Care Costs Research Articles

#950 Conservative care management in chronic kidney disease: a value for the money?

Abstract Background and Aims In Portugal, in 2021 the Directorate General of Health proposed the implementation of conservative care management (or kidney palliative care) as an option to handle frail Chronic Kidney Disease (CKD) patients or those who opt not to proceed to Kidney Replacement Therapy Options (KRT). A guideline regulated the clinical framework for this proposal but its socioeconomic evaluation and subsequent reimbursement has not been established. This has become a barrier to its application by public and private providers. This work intends to evaluate the limitations of costs and outcomes analysis in context of end-of-life care in CKD patients and propose indicators to compare cost effectiveness in dialysis and conservative care management. Method A narrative review from the literature have been made to evaluate epidemiological, social, individual and economic burden of ESKD and its treatment modalities. A reflection has been made on the benefits of Conservative Care (CC) and the limitations to evaluate cost effectiveness for this option compared to dialysis. Results Cost-effectiveness analysis is a method of comparing costs and effects of two or more alternatives in health or social care interventions to an outcome. Conceptual models of cost-effectiveness analysis evaluate outcomes compared to costs. Quality-adjusted life-years (QALYs) is a popular measure of outcome, but its use is problematic in ESKD. Costs of care are mostly elevated at the end of life and the way they are calculated is also debatable (Fig. 1). Some indicators may be used to compare CC and dialysis (Fig. 2). Conclusion The health policies should guarantee access to the health care, with quality, effectiveness and safety in the provision of services with efficiency but at the same time to assure financial sustainability and patients’ satisfaction. For some patients CC may embody an option that represents value for the money. To prove this reality, a cost-effectiveness evaluation must be implemented based on pre-specified indicators that override the limitations of this analysis in this specific context.

Technological Perception with Rural and Urban Differentiation and Its Influence on the Quality of Life of Older People with Age-Related Macular Degeneration

The past decade has seen a global increase in population age, especially in developed countries, where aging involves visual diseases such as age-related macular degeneration (AMD), which severely affect quality of life (QoL) and mental health, as well as increase isolation and care costs. This study investigated how persons with AMD perceive the impact of technology use on their QoL, focusing on potential disparities between urban and rural contexts in Spain. Using a cross-sectional observational design, data from the 2020 National Statistics Institute’s Disability, Personal Autonomy, and Dependency Situations Survey were analyzed, focusing on QoL aspects based on the WHO items of the WHOQOL-100 scale. The results revealed a generally positive perception of technology among participants, with urban residents perceiving technology’s positive impact more favorably. Sex discrepancies in technology perception were also observed, as women exhibited a more positive outlook on technology’s influence on QoL. The analysis of QoL aspects, such as ‘Visibility’, ‘Learning’, ‘Mobility’, and ‘Domestic life’, highlighted distinct challenges faced by rural and urban populations, underscoring the importance of context-specific approaches in technology interventions. However, these perceptions were intertwined with comorbidities, which can exacerbate AMD-related issues. Furthermore, this study explored the role of technology in enhancing QoL among older adults with AMD, examining how it influences daily activities and independence, particularly in the context of AMD management. This study concluded that developing more-inclusive policies tailored to the specific needs of persons with AMD, with special attention to environmental and sex differences, is imperative to enhance the positive impact of technology on their QoL.

Reduction in Healthcare Resource Utilization Following Treatment With a Home-Based Footworn Device in Patients With Knee Osteoarthritis: A Retrospective Claims Analysis

Background: One in 7 US adults has knee osteoarthritis (OA) and almost two-thirds of them suffer from low back pain. OA is the third most rapidly rising condition associated with disability and leads to a significant burden on the healthcare system and society. Objective: This study looked at the healthcare resource utilization (HCRU) in patients with knee OA and low back pain before and after the utilization of a new, home-based, noninvasive, biomechanical intervention. Methods: This was a retrospective claims analysis of 585 patients treated with a personalized, noninvasive, home-based, biomechanical treatment that aims to alleviate knee pain and improve function (AposHealth®). The date of the first AposHealth claim was the index date. Data prior to the index date and post-index date were used to monitor changes in HCRU while in treatment. Descriptive statistics, including frequencies, means and standard deviations, were used to present patient characteristics. To standardize the results, an average monthly claims data rate was calculated and an expected annual rate was extrapolated. Annual HCRU rate per 1000 members was calculated. Results: HCRU decreased after utilizing the new intervention including a decrease of 79% in diagnostic claims, a 70% decrease in outpatient services, a 22% decrease in non-operative treatments, a 61% decrease in pain medications including an 85% drop in opioids use, and a 44% decrease in intra-articular injections. The pre-index estimated rate for total knee replacement (TKR), which is based on existing literature, was 15.1%, whereas the post-index rate of TKR was 0.9%. Conclusions: Patients with knee OA treated with a home-based, noninvasive, biomechanical intervention incurred fewer healthcare resources, leading to an overall reduction in the cost of care.

Exploring X: barriers to care for eosinophilic esophagitis.

Patients with chronic diseases have increasingly turned to social media to discuss symptoms and share the challenges they face with disease management. The primary aim of this study is to use naturally occurring data from X (formerly known as Twitter) to identify barriers to care faced by individuals affected by eosinophilic esophagitis (EoE). For this qualitative study, the X application programming interface with academic research access was used to search for posts that referenced EoE between 1 January 2019 and 10 August 2022. The posts were identified as being either related to barriers to care for EoE or not. Those related to barriers to care were further categorized by the type of barrier that was expressed. A total of 8636 EoE-related posts were annotated of which 12.1% were related to barriers to care in EoE. The themes that emerged about barriers to care included: dietary challenges, limited treatment options, lack of community support, lack of physician awareness of disease, misinformation, cost of care, lack of patient belief in disease or trust in physician, and limited access to care. Saturation of themes was achieved. This study highlights barriers to care in EoE using readily accessible social media data that is not derived from a curated research setting. Identifying these obstacles is key to improving care for this chronic disease.

Incidence of urinary tract infections in patients with permanent percutaneous nephrostomy after implementation of a standardized care program

Incidence of urinary tract infections in patients with permanent percutaneous nephrostomy after implementation of a standardized care program

Cutaneous melanoma in adolescents and young adults.

Cutaneous malignant melanoma (CMM) ranks among the five most common cancers in young people in high-income countries and it features peculiar clinicopathological traits. Very few studies have addressed the quality of care and the costs for adolescents and young adults (AYA) population. To provide a comprehensive epidemiological and clinicopathological profile of CMM in AYA. The study also addresses the cost-of-illness and the diagnostic-therapeutic performance indicators by patient age category. This population-based cohort study included 2435 incident CMM (age range 15-65 years; age 15-39 = 394; age 40-65 = 2041), as recorded in 2015, 2017 and 2019 by the Regional Veneto Cancer Registry (Italy). Cramer's-V tested the strength of association between pairs of variables. The Kaplan-Meier method was used to test the association between age and survival rate. The clinical performance indicators were computed using the Clopper-Pearson exact method. In AYA patients (16.2%), CMM incidence rates increased significantly from 1990 to 2019. Low-stage CMM (p = 0.007), radial growth pattern (p = 0.026) and lower Clark levels (p = 0.007) prevailed; males had less advanced malignancies (p = 0.003), with the trunk as the most common primary site (67.5%); the lower limbs (32.6%) were the most common primary site for females (p < 0.001). Overall survival was better in AYA than adults. No significant difference was detected in the clinical management of the two age groups, with the only exception of the margin in wide local excision. The care costs were lower in AYA (€195.99 vs. €258.94, p = 0.004). In AYA patients, the CMM clinicopathological presentation shows a distinctive profile. The present results provide critical information for optimizing primary and secondary prevention strategies and for tailoring diagnostic therapeutic procedures to the peculiar profile of AYA CMM patients.

Managing "socially admitted" patients in hospital: a qualitative study of health care providers' perceptions.

Emergency departments are a last resort for some socially vulnerable patients without an acute medical illness (colloquially known as "socially admitted" patients), resulting in their occupation of hospital beds typically designated for patients requiring acute medical care. In this study, we aimed to explore the perceptions of health care providers regarding patients admitted as "social admissions." This qualitative study was informed by grounded theory and involved semistructured interviews at a Nova Scotia tertiary care centre. From October 2022 to July 2023, we interviewed eligible participants, including any health care clinician or administrator who worked directly with "socially admitted" patients. Virtual or in-person individual interviews were audio-recorded and transcribed, then independently and iteratively coded. We mapped themes on the 5 domains of the Quintuple Aim conceptual framework. We interviewed 20 nurses, physicians, administrators, and social workers. Most identified as female (n = 11) and White (n = 13), and were in their mid to late career (n = 13). We categorized 9 themes into 5 domains: patient experience (patient description, provision of care); care team well-being (moral distress, hierarchy of care); health equity (stigma and missed opportunities, prejudices); cost of care (wait-lists and scarcity of alternatives); and population health (factors leading to vulnerability, system changes). Participants described experiences caring for "socially admitted" patients, perceptions and assumptions underlying "social" presentations, system barriers to care delivery, and suggestions of potential solutions. Health care providers viewed "socially admitted" patients as needing enhanced care but identified individual, institutional, and system challenges that impeded its realization. Examining perceptions of the people who care for "socially admitted" patients offers insights to guide clinicians and policy-makers in caring for socially vulnerable patients.

Effect of BMI on Complications Following Total Shoulder Arthroplasty: A Population-Wide Analysis

BackgroundEvidence regarding the effect of body mass index (BMI) on complications following anatomic shoulder arthroplasty (aTSA) and reverse shoulder arthroplasty (rTSA) remains controversial. This high-powered study examines the effect of BMI on surgical and medical complications following anatomic shoulder arthroplasty (aTSA) and reverse shoulder arthroplasty (rTSA). MethodsThis retrospective cohort study was conducted using the Premier Healthcare Database (PHD) to query all adult patients who underwent primary, elective TSA (aTSA, rTSA) from 2016 to 2020. Patients eligible for inclusion were identified using ICD-10 and CPT codes for primary TSA. Patients were stratified into three subgroups based on BMI (BMI <30 kg/m2, BMI 30-35 kg/m2, BMI > 35 kg/m2). The primary endpoints assessed were 90-day risks of postoperative complications, revisions, and readmissions among the three BMI groups undergoing primary TSA. ResultsA total of 32,645 patients were analyzed; 10,951 patients underwent aTSA and 21,694 patients underwent rTSA. Patient populations for aTSA and rTSA differed significantly across all BMI categories in terms of age, sex, cost of care, and insurance status. After multivariate regression analysis, there was no increased risk of surgical complications in the aTSA and rTSA cohorts with BMI 30-35 kg/m2 and BMI > 35 kg/m2. In the aTSA cohort, rates of acute respiratory failure (adjusted Odds Ratio (aOR) 2.65) was all significantly higher in the BMI > 35 kg/m2 group. As for rTSA cohort, acute respiratory failure (aOR 1.67) and acute renal failure (aOR 1.53) were significantly higher in the BMI > 35 kg/m2 group. ConclusionWhile we found no increased risk of immediate postoperative surgical risks, patients with a BMI > 35 kg/m2 demonstrated greater risk of medical complications after rTSA. Given this trend, providers should exercise caution in patient selection for TSA and counsel obese patients as to these increased risks. Future studies should aim to provide a more comprehensive picture of the effect of BMI on functional outcomes after TSA.

Estimating the Costs of End-of-Life Care in Patients With Advanced Cancer From the Perspective of an Insurance Organization: A Cross-Sectional Study in Iran

ObjectivesCancers are significant medical conditions that contribute to the rising costs of healthcare systems and chronic diseases. This study aimed to estimate the average costs of medical services provided to patients with advanced cancers at the end of life (EOL). MethodsWe analyzed data from the Sata insurance claim database and the Health Information System of Baqiyatallah hospital in Iran. The study included all adult decedents who had advanced cancer without comorbidities, died between March 2020 and September 2020, and had a history of hospitalization in the hospital. We calculated the average total cost of healthcare services per patient during the EOL period, including both cancer-related and noncancer-related costs. ResultsA total of 220 patients met the inclusion criteria. The average duration of the EOL period for these patients was 178 days, with an average total cost of $8278 (SD $5698) for men and $9396 (SD $6593) for women. Cancer-related costs accounted for 64.42% of the total costs, including inpatient and outpatient services. Among these costs, hospitalization was the primary cost driver and had the greatest impact on EOL costs. This observation was supported by the multiple linear regression model, which suggested that hospitalization in the final days of life could potentially drive costs in these patients. Notably, no specialized palliative care was provided to the patients included in this study. ConclusionsThe results demonstrate that there is a significant rise in costs of care in patients receiving routine cancer care rather than optimized EOL care.

2024 Alzheimer's disease facts and figures.

This article describes the public health impact of Alzheimer's disease (AD), including prevalence and incidence, mortality and morbidity, use and costs of care and the ramifications of AD for family caregivers, the dementia workforce and society. The Special Report discusses the larger health care system for older adults with cognitive issues, focusing on the role of caregivers and non-physician health care professionals. An estimated 6.9 million Americans age 65 and older are living with Alzheimer's dementia today. This number could grow to 13.8 million by 2060, barring the development of medical breakthroughs to prevent or cure AD. Official AD death certificates recorded 119,399 deaths from AD in 2021. In 2020 and 2021, when COVID-19 entered the ranks of the top ten causes of death, Alzheimer's was the seventh-leading cause of death in the United States. Official counts for more recent years are still being compiled. Alzheimer's remains the fifth-leading cause of death among Americans age 65 and older. Between 2000 and 2021, deaths from stroke, heart disease and HIV decreased, whereas reported deaths from AD increased more than 140%. More than 11 million family members and other unpaid caregivers provided an estimated 18.4 billion hours of care to people with Alzheimer's or other dementias in 2023. These figures reflect a decline in the number of caregivers compared with a decade earlier, as well as an increase in the amount of care provided by each remaining caregiver. Unpaid dementia caregiving was valued at $346.6 billion in 2023. Its costs, however, extend to unpaid caregivers' increased risk for emotional distress and negative mental and physical health outcomes. Members of the paid health care and broader community-based workforce are involved in diagnosing, treating and caring for people with dementia. However, the United States faces growing shortages across different segments of the dementia care workforce due to a combination of factors, includingthe absolute increase in the number of people living with dementia. Therefore, targeted programs and care delivery models will be needed to attract, better train and effectively deploy health care and community-based workers to provide dementia care. Average per-person Medicare payments for services to beneficiaries age 65 and older with AD or other dementias are almost three times as great as payments for beneficiaries without these conditions, and Medicaid payments are more than 22 times as great. Total payments in 2024 for health care, long-term care and hospice services for people age 65 and older with dementia are estimated to be $360 billion. The Special Report investigates how caregivers of older adults with cognitive issues interact with the health care system and examines the role non-physician health care professionals play in facilitating clinical care and access to community-based services and supports. It includes surveys of caregivers and health care workers, focusing on their experiences, challenges, awareness and perceptions of dementia care navigation.

Cost-effectiveness of temperature monitoring to help prevent foot ulcer recurrence in people with diabetes: A multicenter randomized controlled trial.

Diabetes-related foot ulcers are common, costly, and frequently recur. Multiple interventions help prevent these ulcers. However, none of these have been prospectively investigated for cost-effectiveness. Our aim was to evaluate the cost-effectiveness of at-home skin temperature monitoring to help prevent diabetes-related foot ulcer recurrence. Multicenter randomized controlled trial. We randomized 304 persons at high diabetes-related foot ulcer risk to either usual foot care plus daily at-home foot skin temperature monitoring (intervention) or usual care alone (control). Primary outcome was cost-effectiveness based on foot care costs and quality-adjusted life years (QALY) during 18 months follow-up. Foot care costs included costs for ulcer prevention (e.g., footwear, podiatry) and for ulcer treatment when required (e.g., consultation, hospitalisation, amputation). Incremental cost-effectiveness ratios were calculated for intervention versus usual care using probabilistic sensitivity analysis for willingness-to-pay/accept levels up to €100,000. The intervention had a 45% probability of being cost-effective at a willingness-to-accept of €50,000 per QALY lost. This resulted from (non-significantly) lower foot care costs in the intervention group (€6067 vs. €7376; p=0.45) because of (significantly) fewer participants with ulcer recurrence(s) in 18months (36% vs. 47%; p=0.045); however, QALYs were (non-significantly) lower in the intervention group (1.09 vs. 1.12; p=0.35), especially in those without foot ulcer recurrence (1.09 vs. 1.17; p=0.10). At-home skin temperature monitoring for diabetes-related foot ulcer prevention compared with usual care is at best equally cost-effective. The intervention resulted in cost-savings due to preventing foot ulcer recurrence and related costs, but this came at the expense of QALY loss, potentially from self-monitoring burdens.

Barriers and enablers to people-centred viral hepatitis care in Vietnam and the Philippines: Results of a patient journey mapping study.

In Vietnam and the Philippines, viral hepatitis is the leading cause of cirrhosis and liver cancer. This study aims to understand the barriers and enablers of people receiving care for hepatitis B and C to support both countries' efforts to eliminate viral hepatitis as a public health threat by 2030. Retrospective, semi-structured interviews were conducted with a purposive, quota-based sample of 63 people living with hepatitis B or C in one province of Vietnam and one region of the Philippines. A rapid deductive approach to thematic analysis produced key findings among the three phases of care: (1) pre-awareness and testing, (2) linkage and treatment initiation and (3) ongoing treatment and recovery. The research found that participants followed five typical journeys, from a variety of entry points. Barriers during the pre-awareness and testing phase included limited awareness about hepatitis and its management, stigma and psychological impacts. Enablers included being familiar with the health system and/or patients benefiting from social connections within the health systems. During the linkage and treatment initiation phase, barriers included difficult physical access, complex navigation and inadequate counselling. In this phase, family support emerged as a critical enabler. During the ongoing treatment and recovery phase, the cost of care and socially and culturally informed perceptions of the disease and medication use were both barriers and enablers. Exploring peoples' journeys with hepatitis B and C in Vietnam and the Philippines revealed many similarities despite the different cultural and health system contexts. Insights from this study may help generate a contextualized, people-centred evidence base to inform the design and improvement of primary care services for hepatitis in both research sites.

Impact of the COVID-19 pandemic on utilization and cost for care of pediatric and young adult ALL

ObjectiveAcute lymphoblastic leukemia (ALL) is the most common childhood malignancy and among the most common malignancies in young adults and requires a unique pattern of healthcare utilization including an acute/emergent presentation and an intensive initial 8 months of therapy followed by two years of outpatient treatment. The COVID-19 pandemic caused massive global disruptions in healthcare use and delivery. This report aims to examine the effects of the COVID-19 pandemic on the presentation, diagnosis and continued management of childhood and young adult ALL in regard to utilization and cost of care among commercially insured individuals in the United States.ResultsUtilizing a commercial insurance claims database, 529 pediatric and young adult patients were identified who were diagnosed with ALL between January 2016 and March 2021. New diagnoses were evaluated by era and demographics. Utilization was measured by COVID-related era as number of inpatient and outpatient encounters, inpatient days, and cumulative cost during the initial 8 months of therapy. None of these cost or utilization factors changed significantly during or shortly after the pandemic. These findings reinforce that the necessary care for pediatric and young adult ALL was unwavering despite the massive shifts in the healthcare system caused by the COVID-19 pandemic. This provides a valuable benchmark as we further examine the factors that influence the pandemic’s impact on health equity and access to care, especially in vulnerable pediatric and young adult populations. This is the first investigation of the effect of the COVID-19 pandemic on utilization and cost of care in pediatric and young adult cancer.

Risk factors of anastomotic leak in colorectal cancer: a multicentric study in a Latin American country.

The anastomotic leak (AL) is one of the most feared complications of colorectal surgery, since it is associated with a high rate of morbidity, mortality, length of hospital stay and cost of care. Our aim was to determine the risk factors associated with anastomosis leak in colorectal cancer patients who underwent surgical resection with anastomosis. A multicentre observational, analytical, retrospective and case-control study was carried out. For each case, two controls were included from three national hospitals from Lima, Peru during the period 2021-2022. To determine the degree of association, multivariate logistic regression model was carried out. A total of 360 patients were included, 120 from each hospital. The mean age of the population was 68.03 ± 14.21 years old. The majority were 65 years old or older (66.1%), 52.8% were female, and 63.3% had clinical stage III. The 40% of the patients had albumin levels lower than 3.5 g/dL. Regarding the surgery, 96.4% were elective, 68.9% underwent open approach, and 80.8% had an operative time of more than 180 minutes. Most of them had right colon cancer (50.8%). In the multivariate analysis, a significant association was found with the age variable (OR = 2.48; 95%CI:1.24-4.97), clinical tumour level (OR = 2.71; 95%CI:1.34-5.48), American Society of Anesthesiologists (ASA) Score (OR = 3.23; 95%CI:1.10-9.50), preoperative serum albumin (OR = 22.2; 95%CI:11.5-42.9). The most important independent risk factors associated with AL among patients with colorectal cancer were pre-operative such as lower preoperative serum albumin levels, followed by a higher ASA Score, clinical-stage III-IV, and an age ≥65 years old.

Horticultural Therapy for Individuals Coping with Dementia: Practice Recommendations Informed by Related Non-Pharmacological Interventions.

Dementia care currently presents a challenge to healthcare providers on many levels. The rapid increase in the number of people with dementia and the costs of care certainly contribute to these challenges. However, managing the behavioral and psychological symptoms of dementia (BPSDs) has become one of the most significant tasks in providing care and can lead to poor health and well-being outcomes, not only for the people living with dementia (PLWD) but also for those providing their care. Cost-effective, easily implemented, highly adaptable, empirically based alternatives are needed. Interventions such as Horticultural Therapy (HT), which is naturally informed by Montessori-Based Methods for Dementia and sensory reminiscence therapies, meets these qualifying factors. This article, based on a review of current best practices and clinical experience, hopes to provide recommendations for such an intervention along with special considerations for PLWD and adaptations for different acuity levels. With additional safe and effective, person-centered, non-pharmacological interventions available for the complex cognitive and neuropsychiatric manifestations of this disease, a better care milieu can be provided, improving the quality of life for both patients and caregivers. This article also identifies the need for continued research into the synergistic effects of person-centered behavioral and psychosocial interventions combined with environmental approaches to provide the optimal healing environment for those coping with dementia.

The Costs of Caring: Quantifying Compassion Fatigue and Compassion Satisfaction in Burn Therapists.

Recovery from a severe burn injury requires early and aggressive therapy, which is often painful and distressing to the patient. Burn therapists who guide these interventions may be prone to experiencing secondary trauma and compassion fatigue through repeated exposure to difficult situations. At the same time, therapists may gain a sense of purpose and altruism from their work, fostering compassion satisfaction. Despite being well documented in other health professions, compassion fatigue and compassion satisfaction have not been sufficiently explored among burn therapists. This study aimed to quantify and characterize burn therapists' compassion fatigue and satisfaction using the Professional Quality of Life scale and to answer the question of what job-related factors may impact these outcomes. A total of 143 burn therapists participated in this study. Results revealed compassion fatigue subsale scores of burnout and secondary traumatic stress in the low or moderate range and compassion satisfaction scores in the moderate or high ranges for all participants. This study presents new knowledge for the field of burn care in its quantification of professional quality of life in burn therapists. While burn therapists experienced moderate-to-high levels of compassion satisfaction in their work, burnout and stress also approached moderate levels. Years of practice was a significant predictor of compassion. Although the reasons for this are not clear, it may be related to increased competence or confidence in practice and may suggest a need for different support strategies for practitioners at each stage of their burn therapy career.

Pharmaceutical company ranks best, worst states to live in for MH

In an analysis published last month, the online pharmacy company, Universal Drugstore, ranked the best and worst states to live in for mental health after evaluating various data points, including the prevalence of mental illness and the cost of care, FortuneWell, reported on April 8. Montana topped the list of best places to live for mental health, scoring 8.06 out of 10. The state had the lowest number by population of “mentally unhealthy adults” who cannot afford care, and residents took the second‐fewest mental health sick days in 2022. By contrast, Nevada ranked as the worst state for mental health, with a score of 2.06 out of 10. The Silver State placed in the top five for several measurements, including the highest number of mental health sick days taken and the most youth reporting depressive episodes. Nevada also had one of the lowest ratios of psychologists to residents across the nation. Breaking the data down further, South Dakota, ranked fourth as the best state for mental health with the fewest reported mental health sick days (three), while West Virginia and Louisiana, ranked 34th and 44th, reported the most (six). Adults in New Jersey, ranked 16th, had the lowest rates of mental illness diagnoses (16%), while adults residing in Utah, ranked 25th, had the highest rates of mental illness (27%). Oregon, in 50th place, ranked as the second‐worst state for mental health with a score of 2.89 out of 10, tied with New Mexico, ranked 42nd, for the nation's highest percentage of youth experiencing depressive episodes (19%); the lowest is in Washington, D.C. (11%). The nation's capital, which ranked 13th, is also home to the highest proportion of psychologists compared to Alabama, Maine, Georgia, and Louisiana. Researchers used data from the U.S. Bureau of Labor Statistics, the Kaiser Family Foundation, Mental Health America, the U.S. Centers for Disease Control and Prevention, and the Substance Abuse and Mental Health Services Administration to compile the rankings. They compared each state's ratio of psychologists to residents, the average number of mental health sick days taken, the prevalence of mental illness for adults and youth, the number of beds available in mental health facilities and the cost of prescription drugs.

Improvement in community wound management: why simple changes in clinical practice matter

Background/Aims Wounds continue to be an increasing burden to society, healthcare systems and patients. Wound care is an urgent challenge that requires new management strategies to help facilitate wound healing. This study aimed to evaluate an early intervention wound project facilitated by the COMPASS programme in a Swedish community setting in terms of treatment outcomes and health economic benefits. Methods An evaluation of wound care practice was completed using data collected on all wounds treated in 1 week in March 2021 (n=97). Single-use negative pressure wound therapy (sNPWT) was then introduced, alongside specialist education for all nurses. A post-intervention evaluation was carried out the following year with data on all wounds treated in 1 week in October 2022 (n=36). The samples were compared in terms of proportion of static and deteriorating wounds, wound characteristics, average number of dressing changes per wound and proportion of wounds requiring the patient to be admitted to hospital or referred to a specialist. Costs of care were calculated and compared for the two samples. Results Wounds in the post-intervention dataset were in a better overall condition (size and depth), with a lower proportion being classified as static or deteriorating (58.8% vs 44.4%). There was a non-significant difference in the average number of dressing changes required per week, with post-intervention wounds requiring fewer changes. A significantly lower proportion of patients required a referral to a specialist in the post-intervention sample compared to the pre-intervention sample (43.3% vs 16.7%; P&lt;0.01). Conclusions Implementing a sNPWT pathway, alongside nurse education and increased involvement of nurses with specialist knowledge, can help to improve wound care outcomes and reduce the burden of wounds on nursing time and healthcare resources.

Impact of Pseudomonas aeruginosa on resource utilization and costs in patients with exacerbated non-cystic fibrosis bronchiectasis

Aims Non‐cystic fibrosis bronchiectasis (NCFB) is a chronic progressive respiratory disorder occurring at a rate ranging from 4.2 to 278.1 cases per 100,000 persons, depending on age, in the United States. For many patients with NCFB, the presence of Pseudomonas aeruginosa (PA) makes treatment more complicated and typically has worse outcomes. Management of NCFB can be challenging, warranting a better understanding of the burden of illness for NCFB, treatments applied, healthcare resources used, and subsequent treatment costs. Comparing patients diagnosed with exacerbated NCFB, with or without PA on antibiotic utilization, treatments, and healthcare resources utilization and costs was the purpose of this study. Materials and methods This was a retrospective cohort study of commercial claims from IQVIA’s PharMetrics Plus database (January 1,2006–December 31, 2020). Study patients with a diagnosis of NCFB were stratified into two groups based on the presence or absence of PA, then followed to identify demographic characteristics, comorbid conditions, antibiotic treatment regimen prescribed, healthcare resources utilized, and costs of care. Results The results showed that patients with exacerbated NCFB who were PA+ had significantly more oral antibiotic fills per patient per year, more inpatient admissions with a longer length of stay, and more outpatient encounters than those who were PA−. For costs, PA+ patients also had significantly greater total healthcare costs per patient when compared to those who were PA−. Conclusion Exacerbated NCFB with PA+ was associated with increased antibiotic usage, greater resource utilization, and increased costs. The major contributor to the cost differences was the use of inpatient services. Treatment strategies aimed at reducing the need for inpatient treatment could lessen the disparities observed in patients with NCFB.

Study of Malnutrition in Children with Malignancies in Northern Garhwal Region

Background: Children with cancer are particularly vulnerable to malnutrition. Adequate nutrition plays a decisive role on treatment response, quality of life, and cost of care. This study aims to find out the prevalence of malnutrition in pediatric cancer patients and assess its grade and severity. Methods: 89 patients included in this observational hospital based study. Nutritional status was assessed at the time of diagnosis then at 3rd and 6th month by different Anthropometric parameters.P &lt; 0.05 was taken as significant. Conclusion: Out of 89 patients, 3 died. According to IAP classification prevalence of malnutrition when weight for age taken as criteria, 22.1% lies in grade I and 16.3% lies in grade II at admission , total 38.4% malnourished at admission. According to WHO 19.8% were moderately wasted at admission and 5.8% were severely wasted. When BMI taken as criteria, 15.1% falls under thinness and 16.3% falls under severe thinness, only 1.2% were obese. After post hoc analysis, there was significant difference between BMI of patients at admission versus 6months and also at 3 months versus 6 months. Prevalence as per WHO criteria at admission 25.6% decreased to 16.3% at six months.