scholarly journals Tele-Dysphagia Management: An Opportunity for Prevention, Cost-Savings and Advanced Training

2012 ◽  
Vol 4 (1) ◽  
pp. 41-46 ◽  
Author(s):  
James Coyle
Keyword(s):  
Health Care ◽  
Health Care System ◽  
Aspiration Pneumonia ◽  
Hospital Admissions ◽  
Cost Savings ◽  
Advanced Training ◽  
Number Of Patients ◽  
Management Of Dysphagia ◽  
University Training ◽  
Care System

Many patients survive severe stroke because of aggressive management in intensive care units.  However, acquiring pneumonia during the post-onset phase significantly reduces both the quality and likelihood of survival. Aspiration pneumonia (AP), a relatively recent addition to the list of the pneumonias, is associated with dysphagia, a swallowing disorder that may cause aspiration of swallowed food or liquids mixed with bacterial pathogens common to saliva, or by aspiration of gastric contents due to emesis or gastroesophageal reflux. While it is within the purview of speech-language pathologists to provide evaluation, treatment, and management of dysphagia, the number of patients with dysphagia is growing faster than the number of qualified dysphagia clinicians.  Because dysphagia consultations via telepractice are feasible and relatively accessible from a technological standpoint, they offer a promising strategy to bring the expertise of distant dysphagia experts to patients in underserved areas.  Tele-dysphagia management has the potential to increase patients’ survival, enhance the expertise of primary, local clinicians, and reduce healthcare costs. Even a modest reduction in either hospital admissions for aspiration pneumonia, or in the length of stay for AP, could save the US health care system hundreds of millions of dollars each year.  Wide spread tele-dysphagia management offers significant opportunities for prevention, cost-savings and advanced training, and is therefore worthy of consideration by stakeholders in the health care system and university training programs.

scholarly journals A113 COST SAVINGS OF SEROLOGIC VERSUS BIOPSY PROVEN DIAGNOSIS OF PEDIATRIC CELIAC DISEASE

2020 ◽  
Vol 3 (Supplement_1) ◽  
pp. 131-132
Author(s):  
M Wiepjes ◽  
H Q Huynh ◽  
J Wu ◽  
M Chen ◽  
L Shirton ◽  
...  
Keyword(s):  
Health Care ◽  
Celiac Disease ◽  
North America ◽  
Cost Saving ◽  
Health Care System ◽  
Cost Savings ◽  
Serologic Diagnosis ◽  
Children's Hospital ◽  
Children’S Hospital ◽  
Care System

Abstract Background Celiac disease (CD) affects approximately one percent of the population in Canada and the United States. At present, endoscopic diagnosis (ED) of CD remains the gold standard in North America, despite mounting evidence and validated European guidelines for serologic diagnosis (SD). Within publicly funded healthcare systems there is pressure to ensure optimal resource utilization and cost efficiency, including for endoscopic services. At Stollery Children’s Hospital, Edmonton, Canada, we have adopted serologic diagnosis as routine practice since 2016. Aims The aim of this study is to estimate cost savings, i.e. hard dollar savings and capacity improvements, to the health care system as well as impacts on families in regard to reduced work days lost and missing child school days for SD versus ED. Initial cost saving data is presented. Methods Micro-costing methods were used to determine health care resource use in patients undergoing ED or SD from 2017–2018. SD testing included anti-tissue glutaminase antibody (aTTG) ≥200IU/mL (on two occasions), human leukocyte antigen (HLA) DQA5/DQ2, blood sampling, transport and laboratory costs. ED diagnosis included gastroenterologist, anesthetist, OR equipment, staff, overhead and histopathology. Cost of each unit of resource was obtained from the schedule of medical benefits (Alberta) and reported average ambulatory cost for day hospital endoscopy for Stollery Children’s Hospital determined in 2016; reported in CAN$. Results Between March 2017-December 2018, 473 patients were referred for diagnosis of CD; 233 had ED and 127 SD. Estimated cost for ED was $1240 per patient; for SD was $85 per patient (6.8% of ED cost). Based on 127 patients not requiring endoscopy and a cost saving of $1155 per patient there was a total cost savings of $146,685 over 22 months. Conclusions A SD approach presents a significant cost savings to the public health care system. It also frees up valuable endoscopic resources, and limits exposure of children to the immediate and long-term risks associated with anesthesia and biopsy. SD also decreases time to diagnosis and the cost of the process to families (lost days of school/work, travel costs etc.). Our costing data can be used in combination with mounting evidence on the test performance of SD versus ED to determine cost-effectiveness of serological diagnosis for pediatric CD. Given the potential for cost saving and more efficient operating room utilization, SD for pediatric CD warrants further investigation in North America. Funding Agencies None

BME and the improvement of doctors

1929 ◽  
Vol 25 (5) ◽  
pp. 570-573
Author(s):  
R. A. Luria
Keyword(s):  
Health Care ◽  
Medical Care ◽  
Health Care System ◽  
Medical Knowledge ◽  
Advanced Training ◽  
Medical Institutions ◽  
Individual Doctor ◽  
Special Scientific ◽  
Life Itself ◽  
Care System

The issues of raising the qualifications of doctors occupy a prominent place in the Soviet health care system and it can be said without exaggeration that improvement is currently the task of each individual doctor, both in the periphery and in the center. This task is given to him every day by life itself, starting with the exuberant growth of the population's needs for qualified and special medical care and ending with a huge network of preventive and medical institutions of the People's Commissariat for Health, constantly in need of not only doctors in general, but especially demanding specialists who are at the height of modern medical knowledge. The institutes for advanced training of doctors, numerous special scientific Institutes of the People's Commissariat of Health, various kinds of individual courses of all kinds are conducting intense and fruitful work to replenish the knowledge of a doctor and to develop scientifically educated specialists in all fields of medicine

Monitoring Health Care System Performance in Iowa

1997 ◽  
Vol 10 (1-2) ◽  
pp. 107-112
Author(s):  
J. E. Rohrer ◽  
M. Vaughan
Keyword(s):  
Health Care ◽  
Medical Care ◽  
Ambulatory Care ◽  
Health Care System ◽  
System Performance ◽  
Hospital Admissions ◽  
High Rate ◽  
Average Risk ◽  
Care System ◽  
Ambulatory Care Sensitive

Monitoring the performance of the health care delivery system is a public health function that becomes more important as organized delivery systems begin to take control over large portions of the medical care market. The study reported here illustrates how standard medical care epidemiology can be applied to analysis of health care system performance to aid governmental efforts to monitor new developments in the medical care market. In order to evaluate the efficiency of hospital care delivered in Iowa, age- and sex-adjusted population admission rates for five common procedures were generated for all 99 counties. The five common procedures were defined as follows: hernia, tonsillectomy, cesarean section, hysterectomy, and cholecystectomy. In addition, variations in 11 ambulatory care-sensitive condition rates were analyzed. Residents of at least 15 counties were at significantly greater than average risk for receiving each of the common procedures (χ2 test, P < 0.05). Counties that had a high rate for one procedure tended to have a high rate for at least one other procedure. Several counties had more than twice the mean rate. Even a 10% reduction, when added across all five common procedures, amounts to well over 2000 hospitalizations avoided. It is assumed that reductions would be concentrated in high-rate counties. If a 50% reduction could be achieved in only part of the ambulatory care-sensitive procedures, more than 10 000 hospital admissions could be avoided.

scholarly journals Development by a Large Integrated Health Care System of an Objective Methodology for Evaluation of Medical Oncology Service Sites

2012 ◽  
Vol 8 (2) ◽  
pp. 70-70
Author(s):  
Marija Bjegovich-Weidman ◽  
Jill Kahabka ◽  
Amy Bock ◽  
Jacob Frick ◽  
Helga Kowalski ◽  
...  
Keyword(s):  
Health Care ◽  
Employee Engagement ◽  
Health Care System ◽  
Patient Experience ◽  
Primary Care Physicians ◽  
Medical Oncology ◽  
Cost Savings ◽  
Full Time ◽  
Medical Oncologists ◽  
Care System

Purpose: Aurora Health Care (AHC) is the largest health care system in Wisconsin, with 14 acute care hospitals. In early 2010, a group of 18 medical oncologists became affiliated with AHC. This affiliation added 13 medical oncology infusion clinics to our existing 12 sites. In the era of health care reform and declining reimbursement, we need an objective method and criteria to evaluate our 25 outpatient medical oncology sites. We developed financial, clinical, and strategic tools for the evaluation and management of our cancer subservice lines and outpatient sites. The key to our success has been the direct involvement of stakeholders with a vested interest in the services in the selection of the criteria and evaluation process. Methods: We developed our objective metrics for evaluation based on strategic, financial, operational, and patient experience criteria. Strategic criteria included: population trends, full-time equivalent (FTE) medical oncologists/primary care physicians, FTE radiation oncologists, FTE oncologic surgeons, new annual cases of patients with cancer, and market share trends. Financial criteria per site included: physician work relative value units, staff FTE by type, staff salaries, and profit and loss. Operational criteria included: facility by type (clinic v hospital based), hours of operation, and facility detail (eg, No. of chairs, No. of procedure and examination rooms, square footage). Patient experience criteria included: nursing model primary/nurse navigators, multidisciplinary support at site, Press Ganey (South Bend, IN; health care performance improvement company) results, and employee engagement score. Results: The outcome of our data analysis has resulted in the development of recommendations for AHC senior leadership and geographic market leadership to consider the consolidation of four sites (phase one, four sites; phase two, two sites) and priority strategic sites to address capacity issues that limit growth. The recommendations if implemented would result in significant cost savings, currently being quantified as a result of consolidation and improved efficiency. A reinvestment of these cost savings would be required to address facility expansion and program enhancement to maximize patient-centered expert care consistently across all of our remaining sites of service.

scholarly journals Avoiding Routine Oxygen Therapy in Patients With Myocardial Infarction Saves Significant Expenditure for the Health Care System—Insights From the Randomized DETO2X-AMI Trial

2022 ◽  
Vol 9 ◽  
Author(s):  
Robin Hofmann ◽  
Tamrat Befekadu Abebe ◽  
Johan Herlitz ◽  
Stefan K. James ◽  
David Erlinge ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Health Care ◽  
Clinical Trial ◽  
Health Care System ◽  
Oxygen Therapy ◽  
Cost Savings ◽  
Ambient Air ◽  
Clinical Trial Registration ◽  
Study Population ◽  
Care System

Background: Myocardial infarction (MI) occurs frequently and requires considerable health care resources. It is important to ensure that the treatments which are provided are both clinically effective and economically justifiable. Based on recent new evidence, routine oxygen therapy is no longer recommended in MI patients without hypoxemia. By using data from a nationwide randomized clinical trial, we estimated oxygen therapy related cost savings in this important clinical setting.Methods: The DETermination of the role of Oxygen in suspected Acute Myocardial Infarction (DETO2X-AMI) trial randomized 6,629 patients from 35 hospitals across Sweden to oxygen at 6 L/min for 6–12 h or ambient air. Costs for drug and medical supplies, and labor were calculated per patient, for the whole study population, and for the total annual care episodes for MI in Sweden (N = 16,100) with 10 million inhabitants.Results: Per patient, costs were estimated to 36 USD, summing up to a total cost of 119,832 USD for the whole study population allocated to oxygen treatment. Applied to the annual care episodes for MI in Sweden, costs sum up to between 514,060 and 604,777 USD. In the trial, 62 (2%) patients assigned to oxygen and 254 (8%) patients assigned to ambient air developed hypoxemia. A threshold analysis suggested that up to a cut-off of 624 USD spent for hypoxemia treatment related costs per patient, avoiding routine oxygen therapy remains cost saving.Conclusions: Avoiding routine oxygen therapy in patients with suspected or confirmed MI without hypoxemia at baseline saves significant expenditure for the health care system both with regards to medical and human resources.Clinical Trial Registration:ClinicalTrials.gov, identifier: NCT01787110.

Simulation-based ventilatory training for the caregivers at primary and rural health care workers in Central India for dealing with COVID-19 pandemic: recommendations

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Shraddha Aditya Patel ◽  
Gajanan Chavan ◽  
Mahendra Gudhe ◽  
Aparna Upadhye ◽  
Vandana Lohana ◽  
...  
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Healthcare System ◽  
Health Care System ◽  
Training Session ◽  
Rural Hospitals ◽  
Primary Health ◽  
Number Of Patients ◽  
Simulation Based ◽  
Care System

Abstract In 2020 COVID-19 made a major burden on health care system. The capacity of the healthcare system particularly emergency departments, ICU, hospital beds are insufficient to manage the increasing number of patients in cities and rural areas too. The primary health care centers and rural hospitals need preparedness for such disasters conditions. Novel and future oriented solutions are needed to effectively address the unprecedented pressure on the healthcare systems created by the COVID-19 pandemic. Considering the lacunae in healthcare system at primary level, various challenges encountered during pandemic has been identified and training session in consortia with simulation based training program for the training of the doctors, nurses, attendants and other related healthcare staff of Primary Health Center and Rural Hospitals intending to prepare them for future challenges in ventilatory care of COVID-19 has been carried out. After these training session certain conclusions and recommendations were drawn which could be able our health care system to be prepared for more critical situations and we can take our primary health care system at new horizon.

scholarly journals The impact of the COVID-19 pandemic on Polish orthopedics, in particular on the level of stress among orthopedic surgeons and the education process

PLoS ONE ◽  
2021 ◽  
Vol 16 (9) ◽  
pp. e0257289
Author(s):  
Łukasz Kołodziej ◽  
Dawid Ciechanowicz ◽  
Hubert Rola ◽  
Szymon Wołyński ◽  
Hanna Wawrzyniak ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care System ◽  
Personal Protective Equipment ◽  
Negative Impact ◽  
Protective Equipment ◽  
Orthopedic Surgeons ◽  
Number Of Patients ◽  
The Impact ◽  
Care System

The Coronovirus Disease 2019 –(COVID-19) pandemic had a significant impact on the health care system and medical staff around the world. The orthopedic units were also subject to new restrictions and regulations. Therefore, the aim of our research was to assess how the COVID-19 pandemic affected orthopedic wards in the last year in Poland. We created an online survey, which was sent to 273 members of the Polish Society of Orthopedics and Traumatology. The survey contained 51 questions and was divided into main sections: Preparedness, Training, Stress, Reduction, Awareness. A total of 80 responses to the survey were obtained. In Preparedness section the vast majority of respondents (90%) replied, that they used personal protective equipment during the pandemic, however only 50% of the respondents indicated that their facility received a sufficient amount of personal protective equipment. Most of the respondents indicated that the pandemic negatively affected the quality of training of future orthopedists (69.4%) and that pandemic has had a negative impact on their operating skills (66,7%). In Reduction section most of the doctors indicated that the number of patients hospitalized in their departments decreased by 20–60% (61,2% respondents), while the number of operations performed decreased by 60–100% (60% respondents). The negative impact of pandemic on education was noticeable especially in the group of young orthopedic surgeons: 0–5 years of work experience (p = 0,029). Among the respondents, the level of stress increased over the last year from 4.8 to 6.9 (p <0.001). The greatest increase in the level of stress was observed among orthopedists working in country hospitals (p = 0,03). In section Awareness 36,3% of respondents feel well or very well informed about the latest Covid-19 regulations. In addition, most doctors (82.6%) believe that the Polish health care system was not well prepared to fight the pandemic and that the regulations applied so far are not sufficient to effectively fight the pandemic (66.2%). The COVID-19 pandemic has impact on orthopedics departments in Poland and negatively affected the quality of training of orthopedic surgeons and the level of stress.

scholarly journals Treatment-Free Remission (TFR) Is Feasible in Clinical Practice Latin-America (LA): A Real-World Cohort of Patients in Colombia

Blood ◽  
2021 ◽  
Vol 138 (Supplement 1) ◽  
pp. 4605-4605
Author(s):  
Virginia Abello ◽  
Isabel Munevar ◽  
Rigoberto Gomez ◽  
Monica Osuna Pérez ◽  
Carlos Daniel Bermudez Silva ◽  
...  
Keyword(s):  
Health Care ◽  
Clinical Practice ◽  
Median Time ◽  
Health Care System ◽  
Real World ◽  
Research Funding ◽  
Chronic Phase ◽  
First Line ◽  
Number Of Patients ◽  
Care System

Abstract BACKGROUND: Long-term Tirosin Kinase Inhibitor (TKI) treatment is related to notable adverse events, quality-of-life impact and significant costs to health systems. Many patients in optimal response are candidates to TKI discotinuation that has proven to be safe in clinical trials. TFR has become a new goal for CML management. Information about its implementation in clinical practice in LA is limited. The aim of this study is to describe the results, safety and assess the possible economic impact of a cohort of patients that has discontinued TKI in clinical practice in Colombia. MATERIAL AND METHODS : The Colombian Association of Hematology and Oncology (ACHO)'s hematological disease registry (RENEHOC) is a multicenter nationwide registry on hematologic malignancies that captures information from 18 academic and general community centers with Institutional Ethics Committee approval, since 2018. Since 2019, it has been collecting information on CML. This report represents a sub-analysis of CML patients in the registry in whom discontinuation was performed. Treatment was according to investigator preferences. A total of 449 CML adult patients treated in the last 20 years have been registered until now on RENEHOC. 29 patients were considered eligible for TFR; in 27 of them, TKI have been discontinued. The main outcome measured is survival without TKI re-initiation. RESULTS: At diagnosis the median age was 58 yrs. (IQR 51-65), all were in the chronic phase and 86% had intermediate-higk risk Sokal score. First line treatment was Imatinib in 11, Dasatinib 9, and Nilotinib 7. 5 patients required a second line with Nilotinib, only one of them was considered to have failed first line. 17 discontinuations were performed as a planned physician strategy, 6 were carried out by patient's decision, 3 were forced by toxicities and in one case it was carried out to search for a pregnancy. Median time on TKIs before discontinuation was 73 months (IQR 59-135) and median time in RMM before TFR was 46 moths (IQR 35-71). Due to its retrospective nature, many patients did not have exact information on MR4.5 achievement date, since it was not available in Colombia until 2016. At a median follow-up of 12.5 months (IQR 4-20), 22 (81%) patients remain on TFR. As has been previously described most patients lost MMR in the first 6 months (median time to restart TKI 6 months; IQR 2-10). Only 1 patient did not achieve the MMR after TKI reinitiated, no progressions to accelerated or blastic phase were reported. 3 patients reinitiated the same ITK and 2 changed to another. 1 patient that was initially treated with Imatinib was changed to Nilotinib after reinitiation and after 2 years in MMR 4.5 has again discontinued TKI and has not lost response after 3 months. 9 (33%) patients developed withdrawal syndrome in most cases (7) with mild symptoms, only 2 had moderate symptoms. The estimated savings on TKIs for Colombian health care system for this patients are US$1.156.937, it is calculated that the cost of the PCR analysis performed for this patients to monitor TFR safely was US$35019. CONCLUSIONS: TKI has change the landscape for CML patients, that currently have a life expectancy similar to the general population; however, indefinitely treatment is associated with significant toxicities and a very high cost for the systems. TFR has become a real goal for a selected group of patients with CML. This report represents real-world data in Colombia, showing its feasibility and safety under well-controlled settings. Also, the estimated savings for a health care system of a middle-income country as Colombia are very significant, which is an additional support to insist with the decision makers of the system in the importance of the optimal access to TKIs and the necessary tests so that a greater number of patients can reach the necessary goals for a safe TFR. Figure 1 Figure 1. Disclosures Abello: Janssen: Honoraria; Amgen: Honoraria; Dr Reddy's: Research Funding. Sossa: Amgen: Research Funding.

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