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Hospitalization cost stroke

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https://www.readbyqxmd.com/read/28229894/mobile-stroke-units-for-prehospital-thrombolysis-triage-and-beyond-benefits-and-challenges
#1
REVIEW
Klaus Fassbender, James C Grotta, Silke Walter, Iris Q Grunwald, Andreas Ragoschke-Schumm, Jeffrey L Saver
In acute stroke management, time is brain. Bringing swift treatment to the patient, instead of the conventional approach of awaiting the patient's arrival at the hospital for treatment, is a potential strategy to improve clinical outcomes after stroke. This strategy is based on the use of an ambulance (mobile stroke unit) equipped with an imaging system, a point-of-care laboratory, a telemedicine connection to the hospital, and appropriate medication. Studies of prehospital stroke treatment consistently report a reduction in delays before thrombolysis and cause-based triage in regard to the appropriate target hospital (eg, primary vs comprehensive stroke centre)...
March 2017: Lancet Neurology
https://www.readbyqxmd.com/read/28225376/a-qualitative-analysis-of-general-emergency-medicine-providers-perceptions-on-pediatric-emergency-telemedicine
#2
Ji Won Kim, Gunjan Tiyyagura, Melissa Langhan
OBJECTIVE: Most children in the United States are evaluated in general emergency departments (ED), which are staffed by practitioners who care for both adults and children and may have limited pediatric resources. The application of telemedicine in pediatrics is growing and has been shown to be effective in outpatient as well as critical care settings. Telemedicine has the potential to address disparities in access to pediatric emergency care. The objective of this study was to explore experiences of general ED providers with telemedicine and their perception about a potential video telemedicine program with pediatric ED providers...
February 21, 2017: Pediatric Emergency Care
https://www.readbyqxmd.com/read/28211020/goal-directed-fluid-restriction-during-brain-surgery-a-prospective-randomized-controlled-trial
#3
Jinfeng Luo, Jing Xue, Jin Liu, Bin Liu, Li Liu, Guo Chen
BACKGROUND: The value of goal-directed fluid therapy in neurosurgical patients, where brain swelling is a major concern, is unknown. The aim of our study was to evaluate the effect of an intraoperative goal-directed fluid restriction (GDFR) strategy on the postoperative outcome of high-risk patients undergoing brain surgery. METHODS: High-risk patients undergoing brain surgery were randomly assigned to a usual care group (control group) or a GDFR group. In the GDFR group, (1) fluid maintenance was restricted to 3 ml/kg/h of a crystalloid solution and (2) colloid boluses were allowed only in case of hypotension associated with a low cardiac index and a high stroke volume variation...
December 2017: Annals of Intensive Care
https://www.readbyqxmd.com/read/28196938/risk-of-acute-stroke-after-hospitalization-for-sepsis-a-case-crossover-study
#4
Amelia K Boehme, Purnima Ranawat, Jorge Luna, Hooman Kamel, Mitchell S V Elkind
BACKGROUND AND PURPOSE: Infections have been found to increase the risk of stroke over the short term. We hypothesized that stroke risk would be highest shortly after a sepsis hospitalization, but that the risk would decrease, yet remain up to 1 year after sepsis. METHODS: This case-crossover analysis utilized data obtained from the California State Inpatient Database of the Healthcare Cost and Utilization Project. All stroke admissions were included. Exposure was defined as hospitalization for sepsis or septicemia 180, 90, 30, or 15 days before stroke (risk period) or similar time intervals exactly 1 or 2 years before stroke (control period)...
February 14, 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/28196524/financial-barriers-and-adverse-clinical-outcomes-among-patients-with-cardiovascular-related-chronic-diseases-a-cohort-study
#5
David J T Campbell, Braden J Manns, Robert G Weaver, Brenda R Hemmelgarn, Kathryn M King-Shier, Claudia Sanmartin
BACKGROUND: Some patients with cardiovascular-related chronic diseases such as diabetes and heart disease report financial barriers to achieving optimal health. Previous surveys report that the perception of having a financial barrier is associated with self-reported adverse clinical outcomes. We sought to confirm these findings using linked survey and administrative data to determine, among patients with cardiovascular-related chronic diseases, if there is an association between perceived financial barriers and the outcomes of: (1) disease-related hospitalizations, (2) all-cause mortality and (3) inpatient healthcare costs...
February 15, 2017: BMC Medicine
https://www.readbyqxmd.com/read/28182800/cost-of-acute-kidney-injury-in-hospitalized-patients
#6
Samuel A Silver, Jin Long, Yuanchao Zheng, Glenn M Chertow
BACKGROUND: The economic burden of acute kidney injury (AKI) is not well understood. OBJECTIVE: To estimate the effects of AKI on hospitalization costs and length of stay (LOS). DESIGN: Using data from the 2012 National Inpatient Sample, we compared hospitalization costs and LOS with and without AKI. We used a generalized linear model with a gamma distribution and a log link fitted to AKI to adjust for demographics, hospital differences, and comorbidities...
February 2017: Journal of Hospital Medicine: An Official Publication of the Society of Hospital Medicine
https://www.readbyqxmd.com/read/28181855/a-contemporary-evaluation-of-carotid-endarterectomy-outcomes-in-patients-with-chronic-kidney-disease-in-the-united-states
#7
Amit R Patel, Viktor Y Dombrovskiy, Todd R Vogel
Objectives Chronic kidney disease (CKD) has been identified as a significant risk factor for poor post-surgical outcomes. This study was designed to provide a contemporary analysis of carotid endarterectomy (CEA) outcomes in patients with CKD, end-stage renal disease (ESRD), and normal renal function (NF). Methods The Nationwide Inpatient Sample data 2006-2012 was queried to select patients aging 40 years old and above who underwent CEA during two days after admission and had a diagnosis of ESRD on long-term hemodialysis, patients with non-dialysis-dependent CKD, or NF...
January 1, 2017: Vascular
https://www.readbyqxmd.com/read/28178979/managed-care-and-inpatient-mortality-in-adults-effect-of-primary-payer
#8
Anika L Hines, Susan O Raetzman, Marguerite L Barrett, Ernest Moy, Roxanne M Andrews
BACKGROUND: Because managed care is increasingly prevalent in health care finance and delivery, it is important to ascertain its effects on health care quality relative to that of fee-for-service plans. Some stakeholders are concerned that basing gatekeeping, provider selection, and utilization management on cost may lower quality of care. To date, research on this topic has been inconclusive, largely because of variation in research methods and covariates. Patient age has been the only consistently evaluated outcome predictor...
February 8, 2017: BMC Health Services Research
https://www.readbyqxmd.com/read/28157746/prevention-and-management-of-poststroke-complications
#9
Josephine F Huang
PURPOSE OF REVIEW: This article provides a synopsis of the immediate and delayed medical complications of stroke, with an emphasis on prevention and management of these complications. RECENT FINDINGS: Meta-analysis of the trials for endovascular treatment of acute stroke shows no significant increase in hemorrhagic events. Rehabilitation guidelines published by the American Heart Association and American Stroke Association in 2016 aid in providing the best clinical practice for patients with stroke, from the time of their initial hospitalization to their return to the community...
February 2017: Continuum: Lifelong Learning in Neurology
https://www.readbyqxmd.com/read/28154592/the-trends-of-atrial-fibrillation-related-hospital-visit-and-cost-treatment-pattern-and-mortality-in-korea-10-year-nationwide-sample-cohort-data
#10
Hancheol Lee, Tae-Hoon Kim, Yong-Soo Baek, Jae-Sun Uhm, Hui-Nam Pak, Moon-Hyoung Lee, Boyoung Joung
BACKGROUND AND OBJECTIVES: The change of in-hospital and out-hospital treatments, and hospital costs for atrial fibrillation (AF) were not well known in rapidly aging Asian countries. This study is to examine the trends of AF management and outcomes in Korea. SUBJECTS AND METHODS: In the sample cohort from Korean National Health Insurance Data Sample Cohort (K-NHID-Sample Cohort) from 2004 through 2013, we identified patients with AF and hospital visit records using Korean Classification of Diseases, 6th Revision (KCD-6)...
January 2017: Korean Circulation Journal
https://www.readbyqxmd.com/read/28150313/improved-outcomes-and-reduced-costs-associated-with-a-health-system-wide-patient-blood-management-program-a-retrospective-observational-study-in-four-major-adult-tertiary-care-hospitals
#11
Michael F Leahy, Axel Hofmann, Simon Towler, Kevin M Trentino, Sally A Burrows, Stuart G Swain, Jeffrey Hamdorf, Trudi Gallagher, Audrey Koay, Gary C Geelhoed, Shannon L Farmer
BACKGROUND: Patient blood management (PBM) programs are associated with improved patient outcomes, reduced transfusions and costs. In 2008, the Western Australia Department of Health initiated a comprehensive health-system-wide PBM program. This study assesses program outcomes. STUDY DESIGN AND METHODS: This was a retrospective study of 605,046 patients admitted to four major adult tertiary-care hospitals between July 2008 and June 2014. Outcome measures were red blood cell (RBC), fresh-frozen plasma (FFP), and platelet units transfused; single-unit RBC transfusions; pretransfusion hemoglobin levels; elective surgery patients anemic at admission; product and activity-based costs of transfusion; in-hospital mortality; length of stay; 28-day all-cause emergency readmissions; and hospital-acquired complications...
February 2, 2017: Transfusion
https://www.readbyqxmd.com/read/28135822/impact-of-warfarin-persistence-on-health-care-utilization-and-costs-among-patients-with-atrial-fibrillation-managed-in-anticoagulation-clinics-in-the-united-states
#12
Steven B Deitelzweig, Michael Evans, Jeffrey Trocio, Kiran Gupta, Melissa Lingohr-Smith, Brandy Menges, Jay Lin
Warfarin is a recommended therapy to reduce the risk of stroke in patients with nonvalvular atrial fibrillation (NVAF). The objectives of this study were to identify potential factors associated with warfarin persistence and evaluate the impact of warfarin persistence on health-care resource utilization and costs among patients with NVAF in the United States. Patients (≥18 years) with ≥1 inpatient or ≥2 outpatient diagnoses of AF without valvular disease were identified from an electronic medical record database (January 1, 2004, to January 31, 2015)...
January 1, 2017: Clinical and Applied Thrombosis/hemostasis
https://www.readbyqxmd.com/read/28119375/timing-of-vessel-imaging-for-suspected-large-vessel-occlusions-does-not-affect-groin-puncture-time-in-transfer-patients-with-stroke
#13
John W Liang, Laura Stein, Natalie Wilson, Johanna T Fifi, Stanley Tuhrim, Mandip S Dhamoon
BACKGROUND: Access to endovascular therapy (ET) in cases of acute ischemic stroke may be limited, and rapid transfer of eligible patients to hospitals with endovascular capability is needed. OBJECTIVE: To determine the optimal timing of diagnostic CT angiography to confirm large vessel occlusion (LVO). METHODS: Of 57 emergency department transfers to Mount Sinai Hospital (MSH) for possible ET from January 2015 through March 2016, 39 (68%) underwent ET, among whom 22 (56%) had CT angiography before transfer and 17 (44%) had CT angiography on arrival...
January 24, 2017: Journal of Neurointerventional Surgery
https://www.readbyqxmd.com/read/28118695/the-effect-of-an-arm-sling-used-for-shoulder-support-on-gait-efficiency-in-hemiplegic-patients-with-stroke-using-walking-aids-a-randomized-clinical-trial
#14
Yeon G Jeong, Yeon J Jeong, Jung W Koo
BACKGROUND: The effects of an arm sling on the physiological costs of walking are not known. Even though a previous study reported that an arm sling can improve gait efficiency, its entrance criteria was only hemiparetic patients able to walk without walking aids independently. AIM: To investigate the effect of shoulder support by an arm sling on gait efficiency in hemiplegic stroke patients using walking aids. DESIGN: Randomized crossover design...
January 24, 2017: European Journal of Physical and Rehabilitation Medicine
https://www.readbyqxmd.com/read/28079673/differences-in-use-of-high-quality-and-low-quality-hospitals-among-working-age-individuals-by-insurance-type
#15
Ioana Popescu, Kevin C Heslin, Rosanna M Coffey, Raynard E Washington, Marguerite L Barrett, Lucy H Karnell, José J Escarce
BACKGROUND: Research suggests that individuals with Medicaid or no insurance receive fewer evidence-based treatments and have worse outcomes than those with private insurance for a broad range of conditions. These differences may be due to patients' receiving care in hospitals of different quality. RESEARCH DESIGN: We used the Healthcare Cost and Utilization Project State Inpatient Databases 2009-2010 data to identify patients aged 18-64 years with private insurance, Medicaid, or no insurance who were hospitalized with acute myocardial infarction, heart failure, pneumonia, stroke, or gastrointestinal hemorrhage...
February 2017: Medical Care
https://www.readbyqxmd.com/read/28073360/centralising-and-optimising-decentralised-stroke-care-systems-a-simulation-study-on-short-term-costs-and-effects
#16
Maarten M H Lahr, Durk-Jouke van der Zee, Gert-Jan Luijckx, Patrick C A J Vroomen, Erik Buskens
BACKGROUND: Centralisation of thrombolysis may offer substantial benefits. The aim of this study was to assess short term costs and effects of centralisation of thrombolysis and optimised care in a decentralised system. METHODS: Using simulation modelling, three scenarios to improve decentralised settings in the North of Netherlands were compared from the perspective of the policy maker and compared to current decentralised care: (1) improving stroke care at nine separate hospitals, (2) centralising and improving thrombolysis treatment to four, and (3) two hospitals...
January 10, 2017: BMC Medical Research Methodology
https://www.readbyqxmd.com/read/28069851/less-intense-postacute-care-better-outcomes-for-enrollees-in-medicare-advantage-than-those-in-fee-for-service
#17
Peter J Huckfeldt, José J Escarce, Brendan Rabideau, Pinar Karaca-Mandic, Neeraj Sood
Traditional fee-for-service (FFS) Medicare's prospective payment systems for postacute care provide little incentive to coordinate care or control costs. In contrast, Medicare Advantage plans pay for postacute care out of monthly capitated payments and thus have stronger incentives to use it efficiently. We compared the use of postacute care in skilled nursing and inpatient rehabilitation facilities by enrollees in Medicare Advantage and FFS Medicare after hospital discharge for three high-volume conditions: lower extremity joint replacement, stroke, and heart failure...
January 1, 2017: Health Affairs
https://www.readbyqxmd.com/read/28065240/endovascular-repair-for-acute-type-b-aortic-dissection
#18
Wei Ye, Chang-Wei Liu, Xiao-Jun Song, Yong-Jun Li, Bao Liu, Yue-Hong Zheng, Rong Zeng
Objective To report experience and result of endovascular repair for acute type B aortic dissection (ATBD). Methods Totally 125 ATBD patients receiving endovascular repair with stent-graft were enrolled in this study. Demographic data,operation details,perioperative findings,and follow-up results were retrospectively analyzed. Results All the 125 patients were successfully implanted with 135 stent-grafts. Thirteen cases were covered left subclavian artery,16 cases underwent left subclavian artery revascularization,and 10 cases underwent visceral artery revascularization...
December 20, 2016: Zhongguo Yi Xue Ke Xue Yuan Xue Bao. Acta Academiae Medicinae Sinicae
https://www.readbyqxmd.com/read/28062805/intravenous-thrombolysis-before-endovascular-therapy-for-large-vessel-strokes-can-lead-to-significantly-higher-hospital-costs-without-improving-outcomes
#19
Ansaar T Rai, SoHyun Boo, Chelsea Buseman, Amelia K Adcock, Abdul R Tarabishy, Maurice M Miller, Thomas D Roberts, Jennifer R Domico, Jeffrey S Carpenter
BACKGROUND: Limited efficacy of IV recombinant tissue plasminogen activator (rt-PA) for large vessel occlusions (LVO) raises doubts about its utility prior to endovascular therapy. PURPOSE: To compare outcomes and hospital costs for anterior circulation LVOs (middle cerebral artery, internal carotid artery terminus (ICA-T)) treated with either primary endovascular therapy alone (EV-Only) or bridging therapy (IV+EV)). METHODS: A single-center retrospective analysis was performed...
January 6, 2017: Journal of Neurointerventional Surgery
https://www.readbyqxmd.com/read/28028150/cost-effectiveness-of-solitaire-stent-retriever-thrombectomy-for-acute-ischemic-stroke-results-from-the-swift-prime-trial-solitaire-with-the-intention-for-thrombectomy-as-primary-endovascular-treatment-for-acute-ischemic-stroke
#20
Theresa I Shireman, Kaijun Wang, Jeffrey L Saver, Mayank Goyal, Alain Bonafé, Hans-Christoph Diener, Elad I Levy, Vitor M Pereira, Gregory W Albers, Christophe Cognard, Werner Hacke, Olav Jansen, Tudor G Jovin, Heinrich P Mattle, Raul G Nogueira, Adnan H Siddiqui, Dileep R Yavagal, Thomas G Devlin, Demetrius K Lopes, Vivek K Reddy, Richard du Mesnil de Rochemont, Reza Jahan, Katherine A Vilain, John House, Jin-Moo Lee, David J Cohen
BACKGROUND AND PURPOSE: Clinical trials have demonstrated improved 90-day outcomes for patients with acute ischemic stroke treated with stent retriever thrombectomy plus tissue-type plasminogen activator (SST+tPA) compared with tPA. Previous studies suggested that this strategy may be cost-effective, but models were derived from pooled data and older assumptions. METHODS: In this prospective economic substudy conducted alongside the SWIFT-PRIME trial (Solitaire With the Intention for Thrombectomy as Primary Endovascular Treatment for Acute Ischemic Stroke), in-trial costs were measured for patients using detailed medical resource utilization and hospital billing data...
February 2017: Stroke; a Journal of Cerebral Circulation
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