Home hospitalization in children and youth with special health care needs (cyshcn): financial perspectives in hospital de alta complexidad, Chile

Introduction. The absence of home hospitalization (HH) of children and youth with special health care needs (CYSHCN) generates prolonged hospitalizations in closed care (CC). Objective: To compare the estimated cost of HH of high complexity CYSHCN versus the actual cost of the same patient in CC and its impact on hospital production. Methods: Descriptive and comparative study between costs of both hospitalization modalities of high complexity CYSHCN. From January to December 2016, non-oncological CYSHCN hospitalizations were registered by the Pediatric Service (PS) according to the Ministry of Health-Chile (MINSAL) norm. It was classified for clinical groups and similar consumption of resources according to groups related to diagnosis (DRG). The stay was adjusted, and financial analysis of both modalities (CC) and (HH) was performed to evaluate the impact on hospital production. Results: Of 3690 discharges, 126 (3.4%) were related to 27 CYSHCN, the average age was 4.6 years (± 5 SD) with technological dependencies to live. The mean CYSHCN stay was 16 days, compared with 5.9 for patients without special health needs. CYSHCN stays reached 2017 days (8.6%). Disregarding the CYSHCN discharges would have contributed 320 additional discharges, and his HH would have saved US $ 15 / day per patient, which for the total number of stays consumed would have been an annual saving of US $ 29170. Conclusion: HH has an estimated cost lower than the CA of high complexity CYSHCN, improves hospital productivity, and frees critical beds with financially viable investment.

Patterns of hospital utilization in the Unified Health System in six Brazilian capitals: comparison between the year before and the first six first months of the COVID-19 pandemic

Objective To analyze the temporal evolution of the pattern of hospital use in the context of the COVID-19 pandemic in Brazil. Methods This retrospective observational study compared hospital use and mortality in the Brazilian Unified Health System (SUS) in the first six months of the COVID-19 pandemic with the year before the onset of the pandemic in six Brazilian capitals (São Paulo, Rio de Janeiro, Manaus, Fortaleza, Recife, and Brasilia). It was based on secondary administrative data from the SUS Hospital Information System (SIH), focusing on the number of hospitalizations per fortnight, age, and gender of patients, hospital length of stay, and the proportions of surgical, elective, with the use of ICU, and resulting in death hospitalizations. It also compared the number of hospitalizations and mortality related to frequent diagnostic groups. Results A significant drop was identified in the number of hospitalizations as of March 2020, with the first peak of COVID-19 hospitalizations in five capitals recorded in May 2020. In the six capitals, we observed significant reductions in the mean number of hospitalizations per fortnight from the beginning of the pandemic. We also identified an increase in the mean age of the patients and the proportion of male patients. The proportion of surgical and elective hospitalizations dropped significantly in all capitals, while the proportion of hospitalizations with ICU use increased significantly. Significant increases in-hospital mortality were also recorded in the six capitals with the pandemic, including or excluding COVID-19 hospitalizations from the comparison. Conclusion The pandemic caused changes in the pattern of use and hospital indicators in the first six months in the cities considered, evidencing the need for attention to diseases with a hospital production altered by the COVID-19 course and health system performance problems in the face of challenges.

Rates of hospitalizations for epilepsy in children between 2014 and 2020 in Bahia

Background: Epilepsy is a neurological disease characterized by abnormal and excessive electrical discharges in the brain, with the occurrence of two or more seizures during 12 months, without causing fever, traumatic brain injury, hydroelectrolytic alteration or concomitant disease. Knowing the panorama of hospitalizations makes it possible to manage and direct resources in order to adapt to the needs of the age group. Objectives: Compare the age groups in relation to the number of hospitalizations for Epilepsy in Bahia between 2014 and 2020. Methods: Work carried out based on secondary data through public consultation to the DataSUS platform, through the Hospital Production System of the Unified Health System (SIH- SUS). All cases of hospitalization for epilepsy in children between January 2014 and December 2020, in the state of Bahia, were included. Results: The age group that presented the highest rate of hospitalization was 1-4 years old with an average of 39.49%, followed by the age group between 5-9 years old with 20.16%, in addition to those younger than 1 year old with 16, 70%, with the age groups between 10-14 years old and 15-19 being the last with 13.65% and 10% respectively. Conclusions: It is observed that there is a higher incidence rate of hospitalizations in children under 9 years of age, explained by the high rate of epilepsy that evolve, most of the time, with the disappearance in adolescence, elucidating the lowest rates in the age group over 10 years.

Analysis of hospitalization rates for epilepsy in children between 2014 and 2020 in Bahia

Background: Epilepsy is a neurological disease characterized by abnormal and excessive electrical discharges in the brain, with the occurrence of two or more seizures during 12 months, without causing fever, traumatic brain injury, hydroelectrolytic alteration or concomitant disease. Knowing the panorama of hospitalizations makes it possible to manage and direct resources in order to adapt to the needs of the age group. Objectives: Compare the age groups in relation to the number of hospitalizations for Epilepsy in Bahia between 2014 and 2020. Methods: Work carried out based on secondary data through public consultation to the DataSUS platform, through the Hospital Production System of the Unified Health System (SIH- SUS). All cases of hospitalization for epilepsy in children between January 2014 and December 2020, in the state of Bahia, were included. Results: The age group that presented the highest rate of hospitalization was 1-4 years old with an average of 39.49%, followed by the age group between 5-9 years old with 20.16%, in addition to those younger than 1 year old with 16, 70%, with the age groups between 10-14 years old and 15-19 being the last with 13.65% and 10% respectively. Conclusions: It is observed that there is a higher incidence rate of hospitalizations in children under 9 years of age, explained by the high rate of epilepsy that evolve, most of the time, with the disappearance in adolescence, elucidating the lowest rates in the age group over 10 years.

Assessment of the attractiveness of robotic-assisted radical prostatectomy in the hospitals in Milan

Background Robotic-Assisted Radical Prostatectomy (RARP) performed in the hospitals of the Health Protection Agency (ATS) of Milan increased from 302 in 2011 to 1275 in 2019. On the contrary, Traditional Radical Prostatectomy (TRP) remained essentially unchanged (919 hospitalization in 2011, 937 in 2019). The increase in RARP occurred both for Lombardy (L) (223,7%) and particularly for out-of-Lombardy residents (EL) (565,5%). In 2011 66.5% of all EL treated with Radical Prostatectomy (RP) (RARP + TRP) in the ATS area were enrolled in hospitals equipped with robots, while in 2019 this percentage rose to 97.5%. In view of this important increase and considering the high density of hospitals with robots in Milan, it was analyzed if the reason for the EL displacement could be due to the possibility of performing a RARP. Methods The Hospital Discharge Cards (SDO) database was used for the analysis. Admissions to be considered were identified through the main diagnosis of localized malignant prostatic cancer and the surgical intervention of RP. The other urological interventions were identified through the discharge ward. The “residency” field allowed to separate L from EL. Results Considering the four hospitals where robot technology was already available in 2011, the percentage changes in hospitalizations were compared for: only RP interventions, all urological interventions excluding RP, total hospital production distinguishing between L and EL. RP increased by about 5 percentage points in EL (from 43.5% in 2011 to 48.7% in 2019). For other urological surgeries excluding RP, the increase was about 11 pp (from 16.1% in 2011 to 27.3% in 2019), as well as for general procedures (15.5% in 2011, 26, 2% in 2019). Conclusions The increase in EL for RP is lower than the increase observed for other urological surgeries and on all hospital production. It can be concluded that it is not the RARP technique itself that is attractive to EL, but rather the reputation of the hospital. Key messages In 2019 the number of robotic-assisted radical prostatectomy increased 4,2 times compared to 2011. R-assisted radical prostatectomy is not a determining factor for health mobility towards Lombardy.

ARRONAX Cyclotron: Setting up of In-House Hospital Radiopharmacy

Whilst radiopharmaceuticals have an important role to play in both imaging and treatment of patients, most notably cancer patients, nuclear medicine and radiopharmacy are currently facing challenges to create innovative new drugs. Traditional radiopharmaceutical manufacture can be considered as either a routine hospital production or a large-scale industrial production. The gap between these two practices has meant that there is an inability to supply innovative radiopharmaceuticals for use at the local level for mono- or multicentric clinical trials with satisfactory quality and safety specifications. This article highlights the regulatory requirements in aseptic pharmaceutical processing and in nuclear medicine to be able to locally produce radiopharmaceuticals. We validate the proof-of-concept for an “in-house” hospital-based radiopharmacy including an on-site cyclotron, that can fulfill the conflicting requirements between radiation safety and aseptic processing. The ARRONAX in-house radiopharmacy is currently able to provide sterile and pyrogenic-free injectable radiopharmaceutical compounds for both industrial and institutional clinical trials.

Análise de custos de nutrição parenteral

RESUMOObjetivo: avaliar o custo envolvido no preparo da nutrição parenteral em hospital universitário ao adquirido de uma empresa terceirizada. Método: trata-se de um estudo quantitativo, descritivo, exploratório com análise retrospectiva de dados. Obtiveram-se os dados por meio das prescrições médicas e notas fiscais das NP’s. Calcularam-se, para a comparação de custos, os custos médios, em reais, das NP’s por prescrição praticados pela empresa terceirizada, o valor estimado da produção no hospital comparado com o valor de ressarcimento pelo SUS, de acordo com a tabela Sistema de Gerenciamento da Tabela de Procedimento (SIGTAP) do SUS. Apresentaram-se os resultados em forma de tabelas. Resultados: analisaram-se 1818 prescrições, sendo 51,05% das prescrições de adultos; 22,71% de Pediatria e 26,24% de Neonatologia. Conclusão: conclui-se que os valores pagos pelo SUS são inferiores aos gastos pelos serviços de saúde, independentemente do tipo de produção da NP. Considera-se este estudo importante para auxiliar os gestores dos serviços hospitalares na tomada de decisões. Descritores: Custos e Análise de Custo; Alocação de Custos; Organização e Administração; Custos Hospitalares; Nutrição Parenteral; Soluções de Nutrição Parenteral.ABSTRACT Objective: to evaluate the cost involved in the preparation of parenteral nutrition in a university hospital when acquired from a third party company. Method: this is a quantitative, descriptive, exploratory study with retrospective data analysis. The data was obtained through the medical prescriptions and fiscal notes of the PNs. The average costs, in reais, of the prescription PNs practiced by the outsourced company were calculated for the comparison of costs, the estimated value of the hospital production compared to the UHS compensation amount, according to the Management System table of the UHS Procedure Table (SIGTAP). Results were presented in the form of tables. Results: 1818 prescriptions were analyzed, being 51.05% of adult prescriptions; 22.71% of Pediatrics and 26.24% of Neonatology. Conclusion: it is concluded that the amounts paid by the UHS are lower than those spent by the health services, regardless of the type of PN production. This study is considered important to assist hospital managers in decision-making. Descriptors: Costs and Cost Analysis; Cost Allocation; Organization and Administration; Hospital Costs; Parenteral Nutrition; Parenteral Nutrition Solutions. RESUMEN Objetivo: evaluar el costo involucrado en la preparación de la nutrición parenteral en un hospital universitario al adquirido de una empresa tercerizada. Método: se trata de un estudio cuantitativo, descriptivo, exploratorio con análisis retrospectivo de datos. Se obtuvieron los datos por medio de las prescripciones médicas y las notas fiscales de las NP's. Se calcularon, para la comparación de costos, los costos medianos, en reales, de las NP's por prescripción practicados por la empresa tercerizada, el valor estimado de la producción en el hospital comparado con el valor de resarcimiento por el SUS, de acuerdo con la tabla Sistema de Gestión de la Tabla de Procedimiento (SIGTAP) del SUS. Se presentaron los resultados en forma de tablas. Resultados: se analizaron 1818 prescripciones, siendo el 51,05% de las prescripciones de adultos; el 22,71% de Pediatría y el 26,24% de Neonatología. Conclusión: se concluye que los valores pagados por el SUS son inferiores a los gastos por los servicios de salud, independientemente del tipo de producción de la NP. Se considera este estudio importante para auxiliar a los gestores de los servicios hospitalarios en la toma de decisiones. Descritores: Costos y Análisis de Costo; Asignación de Costos; Organización y Administración; Costos de Hospital; Nutrición Parenteral; Soluciones para Nutrición Parenteral.