Daily Cost Research Articles

Data-driven insights into interhospital care fragmentation: Implications for health policy and equity among older adults.

To determine factors leading to interhospital care fragmentation (ICF); evaluate how ICF affects rehospitalization costs, length of stays (LOS), and delayed discharge; and analyze ICF disparity among equity-seeking groups. We used a 13-year retrospective cohort of older adults (65+) in Ontario, Canada. Utilizing multivariable logistic regression, we identified characteristics associated with ICF and determined its association with outcomes. Discharge to facilities except home and homecare and travel distance were the strongest risk factors for ICF. Patients were less likely to experience ICF if they were older, frail, or had multiple comorbidities. ICF was strongly associated with an increase in the daily costs of readmission. Moreover, the risks of a prolonged LOS after ICF and delayed discharge were higher among returning surgical patients. The rural residency was a source of health inequality. ICF exacerbates health disparities and worsens patient outcomes. Our study identified several risk factors associated with ICF, some of which are controllable, paving the way for interventions to mitigate this issue. To promote health equity and reduce adverse outcomes, policymakers should focus on policies for reducing care discontinuity, particularly addressing the controllable risk factors.

Low energy density, high nutrient adequacy and high nutrient density are each associated with higher diet costs in Chinese adults from Henan Province

ObjectivesFood price is a determining factor in food choice which affect diet quality accordingly. However, the association between food price and diet quality has not been thoroughly discussed among Chinese adults. This study aimed to analyze the association of daily energy-adjusted dietary costs (CNY/2000 kcal) and diet quality among Chinese adults.MethodsA total of 680 Chinese adults aged above 25 years from Henan province were investigated in 2020. Three indices were adopted for evaluating diet quality: the nutrient-rich foods 9.2 (NRF 9.2) index for evaluating nutrient density, the mean adequacy ratio (MAR) for evaluating nutrient adequacy, energy density (ED) based on solid foods only for evaluating energy density. The daily energy-adjusted diet cost was calculated by dividing the estimated daily diet costs (CNY/day) by the energy intake per day (kcal/day) and multiplying the result by 2000.ResultsSubjects who closely adhered to the NRF9.2, MAR, and ED paid ¥8.92, ¥13.17, and ¥14.34 more for daily food consumption, respectively, than those who weakly adhered to these dietary patterns did. Furthermore, multiple linear regression analysis adjusted covariance revealed that an increase in ¥1 of the energy-adjusted diet cost per day was associated with changes of 0.494 units (P < 0.001), 0.003 units (P < 0.001), and − 0.018 units (P < 0.001) in the NRF9.2, MAR, and ED, respectively.ConclusionHigher energy-adjusted diet cost was associated with higher quality diets. This might be important for public health policies to develop strategies to promote healthy diets by regulating food supply and its costs.

P-1563. Assessing the Global Economic Burden of Complicated Urinary Tract Infections

Abstract Background Complicated urinary tract infections (cUTIs) arise in patients with structural or functional abnormalities of the genitourinary tract or in those with nonurogenital comorbidities. cUTIs are common in older or catheterized persons and can be associated with high healthcare resource utilization (HCRU). We conducted a systematic literature review to understand the economic burden of cUTI. Methods A systematic literature review was conducted using PubMed, Embase, Cochrane, and EconLit databases to identify observational studies evaluating the burden of cUTI, including acute pyelonephritis and catheter-associated UTI (CAUTI), within the last decade from China, Europe, France, Italy, Germany, Japan, Spain, United Kingdom (UK), and United States (US) (PROSPERO-CRD42023454794). Results Of 1,041 studies identified, 154 from databases were selected for full-text review; a total of 53 met the economic inclusion criteria, reporting direct costs (18 US, 2 China, 2 Spain, 1 Italy) and/or healthcare utilization (28 US, 13 Spain, 4 China, 4 Italy, 3 multicountry/European region, 2 France, 1 UK). No studies of direct cUTI costs were identified for France, Germany, Japan, the UK, or Europe. Mean hospitalization costs per cUTI varied by country, from $2,328 in China to $23,400 for hospital-acquired CAUTI in US children. The highest costs were observed in patients with multi-drug-resistant infections. US national all-cause median 30-day total healthcare costs of cUTIs were estimated at &amp;gt; $6 billion (Table 1). No studies reporting the indirect cost of cUTI were identified, and costs associated with readmissions were reported in only 1 study. Length of stay (LOS) was the most common HCRU outcome reported, and median LOS was similar among studies (7 days). Patients with CAUTI had longer LOS than controls. ICU admissions in patients with extended-spectrum β-lactamase (ESBL)–positive cUTI ranged between 3% and 27.4%. Conclusion Available data indicate that the economic burden associated with cUTI is substantial. However, except for the US, direct costs were missing or reported in only 1 or 2 studies for the countries examined. Similarly, HCRU outcomes were missing or reported in only a few studies, except for the US and Spain. Disclosures Edward I. Broughton, PhD, Pfizer: Ownership Interest Kristi Kuper, PharmD, BCPS, FIDSA, Pfizer: Employee|Pfizer: Stocks/Bonds (Public Company) Maria Fernandez, PhD, MBA, Pfizer: Stocks/Bonds (Public Company) Amer Al-Taie, MSc, Pfizer: Stocks/Bonds (Public Company) Ramy El Mahdy Kotb, MD, Pfizer: Stocks/Bonds (Public Company)

Rehabilitation success and related costs following stroke in a regional hospital: a retrospective analysis based on the Australian National Subacute and Non-Acute Patient (AN-SNAP) classification

BackgroundEvidence is limited on the factors influencing successful stroke rehabilitation in regional contexts. Additionally, the relationship between rehabilitation costs following acute stroke, based on Australian National Subacute and Non-Acute Patient (AN-SNAP) casemix classification, and rehabilitation success remains unclear.ObjectiveThis retrospective cohort study investigated the factors contributing to improved functional outcomes following stroke rehabilitation in an Australian regional hospital, also evaluating the respective average daily and total payments.MethodsStroke patients’ admission records, during 2010–2020, were linked with rehabilitation registry data. Rehabilitation success was defined as relative functional gain (RFG) ≥ 0.5 and Functional Independence Measure (FIM) efficiency ≥ 1. Multivariate mixed effects logistical regressions modelled the sociodemographic and medical (i.e., comorbidities and stroke type) predictors of rehabilitation success, while logarithms of average daily and total rehabilitation payments were modelled using robust regressions.ResultsOf 582 included patients, 315 (54.1%) achieved RFG ≥ 0.5 and 258 (52.2%) achieved FIM efficiency ≥ 1. A longer delay in starting rehabilitation was associated with a lower likelihood of achieving RFG success [Odds Ratio (OR): 0.85, 95% confidence interval (CI): 0.78–0.93, P < 0.001] and FIM efficiency success (OR: 0.89, 95% CI: 0.82–0.97, P = 0.010). A higher FIM score at admission was associated with decreased odds of FIM efficiency success (OR: 0.35, 95% CI: 0.20–0.60, P < 0.001). The average daily and total rehabilitation payments for inpatients were $AU1,255 (median) [interquartile range (IQR): 1,040, 1,771] and $AU28,363 (median) (IQR: 18,822, 41,815), respectively. FIM efficiency success was positively associated with the average daily payment (Beta: 0.25, 95% CI: 0.20–0.30, P < 0.001), but negatively correlated with the total payment (Beta: -0.18, 95% CI: -0.24–0.13, P < 0.001). No significant associations were found between RFG success and these payments.ConclusionThis study identifies key factors affecting stroke rehabilitation outcomes in a regional Australian setting. Delays in starting rehabilitation were linked to lower success rates, underscoring the importance of timely intervention. While higher average daily costs were associated with better FIM efficiency, total costs did not correlate with relative functional gains. These findings may inform rehabilitation practices and may influence future funding strategies for rehabilitation services.

Effects of Different Molasses Levels and Slow-Release Urea Combinations on Growth Performance, Serum Biochemistry, Rumen Fermentation, and Microflora of Holstein Fattening Bulls

The aim of this study was to investigate the effects of different combinations of molasses levels and slow-release urea on Holstein fattening bulls. Sixty Holstein fattening bulls of a similar age, weight, and health status were randomly divided into four groups of fifteen Holstein fattening bulls each. All of the treatments were as follows: (1) basic diet group (CON); (2) 2% molasses slow-release urea group (LMU); (3) 4% molasses slow-release urea group (MMU); and (4) 6% molasses slow-release urea group (HMU). The results of the study showed that the MMU had an outstanding performance, with a 13.3% increase in average daily weight gain compared with the control group, a significant decrease in feed conversion ratio (p &lt; 0.05), and a significant increase in apparent digestibility of crude protein (p &lt; 0.05). In terms of serum biochemical indices, blood ammonia and alanine aminotransferase (ALT) concentrations were significantly higher in the MMU than in the CON (p &lt; 0.05). The rumen pH of all treatment groups was lower than that of the CON (p &lt; 0.05), whereas the concentrations of microbial crude protein (MCP), as well as acetic acid, propionic acid, and total volatile fatty acids (TVFA) were significantly higher in both the MMU and HMU (p &lt; 0.05). The dominant phyla in each group were Bacteroidetes, Firmicutes, and Patescibacteria, and the relative abundance of Bacteroidetes in the MMU increased by 5.47% compared with that in the CON. In the MMU, Prevotellaceae, Lachnospiraceae, and Ruminococcaceae increased by 9.03%, 0.67%, and 3.43%, respectively, compared with the CON. The economic benefit analysis showed that the daily feeding cost of fattened cattle in the MMU was reduced by RMB 1.62 yuan, and the daily farming benefit of each cow was increased by RMB 7.19 yuan. In conclusion, the MMU was effective in improving the growth performance of fattening cows, optimizing rumen fermentation, reducing cost, and increasing profit, which is a nutritional strategy with great application value.

Machine-learning-based cost prediction models for inpatients with mental disorders in China

BackgroundMental disorders are increasingly prevalent, leading to increased medical expenditures. To refine the reimbursement of medical costs for inpatients with mental disorders by health insurance, an accurate prediction model is essential. Per-diem payment is a common internationally implemented payment method for medical insurance of inpatients with mental disorders, necessitating the exploration of advanced machine learning methods for predicting the average daily hospitalization costs (ADHC) based on the characteristics of inpatients with mental disorders.MethodsWe used data including demographic information, clinical/functional characteristics, institutional features, and cost information of 5070 hospitalized patients with mental disorders in Jinhua, China, and employed six algorithms to predict ADHC. Performance of these six algorithms was evaluated through 5- old cross-validation combined with bootstrap method to select the most suitable algorithm and identify key factors influencing ADHC.ResultsThe random forest (RF) model demonstrated better performance (R-squared (R2) = 0.6417 (95% CI, 0.6236–0.6611), root-mean-square error (RMSE) = 0.2398 (95% CI, 0.2252–0.2553), mean-absolute error (MAE) = 0.1677 (95% CI, 0.1626–0.1735), mean-absolute-percentage error (MAPE) = 0.0295 (95% CI, 0.0287–0.0304)). According to feature importance ranking, models incorporating top 11 factors (> 0.01) demonstrated comparable performance to those encompassing all variables. Top four factors (> 0.05) were level of medical institution, age, functional classification, and cognitive classification. Notably, level of medical institutions was the most significant factor across all primary models. Higher medical institutions level, patients below 20 and above 75 years old, lower functional classification, and lower cognitive classification are associated with increased ADHC.ConclusionsMachine learning algorithms, particularly RF algorithm, enhance accuracy of predicting ADHC for mental health patients. The findings of this study provide evidence for setting up more reasonable insurance payment standards for inpatients with mental disorders and support resource allocation in clinical practice.

Percutaneous Ablation vs Radiotherapy for Pain Related to Bone and Soft Tissue Malignancies: A Multi-Payor Database Analysis of Outcomes.

The purpose of this study was to compare key hospitalization outcomes and cost between percutaneous ablation and external beam radiation therapy (EBRT) among patients admitted with acute cancer-related pain. The Merative MarketScan Research Database was queried for all cancer-related hospitalizations from 2009 to 2022 for patients who underwent percutaneous palliative ablation or EBRT for painful bone or soft tissue tumors. Hospital length of stay (LOS), 30-day readmission rate, in-hospital mortality, and total hospitalization costs from the payor perspective were compared using multivariable generalized linear models controlling for patient demographics, comorbid conditions, geographic location, and calendar year. Sensitivity analyses were conducted using different model specifications and coarsened exact matching. Amongst 19,793 hospitalizations, patients underwent ablation in 185 (0.9%) cases, and EBRT in 19,608 (99.1%). Compared to EBRT, ablation was associated with shorter LOS (-2.0 days; 95% confidence interval [CI]: -3.9 to -0.03; p = .046), lower risk of in-hospital mortality (-3.4 percentage points [p.p.]; 95% CI: -5.6 to -1.3; p = .002), lower risk of 30-day readmission (-7.4 p.p.; 95% CI: -13.7 to -1.2; p = .019), and no statistically significant difference in total hospitalization costs ($8,379; 95% CI: -1,947 to 18,706; p = .11). Less than 1% of patients hospitalized with acute cancer-related pain and treated with tumor-directed therapy (either via radiation oncology or IR) undergo percutaneous tumor ablation. In this study, percutaneous ablation was associated with shorter LOS, lower risk of in-hospital mortality, and lower risk of 30-day readmission.

A two‐level optimal scheduling control strategy for air source heat pump loads with phase change energy storage

AbstractReasonable scheduling and control of air‐source heat pumps (ASHPs) contribute to reducing operational costs for users while encouraging their participation in grid demand response. This article proposes a two‐layer optimal scheduling and control strategy for ASHP loads incorporating phase change energy storage (PCES). First, an electricity‐heat coupling model for ASHP loads is proposed. This model integrates PCES technology and considers the influence of outlet water temperature, ambient temperature, and the cold island effect on the coefficient of performance. Subsequently, a PCES capacity configuration model is established with the objective of maximizing the overall benefits of the PCES device. Finally, a two‐layer optimal scheduling and control strategy for ASHPs is introduced: The upper‐layer model employs model predictive control to minimize heating costs based on user comfort, leveraging PCES and building thermal storage characteristics, in conjunction with time‐of‐use electricity pricing. The lower‐layer model schedules periodic start–stop cycles of the ASHP units to respond to the upper‐layer power demand and mitigates the impact of the cold island effect on ASHP performance through unit interval sequencing. The simulation results show that the proposed strategy reduces the daily operation cost and power consumption by 38.9% and 25.0%, respectively, significantly improving the building's regulation capability.

Optimal design of thermal storage in hybrid energy systems: application to a laboratory-scale case study with experimental validation

Abstract The benefits of thermal storage in hybrid energy systems (HESs) are multiple, being among others the enhancement of flexibility of the network and of the efficiency in the energy resources use, by also reducing the overall cost of the energy system. Choosing the capacity of TSS to minimize the operational cost of the HES is not a trivial task, depending on several variables existing at both supply and demand sides. The contribution of this paper is to present the experimental validation of an innovative optimization model aiming to identify the optimal capacity of TSS in HESs that maximizes the economic performances. The optimization model is based on a mixed-integer linear programming approach and allows determining the optimal hourly operating strategies of the system components as well as the optimal capacity of the TSS, while minimizing the total daily energy costs. The optimized hourly operation schedule of the HES was simulated experimentally by using one of the systems from the TSS laboratory of ENEA Portici Research Center. The experimental results demonstrated the practical applicability of the proposed optimization model. In fact, a good overlap was found between the results obtained from the implementation of the optimization model with those obtained from the experimental simulation, both considering energy and economic data.

The Relationship between Diet Costs and Dietary Adequacy: A Scoping Review of Measures and Methods with a Focus on Cost Estimation using Food Supply Data.

"Diet cost" refers to a methodological approach developed by Drewnowski etal. to estimate individual daily diet costs, where cost vectors are derived by matching prices from food supply data to the food sources of reported intakes from dietary assessment tools. The dietary assessment method and food price collection approach have been found to vary diet cost estimates. There is a need to better understand how food supply prices might be better standardized and attached to price individuals' diets. To conduct a scoping review to examine Drewnowski's diet cost method, with a focus on a detailed description and charting of cost estimation measures and methods used to price individuals' consumed diets. Five databases were searched from the inception of each database to March 2023. Included articles comprised analyses of individual-level dietary assessment data matched to food prices to assign estimates of individual daily diet costs. A total of 55 articles were included, published between 1999 and 2022 from 17 countries. In all studies, cost estimates were intended to be representative of price exposures among individual respondents' dietary assessment data. All studies derived cost estimates from separately collected food prices. A total of 34 (62%) of included articles collected food prices from retail (supermarket) audits. A minority of studies (19, 35%) reported the number of food prices used to cost diets, and those varied widely, ranging from 57 to nearly 4600 distinct foods priced per study. In the absence of a standardized approach to study the relationship between diet costs and dietary adequacy, this scoping review has described methodological concepts and parameters used to price individuals' consumed diets. Our review shows that despite common arithmetic to calculate cost vectors, there is substantial variation in the methods used to select and attach prices from the food supply to self-reported dietary intake assessments.

Enhancing Power Quality in Smart Grid‐Connected Renewable Energy Systems Using A Hybrid Deep Learning‐Based DSTATCOM: Self‐Improved Jellyfish Optimizer (Si‐Jo)

ABSTRACTThis manuscript introduces a robust stochastic optimization technique for real‐time energy management in household solar (PV) storage systems, which addresses the constraints provided by the stochastic nature of solar power and load demand. Traditional offline solutions for day‐ahead Battery Energy Storage (BES) scheduling frequently result in real‐time energy losses, while online alternatives do not adequately reduce electricity prices. The proposed system combines an offline optimization model with a real‐time rule‐based controller and a deep learning‐based Conditional Self‐Attention Generative Adversarial Network (CSAGAN) for load and solar generation predictions to address these constraints. The War Strategy Optimization (WSO) Algorithm, which operates inside a receding horizon framework, optimizes BES dispatch set‐points to lower daily electricity costs. The research also introduces a DSTATCOM‐based hybrid technique for improving power quality (PQ) in grid‐connected solar and wind systems, which makes use of a hybrid deep learning model consisting of Deep Belief Networks (DBNs) and Multilayer Perceptrons (MLPs). The Self‐Increased Jellyfish Optimizer (SI‐JO) generates control signals and optimizes the six‐leg voltage source converter (VSC) and the buck‐boost converter. MATLAB simulations show considerable increases in energy efficiency, harmonic distortion reduction, and system stability under various irradiance and grid fault scenarios, demonstrating the efficacy of the proposed techniques.

Optimization Operation Strategy for Comprehensive Energy System Considering Multi-Mode Hydrogen Transportation

The transformation from a fossil fuel economy to a low-carbon economy has reshaped the way energy is transmitted. As most renewable energy is obtained in the form of electricity, using green electricity to produce hydrogen is considered a promising energy carrier. However, most studies have not considered the transportation mode of hydrogen. In order to encourage the utilization of renewable energy and hydrogen, this paper proposes a comprehensive energy system optimization operation strategy considering multi-mode hydrogen transport. Firstly, to address the shortcomings in the optimization operation of existing systems regarding hydrogen transport, modeling is conducted for multi-mode hydrogen transportation through hydrogen tube trailers and pipelines. This model reflects the impact of multi-mode hydrogen delivery channels on hydrogen utilization, which helps promote the consumption of new energy in electrolysis cells to meet application demands. Based on this, the constraints of electrolyzers, combined heat and power units, hydrogen fuel cells, and energy storage systems in integrated energy systems (IESs) are further considered. With the objective of minimizing the daily operational cost of the comprehensive energy system, an optimization model for the operation considering multi-mode hydrogen transport is constructed. Lastly, based on simulation examples, the impact of multi-mode hydrogen transportation on the operational cost of the system is analyzed in detail. The results indicate that the proposed optimization strategy can reduce the operational cost of the comprehensive energy system. Hydrogen tube trailers and pipelines will have a significant impact on operational costs. Properly allocating the quantity of hydrogen tube trailers and pipelines is beneficial for reducing the operational costs of the system. Reasonable arrangement of hydrogen transportation channels is conducive to further promoting the green and economic operation of the system.

AIHEMAF-P: An Innovative Healthcare Model for Atrial Fibrillation Patients.

Atrial fibrillation (AF) is one of the most common cardiac arrhythmias of clinical relevance and a major cause of cardiovascular morbidity and mortality. Following a diagnosis of AF, patients are directed towards therapy with anticoagulant drugs to reduce the thromboembolic risk and antiarrhythmics to control their cardiac rhythm, with periodic follow-up checks. Despite the great ease of handling these drugs, we soon realized the need for follow-up models that would allow the appropriateness and safety of these pharmacological treatments to be monitored over time. This pilot study was conducted at a rural pharmacy. The study comprised 47 patients (average age 71.22 years) with nonvalvular atrial fibrillation (68% being paroxysmal) on NOACs. Twenty percent of the enrolled subjects lived alone and fifty-four percent of the participants stated that they were not independent in managing their treatment. The primary aim was to describe the implementation and the outcomes of an innovative smart clinic model in which a local trained pharmacist is a case manager, and the patient carries out the required checks via telemedicine and point-of-care testing systems (POCT) under the service pharmacy regime; the results of the checks could be shared in real time with the attending general practitioner and the relevant specialist. The secondary aims of this study were to evaluate adherence to the planned controls, the prescriptive appropriateness of the dosages and drugs and adherence to the prescribed therapy, the occurrence of pharmacological problems linked to drug type interactions, the occurrence of hemorrhagic and/or thromboembolic complications, the acceptance by the general practitioners and/or the specialists of the reports made by the pharmacist on the subsequent actions undertaken, the economic and social impact of this model on the National Health Service and on the patient, and the impact on the quality perceived by the patients involved in this innovative monitoring process. Compliance with the planned checks was 93%. The dosage of the anticoagulant drug during enrollment was found to be inappropriate, without apparent clinical reasons, in 11% of the sample. Adherence to the anticoagulant therapy was found to be 98%. In total, 214 drug-drug interactions of varying clinical relevance were detected. No embolic events were detected; however, 13% of the sample reported a major hemorrhagic event, which came to light thanks to the close monitoring of hemoglobinemia. A total of 109 reports were made to the patients' referring doctors in relation to the summarized anomalies, and 84% were accepted by the referring clinicians. Therefore, community pharmacists and pharmacy services represent ideal actors and contexts that, when integrated into the care network, can really favor individual care plan adherence and achieve daily morbidity reductions and cost savings through proper disease control and the early diagnosis of complications.

Postoperative delirium following total joint arthroplasty: epidemiology, risk factors, and associated complications.

Postoperative delirium (POD) is a feared complication following major surgery in elderly patients. Further investigation of the risk factors and consequences of POD following total joint arthroplasty is warranted. Patients who underwent total knee arthroplasty (TKA) or total hip arthroplasty (THA) were identified using PearlDiver. Patients were filtered into 2 cohorts based on the presence or absence of POD within 7 days of surgery. Epidemiological analyses were performed to examine trends in POD following TKA and THA by age group and year. Comparative analyses were performed on patient demographics and baseline cognitive status. After matching by age, sex, and comorbidities, electrolyte disturbances and 90-day postoperative complications were analysed. Among 2,518,918 (99.7%) no POD and 7240 (0.3%) POD patients who underwent total knee or hip arthroplasty, mean age was 65.58 years, 60.2% were female, and mean CCI was 1.50 for the whole cohort. POD patients frequently had baseline cognitive impairment (P < 0.001). Incidence of POD decreased from 0.54% in 2010 to 0.10% in 2022 (P < 0.001) and increased with age (P < 0.001). POD patients had higher 90-day costs (TKA = $19,572 vs. $10,397, P < 0.001; THA = $18,496 vs. $9,877 P < 0.001). After matching, POD TKA patients had higher rates of hypernatraemia (6.1% vs 4.5%, P = 0.001) and POD THA patients had higher rates of hyponatraemia (26.5% vs 23.1%, P = 0.008). POD patients had higher rates of 90-day postoperative medical and surgical complications (P < 0.05) than no POD patients. Nearly 0.3% of patients who underwent either TKA or THA between 2010 and 2022 developed transient delirium. POD was most common in elderly patients with baseline cognitive impairment undergoing revision surgery. POD patients had higher rates of 90-day postoperative surgical and joint-related complications. While POD rates have decreased, continued initiative to prevent POD in total joint arthroplasty patients is imperative.

Factors related to cost-effective use of palliative care services in Türkiye

Introduction: The aim of this study was to determine the components affecting the cost in palliative care (PC) and to determine how much they affect this cost separately and to evaluate the relationship between PC components and PC cost in order to determine the cost table of both the patient and the hospital in a more planned way and for a more cost-effective management. Methods: This was a retrospective cohort study. Data on patients, demographic characteristics, chronic disease profiles, duration of antibiotic use, antibiotic costs, length of stay, presence and number of hospital infections, feeding methods, opioid use, mortality rate, presence of decubitus ulcer, central venous catheter and tracheostomy were evaluated to determine their effects on cost. Results: No significant relationship was found between cost of palliative care and mortality, age, gender, opioid use and chronic diseases. The cost of palliative care for the cancer group was statistically lower, with an average daily cost of $177. Length of stay, decubitus ulcers, duration of antibiotic use, number of nosocomial infections, presence of central venous catheter and tracheostomy, and nutritional status showed a positive correlation with cost of palliative care. Conclusions: It was observed that some components of PC were associated with high costs, but mortality was independent of costs. While calculating the cost-effectiveness in PC, mortality should also be taken into consideration along with other components, and PC efficiency should not be ignored while targeting cost-effectiveness.

Effects of Inpatient Hospice Care on Cost and Medication Use in Patients with Lung Cancer: A Population-Based Retrospective Study in South Korea.

Background: Inpatient hospices (IHs) can alleviate distress and address economic burdens on patients with terminal cancer. However, there have been inconsistent findings regarding IHs in terms of cost savings and medication use. Objective: We aimed to examine cost savings associated with IHs, according to the timing of first hospitalization before death, and analyze their use of medication, among Korean patients with terminal lung cancer. Methods: Using the South Korean national health insurance claim database, we identified 31,139 patients with lung cancer who died between 2017 and 2020. Their daily hospitalization costs were analyzed using a generalized linear model stratified by time of first hospitalization before death. Medication use was examined using a negative binomial model. Results: IHs spent $134, and $21 less on patients during days 1-7, and 8-30 before death, but $18, $44, $36, and $54 more during days 31-60, 61-90, and 91-180, respectively, compared with non-IHs (all p < 0.05). However, total hospitalization costs in the year preceding death did not differ (relative risk: 0.990, 95% confidence interval [CI]: 0.972-1.007, p > 0.05). IHs used 2.103 times more opioid analgesics (95% CI: 1.980-2.233, p < 0.001). They also used more antiemetics, delirium medications, and antianxiety agents, as well as fewer antidepressive agents, systemic steroids, diuretics, total parenteral nutrition, and antibiotics (all p < 0.05). Conclusions: Patients with terminal lung cancer in IHs in Korea were more likely to receive symptom-oriented medications and experienced reduced hospitalization costs only during the 30 days preceding death.

Outliers of total shoulder arthroplasty in the bundled payment era.

The Centers for Medicare & Medicaid Services implemented the Bundled Payments for Care Improvement Advanced (BPCIA) Model that covers 90-day care episodes after select orthopedic procedures including anatomic or reverse ball-and-socket total shoulder arthroplasty (TSA/rTSA). This study investigated whether patients undergoing TSA/rTSA for nondegenerative processes incur higher costs than patients undergoing arthroplasty for degenerative processes. A retrospective review was conducted of all patients at a single academic medical center enrolled in the BPCIA model for TSA/rTSA from October 1, 2018, through December 31, 2022. We investigated whether patients undergoing arthroplasty for nondegenerative indications accrued more 90-day postoperative costs compared to patients undergoing arthroplasty for degenerative processes. A Break-even ratio was calculated to determine the number of degenerative TSA/rTSA that would need to be performed to account for the increased expenditures associated with nondegenerative TSA/rTSA. One hundred patients met inclusion criteria during the study period. Costs for TSA/rTSA due to nondegenerative indications exceeded bundle payment amounts at a significantly higher rate compared to degenerative indications (43% vs. 18%, P=.021). TSA/rTSA for nondegenerative indications was also associated with significantly higher total costs ($27,100 vs. $22,200, P=.014), significantly more postoperative emergency department visits (43% vs. 18%, P=.035), and longer hospital length of stay (2.2 vs. 1.6days, P=.121). Break-even ratio analysis demonstrated 1.22-1.54 TSA/rTSA for degenerative indications need to be performed to equal the total spending of one TSA/rTSA for nondegenerative indications. Patients undergoing shoulder arthroplasty for nondegenerative indications within the Centers for Medicare & Medicaid Services BPCIA bundled payments program were at greater risk for incurring higher costs than allocated target payments, as well as significantly higher costs when compared to patients undergoing arthroplasty for degenerative processes. We may need to consider the roles bundled-payment programs have for these patients.

A novel two-stage energy sharing method for data center cluster considering ‘Carbon-Green Certificate’ coupling mechanism

The energy consumption of data centers is on a sharp upward trend, and how to achieve joint optimal scheduling and energy management of multiple data centers is the key to the economic and low-carbon operation of data center prosumers (DCPs). This study introduces shared electric-hydrogen energy storage (SEHES) for DCPs, constructs a data center cluster (DCC) framework, and proposes a two-stage energy sharing model for DCC considering the ‘Carbon-Green Certificate’ coupling mechanism (C-GCCM). First, the DCC framework containing DCC operator (DCCO) and DCPs is established, and the C-GCCM based on conversion coefficients is designed to improve the energy saving and emission reduction level of DCC. In the day-ahead optimization stage, a stochastic multi-objective scheduling model for SEHES considering economy and environmental protection is developed. In the real-time optimization stage, considering the C-GCCM and the difference in on-grid prices, the Stackelberg game model of DCC is constructed according to the internal energy price set by DCCO and the trading strategies of DCPs. Finally, the proposed model is solved using the normal boundary intersection algorithm, the particle swarm algorithm and CPLEX. Simulation results demonstrate that the proposed DCC framework can reduce the daily operating cost of DCPs by 67.05%. The introduction of C-GCCM has resulted in a shift from negative to positive benefits on carbon emission trading for DCC and a 42.33% increase in benefits on green certificate trading.

Cost awareness among intensivists in their daily clinical practice: a prospective multicentre study.

Better cost-awareness is a prerogative in achieving the best benefit/risk/cost ratio in the care. We aimed to assess the cost-awareness of intensivists in their daily clinical practice and to identify factors associated with accurate estimate of cost (50-150% of the real cost). We performed a prospective observational study in seven French ICUs. We compared the estimate of intensivists of the daily costs of caring with the real costs on a given day. The estimates covered five categories (drugs, laboratory tests, imaging modalities, medical devices, and waste) whose sum represented the overall cost. Of the 234 estimates made by 65 intensivists, 70 (29.9%) were accurate. The median overall cost estimate (€330 [170; 620]) was significantly higher than the real cost (€178 [124; 239], p < 0.001). This overestimation was found in four categories, in particular for waste (€40 [15; 100] vs. €1.1 [0.6; 2.3], p < 0.001). Only the laboratory tests were underestimated (€65 [30; 120] vs. €106 [79; 138], p < 0.001). Being aware of the financial impact of prescriptions was factor associated with accurate estimate (OR: 5.05, 95%CI:1.47-17.4, p = 0.01). However, feeling able to accurately perform estimation was factor negatively associated with accurate estimate (OR: 0.11, 95%CI: 0.02-0.71, p = 0.02). French intensivists have a poor awareness of costs in their daily clinical practice. Raising awareness of the financial impact of prescriptions, and of the cost of laboratory tests and waste are the main areas for improvement that could help achieve the objective of the best care at the best cost.

Association of transplant recipient status with clinical and financial outcomes among patients undergoing major surgery

BackgroundTransplant recipients undergoing surgery may represent a vulnerable population because of transplant-related comorbidities as well as reliance on immunosuppressive medications. We sought to characterize the association of prior transplant status on postoperative outcomes among patients undergoing major non–transplant-related surgical procedures. MethodsData on patients who underwent a major surgical procedure (pneumonectomy, coronary artery bypass graft, abdominal aortic aneurysm repair, Whipple, colectomy) between 2016 and 2020 were obtained from the Nationwide Readmission Database. After balancing the 2 cohorts using entropy balancing, multivariable regression models were used to assess the relationship between post-transplant status and patient outcomes. ResultsAmong 1,818,973 patients, 0.45% (n = 8,212) had a history of solid organ transplantation (liver: n = 1,773, 21.6%; heart/lung: n = 1,087, 13.2%; kidney/pancreas: n = 4,891, 59.6%; and multiple: n = 461, 5.6%). In the unmatched cohort, patients who had a history of organ transplant were more likely to be male (64.1% vs 57.7%) and have Medicare insurance (71.7% vs 59.3%) (both P < .001). On multivariable analysis, prior transplant recipient status was associated with higher odds of postoperative complications (odds ratio 1.30, 95% confidence interval 1.22–1.38), 30-day readmission (odds ratio 1.42, 95% confidence interval 1.31–1.54), and in-hospital mortality (odds ratio 1.20, 95% confidence interval 1.03–1.40) (all P < .05). Moreover, organ transplantation was associated with higher index hospitalization costs (14.4% difference, 95% confidence interval 14.1%–14.6%) and 30-day postdischarge costs (16.2% difference, 95% confidence interval 15.3%–17.0%) (both P < .001). ConclusionsPrior transplant recipient status was associated with adverse clinical and financial outcomes following subsequent major surgery. Prior history of transplant may be an important factor to incorporate into risk stratification of patients undergoing subsequent major surgical procedures.