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cost conscious

Sooyeon Kim, Sage P Kramer, Adam J Dugan, David J Minion, John C Gurley, Daniel L Davenport, Victor A Ferraris, Sibu P Saha
BACKGROUND: Iliac arterial stenting is performed both in the operating room (OR) and the catheterization lab (CL). To date, no analysis has compared resource utilization between these locations. METHODS: Consecutive patients (n = 105) treated at a single center were retrospectively analyzed. Patients included adults with chronic, symptomatic iliac artery stenosis with a minimum Rutherford classification (RC) of 3, treated with stents. Exclusion criteria were prior stenting, acute ischemia, or major concomitant procedures...
October 12, 2016: International Journal of Surgery
Jens Henrichs, Viki Verfaille, Laura Viester, Myrte Westerneng, Bert Molewijk, Arie Franx, Henriette van der Horst, Judith E Bosmans, Ank de Jonge, Petra Jellema
BACKGROUND: Intrauterine growth retardation (IUGR) is a major risk factor for perinatal mortality and morbidity. Thus, there is a compelling need to introduce sensitive measures to detect IUGR fetuses. Routine third trimester ultrasonography is increasingly used to detect IUGR. However, we lack evidence for its clinical effectiveness and cost-effectiveness and information on ethical considerations of additional third trimester ultrasonography. This nationwide stepped wedge cluster-randomized trial examines the (cost-)effectiveness of routine third trimester ultrasonography in reducing severe adverse perinatal outcome through subsequent protocolized management...
October 13, 2016: BMC Pregnancy and Childbirth
Chiara Zucchella, Massimo Di Santis, Biagio Ciccone, Massimiliano Pelella, Marina Scappaticci, Giovanna Badalassi, Susanna Lavezzi, Michelangelo Bartolo
INTRODUCTION: Preliminary evidences showed that telemedicine may allow a reduction of costs and an enhancement of patients' satisfaction and quality of life (QoL), with the same effectiveness of conventional methods of healthcare delivery. Literature is quite absent in relation to the use of telemedicine for patients with disorders of consciousness (DoC) whose management is delegated almost entirely to the family. In order to promote an alternative setting to manage persons affected by DoC, also supporting their families, a pilot project was designed to test the feasibility of home-care assistance based on a system of telemonitoring...
October 12, 2016: Journal of Telemedicine and Telecare
Di Dong, Semra Ozdemir, Yong Mong Bee, Sue-Anne Toh, Marcel Bilger, Eric Finkelstein
OBJECTIVES: To investigate patient preferences and willingness to pay (WTP) for a genetic test that can reduce the risk of life-threatening adverse drug reactions (ADRs). We hypothesize that test features (risk of developing the adverse reaction with and without testing, test cost, and treatment cost) and the choice context (physician recommendation and the most common choice made by peer patients) will influence choices. METHODS: A discrete choice experiment was conducted in which 189 patients at high risk for gout were asked to choose between treatment options that varied along key attributes...
September 2016: Value in Health: the Journal of the International Society for Pharmacoeconomics and Outcomes Research
Sophie Gubbels, Kenn Schultz Nielsen, Jakob Sandegaard, Kåre Mølbak, Jens Nielsen
INTRODUCTION: The Danish National Patient Registry (DNPR) contains clinical and administrative data on all patients treated in Danish hospitals. The data model used for reporting is based on standardized coding of contacts rather than courses of admissions and ambulatory care. METHODS: To reconstruct a coherent picture of courses of admission and ambulatory care, we designed an algorithm with 28 rules that manages transfers between departments, between hospitals and inconsistencies in the data, e...
November 2016: International Journal of Medical Informatics
Benjamin P Falit, Hubert Y Pan, Benjamin D Smith, Brian M Alexander, Anthony L Zietman
Examinations of the US radiation oncology workforce offer inconsistent conclusions, but recent data raise significant concerns about an oversupply of physicians. Despite these concerns, residency slots continue to expand at an unprecedented pace. Employed radiation oncologists and professional corporations with weak contracts or loose ties to hospital administrators would be expected to suffer the greatest harm from an oversupply. The reduced cost of labor, however, would be expected to increase profitability for equipment owners, technology vendors, and entrenched professional groups...
November 1, 2016: International Journal of Radiation Oncology, Biology, Physics
Perrine Séguin, Annie Moulin, Lesly Fornoni, Jérémie Mattout, Emmanuel Maby, Brice Lapin, Véronique Blandin, Pascal Giraux
OBJECTIVE: Brainstem lesions can cause a locked-in syndrome (LIS). At the initial state, the LIS can be complete (CLIS), without any possibility for the patient to communicate. The main issues are to do the right diagnosis and the recovery of a communication. The delay to the diagnosis of LIS is of about 78 days after the initial injury (León-Carrión, 2002). The aim of this study is to identify possibilities to improve the care of persons with LIS at the initial state. MATERIAL/PATIENTS AND METHODS: An original questionnaire of 33 items, concerning patient's feelings and communication possibilities at the initial state of LIS, was sent to the 274 LIS members of the French association of LIS (ALIS) in November, 2015...
September 2016: Annals of Physical and Rehabilitation Medicine
Tim Schutte, Jelle Tichelaar, Prabath Nanayakkara, Milan Richir, Michiel van Agtmael
Given the increasing healthcare costs of an ageing population, there is growing interest in rational prescribing, which takes costs of medication into account. We aimed to gain insight into the attitude to and knowledge of medication costs of medical students and doctors in daily practice. This was a cross-sectional electronic survey among medical students (bachelor/master) and doctors (consultants/registrars). Attitude to costs was evaluated using a cost-consciousness scale. In open questions, the participants estimated the cost of commonly prescribed (generic/non-generic) drugs (including separate pharmacy dispensing costs)...
September 17, 2016: Basic & Clinical Pharmacology & Toxicology
Afshin A Anoushiravani, Zain Sayeed, Mouhanad M El-Othmani, Peter K Wong, Khaled J Saleh
As health care reimbursement models shift from volume-based to value-based models, orthopedic surgeons must provide patients with highly reliable care, while consciously minimizing cost, maintaining quality, and providing timely interventions. An established means of achieving these goals is by implementing a highly reliable care model; however, before such a model can be initiated, a safety culture, robust improvement strategies, and committed leadership are needed. This article discusses interdependent and critical changes required to implement a highly reliable care system...
October 2016: Orthopedic Clinics of North America
Tehsina F Devji, Arin L Madenci, Elizabeth Carpino, Izabela C Leahy, Mihail Samnaliev, Jennifer L Dearden, Brent R Weil, Christopher B Weldon, Joseph Cravero
PURPOSE: The current emphasis on fiscally responsible health spending in the era of the Affordable Care Act and other health care reform necessitates cost-conscious delivery of care. "Value" in health care is defined as the quality of care divided by the cost. As such, health systems optimize value by providing the most cost-effective care possible without sacrificing safety or outcomes. Elective, minimal risk surgical procedures in children may be value-enhanced by moving from an operating room (OR) to a more cost-efficient setting...
November 2016: Journal of Pediatric Surgery
E Gedda, A Robbins, M Hentzien, A Giltat, V Pinel-Petit, J Souille, Y N'Guyen
INTRODUCTION: We assessed (i) the frequency of consultations for faintness in the Emergency department (ED) of a University hospital centre (UHC), (ii) clinical epidemiology and (iii) cost of faintness, taking a particular interest into the determining risk factors for hospitalization. METHODS: This epidemiological study has been conducted retrospectively, from data obtained for every patient having consulted for faintness in ED of Reims UHC (01/01/12-03/31/12)...
September 9, 2016: La Revue de Médecine Interne
P Madhan Mohan, V Nagarajan, J C Vignesh
Due to increasing health consciousness among people, it is imperative to have low-cost health care devices to measure the vital parameters like heart rate and arterial oxygen saturation (SpO2). In this paper, an efficient heart rate monitoring algorithm based on the morphology of photoplethysmography (PPG) signals to measure the spot heart rate (HR) and its real-time implementation is proposed. The algorithm does pre-processing and detects the onsets and systolic peaks of the PPG signal to estimate the heart rate of the subject...
September 9, 2016: Journal of Medical Engineering & Technology
Jack W Weick, Harpreet S Bawa, Douglas R Dirschl
BACKGROUND: The prevalence of knee osteoarthritis is increasing in the aging U.S. POPULATION: The efficacy and cost-effectiveness of the use of hyaluronic acid (HA) injections for the treatment of knee osteoarthritis are debated. In this study, we assessed the utilization and costs of HA injections in the 12 months preceding total knee arthroplasty (TKA) and evaluated the usage of HA injections in end-stage knee osteoarthritis management in relation to other treatments...
September 7, 2016: Journal of Bone and Joint Surgery. American Volume
Houmehr Hojjat, Peter F Svider, Adam J Folbe, Syed N Raza, Michael A Carron, Mahdi A Shkoukani, Albert L Merati, Ross M Mayerhoff
OBJECTIVES/HYPOTHESIS: To evaluate the cost-effectiveness of routine computed tomography (CT) in individuals with unilateral vocal fold paralysis (UVFP) STUDY DESIGN: Health Economics Decision Tree Analysis METHODS: A decision tree was constructed to determine the incremental cost-effectiveness ratio (ICER) of CT imaging in UVFP patients. Univariate sensitivity analysis was utilized to calculate what the probability of having an etiology of the paralysis discovered would have to be to make CT with contrast more cost-effective than no imaging...
September 7, 2016: Laryngoscope
Aladine A Elsamadicy, Owoicho Adogwa, Victoria D Vuong, Ankit I Mehta, Raul A Vasquez, Joseph Cheng, Isaac O Karikari, Carlos A Bagley
BACKGROUND: Hospital readmission within 30-days of index surgery is receiving increased scrutiny as an indicator of poor quality of care. Accordingly, reducing readmissions achieves the dual benefit of improving quality and reducing costs. With the growing prevalence of obesity, understanding its impact on 30-day unplanned readmissions and patients' perception of health status is important for appropriate risk stratification of patients. The aim of this study is to determine if obesity is an independent risk factor for unplanned 30-day readmissions following elective spine surgery...
September 1, 2016: World Neurosurgery
Sindhu R Kaitha, George Salem, Yan D Zhao, Mohammad F Madhoun, Allshine Chen, William M Tierney
OBJECTIVES: The need to define the cost of endoscopic procedures becomes increasingly important in an era of providing low-cost, high-quality care. We examined the impact of informing endoscopists of the cost of accessories and pathology specimens as a cost-minimization strategy. METHODS: We conducted a prospective observational cohort study of therapeutic outpatient esophagogastroduodenoscopy (EGD) and colonoscopy. During the pre-intervention phase (phase 1), the endoscopists were not briefed on the cost of accessories or pathology specimens obtained during the procedure...
August 30, 2016: American Journal of Gastroenterology
Alan Siu, Jigarkumar Patel, Heather A Prentice, Justin M Cappuzzo, Homayoun Hashemi, Dipankar Mukherjee
BACKGROUND: Medical care in the United States has evolved into a more cost-conscious value-based health care system that necessitates a comparison of costs when there are alternative interventions considered to be acceptable in the treatment of a disease. This study compares the cost differences between regional (RA) and general anesthesia (GA) for carotid endarterectomy (CEA). METHODS: Data from 346 consecutive patients who underwent CEA between January 2012 and September 2014 were retrospectively reviewed for the type of anesthesia used, outcomes data, and cost variables...
August 20, 2016: Annals of Vascular Surgery
Eliana V Hempel, Edward R Bollard
Anemia is a prevalent disease with multiple possible etiologies and resultant complications. Iron deficiency anemia is a common cause of anemia and is typically due to insufficient intake, poor absorption, or overt or occult blood loss. Distinguishing iron deficiency from other causes of anemia is integral to initiating the appropriate treatment. In addition, identifying the underlying cause of iron deficiency is also necessary to help guide management of these patients. We review the key components to an evidence-based, cost-conscious evaluation of suspected iron deficiency anemia...
September 2016: Medical Clinics of North America
Jesse M Pines, Frank McStay, Meaghan George, Jennifer L Wiler, Mark McClellan
Current alternative payment models (APMs) that move away from traditional fee-for-service payment often have explicit goals to reduce utilization in episodic settings, such as emergency departments (ED). We apply the new HHS payment reform taxonomy to illustrate a pathway to success for EDs in APMs. Despite the unique challenges faced by EDs, a variety of category 2 and 3 APMs may be applicable to EDs in the short- and long term to improve efficiency and value. Full and partially capitated models create incentives for longitudinal and episodic ED providers and payers to unite to create interventions to reduce costs...
August 2016: American Journal of Managed Care
A Hamilton-Webb, R Naylor, R Little, D Maye
Relatively little is known about the perceived influence of different compensation systems on animal keepers' management of exotic livestock disease. This paper aims to address this research gap by drawing on interviews with 61 animal keepers and 21 veterinarians, as well as a series of nine animal keeper focus groups across five different livestock sectors in England. The perceived influence of current compensation systems on disease control behaviour was explored and alternative compensation systems that respectively reward positive practices and penalise poor practices were presented in the form of scenarios, alongside a third system that considered the option of a cost-sharing levy system between industry and government...
August 18, 2016: Veterinary Record
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