Delayed Tuberculosis Diagnosis in a Low Incidence Country and its Effect on Cost of Care

Abstract Background Tuberculosis elimination (TB) is a global priority that requires high-quality timely care to be achieved. In low TB incidence countries such as Ireland, delayed diagnosis is common. Despite cost being central to policy making, it is not known if delayed care affects care cost among TB patients in a low-incidence setting. Methods Health care records of patients with signs and symptoms of TB evaluated by a tertiary service in Ireland between July 1st 2018 and December 31st 2019 were reviewed to measure and determine predictors of patient-related delays, health care-provider related delay and the cost of TB care. Benchmarks against which the outcomes were compared were derived from the literature. Results Thirty-seven patients were diagnosed with TB and 51% (19/37) had pulmonary TB (PTB). The median patient-related delay was 60 days among those with PTB, greater than the benchmark derived from the literature (38 days). The median health care provider-related delay among patients with PTB was 16 days and, although similar to the benchmark (median 22 days, minimum 11 days, maximum 36 days) could be improved. The health care-provider related delay among patients with EPTB was 66 days, greater than the benchmark (42 days). The cost of care was €8298, and while similar to that reported in the literature (median €9,319, minimum €6,486, maximum €14,750) could be improved. Patient-related delay among those with PTB predicted care costs. Conclusion Patient-related and health care-related delays in TB diagnosis in Ireland must be reduced. Initiatives to do so should be resourced.

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Typhoid and Paratyphoid Cost of Illness in Pakistan: Patient and Health Facility Costs From the Surveillance for Enteric Fever in Asia Project II

Clinical Infectious Diseases ◽

10.1093/cid/ciaa1336 ◽

2020 ◽

Vol 71 (Supplement_3) ◽

pp. S319-S335 ◽

Cited By ~ 1

Author(s):

Nelly Mejia ◽

Farah Qamar ◽

Mohammad T Yousafzai ◽

Jamal Raza ◽

Denise O Garrett ◽

...

Keyword(s):

Health Care ◽

Health Care Provider ◽

Cost Of Illness ◽

Care Provider ◽

Enteric Fever ◽

Unit Cost ◽

Control Measures ◽

Illness Onset ◽

Provider Perspective ◽

The Cost

Abstract Background The objective of this study was to estimate the cost of illness from enteric fever (typhoid and paratyphoid) at selected sites in Pakistan. Methods We implemented a cost-of-illness study in 4 hospitals as part of the Surveillance for Enteric Fever in Asia Project (SEAP) II in Pakistan. From the patient and caregiver perspective, we collected direct medical, nonmedical, and indirect costs per case of enteric fever incurred since illness onset by phone after enrollment and 6 weeks later. From the health care provider perspective, we collected data on quantities and prices of resources used at 3 of the hospitals, to estimate the direct medical economic costs to treat a case of enteric fever. We collected costs in Pakistani rupees and converted them into 2018 US dollars. We multiplied the unit cost per procedure by the frequency of procedures in the surveillance case cohort to calculate the average cost per case. Results We collected patient and caregiver information for 1029 patients with blood culture–confirmed enteric fever or with a nontraumatic terminal ileal perforation, with a median cost of illness per case of US $196.37 (IQR, US $72.89–496.40). The median direct medical and nonmedical costs represented 8.2% of the annual labor income. From the health care provider perspective, the estimated average direct medical cost per case was US $50.88 at Hospital A, US $52.24 at Hospital B, and US $11.73 at Hospital C. Conclusions Enteric fever can impose a considerable economic burden in Pakistan. These new estimates of the cost of illness of enteric fever can improve evaluation and modeling of the costs and benefits of enteric fever prevention and control measures, including typhoid conjugate vaccines.

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Custo efetividade da auditoria concorrente em uma operadora de saúde

Revista de Administração em Saúde ◽

10.23973/ras.75.162 ◽

2019 ◽

Vol 19 (75) ◽

Author(s):

Ana Fátima Souza Melo de Andrade ◽

Luiza Nauane Borges Benevides

Keyword(s):

Health Care ◽

Cost Effectiveness ◽

Hospital Stay ◽

Health Care Provider ◽

Care Provider ◽

Economic Losses ◽

Correlation Technique ◽

Strong Positive Correlation ◽

Care Providers ◽

The Cost

A busca por qualidade, faturamento correto da conta hospitalar e redução de gastos indevidos é a perspectiva atual das operadoras de saúde. Nessa linha de pensamento, o objetivo principal foi analisar a redução de custos hospitalares de uma operadora de saúde do estado de Sergipe, Brasil, entre janeiro e outubro de 2018, por meio da auditoria concorrente. Trata-se de um estudo descritivo, com abordagem quanti-qualitativa, do tipo relato de experiência. A análise qualitativa tratou-se de observações a partir da vivência como profissional. Na análise quantitativa, utilizou-se da estatística univariada para descrição dos indicadores e das variações. Para identificar a relação entre o indicador econômico, financeiro e os de qualidade, foi utilizada a técnica de correlação de Pearson. Como resultado, analisou-se que as glosas recuperaram perdas econômicas, mas não aumentaram de forma linear o custo efetividade para a operadora de saúde. Houve correlação moderada negativa (p<0,001) entre permanência hospitalar e custo-efetividade da auditoria concorrente. Enquanto que a desospitalização obteve uma correlação positiva forte (p<0,001), com o custo efetividade da auditoria concorrente. A partir destes dados, concluiu-se que o crescimento da desospitalização e a diminuição da permanência hospitalar impactaram no aumento da eficácia da auditoria concorrente.Palavras-chave: Auditoria de Enfermagem. Avaliação de Custo-Efetividade. Economia e Organizações de Saúde. ABSTRACTThe search for quality, correct billing of the hospital bill and reduction of undue expenses is the current perspective of health care providers. In this line of thought, the main objective was to analyze the reduction of hospital costs of a health care provider in the state of Sergipe, Brazil, between January and October of 2018, through a concurrent audit. This is a descriptive study, with quantitative-qualitative approach, of the type of experience report. The qualitative analysis was about observations from the experience as a professional. In the quantitative analysis, univariate statistics were used to describe indicators and variations. In order to identify the relationship between economic, financial and quality indicators, the Pearson correlation technique was used. As a result, it was analyzed that the glosses recovered economic losses, but did not linearly increase the cost effectiveness for the health care provider. There was a moderate negative correlation (p <0.001) between hospital stay and cost-effectiveness of the concurrent audit. While the de-hospitalization obtained a strong positive correlation (p <0.001), with the cost effectiveness of the concurrent audit. Based on these data, it was concluded that the increase in de-hospitalization and the decrease in hospital stay had an impact on the effectiveness of the concurrent audit. Keywords: Nursing Audit. Cost-effectiveness Evaluation. Health Care Economics and Organizations.

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Costs and Cost Effectiveness of a Health Care Provider–Directed Intervention to Promote Colorectal Cancer Screening Among Veterans

Journal of Clinical Oncology ◽

10.1200/jco.2005.02.6278 ◽

2005 ◽

Vol 23 (34) ◽

pp. 8877-8883 ◽

Cited By ~ 22

Author(s):

Michael S. Wolf ◽

Karen A. Fitzner ◽

Eowyn F. Powell ◽

Kathryn R. McCaffrey ◽

A. Simon Pickard ◽

...

Keyword(s):

Colorectal Cancer ◽

Health Care ◽

Information Technology ◽

Cost Effectiveness ◽

Cancer Screening ◽

Colorectal Cancer Screening ◽

Health Care Provider ◽

Care Provider ◽

Sensitivity Analyses ◽

The Cost

Purpose Colorectal cancer screening is underused, particularly in the Veterans Affairs (VA) population. In a randomized controlled trial, a health care provider–directed intervention that offered quarterly feedback to physicians on their patients' colorectal cancer screening rates led to a 9% increase in colorectal cancer screening rates among veterans. The objective of this secondary analysis was to assess the cost effectiveness of the colorectal cancer screening promotion intervention. Methods Providers in the intervention arm attended an educational workshop on colorectal cancer screening and received confidential feedback on individual and group-specific colorectal cancer screening rates. The primary end point was completion of colorectal cancer screening tests. Sensitivity analyses investigated cost-effectiveness estimates varying the data collection methods, costs of labor and technology, and the effectiveness of the intervention. Results Rates of colorectal cancer screening for the intervention versus control arms were 41.3% v 32.4%, respectively (P < .05). The incremental cost-effectiveness ratio was $978 per additional veteran screened based on feedback reports generated from manual review of records. However, if feedback reports could be generated from information technology systems, sensitivity analyses indicate that the cost-effectiveness estimate would decrease to $196 per additional veteran screened. Conclusion An intervention based on quarterly feedback reports to physicians improved colorectal cancer screening rates at a VA medical center. This intervention would be cost effective if relevant data could be generated by existing information technology systems. Our findings may have broad applicability because a 2005 Medicare initiative will provide the VA electronic medical record system as a free benefit to all US physicians.

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2. Understanding Patient Preferences for Meningococcal Serogroup B Vaccines in the United States

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.047 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S23-S23

Author(s):

Reed Johnson ◽

Angelyn Fairchild ◽

Dale Whittington ◽

Jessica Presa ◽

Amit Srivastava ◽

...

Keyword(s):

Health Care ◽

Young Adults ◽

Willingness To Pay ◽

Health Care Provider ◽

Care Provider ◽

Clinical Decision Making ◽

Stated Preference ◽

The United States ◽

Low Incidence ◽

Research Grant

Abstract Background Among US adolescents, meningococcal disease serogroup B (MenB) causes more cases (62% in 2018) than other 4 serogroups (A, C, W, Y). ACIP’s recommendation for shared clinical decision-making calls for individuals to be given the choice of vaccination after consultation with their health care provider. No data are available to-date that formally quantify values and preferences for MenB vaccines. Our objective is to quantify such values. Methods Following best-practice standards for stated-preference research, a survey employed a discrete choice experiment (DCE) and contingent-valuation (CV) questions to quantify respondents’ trade-off preferences for vaccines that protect against diseases with various levels of severity and incidence, and to estimate the monetary value of receiving additional consultation regarding MenB vaccination with healthcare providers. A total of 2162 respondents (1203 young adults and 1185 parents) completed on-line surveys between August - October 2019. Results DCE analysis identified 3 classes of respondents for parents (table 1) and young adults, respectively. Overall, half of the respondents considered vaccines for low-incidence, high-severity diseases such as MenB to be at least as important as vaccines for high-incidence, low- severity diseases. Respondents were asked to react to a hypothetical situation in which the health care provider did not discuss MenB vaccines with them and found out later. Approximately 70% of respondents expressed reactions ranging from ‘Concerned’ to ‘Angry or Disgusted’ (Figure 1). The majority of young adults and parents wanted physician-provided information about protection against low-incidence but serious diseases such as MenB. The CV analysis estimated that willingness to pay for the MenB vaccine was about US$300 for young adults and over US$400 for parents. However, they often felt entitled to the consultation with their health care provider about the MenB vaccines and were not willing to pay much for it (Figure 2). Table 1. Parent Class Results (n=1185) Figure 1. Respondents’ Reactions to Health Care Provider Choosing Not to Discuss the MenB Vaccine with Them Figure 2. Mean Willingness to Pay for Additional Time with Doctor for Discussing MenB Vaccine and Willingness to Pay for MenB Vaccine Conclusion The study found that parents of adolescents and young adults placed significant value on obtaining information about and protection against low-incidence diseases such as MenB that can result in severe long-term disabilities and death. Disclosures Reed Johnson, PhD, Pfizer (Research Grant or Support) Angelyn Fairchild, BA, Pfizer (Research Grant or Support) Dale Whittington, PhD, Pfizer (Research Grant or Support) Jessica Presa, MD, Pfizer (Employee) Amit Srivastava, PhD, Pfizer (Employee) Liping Huang, MD, MA, MS, Pfizer (Employee)

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Post-Thrombotic Syndrome: Assessment of Patient and Health Care Provider Knowledge and Awareness.

Blood ◽

10.1182/blood.v116.21.3835.3835 ◽

2010 ◽

Vol 116 (21) ◽

pp. 3835-3835

Author(s):

Sara R azquez ◽

Susan Kahn

Keyword(s):

Health Care ◽

General Hospital ◽

Health Care Provider ◽

Health Care Providers ◽

Care Provider ◽

Signs And Symptoms ◽

Care Providers ◽

Improvement Project ◽

University Of Utah ◽

Jewish General Hospital

Abstract Abstract 3835 Background: Despite evidence demonstrating that the post-thrombotic syndrome (PTS) is a common and burdensome long-term complication of deep vein thrombosis (DVT), we hypothesized that patient and health care provider awareness of this condition was poor, thereby limiting the use of measures to prevent and screen for PTS. Objectives: We designed a quality improvement project to (1) identify existing gaps in health care provider and patient knowledge and awareness of PTS, and (2) use this information to guide the development and implementation of a PTS educational curriculum. Methods: Health care providers (internal medicine or family medicine physicians and anticoagulation pharmacists) at two clinical centers were asked to complete a brief survey about PTS knowledge and practice patterns. Patients diagnosed with proximal lower extremity deep vein thrombosis (DVT) who were managed in the Thrombosis Service at each center were asked to complete a brief survey with questions about basic PTS knowledge (University of Utah) or PTS education received and use of elastic compression stockings (ECS) for PTS prevention (Jewish General Hospital). Results: Provider survey: Of the 358 surveys sent to health care providers from both institutions, 77 surveys were completed (17/134 for the University of Utah, 60/224 for Jewish General Hospital). Survey respondents included 59 physicians or resident physicians, and 18 pharmacists. When asked to identify the average incidence of PTS after DVT, only 35% of providers responded correctly. Providers correctly identified that wearing ECS following DVT can prevent PTS in some cases (94% correct), and that diuretic medications are not used to treat PTS (100% correct). However, only 31% of providers at both institutions “always” or “frequently” discuss the risk of PTS with DVT patients, only 25% “always” or “frequently” prescribe ECS for PTS prevention following DVT, and only 26% “always or “frequently” evaluate patients for the development of PTS after DVT. The primary barrier that reportedly prevents providers from performing these functions more frequently is the lack of personal knowledge or expertise to discuss or diagnose PTS. The majority of providers surveyed report they have not received prior education about PTS. Patient survey: Patients at each institution completed a different survey, each exploring different aspects of PTS knowledge. At the University of Utah (n=106 completed surveys), 54% of patients surveyed reported they had never heard of PTS. Only 50% chose the correct answer when asked to identify signs and symptoms of PTS (leg pain and swelling), and only 25% correctly identified a risk factor for PTS (blood clot above the knee). The majority of patients correctly identified appropriate leg elevation technique (67%), and the fact that lower extremities do not always return to normal following DVT (82%). When asked about a possible treatment for PTS, 66% of patients correctly chose ECS, but only 44% correctly chose ECS as also a possible PTS preventive therapy. At Jewish General Hospital (n=60 completed surveys), only 38% of patients reported receiving PTS education, and this was done primarily in the form of verbal teaching by the physician or vascular lab staff. Additionally, 38% of patients reported they were prescribed ECS following DVT, and the majority of those patients did go on to purchase the stockings and wear them regularly. Conclusion: The results of our survey establish that there is tremendous potential to impact and improve both health care provider and patient knowledge of PTS. We found that the majority of providers underestimate the incidence of PTS, which is underscored by the fact that only 1/3 of providers routinely discuss the risk of PTS with DVT patients, and only 1/4 routinely prescribe ECS and/or assess DVT patients for the development of PTS. The gaps in provider knowledge correlate with those in DVT patients surveyed. Most patients have never heard of PTS, and therefore are largely unaware of PTS risk factors, signs and symptoms, and possible preventive methods. These data will be used in the second phase of our quality improvement project to inform the development of educational materials and tools specifically tailored to the learning needs of patients and health care providers. Disclosures: No relevant conflicts of interest to declare.

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