Costs to hospitals of acquiring and processing blood in the US: a survey of hospital-based blood banks and transfusion services.

BACKGROUND: little is known about the economics of acquiring and processing the more than 14 million units of red blood cells used annually in the US. OBJECTIVE: to determine the average price paid by hospitals to suppliers for a unit of red blood cells and to identify cost variations by region and facility type and size. A secondary objective was to examine costs for additional blood components as well as costs for blood-related processes performed by hospitals. Qualitative input was sought to identify potential cost drivers. METHODS: a cross-sectional survey was performed of a randomized sample of hospital-based blood bank and transfusion service directors. The survey instrument assessed costs of specific blood components and services as incurred by hospitals. Analysis of variance was performed to test for significant variation in costs for red blood cells by geographic region and division, facility type and bed capacity. RESULTS: a total of 213 surveys were completed. The mean (SD) acquisition cost for one unit of red blood cells purchased from a supplier (n = 204) was $US210.74 ± 37.9 and the mean charge to the patient (n = 167) was $US343.63 ± 135. There was significant statistical variation in acquisition cost by US census region (p < 0.0001) and division (p < 0.0001). Teaching hospitals were more likely to receive volume discounts than other facility types. The mean prices paid per unit for fresh frozen plasma (n = 167) and apheresis platelets (n = 153) were $US60.70 ± 20 and $US533.90 ± 69, respectively. The median cost for mandated screening performed onsite (n = 56) was $US50.00 ± 120 and the median storage and retrieval cost (n = 46) was $US68.00 ± 81 per unit. A total of 28% of respondents reported that costs for acquisition, screening and transfusion had 'increased dramatically' over the past 5 years and 23% reported that blood shortages were a significant problem. CONCLUSIONS: the cost of blood continues to increase and price varies by geography. However, the rate of increase in acquisition costs for red blood cells appears to be slowing. This information should be used by organizations and policy makers to improve financing and utilization management for blood components and services.

End-of-life care for hospitalized patients with lung cancer: utilization of a palliative care service.

PURPOSE: High symptom burden and hospital mortality among patients with lung cancer argues for early palliative care intervention. Patient characteristics and discharge dispositions in hospitalized patients with lung cancer receiving usual care were compared to those referred to a new palliative care service. METHODS: A retrospective database review of all lung cancer discharges receiving usual care (UC) and palliative care service (PCS) consultation was conducted. Demographics, length of stay, discharge disposition, and mortality were described and compared. Palliative Performance Scale scores were described according to discharge disposition in the PCS group. Disposition of all patients receiving either chemotherapy or surgery was also noted. RESULTS: A total of 1476 hospital discharges with a diagnosis of lung cancer occurred between March 15, 2006 and June 30, 2009. Among all discharges, 9% received chemotherapy and 29% had surgery. The PCS was consulted for 8% of all lung cancer patients most commonly to address end-of-life-issues. PCS patients were more likely to be at the end-of-life than UC patients as evidenced by higher hospital mortality (31% versus 7%), higher intensive care (ICU) mortality (67% versus 16%) and more frequent discharge to hospice (41% versus 7%). PCS patients were hospitalized a median of 6 days before a referral was made. Hospitalization was significantly longer for PCS patients (M = 16.3 days, p < 0.001) than UC patients (M = 8.3 days). CONCLUSIONS: In the first 3 years of a new palliative care initiative consults for lung cancer patients occurred late in the hospital stay or when death was imminent.

Obesity management interventions: a review of the evidence.

The burden of disease associated with the obesity epidemic shortens lives, and prevalence is accelerating. As with other chronic diseases, improved outcomes are associated with effective self-management of obesity across the life span. The disease of obesity, then, fits squarely within the disease management and chronic care models. This article reviews selected interventions, described in peer-reviewed literature, designed to achieve significant weight loss for individuals identified as overweight or obese. The study objective is to provide an overview of the full range of methods and models for weight loss, including some available without medical supervision. The intended audience includes individuals and organizations with an expressed interest in disease management and the chronic care models. Our review identified promising lines of investigation for future research that span diverse medical disciplines applied to obesity. The quality of the studies included in our review was uneven, and compromises the current evidence for effectiveness and efficacy. Generally, our results showed that combination approaches-surgical or pharmacologic, combined with a behavioral intervention-were most likely to be effective.

Quality measurement in diabetes care.

This study aimed to evaluate diabetes quality measurement efforts, assess their strengths and areas for improvement, and identify gaps not adequately addressed by these measures. We conducted an environmental scan of diabetes quality measures, focusing on metrics included in the National Quality Measures Clearinghouse or promulgated by leading measurement organizations. Key informant interviews were also completed with thought leaders who develop, promote, and use quality measures. The environmental scan identified 146 distinct measures spanning 31 clinical processes or outcomes. This suggests a measurement system that is both redundant and inconsistent, with many different measures assessing the same clinical indicators. Interviewees believe that current diabetes measurement efforts are excessively broad and complex and expressed a need for better harmonization of these measures. Several gaps were also found, including a lack of measures focusing on population health, structural elements of health care, and prevention of diabetes.