scholarly journals The economic impact of ventriculoperitoneal shunt failure

2011 ◽  
Vol 8 (6) ◽  
pp. 593-599 ◽  
Author(s):  
Chevis N. Shannon ◽  
Tamara D. Simon ◽  
Gavin T. Reed ◽  
Frank A. Franklin ◽  
Russell S. Kirby ◽  
...  
Keyword(s):  
Demographic Data ◽  
Private Insurance ◽  
Third Party ◽  
Shunt Failure ◽  
Public Insurance ◽  
Shunt Placement ◽  
Significant Difference ◽  
Out Of Pocket Expenses ◽  
The Cost ◽  
Median Rate

Object Detailed costs to individuals with hydrocephalus and their families as well as to third-party payers have not been previously described. The purpose of this study was to determine the primary caregiver out-of-pocket expenses and the third-party payer reimbursement rate associated with a shunt failure episode. Methods A retrospective study of children born between 2000 and 2005 who underwent initial ventriculoperitoneal (VP) shunt placement and who subsequently experienced a shunt failure requiring surgical intervention within 2 years of their initial shunt placement was conducted. Institutional reimbursement and demographic data from Children's Hospital of Alabama (CHA) were augmented with a caregiver survey of any out-of pocket expenses encountered during the shunt failure episode. Institutional reimbursements and caregiver out-of-pocket expenses were then combined to provide the cost for a shunt failure episode at CHA. Results For shunt failures, the median reimbursement total was $5008 (interquartile range [IQR] $2068–$17,984), the median caregiver out-of-pocket expenses was $419 (IQR $251–$1112), and the median total cost was $5411 (IQR $2428–$18,582). Private insurance reimbursed at a median rate of $5074 (IQR $2170–$14,852) compared with public insurance, which reimbursed at a median rate of $4800 (IQR $1876–$19,395). Caregivers with private insurance reported a median $963 (IQR $322–$1741) for out-of-pocket expenses, whereas caregivers with public insurance reported a median $391 (IQR $241–$554) for out-of-pocket expenses (p = 0.017). Conclusions This study confirmed that private insurance reimbursed at a higher rate, and that although patients had a shorter length of stay as compared with those with public insurance, their out-of-pocket expenses associated with a shunt failure episode were greater. However, it could not be determined if the significant difference in out-of-pocket expenses between those with private and those with public insurance was due directly to the cost of shunt failure. This model does not take into consideration community resources and services available to those with public insurance. These resources and services could offset the out-of-pocket burden, and therefore should be considered in future cost models.

scholarly journals MON-083 Childhood Diabetic Ketoacidosis (DKA) in New-Onset and Established Patients in Central Illinois: Contributing Factors and Risk Stratification

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Vivian Szymczuk ◽  
James Dunneback ◽  
Yanzhi Wang ◽  
Valeria C Benavides
Keyword(s):  
Insulin Pump ◽  
Demographic Data ◽  
Private Insurance ◽  
Health Care Facilities ◽  
Population Characteristics ◽  
Contributing Factors ◽  
Public Insurance ◽  
Significant Difference ◽  
Central Illinois ◽  
New Onset

Abstract Introduction: DKA is the leading cause of hospitalizations in children with type 1 diabetes mellitus (T1DM). Although most cases are preventable, DKA continues to occur in established patients. Aim: To identify contributing factors and outcomes of DKA pediatric admissions in a tertiary referral center with a large rural catchment area to assess for actionable items to prevent DKA. Methods: A retrospective, single-center chart review assessing children ˂19 years old admitted in DKA from October 2014 to May 2018. DKA was defined as a pH of ≤7.3 or bicarbonate of ≤15. Demographic data included gender, age, zip code, insurance type and ethnicity. Admission measures included HbA1c, DKA group (new-onset “NT1” or “ET1” established T1DM diagnosis), DKA severity (severe pH <7.1, CO2 <5mEq/L), contact with clinic, home insulin delivery. Outcomes included length of stay (LOS), total admission costs (TAC) and reimbursements amounts (RA). Results: 272 patients were included (mean age 11.7 y, range 4.4-16; 60% female, 83% Caucasian, 14% African American). Of these, 33% were NT1 DKA. Compared to NT1 DKA, ET1 DKA patients were older (8.7 vs. 13.1 years, p < 0.001), more likely female (49% vs. 65%, p 0.034) with public insurance (55% vs 63%, p 0.028); 73% didn’t contact the diabetes team prior to admission and 52% used an insulin pump. There were no significant differences in HbA1c or DKA severity. LOS was similar between NT1 and ET1 DKA (p 0.051). Severe DKA was associated with longer LOS (RR 1.47, p < 0.0001). Public vs. private insurance was associated with 1.28 times longer LOS (p < 0.0001). While there was no difference in TAC between NT1 and ET1 DKA groups (p 0.877), costs were higher with public vs. private insurance (>$900, p 0.050) and severe DKA (RR 1.92; 95% CI 1.62-2.27; p <0.0001). TAC were different between regions within central Illinois (RR 1.39; 95% CI 1.08-1.80; p 0.002). Hospital RA was higher for NT1 vs. ET1 group (RR 1.26; 95%CI 1.03-1.54; p 0.0237) and higher DKA severity (RR 1.57; 95% CI 1.26-1.95; p <0.0001); but lower for public vs. private insurance (RR 0.43; 95% CI 0.35-0.52; p <0.0001). Discussion: Established DKA patients tended to be rural teenage females, poorly controlled and public health insured. Severity of DKA and LOS did not differ between the groups. While TAC were similar among the groups, TAC were higher with public insurance and severe DKA. Lower hospital RA were seen for recurrent cases and public insurance. This study provides valuable information about non-metropolitan at-risk population characteristics to inform targeted preventive interventions. These findings suggest a significant difference in hospitalization RA, providing incentive for health care facilities / providers to invest in early outpatient interventions and QI initiatives.

Shunt survival after failed endoscopic treatment of hydrocephalus

2012 ◽  
Vol 10 (6) ◽  
pp. 463-470 ◽  
Author(s):  
Benjamin C. Warf ◽  
Salman Bhai ◽  
Abhaya V. Kulkarni ◽  
John Mugamba
Keyword(s):  
Cox Regression ◽  
Cox Proportional Hazards ◽  
Hazard Ratio ◽  
Third Ventriculostomy ◽  
Ventricular Catheter ◽  
Shunt Failure ◽  
Vp Shunt ◽  
Shunt Placement ◽  
Significant Difference ◽  
Shunt Survival

Object It is not known whether previous endoscopic third ventriculostomy (ETV) affects the risk of shunt failure. Different epochs of hydrocephalus treatment at the CURE Children's Hospital of Uganda (CCHU)—initially placing CSF shunts in all patients, then attempting ETV in all patients, and finally attempting ETV combined with choroid plexus cauterization (CPC) in all patients—provided the opportunity to assess whether prior endoscopic surgery affected shunt survival. Methods With appropriate institutional approvals, the authors reviewed the CCHU clinical database to identify 2329 patients treated for hydrocephalus from December 2000 to May 2007. Initial ventriculoperitoneal (VP) shunt placement was performed in 900 patients under one of three circumstances: 1) primary nonselective VP shunt placement with no endoscopy (255 patients); 2) VP shunt placement at the time of abandoned ETV attempt (with or without CPC) (370 patients); 3) VP shunt placement subsequent to a completed but failed ETV (with or without CPC) (275 patients). We analyzed time to shunt failure using the Kaplan-Meier method to construct survival curves, Cox proportional hazards regression modeling, and risk-adjusted analyses to account for possible confounding differences among these groups. Results Shunt failure occurred in 299 patients, and the mean duration of follow-up for the remaining 601 was 28.7 months (median 18.8, interquartile range 4.1–46.3). There was no significant difference in operative mortality (p = 0.07 by log-rank and p = 0.14 by Cox regression adjusted for age and hydrocephalus etiology) or shunt infection (p = 0.94, log-rank) among the 3 groups. There was no difference in shunt survival between patients treated with primary shunt placement and those who underwent shunt placement at the time of an abandoned ETV attempt (adjusted hazard ratio [HR] 1.14, 95% CI 0.86–1.51, p = 0.35). Those who underwent shunt placement after a completed but failed ETV (with or without CPC) had a lower risk of shunt failure (p = 0.008, log-rank), with a hazard ratio (adjusted for age at shunting and etiology) of 0.72 (95% CI 0.53–0.98), p = 0.03, compared with those who underwent primary shunt placement without endoscopy; but this was observed only in patients with postinfectious hydrocephalus (PIH) (adjusted HR 0.55, 95% CI 0.36–0.85, p = 0.007), and no effect was apparent for hydrocephalus of noninfectious etiologies (adjusted HR 0.98, 95% CI 0.64–1.50, p = 0.92). Improved shunt survival after failed ETV in the PIH group may be an artifact of selection arising from the inherent heterogeneity of ventricular damage within that group, or a consequence of the timing of shunt placement. The anticipated benefit of CPC in preventing future ventricular catheter obstruction was not observed. Conclusions A paradigm for infant hydrocephalus involving intention to treat by ETV with or without CPC had no adverse effect on mortality or on subsequent shunt survival or infection risk. This study failed to demonstrate a positive effect of prior ETV or CPC on shunt survival.

Disparities of Care in Post-Concussive Pediatric Patients

Neurology ◽  
2021 ◽  
Vol 98 (1 Supplement 1) ◽  
pp. S13.1-S13
Author(s):  
James Pate ◽  
Ian Cummins ◽  
Kasey Cooper ◽  
Marshall Chandler McLeod ◽  
Laura Ferrill ◽  
...  
Keyword(s):  
Emergency Department ◽  
Sports Medicine ◽  
Private Insurance ◽  
Insurance Status ◽  
Public Insurance ◽  
Tertiary Referral Center ◽  
Significant Difference ◽  
Follow Up Care ◽  
Icd 10

ObjectiveThe objective of this study was to examine the association between insurance status and prevalence of follow up care at a tertiary referral center compared to the emergency department.BackgroundConcussions are extremely common in today's society, affecting patients of all demographic backgrounds. There is concern that public insurance status may affect follow up care at tertiary treatments centers compared to children with private insurance, as evidenced by Copley et al. who documented insurance disparities between children presenting to a sports medicine clinic with orthopedic injuries verses concussion.Design/MethodsWe compared insurance status of patients presenting to our pediatric concussion clinic to the insurance status of patients diagnosed with concussion at the emergency department of our tertiary hospital. From 2018 to 2019, 725 patients received an ICD-10 diagnosis code for concussion in our clinic. Patients were excluded if insurance status was not available for the clinic visit (4), or if they were lost to follow up (380). ICD-10 codes for concussion during the same period were recorded from the COA emergency department (ED). The insurance status was then recorded for each patient.ResultsOf the 345 patients included from the COA concussion clinic, 253 (73%) patients had private insurance while only 92 (27%) had public insurance. In comparison, of the 1,160 patients diagnosed with concussion in the COA ED, 642 (55%) patients had private insurance, 478 (41%) had public insurance, 37 (3.1%) were self-pay, and 3 (0.3%) were listed as “other.”ConclusionsThere is a significant difference in the insurance status of patients with concussion that present to the COA ED when compared to those presenting to concussion clinic. As a result, children with public insurance may have prolonged recovery and more significant symptoms burden compared to children with private insurance.

scholarly journals Medical Cost of Cancer Care for Privately Insured Children in Chile

2021 ◽  
Vol 18 (13) ◽  
pp. 6746
Author(s):  
Florencia Borrescio-Higa ◽  
Nieves Valdés
Keyword(s):  
Medical Cost ◽  
Cancer Care ◽  
Financial Burden ◽  
Private Insurance ◽  
Children With Cancer ◽  
Total Cost ◽  
Out Of Pocket Payments ◽  
Catastrophic Expenditures ◽  
Out Of Pocket Expenses ◽  
The Cost

Medical care for children with cancer is complex and expensive, and represents a large financial burden for families around the world. We estimated the medical cost of cancer care for children under the age of 18, using administrative records of the universe of children with private insurance in Chile in the period 2007–2018, based on a sample of 3853 observations. We analyzed total cost and out-of-pocket spending by patients’ characteristics, type of cancer, and by service. Children with cancer had high annual medical costs, USD 32,287 on average for 2018. Costs were higher for the younger children in the sample. The vast majority of the cost was driven by inpatient hospital care for all types of cancer. The average total cost increased 20% in real terms over the period of study, while out-of-pocket expenses increased almost 29%. Private insurance beneficiaries faced a significant economic burden associated with medical treatment of a child with cancer. Interventions that reduce hospitalizations, as well as systemwide reforms that incorporate maximum out-of-pocket payments and prevent catastrophic expenditures, can contribute to alleviating the financial burden of childhood cancer.

scholarly journals Endoscopic third ventriculostomy has no higher costs than ventriculoperitoneal shunt

2014 ◽  
Vol 72 (7) ◽  
pp. 524-527 ◽  
Author(s):  
Benicio Oton de Lima ◽  
Riccardo Pratesi
Keyword(s):  
Ventriculoperitoneal Shunt ◽  
Prospective Cohort ◽  
Endoscopic Third Ventriculostomy ◽  
Treatment Costs ◽  
Third Ventriculostomy ◽  
First Year ◽  
Shunt Failure ◽  
Significant Difference ◽  
The Cost

Objective: To evaluate the cost of endoscopic third ventriculostomy (ETV) compared to ventriculoperitoneal shunt (VPS) in the treatment of hydrocephalus in children. Method: We studied 103 children with hydrocephalus, 52 of which were treated with ETV and 51 with VPS in a prospective cohort. Treatment costs were compared within the first year after surgery, including subsequent surgery or hospitalization. Results: Twenty (38.4%) of the 52 children treated with VPS needed another procedure due to shunt failure, compared to 11 (21.5%) of 51 children in the ETV group. The average costs per patient in the group treated with ETV was USD$ 2,177,66±517.73 compared to USD$ 2,890.68±2,835.02 for the VPS group. Conclusions: In this series there was no significant difference in costs between the ETV and VPS groups.

Demographic trends in clinical trial withdrawal rate within the Bubble Study: Updated analysis.

2014 ◽  
Vol 32 (30_suppl) ◽  
pp. 71-71
Author(s):  
Elizabeth Carloss Riley ◽  
Anthony E. Dragun ◽  
Kelly McMasters ◽  
Amy R. Quillo ◽  
Charles Raben Scoggins ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Early Stage ◽  
Demographic Data ◽  
Private Insurance ◽  
Drop Out ◽  
Adherence Rate ◽  
Trial Participation ◽  
Marginal Effect ◽  
Clinical Trial Participation ◽  
Significant Difference

71 Background: There are well described barriers to clinical trial participation among varied racial/ethnic and demographic groups. Little is known about clinical trial drop-out rate among these groups. This is an updated analysis of the demographic and clinical characteristics of patients who originally enrolled in the “Bubble Study” clinical trial but then withdrew at a later date. Bubble Study is a non-blinded, prospective observational cohort study designed to assess the adherence rate of adjuvant endocrine therapy among women with early stage breast cancer. Methods: From Aug 2012 to April of 2014, 88 women were enrolled. Demographic data (age, race. insurance status) and treatment factors (stage, surgery type, therapy duration, co-morbidites) were collected. Comorbidities were defined as none, moderate (1-3) or significant (>3.) Descriptive statistics were produced for the entire cohort and the subjects of cohort. Frequencies were compared using a Chi-square test (Fisher’s exact test when expected cell frequencies are small). Results were declared significant at significance level of 5% and all analyses are performed using SAS (2003, 2005). Results: At the time of analysis, 86 patients enrolled (E), 41 of which withdrew (W.) Blacks represented 21% of the total E. Private insurance represented the majority (60.4% of those E and Medicare, Medicaid and Uninsured followed in that order (24.4%, 14% and 1.2% respectively.) There was no significant difference with regards to race and insurance between the E and W group although there was a trend toward a higher rate of W among Blacks (p=0.21). Stage, surgery type or age did not predict for W. Comorbidites had a marginal effect on W (p=0.02) The most common reasons reported for W were financial and/or insurance reasons (22%) and inconvenience of pharmacy pick up (15%.) Conclusions: Demographic characteristics that traditionally predict for under-representation in clinical trial enrollment did not predict for W from the Bubble Study. Although this sample size is small this data may suggest disparities in clinical trial participation are largely due to enrollement rather than withdrawal. Continued analysis of this trial and others will help confirm these findings. Clinical trial information: NCT01694225.

Comparing fourth ventricle shunt survival after placement via stereotactic transtentorial and suboccipital approaches

2013 ◽  
Vol 11 (6) ◽  
pp. 623-629 ◽  
Author(s):  
Sarah T. Garber ◽  
Jay Riva-Cambrin ◽  
Frank S. Bishop ◽  
Douglas L. Brockmeyer
Keyword(s):  
Fourth Ventricle ◽  
Retrospective Chart Review ◽  
Pediatric Neurosurgery ◽  
Shunt Revision ◽  
Shunt Failure ◽  
Survival Times ◽  
Shunt Placement ◽  
Significant Difference ◽  
Shunt Survival ◽  
Suboccipital Approach

Object Fourth ventricle hydrocephalus, or a “trapped” fourth ventricle, presents a treatment challenge in pediatric neurosurgery. Fourth ventricle hydrocephalus develops most commonly as a result of congenital anomalies, intraventricular hemorrhage, or infection. Standard management of loculated fourth ventricle hydrocephalus consists of fourth ventricle shunt placement via a suboccipital approach. An alternative approach is stereotactic-guided transtentorial fourth ventricle shunt placement via the nondominant superior parietal lobule. In this report, the authors compare shunt survival after placement via the suboccipital and stereotactic parietal transtentorial (SPT) approaches. Methods A retrospective chart review was performed to find all patients with a fourth ventricle shunt placed between January 1, 1998, and December 31, 2011. Time to shunt failure was quantified as the number of days from shunt placement to first shunt revision or removal. Other variables studied included patient age and sex, origin of hydrocephalus, comorbidities, number of existing supratentorial catheters at the time of fourth ventricle shunt placement (as a proxy for complexity), operating surgeon, and number of previous shunt revisions. The crossover rate from one technique to the other after shunt failure from the original approach was also investigated. Results In the 29 fourth ventricle shunts placed during the study period, 18 were placed via the suboccipital approach (62.1%) and 11 via the SPT approach (37.9%). There was a statistically significant difference in time to shunt failure, with the SPT shunts lasting an average of 901 days and suboccipital shunts lasting 122 days (p = 0.04). In addition, there was a significant difference in the rate of crossover from one technique to another, with 1 SPT shunt changed to a suboccipital shunt (5.6%) and 5 suboccipital shunts changed to SPT shunts (45.5%). Conclusions Fourth ventricle shunt placement using an SPT approach resulted in significantly longer shunt survival times and lower rates of revision than the traditional suboccipital approach, despite a higher rate of crossover from previously failed shunting procedures. Stereotactic parietal transtentorial shunt placement may be considered for patients with loculated fourth ventricle hydrocephalus, especially when shunt placement via the standard suboccipital approach fails. It is therefore reasonable to offer this procedure either as a first option for the treatment of fourth ventricle hydrocephalus or when the need for fourth ventricle shunt revision arises.

Parent’s Experiences from the Treatment of their Children at the Physic Children’s Surgery Clinic in Skopje.

2020 ◽  
Vol 4 (1) ◽  
Author(s):  
M. Trajchevska ◽  
A. Lleshi ◽  
S. Gjoshev ◽  
A. Trajchevski
Keyword(s):  
Health Care ◽  
Health Status ◽  
Independent Predictor ◽  
Demographic Data ◽  
Parental Satisfaction ◽  
Pediatric Care ◽  
Simple Random Sample ◽  
Significant Independent Predictor ◽  
Cross Sectional ◽  
Significant Difference

Background: The respect of the needs and wishes of the patients is in the focus of the human health system. The experience of the parents in terms of child’s health care may be used as an indicator of quality of the health care. Material and methods: The research is a quantitative analytical cross-sectional study. In accordance with the inclusion and exclusion criteria, simple random sample of 207 parents / guardians is covered, whose children in the period of three months, had been hospitalized in the hospital department JZUU Pediatric Surgery Clinic in Skopje.It was used a two parted questionnaire. The first part is a standardized questionnaire (Parent Experience of Pediatric Care - PECP), and the second part concerns the general socio-demographic data of the parent/guardian. Statistical evaluation was performed using appropriate statistical programs (Statistics for Windows 7,0 and SPSS 17.0). Results: In accordance with the age of the parents, the survey respondents were divided into two groups: a) age ≤ 33 years - 107 (51.69%) and b) age> 33 years - 100 (48.31%).Significant independent predictor of parental satisfaction from the receipt of their child to the clinic research confirms the age of the parent under / over 33 years due to 4.1% of the change in satisfaction (R2 = 0,041). Parents generally believe that their children's room of the clinic is "good", without significant difference between parental satisfaction from both age groups (Mann-Whitney U Test Z = -0,9613 p = 0,3364). Significant independent predictor of parental satisfaction from the room of their child improves the health status after treatment due to 6% of the change in satisfaction (R2 = 0,060). Parents generally believe that testing and treatment of their children in the clinic was "very good" and an independent significant predictor is to improve the health status after the treatment - 7,8% (R2 = 0,078). Conclusions: Regardless of the generally good parental satisfaction about health care for their children, it is necessary to continuously monitor the status of the clinic in order to consider the possible deficiencies and needs of intervention.

Effect of Chewing Gum on Bowel Motility in Women Undergoing Post-Operative Cesarean Section

2018 ◽  
Vol 3 (06) ◽  
Author(s):  
Dr.Randa Mohammed AboBaker
Keyword(s):  
Cesarean Section ◽  
Hospital Stay ◽  
Demographic Data ◽  
Length Of Hospital Stay ◽  
Chewing Gum ◽  
Control Group ◽  
Controlled Clinical Trial ◽  
Bowel Motility ◽  
Gum Chewing ◽  
Significant Difference

Postoperative Ileus (POI) is one of the most common problems after obstetrics, gynecologic and abdominal surgeries. Sham feeding, such as gum chewing, accelerates the return of bowel function and the length of hospital stay. The present study aims to evaluate the effect of chewing gum on bowel motility in women undergoing post-operative cesarean section. Intervention study was used at the Postpartum Department of Maternity and Children Hospital, KSA. A randomized controlled clinical trial research design. Through a convenience technique, 80 post Caesarian Section (CS) women were included in the study. Data were collected through three tools: Tool (I): Socio-demographic data and reproductive history interview schedule. Tool (II): Postoperative Assessment Sheet. Tool (III): Outcomes of gum chewing and the length of hospital stay.  Method: subjects were assigned randomly into two groups of (40) the experimental and (40) the control. Subjects in the study group were asked to chew two pieces of sugarless gum for 30 min/three times daily in the morning, noon, and evening immediately after recovery from anesthesia and in Postpartum Department; while subjects in the control group followed the hospital routine care. Each woman in both groups was tested abdominally using a stethoscope to auscultate the bowel sounds and asked to report immediately the time of either passing flatus or stool. Results: illustrated that a highly statistically significant difference was observed between the two groups concerning their gum chewing outcomes. Where, P = 0.000. The study concluded that gum chewing is safe, well tolerated and appears to be effective in reducing the incidence and consequences of POI following CS.

Social versus Private Insurance

2018 ◽  
Author(s):  
Pierre Pestieau ◽  
Mathieu Lefebvre
Keyword(s):  
Social Insurance ◽  
Private Insurance ◽  
Population Ageing ◽  
Fiscal Competition ◽  
Public Insurance ◽  
The Public ◽  
Social Risks ◽  
The Family ◽  
Private And Public

This chapter looks at the role of the public versus the private sector in the provision of insurance against social risks. After having discussed the evolution of the role of the family as support in the first place, the specificity of social insurance is emphasized in opposition to private insurance. Figures show the extent of spending on both private and public insurance and the chapter presents economic reasons to why the latter is more developed than the former. Issues related to moral hazard and adverse selection are addressed. The chapter also discusses somewhat more general arguments supporting social insurance such as population ageing, unemployment, fiscal competition and social dumping.

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