Direct costs of hospital care according to coinfection in adult COVID-19 patients

Objective: To estimate the direct costs of hospital care according to coinfection in adult COVID-19 patients. Material(s) and Method(s): A retrospective follow-up study of adult patients hospitalized for COVID-19 between March and August 2020 at the San Vicente Foundation Hospitals (Medellin and Rionegro, Colombia). Patients whose diagnosis of SARS-Cov2 pneumonia was confirmed by RT-PCR test were included. Death from any cause and length of stay were considered outcome variables. Costs were estimated in 20 20 US dollars. Result(s): 365 patients with an average age of 60 years (IQR: 46-71), 40% female, were analyzed. 60.5% required an Intensive Care Unit (ICU). All-cause mortality was 2.87 per 100 patient-days. Patients admitted to the ICU who developed coinfection had an average length of stay of 27.8 days (SD:17.1) and an average cost of $23,935.7 (SD: $16,808.2);patients admitted to the ICU who did not develop a coinfection had an average length of stay of 14.7 days (SD:8.6) and an average cost of $9,968.5 (SD: $8,054.0). Conclusion(s): A high percentage of patients required intensive care, and there was a high mortality due to COVID-19. In addition, a higher cost of care was observed for those patients who developed coinfection and were admitted to ICU.Copyright © 2023 Asociacion Colombiana de Infectologia. All rights reserved.

Diabetes in Poland - public health challenges and opportunities

Introduction and objective: Diabetes, with its medical complications and societal consequences, is one the most difficult concerns for modern society. The purpose of this narrative review is to characterize the selected public health challenges and opportunities resulting from diabetes in Poland, as well as to identify public health measures that may be adopted to lower the diabetes burden in Poland. Review methods: This narrative review is based on the literature about diabetes in Poland. Scientific papers on diabetes published between 1 January 2010-31 January 2023, available in the PubMed database, were identified using a combination of the following key words: 'diabetes', 'Poland', 'public knowledge', 'management' and 'costs'. Particular attention was paid to the following diabetes-related issues: (1) current and forecast prevalence of diabetes in Poland, (2) diabetic care before and after the COVID-19 pandemic onset, (3) public knowledge of diabetes and diabetes risk factors, and (4) public health interventions to reduce the diabetes burden at the population level. Abbreviated description of the state of knowledge: A continuous growth of both the incidence and the prevalence of diabetes is predicted. Due to insufficient public awareness of diabetes risk factors and symptoms, and the health-debt caused by COVID-19 pandemic, a further rise in the number of diabetic complications is expected, as well as an increase in public spending on health care and social insurance systems. Summary: Public health interventions targeted at preventing diabetes and its complications should not be confined to reducing complications and improving diabetes care, but also include a wide range of initiatives aimed at addressing the fundamental causes of diabetes. Future study should look at the cost-effectiveness of such initiatives in order to mobilize different stakeholders and society.

Special Issue: Recent learnings and development in healthcare financing: A global perspective. (Special Issue: Recent learnings and development in healthcare financing: A global perspective.)

This special issue contains 11 s that discuss recent learnings and developments in healthcare financing from a global perspective. The s cover a range of topics such as the impact of mental illness on poverty and catastrophic health expenditure in India, financing challenges in the American healthcare industry, comparative analysis of health system financing in India and Saudi Arabia, and the contribution of the Ghana National Health Insurance Scheme to inequality in healthcare utilisation. Other s explore the influence of socio-economic status on health financing choices in Jambi Province, households' willingness to pay for community-based health insurance in Bangladesh, and changes in household expenditures during the first wave of COVID-19 in India. The issue also includes discussions on managing the provider-purchaser split in India and reconsidering patient value to create better healthcare.

Opioid prescriptions and patients' health services utilization and cost before and during the COVID-19 pandemic: an exploratory population-based administrative data analysis.

The objective was to explore percentages of the population treated with prescribed opioids and costs of opioid-related hospitalizations and emergency department (ED) visits among individuals treated with prescription opioids and costs of all opioid-related hospitalizations and ED visits in the province (i.e., provincial costs) before and during the coronavirus disease 2019 (COVID-19) pandemic in Alberta, Canada. In administrative data, we identified individuals treated with prescription opioids and opioid-related hospitalizations and ED visits among those individuals and among all individuals in the province between 2015/16 and 2021/22 fiscal years. Services used were counted on an item-by-item basis and costed using case-mix approaches. Annually, from 9.98% (2020/21-2021/22) to 14.52% (2017/18) of the provincial population was treated with prescription opioids. Between 2015/16 and 2021/22, annual costs of opioid-related hospitalizations and ED visits among individuals treated with prescription opioids were ∼$5 and ∼$2 million, respectively. In 2020/21-2021/22, the provincial costs of opioid-related hospitalizations (∼$14 million) and ED visits (∼$7.0 million) were almost twice the costs observed in 2015/16 and immediately before the pandemic (2019/20). Our findings suggest that increases in the opioid-related utilization of inpatient and ED services between 2015/16 and 2021/22, including the drastic increases observed during the COVID-19 pandemic, were likely driven by unregulated substances.

Advancing patient safety governance in the COVID-19 response

In the backdrop of the COVID-19 pandemic, ensuring the safety of health care services remains a serious, ongoing challenge. This once-in-a-century global health crisis exposed the vulnerability of healthcare delivery systems and the subsequent risks of patient harm. Given the scale of the occurrence and costs of preventable patient safety events, intervention and investment are still relatively modest. Good patient safety governance focuses on what leaders and policy makers can do to improve system performance and reduce the financial burden of avoidable care. Moreover, it is essential in driving progress in improving safety outcomes. This report examines how patient safety governance mechanisms in OECD countries have withstood the test of COVID-19 and provides recommendations for countries in further improving patient safety governance and strengthening health system resilience.

Primary care behavioral health in the time of COVID-19

People are commonly receiving mental health treatment from primary care providers rather than from behavioral health providers. To address this issue, the healthcare system has begun to integrate behavioral health providers into primary care clinics, known as integrated primary care (IPC). Research suggests that IPC can lead to a number of benefits, including increased likelihood of patients receiving the appropriate standard of care, as well as reduction in healthcare costs due to medical cost offset. While IPC is a promising method of healthcare delivery, additional research is needed to optimize this system. Additionally, the onset of the COVID-19 pandemic has drastically impacted the mental and physical health needs of the United States population, especially for low income and racial and ethnic minority populations. However, there is little research on how this has impacted the presenting problems seen in IPC, or how IPC utilization may have been impacted. This study will examine patient characteristics and IPC utilization of two clinics serving a low income and racial and ethnic minority population and assess how patient and provider characteristics are impacting the process of IPC. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Improving the timeliness of health expenditure tracking in OECD and low-and middle-income countries

The COVID-19 pandemic has highlighted that access to timely health spending data is crucial for informed policy-making. This Health Working Paper summarises and compares the methodologies applied in around half of OECD countries to estimate public and private health spending for the most recent year (i.e. t-1) as well as the approaches taken by the OECD Secretariat to fill existing data gaps for the remaining OECD countries. For the first time, the paper also explores the feasibility of nowcasting health spending for the current year (i.e. t) and examines data sources that could be potentially useful in such an exercise. While this review should help OECD countries that do not yet have experience in estimating health spending for year t-1 to improve the timeliness in their data reporting, a special focus in this paper lies on testing the applicability of the methods in low- and middle-income countries (LMIC), using the WHO Western Pacific Region (WPRO) as an example. Generally, different data sources exist in many countries that would allow for a more timely estimation for health spending aggregates.

Effect of computerized physician order entry inactivation to order complementary studies in an emergency department / [Efecto de la inactivación de las órdenes múltiples para solicitud de estudios complementarios en una central de emergencias.]

Introduction: The computerized provider order entry (CPOE) is a computing tool that could lead to unintended consequences despite its myriad benefits. We aimed to explore the effect of its inactivation on requests for complementary studies and the associated costs. Methods: Cross sectional study at the Emergency Department of Hospital Italiano de Buenos Aires, which included a consecutive sample of pre-intervention (January-February 2020) and post-intervention (2021) consultations. Using secondary bases, the variables included were administrative debits and their respective billing prices. Results: There were 27,671 consultations in 2020 with a total median value of $474, and 20,819 with $1,639 in 2021. After the analysis restricted to the area of ​​moderately complex clinics (excluding COVID-19 consultations), the following was found: a decrease in the median number of practices per consultation (median of 11 vs. 10, p=0.001), a decrease in the request for at least one laboratory practice (45% vs. 39%, p=0.001), without finding significant changes in global costs (median $1,419 vs. $1,081; p=0.122) or in specific laboratory costs (median $1,071 vs. $1,089, p=0.710). Conclusion: Despite inflation, a significant reduction in the number of practices was achieved and overall costs per consultation were maintained. These findings demonstrate the effectiveness of the intervention, but an educational intervention aimed at reminding the potential harm of overuse and the health costs of unnecessary studies will be necessary.

Introducción: La plantilla de órdenes múltiples es una herramienta informática que podría producir consecuencias inadvertidas pese a sus innumerables beneficios. Nos propusimos explorar el efecto de su inactivación sobre las solicitudes de estudios complementarios y los costos asociados. Métodos: Corte transversal en la Central de Emergencias de Adultos del Hospital Italiano de Buenos Aires, que incluyó muestra consecutiva de consultas pre-intervención (Enero-Febrero 2020) y post-intervención (2021). Mediante el uso de bases secundarias, las variables incluidas fueron los débitos administrativos y sus respectivos precios de facturación. Resultados: Hubo 27.671 consultas en 2020 con una mediana de valor total de 474$, y 20.819 con 1.639$ en 2021. Tras el análisis restringido al área de consultorios de moderada complejidad (excluyendo consultas por COVID-19), se encontró: una disminución en la mediana del número de prácticas por consulta (mediana de 11 vs 10, p=0,001), una disminución en la solicitud de al menos una práctica de laboratorio (45% versus 39%, p=0,001), sin encontrar cambios significativos en costos globales (mediana 1.419$ vs 1.081$; p=0,122) ni en costos específicos de laboratorio (mediana 1.071$ vs 1.089$, p=0,710). Conclusión: Pese a la inflación interanual, se logró una reducción significativa en el número de prácticas y se mantuvieron los costos globales por consulta. Estos hallazgos demuestran la efectividad de la intervención, pero serán necesarias medidas educativas que apunten al recordatorio de los potenciales daños en la sobreutilización, y los costos sanitarios de los estudios innecesarios.

Organized Psychiatry Provides Strength and Value to Mental Health Professionals

The article discusses the impact of organized psychiatry on mental health professionals. Topics include results of the 2018 Survey of America's Physicians: Practice Patterns and Perspectives, complaints received each year by the American Psychiatric Association (APA) when its membership renewals reach members, and the struggle by specialty organizations to keep members active during these changing times.

Direct medical costs analysis of COVID-19 patients in the hospitals of Ilam University of Medical Sciences

Background: The most well-known classification of the cost of diseases is direct medical cost. The aim of this study is to investigate and analyze direct treatment costs of patients with Covid-19 by hospitals affiliated with Ilam University of Medical Sciences. Methods: This was a descriptive-analytical, cross-sectional study performed retrospectively. The hospital expenditure information in Ilam province from March to October 2020 was used. Cost information related to all patients was collected and classified and reviewed using Excel 2016 software. The average direct treatment costs of hospitalized patients were also determined. Results: The direct costs of treatment in hospitalized patients in Ilam were estimated at $ 2349272.094 (98669427959 billion Rials). The per capita direct medical costs were calculated to be $ 1228.056 (51578373 million Rials). The largest share of the cost related to pharmaceutical services and the share of basic insurance was equal to $ 934.570 (39,252,109 million Rials). Conclusion: Results of the study indicated that the treatment costs of patients entering Ilam province are high, and the highest cost concerns pharmaceutical services. Taking necessary measures to prevent and control the spread of coronary artery, using the most cost-effective drug interventions and reducing unnecessary hospital stays of patients can increase the efficiency of financial resources and reduce direct medical costs in Ilam province.

Pharmacotherapy analysis for hospitalized patients with COVID-19 (prescriptions, costs and outcomes)

Background: The COVID-19 pandemic has caused many economic problems worldwide, in Iran as well, causing Hospitals to face many financial problems. Objectives: Based on documented data on pharmacotherapy, costs, and its effectiveness, this study aimed to analyze the costs and outcomes of hospitalized patients with COVID-19 under pharmacotherapy in Iran. Methods: This research was a retrospective analytical descriptive study. Relevant data of the COVID-19 hospitalized patients' were extracted from the Hospital's Medical Records Department. All items of direct medical costs, such as visits, nursing services, consuming materials, laboratories, imaging, medical operations, medications, and beds, were extracted by reviewing COVID-19 hospitalized patients' files in different wards of the Shohada Ashayer Hospital in Khorramabad city in 2021. Results: A total of 399 patients were examined in this study. The total direct medical costs per patient was 338.63 US$. Of note, the highest cost was related to medicine (32.56%), more than the cost of bed (22.77%). The most commonly used drugs were Lopinavir (95%) and Azithromycin (90%), and the highest medicine cost per patient was related to Immunoglobulin (64.32 US$) and Remdesivir (46.91 US$). Conclusion: Medicine and hospitalization costs accounted for the largest share of the total treatment costs of patients. Therefore, reducing bed costs requires home treatments and outpatient injections. Furthermore, due to rising drug costs, prescriptions should be based on standard treatment protocols.

Calidad de vida de los cafeticultores en las Altas Montañas de Veracruz, México

Introduction: The High Mountain Region (RHM) is the most productive and socioeconomic region for the coffee cultivation in the state of Veracruz, Mexico, and one of the most representative of the sector at the national level. Background: To determine the quality of life (QL) from the objective and subjective point of view of the small coffee producers (SP) in RHM, Mexico. Materials and methods: One hundred and fifty semi-structured interviews were applied to producers in eleven municipalities located in: Comapa, Coscomatepec, Huatusco, Ixhuatl..n del caf.., Sochiapa, Tenampa, Tomatl..n, Totutla, Tlaltetela, Tlacotepec, and Zentla, during 2020. Descriptive statistics and trend measurements were obtained. Results: At objective level the QL was found to be low, but at the farmers' subjective level, it was determined to be acceptable. In the objective assessment, it was identified that the SP have minimal education (primary), the income is not adequate (they require activities outside the farm with an average net annual income of US $ 416 to US $ 1115), the cost of health has increased (due to the COVID-19 pandemic), and proper nutrition is lacking (19 to 25 meals per month). In the subjective assessment there is insecurity and distrust with the government authorities, however, the producers have adapted to living in adverse socioeconomic contexts, since they value community life, intra-family relationships and their environment (coffee growing), which could be influenced by their own worldview. Conclusion: With or without knowledge of the concept of quality, producers have developed a learned or acquired capacity, both individually and collectively to adapt to the environment. Objectively, the quality of life is considered low, however, the interviewees had a perception of satisfaction both individually and collectively.

How transformational leaders increase nurse retention and decrease attrition

The COVID-19 pandemic exacerbated the problem of nurse attrition, which negatively impacted the lives of nurses, decreased patients' perception of their healthcare, and increased the cost of healthcare. Facility administrators who lack strategies to decrease nurse turnover may lose their ability to provide quality nursing services in their facility and control their costs of care. Grounded in the transformational leadership theory, the purpose of this qualitative multiple case study was to explore the strategies private medical treatment facility administrators use to decrease nurse attrition. Five private medical treatment facility administrators located in Southern Texas completed semistructured, open-ended interviews, and three employee engagement survey results were analyzed. Results were analyzed using thematic analysis. Four themes emerged: develop a culture of engagement, approach associates' concerns from a perspective of listening, provide financial benefits within the control of management, and advocate to the United States Federal Government. A key recommendation for facility administrators is to remain visible leaders and conduct unit rounding often. The implications for social change include the potential to improve the lives of nurses, increase patients' perception of their healthcare, and decrease the cost of healthcare. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Cost of treating coronavirus disease 2019 (COVID-19) patients in hospitals and influencing factors: a systematic literature review

Background: Increasing beds for COVID-19 patients is not a simple matter for hospitals because hospitals cannot directly increase the number of existing beds due to limited facilities, infrastructure, equipment, and resources. Careful calculations are needed in terms of preparing the room and treating COVID patients, especially the estimated costs needed to treat COVID patients in the hospital. This expenditure is important so that it can be an illustration of the hospital how much expenditure is needed. This study aimed to determine the number of costs incurred for treating COVID-19 patients in hospitals and the factors that influence these costs. Methods: This study was conducted by systematic literature review using the PRISMA statement conducted May-June 2021. An article search was conducted on Pubmed, Scopus, Proquest, and Google Scholar with the inclusion criteria, namely research related to the cost of treating COVID-19 patients in hospitals and the factors that influence the amount of these costs. Results: A systematic search obtained six articles. Studies vary greatly in study design and perspective included in the cost category. Estimated costs for COVID-19 care range from $63/day to $2,990/day. Factors that affect the cost of care include age, previous medical history, degree of infection or severity of COVID-19, length of stay, place of care, and need for a ventilator. Conclusion: There is a considerable economic burden associated with the incident of COVID-19. Several factors affect the cost of COVID-19, namely the length of the treatment period and the need for intensive rooms and ventilators.

Comparison of COVID-19 hospitalization costs across care pathways: a patient-level time-driven activity-based costing analysis in a Brazilian hospital.

BACKGROUND: The COVID-19 pandemic raised awareness of the need to better understand where and how patient-level costs are incurred in health care organizations, as health managers and other decision-makers need to plan and quickly adapt to the increasing demand for health care services to meet patients' care needs. Time-driven activity-based costing offers a better understanding of the drivers of cost throughout the care pathway, providing information that can guide decisions on process improvement and resource optimization. This study aims to estimate COVID-19 patient-level hospital costs and to evaluate cost variability considering the in-hospital care pathways of COVID-19 management and the patient clinical classification. METHODS: This is a prospective cohort study that applied time-driven activity-based costing (TDABC) in a Brazilian reference center for COVID-19. Patients hospitalized during the first wave of the disease were selected for their data to be analyzed to estimate in-hospital costs. The cost information was calculated at the patient level and stratified by hospital care pathway and Ordinal Scale for Clinical Improvement (OSCI) category. Multivariable analyses were applied to identify predictors of cost variability in the care pathways that were evaluated. RESULTS: A total of 208 patients were included in the study. Patients followed five different care pathways, of which Emergency + Ward was the most followed (n = 118, 57%). Pathways which included the intensive care unit presented a statistically significant influence on costs per patient (p <  0.001) when compared to Emergency + Ward. The median cost per patient was I$2879 (IQR 1215; 8140) and mean cost per patient was I$6818 (SD 9043). The most expensive care pathway was the ICU only, registering a median cost per patient of I$13,519 (IQR 5637; 23,373) and mean cost per patient of I$17,709 (SD 16,020). All care pathways that included the ICU unit registered a higher cost per patient. CONCLUSIONS: This is one of the first microcosting study for COVID-19 that applied the TDABC methodology and demonstrated how patient-level costs vary as a function of the care pathways followed by patients. These findings can be used to develop value reimbursement strategies that will inform sustainable health policies in middle-income countries such as Brazil.

2023 Alzheimer's disease facts and figures.

This article describes the public health impact of Alzheimer's disease, including prevalence and incidence, mortality and morbidity, use and costs of care, and the overall impact on family caregivers, the dementia workforce and society. The Special Report examines the patient journey from awareness of cognitive changes to potential treatment with drugs that change the underlying biology of Alzheimer's. An estimated 6.7 million Americans age 65 and older are living with Alzheimer's dementia today. This number could grow to 13.8 million by 2060 barring the development of medical breakthroughs to prevent, slow or cure AD. Official death certificates recorded 121,499 deaths from AD in 2019, and Alzheimer's disease was officially listed as the sixth-leading cause of death in the United States. In 2020 and 2021, when COVID-19 entered the ranks of the top ten causes of death, Alzheimer's was the seventh-leading cause of death. Alzheimer's remains the fifth-leading cause of death among Americans age 65 and older. Between 2000 and 2019, deaths from stroke, heart disease and HIV decreased, whereas reported deaths from AD increased more than 145%. This trajectory of deaths from AD was likely exacerbated by the COVID-19 pandemic in 2020 and 2021. More than 11 million family members and other unpaid caregivers provided an estimated 18 billion hours of care to people with Alzheimer's or other dementias in 2022. These figures reflect a decline in the number of caregivers compared with a decade earlier, as well as an increase in the amount of care provided by each remaining caregiver. Unpaid dementia caregiving was valued at $339.5 billion in 2022. Its costs, however, extend to family caregivers' increased risk for emotional distress and negative mental and physical health outcomes - costs that have been aggravated by COVID-19. Members of the paid health care workforce are involved in diagnosing, treating and caring for people with dementia. In recent years, however, a shortage of such workers has developed in the United States. This shortage - brought about, in part, by COVID-19 - has occurred at a time when more members of the dementia care workforce are needed. Therefore, programs will be needed to attract workers and better train health care teams. Average per-person Medicare payments for services to beneficiaries age 65 and older with AD or other dementias are almost three times as great as payments for beneficiaries without these conditions, and Medicaid payments are more than 22 times as great. Total payments in 2023 for health care, long-term care and hospice services for people age 65 and older with dementia are estimated to be $345 billion. The Special Report examines whether there will be sufficient numbers of physician specialists to provide Alzheimer's care and treatment now that two drugs are available that change the underlying biology of Alzheimer's disease.

Actual status and future directions of cardiac telerehabilitation.

Telerehabilitation (TR) was developed to achieve the same results as would be achieved by the standard rehabilitation process and to overcome potential geographical barriers and staff deficiencies. This is especially relevant in periodic crisis situations, including the current COVID-19 pandemic. Proper execution of TR strategy requires both well-educated staff and dedicated equipment. Various studies have shown that TR may have similar effects to traditional rehabilitation in terms of clinical outcomes and may also reduce total healthcare costs per participant, including rehospitalization costs. However, as with any method, TR has its advantages and disadvantages, including a lack of direct contact or prerequisite, rudimentary ability of the patients to handle mobile devices, among other competencies. Herein, is a discussion of the current status of TR, focusing primarily on cardiac TR, describing some technical/organizational and legal aspects, highlighting the indications, examining cost-effectiveness, as well as outlining possible future directions.

Telemedicine as technoinnovation to tackle COVID-19: A bibliometric analysis

Telemedicine has become fundamental for the challenges posed to healthcare. This set of instruments turns pivotal for facing one of the most relevant emergencies in human history: the COVID-19 pandemic. The multisectoral crisis led to a vigorously sustained adoption of innovations, including telemedicine technology. Telehealth was proven, in this context, to be a relevant tool to reduce healthcare costs, reduce not-needed hospitalizations, and improve the results in health care. Some barriers such as the costs of technologies, patient privacy and technical literacy have slowed down telemedicine adoption. Amidst the COVID-19 era, telemedicine calls for a managerial duty to change healthcare's organizational models. The present work aims to explore the growing literature to illuminate the relationships between telemedicine, innovations and healthcare in the COVID-19 framework. A bibliometric analysis of the existing literature based on 285 published works in 2019–2020 is put forward with the aim to detect the relevant literature, themes and approaches on telemedicine and COVID-19. Making use of community detection on the co-occurrence keywords network, we identify the "semantic cores” in the literature representing the relevant results on critical themes. The sorting implications are important for researchers and policymakers by mapping the existing literature and results in evidence-based analysis. We provide the key communities as the "semantic core” of the publications and results for the considered period. This allows for future research to be oriented towards perduring health policies that could lead to the adoption of telemedicine technologies in a post-pandemic scenario. © 2021

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