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Cost to Medicare of acute kidney injury in percutaneous coronary intervention

Acute kidney injury (AKI), including contrast-induced AKI (CI-AKI), is an important complication of percutaneous coronary intervention (PCI), resulting in short- and long-term adverse clinical outcomes. While prior research has reported an increased cost burden to hospitals from CI-AKI, the incremental cost to payers remains unknown. Understanding this incremental cost may inform decisions and even policy in the future. The objective of this study was to estimate the short- and long-term cost to Medicare of AKI overall, and specifically CI-AKI, in PCI. Patients undergoing inpatient PCI between January 2017 and June 2020 were selected from Medicare 100% fee-for-service data. Baseline clinical characteristics, PCI lesion/procedural characteristics, and AKI/CI-AKI during the PCI admission, were identified from diagnosis and procedure codes. Poisson regression, generalized linear modelling, and longitudinal mixed effects modelling, in full and propensity-matched cohorts, were used to compare PCI admission length of stay (LOS) and cost (Medicare paid amount inflated to 2022 US$), as well as total costs during 1-year following PCI, between AKI and non-AKI patients. The study cohort included 509,039 patients, of whom 104,033 (20.4%) were diagnosed with AKI and 9,691 (1.9%) with CI-AKI. In the full cohort, AKI was associated with+4.12 (95% confidence interval=4.10, 4.15) days index PCI admission LOS, +$11,313 ($11,093, $11,534) index admission costs, and +$14,800 ($14,359, $15,241) total 1-year costs. CI-AKI was associated with+3.03 (2.97, 3.08) days LOS, +$6,566 ($6,148, $6,984) index admission costs, and +$13,381 ($12,118, $14,644) cumulative 1-year costs (all results are adjusted for baseline characteristics). Results from the propensity-matched analyses were similar. AKI, and specifically CI-AKI, during PCI is associated with significantly longer PCI admission LOS, PCI admission costs, and long-terms costs.

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Turó de la Peira/ Can Peguera. Nou Barris (Barcelona) Construcción de un espacio público para todos

El presente trabajo, encargado en el Máster en Diseño Urbano de la Universitat de Barcelona, presenta una línea base de investigación desarrollada en el periodo de crisis de la COVID19, mediante la herramienta Google Earth, que pretende dar una lectura rápida de dos de los trece barrios que conforman el distrito de Nou Barris de Barcelona: Can Peguera y Turó de la Peira.Ambos barrios han sido un punto de acogida de una parte importante de la inmigación de la ciudad de Barcelona. Por un lado, el barrio Can Peguera tiene su origen en el proyecto de reubicación en el año 1929 con el cual se pretendía reubicar a los obreros que vivían en chabolas en Montjuïc, en grupos de viviendas conocidas popularmente como casas baratas.Como resultado del desarrollismo franquista, el territorio de Turó de la Peira fue urbanizado en el año 1955 amparado por un Plan Parcial en el marco del Plan Comarcal de 1953; lo cual generó una especulación urbanística descontrolada y el uso de materiales de baja calidad lo cual se evidenció con el hundimiento, en la década de 1980, por aluminosis del primer edificio de viviendas en la Calle Cadí en el Turó de la Peira.Bajo este contexto se han establecido criterios de investigación en función de la evolución histórica territorial, las características socioeconómicas básicas, planeamientos urbanísticos aplicados, el análisis de los sistemas conectividad y el análisis de la morfología del mismo mediante el análisis del espacio público a ojo de águila utilizando Google Earth ya que no se podía transitar por el territorio.

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Developing the Agile Implementation Playbook for Integrating Evidence-Based Health Care Services Into Clinical Practice

ProblemDespite the more than $32 billion the National Institutes of Health has invested annually, evidence-based health care services are not reliably implemented, sustained, or distributed in health care delivery organizations, resulting in suboptimal care and patient harm. New organizational approaches and frameworks that reflect the complex nature of health care systems are needed to achieve this goal.ApproachTo guide the implementation of evidence-based health care services at their institution, the authors used a number of behavioral theories and frameworks to develop the Agile Implementation (AI) Playbook, which was finalized in 2015. The AI Playbook leverages these theories in an integrated approach to selecting an evidence-based health care service to meet a specific opportunity, rapidly implementing the service, evaluating its fidelity and impact, and sustaining and scaling up the service across health care delivery organizations. The AI Playbook includes an interconnected eight-step cycle: (1) identify opportunities; (2) identify evidence-based health care services; (3) develop evaluation and termination plans; (4) assemble a team to develop a minimally viable service; (5) perform implementation sprints; (6) monitor implementation performance; (7) monitor whole system performance; and (8) develop a minimally standardized operating procedure.OutcomesThe AI Playbook has helped to improve care and clinical outcomes for intensive care unit survivors and is being used to train clinicians and scientists in AI to be quality improvement advisors.Next StepsThe authors plan to continue disseminating the details of the AI Playbook and illustrating how health care delivery organizations can successfully leverage it.

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