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https://www.readbyqxmd.com/read/28533920/inflammatory-bowel-disease-efficient-remission-maintenance-is-crucial-for-cost-containment
#1
REVIEW
Giovanni C Actis, Rinaldo Pellicano
The inflammatory bowel diseases (IBD) are chronic incurable inflammatory disorders of the gut. Some 10% run a downhill course, requiring emergency medical support and often surgery; another small subset are monogenic, and, threatening pediatric patients, are the challenge of these days. The majority of the IBDs, however, are polygenic low-penetrance diseases, running a lifetime waxing-and-waning course. The prevalent trend is towards a slow worsening and steady cost increase. Each and all drugs of the available arsenal exhibit strengths and weaknesses: Mesalamines are chiefly effectively for mild-moderate colitis, and do not work in Crohn's; steroids do not control some 40% of the ulcerative colitis cases, and are not indicated for Crohn's; thiopurines are effective in the maintenance of the IBDs but do not prevent relapses on withdrawal; biologics are still being used empirically (not monitored) causing further increase of their cost over that of hospitalization...
May 6, 2017: World Journal of Gastrointestinal Pharmacology and Therapeutics
https://www.readbyqxmd.com/read/28532488/mitigating-the-heroin-crisis-in-baltimore-md-usa-a-cost-benefit-analysis-of-a-hypothetical-supervised-injection-facility
#2
Amos Irwin, Ehsan Jozaghi, Brian W Weir, Sean T Allen, Andrew Lindsay, Susan G Sherman
BACKGROUND: In Baltimore, MD, as in many cities throughout the USA, overdose rates are on the rise due to both the increase of prescription opioid abuse and that of fentanyl and other synthetic opioids in the drug market. Supervised injection facilities (SIFs) are a widely implemented public health intervention throughout the world, with 97 existing in 11 countries worldwide. Research has documented the public health, social, and economic benefits of SIFs, yet none exist in the USA. The purpose of this study is to model the health and financial costs and benefits of a hypothetical SIF in Baltimore...
May 12, 2017: Harm Reduction Journal
https://www.readbyqxmd.com/read/28526311/dramatic-effects-of-a-new-antimicrobial-stewardship-program-in-a-rural-community-hospital
#3
Claudia R Libertin, Stephanie H Watson, William L Tillett, Joy H Peterson
BACKGROUND: New Joint Commission antimicrobial stewardship requirements took effect on January 1, 2017, promoted as a central strategy for coping with the emerging problems of antimicrobial resistance and Clostridium difficile infection. Our objective was to measure the effects of a new antimicrobial stewardship program (ASP) in a rural community hospital with no prior ASP, in the context of having a new infectious disease specialist on staff. METHODS: An ASP team was formed to implement a prospective audit with health care provider feedback and targeting 12 antimicrobial agents in a rural hospital in Georgia...
May 16, 2017: American Journal of Infection Control
https://www.readbyqxmd.com/read/28511924/evaluation-of-the-effectiveness-of-a-phone-based-care-coordination-pilot-on-hospital-utilisation-and-costs-for-patients-with-chest-pain
#4
Peita Price, Ruth Vincent, Mark Tacey, Jane Gilchrist, Danny Liew, Leeanne Grigg, Lucio Naccarella
BACKGROUND: A small percentage of the population represents a disproportionate number of attendances at emergency departments (ED). "Frequent presenters" to ED with chest pain do not always fit into established pathways for acute myocardial events. With accelerated "rule out" protocols, patients are often discharged from the Emergency Department (ED) after short lengths of stay. This research will evaluate the effectiveness of a phone based care-coordination pilot designed to meet the needs of patients attending ED with cardiac and non-cardiac chest pain...
April 20, 2017: Heart, Lung & Circulation
https://www.readbyqxmd.com/read/28506855/rates-and-risk-factors-for-opioid-dependence-and-overdose-after-urologic-surgery
#5
Arpeet S Shah, Robert H Blackwell, Paul C Kuo, Gopal N Gupta
INTRODUCTION: Effective pain management is a critical component of the perioperative process, with opioids representing a mainstay of therapy. The opioid epidemic is a growing concern in the United States. The goal of this study was to quantify the risk of opioid dependence or overdose (ODO) among patients undergoing urologic surgery and to identify risk factors of ODO. METHODS: A retrospective review of urologic surgery from 2007-2011. Data sources included the Healthcare Cost and Utilization Project Inpatient, Ambulatory Surgery, and Emergency Department datasets...
May 12, 2017: Journal of Urology
https://www.readbyqxmd.com/read/28498094/predictors-of-all-cause-30-day-readmission-among-medicare-patients-with-type-2-diabetes
#6
Jenna Collins, Ibrahim M Abbass, Raymond Harvey, Brandon Suehs, Claudia Uribe, Jonathan Bouchard, Todd Prewitt, Tony DeLuzio, Elsie Allen
OBJECTIVE: Readmission is costly among patients with type 2 diabetes (T2DM) in Medicare Advantage Prescription Drug Plans; identifying high-risk patients is necessary for targeting reduction programs. The objective of this study was to develop a claims-based algorithm to predict all-cause 30-day readmission among patients with T2DM. METHODS: This study used administrative data from 1/1/2012 through 1/31/2014. The cohort included hospitalized T2DM patients, aged 18-90 with ≥12 months' continuous-enrollment before an unplanned hospital admission and ≥1 month of enrollment post-discharge, excluding patients in long-term care >30 days pre-index...
May 12, 2017: Current Medical Research and Opinion
https://www.readbyqxmd.com/read/28497037/timeliness-of-operating-room-case-planning-and-time-utilization-influence-of-first-and-to-follow-cases
#7
Claudius Balzer, David Raackow, Klaus Hahnenkamp, Steffen Flessa, Konrad Meissner
Resource and cost constraints in hospitals demand thorough planning of operating room schedules. Ideally, exact start times and durations are known in advance for each case. However, aside from the first case's start, most factors are hard to predict. While the role of the start of the first case for optimal room utilization has been shown before, data for to-follow cases are lacking. The present study therefore aimed to analyze all elective surgery cases of a university hospital within 1 year in search of visible patterns...
2017: Frontiers in Medicine
https://www.readbyqxmd.com/read/28496344/adherence-to-disease-modifying-therapies-and-its-impact-on-relapse-health-resource-utilization-and-costs-among-patients-with-multiple-sclerosis
#8
Jack Burks, Thomas S Marshall, Xiaolan Ye
PURPOSE: To evaluate adherence to disease-modifying therapies (DMTs) among patients with multiple sclerosis (MS) initiating oral and injectable DMTs, and to estimate the impact of adherence on relapse, health resource utilization, and medical costs. PATIENTS AND METHODS: Commercially insured MS patients (aged 18-65 years, two or more MS diagnoses, one or more DMT claims) with continuous eligibility 12 months before and after the first DMT claim date (index date) and no DMT claim during the pre-index period were identified from a large commerical claims database for the period from January 1, 2008, to September 30, 2015...
2017: ClinicoEconomics and Outcomes Research: CEOR
https://www.readbyqxmd.com/read/28494806/what-makes-weekend-allied-health-services-effective-and-cost-effective-or-not-in-acute-medical-and-surgical-wards-perceptions-of-medical-nursing-and-allied-health-workers
#9
Lisa O'Brien, Deb Mitchell, Elizabeth H Skinner, Romi Haas, Marcelle Ghaly, Fiona McDermott, Kerry May, Terry Haines
BACKGROUND: There is strong public support for acute hospital services to move to genuine 7-day models, including access to multidisciplinary team assessment. This study aimed to identify factors that might enable an effective and cost-effective weekend allied health services on acute hospital wards. METHODS: This qualitative study included 22 focus groups within acute wards with a weekend allied health service and 11 telephone interviews with weekend service providers...
May 12, 2017: BMC Health Services Research
https://www.readbyqxmd.com/read/28493774/urinary-catheter-related-visits-to-the-emergency-department-and-implications-for-community-services
#10
Tiziana Ansell, Danielle Harari
Thousands of patients live with urinary catheters and the potential complications deriving from long-term use. Disjointed community services may result in patients attending the emergency department (ED) to manage catheter complications. AIM: to conduct a service review of catheterised patients attending the ED of a large London hospital; to describe incidence, reasons for attendance and cost to inform future planning for out-of-hospital care. METHOD: a catheter collaborative, consisting of multidisciplinary health professionals and patients, formulated survey questions...
May 11, 2017: British Journal of Nursing: BJN
https://www.readbyqxmd.com/read/28485885/hospital-occupancy-and-discharge-strategies-a-simulation-based-study
#11
S Qin, C Thompson, T Bogomolov, D Ward, P Hakendorf
BACKGROUND: Increasing demand for hospital services has resulted in more arrivals to emergency department (ED), increased admissions, and, quite often, access block and ED congestion, along with patients' dissatisfaction. Cost constraints limit an increase in the number of hospital beds, so alternative solutions need to be explored. AIMS: The aims of this study were to propose and test different discharge strategies which, potentially, could reduce occupancy rates in the hospital, thereby improving patient flow and minimising frequency and duration of congestion episodes...
May 9, 2017: Internal Medicine Journal
https://www.readbyqxmd.com/read/28465768/comparing-healthcare-costs-associated-with-oral-and-subcutaneous-methotrexate-or-biologic-therapy-for-rheumatoid-arthritis-in-the-united-states
#12
Joseph Lee, Ryan Pelkey, Julieanna Gubitosa, Michael F Henrick, Michael L Ganz
BACKGROUND: Methotrexate (MTX) is the primary disease-modifying antirheumatic drug used for the treatment of rheumatoid arthritis (RA). Optimizing the use of oral and subcutaneous MTX may delay the use of expensive biologic therapies; the effect of such a delay on overall medical costs is currently unknown. OBJECTIVE: To compare the 5-year healthcare costs of treatment pathways for patients with RA who initiate oral MTX in the United States. METHODS: We identified patients with RA in the Symphony Health Solutions database (Integrated Dataverse) who initiated treatment with oral MTX in 2009 and had RA-related claims for each year through 2014...
February 2017: American Health & Drug Benefits
https://www.readbyqxmd.com/read/28465038/development-of-a-financially-viable-model-for-the-management-of-mandibular-fractures-as-day-cases-in-a-level-1-major-trauma-centre
#13
J Haq, J Olding, S Chegini, C Huppa, R Bentley, K Fan
There is a subgroup of patients with mandibular fractures who could safely and effectively be managed in an outpatient day-care unit. Suitability depends on medical, social, and operative factors, and identification of the correct criteria will govern management after that in the emergency department. Reduced use of beds would lead to less money being spent on emergency treatment, and increased capacity for elective surgery. The aims of this study were to identify a group of patients with mandibular fractures whose duration of operation and period of recovery would be suitable for treatment in the day-care unit, and to evaluate the potential financial benefits...
April 29, 2017: British Journal of Oral & Maxillofacial Surgery
https://www.readbyqxmd.com/read/28457798/cardiology-consultation-in-the-emergency-department-reduces-re-hospitalizations-for-low-socioeconomic-patients-with-acute-decompensated-heart-failure
#14
Corey E Tabit, Mitchell J Coplan, Kirk T Spencer, Charina F Alcain, Thomas Spiegel, Adam S Vohra, Daniel Adelman, James K Liao, Rupa Mehta Sanghani
BACKGROUND: Re-hospitalization after discharge for acute decompensated heart failure is a common problem. Low-socioeconomic urban patients suffer high rates of re-hospitalization and often over-utilize the Emergency Department (ED) for their care. We hypothesized that early consultation with a cardiologist in the ED can reduce re-hospitalization and healthcare costs for low-socioeconomic urban patients with acute decompensated heart failure. METHODS: 392 patients treated at our center for acute decompensated heart failure received standardized education and follow-up...
April 27, 2017: American Journal of Medicine
https://www.readbyqxmd.com/read/28456828/resource-utilization-associated-with-extracardiac-co-morbid-conditions-following-congenital-heart-surgery-in-infancy
#15
Krista E Tuomela, John B Gordon, Laura D Cassidy, Sarah Johaningsmeir, Nancy S Ghanayem
Congenital heart disease (CHD) is often associated with chronic extracardiac co-morbid conditions (ECC). The presence of ECC has been associated with greater resource utilization during the operative period; however, the impact beyond hospital discharge has not been described. This study sought to understand the scope of chronic ECC in infants with CHD as well as to describe the impact of ECC on resource utilization after discharge from the index cardiac procedure. IRB approved this retrospective study of infants <1 year who had cardiac surgery from 2006 and 2011...
April 29, 2017: Pediatric Cardiology
https://www.readbyqxmd.com/read/28455097/severity-of-acute-kidney-injury-in-the-post-lung-transplant-patient-is-associated-with-higher-healthcare-resources-and-cost
#16
Albert P Nguyen, Rodney A Gabriel, Eugene Golts, Erik B Kistler, Ulrich Schmidt
OBJECTIVE: Perioperative risk factors and the clinical impact of acute kidney injury (AKI) and failure after lung transplantation are not well described. The incidences of AKI and acute renal failure (ARF), potential perioperative contributors to their development, and postdischarge healthcare needs were evaluated. DESIGN: Retrospective. SETTING: University hospital. PARTICIPANTS: Patients undergoing lung transplantation between January 1, 2011 and December 31, 2015...
February 5, 2017: Journal of Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/28453429/anti-microbial-coating-innovations-to-prevent-infectious-diseases-amici-cost-action-ca15114
#17
Colum P Dunne, Minna M Keinänen-Toivola, Anne Kahru, Birgit Teunissen, Hulya Olmez, Isabel Gouveia, Luis Melo, Kazimierz Murzyn, Martina Modic, Merja Ahonen, Pete Askew, Theofilos Papadopoulos, Christian Adlhart, Francy R L Crijns
Worldwide, millions of patients are affected annually by healthcare-associated infection (HCAI), impacting up to 80,000 patients in European Hospitals on any given day. This represents not only public health risk, but also an economic burden. Complementing routine hand hygiene practices, cleaning and disinfection, antimicrobial coatings hold promise based, in essence, on the application of materials and chemicals with persistent bactericidal or -static properties onto surfaces or in textiles used in healthcare environments...
April 28, 2017: Bioengineered
https://www.readbyqxmd.com/read/28450741/hospital-readmissions-for-copd-a-retrospective-longitudinal-study
#18
Timothy H Harries, Hannah Thornton, Siobhan Crichton, Peter Schofield, Alexander Gilkes, Patrick T White
Prevention of chronic obstructive pulmonary disease hospital readmissions is an international priority aimed to slow disease progression and limit costs. Evidence of the risk of readmission and of interventions that might prevent it is lacking. We aimed to determine readmission risk for chronic obstructive pulmonary disease, factors influencing that risk, and variation in readmission risk between hospitals across 7.5 million people in London. This retrospective longitudinal observational study included all chronic obstructive pulmonary disease admissions to any hospital in the United Kingdom among patients registered at London general practices who had emergency National Health Service chronic obstructive pulmonary disease hospital admissions between April 2006 and March 2010...
April 27, 2017: NPJ Primary Care Respiratory Medicine
https://www.readbyqxmd.com/read/28449686/the-frequency-of-asthma-exacerbations-and-healthcare-utilization-in-patients-with-asthma-from-the-uk-and-usa
#19
Robert Y Suruki, Jonas B Daugherty, Nada Boudiaf, Frank C Albers
BACKGROUND: Asthma exacerbations are frequent in patients with severe disease. This report describes results from two retrospective cohort studies describing exacerbation frequency and risk, emergency department (ED)/hospital re-admissions, and asthma-related costs by asthma severity in the US and UK. METHODS: Patients with asthma in the US-based Clinformatics™ DataMart Multiplan IMPACT (2010-2011; WEUSKOP7048) and the UK-based Clinical Practice Research Datalink (2009-2011; WEUSKOP7092) databases were categorized by disease severity (Global Initiative for Asthma [GINA]; Step and exacerbation history) during the 12 months pre-asthma medical code (index date)...
April 27, 2017: BMC Pulmonary Medicine
https://www.readbyqxmd.com/read/28448570/disease-burden-for-patients-with-primary-immunodeficiency-diseases-identified-at-reference-hospitals-in-guanajuato-mexico
#20
Eduardo Guaní-Guerra, Ana Isabel Jiménez-Romero, Ulises Noel García-Ramírez, José Manuel Velázquez-Ávalos, Edgar Martínez-Guzmán, Eunice Sandoval-Ramírez, Ignacio Camacho-Meza
BACKGROUND: In addition to the deleterious effect on health, there is considerable economic and psychosocial morbidity associated with primary immunodeficiency diseases (PID). Also, the cost of a late diagnosis frequently results in a heavy disease burden on the patient. The objective of this study was to collect and analyze data on patients with PID in the state of Guanajuato in Mexico, to indirectly estimate the burden of the disease. METHODS: An observational, longitudinal, and comparative study was conducted...
2017: PloS One
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