Estimación del ahorro hospitalario con el reemplazo de inmunosupresores genéricos en trasplante renal / Cost savings after switching from innovative tacrolimus to a generic version of the drug in transplant recipients

Background The use of narrow therapeutic index generic immunosuppressant in solid organ transplantation is controversial. Most experiences switching to these drugs have short term follow-up periods, analyze only pharmacokinetic issues and do not systematically include either complications or cost analyses. Aim To analyze the costs and benefits of switching our kidney transplant recipients from innovative tacrolimus to a generic version of the drug. Material and Methods Fifty-seven stable transplant recipients were switched from innovative tacrolimus to a generic version of the drug, maintaining the same dose. They were followed for eight months recording all events during such period. Results We observed two infectious episodes, five allograft biopsies were performed and two patients had acute rejections. Conclusions From the payer's perspective, if all the costs associated with the change to generic tacrolimus are considered, savings related to a lower cost of the drug translate in a real financial loss for the public health system. The analysis also showed that frequent switches, even from one generic drug to a cheaper one is an even worse strategy to save money.

Gestão de custos assistenciais em operadoras de planos de saúde: interface com auditoria do cuidado / Management of assistance costs in health plan operators: interface with audit of care / Gestión de costos de asistencia en operadores del plan de salud: interfaz con la auditoría de cuidado

Objetivo: este estudo buscou identificar estratégias utilizadas na Gestão de Custos Assistenciais com interface na Auditoria do Cuidado. Método: trata-se de pesquisa de cunho qualitativo do tipo revisão integrativa da literatura. Foi realizada busca em bases de dados da área da saúde: SciELO, Pubmed, LILACS e Ibecs. O período de publicação compreendeu os últimos cinco anos, artigos disponíveis online e em língua portuguesa, inglês ou espanhola. Foram selecionados 11 artigos. Resultados: a análise dos dados teve como base o proposto pela pesquisa qualitativa em saúde, conforme Minayo. Uma categoria temática intitulada: 'Gestão de custos assistenciais e a interface com auditoria do cuidado'. Conclusões: o enfermeiro é o profissional que pode realizar a auditoria voltada a qualidade do cuidado, gerenciando os custos relacionados ao mesmo. Quando associado a tecnologias, protocolos, instrumentos avaliativos, a auditoria do cuidado se mostra mais efetiva, sendo estas as principais estratégias para a gestão de custos assistenciais com interface direta na auditoria do cuidado.(AU)

Objective: this study sought to identify strategies used in the Management of Assistance Costs with an interface in the Care Audit. Method: this is a qualitative research of the type of integrative literature review. A search was carried out in health databases: SciELO, Pubmed, LILACS and Ibecs. The publication period included the last five years, articles available online and in Portuguese, English or Spanish. Eleven articles were selected. Results: the data analysis was based on that proposed by qualitative health research, according to Minayo. A thematic category entitled: 'Care cost management and the interface with care audit'. Conclusions: the nurse is the professional who can perform the audit focused on the quality of care, managing the costs related to it. When associated with technologies, protocols, evaluation instruments, the audit of care is more effective, these being the main strategies for the management of care costs with a direct interface in the audit of care.(AU)

Objetivo: este estudio buscó identificar estrategias utilizadas en la Gestión de Costos de Asistencia con una interfaz en la Auditoría de Atención. Método: se trata de una investigación cualitativa del tipo de revisión bibliográfica integradora. Se realizó una búsqueda en bases de datos de salud: SciELO, Pubmed, LILACS e Ibecs. El período de publicación incluyó los últimos cinco años, artículos disponibles en línea y en portugués, inglés o español. Once artículos fueron seleccionados. Resultados: el análisis de datos se basó en lo propuesto por la investigación cualitativa en salud, según Minayo. Una categoría temática titulada: "Gestión de costos de atención y la interfaz con la auditoría de atención". Conclusiones: la enfermera es el profesional que puede realizar la auditoría centrada en la calidad de la atención, gestionando los costos relacionados con ella. Cuando se asocia con tecnologías, protocolos, instrumentos de evaluación, la auditoría de atención es más efectiva, siendo estas las estrategias principales para la gestión de los costos de atención con una interfaz directa en la auditoría de atención.(AU)

Impact of One-Catheter Strategy with TIG I Catheter on Coronary Catheterization Performance and Economic Costs / Impacto da Estratégia de um Cateter com Cateter TIG I no Desempenho da Coronariografia por Cateterismo e Custos Econômicos

Abstract Background: Coronary angiography with two catheters is the traditional strategy for diagnostic coronary procedures. TIG I catheter permits to cannulate both coronary arteries, avoiding exchanging catheters during coronary angiography by transradial access. Objective: The aim of this study is to evaluate the impact of one-catheter strategy, by avoiding catheter exchange, on coronary catheterization performance and economic costs. Methods: Transradial coronary diagnostic procedures conducted from January 2013 to June 2017 were collected. One-catheter strategy (TIG I catheter) and two-catheter strategy (left and right Judkins catheters) were compared. The volume of iodinated contrast administered was the primary endpoint. Secondary endpoints included radial spasm, procedural duration (fluoroscopy time) and exposure to ionizing radiation (dose-area product and air kerma). Direct economic costs were also evaluated. For statistical analyses, two-tailed p-values < 0.05 were considered statistically significant. Results: From a total of 1,953 procedures in 1,829 patients, 252 procedures were assigned to one-catheter strategy and 1,701 procedures to two-catheter strategy. There were no differences in baseline characteristics between the groups. One-catheter strategy required less iodinated contrast [primary endpoint; (60-105)-mL vs. 92 (64-120)-mL; p < 0.001] than the two-catheter strategy. Also, the one-catheter group presented less radial spasm (5.2% vs. 9.3%, p = 0.022) and shorter fluoroscopy time [3.9 (2.2-8.0)-min vs. 4.8 (2.9-8.3)-min, p = 0.001] and saved costs [149 (140-160)-€/procedure vs. 171 (160-183)-€/procedure; p < 0.001]. No differences in dose-area product and air kerma were detected between the groups. Conclusions: One-catheter strategy, with TIG I catheter, improves coronary catheterization performance and reduces economic costs compared to traditional two-catheter strategy in patients referred for coronary angiography.

Resumo Fundamento: A cineangiocoronariografia com dois cateteres é a estratégia tradicional para procedimentos coronarianos de diagnóstico. O cateter TIG I permite canular ambas as artérias coronárias, evitando a troca de cateteres durante a cineangiocoronariografia por acesso transradial. Objetivo: O objetivo deste estudo é avaliar o impacto da estratégia de um cateter, evitando a troca de cateter, no desempenho da coronariografia por cateterismo e nos seus custos econômicos. Métodos: Foram coletados os procedimentos diagnósticos coronarianos transradiais realizados entre janeiro de 2013 e junho de 2017. A estratégia de um cateter (cateter TIG I) e a estratégia de dois cateteres (cateteres coronários direito e esquerdo de Judkins) foram comparadas. O volume de contraste iodado administrado foi o endpoint primário. Os endpoints secundários eram espasmo radial, duração do procedimento (tempo de fluoroscopia) e exposição a radiações ionizantes (produto dose-área e kerma no ar). Os custos econômicos diretos também foram avaliados. Para as análises estatísticas, valores de p < 0,05 bicaudais foram considerados estatisticamente significativos. Resultados: De um total de 1.953 procedimentos em 1.829 pacientes, 252 procedimentos foram atribuídos à estratégia de um cateter e 1.701 procedimentos à estratégia de dois cateteres. Não houve diferenças nas características basais entre os grupos. A estratégia de um cateter exigiu menos contraste iodado [endpoint primário; (60-105) -mL vs. 92 (64-120) -mL; p < 0,001] em comparação com a estratégia de dois cateteres. Além disso, o grupo da estratégia de um cateter apresentou menos espasmo radial (5,2% vs. 9,3%, p = 0,022) e menor tempo de fluoroscopia [3,9 (2,2-8,0) -min vs. 4,8 (2,9-8,3) -min, p = 0,001] e economia de custos [149 (140-160)-€/procedimento vs. 171 (160-183) -€/procedimento; p < 0,001]. Não foram detectadas diferenças no produto dose-área e kerma no ar entre os grupos. Conclusões: A estratégia de um cateter, com cateter TIG I, melhora o desempenho da coronariografia por cateterismo e reduz os custos econômicos em comparação com a estratégia tradicional de dois cateteres em pacientes encaminhados para cineangiocoronariografia.

Preventive healthcare-seeking behavior among poor older adults in Mexico: the impact of Seguro Popular, 2000-2012 / Comportamiento en cuidado preventivo de salud entre adultos pobres mayores en México: impacto del Seguro Popular, 2000-2012

Abstract: Objective: Determine the effect of Seguro Popular (SP) on preventive care utilization among low-income SP beneficiaries and uninsured elders in Mexico. Materials and methods: Fixed-effects instrumental-variable (FE-IV) pseudo-panel estimation from three rounds of the Mexican National Health and Nutrition Survey (2000, 2006 and 2012). Results: Our findings suggest that SP has no significant effect on the use of preventive services, including screening for diabetes, hypertension, breast cancer and cervical cancer, by adults aged 50 to 75 years. Conclusions: Despite the evidence that suggests that SP has increased access to health insurance for the poor, inequalities in healthcare access and utilization still exist in Mexico. The Mexican government must keep working on extending health insurance coverage to vulnerable adults. Additional efforts to increase health care coverage and to support preventive care are needed to reduce persistent disparities in healthcare utilization.

Resumen: Objetivo: Determinar el efecto del Seguro Popular (SP) en la utilización de la atención preventiva entre beneficiarios de SP de bajos ingresos y ancianos sin seguro en México. Material y métodos: Estimación de pseudopanel de variables instrumentales de efectos fijos (FE-IV) en tres rondas de la Encuesta Nacional de Salud y Nutrición de México (2000, 2006 y 2012). Resultados: El SP no tiene un efecto significativo en el uso de los servicios preventivos, incluida la detección de diabetes, hipertensión, cáncer de mama y cáncer de cuello uterino en adultos de 50 años o más. Conclusiones: Aún existen desigualdades en el acceso a la asistencia médica en México. El gobierno mexicano debe seguir trabajando para extender la cobertura del seguro de salud a la población más vulnerable. Se necesitan esfuerzos adicionales para aumentar la cobertura de atención médica y apoyar la atención preventiva para reducir las disparidades persistentes.

Abortos seguros e inseguros: Costos monetarios totales y costos para el sistema de salud de la Argentina en 2018 / Safe and unsafe abortions: Total monetary costs and health care system costs in Argentina in 2018

RESUMEN Durante el primer semestre de 2018, en Argentina se inició un profundo debate sobre la legalización de la práctica del aborto, que puso en evidencia la falta de estudios científicos que aborden la dimensión económica del tema en la Argentina. Este trabajo busca avanzar en la cuantificación de los costos del aborto bajo dos escenarios: el del actual contexto de ilegalidad y los costos potenciales si se aplicaran los protocolos internacionales recomendados, en un contexto de legalización de la práctica. Los resultados de la comparación de los costos monetarios totales en 2018 (privados o de bolsillo y para el sistema de salud) del escenario actual de ilegalidad y práctica insegura del aborto, frente a escenarios potenciales de prácticas seguras, muestran que se podría ahorrar una gran cantidad de recursos si se implementaran los protocolos recomendados. Dichos resultandos, además, se muestran robustos al realizar una serie de ejercicios de sensibilidad sobre los principales supuestos incluidos en las comparaciones.

ABSTRACT During the first semester of 2018, a profound debate on the legalization of the practice of abortion was initiated in Argentina, which exposed the lack of scientific studies addressing the economic dimension of abortion in this country. This work seeks to move forward in the quantification of the costs of abortion under two scenarios: the current context of illegality and the potential costs if the recommended international protocols were applied in a context of legalization of the practice. The results of the comparison between, on the one hand, the total monetary costs in 2018 (private or out-of-pocket expenditure and costs for the health care system) of the current scenario of illegality and unsafe practice of abortion and, on the other hand, potential scenarios of safe practices, shows that a large amount of resources could be saved if the recommended protocols were implemented. These results proved to be robust after carrying out a series of sensitivity exercises on the main assumptions included in the comparisons.

Knowledge and Viewpoints on Biosimilar Monoclonal Antibodies among Asian Physicians: Comparison with European Physicians / 대한소화기학회지

BACKGROUND/AIMS: Current knowledge and viewpoints regarding biosimilars among physicians in Asia are unknown, even though these were investigated by European Crohn's and Colitis Organization (ECCO) members in 2013 and 2015. Thus, this study conducted a multinational survey to assess the awareness of biosimilar monoclonal antibodies among Asian physicians.METHODS: A 17-question multiple-choice anonymous web survey was conducted with the logistic support of the Asian Organization of Crohn's and Colitis (AOCC). Randomly selected AOCC members were invited by e-mail to participate between February 24, 2017 and March 26, 2017.RESULTS: In total, 151 physicians from eight Asian countries responded to the survey. Most of the participants were gastroenterologists (96.6%), and 77.5% had cared for inflammatory bowel diseases (IBD) patients for more than 5 years. The majority of the respondents (66.2%) were aware that a biosimilar is similar but not equivalent to the originator. The majority of respondents (77.5%) considered cost saving to be the main advantage of biosimilars, but a high percentage of respondents (38.4%) were concerned about a different immunogenicity from that of the originator (92.4% and 27.1% respectively in ECCO 2015). Only 19.2% considered that the originator and biosimilars were interchangeable, and only 6.0% felt very confident in the use of biosimilars (44.4% and 28.8% respectively in ECCO 2015).CONCLUSIONS: Asian gastroenterologists in 2017 are generally well informed about biosimilars. On the other hand, compared to the ECCO members surveyed in 2015, Asian gastroenterologists had more concerns and less confidence about the use of biosimilars in clinical practice. Thus, IBD-specific data on the comparison of the efficacy, safety, and immunogenicity in Asian patients are needed.

Elaboração de fichas técnicas das preparações oferecidas em serviço de alimentação e nutrição de Hospital Público de Salvador, BA / Elaboration of files preparations techniques offered in service of Food and nutrition of public hospital Salvador, BA

A Ficha Técnica de Preparo é um instrumento gerencial de apoio operacional, onde se registram custos, ordenação do preparo e o cálculo do valor nutricional das preparações, especificando, em um formato padrão, as características de produção de cada preparação, sendo necessária observação do modo de preparo das refeições no local avaliado. O presente estudo foi desenvolvido em uma unidade de médio porte, onde diariamente são servidas cerca de 220 refeições no almoço, para funcionários e acompanhantes de pacientes internados. Foram elaboradas Fichas Técnicas de Preparo (FTP) dos pratos e principais e das opções presentes no cardápio do almoço elaborado para funcionários e acompanhantes no período de sete dias úteis, objetivando propor a padronização na elaboração destas preparações do cardápio da UAN. As informações coletadas foram organizadas em fichas contendo o nome da preparação, a categoria, as porções, valores per capita, ingredientes, equipamentos e utensílios, modo de preparo, Peso Bruto, Peso Líquido, Peso Cozido, Fator de Correção e Índice de Cocção, informações nutricionais e o custo das preparações. O uso das FTP poderá possibilitar o controle e redução de custos, a padronização das preparações e o conhecimento dos valores nutricionais das preparações, além de permitir a análise de quais preparações são menos custosas para o serviço.

The technical card of preparation is a management tool for operational support, in which is made the raising of costs, preparation sorting and is calculated the nutritional value of preparations, specifying, in a standard format, the production characteristics of each preparation, and requires method of preparation of on-site observation. This study was conducted in a mid-sized unit where is served daily around 220 meals at lunch for staff and companions of hospitalized patients. Were made Technical Preparation Cards of the main course and the options at lunch menu prepared for staff and caregivers within 7 working days, aiming to propose standardization in the preparation of the UAN menu preparations. The data were organized into records containing the name of the preparation, the category, the portions, per capita values, ingredients, equipment and utensils, preparation mode, Gross Weight, Net Weight, Cooked Weight, Correction Factor and Cooking Index, nutritional information and the cost of preparations. The use of FTP can allow control and cost reduction, standardization of preparations and knowledge of nutritional values of preparations, and allows analysis of which preparations are less costly to service.

Causas de retrabalho de produtos para saúde no centro de materiais e esterilização / Causes of rework of health products at the material and sterilization center / Causas de retrabajo de productos para salud en el centro de materiales y esteriliz

Objetivo: Identificar as principais causas de retrabalho de produtos para saúde (PPS) detectadas no Centro de Materiais e Esterilização (CME) de um hospital particular de Belo Horizonte, Minas Gerais, Brasil. Método: Estudo descritivo, desenvolvido em um CME de classe II de um hospital privado de Belo Horizonte. Foi realizada análise documental entre janeiro e junho de 2016, por meio de 181 registros de checklist e documentos de trabalho. Para tratamento dos dados, utilizou-se análise estatística descritiva para apresentação de valores absolutos e porcentagens geradas pelo programa EpiInfo 7®. Resultados: Foram encontrados 605 itens de retrabalho, que representaram uma taxa de 0,75% do total de caixas e pacotes produzidos. As principais causas foram relacionadas a produtos vencidos (74%) e resíduos orgânicos pós-esterilização (13%). Conclusão: O enfermeiro deve trabalhar com a equipe para redução das causas de retrabalho que impactam em desperdícios e custos desnecessários.

Objective: To identify the main causes of rework of health products detected at the Materials and Sterilization Center of a private hospital in Belo Horizonte, Minas Gerais, Brazil. Methods: A descriptive study was developed in a class II Sterilization Center of a private hospital in Belo Horizonte, Minas Gerais, Brazil. Documentary analysis was performed between January and June 2016, through 181 checklist records and working documents. For data treatment, descriptive statistical analysis was used for the presentation of absolute values and percentages generated by the Epi Info 7® program. Results: We found 605 rework items, which represented the rate of 0.75% of the total boxes and packages produced. The main causes were related to overdue products (74%) and post-sterilization organic wastes (13%). Conclusion: The nurse must work with its team to reduce the causes of rework, that impact unnecessary waste and costs.

Objetivo: Identificar las principales causas de retrabajo de productos para salud (PPS) detectadas en el Centro de Materiales y Esterilización (CME) de un hospital privado de Belo Horizonte, Minas Gerais, Brasil. Método: Estudio descriptivo, desarrollado en un CME de clase II de un hospital privado de Belo Horizonte. Se realizó un análisis documental entre enero y junio de 2016, a través de 181 registros de checklist y documentos de trabajo. Para el tratamiento de los datos, se utilizó análisis estadístico descriptivo para presentación de valores absolutos y porcentajes generados por el programa EpiInfo 7®. Resultados: Se encontraron 605 ítems de retrabajo, que representaron una tasa del 0,75% del total de cajas y paquetes producidos. Las principales causas fueron relacionadas con productos vencidos (74%) y residuos orgánicos post-esterilización (13%). Conclusión: El enfermero debe trabajar con un equipo para reducir las causas de retrabajo, que impactan en desperdicios y costos innecesarios.

Trends in Utilization of Transnasal Esophagoscopy

The development of office-based, unsedated transnasal esophagoscopy (TNE) has proven to be a major technological advance and with time and experience the application of this technology is becoming more widespread. TNE has allowed otolaryngologists to perform a variety of diagnostic and therapeutic procedures in the office setting. Studies consistently demonstrate that the image quality and diagnostic capability of TNE is equivalent to conventional esophagoscopy. The modern TNE endoscopes offer high quality optics, air-insufflation, and irrigation capability through a 2-mm working channel, and the ability to perform biopsies and select procedures. In general, the role of TNE in the head and neck patient is three-fold : to screen for synchronous and metachronous esophageal squamous cell carcinoma (ESCC) ; to differentiate post-treatment changes/symptoms from malignancy ; and to perform certain office-based procedures. TNE offers many specific advantages to the head and neck patient that are not afforded by conventional esophagoscopy. Because of surgical and postirradiation changes, many HNSCC patients have trismus or neck stiffness preventing completion of conventional transoral esophagoscopy. Perhaps most importantly, TNE provides enhanced patient safety, increased tolerability, better practice efficiency, and cost savings. For these reasons, TNE has become a particularly useful tool in the otolaryngologist's armamentarium.

Reducing Test Utilization in Hospital Settings: A Narrative Review

BACKGROUND: Studies addressing the appropriateness of laboratory testing have revealed approximately 20% overutilization. We conducted a narrative review to (1) describe current interventions aimed at reducing unnecessary laboratory testing, specifically in hospital settings, and (2) provide estimates of their efficacy in reducing test order volume and improving patient-related clinical outcomes. METHODS: The PubMed, Embase, Scopus, Web of Science, and Canadian Agency for Drugs and Technologies in Health-Health Technology Assessment databases were searched for studies describing the effects of interventions aimed at reducing unnecessary laboratory tests. Data on test order volume and clinical outcomes were extracted by one reviewer, while uncertainties were discussed with two other reviewers. Because of the heterogeneity of interventions and outcomes, no meta-analysis was performed. RESULTS: Eighty-four studies were included. Interventions were categorized into educational, (computerized) provider order entry [(C)POE], audit and feedback, or other interventions. Nearly all studies reported a reduction in test order volume. Only 15 assessed sustainability up to two years. Patient-related clinical outcomes were reported in 45 studies, two of which found negative effects. CONCLUSIONS: Interventions from all categories have the potential to reduce unnecessary laboratory testing, although long-term sustainability is questionable. Owing to the heterogeneity of the interventions studied, it is difficult to conclude which approach was most successful, and for which tests. Most studies had methodological limitations, such as the absence of a control arm. Therefore, well-designed, controlled trials using clearly described interventions and relevant clinical outcomes are needed.

Economic Burden of the Inadequate Management of Allergic Rhinitis and Urticaria in Asian Countries Based on the GA²LEN Model

PURPOSE: Across Hong Kong, Malaysia, the Philippines, Singapore, Thailand and Vietnam, (referred to as Asia) approximately 30–53 million individuals of the 151 million employed suffer from allergic rhinitis (AR) and urticaria. It is estimated that approximately 90% of patients with these allergic conditions are insufficiently treated, impacting the socioeconomic burden in terms of absence from work and decreased productivity. This study aims to estimate the socioeconomic burden of allergies in Asia and the cost savings that their adequate management can provide. Due to the limited availability of regional data, this study focused AR and urticaria in selected countries. METHODS: Published literature, information from statistical bureaus, clinician surveys and extrapolation of selected data from the European Union were used to determine the socioeconomic costs of AR and urticaria. RESULTS: Many patients in Asia suffer from perennial allergies and experience symptoms of AR and urticaria for up to 298 days per year. An estimate of the indirect costs of patients insufficiently treated for AR and urticaria amounts to USD 105.4 billion a year, which equates to USD 1,137–2,195 per patient due to absenteeism and presenteeism. Adherence to guideline-approved treatment can lead to estimated savings of up to USD 104 billion. CONCLUSIONS: The current study suggests that within Asia, the socioeconomic impact of AR and urticaria is similar to that seen in the European Union in spite of the lower wages in Asia. This is due to the mainly perennial allergens prevailing in Asia, whereas the sensitization patterns observed in the European Union are dominated by seasonal exposure to pollen. These results underline the need for governmental initiatives to increase public awareness on the prevention and treatment of these and other allergic diseases as well as greater research funding and large-scale studies to reduce their growing socioeconomic burden in coming years.

Do Fraud Investigations Impact Healthcare Expenditures of Medical Institutions?: An Interrupted Time Series Analysis of Healthcare Costs in Korea / 보건행정학회지

BACKGROUND: The aim of our study was to review the findings of health insurance fraud investigations and to evaluate their impacts on medical costs for target and non-target organizations. An interrupted time series study design using generalized estimation equations was used to evaluate changes in cost following fraud investigations. METHODS: We used National Health Insurance claims data from 2009 to 2015, which included 20,625 medical institutions (1,614 target organizations and 19,011 non-target organizations). Outcome variable included cost change after fraud investigation. RESULTS: Following the initiation of fraud investigations, we found statistically significant reductions in cost level for target organizations (−1.40%, p < 0.001). In addition, a reduction in cost trend change per month was found for both target organizations and non-target organizations after fraud investigation (target organizations, −0.33%; non-target organizations of same region, −0.19%; non-target organizations of other regions, −0.17%). CONCLUSION: This study suggested that fraud investigations are associated with cost reduction in target organization. We also found similar effects of fraud investigations on health expenditure for non-target organizations located in the same region and in different regions. Our finding suggests that fraud investigations are important in controlling the growth of health expenditure. To maximize the effects of fraud investigation on the growth of health expenditure, more organizations needed to be considered as target organizations.

Marginal socio-economic effects of an employer's efforts to improve the work environment

BACKGROUND: Workplace health promotion (WHP) strongly requires the employer’s efforts to improve the psychosocial, ergonomic, and physical environments of the workplace. There are many studies discussing the socio-economic advantage of WHP intervention programmes and thus the internal and external factors motivating employers to implement and integrate such programmes. However, the socio-economic impacts of the employer’s multifactorial efforts to improve the work environment need to be adequately assessed. METHODS: Data were collected from Swedish company Sandvik Materials Technology (SMT) through a work environment survey in April 2014. Different regression equations were analysed to assess marginal effects of the employer’s efforts on overall labour effectiveness (OLE), informal work impairments (IWI), lost working hours (LWH), and labour productivity loss (LPL) in terms of money. RESULTS: The employer’s multifactorial efforts resulted in increasing OLE, decreasing IWI and illness-related LWH, and cost savings in terms of decreasing LPL. CONCLUSION: Environmental factors at the workplace are the important determinant factor for OLE, and the latter is where socio-economic impacts of the employer’s efforts primarily manifest.

Avaliação e controle de instrumentais utilizados em sala operatória durante cirurgias torácicas / Assessment and control of instruments utilized in operating room during thoracic surgeries / Evaluación y control de instrumentales utilizados en quirófano durante cirugías torácicas

Objetivo: Avaliar o número de instrumentais cirúrgicos não utilizados durante as cirurgias torácicas realizadas em um hospital universitário. Métodos: Trata-se de um estudo exploratório, descritivo, transversal com abordagem quantitativa, realizado a partir do levantamento de dados sobre a utilização ou não de instrumentais cirúrgicos presentes nas caixas cirúrgicas. Resultados: Foram observadas 30 cirurgias torácicas, sendo a média de instrumentais utilizados por cirurgia de 84,53% e a média de instrumentais não utilizados de 15,48%. Conclusão: São necessárias reformulações na composição das caixas cirúrgicas dessa especialidade a fim de otimizar a utilização e o processamento dos instrumentais.

Objective: To assess the number of unused surgical instruments during thoracic surgeries performed at a university hospital. Methods: An exploratory, descriptive, cross-sectional study with a quantitative approach, conducted by gathering data on the use or lack of use of surgical instruments present in the surgical box. Results: A total of thirty thoracic surgeries were observed, with a mean of 84.53% of instruments utilized for surgery and a mean of 15.48% of instruments left unused. Conclusion: A reconfiguration of the surgical boxes for this specialty is needed in order to optimize the utilization and the process of these instruments.

Objetivo: Evaluar el número de instrumentales quirúrgicos no utilizados durante las cirugías torácicas realizadas en un hospital universitario. Métodos: Se trata de un estudio exploratorio, descriptivo, transversal con abordaje cuantitativo, realizado a partir del levantamiento de datos sobre a utilización o no de instrumentales quirúrgicos presentes en las cajas quirúrgicas. Resultados: Fueron observadas 30 cirugías torácicas, siendo el promedio de instrumentales utilizados por cirugía del 84,53% y el promedio de instrumentales no utilizados del 15,48%. Conclusión: Son necesarias reformulaciones en la composición de las cajas quirúrgicas de esa especialidad a fin de optimizar la utilización y el procesamiento de los instrumentales.

Value-based healthcare: prerequisites and suggestions for full-fledged implementation in the Republic of Korea

Healthcare systems around the world share the common goals of improving clinical outcomes, optimizing cost reductions and efficiencies, and expanding access to care in a patient-centric manner, yet they are stymied by 2 critical challenges: wide variations in patients' clinical outcomes and soaring costs. In response to these challenges, many healthcare systems throughout the world are pivoting towards value-based healthcare (VBHC), to ultimately 1) move from volume-based to value-based care, 2) promote patient-centric care, and 3) reverse rising costs. While the United States and European nations are piloting alternative payment models, South Korea has a similar set of objectives to adopt value or performance-based payment systems. Two exemplary programs helping to move Korea towards a VBHC model are currently under way: the Support Fund Program for Care Quality Assessment and the Healthcare Benefit Appropriateness Assessment Program. However, in order to permanently establish a full-fledged VBHC system in Korea, the following prerequisites must be met: 1) normalization of provider payment rates, 2) development and dissemination of critical pathways, 3) implementation of pilot projects in the medical device sector that contain risk-share payment schemes, 4) implementation of registries to aid data-driven coverage decisions, and 5) implementation of bundled payment pilot programs for the medical conditions for which proven critical pathways already exist. Ultimately, the medical device industry is in a unique position to enhance ongoing endeavors by Korean health authorities and providers to achieve quality patient care and cost savings, all in the service of the transition to VBHC.

Cost-Effective Mobile-Based Healthcare System for Managing Total Joint Arthroplasty Follow-Up / 대한의료정보학회지

OBJECTIVES: Long-term follow-up care after total joint arthroplasty is essential to evaluate hip and knee arthroplasty outcomes, to provide information to physicians and improve arthroplasty performance, and to improve patients' health condition. In this paper, we aim to improve the communication between arthroplasty patients and physicians and to reduce the cost of follow-up controls based on mobile application technologies and cloud computing. METHODS: We propose a mobile-based healthcare system that provides cost-effective follow-up controls for primary arthroplasty patients through questions about symptoms in the replaced joint, questionnaires (WOMAC and SF-36v2) and the radiological examination of knee or hip joint. We also perform a cost analysis for a set of 423 patients that were treated in the University Clinic for Orthopedics in Essen-Werden. RESULTS: The estimation of healthcare costs shows significant cost savings (a reduction of 63.67% for readmission rate 5%) in both the University Clinic for Orthopedics in Essen-Werden and the state of North Rhine-Westphalia when the mobile-based healthcare system is applied. CONCLUSIONS: We propose a mHealth system to reduce the cost of follow-up assessments of arthroplasty patients through evaluation of diagnosis, self-monitoring, and regular review of their health status.