In-hospital morbidity and mortality after endovascular treatment of unruptured intracranial aneurysms in the United States, 1996-2000: effect of hospital and physician volume.
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BACKGROUND AND PURPOSE: Endovascular therapy is increasingly being used for the treatment of unruptured intracranial aneurysms. Our purpose was to determine the risk of adverse outcomes after contemporary endovascular treatment of unruptured intracranial aneurysms in the United States. Patient, treating physician, and hospital characteristics were tested as potential outcome predictors, with particular attention paid to volume of care. METHODS: We conducted a retrospective cohort study by using the Nationwide Inpatient Sample, 1996-2000. Multivariate logistic and ordinal regressions were used with end points of mortality, discharge other than to home, length of stay, and total hospital charges. RESULTS: Four hundred twenty-one patients underwent endovascular treatment at 81 hospitals. The in-hospital mortality rate was 1.7%, and 7.6% were discharged to institutions other than home. Analysis was adjusted for age, sex, race, primary payer, year of treatment, and four variables measuring acuity of treatment and medical comorbidity. Median annual number of unruptured aneurysms treated was nine per hospital and three per treating physician. Higher volume hospitals had fewer adverse outcomes; discharge other than to home occurred after 5.2% of operations at high volume hospitals (>23 admissions per year) compared with 17.6% at low volume hospitals (fewer than four admissions per year) (P<.001). Higher physician volume had a similar effect (0% versus 16.4%, P=.03). The mortality rate was lower at high volume hospitals (1.0% versus 3.7%) but not significantly so. At high volume hospitals, length of stay was shorter (P<.001) and total hospital charges were lower (P<.001). CONCLUSION: For patients with unruptured aneurysms treated in the United States from 1996 to 2000, endovascular treatment at high volume institutions or by high volume physicians was associated with significantly lower morbidity rates and modestly lower mortality rates. Length of stay was shorter and total hospital charges lower at high volume centers. (+info)
Resource use in treating alcohol- and drug-related diagnoses.
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OBJECTIVE: This study examined the variations in hospital resource use in the treatment of alcohol and drug diagnoses. Specifically, the study tested 2 hypotheses: 1). patients treated in teaching hospitals will have shorter lengths of stay and lower hospital charges than patients treated in nonteaching hospitals; and 2). patients treated in hospitals with more experience treating these conditions will have shorter lengths of stay and lower hospital charges. DESIGN: A retrospective cross-sectional study design used data from the 1996 Health Care Utilization Project to test the proposed hypotheses. PATIENTS/PARTICIPANTS: The population for this study consisted of patients over 18 years old with an acute alcohol- or drug-related discharge diagnostic related group code. MEASUREMENT AND MAIN RESULTS: The variables of interest were teaching hospital status, as defined by the Council of Teaching Hospitals, and hospital experience, defined as the ratio of alcohol- and drug-related diagnoses to the hospital's total admissions. Measures of hospital resource use included the patient's length of stay and total hospital charges. Patients treated at hospitals with relatively more experience in treating alcohol- and drug-related diagnoses had 10.3% (US dollars 321) lower total charges (P =.017). CONCLUSIONS: Similar to research for high-volume surgical hospitals, these findings confirm that hospitals that have greater experience with complex medical conditions such as alcohol and drug intoxication and withdrawal may be more efficient. This important finding provides a rationale for further exploration of the key factors associated with higher quality and more efficient care for complex medical conditions. (+info)
The epidemic of pediatric traffic injuries in South Florida: a review of the problem and initial results of a prospective surveillance strategy.
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This study identified specific regional risk factors for the high rate of pediatric pedestrian trauma in Florida. Of the 29 cases studied prospectively, 3 (10%) occurred near ice cream trucks and 13 (45%) involved "dart-outs"; mean hospital charges were 24,478 +/- 43,939 US dollars. Recommendations included an engineering change for a dangerous intersection, and a population-based recommendation was to equip ice cream trucks with extending stop signs. (+info)
The economic burden of hospitalizations associated with child abuse and neglect.
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OBJECTIVES: This study assessed the economic burden of child abuse-related hospitalizations. METHODS: We compared inpatient stays coded with a diagnosis of child abuse or neglect with stays of other hospitalized children using the 1999 National Inpatient Sample of the Healthcare Costs and Utilization Project. RESULTS: Children whose hospital stays were coded with a diagnosis of abuse or neglect were significantly more likely to have died during hospitalization (4.0% vs 0.5%), have longer stays (8.2 vs 4.0 days), twice the number of diagnoses (6.3 vs 2.8), and double the total charges (19,266 vs 9513 US dollars) than were other hospitalized children. Furthermore, the primary payer was typically Medicaid (66.5% vs 37.0%). CONCLUSION: Earlier identification of children at risk for child abuse and neglect might reduce the individual, medical, and societal costs. (+info)
The impact of the introduction of user fees at a district hospital in Cambodia.
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Proponents of user fees in the health sector in poor countries cite a number of often interrelated rationales, relating inter alia to cost recovery, improved equity and greater efficiency. Opponents argue that dramatic and sustained decreases in service utilization follow the introduction of user fees, highlighting evidence that user fees reduce service utilization when they fail to result in improved quality of care and/or when services are priced higher than those charged by private health care providers. Utilization of public health services in Cambodia is low. Supply-side factors are significant determinants of such low public sector utilization, including low official salaries of service providers (forcing many to seek additional income in the private sector), and operations budgets which are erratic and often insufficient to cover running costs of service delivery outlets. The Cambodia Ministry of Health (MOH) encourages user fee schemes at operational district level. By allowing revenue to be retained at the health facility level, the MOH aims to improve health care delivery--and consequently service utilization--through increased salaries to health facility staff and increases in operations budgets. This case study of the introduction of user fees at a district referral hospital in Kirivong Operational District in Cambodia, using the findings from empirical research, examines the impact of user fees on health-careseeking behaviour, ability to pay and consultation prices at private practitioners. The research showed that consultation fees charged by private providers increased in tandem with price increases introduced at the referral hospital. It further demonstrates--for the first time that we are aware of from the available literature--that the introduction and subsequent increase in user fees created a 'medical poverty trap', which has significant health and livelihood impact (including untreated morbidity and long-term impoverishment). Addressing the medical poverty trap will require two interventions to be implemented immediately: regulation of the private sector, and reimbursing health facilities for services provided to patients who are exempted from paying user fees because of poverty. A third, longer-term initiative is also suggested: the establishment of a social health insurance mechanism. (+info)
Consequences and costs of lower extremity injuries.
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Lower extremity injuries resulting from motor vehicle crashes are common and have become relatively more important as more drivers with newer occupant restraints survive high-energy crashes. CIREN data provide a greater level of clinical detail based on coding guidelines from the Orthopedic Trauma Association. These detailed data, in conjunction with long-term follow-up data obtained from patient interviews, reveal that the most costly and disabling injuries are those involving articular (joint) surfaces, especially those of the ankle/foot. Patients with such injuries exhibit residual physical and psychosocial problems, even at one year post-trauma. (+info)
Comparison of hospital charge prediction models for colorectal cancer patients: neural network vs. decision tree models.
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Analysis and prediction of the care charges related to colorectal cancer in Korea are important for the allocation of medical resources and the establishment of medical policies because the incidence and the hospital charges for colorectal cancer are rapidly increasing. But the previous studies based on statistical analysis to predict the hospital charges for patients did not show satisfactory results. Recently, data mining emerges as a new technique to extract knowledge from the huge and diverse medical data. Thus, we built models using data mining techniques to predict hospital charge for the patients. A total of 1,022 admission records with 154 variables of 492 patients were used to build prediction models who had been treated from 1999 to 2002 in the Kyung Hee University Hospital. We built an artificial neural network (ANN) model and a classification and regression tree (CART) model, and compared their prediction accuracy. Linear correlation coefficients were high in both models and the mean absolute errors were similar. But ANN models showed a better linear correlation than CART model (0.813 vs. 0.713 for the hospital charge paid by insurance and 0.746 vs. 0.720 for the hospital charge paid by patients). We suggest that ANN model has a better performance to predict charges of colorectal cancer patients. (+info)
Gastric decompression and enteral feeding through a double-lumen gastrojejunostomy tube improves outcomes after pancreaticoduodenectomy.
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OBJECTIVE: The objective of this study was to assess the feasibility and safety of inserting a double-lumen gastrojejunostomy tube (GJT) after pancreaticoduodenectomy (PD) and to evaluate associated outcomes. BACKGROUND: Gastroparesis is a frequent postoperative event following PD. This often necessitates prolonged gastric decompression and nutritional support. A double-lumen GJT may be particularly useful in this situation: gastric decompression may be achieved through the gastric port without a nasogastric tube; enteral feeding may be administered through the jejunal port. METHODS: Thirty-six patients with periampullary tumors were randomized at the time of PD to insertion of GJT or to the routine care of the operating surgeon. Outcomes, including length of stay, complications, and costs, were followed prospectively. RESULTS: The 2 groups had similar characteristics. Prolonged gastroparesis occurred in 4 controls (25%) and in none of the patients who had a GJT (P = 0.03). Complication rates were similar in each group. Mean postoperative length of stay was significantly longer in controls compared with patients who had a GJT (15.8 +/- 7.8 days versus 11.5 +/- 2.9 days, respectively; P = 0.01). Hospital charges were 82,151 +/- 56,632 dollars in controls and 52,589 +/- 15,964 dollars in the GJT group (P = 0.036). CONCLUSIONS: In patients undergoing PD, insertion of a GJT is safe. Moreover, insertion of a GJT improves average length of stay. At the time of resection of periampullary tumors, GJT insertion should be considered, especially given this is a patient population in which weight loss and cachexia are frequent. (+info)