A clinical audit and cost analysis of latent TB management at a tertiary referral centre in Ireland.

INTRODUCTION: It is estimated that 24.8% of the world's population has latent TB. The World Health Organization's (WHO) End TB Strategy states that the systematic identification and management of LTBI in groups of people at high risk of reactivation is an essential part of TB elimination in low-incidence countries. AIM: Our aims were to evaluate the effectiveness of LTBI management at our tertiary referral outpatient department (OPD) and to identify how our service could be improved. METHODS: We included all patients seen in the infectious diseases outpatient service who were referred querying a diagnosis of latent TB. Patients had to have attended the outpatient clinic at least once in the 6 months from 1 July 2018 to 31 December 2018. Patients who were referred for assessment of possible active TB were not included in. A retrospective review of each patient's electronic record was performed by two auditors. RESULTS: Twenty-five patients reviewed in our TB clinic were referred querying a diagnosis of LTBI. Twenty-two of 25 (88%) were diagnosed with LTBI; 21/25 (84%) were offered treatment. All patients offered treatment accepted treatment. Seventeen of 21 (81%) patients completed treatment. The mean cost per patient seen in the clinic was €1378.66. The mean cost per LTBI successfully treated was €2027.45. No patient had a raised ALT detected. There were no other adverse events. CONCLUSION: Our TB clinic is effective in the assessment and safe management of latent TB in accordance with national guidelines. Interventions for improvement are the creation of referral guidelines and a referral proforma and exploring alternative clinic models.

Reducing caesarean delivery: An economic evaluation of routine induction of labour at 39 weeks in low-risk nulliparous women.

BACKGROUND: Clinical interventions known to reduce the risk of caesarean delivery include routine induction of labour at 39 weeks, caseload midwifery and chart audit, but they have not been compared for cost-effectiveness. OBJECTIVE: To assesses the cost-effectiveness of three different interventions known to reduce caesarean delivery rates compared to standard care; and conduct a budget impact analysis. METHODS: A Markov microsimulation model was constructed to compare the costs and outcomes produced by the different interventions. Costs included all costs to the health system, and outcomes were quality-adjusted life years (QALY) gained. A budget impact analysis was undertaken using this model to quantify the costs (in Australian dollars) over three years for government health system funders. RESULTS: All interventions, plus standard care, produced similar health outcomes (mean of 1.84 QALYs gained over 105 weeks). Caseload midwifery was the lowest cost option at $15 587 (95% confidence interval [CI] 15 269, 15 905), followed by routine induction of labour ($16 257, 95% CI 15 989, 16 536), and chart audit ($16 325, 95% CI 15 979, 16 671). All produced lower costs on average than standard care ($16 905, 95% CI 16 551, 17 259). Caseload midwifery would produce the greatest savings of $172.6 million over three years if implemented for all low-risk nulliparous women in Australia. CONCLUSIONS: Caseload midwifery presents the best value for reducing caesarean delivery rates of the options considered. Routine induction of labour at 39 weeks and chart audit would also reduce costs compared to standard care.

Modelling the costs and consequences of reducing healthcare-associated infections by improving hand hygiene in an average hospital in England.

OBJECTIVE: To assess the potential clinical and economic impact of introducing an electronic audit and feedback system into current practice to improve hand hygiene compliance in a hypothetical general hospital in England, to reduce the incidence of healthcare-associated infections (HCAIs). METHODS: Decision analysis estimated the impact of introducing an electronic audit and feedback system into current practice to improve hand hygiene compliance among front-line healthcare practitioners (HCPs). RESULTS: The model assumed 4.7% of adult inpatients (ie, ≥18 years of age) and 1.72% of front-line HCPs acquire a HCAI in current practice. The model estimated that if use of the electronic audit and feedback system could lead to a reduction in the incidence of HCAIs of between 5% and 25%, then the annual number of HCAIs avoided could range between 184 and 921 infections per hospital and HCAI-related mortality could range between 6 and 31 deaths per annum per hospital. Additionally, up to 86 days of absence among front-line HCPs could be avoided and up to 7794 hospital bed days could be released for alternative use. Accordingly, the total annual hospital cost attributable to HCAIs could be reduced by between 3% and 23%, depending on the effectiveness of the electronic audit and feedback system. If introduction of the electronic audit and feedback system into current practice could lead to a reduction in the incidence of HCAIs by at least 15%, it would have a ≥0.75 probability of affording the National Health Service (NHS) a cost-effective intervention. CONCLUSION: If the introduction of the electronic audit and feedback system into current practice in a hypothetical general hospital in England can improve hand hygiene compliance among front-line HCPs leading to a reduction in the incidence of HCAIs by ≥15%, it would potentially afford the NHS a cost-effective intervention.

Processo de formação de contas em um hospital de ensino especializado em cardiologia e pneumonia / The billing process at a teaching hospital specialized in cardiology and pulmonology / Proceso de formación de cuentas en un hospital de enseñanza especializado en cardiología y neumología

Esta pesquisa exploratória objetivou descrever e mapear o processo de formação de contas em um hospital público universitário, de nível terciário, especializado em cardiologia e pneumologia. No período de maio a junho de 2012, procedeu-se à identificação e documentação das etapas do processo que foram validadas junto aos profissionais envolvidos na auditoria de contas hospitalares. Evidenciou-se que, no momento da pré-análise das contas, os auditores realizam correções para fundamentar a cobrança dos procedimentos e evitar glosas e perdas de faturamento. O mapeamento do processo permitiu a proposição de estratégias visando minimizar o tempo de apresentação de contas às fontes pagadoras. Ao conferir visibilidade à dinâmica deste processo, fundamental para o equilíbrio econômico-financeiro do hospital estudado, torna-se esse conhecimento de domínio público e acessível a outras organizações de saúde que queiram incrementar o seu faturamento e reduzir as divergências entre o prontuário clínico e a conta hospitalar do paciente.

The objective of this exploratory study was to describe and map out the billing process in a public tertiary-level university hospital specialized in cardiology and pulmonology. In the period between May and June of 2012, we identified and documented the steps in the process validated by the professionals involved in the hospital bill audit service. We found that during billing pre-analysis, auditors make corrections to justify the billing of procedures and to avoid unwarranted billing and loss of revenue. Mapping out the process allowed us to propose strategies to minimize the time for presenting bills to payment sources. By bringing visibility to this process, which is fundamental for the economic-financial balance of the studied hospital, we bring such knowledge to the public domain. Thus, it is accessible to other health organizations that wish to increment their revenue and reduce divergences be tween patient charts and the patient's hospital bill

Se objetivó describir y mapear el proceso de formación de cuentas en un hospital público universitario terciario especializado en cardiología y neumología. Entre mayo y junio de 2012 se procedió a identificar la documentación de las etapas del proceso, validadas con los profesionales involucrados en la auditoría de cuentas hospitalarias. Se evidenció que antes del análisis de cuentas, los auditores realizan correcciones para fundamentar la cobranza de los procedimientos y evitar divergencias y pérdidas de facturación. El mapeo del proceso permitió la propuesta de estrategias orientadas a disminuir el tiempo de presentación de cuentas a las fuentes de pago. Al otorgársele visibilidad a la dinámica del proceso, fundamental para el equilibrio económico-financiero del hospital estudiado, ese conocimiento se vuelve de dominio público y es accesible para otras organizaciones de salud que quieran incrementar su facturación y reducir las divergencias entre las historias clínicas y la cuenta hospitalaria del paciente.

The concept of marketing in the public-private partnership in the medical system in Romania.

During the transition period, the Romanian medical system, subject (like other areas) to a process of reform, had to go through a difficult path, not without obstacles (malpractice, underfunding, embezzlement scandals in the media etc.). Consequently, Romania has faced (and unfortunately still is still facing) the massive exodus of health professionals to countries where they can benefit from better working conditions and payment, and those who suffer from health care crisis are the patients. Reform means "the people in the system for the people", which requires a change of mindset within the medical staff, especially in the continuous professional development. However, to talk about the quality of the medical act requires that all those involved in the medical system should create appropriate conditions - i.e. advanced technical equipment and appropriate salaries. In addition, as underfunding is the main cause of failure in the health system, that management remains the only tool that can lead to the appropriate use of the existing resources and the quality of health services. Therefore, the idea of public-private partnership - which occurred as a challenge, especially after the EU accession - can be considered a solution designed to improve the quality and cost of health services. In other words, the cooperation of the private sector with the public authority means increasing the rigor of the medical equipment performance, fostering professional competition, and an increased attention to the patient, in a word: performance. Currently, more and more frequently, the management has studied to identify opportunities for innovation in health care services in an attempt to bring together patients and practitioners in the field by resorting to the identification of the ways they can receive health care services promptly, fairly and efficiently. Therefore, a clear and responsible design in the spirit of ethics and medical ethic will help the marketing manager solve many of the complex issues raised by the marketing activity in the field of health care.

Evaluating the impact of new anticoagulants in the hospital setting / Evaluando el impacto de los nuevos anticoagulantes en ambiente hospitalario

The short-comings of current anticoagulants have led to the development of newer, albeit more expensive, oral alternatives. Objective: To explore the potential impact the new anticoagulants dabigatran and rivaroxaban in the local hospital setting, in terms of utilisation and subsequent costing. Method: A preliminary costing analysis was performed based on a prospective 2-week clinical audit (29th June - 13th July 2009). Data regarding current anticoagulation management were extracted from the medical files of patients admitted to Ryde Hospital. To model potential costing implications of using the newer agents, the reported incidence of VTE/stroke and bleeding events were obtained from key clinical trials. Results: Data were collected for 67 patients treated with either warfarin (n=46) or enoxaparin (n=21) for prophylaxis of VTE/stroke. At least two-thirds of all patients were deemed suitable candidates for the use of newer oral anticoagulants (by current therapy: warfarin: 65.2% (AF), 34.8% (VTE); enoxaparin: 100%, (VTE)). The use of dabigatran in VTE/stroke prevention was found to be more costeffective than warfarin and enoxaparin due to significantly lower costs of therapeutic monitoring and reduced administration costs. Rivaroxaban was more cost-effective than warfarin and enoxaparin for VTE/stroke prevention when supplier-rebates (33%) were factored into costing. Conclusion: This study highlights the potential costeffectiveness of newer anticoagulants, dabigatran and rivaroxaban, compared to warfarin and enoxaparin. These agents may offer economic advantages, as well as clinical benefits, in the hospital-based management of anticoagulated patients (AU)

Los defectos de los actuales anticoagulantes han llevado al desarrollo de nuevas y, a la vez más caras, alternativas orales. Objetivo: Explorar el impacto potencial de los nuevos anticoagulantes dabigatran y rivaroxaban en el ambiente hospitalario local, en términos de utilización y subsiguiente coste. Método: Se realizó un análisis de costes preliminar basado en una auditoria clínica prospectiva de 2 semanas (29 junio - 13 julio de 2009). Se extrajeron los datos relativos al manejo actual de la anticoagulación de las historias clínicas de los pacientes ingresados en el Hospital Ryde. Para modelizar implicaciones potenciales del uso de los nuevos agentes en el coste, se obtuvieron de los ensayos clínicos clave los datos de incidencia comunicada de tromboembolismo venososo/infarto y hemorragias. Resultados: Se recogieron datos de 67 pacientes tratados o con warfarina (n=46) o enoxaparina (n=21) para la profilaxis de TEV/infarto. Al menos dos tercios de todos los pacientes fueron considerados candidatos para el uso de los nuevos anticoagulantes orales (por tratamiento actual: warfarina: 65.2% (fibrilación), 34.8% (TEV); enoxaparina: 100%, (TEV)). El uso de dabigatran para la prevención de TEV/infarto se vio más costeefectivo que la warfarina y la enoxaparina, debido a los significativamente menores costes de la monitorización y menores costes de administración. El rivaroxaban fue más coste-efectivo que la warfarina y la enoxiparina para prevención de TEV/infarto cuando se tuvieron en cuenta los descuentos del 33 del proveedor. Conclusión: Este estudio ensalza la posible costeefectividad de los nuevos anticoagulantes dabigatran y rivaroxaban, comparados con warfarina y enoxiparina. Estos agentes pueden ofrecer ventajas económicas, así como beneficios clínicos, en el manejo hospitalario de pacientes anticoagulados (AU)

Clinical audits and regulatory inspections--double efforts and expenses for radiation protection?

BACKGROUND: Clinical audit as a systematic examination of medical procedures improves the quality and outcome of patient care. The purpose of a regulatory inspection is to check and verify that the operation and facilities are in full conformance with all legal requirements. PURPOSE: To examine the content of the clinical audits and regulatory inspections of radiological procedures and whether these overlap, and to evaluate the costs to radiological units. MATERIAL AND METHODS: Clinical audits were carried out at each imaging unit of Helsinki University Hospital (HUS) Medical Imaging Center in Finland in 2004 and 2005. The regulatory inspections were carried out after the clinical audits from 2005 to late 2007. The contents of the clinical audit and inspection reports were analyzed statistically and by content analysis. The results of the audits and the inspections were compared to analyze the overlaps, differences, and costs. RESULTS: The validity and conditions of the safety license, lines of authority, and responsibilities for the use of radiation and patient doses caused by different examinations were evaluated in both audits and inspections. The coverage and frequency of quality control procedures were monitored in every audit and inspection, but inspectors, in addition, checked radiation output. The costs of clinical audit and inspection were under 20 cents per radiological procedure. The auditors gave 98 recommendations, while inspectors gave 62 recommendations and 25 requirements. In clinical audits most of the recommendations concerned guidelines for examining a patient. In the inspections most recommendations were in the category of quality assurance activities. CONCLUSION: The clinical audits and regulatory inspections were cheap and had few overlapping topics, but several differences were apparent: in clinical audits, a broader and deeper view of the clinical procedures was taken by comparison with good practices, while regulatory inspections have mainly verified conformance to basic regulatory requirements.