Factors associated with costs of care in community-dwelling persons with dementia from a third party payer and societal perspective: a cross-sectional study.

BACKGROUND: Besides the importance of estimating the global economic impact of care for persons with dementia, there is an emerging need to identify the key factors associated with this cost. The aim of this study was to analyze associations between the cost of care in community-dwelling persons with dementia and caregiver characteristics from both the healthcare third party payer perspective and the societal perspective. METHODS: Several characteristics based on the cross-sectional data of 355 dyads of informal caregivers and persons with dementia living in Belgium were identified to include in a log-gamma generalized linear model and were used in a multiple linear regression model with bootstrapping to test robustness. RESULTS: The mean monthly cost of care for a community-dwelling person with dementia was estimated at € 2339 (95% CI € 2133 - € 2545) per person from a societal perspective and at € 968 (95% CI € 825 - € 1111) per person from a third party payer viewpoint. Informal care accounted for the majority of the monthly costs from the societal perspective. Community based healthcare resource use represented the largest cost from the third party perspective. According to the regression analyses, a higher level of functional dependency of the person with dementia and a higher educational level of the caregiver were associated with a higher monthly cost from both a third party payer perspective and a societal perspective. In addition, being retired and a higher quality of life in the caregivers were associated with a lower monthly cost of care from the societal perspective. CONCLUSIONS: Several characteristics of the caregiver and the person with dementia were associated with the monthly costs of care from a third party payer and a societal perspective. Despite the lack of clear causal relationships, the results of this study can assist policy makers in planning and financing future dementia care. TRIAL REGISTRATION: Clinicaltrials.gov NCT02630446, December 15, 2015.

Cost-effectiveness and budget impact analysis of a population-based screening program for colorectal cancer.

BACKGROUND: Colorectal cancer (CRC) is one of the leading causes of cancer mortality in Belgium. In Flanders (Belgium), a population-based screening program with a biennial immunochemical faecal occult blood test (iFOBT) in women and men aged 56-74 has been organised since 2013. This study assessed the cost-effectiveness and budget impact of the colorectal population-based screening program in Flanders (Belgium). METHODS: A health economic model was conducted, consisting of a decision tree simulating the screening process and a Markov model, with a time horizon of 20years, simulating natural progression. Predicted mortality and incidence, total costs, and quality-adjusted life-years (QALYs) with and without the screening program were calculated in order to determine the incremental cost-effectiveness ratio of CRC screening. Deterministic and probabilistic sensitivity analyses were conducted, taking into account uncertainty of the model parameters. RESULTS: Mortality and incidence were predicted to decrease over 20years. The colorectal screening program in Flanders is found to be cost-effective with an ICER of 1681/QALY (95% CI -1317 to 6601) in males and €4,484/QALY (95% CI -3254 to 18,163). The probability of being cost-effective given a threshold of €35,000/QALY was 100% and 97.3%, respectively. The budget impact analysis showed the extra cost for the health care payer to be limited. CONCLUSION: This health economic analysis has shown that despite the possible adverse effects of screening and the extra costs for the health care payer and the patient, the population-based screening program for CRC in Flanders is cost-effective and should therefore be maintained.

Nursing staff and their team: Impact on intention to leave.

AIM: The aim was to examine the relationship between the quality of team-member exchange experienced by nursing staff and their intention to leave. Job satisfaction and affective organizational commitment are considered as mediators. BACKGROUND: While the shortage of nurses is a management and policy priority, few studies have studied the relationships between nursing staff and their team, key organizational attitudes, and intentions to leave the organization. METHOD: A questionnaire was administered to 217 registered nurses and nurse assistants in Belgium. Data were collected in 2012. To analyse the data, descriptive statistics, correlation, regression and path analyses were conducted. FINDINGS: Team-member exchange has a positive impact on nursing staff satisfaction and affective commitment. Job satisfaction and affective organizational commitment fully mediated the impact of team-member exchange on nursing staff's intention to leave. CONCLUSION AND IMPLICATIONS FOR NURSING AND HEALTH POLICY: This study illustrates the potential benefits of the positive influence of team-member exchange on key organizational attitudes of nursing staff, and the negative influence on intention to leave through affective commitment and job satisfaction.

Hospital-acquired infections in Belgian acute-care hospitals: financial burden of disease and potential cost savings.

INTRODUCTION: Hospital Acquired Infections (HAIs) are considered to be one of the most serious patient safety issues in healthcare today. It has been shown that HAIs contribute significantly not only to morbidity and mortality, but also to excessive costs for the health care system and for hospitalized patients. Since possibilities of prevention and control exist, hospital quality can be improved while simultaneously the cost of care is reduced. The objectives of this study were to examine the prevalence and the excess costs associated with HAIs. METHODS: A retrospective observational study was performed to estimate costs associated with hospital-acquired infections in Belgian hospitals, both in procedural admissions and in medical admissions. Hospital, diagnosis-related group, age and gender were used as matching factors to compare stays associated with HAIs and stays without HAIs. Data were obtained from the Minimum Basic Data Set 2008 used by Belgian hospitals to register case-mix data for each admission to obtain reimbursement from the authorities. Data included information from 45 hospitals representing 16,141 beds and 2,467,698 patient stays. Using the 2008 national feedback programme of the Belgian government, cost data were collected (prolonged length of stay, additional pharmaceuticals and procedures) and subsequently linked to the data set. By means of a sensitivity analysis we estimated potential monetary savings when a reduction in the incidence of HAIs in hospitals having a higher rate of hospital-acquired infections in comparison to other hospitals would be realized. RESULTS: In our sample 5.9% of the hospital stays were associated with a hospital-acquired infection. In the procedural admission subset this was the case for 4.7% of the hospital stays. The additional mean cost of the hospital-acquired infection was Euro 2,576 for all stays (P < 0.001) and Euro 3,776 for procedural stays (P < 0.001). The total burden of disease in Belgium is estimated at Euro 533,076,110 for all admissions and Euro 235,667,880 for the subset of procedural admissions. The excess length of stay varied between hospitals from 2.52 up to 8.06 days (Md 4.58, SD 1.01), representing an associated cost of Euro 355,060,174 (66.61% of the total cost). The cost of additional medical procedures and additional pharmaceutical products was estimated at Euro 62,864,544 (11.97%) and Euro 115,151,939 (21.60%) respectively. Overall, our results showed that considerable variability between hospitals regarding the incidence of HAIs (3.77-9.78%) for all hospital stays is present, indicating a potential for improvement. We provide a full overview of the potential monetary savings when reductions in HAIs are realized by applying different thresholds. For instance, if all Belgian hospitals having a higher rate of hospital-acquired infections improve their rate to the level of the hospital corresponding to percentile 75 (= 7.5% HAL) savings would be Euro 17,799,326. CONCLUSION: HALs are associated with important additional healthcare costs. Although not all hospital-acquired infections can be prevented, an opportunity to increase cost-effectiveness of hospital care delivery presents itself. This study is the first to estimate the annual economic burden of HALs for Belgium at a national level, incorporating all associated hospital costs. Apart from the fact that the cost of prolonged length of stay is of major importance, we have also shown that the cost of additional procedures and pharmaceutical products cannot be neglected when estimating the financial burden of HAIs.

Costs associated with readmissions in Belgian acute-care hospitals.

INTRODUCTION: Internationally, hospital readmissions have a great appeal as an indicator of hospital quality. Since possibilities in prevention and control exist, reducing rates of hospital readmission has attracted attention of policymakers as a way to improve quality of care while simultaneously reducing costs. Therefore reducing the number of readmissions is considered to be a pillar of more cost-effective hospital care. The goal of this study was to estimate the cost of hospital readmissions at a national level, describe differences in readmission rates between hospitals and to calculate the potential monetary savings of reducing excess readmissions. METHODS: Stays data were obtained from the Minimum Basic Data Set 2008 in a sample of 45 hospitals representing 16,141 beds. Readmissions were identified as a second admission for the same patient with the same APR-DRG code within 1 month or 3 months after discharge. Hospital type, diagnosis-related group, age and gender were used as matching factors in comparing readmission rates. Specific types of readmissions that occur naturally in each other's proximity due to the repeating nature of the therapy were excluded from the analysis. The costs per readmission were then calculated by linking the stays data with the cost data per APR-DRG and per severity index using the 2008 national feedback. The results of our sample were then extrapolated to all Belgian hospitals in order to calculate the total cost of readmissions. By means of a sensitivity analysis we estimated potential monetary savings when a reduction in the incidence of readmissions in hospitals having a higher readmission rate in comparison to other hospitals would be realized. RESULTS: In our sample 1.5% readmissions within 1 month after discharge and 2.1% within 3 months after discharge were identified. The additional weighted mean cost of these readmissions was Euro 3,495.58 within 1 month and Euro 3,572.20 within 3 months. The total financial burden, as extrapolated to the Belgian setting, is estimated at Euro 280,091,471.The wide variability between hospitals in incidence of readmissions (1.17-6.40%) indicates a potential for improvement. For instance, if all Belgian hospitals having a higher readmission rate improve their rate to the level of the hospital corresponding to percentile 75 (= 2.4% readmissions) savings would amount to Euro 14,118,509. CONCLUSION: The observed incidence of readmissions is associated with important additional healthcare costs. Although not all readmissions can be prevented, there is clearly a potential to increase cost-effectiveness of hosp tal care delivery.

Determinants of nonurgent use of the emergency department for pediatric patients in 12 hospitals in Belgium.

INTRODUCTION: The nonurgent use of the emergency department (ED) for pediatric patients is an increasing problem facing healthcare systems worldwide. To evaluate the magnitude of the phenomenon and to identify associated factors, an observational prospective survey was performed including all patients (<15 years) attending the ED in 12 Belgian hospitals during 2 weeks in autumn 2010. Use of ED was considered appropriate if at least one of the following criteria was met: child referred by doctor or police, brought by ambulance, in need for short stay, technical examination or orthopedic treatment, in-patient admission, or death. Among the 3,117 children, attending ED, 39.9 % (1,244) of visits were considered inappropriate. Five factors were significantly associated with inappropriate use: age of child, distance to ED, having a registered family doctor, out-of-hours visit, and geographic region. The adjusted odds ratio and 95 % confidence intervals are respectively-1.7 (1.3-2.0), 1.7 (1.3-2.2), 1.5 (1.1-2.2), 1.5 (1.2-1.9), and 0.6 (0.5-0.8). CONCLUSIONS: Almost 40 % of all paediatric ED attendances did not require hospital expertise. The risk of an inappropriate use of ED by pediatrician patients is predominantly associated with organizational and cultural factors. Access, equity, quality of care, and medical human resources availability have to be taken into account to design financially sustainable model of care for those patients. Furthermore, future research is needed to explain reasons why parents visit ED rather than using of primary-care services.