eleni Poptsi ◽  
Magda Tsolaki ◽  
Sverre Bergh ◽  
Bruno Mario Cesana ◽  
Alfonso Ciccone ◽  
...  
Keyword(s):  
Cohort Study ◽  
Psychotropic Drug ◽  
Psychological Symptoms ◽  
Cost Of Care ◽  
Community Dwelling ◽  
Drug Consumption ◽  
Study Results ◽  
Short And Long Term ◽  
Behavioral And Psychological Symptoms

Background: Behavioral and psychological symptoms of dementia (BPSD) are quite challenging problems during the dementia course. Special Care Units for people with dementia (PwD) and BPSD (SCU-B) are residential medical structures, where BPSD patients are temporarily admitted, in case of unmanageable behavioral disturbances at home. Objective: RECage (REspectful Caring for AGitated Elderly) aspires to assess the short and long-term effectiveness of SCU-Bs toward alleviating BPSD and improving the quality of life (QoL) of PwD and their caregivers. Methods: RECage is a three-year, prospective study enrolling 500 PwD. Particularly, 250 community-dwelling PwDs presenting with severe BPSD will be recruited by five clinical centers across Europe, endowed with a SCU-B, for a short period of time; a second similar group of 250 PwD will be followed by six other no-SCU-B centers solely via outpatient visits. RECage’s endpoints include short and long-term SCU-B clinical efficacy, QoL of patients and caregivers, cost-effectiveness of the SCU-B, psychotropic drug consumption, caregivers’ attitude toward dementia, and time to nursing home placement. Results: PwD admitted in SCU-Bs are expected to have diminished rates of BPSD and better QoL and their caregivers are also expected to have better QoL and improved attitude towards dementia, compared to those followed in no-SCU-Bs. Also, the cost of care and the psychotropic drug consumption are expected to be lower. Finally, PwD followed in no-SCU-Bs are expected to have earlier admission to nursing homes. Conclusion: The cohort study results will refine the SCU-B model, issuing recommendations for implementation of SCU-Bs in the countries where they are scarce or non-existent.

ADA Standards of Medical Care in Diabetes: implications for Older Adults

2020 ◽  
Vol 35 (6) ◽  
pp. 258-265
Author(s):  
Catherine E. Travis ◽  
Caren McHenry Martin
Keyword(s):  
Older Adults ◽  
Older People ◽  
Medical Care ◽  
Microvascular Complications ◽  
Cost Of Care ◽  
Individualized Treatment ◽  
Treatment Goals ◽  
Long Term Outcomes ◽  
New Literature

Each year, new literature and recommendations are incorporated into updates in the American Diabetes Association's Standards of Medical Care in Diabetes. The 2020 update increased the focus on the rising cost of care for diabetes, long-term outcomes of newer antihyperglycemics in reducing macrovascular and microvascular complications of diabetes, and the importance of individualized treatment goals. These principles are of particular significance when managing older people with diabetes. This article focuses on updates pertinent to care of the older people.

scholarly journals Economic cost of congenital CMV in the UK

2018 ◽  
Vol 104 (6) ◽  
pp. 559-563 ◽  
Author(s):  
Jenny Retzler ◽  
Nick Hex ◽  
Chris Bartlett ◽  
Anne Webb ◽  
Sharon Wood ◽  
...  
Keyword(s):  
Public Sector ◽  
Vaccine Development ◽  
Cost Model ◽  
Financial Burden ◽  
Secondary Data ◽  
Economic Cost ◽  
Future Research ◽  
The Public ◽  
The Uk

ObjectiveCongenital cytomegalovirus (cCMV) is the most common infectious cause of congenital disability. It can disrupt neurodevelopment, causing lifelong impairments including sensorineural hearing loss and developmental delay. This study aimed, for the first time, to estimate the annual economic burden of managing cCMV and its sequelae in the UK.DesignThe study collated available secondary data to develop a static cost model.SettingThe model aimed to estimate costs of cCMV in the UK for the year 2016.PatientsIndividuals of all ages with cCMV.Main outcome measuresDirect (incurred by the public sector) and indirect (incurred personally or by society) costs associated with management of cCMV and its sequelae.ResultsThe model estimated that the total cost of cCMV to the UK in 2016 was £732 million (lower and upper estimates were between £495 and £942 million). Approximately 40% of the costs were directly incurred by the public sector, with the remaining 60% being indirect costs, including lost productivity. Long-term impairments caused by the virus had a higher financial burden than the acute management of cCMV.ConclusionsThe cost of cCMV is substantial, predominantly stemming from long-term impairments. Costs should be compared against investment in educational strategies and vaccine development programmes that aim to prevent virus transmission, as well as the value of introducing universal screening for cCMV to both increase detection of children who would benefit from treatment, and to build a more robust evidence base for future research.

scholarly journals A team approach to the introduction of safe early mobilisation in an adult critical care unit

2018 ◽  
Vol 7 (4) ◽  
pp. e000339 ◽  
Author(s):  
Sanjiv Chohan ◽  
Sara Ash ◽  
Lorraine Senior
Keyword(s):  
Critical Care ◽  
Intensive Care ◽  
Staff Development ◽  
Critical Care Unit ◽  
Average Length ◽  
Team Approach ◽  
Early Mobilisation ◽  
Long Term Outcomes ◽  
Average Length Of Stay

Delirium and intensive care unit acquired weakness are common in patients requiring critical care and associated with higher mortality and poor long-term outcomes. Early mobilisation has been shown to reduce the duration of both conditions and is recommended as part of a strategy of rehabilitation of critically ill patients starting during their stay in intensive care. Our aim was to achieve 95% reliability with a standardised mobilisation process. Multidisciplinary involvement through the use of regular focus groups lead to the development of a standardised process of sitting a ventilated or non-ventilated patient at the side of the bed for a set period of time, which was called the daily dangle. Team learning from Plan, Do, Study, Act (PDSA)cycles, as well as feedback from both staff and patients, allowed us to develop the process and achieve a median 87% reliability. Delirium rates fell from 54.1% to 28.8%. There was no change in average length of stay, and no adverse events. Ownership by the staff, development of the process by staff, iterative testing and learning, and designs for reliability were the factors behind the successful adoption of a new and challenging process. Particular changes which drove reliability were standardisation of the criteria for a dangle, standardisation of the dangle itself and a reminder included on the daily goals checklist.

An Analysis by Gender of Long-Term Postschool Outcomes for Youth with and without Disabilities

1994 ◽  
Vol 61 (3) ◽  
pp. 282-300 ◽  
Author(s):  
Phyllis Levine ◽  
Eugene Edgar
Keyword(s):  
Gender Differences ◽  
Learning Disabilities ◽  
Mental Retardation ◽  
School Districts ◽  
Marital Status ◽  
Postsecondary Education ◽  
Independent Living ◽  
Mild Mental Retardation ◽  
Postschool Outcomes

This study analyzed gender differences in postschool outcomes for youth with learning disabilities, mild mental retardation, and no disabilities. Data were collected on two cohorts of graduates (549 youth who were graduated in 1985; 398 youth, in 1990) from three school districts. Data were collected at 1, 2, 6, and 7 years postgraduation. Comparisons were made between genders within disability groups on employment, postsecondary education attendance and graduation, engagement, independent living, marital status, and parenting. In contrast to the findings of other studies, few significant differences were noted between genders, except for the parenting category. A similar analysis between youth by disability category resulted in considerably more significant differences.

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