scholarly journals Costs variations for percutaneous nephrolithotomy in the U.S. from 2003–2015: A contemporary analysis of an all-payer discharge database

2018 ◽  
Vol 12 (12) ◽  
Author(s):  
Jeffrey J. Leow ◽  
Anne-Sophie Valiquette ◽  
Benjamin I. Chung ◽  
Steven L. Chang ◽  
Quoc-Dien Trinh ◽  
...  
Keyword(s):  
Percutaneous Nephrolithotomy ◽  
Low Cost ◽  
Hospital Costs ◽  
Population Based ◽  
Teaching Hospitals ◽  
Hierarchical Regression ◽  
Healthcare Database ◽  
Comorbidity Status ◽  
Mean Cost ◽  
The U.S

Introduction: We sought to evaluate population-based cost variations and predictors of outlier costs for percutaneous nephrolithotomy (PCNL) in the U.S. Methods: Using the Premier Healthcare Database, we identified all patients diagnosed with kidney/ureter calculus who underwent PCNL from 2003–2015. We evaluated 90-day direct hospital costs, defining high- and low-cost surgery as those >90th and <10th percentile, respectively. We constructed a multilevel, hierarchical regression model and calculated the pseudo-R2 of each variable, which translates to the percentage variability contributed by that variable on 90-day direct hospital costs. Results: A total of 114 581 patients underwent PCNL during the 12-year study period. Mean cost in the low-cost group was $5787 (95% confidence interval [CI] 5716–5856) vs. $38 590 (95% CI 37 357–39 923) in the high-cost group. Cost variations were substantially impacted by patient (63.7%) and surgical (18.5%) characteristics and less so by hospital characteristics (3.9%). Significant predictors of high costs included more comorbidities (≥2 vs. 0: odds ratio [OR] 1.81; p=0.01) and hospital region (Northeast vs. Midwest: OR 2.04; p=0.03). Predictors of low cost were hospital bed size of 300–499 beds (OR 1.35; p<0.01) and urban hospitals (OR 2.77; p=0.01). Factors less likely to be associated with lowcost PCNL were more comorbidities (Charlson Comorbidity Index [CCI] ≥2: OR 0.69; p<0.0001), larger hospitals (OR 0.61; p=0.01), and teaching hospitals (OR 0.33; p<0.0001). Conclusions: Our contemporary analysis demonstrates that patient and surgical characteristics had a significant effect on costs associated with PCNL. Poor comorbidity status contributed to high costs, highlighting the importance of patient selection.

The effect of hospital characteristics on pediatric neuromuscular scoliosis fusion cost

2019 ◽  
Vol 24 (6) ◽  
pp. 713-721
Author(s):  
Jonathan Dallas ◽  
Chevis N. Shannon ◽  
Christopher M. Bonfield
Keyword(s):  
Spinal Fusion ◽  
Economies Of Scale ◽  
Hospital Costs ◽  
Neuromuscular Scoliosis ◽  
Teaching Hospitals ◽  
Inclusion Criteria ◽  
Cost Information ◽  
Nonprofit Hospitals ◽  
Disease Etiology ◽  
Hospital Characteristics

OBJECTIVESpinal fusion is used in the treatment of pediatric neuromuscular scoliosis (NMS) to improve spine alignment and delay disease progression. However, patients with NMS are often medically complex and require a higher level of care than those with other types of scoliosis, leading to higher treatment costs. The purpose of this study was to 1) characterize the cost of pediatric NMS fusion in the US and 2) determine hospital characteristics associated with changes in overall cost.METHODSPatients were identified from the National Inpatient Sample (2012 to the first 3 quarters of 2015). Inclusion criteria selected for patients with NMS, spinal fusion of at least 4 vertebral levels, and elective hospitalization. Patients with no cost information were excluded. Sociodemographics, treating hospital characteristics, disease etiology/severity, comorbidities, length of stay, and hospital costs were collected. Univariable analysis and multivariable gamma log-link regression were used to determine hospital characteristics associated with changes in cost.RESULTSA total of 1780 weighted patients met inclusion criteria. The median cost was $68,815. Following multivariable regression, both small (+$11,580, p < 0.001) and medium (+$6329, p < 0.001) hospitals had higher costs than large hospitals. Rural hospitals had higher costs than urban teaching hospitals (+$32,438, p < 0.001). Nonprofit hospitals were more expensive than both government (–$4518, p = 0.030) and investor-owned (–$10,240, p = 0.001) hospitals. There was significant variability by US census division; compared with the South Atlantic, all other divisions except for the Middle Atlantic had significantly higher costs, most notably the West North Central (+$15,203, p < 0.001) and the Pacific (+$22,235, p < 0.001). Hospital fusion volume was not associated with total cost.CONCLUSIONSA number of hospital factors were associated with changes in fusion cost. Larger hospitals may be able to achieve decreased costs due to economies of scale. Regional differences could reflect uncontrolled-for variability in underlying patient populations or systems-level and policy differences. Overall, this analysis identified multiple systemic patterns that could be targets of further cost-related interventions.

Retrospective on the 1970’s “Low Cost Shore Protection” program

Shore & Beach ◽  
2019 ◽  
pp. 3-12
Author(s):  
Joan Pope
Keyword(s):  
Coastal Erosion ◽  
Low Cost ◽  
Management Strategies ◽  
Public Information ◽  
Coastal Engineering ◽  
Shoreline Erosion ◽  
Shore Protection ◽  
Demonstration Program ◽  
Alternative Approaches ◽  
The U.S

In the 1970s, the U.S. Congress authorized and funded a five-year demonstration program on low-cost methods for shore protection called the “U.S. Army Engineers Shoreline Erosion Control Demonstration (Section 54) Program.” The Section 54 also known as the “Low-Cost Shore Protection” demonstration program is revisited. Demonstration and monitoring sites including the materials, devices, vegetative plantings, approaches tested, and program findings are discussed. Simply put, a major finding of the Section 54 program was that the concept of “low-cost shore protection” was a bit naïve. However, the program did lead to a wealth of public information documents and practical coastal engineering lessons that are still resonating as home owners, communities, and engineers consider alternative approaches for managing coastal erosion. The program structure and findings are applicable 40 years later as consideration is given toward the use of Natural and Nature-based Features (NNBF) for addressing coastal erosion. Evolution in thought relative to coastal erosion and shoreline enhancement activities since the 1970s has built upon many of the lessons and concepts of the Section 54 program and other real-world coastal erosion management success-failure experiences. This growth has led to a modern appreciation that those features that emulate NNBF are promising and responsible alternative coastal erosion management strategies if proper engineering standard elements of design are included in the project.

A population-based analysis in 375,233 cases of heart failure stages A, B and C. Real world epidemiology of prevalence and temporal trends in South-European populations

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
S Jimenez ◽  
M Cainzos-Achirica ◽  
D Monterde ◽  
L Garcia-Eroles ◽  
C Enjuanes ◽  
...  
Keyword(s):  
Heart Failure ◽  
Chronic Conditions ◽  
Temporal Trends ◽  
Population Level ◽  
Population Based ◽  
Relative Increase ◽  
Funding Source ◽  
Private Company ◽  
Healthcare Database ◽  
Evolutionary Changes

Abstract Background Prevalence of congestive heart failure (CHF) and predisposing conditions has described previously. Most of these studies evaluated centre-European or north-American populations. However, the prevalence and evolutionary changes of Heart Failure stages A, B and C has not been fully elucidated in Mediterranean cohorts. Purpose To estimate the prevalence of CHF (HF Stage C) and four additional key chronic cardiovascular, metabolic and renal conditions predisposing to the development of CHF (HF Stages A and B) at a population level in a south-European healthcare area. We analysed the evolutionary changes in the prevalence in these five conditions. Methods In a healthcare area of 1,3Millions inhabitants, we extracted health related information of all individuals ≥55 years old. We analysed data of 375,233 individuals included in the population-based healthcare database of a public Institute of Health between 2015 and 2017. The conditions of interest were CHF, chronic kidney disease (CKD), diabetes mellitus (DM), ischemic heart disease (IHD) and hypertension (HTN). Results The prevalence of chronic conditions was high, particularly of HTN (48.2–48.9%) and DM individuals (14.6–14.8%). The other conditions were less frequent, with prevalence around 2–4% for IHD, 5–9% for CKD and 2–4% for CHF (Table). However, the less frequent conditions had a striking upward trend with over 1,500 new prevalent cases per year between 2015 and 2017 for CHF (45% relative increase), more than 2,500 new prevalent cases for IHD (67% relative increase) and more than 4,000 new prevalent cases per year for CKD (44% relative increase). Conclusion In this south European cohort, there were a high prevalence of HTN and DM as risk factors and a significant trend of increasing prevalence in high cost chronic conditions such as CHF, IHD and CKD. Funding Acknowledgement Type of funding source: Private company. Main funding source(s): The present study was funded by an unrestricted research grant from Vifor Pharma.

scholarly journals Lifestyle risk factor related disparities in oral cancer examination in the U.S: a population-based cross-sectional study

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Aderonke A. Akinkugbe ◽  
Dina T. Garcia ◽  
Tegwyn H. Brickhouse ◽  
Maghboeba Mosavel
Keyword(s):  
Risk Factor ◽  
Oral Cancer ◽  
Population Based ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Lifestyle Risk Factor ◽  
Cross Sectional ◽  
Lifestyle Risk ◽  
Oral Cancer Examination ◽  
The U.S

Prevalence and Incidence of Heart Failure Among Urban Patients in China: A National Population-Based Analysis

2021 ◽  
Author(s):  
Hua Wang ◽  
Ke Chai ◽  
Minghui Du ◽  
Shengfeng Wang ◽  
Jian-Ping Cai ◽  
...  
Keyword(s):  
Heart Failure ◽  
Large Scale ◽  
International Classification Of Diseases ◽  
Population Based ◽  
Unique Identifier ◽  
Classification Of Diseases ◽  
Per Capita ◽  
Mean Cost ◽  
Incident Cases

Background: Large-scale and population-based studies of heart failure (HF) incidence and prevalence are scarce in China. The study sought to estimate the prevalence, incidence, and cost of HF in China. Methods: We conducted a population-based study using records of 50.0 million individuals ≥25 years old from the national urban employee basic medical insurance from 6 provinces in China in 2017. Incident cases were individuals with a diagnosis of HF (International Classification of Diseases code, and text of diagnosis) in 2017 with a 4-year disease-free period (2013–2016). We calculated standardized rates by applying age standardization to the 2010 Chinese census population. Results: The age-standardized prevalence and incidence were 1.10% (1.10% among men and women) and 275 per 100 000 person-years (287 among men and 261 among women), respectively, accounting for 12.1 million patients with HF and 3.0 million patients with incident HF ≥25 years old. Both prevalence and incidence increased with increasing age (0.57%, 3.86%, and 7.55% for prevalence and 158, 892, and 1655 per 100 000 person-years for incidence among persons who were 25–64, 65–79, and ≥80 years of age, respectively). The inpatient mean cost per-capita was $4406.8 and the proportion with ≥3 hospitalizations among those hospitalized was 40.5%. The outpatient mean cost per-capita was $892.3. Conclusions: HF has placed a considerable burden on health systems in China, and strategies aimed at the prevention and treatment of HF are needed. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: ChiCTR2000029094.

scholarly journals A Cotton Module Feeder Plastic Contamination Inspection System

2020 ◽  
Vol 2 (2) ◽  
pp. 280-293
Author(s):  
Mathew G. Pelletier ◽  
Greg A. Holt ◽  
John D. Wanjura
Keyword(s):  
Mechanical Design ◽  
Low Cost ◽  
Processing System ◽  
Technical Note ◽  
Inspection System ◽  
Learning Program ◽  
Cotton Lint ◽  
Cotton Industry ◽  
Bill Of Materials ◽  
The U.S

The removal of plastic contamination in cotton lint is an issue of top priority to the U.S. cotton industry. One of the main sources of plastic contamination showing up in marketable cotton bales, at the U.S. Department of Agriculture’s classing office, is plastic from the module wrap used to wrap cotton modules produced by the new John Deere round module harvesters. Despite diligent efforts by cotton ginning personnel to remove all plastic encountered during unwrapping of the seed cotton modules, plastic still finds a way into the cotton gin’s processing system. To help mitigate plastic contamination at the gin; an inspection system was developed that utilized low-cost color cameras to see plastic on the module feeder’s dispersing cylinders, that are normally hidden from view by the incoming feed of cotton modules. This technical note presents the design of an automated intelligent machine-vision guided cotton module-feeder inspection system. The system includes a machine-learning program that automatically detects plastic contamination in order to alert the cotton gin personnel as to the presence of plastic contamination on the module feeder’s dispersing cylinders. The system was tested throughout the entire 2019 cotton ginning season at two commercial cotton gins and at one gin in the 2018 ginning season. This note describes the over-all system and mechanical design and provides an over-view and coverage of key relevant issues. Included as an attachment to this technical note are all the mechanical engineering design files as well as the bill-of-materials part source list. A discussion of the observational impact the system had on reduction of plastic contamination is also addressed.

scholarly journals Improved 8-Year Survival for Patients With Stage IIIC Ovarian Cancer Operated on at Teaching Hospitals: Population-Based Study in Norway 2002

2012 ◽  
Vol 5 (2) ◽  
pp. 60-66 ◽  
Author(s):  
Torbjørn Paulsen ◽  
Witold Szczesny ◽  
Janne Kærn ◽  
Ingvild Vistad ◽  
Claes Tropé
Keyword(s):  
Ovarian Cancer ◽  
Population Based ◽  
Teaching Hospitals ◽  
Stage Iiic ◽  
Population Based Study

Acceptability of a School-Based Intervention for the Prevention of Adolescent Obesity

2006 ◽  
Vol 22 (5) ◽  
pp. 269-277 ◽  
Author(s):  
Leanne M. Mauriello ◽  
Mary Margaret H. Driskell ◽  
Karen J. Sherman ◽  
Sara S. Johnson ◽  
Janice M. Prochaska ◽  
...  
Keyword(s):  
Transtheoretical Model ◽  
Fruits And Vegetables ◽  
School Administrators ◽  
Low Cost ◽  
Population Based ◽  
Student Responses ◽  
School Based Intervention ◽  
School Based ◽  
Computer Based ◽  
Obesity Prevention Program

This article describes the development and pilot testing of a computer-based, multiple-behavior obesity prevention program for adolescents. Using the Transtheoretical Model as a framework, this intervention offers individualized feedback based on readiness to engage in physical activity, to consume fruits and vegetables, and to limit television viewing. Focus groups and interviews with students, teachers, school administrators, and experts guided the development. Forty-five students participated in a baseline intervention session and completed a 16-item acceptability measure. Ratings were positive, with item means ranging from 3.60–4.75 on a 5-point scale. Student responses to open-ended questions aided in the enhancement of the intervention, for which an effectiveness trial begins in September 2006. This formative work demonstrated the acceptability of this school-based intervention approach, which can be promoted and prescribed by school nurses. Further, if found effective, it can be disseminated as an efficient, low-cost, population-based approach designed to address the epidemic of obesity.

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