scholarly journals High-Cost Hospitalizations Among Elderly Patients With Cancer

2019 ◽  
Vol 15 (5) ◽  
pp. e447-e457 ◽  
Author(s):  
Jaqueline Avila ◽  
Daniel Jupiter ◽  
Mariana Chavez-MacGregor ◽  
Claire de Oliveira ◽  
Sapna Kaul
Keyword(s):  
Health Care ◽  
Elderly Patients ◽  
Odds Ratio ◽  
Lower Cost ◽  
Metastatic Cancer ◽  
The United States ◽  
National Sample ◽  
Interquartile Range ◽  
Care Needs ◽  
Patients With Cancer

PURPOSE: Health care costs are driven by a small proportion of patients, and it is important to identify their characteristics to effectively manage their health care needs. We examined characteristics associated with high-cost inpatient visits of elderly patients with cancer using a national sample. METHODS: We identified 574,367 inpatient visits of individuals age 65 years or older with a cancer diagnosis using the 2014 National Inpatient Sample data, an all-payer sample of inpatient stays in the United States. High-cost visits were defined as those with a total cost at or above the 90th percentile. The remaining visits were defined as the lower-cost group. We examined patients’ clinical characteristics and hospital characteristics for both groups. Logistic regression was used to identify characteristics associated with being in the high-cost group. RESULTS: The median visit cost in the high-cost group was $38,194 (interquartile range, $31,405 to $51,802), which was nearly five times the cost of the lower-cost group (median, $8,257; interquartile range, $5,032 to $13,335). Hematologic malignancies were the most common cancer in the high-cost group. Those in the high-cost group were more likely to have metastatic cancer. Compared with patients with no comorbidities, those with five or more comorbidities were four times more likely to be in the high-cost group (odds ratio, 4.08; 95% CI, 3.74 to 4.46). Patients with a greater number of procedures were also more likely to be in the high-cost group (odds ratio, 1.57; 95% CI, 1.52 to 1.61). CONCLUSION: High-cost cancer visits were five times more expensive than the remaining visits. Identification of high-cost visits and the associated factors may help provide tailored strategies to effectively manage costly inpatient admissions.

scholarly journals Health care needs of elderly patients with lung, liver, or colon cancer in Taiwan

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Tzu-Yin Lee ◽  
Henny Dwi Susanti ◽  
Kuo-Chen Hung ◽  
Su-Yueh Yang ◽  
Hui-Fen Fang ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Health Care ◽  
Liver Cancer ◽  
Elderly Patients ◽  
Functional Status ◽  
Advanced Cancer ◽  
Daily Living ◽  
Health Care Needs ◽  
Care Needs ◽  
More Care

Abstract Background Globally, different age groups in the elderly population have experienced major shifts over time. Human life expectancy doubled from the 19th to the twentieth century and has increased to 80 years in the twenty-first century. These conditions imply economic challenges and the increasing prevalence of certain health conditions. Old age is associated with increased care needs in various aspects of daily life. This study assessed the health care needs of elderly patients with lung, liver, and colorectal cancer in Taiwan and analyzed the factors underlying their needs. Methods This cross-sectional descriptive survey assessed 234 elderly patients with diagnosis of lung, liver, and colorectal cancer in Taiwan. We investigated their health care needs and daily living functions by using the Supportive Care Needs Survey and Karnofsky Performance Status, respectively. Results Patients required the most assistance in physical functioning and daily living. Patients aged ≥85 years required more care than those aged 65–74 years in terms of information access and sexuality needs. Patients with poor functional status required more care than those capable of undertaking normal activities. Patients diagnosed as having liver cancer required more care than those with lung or colorectal cancer. Patients with advanced cancer required more physical and daily care than those with early-stage cancer. Conclusions Patients’ health care needs differed with age, primary cancer site, and functional status. Patients aged ≥85 years and those with poor function, primary liver cancer, and advanced cancer had higher care needs.

scholarly journals Empowering Health Care Professionals: An Interprofessional Education Model Implementation and Evaluation

2019 ◽  
Author(s):  
Jessica Shank Coviello
Keyword(s):  
Health Care ◽  
Health Care Professionals ◽  
Interprofessional Education ◽  
Healthcare Professionals ◽  
The United States ◽  
Healthcare Systems ◽  
World Health ◽  
Institute Of Medicine ◽  
Care Needs ◽  
Ensure Patient Safety

In 2016, the Institute of Medicine (IOM) reported medical error as the 3rd leading cause of death in healthcare systems in the United States. Effective communication of patient care needs across healthcare disciplines is critical to ensure patient safety, quality of care, and to improve operational efficiencies in healthcare systems. Ineffective collaboration and communication among healthcare professionals within the procedural areas increases the potential of harm as a patient moves from one healthcare professional to another. Health care systems are thus encouraged to train employees with a focus on interprofessional education (IPE) and collaborative practice. IOM and World Health Organization (WHO) recommend the use of IPE to help improve communication and collaboration. However the current educational structure in many institutions does not include IPE. As such, healthcare professionals work in silos, with little or no collaboration with one another, which may result in service duplication, increased service cost, and poor health outcomes for patients.

scholarly journals FSMB Census of Licensed Physicians in the United States, 2018

2019 ◽  
Vol 105 (2) ◽  
pp. 7-23 ◽  
Author(s):  
Aaron Young ◽  
Humayun J. Chaudhry ◽  
Xiaomei Pei ◽  
Katie Arnhart ◽  
Michael Dugan ◽  
...  
Keyword(s):  
United States ◽  
Health Care ◽  
Medical School ◽  
Census Data ◽  
Medical Schools ◽  
The United States ◽  
Geographic Region ◽  
Physician Workforce ◽  
Care Needs ◽  
State Medical Boards

ABSTRACT There are 985,026 physicians with Doctor of Medicine (MD) and Doctor of Osteopathic Medicine (DO) degrees licensed to practice medicine in the United States and the District of Columbia, according to physician census data compiled by the Federation of State Medical Boards (FSMB). These qualified physicians graduated from 2,089 medical schools in 167 countries and are available to serve a U.S. national population of 327,167,434. While the percentage of physicians who are international medical graduates have remained relatively stable over the last eight years, the percentage of physicians who are women, possess a DO degree, have three or more licenses, or are graduates of a medical school in the Caribbean have increased by varying degrees during that same period. This report marks the fifth biennial physician census that the FSMB has published, highlighting key characteristics of the nation's available physician workforce, including numbers of licensees by geographic region and state, type of medical degree, location of medical school, age, gender, specialty certification and number of active licenses per physician. The number of licensed physicians in the United States has been growing steadily, due in part to an expansion in the number of medical schools and students during the past two decades, even as concerns of a physician shortage to meet health care demands persist. The average age of licensed physicians continues to increase, and more licensed physicians appear to be specialty certified, though the latter finding may reflect more comprehensive reporting. This census was compiled using the FSMB's Physician Data Center (PDC), which collects, collates and analyzes physician data directly from the nation's state medical and osteopathic boards and is uniquely positioned to provide a comprehensive snapshot of information about licensed physicians. A periodic national census of this type offers useful demographic and licensure information about the available physician workforce that may be useful to policy makers, researchers and related health care organizations to better understand and address the nation's health care needs.

scholarly journals Health Care Today: Whom Do We Really Care About

2020 ◽  
pp. 002436392095166
Author(s):  
Brother Ignatius Perkins
Keyword(s):  
Health Care ◽  
Common Good ◽  
Human Person ◽  
The United States ◽  
American People ◽  
Health Care Needs ◽  
Care Needs ◽  
Moral Issues ◽  
The Common ◽  
The Continuum

Health services in the United States, driven by moral relativism, technology, financial algorithms, present draconian threats to the ability of these services to respond to the health care needs of the American people. Critical moral issues must be addressed, resolved, and serve as the foundation for a renewed health care system that fulfills the call for the common good and provides services in response to the question “who do we really care about.” Millions of our brothers and sisters continue to join the ranks of the uninsured and unemployed. What is urgently needed is a fair, equitable, accessible, affordable, and, most importantly, an ethical system of health care where the dignity and freedom of the human person, across the continuum of life from conception to natural death, is once again recognized as the summit of the work before us.

Emerging Pharmacotherapy and Health Care Needs of Patients in the Age of Artificial Intelligence and Digitalization

2020 ◽  
Vol 54 (10) ◽  
pp. 1038-1046
Author(s):  
Barbara J. Zarowitz
Keyword(s):  
Artificial Intelligence ◽  
Health Care ◽  
Ethnic Diversity ◽  
Health Care Professionals ◽  
Large Data ◽  
The United States ◽  
Wearable Devices ◽  
Data Sets ◽  
Care Needs ◽  
Clinician Training

Advances in the application of artificial intelligence, digitization, technology, iCloud computing, and wearable devices in health care predict an exciting future for health care professionals and our patients. Projections suggest an older, generally healthier, better-informed but financially less secure patient population of wider cultural and ethnic diversity that live throughout the United States. A pragmatic yet structured approach is recommended to prepare health care professionals and patients for emerging pharmacotherapy needs. Clinician training should include genomics, cloud computing, use of large data sets, implementation science, and cultural competence. Patients will need support for wearable devices and reassurance regarding digital medicine.

scholarly journals Survival and Toxicity After Cisplatin Plus Etoposide Versus Carboplatin Plus Etoposide for Extensive-Stage Small-Cell Lung Cancer in Elderly Patients

2016 ◽  
Vol 12 (7) ◽  
pp. 666-673 ◽  
Author(s):  
Laura A. Hatfield ◽  
Haiden A. Huskamp ◽  
Elizabeth B. Lamont
Keyword(s):  
Lung Cancer ◽  
Health Care ◽  
Elderly Patients ◽  
Small Cell Lung Cancer ◽  
Cell Lung Cancer ◽  
Odds Ratio ◽  
Small Cell ◽  
Small Cell Lung ◽  
First Line ◽  
Extensive Stage

Purpose: Elderly patients with cancer are under-represented in clinical trials and risk greater toxicity from chemotherapy. These patients and their physicians need better evidence to decide among guideline-recommended regimens. We test whether patients with extensive-stage small-cell lung cancer (ES SCLC) have noninferior survival and less hospital-based health care after carboplatin/etoposide compared with cisplatin/etoposide. Methods: We analyzed SEER-Medicare data for beneficiaries with ES SCLC diagnosed at age 67 years and older between 1995 and 2009. Among patients treated with first-line chemotherapy in the ambulatory setting, 831 received cisplatin/etoposide and 2,846 received carboplatin/etoposide. Propensity score matching (2:1 ratio) yielded 778 cisplatin/etoposide and 1,502 carboplatin/etoposide patients. Results: Survival was nearly identical in the two groups: 35.7 weeks for cisplatin/etoposide and 35.9 weeks for carboplatin/etoposide. The hazard ratio of 1 (95% CI, 0.91 to 1.09) excluded our prespecified threshold, indicating noninferiority. Mortality at 6 months was indistinguishable: 35% for cisplatin/etoposide and 34% for carboplatin/etoposide. After carboplatin/etoposide, patients were less likely to be admitted to a hospital (80% v 86%, P < .001) and had fewer hospitalizations (median 1 v 2, odds ratio 0.76, 95% CI, 0.65 to 0.9), ED visits (median 1 v 2, odds ratio 0.82, 95% CI, 0.7 to 0.96), and ICU stays (median 0 v 0, odds ratio 0.82, 95% CI, 0.69 to 0.99). Conclusion: First-line carboplatin/etoposide is associated with similar survival and less subsequent hospital-based health care use than cisplatin/etoposide among elderly patients with ES SCLC treated in ambulatory settings.

scholarly journals Analyzing U.S. nurse turnover: Are nurses leaving their jobs or the profession itself?

2015 ◽  
Vol 4 (4) ◽  
pp. 48 ◽  
Author(s):  
Olena Mazurenko ◽  
Gouri Gupte ◽  
Guogen Shan
Keyword(s):  
Health Care ◽  
Registered Nurses ◽  
Quality Care ◽  
The United States ◽  
National Sample ◽  
Sample Survey ◽  
P Value ◽  
Health Care Managers ◽  
Policy Makers ◽  
Care Managers

Objective: To examine and compare factors associated with making the decision to vacate a job (organizational turnover) versus leaving the profession (professional turnover) among registered nurses (RN) in the United States (U.S.).Methods: Nationally representative data from the 2008 National Sample Survey of Registered Nurses was used. The sample consisted of 8,796 RNs who held an active RN license as of March 10, 2008, but changed a place of work or left the profession entirely. The analysis has been performed using SAS, version 9.3.Results: The results of binary logistic regression revealed that RNs who reported work-related disability (OR = 14.51; p-value: < .001), illness (OR = 3.32; p-value: < .001), experienced high physical demands (OR = 1.57; p-value: < .001) or burnout (OR = 1.39; p-value: < .001), were unsatisfied with their schedule (OR = 2.16; p-value: < .001), or staffing arrangements (OR = 1.41; p-value: < .001) were more likely to leave the profession. Whereas RNs who reported high levels of stress (OR = 0.59; p-value: < .001) were unsatisfied with the organization’s leadership (OR = 0.22; p-value: < .001), unsatisfied with their opportunity to advance their career (OR = 0.56; p-value: < .001), or were not adequately compensated (OR = 0.63; p-value: < .001), were more likely to leave the organization.Conclusions: Policy makers and health care managers should be aware of the different factors that are associated with RNs’ decision to leave the profession or an organization. Health care managers involved in the development of nurse retention strategies should address organizational leadership and consider development of comprehensive career development programs. Policy makers should consider allocating additional resources to ensure that RN workforce is of adequate size, is qualified, and is able to provide high quality care in the U.S..

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