Family Annualized Cost of Leaving: The Household as the Decision Unit in Military Retention

Author(s):  
Paul F. Hogan
1976 ◽  
Vol 61 (4) ◽  
pp. 493-500 ◽  
Author(s):  
Michael J. O'Connell ◽  
Larry L. Cummings ◽  
George P. Huber

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Deepak Nair ◽  
Michael Gibbons ◽  
Huaping Wang ◽  
Min-Chul Kim ◽  
Judi Beck ◽  
...  

Introduction: Because TIA increases the risk of subsequent stroke, rapid TIA management is key to stroke prevention. Controversy remains regarding the appropriate site of care for TIA patients. Recent literature shows high variability in care processes, admission rates, timeliness of interventions, cost of care, and outcomes, regardless of site of care. We developed a rapid TIA management process in our Clinical Decision Unit (CDU) to reduce cost and adverse outcomes. TIA patients that present to our ED are admitted to the CDU, but transfer patients with TIA are admitted to the inpatient unit (IPU). Methods: Retrospectively, we identified TIA cases by ICD coding, and reviewed records from 4/1/2012 to 3/31/2016 for patients in the CDU and in the IPU. We compared length of stay (LOS), cost of care, readmission rates, and TIA/stroke recurrence between the two groups. Statistical analysis included Chi-square and Wilcoxon two-sample test for recurrence and readmission rates, and generalized linear modeling and Poisson analysis for LOS and cost analysis. Results: A total of 731 patients presented for TIA management in the study period; 393 in CDU, and 338 in IPU. There was no statistical difference in age or sex between the two groups. Mean LOS (hours) in CDU vs IPU was 15 vs 108 (p<0.001), respectively. Total cost of care in CDU vs IPU was $3,835 vs $11,904 (p<0.001), respectively. Univariate analysis showed no appreciable difference in recurrent TIA or stroke rates; multivariate analysis of stroke recurrence for CDU (1.0%) vs IPU (3.6%) did show a small difference (p=0.024). When factoring in reduction of stroke recurrence, the final cost savings of the CDU program equaled $8,258 per patient. There was no difference in readmission rates between the two groups. Conclusion: Using a rapid TIA management protocol yielded a significantly lower LOS and cost per patient. This may justify an avoidance of inpatient admission for TIA patients.


2012 ◽  
Vol 19 (5) ◽  
pp. 323-328 ◽  
Author(s):  
Jamie G. Cooper ◽  
Dafydd Hammond-Jones ◽  
Eilis O’Neill ◽  
Rafiuddin Patel ◽  
Ross Murphy ◽  
...  

Author(s):  
Tobias Deutsch ◽  
Clemens Muchitsch ◽  
Heimo Zeilinger ◽  
Markus Bader ◽  
Markus Vincze ◽  
...  

2018 ◽  
pp. emermed-2017-206997 ◽  
Author(s):  
Muhammad Fahmi Ismail ◽  
Kieran Doherty ◽  
Paula Bradshaw ◽  
Iomhar O’Sullivan ◽  
Eugene M Cassidy

IntroductionWe previously reported that benzodiazepine detoxification for alcohol withdrawal using symptom-triggered therapy (STT) with oral diazepam reduced length of stay (LOS) and cumulative benzodiazepine dose by comparison with standard fixed-dose regimen. In this study, we aim to describe the feasibility of STT in an emergency department (ED) short-stay clinical decision unit (CDU) setting.MethodsIn this retrospective cohort study, we describe our experience with STT over a full calendar year (2014) in the CDU. A retrospective chart review was conducted and data collection included demographics, clinical details, total cumulative dose of diazepam, receipt of parenteral thiamine, LOS and disposition.Results5% (n=174) of 3222 admissions to CDU required STT. Collapse or seizure (41%, n=71) and alcohol withdrawal (21%, n=37) were the most common reasons recorded for admission to CDU in those who required STT. Median Alcohol Use Disorders Identification Test score was 25 and 112 patients (64%) had at least one Clinical Institute Withdrawal Assessment for Alcohol revised measurement ≥10, triggering a dose of diazepam (20 mg). The median cumulative oral diazepam dose was 20 mg while 24 (15%) patients received a cumulative dose of 100 mg or more. Median time for STT was 12 hours (IQR=12, R=1–48). 3% (n=5) of patients required further general hospital admission and median LOS in CDU, was 22 hours (IQR=20, R=1–168).ConclusionSTT is potentially feasible as a rapid and effective approach to managing alcohol withdrawal syndrome in the ED/CDU short-stay inpatient setting where patient LOS is generally less than 24 hours.


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