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Abstract Introduction: Prevention, identification, analysis and reduction of adverse events (AEs) are all activities designed to increase safety of care in the clinical setting. Closed claims reviews are a strategy that allows to identify patient safety issues. This study analyzes adverse events resulting in malpractice lawsuits against anesthesiologists affiliated to an insurance fund in Colombia between 2013-2019. Objective: To analyze adverse events in closed medicolegal lawsuits against anesthesiologists affiliated to an insurance fund between 2013-2019. Methods: Cross-sectional observational study. Convenience sampling was used, including all closed claims in which anesthesiologists affiliated to an insurance fund in Colombia were sued during the observation period. Variables associated with the occurrence of AEs were analyzed. Results: Overall, 71 claims were analyzed, of which 33.5% were due to anesthesia-related AEs. Adverse events were found more frequently among ASA I-II patients (78.9%), and in surgical procedures (95.8%). The highest number of adverse events occurred in plastic surgery (29.6%); the event with the highest proportion was patient death (43.7%). Flaws in clinical records and failure to comply with the standards were found in a substantial number of cases. Conclusions: When compared with a previously published study in the same population, an increase in ethical, disciplinary and administrative claims was found, driven by events not directly related to anesthesia. Most of the anesthesia-related events occurred in the operating room during surgical procedures in patients and procedures categorized as low risk, and most of them were preventable.
Resumen Introducción: La prevención, identificación, análisis y reducción de los eventos adversos (EA), son actividades direccionadas a incrementar la seguridad de la atención en el entorno clínico. El estudio de los casos cerrados es una estrategia que permite identificar problemas relacionados con la seguridad del paciente. En este estudio se analizan eventos adversos conducentes a procesos medicolegales cerrados contra anestesiólogos afiliados a un fondo de aseguramiento en Colombia entre 2013-2019. Objetivo: Analizar los eventos adversos en procesos medicolegales cerrados de anestesiólogos afiliados a un fondo de aseguramiento entre 2013-2019. Métodos: Estudio observacional de corte transversal. Se analizó una muestra a conveniencia en la que se incluyeron todos los casos cerrados en los que anestesiólogos afiliados a un fondo de aseguramiento en Colombia fueron objeto de reclamaciones en el período de observación. Se analizaron variables relacionadas con la presentación del EA. Resultados: Se analizaron 71 reclamaciones, de las cuales el 33,5 % fueron por EA relacionado con anestesia. Los eventos adversos se encontraron con mayor frecuencia en pacientes ASA I-II (78,9 %), y en procedimientos quirúrgicos (95,8 %). El mayor número de eventos adversos se presentó en cirugía plástica (29,6 %); el evento de mayor proporción fue el fallecimiento del paciente (43,7 %). En un importante número de casos se demostró fallos en el registro de la historia clínica e incumplimiento de normas. Conclusiones: En relación con un estudio publicado previamente en la misma población, se encuentra un incremento en los procesos éticos, disciplinarios y administrativos, motivados por eventos sin una relación directa con el acto anestésico. La mayoría de eventos adversos relacionados con anestesia se presentan en procedimientos quirúrgicos, en salas de cirugía, en pacientes y procedimientos catalogados como de bajo riesgo, y son en su mayoría prevenibles.
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Introduction: Professional indemnity (PI) or medical malpractice insurance (MMI) has been a hot topic considering the increasing number of medical negligence cases rising worldwide. However, there is a palpable difference in understanding and usage of this tool in developed countries and regions such as India. Aim: This study aimed to analyze the general understanding of resident doctors and consultants about MMI and knowledge about its technical jargon. Materials and Methods: We distributed short Google Form questionnaires about various aspects of MMI. We recorded the data from 141 resident doctors and 42 consultants in the Navi Mumbai area of India. As it was a survey, we required no ethical review. Results: As consultants’ experience grew, so did their understanding of medical indemnity. Approximately 90%, 64%, and 22% of consultants with 10 years, 5–10 years, and 5 years of experience had acquired PI. The AOY:AOT (any one year:anyone time) ratio was known to just 35% of these specialists. About half of the resident doctors were aware of PI and the effects of medical specialization on PI. Around a fifth of the individuals had only acquired the PI. Conclusion: There needs to be more clarity between the need and knowledge of MMI in India. This needs to be addressed by teaching medical postgraduates about it during training. “There should be special emphasis on medical indemnity in terms of its need, clauses, and cost during postgraduate medical training.”
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ABSTRACT OBJECTIVE To assess the availability of different promotional strategies applied for UPF sales in Brazilian food retailers. METHODS Information available on food packaging was gathered from all packaged products sold in the five largest food retail chains in Brazil in 2017. UPF were identified using the NOVA food classification system. From this sample, data related to promotional characteristics, nutrition claims and health claims were collected and coded using the INFORMAS methodology. Additional claims referring to the Brazilian Dietary Guidelines were also collected. RESULTS This study evaluated the packaging of 2,238 UPF, of which 59.8% presented at least one promotional strategy. Almost one third denoted a simultaneous use of different promotional strategies in the same packaging. Nutrition claims were the most commonly found promotional strategy, followed by health claims and the use of characters. The food subgroups comprising the highest prevalence of promotional strategies on their labels were: noncaloric sweeteners (100.0%), breakfast cereals and granola bars (96.2%), juices, nectars and fruit-flavoured drinks (92.9%), other unsweetened beverages (92.9%), and other sweetened beverages (92.6%). CONCLUSIONS Considering the poor nutritional quality of UPF, the widespread presence of promotional features on their packaging highlights the need for marketing restrictions on this kind of product.
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Food Packaging , Marketing , Food Labeling , Food, ProcessedABSTRACT
Objective: Health information, including the labelling, must be presented in a manner that is easily understandable to consumers. In recent years, the European Union and the United States have introduced standards for providing health information in a way that is easy for consumers to understand. The Clear Communication Index (CCI) published by the Centers for Disease Control and Prevention (CDC) is a useful tool for this purpose. Unfortunately, there is no such tool in Japan. Therefore, focusing on the package labelling of foods with functional claims (FFCs) sold in Japan, we constructed a Functional Clear Communication Index (F-CCI) and evaluated the FFCs.Methods: The F-CCI was developed by six people, including university staff with pharmacist qualifications and public health experts, by referring to the CDC CCI. The evaluation of FFCs using the F-CCI was performed using the Delphi method, which is one of the formal consensus-building methods in the field of health and medical information. The evaluation was conducted by three qualified pharmacists on five FFC products, and the degree of internal agreement among the evaluators was calculated using Fleiss’ κ.Results: The F-CCI consisted of 18 items that assessed the FFC characteristics. After assessing the labelling of FFCs using the F-CCI, the scores of all the materials ranged between 70 and 80% on the F-CCI, and none achieved 90%, which was considered the acceptable standard (overall κ value_ 0.865). Moreover, it was clear that the ‘readability’ and ‘understandability’ of the labelling were inadequate.Conclusion: The F-CCI developed in this study for the objective evaluation of the labelling of FFC products will act as a tool that will subsequently lead to the proper understanding and use of FFCs by consumers. Further efforts are needed to build and disseminate such tools and user-friendly ways of providing relevant information.
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Abstract Objective: To identify the average direct cost related to the direct labor of the inspectors involved in the "in loco inspection" step of the inspection process carried out at the Headquarters of the Regional Nursing Council of São Paulo. Method: Quantitative, exploratory-descriptive research, in the form of a single case study. The non-probabilistic convenience sample consisted of records of initial and return "in loco inspections", carried out by inspectors working at the Headquarters of The Regional Nursing Council of São Paulo, from January 13, 2020 to March 13, 2020. Results: The average direct cost of initial in loco inspection (N = 182) corresponded to BRL 331.67 (SD = 140.32), ranging from BRL 115.80 to BRL 1071.15, and that of return in loco inspection (N = 98) to BRL 256.16 (SD = 130.90), ranging from BRL 77.20 to BRL 694.80. Time and cost variables analysis of initial and return in loco inspections showed an alpha significance level of 0.05, and it was possible to statistically state that the time (p ≤ 0.001) and the cost of initial in loco inspection (p ≤ 0.001) are higher than those for return in loco inspection. Conclusion: the cost of the step of "in loco inspection" will support the Nursing Council in the decision-making process aiming at allocating efficiency of human resources required in the inspection process.
RESUMEN Objetivo: Identificar el coste medio directo relacionado con la labor directa de los inspectores involucrados en la etapa de "inspección in loco" del proceso de inspección realizado en la Unidad Sede del Consejo Regional de Enfermería de São Paulo. Método: Investigación cuantitativa, exploratoria-descriptiva, en forma de estudio de caso único. La muestra de conveniencia no probabilística consistió en registros de "inspecciones in loco", iniciales y de retorno, realizadas por inspectores que trabajan en la Sede, desde el 13/01/2020 al 13/03/2020. Resultados: El coste medio directo de la inspección inicial (N = 182) correspondió a R$ 331,67 (DP = 140,32), con un rango de R$ 115,80 a R$ 1071,15, y el de la inspección de retorno (N = 98) a R$ 256,16 (DP = 130,90), oscilando entre R$ 77,20 y R$ 694,80. El análisis de las variables tiempo y coste de las inspecciones inicial y de retorno indicó un nivel de significancia alfa de 0.05, y fue posible afirmar estadísticamente que el tiempo (p ≤ 0.001) y el costo de la inspección inicial (p ≤ 0,001) son mayores que los de la inspección de retorno. Conclusión: el costo de la etapa de "inspección in loco" subsidiará el Consejo en el proceso de toma de decisiones buscando la eficiencia en la asignación de los recursos humanos requeridos en el proceso de inspección.
RESUMO Objetivo: Identificar o custo direto médio relativo à mão de obra direta dos fiscais envolvidos na etapa "inspeção in loco" do processo de fiscalização realizado na Unidade Sede do Conselho Regional de Enfermagem de São Paulo. Método: Pesquisa quantitativa, exploratório-descritiva, na modalidade de estudo de caso único. A amostra de conveniência, não probabilística, foi constituída por registros de "inspeções in loco", iniciais e de retorno, realizadas por fiscais atuantes na Unidade Sede, no período de 13/01/2020 a 13/03/2020. Resultados: O custo direto médio da inspeção in loco inicial (N = 182) correspondeu a R$ 331,67 (DP = 140,32), variando de R$ 115,80 a R$ 1071,15, e da inspeção in loco de retorno (N = 98) a R$ 256,16 (DP = 130,90), variando entre R$77,20 e R$ 694,80. A análise das variáveis tempo e custo das inspeções in loco iniciais e de retorno evidenciou nível de significância alfa de 0,05, sendo possível afirmar estatisticamente que o tempo (p ≤ 0,001) e o custo da inspeção in loco inicial (p ≤ 0,001) são maiores do que os da inspeção in loco de retorno. Conclusão: o custeio da etapa "inspeção in loco" subsidiará o Conselho no processo decisório visando à eficiência alocativa dos recursos humanos requeridos no processo de fiscalização.
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Costs and Cost Analysis , Health Care Coordination and Monitoring , Nursing Services , Professional Review Organizations , Administrative Claims, Healthcare , Nursing StaffABSTRACT
Objective: Many countries have recently established registration databases in the field of rehabilitation to clarify their current status. However, these databases are primarily created for inpatients, with only a few large-scale databases for outpatients. The present study aimed to clarify secular changes, age distribution, and regional disparities in the implementation of outpatient rehabilitation in Japan using the National Database of Health Insurance Claims.Materials and Methods: Using the National Database of Health Insurance Claims Open Data published by the Ministry of Health, Labor, and Welfare, the number of outpatient rehabilitation units from 2014 to 2018 were extracted and examined.Results: The total number of units for outpatient rehabilitation increased gradually from 2014 to 2018. Orthopedic rehabilitation accounted for more than 80% of the total number of units for outpatient rehabilitation in 2018. The total number of units for outpatient rehabilitation according to age was highest among those in their late 70s, while cerebrovascular and dysphagia rehabilitation had the highest number of units in children.Conclusion: The total number of units for outpatient rehabilitation gradually increased from 2014 to 2018; whereas the number of total units for outpatient rehabilitation according to age was the highest among those in their late 70s. However, cerebrovascular rehabilitation and dysphagia rehabilitation had the highest number of units in children. The implementation status of rehabilitation in each region varied greatly among prefectures, suggesting the need for policy planning to eliminate regional disparities.
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Studies using real-world data are recently increasing worldwide. Various types of real-world data are available in Japan. Administrative claims databases include the National Database (NDB) and other types of databases including several commercially available databases. This article describes the DeSC database, newly constructed by DeSC Healthcare Co., Ltd. in 2020. One of the features of the DeSC database is that it includes data from the National Health Insurance, Health Insurance, and Advanced Elderly Medical Service System. In the present article, we referred to our previous study on population representativeness of the DeSC database and explained its overview. Estimated prevalence of some diseases were described for each type of insurance. Furthermore, we discussed the use of the DeSC database for clinical epidemiology and pharmacoepidemiology research.
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Dietas populares, como as detox, surgem a todo o momento. Todavia, poucos dados científicos comprovam a eficácia e segurança destas dietas. Este trabalho avaliou rótulos de bebidas à base de frutas e vegetais e identificou as que se autodenominam detox. Tratou-se de estudo transversal descritivo, realizado de setembro a outubro/2016. O tamanho da porção na informação nutricional e as alegações encontradas nos rótulos foram analisados em relação às legislações vigentes. Composição nutricional, quantidade total de ingredientes e presença de aditivos alimentares e/ou outros ingredientes não usuais em preparações culinárias foram comparados entre as bebidas detox e as comuns. De 83 produtos analisados, 9,6% (n=8) se autodenominaram detox. A composição nutricional e o número médio de ingredientes não diferiram entre as bebidas detox e as comuns. Alegações nutricionais e de saúde estavam presentes em 77,1% (n=64) dos produtos e 53,0% (n=44) apresentaram alegações não previstas na RDC nº 54/2012. As informações mais frequentes foram quanto aos teores de micronutrientes, açúcares, sódio e fibras. O termo detox, apesar de não permitido, é encontrado neste tipo de produto no mercado brasileiro. Os resultados sugerem que o termo detox seja utilizado mais como estratégia de marketing do que como real alegação de propriedade nutricional. (AU)
Popular diets, such as detox, appear all the time. However, few scientific data prove the efficacy and safety of these diets. This work evaluated labels of drinks based on fruits and vegetables and identified those that call detox. This was a descriptive cross-sectional study, carried out from September to October/2016. The portion size in the nutrition information and the claims found on the labels were analyzed in relation to the current legislation. Nutritional composition, total amount of ingredients and presence of food additives and other unusual ingredients in culinary preparations were compared between detox and ordinary drinks. Of 83 products analyzed, 9.6% (n=8) called detox. The nutritional composition and the average number of ingredients did not differ between detox drinks and ordinary drinks. Nutritional and health claims were present in 77.1% (n=64) of the products and 53.0% (n=44) presented claims not provided for in RDC nº 54/2012. The most frequent information was about the levels of micronutrients, sugars, sodium and fibers. The term detox, although not allowed, is found in this type of product in the Brazilian market. The results suggest that the term detox is used more as a marketing strategy than as a real claim of nutritional property. (AU)
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Functional Food/analysis , Fruit and Vegetable Juices/analysis , Food Labeling , Cross-Sectional Studies , Industrialized FoodsABSTRACT
Abstract: Objectiv: To explore the perception of the use and comprehension of the nutrition labeling (GDA, NFT, NS) and claims in packaged foods among different socio economic-status (SES). Materials and methods: This was a qualitative study, 12 focus groups were performed in four cities of Mexico. Participants were recruited outside the supermarkets, which were selected according to SES using Basic Geostatistical Areas. The focus groups had a total of 78 participants. Results: Participants perceived several barriers to the use and understanding of the GDA; like technicalities of the terms used, and the format (small font size and percentages). Claims are mistrusted in general. Participants from the high SES believed that the claims are just a marketing strategy. Conclusion: This study shows the consumers' difficulties to understand the current nutrition labeling system regardless SES. These data might call attention in order to implement a simpler nutrition labeling system that is understood regardless of SES.
Resumen: Objetivo: Explorar la percepción sobre el uso y la comprensión del etiquetado de alimentos (GDA, NFT, NS) y sobre las declaraciones de alimentos empaquetados entre diferentes niveles socioeconómicos (NSE). Material y métodos: Estudio cualitativo en el que se formaron 12 grupos focales en cuatro ciudades de México. Los participantes fueron reclutados afuera de supermercados y fueron seleccionados por nivel socioeconómico, a partir de Áreas Geoestadísticas Básicas. El número total de participantes fue 78. Resultados: Los participantes percibieron barreras para el uso y comprensión del GDA como términos técnicos utilizados, fuente pequeña y porcentajes numéricos. Se reportó desconfianza hacia las declaraciones en alimentos empaquetados. Los participantes del NSE alto perciben que las declaraciones son estrategia de marketing. Conclusión: Este estudio muestra las dificultades para entender el etiquetado de alimentos actual entre diferentes NSE. Estos datos enfatizan la necesidad de implementar un etiquetado que sea comprendido entre NSE.
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Adult , Female , Humans , Male , Middle Aged , Social Class , Attitude , Focus Groups , Comprehension , Food Labeling , Printing/standards , Cities , Focus Groups/statistics & numerical data , Nutrition Policy , Consumer Behavior , Qualitative Research , Mexico , Terminology as TopicABSTRACT
Objective: To describe the treatment patterns and time to next treatment (TTNT) in newly diagnosed multiple myeloma patients (MM) using a large-scale claims database in Japan.Design: Cohort studyMethods: The patients with newly diagnosed MM from 2008 to 2015 were classified into two groups: age <65 years, and age ≥65 years. Specific regimens and general regimens were identified with a complex algorithm considering interval of no therapy, additional and discontinued agents. Correspondingly, TTNT between the first- and second-line were measured among non-transplant patients with Kaplan-Meier method.Results: A total of 425 patients were eligible to participate in the analysis. The most common regimen for the treatment of MM was bortezomib-based regimens (52.9％ in the first-line, 28.2％ in later lines), followed by melphalan-prednisolone (27.1％ in the first-line, 12.9％ in later lines) and lenalidomide-based regimens (4.7％ in the first-line, 26.1％ in later lines). TTNT between the first- and second-line was 11.4 months and was seen to vary greatly with each regimen. A statistically longer TTNT was observed in subgroups of patients aged 65 years or over compared with patients aged younger than 65 years, but no statistical difference was found between conventional therapy and novel therapy.Conclusion: Based on the data from the study, patients with MM were commonly treated with novel agent-based regimens, especially bortezomib-based regimens. Between the first- and second-line therapies a relatively short TTNT was observed, indicating that therapies in clinical practice poorly complied with treatment guidelines.
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Objective: To describe the treatment patterns and time to next treatment (TTNT) in newly diagnosed multiple myeloma patients (MM) using a large-scale claims database in Japan.Design: Cohort studyMethods: The patients with newly diagnosed MM from 2008 to 2015 were classified into two groups: age <65 years, and age ≥65 years. Specific regimens and general regimens were identified with a complex algorithm considering interval of no therapy, additional and discontinued agents. Correspondingly, TTNT between the first- and second-line were measured among non-transplant patients with Kaplan-Meier method.Results: A total of 425 patients were eligible to participate in the analysis. The most common regimen for the treatment of MM was bortezomib-based regimens (52.9％ in the first-line, 28.2％ in later lines), followed by melphalan-prednisolone (27.1％ in the first-line, 12.9％ in later lines) and lenalidomide-based regimens (4.7％ in the first-line, 26.1％ in later lines). TTNT between the first- and second-line was 11.4 months and was seen to vary greatly with each regimen. A statistically longer TTNT was observed in subgroups of patients aged 65 years or over compared with patients aged younger than 65 years, but no statistical difference was found between conventional therapy and novel therapy.Conclusion: Based on the data from the study, patients with MM were commonly treated with novel agent-based regimens, especially bortezomib-based regimens. Between the first- and second-line therapies a relatively short TTNT was observed, indicating that therapies in clinical practice poorly complied with treatment guidelines.
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The use of medicinal plants is a fundamental component of Indian traditional healthcare system. It is the oldest and most used health care system among all therapeutic systems. In many parts of India and specifically here in Odisha this traditional system of healing is the mainstay healthcare system. These undocumented but locally proven system has a potential for research for the benefit of human race which is all most at end point of contemporary healthcare system. The present article deals with the database usage of nearly 14 species of medicinal plants found around Gandhamardhan hills, Nrusinghnath forest areas in odisha and its important folklore claims.
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PURPOSE: This study aimed to estimate the prevalence, prescription pattern and burden of pediatric asthma in Korea by analyzing the National Health Insurance (NHI) claims data. METHODS: We retrospectively analyzed the insurance claim records from the Korean NHI claims database from January 2010 to December 2014. Asthmatic patients were defined as children younger than 18 years, with appropriate 10th Revision of the International Classification of Diseases codes (J45 or J46) and a prescription for 1 or more asthma maintenance medications at the same date. Hospitalization and emergency department visits for asthma were defined as use of short-acting beta2-agonists during hospital visits among asthmatic patients. RESULTS: There were 1,172,807 asthmatic children in 2010, which increased steadily to 1,590,228 in 2014 in Korea. The prevalence showed an increasing trend annually for all ages. The mean prevalence by age in those older than 2 years decreased during the study period (from 39.4% in the 2–3 year age group to 2.6% in the 15–18 year age group). In an outpatient prescription, leukotriene receptor antagonists were the most commonly prescribed medication for all ages. Patients older than 6 years for whom inhaled corticosteroids were prescribed comprised less than 15% of asthmatic patients. The total direct medical cost for asthma between 2010 and 2014 ranged from $376 to $483 million. Asthma-related medical cost per person reached its peak in $366 in 2011 and decreased to $275 in 2014. CONCLUSIONS: The prevalence of pediatric asthma increased annually and decreased with age. Individual cost of asthma showed a decreasing trend in Korean children.
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Child , Humans , Adrenal Cortex Hormones , Asthma , Cost of Illness , Emergency Service, Hospital , Hospitalization , Insurance , International Classification of Diseases , Korea , Leukotriene Antagonists , National Health Programs , Outpatients , Prescriptions , Prevalence , Retrospective StudiesABSTRACT
BACKGROUND/AIMS: The risk of herpes zoster (HZ) among patients with inflammatory bowel disease (IBD) remains unclear in terms of age and metabolic comorbidities, including diabetes mellitus, hypertension, or dyslipidemia. We conducted a nationwide population-based study to investigate the risk of HZ in patients with IBD. METHODS: From 2010 to 2013, a retrospective study was performed using claims data in Korea. We compared the incidence of HZ between 30,100 IBD patients (10,517 Crohn’s disease [CD] and 19,583 ulcerative colitis [UC] patients) and 150,500 non-IBD controls matched by age and sex. RESULTS: During a mean follow-up of 5.0 years, incidence rates of HZ (per 1,000 person-years) were 13.60, 14.99, and 9.19 in the CD, UC, and control groups, respectively. The risk of HZ was significantly higher in patients with CD (adjusted hazard ratio [HR], 2.13; p<0.001) and UC (adjusted HR, 1.40; p<0.001) than in the controls. The impact of CD on developing HZ was significantly more prominent in younger patients (adjusted HR, 2.61 for age <15, whereas 1.39 for age ≥60; interaction p=0.001) and in patients without metabolic comorbidities (adjusted HR, 2.24, whereas 1.59 in those with metabolic comorbidities; interaction p=0.015). Moreover, the impact of UC on developing HZ significantly increased in younger patients (adjusted HR, 2.51 in age <15, whereas 1.22 in age ≥60; interaction p=0.014) and patients without metabolic comorbidities (adjusted HR, 1.49 whereas 1.16 in those with metabolic comorbidities; interaction p<0.001). CONCLUSIONS: IBD was associated with an increased risk of HZ, especially in younger patients without metabolic comorbidities.
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Humans , Colitis, Ulcerative , Comorbidity , Diabetes Mellitus , Dyslipidemias , Follow-Up Studies , Herpes Zoster , Hypertension , Incidence , Inflammatory Bowel Diseases , Korea , Retrospective StudiesABSTRACT
BACKGROUND: Controversies exist whether arteriovenous fistula (AVF) placement is preferred over arteriovenous graft (AVG) for elderly patients. Current guidelines did not offer specific recommendations. Thus, this study was conducted to analyze the all-cause mortality and primary patency associated with various vascular access (VA) types according to age group. METHODS: This retrospective observational study investigated the Korean insurance claims data of chronic kidney disease patients who began hemodialysis between January 2008 and December 2016. We investigated all-cause mortality associated with initial VA in incident hemodialysis patients and primary patency between AVF and AVG according to age group. RESULTS: The proportion of patients with a tunneled dialysis catheter (TDC) that was first placed for VA increased from 18.4% in 2008 to 52.3% in 2016. Incident hemodialysis patients with a TDC or AVG for the initial VA had significantly higher mortality risk than patients with an AVF, except for patients over 85 years, who showed no significant difference in all-cause mortality regardless of VA type. In the patency analysis on initial AV access, AVG had significantly poorer primary patency than AVF in all age groups. CONCLUSION: AVF had better patency than AVG in all age groups; however, the benefit of AVF attenuated in the older age groups. The mortality rate between AVF and AVG was not significantly different in patients over 85 years. Therefore, a “patient-first” approach should be emphasized over a “fistula-first” approach in AV access creation for incident hemodialysis patients older than 85 years.
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Aged , Humans , Administrative Claims, Healthcare , Arteriovenous Fistula , Catheters , Dialysis , Insurance , Mortality , National Health Programs , Observational Study , Renal Dialysis , Renal Insufficiency, Chronic , Retrospective Studies , TransplantsABSTRACT
BACKGROUND: This study aimed to estimate the nationwide prevalence of live births with Down syndrome (DS) and its trends and compare the observed and model-based predicted prevalence rates. Further, we compared the direct medical expenditures among DS and non-DS patients. METHODS: Using the health administrative data of Health Insurance Review and Assessment in Korea, we selected 2,301 children with DS who were born between 2007 and 2016 to estimate the prevalence of live births with DS, and 12,265 non-DS children who were born between 2010 and 2014 to compare the direct medical expenditures among patients. RESULTS: The prevalence of live births with DS was 5.03 per 10,000 births in 9 years, and 13% of children with DS were medical aid recipients during the study period. The medical expenditure of children with DS was about 10-fold higher than that of non-DS children and their out-of-pocket expenditure was about twice as high. CONCLUSION: The prevalence of live birth with DS is high in the low socioeconomic group and the healthcare costs for the children with DS are significantly higher than those for non-DS children. Therefore, health authorities should help mothers at lower socioeconomic levels to receive adequate antenatal care and consider the cost of medical care for children with DS.
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Child , Humans , Down Syndrome , Health Care Costs , Health Expenditures , Insurance, Health , Korea , Live Birth , Mothers , Parturition , PrevalenceABSTRACT
Medical claims database is an important source of data for studying the characteristics, and burden of diseases, to provide a basis for the development of policy on management. The database is usually used to identify patients through International Classification of Diseases and free text-building algorithms, thus it is crucial to validate whether the algorithm is correctly identifing the targeted population. This paper introduces both traditional and emerging validation methods including machine learning, natural language processing and database linkage etc.. We also have tried to present a suitable validation method for the current situation in China, so as to promote the application of big data in medical areas and to provide reference for epidemiology studies, based on medical claims database in this country.
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Background@#In the continuity of care, family and community physicians take into consideration patient insurance coverage, especially for those who require higher levels of care. The Philippine Health Insurance Corporation (PhilHealth) has had its electronic reimbursement claims processing since 2011 but the utilization of this system by hospitals may be affected by delays in claims reimbursement. Factors associated with such delays warrant further investigation.@*Objectives@#This study aimed to determine the perceived factors by concerned hospital staff that affect delays in PhilHealth’s electronic claims processing system.@*Methods@#Three focus group discussions (FGDs) were conducted using a predetermined set of questions. The hospitals were selected from respondents of a survey of a bigger study on the applicability of PhilHealth’s electronic claims processing. Each FGD involved eight-to-ten participants, mostly PhilHealth officers or information technology personnel from different hospitals covering Luzon, Visayas, and Mindanao. The hospitals were of different types/levels and included both government-run and privately-owned.@*Results@#Factors affecting delays in electronic claims reimbursement are intrinsic to the hospitals’ operations, with delays in obtaining the physician’s signature as the most common cause. Accessing PhilHealth’s server was another major factor and was aggravated by problems in clarifying patient eligibility, non-updated data, and variations in the emphasis of regional evaluators. Hospitals within the national capital region and those using their own electronic medical records and health information system had better experiences with the electronic claims reimbursement.@*Conclusions@#The main factors affecting delays in electronic claims reimbursement among hospitals are associated with the hospitals’ institutional processes. The active participation of family physicians and primary care providers can help address these issues and subsequently improve service delivery, PhilHealth utilization, and overall patient satisfaction.
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Humans , Electronics , Surveys and QuestionnairesABSTRACT
Resumen: El presente artículo tiene por objeto dar a conocer un particular tipo de cláusula que puede encontrarse en las pólizas de seguro por actividades profesionales: la cláusula de delimitación temporal llamada claims made. Ésta presenta múltiples problemáticas desde el punto de vista jurídico, que tienen directa incidencia en el ámbito práctico de la responsabilidad médica. Una de ellas, se produce en aquellos casos en que los siniestros no reciben cobertura de la compañía, aun estando vigente y debidamente pagada la póliza por el asegurado, debiendo asumirse el pago de la indemnización por el propio médico frente a la víctima.
Abstract: The purpose of this paper is to present a particular type of clause that can be found in an insurance contract related to professional activities: the claims made clause. This clause presents multiple legal problems which have a direct impact on the practical application in the medical liability. One of these occurs in cases where the damage is not covered by the insurance company even if the policy has been properly paid by the insured, and the compensation must be paid by the doctor to the victim.
Subject(s)
Humans , Liability, Legal , Contracts , Insurance, Health/legislation & jurisprudence , Chile , Damage Liability , Compensation and Redress , Insurance, LiabilityABSTRACT
Abstract Introduction: Medical malpractice claims have been increasing at a constant rate worldwide, resulting in a burden for practitioners as well as for the health system. In obstetrics, the problem is even greater considering that it is one of the medical specialties with the largest number of medical malpractice suits. Objective: To characterize medical malpractice claims in the area of obstetrics in Colombia from the perspectives of the physician, the patient, the institution, the medical care provided, and the legal proceeding. Materials and methods: Historical descriptive cohort of closed medical malpractice cases between 1999 and 2014 filed against obstetricians affiliated to a special solidarity fund for support in lawsuit cases. Simple random sampling (n = 279) in a universe of 982 proceedings. Variables related to the proceeding, the obstetrician, the institution, medical care, and the patient were measured. Results: The most frequent lawsuits were related to ethics (44.4%). The proportion of unfavorable rulings was 7.7%, more frequently in civil cases (31.8%). The prevalence of lawsuits was higher in private institutions (60%). The majority of the cases were related to patients in the second half of the gestation period (86%). In 74.7% of the cases, legal action was initiated as a result of events occurring during childbirth. The most frequent cause was neonatal compromise (38.9%), followed by fetal compromise (24.7%). Conclusion: Care during childbirth, fetal, and neonatal demise are critical sources of medical malpractice claims.
Resumen Introducción: Los procesos de responsabilidad médica han tenido un aumento sostenido en el mundo, representando una carga para el profesional y el sistema de salud. En obstetricia el problema es aún mayor dada que es una de las especialidades con más acciones médico legales. Objetivo: Caracterizar los procesos de responsabilidad médica en obstetricia en Colombia, desde las dimensiones del médico, la paciente, la institución, la atención médica provista y el proceso legal. Materiales y métodos: Cohorte histórica descriptiva de procesos médico legales cerrados entre 1999 y 2014 contra obstetras asociados a un fondo solidario especial para auxilio en caso de demandas. Muestreo aleatorio simple (n = 279) de un universo de 982 procesos. Se midieron variables del proceso, obstetra, la institución, la atención médica y la paciente. Resultados: Los procesos más frecuentes fueron éticos (44,4%). La proporción de procesos desfavorables fue del 7.7%, con mayor frecuencia en procesos civiles (31,8%). Hubo mayor prevalencia de procesos en instituciones privadas (60%). La mayoría de los procesos ocurrió en pacientes en la segunda mitad de la gestación (86%). La acción judicial estuvo relacionada a hechos acaecidos durante la atención del parto en un 74,7% de las pacientes. La causa más frecuente de la acción legal, fue el compromiso del recién nacido (38,9%) seguido por el compromiso del feto (24,7%). Conclusiones: La atención del parto, la mortalidad fetal y del recién nacido son áreas críticas en la generación de procesos médico legales.