A comparative cost analysis between two quick diagnosis units of different levels of complexity

Author(s):  
Xavier Bosch ◽  
Elisabet Montori ◽  
Maria J Merino-Peñas ◽  
Yaroslau Compta ◽  
Andrea Ladino ◽  
...  

Aim: To compare by micro-costing the costs incurred by quick diagnosis units of tertiary and second-level hospitals. Patients & methods: We included 407 patients from a tertiary and secondary hospital unit. A bottom-up approach was applied. Results: Cost per patient was €577.5 ± 219.6 in the tertiary versus €394.7 ± 92.58 in the secondary unit (p = 0.0559). Mean number of visits and ratio of successive/first visits were significantly higher in the former (3.098 and 2.07 vs 2.123 and 1.12, respectively). Personnel and indirect costs including their percent contribution to overall costs accounted for the main differences. Conclusion: A greater volume of appointments, number of staff and staff time and a greater complexity of patients from the tertiary hospital unit justified the differences in cost outcomes.

Author(s):  
Sara C. Keller ◽  
Sara Pau ◽  
Alejandra B. Salinas ◽  
Opeyemi Oladapo-Shittu ◽  
Sara E. Cosgrove ◽  
...  

Abstract Background: Physical distancing among healthcare workers (HCW) is an essential strategy in preventing HCW-to-HCW transmission of the SARS-CoV-2 virus. Objective: To understand barriers to physical distancing among HCW on an inpatient unit and identify strategies for improvement. Design: Qualitative study including observations and semi-structured interviews over three months. Setting: A non-COVID adult general medical unit in an academic tertiary hospital. Participants: HCWs based on the unit. Methods: We performed a qualitative study in which we (1) observed HCWs activities and proximity to each other on the unit during weekday shifts July-October 2020 and (2) conducted semi-structured interviews of HCWs to understand their experiences with and perspectives of physical distancing in the hospital. Qualitative data were coded based on a human factors engineering model. Results: We completed 25 hours of observations and 20 HCW interviews. High-risk interactions often occurred during handoffs of care at shift changes and patient rounds, where HCWs gathered regularly in close proximity for at least 15 minutes. Identified barriers included spacing and availability of computers, the need to communicate confidential patient information, and the desire to maintain relationships at work. Conclusions: Physical distancing can be improved in hospitals by restructuring computer workstations, work rooms, and breakrooms; applying visible cognitive aids; adapting shift times; and supporting rounds and meetings with virtual conferencing. Additional strategies to promote staff adherence to physical distancing include rewarding positive behaviors, having peer leaders model physical distancing, and encouraging additional safe avenues for social connection at a safe distance.


2021 ◽  
Author(s):  
Ning Xie ◽  
Zheng Zheng ◽  
Qilian Yang ◽  
Man Li ◽  
Xiaofen Ye

Abstract Background: To know the knowledge on inhaler devices in medical staff, this study surveyed knowledge of inhaled therapy and the use of inhaler devices in nurses in China.Methods: 1831 nurses were selected to survey on a new self-designed questionnaire online. The questionnaire has 11 questions, including the storage location of the inhaler devices, steps of using the inhaler device, and the common errors when using various devices, etc. Results: Among the 1831 participants, 816(44.57%), 122(6.66%) and 893(48.77%) nurses worked in community hospital, secondary hospital and tertiary hospital respectively. Adequate knowledge of inhaler devices was demonstrated by nurses working in community hospital(20.10%)、Secondary hospital(8.2%) and Tertiary hospital(13.1%). 27.70% nurses in community hospital knew operational key points in using inhaler compared to in secondary hospital (15.57%) and tertiary hospital (23.18%) P<0.01. Only 9.5%-26.00% of participants chosen correct answers about the ten questions about the use of inhaler. Question six (Which of the following is the wrong option when using Ellpta?) was the one with the highest percentage of correct answers (26.00%). The question with lowest rate of correct answers (9.50%) was question 3 (What are the main points that need to be followed when using DPI?). The most people of correct answers number is Ellpta(26.00%) and the least is Respimat(10.32%). Conclusion: The focus on community hospitals has some results in China. However, knowledge on inhaler devices should be continued to strengthen among nurses in hospital. It is necessary to create training opportunities for nurses to increase their awareness and knowledge of chronic respiratory diseases management.


2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Julia Brandenberger ◽  
Christian Pohl ◽  
Florian Vogt ◽  
Thorkild Tylleskär ◽  
Nicole Ritz

Abstract Background Asylum-seeking children represent an increasing and vulnerable group of patients whose health needs are largely unmet. Data on the health care provision to asylum-seeking children in European contexts is scarce. In this study we compare the health care provided to recent asylum-seeking and non-asylum-seeking children at a Swiss tertiary hospital. Methods We performed a cross-sectional retrospective study in a pediatric tertiary care hospital in Basel, Switzerland. All patients and visits from January 2016 to December 2017 were identified, using administrative and medical electronic health records. The asylum-seeking status was systematically assessed and the patients were allocated accordingly in the two study groups. Results A total of 202,316 visits by 55,789 patients were included, of which asylum-seeking patients accounted for 1674 (1%) visits by 439 (1%) individuals. The emergency department recorded the highest number of visits in both groups with a lower proportion in asylum-seeking compared to non-asylum-seeking children: 19% (317/1674) and 32% (64,315/200,642) respectively. The median number of visits per patient was 1 (IQR 1–2) in the asylum-seeking and 2 (IQR 1–4) in the non-asylum-seeking children. Hospital admissions were more common in asylum-seeking compared to non-asylum-seeking patients with 11% (184/1674) and 7% (14,692/200,642). Frequent visits (> 15 visits per patient) accounted for 48% (807/1674) of total visits in asylum-seeking and 25% (49,886/200,642) of total visits in non-asylum-seeking patients. Conclusions Hospital visits by asylum-seeking children represented a small proportion of all visits. The emergency department had the highest number of visits in all patients but was less frequently used by asylum-seeking children. Frequent care suggests that asylum-seeking patients also present with more complex diseases. Further studies are needed, focusing on asylum-seeking children with medical complexity.


2021 ◽  
Author(s):  
Fraence Hardtstock

Background: In order to evaluate unmet therapeutic need, this study sought to describe treatment patterns, as well as associated healthcare resource use (HCRU) and costs incurred by migraine patients in Germany. Methods: We conducted a retrospective analysis of a German claims dataset from 2013-2017, including over three million publicly-insured patients. Adult patients were included if they received at least one inpatient and/or two confirmed outpatient claims for headache/migraine from 2013-2016. Using prescription data from 2017, patients were separated into four main cohorts: those receiving prescriptions for (1) acute agents only, (2) prophylactic agents only, (3) both acute and prophylactic agents, and (4) neither acute nor prophylactic agents. Baseline characteristics were observed from 2013-2016; treatment and HCRU/cost outcomes were assessed in 2017. Results: In total, 199,283 patients were included in this analysis (mean age, 49.49 years; 73.04%, female) and 9,005 prophylactic therapy starters were identified. Overall, 43.47% of migraine patients did not receive acute or prophylactic medication in 2017, while 33.81% received only acute treatment, 9.45% received only prophylactic medication and 13.28% received both. Only 28.90% of patients initiating a prophylactic treatment were persistent after two years. HCRU was elevated for all groups, while direct costs ranged from €2,288-7,246 per year, and indirect costs ranged from €868-1,859. Conclusions: Despite high levels of HCRU, few migraine patients were treated with prophylactic agents, and those who did were at an elevated risk of early discontinuation. Ultimately, these findings indicate a resounding need for safe, timely, and efficacious use of prophylaxis among migraine patients.


2019 ◽  
Author(s):  
Julia Regina Brandenberger ◽  
Christian Pohl ◽  
Florian Vogt ◽  
Thorkild Tylleskär ◽  
Nicole Ritz

Abstract Background & Methods To compare health care provided to asylum-seeking and non-asylum-seeking children, we performed a cross-sectional study in a paediatric tertiary care hospital in Switzerland. Patients were identified using administrative and medical electronic health records from January 2016 - December 2017. Results A total of 202’316 visits by 55’789 patients were included, of which asylum-seeking patients accounted for 1674 (1%) visits by 439 (1%) patients. The emergency department had the highest number of visits in both groups with a lower proportion in asylum-seeking compared to non-asylum-seeking children: 19% (317/1674) and 32% (64’315/200’642) respectively. Hospital admissions were more common in asylum-seeking patients 11% (184/1674) and 7% (14’692/200’642). Frequent visits accounted for 48% (807/1674) of total visits in asylum-seeking and 25% (49’886/200’642) of total visits in non-asylum-seeking patients. Conclusions Hospital visits by asylum-seeking children represented a small proportion of all visits. The emergency department had the highest number of visits in all patients and was less frequently used in asylum-seeking children. Higher admission rates and a larger proportion of visits from frequently visiting patients suggest that asylum-seeking patients may present with more complex diseases.


2021 ◽  
Author(s):  
Albert Brühl

Different levels of differentiation between residents in need of care are reflected in the number of differentiations made systematically across all residents. Some caregivers only roughly divide residents into two groups, e.g. extremely dependent and independent residents. Other caregivers are able to differentiate much more finely and do so systematically. Whether systems can be found in this respect, how complex they are and what kind of testing such systems can withstand can be analysed statistically. The currently regulated specialist staffing ratios do not ensure a minimum level of specialist staffing, since they are based on degrees of care and only account for ten per cent of specialist staff time. The current systems for staffing and quality assurance must be overcome if care is to be developed and not just capped.


2020 ◽  
Author(s):  
Chen Chen ◽  
Jinglin Song ◽  
Shaoyang Zhao ◽  
Leming Zhou ◽  
Hong Chen

Abstract Background This study examines the impact of healthcare staffing levels on the quality of healthcare services. Methods We use data from a 10% random sample of inpatients in a city in China from January 2014 to June 2019, and annual reports from healthcare providers to exclude disease types related to air pollution. The final analysis uses a sample of 1122 disease types and 862,722 cases from 517 hospitals. The impact of changes in hospital admissions on length of patients’ stay in hospitals (patient hospital days) and the mortality rate of patients is analyzed by building ordinary least squares and instrumental variable measurement models and comparing the differences in the impact of healthcare staffing levels on the quality of care between different levels of hospitals. Results The patient hospital days decrease and mortality rate increases with increased attendance. Using the instrumental variable method, for every one-unit increase in the number of visits to the hospital, there is a 5.87% decrease in patient hospital days and an increase in mortality of about 0.37%. Both results are significant at the 1% level. The impact of healthcare staffing level on the quality of care varies between different levels of hospitals. The quality of care in tertiary hospitals is most affected by the number of visits, with an average decrease of 4.36% in patient hospital days and an increase of 0.27% in mortality for every one-unit increase in visits, significant at the 1% level. Conclusions Currently, China is in the transition period of a healthcare reform, and faces a large shortage of medical resources, there is considerable variation in healthcare staffing across different tiers of hospital. Continued sole reliance by hospitals on increasing the working hours of medical staff to meet patients’ medical needs is not sustainable, and may even have a negative impact on the quality of medical services.


2014 ◽  
Vol 35 (4) ◽  
pp. 86-93 ◽  
Author(s):  
Thiago Roberto Castellane Arena ◽  
Marli de Carvalho Jericó ◽  
Liliana Cristina de Castro ◽  
Valéria Castilho ◽  
Antonio Fernandes Costa Lima

The aims of this study were to analyze unnecessary laboratory exams for patients with hypertension and diabetes and to check the expenditures involved. This is an exploratory-descriptive, cross-sectional study with a quantitative approach. We used data from medical records of 293 patients registered in primary units - the Family Health Center (NSF3); secondary: School Health Center (CSE); and tertiary: Hospital das Clínicas (HC) from 2006 to 2009 in a city in Southeastern Brazil. We identified a total of 9,522 laboratory tests, of which 5.97% were unnecessary. Of these, about 58% were requested by NSF3 and 42% by CSE. Results suggest there is a lack of integration among different levels of health care, which result in misallocation of resources and unnecessary spending.


BMJ Open ◽  
2020 ◽  
Vol 10 (9) ◽  
pp. e039030
Author(s):  
Makoto Kaneko ◽  
Machiko Inoue ◽  
Masashi Okubo ◽  
Allison K Cullen Furgal ◽  
Benjamin F Crabtree ◽  
...  

ObjectivesAlthough frequent emergency department (ED) use is a global issue, little research has been conducted in a country like Japan where universal health insurance is available. The study aims to (1) document the proportion of ED visits that are by frequent users and (2) describe the differences in characteristics of frequent ED users and other ED users including expenditures between a secondary and a tertiary hospital.DesignA prevalence study for a period of 1 year.SettingA secondary hospital and a tertiary hospital in central Japan.ParticipantsAll patients who presented to the EDs.Primary outcome measuresWe defined frequent ED user as a patient who visited the ED≥5 times/year. The main outcome measures were the proportion of frequent ED users among all ED users and the proportion of healthcare expenditures by the frequent ED users among all ED expenditures.ResultsOf 25 231 ED visits over 1 year, 134 frequent ED users accounted for 1043 visits—0.66% of all ED users, comprised 4.1% of all ED visits, and accounted for 1.9% of total healthcare expenditures. Median ED visits per one frequent ED user was 7.9. At the patient level, after adjusting for age, gender and receiving public assistance, older age (OR 1.01, 95% CI: 1.00 to 1.02) and receiving public assistance (OR 7.19, 95% CI 2.87 to 18.07) had an association with frequent ED visits. At the visit-level analysis, evaluation by internal medicine (OR 1.27, 95% CI 1.02 to 1.57), psychiatry (OR 124.69, 95% CI 85.89 to 181.01) and obstetrics/gynaecology (OR 2.77, 95% CI 2.09 to 3.67) were associated with frequent ED visits.ConclusionThe proportion of frequent ED users, of total visits, and of expenditures attributable to them—while still in the low end of the distribution of published ranges—are lower in this study from Japan than in reports from many other countries.


2020 ◽  
Vol 11 (4) ◽  
pp. 7442-7453
Author(s):  
Dwi Endarti ◽  
Anna Wahyuni Widayanti ◽  
Ehga Ayodya Rahmawati ◽  
Nellatul Khaher ◽  
Siti Rahayu

Diabetes mellitus is a major health problem that had a consequence of high cost related to treatment and disease impact. This study aimed to estimate the cost of illness related T2DM from the perspective of patients. This study applied a prevalence-based cost of illness study from the perspective of patients. Data of direct medical costs, direct non-medical costs and indirect costs were collected by interviewing patients. The study involved patients covered by the national health insurance scheme as study respondents, which consisted of 96 patients visiting three public primary healthcare centres and 35 patients visiting a private secondary hospital in Yogyakarta Province, Indonesia. From the perspective of patients in Yogyakarta-Indonesia, the total cost of illness of T2DM within three months period was IDR 95,458 (USD 6.58) for patients at PHCs and IDR 340,159 (USD 23.46) for patients at the hospital, which were about 2% to 7% of the minimum wage rate. Indirect cost was the highest contribution of cost of illness (IDR 40,436/USD 2.79) to IDR 398,836/USD 17.63) and followed by direct medical cost (IDR 32,349/USD 2.23 to IDR 44,157/USD 3.05) and direct non-medical cost (IDR 22,673/USD 1.56 to IDR 40,334/USD 2.78). Cost of illness from out of pocket patients in this study was led by visits to other health facilities (the health facilities outside of study site) for obtaining health service related to T2DM disease. This study anticipated that T2DM had a consequence to out of the pocket cost of treatment and further productivity lost of patients and their caregivers.


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