Cost Of Care For Patients Research Articles

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.

Stress and Coping in Emergency Nurses Following Trauma Patient Care: A Qualitative Grounded Theory Approach.

Experiencing symptoms of traumatic stress may be the cost of caring for trauma patients. Emergency nurses caring for trauma patients are at risk for traumatic stress reactions. This study explored the stress and coping behaviors experienced by emergency nurses who provide trauma care. Focus groups were held at three urban trauma centers in the Midwestern United States: a Level I pediatric trauma center, a Level I adult trauma center, and a Level III adult trauma center. Data were collected between December 2009 and March 2010. Data analysis was guided by the principles of grounded theory. Line-by-line coding and constant comparative analysis techniques were used to identify recurring constructs. A total of 48 emergency nurses participated. Recurring constructs emerged in the data analysis and coding, revealing four major themes: care of the trauma patient, professional practice, personal life, and support. Nurse job engagement, burnout, and professional and personal relationships are influenced by trauma patient care. The study's resulting themes of care of the trauma patient, professional practice, personal life, and support resulted in the development of the "trauma nursing is a continual experience theory" that can be used as a framework to address these effects. Intentional support and timely interventions based on this new theory can help mitigate the effects of traumatic stress experienced by trauma nurses.

Identification of a Patient Suitable for CAR-T Cell Therapy in the Outpatient Setting: A Vodcast and Case Example.

Chimeric antigen receptor T cell (CAR-T) therapies targeting the CD19 antigen have been associated with high and durable response rates in patients with diffuse large B cell lymphoma (DLBCL). CAR-T cell therapies are commonly administered in the inpatient setting due to the average onset of cytokine release syndrome within the first 3days post infusion, but there has been growing interest in delivering CAR-T cell therapies in the outpatient setting to overcome frequent hospital bed shortages and the high cost of inpatient care. Although this approach could improve access whilst catering to patient preference, it requires a multidisciplinary approach as well as careful patient selection. Herein, Dr. Foley and Dr. Kuruvilla discuss the case of a patient presenting with the ideal profile for CAR-T cell therapy referral whilst also determining the key attributes for eligibility from a clinician's perspective. Solutions for successful outpatient management include proper education, caregiver support, and early referral to ensure a timely infusion. In conclusion, outpatient administration of CAR-T cell therapy in patients with DLBCLs should be assessed on a case-by-case basis.A vodcast feature is available for this article.

Healthcare resource utilisation and direct medical cost for individuals with 5q spinal muscular atrophy in Sweden.

Spinal muscular atrophy (SMA) is a rare, progressive, neuromuscular disorder. Recent advances in treatment require an updated assessment of burden to inform reimbursement decisions. To quantify healthcare resource utilisation (HCRU) and cost of care for patients with SMA. Cohort study of patients with SMA identified in the Swedish National Patient Registry (2007-2018), matched to a reference cohort grouped into four SMA types (1, 2, 3, unspecified adult onset [UAO]). HCRU included inpatient admissions, outpatient visits, procedures, and dispensed medications. Direct medical costs were estimated by multiplying HCRU by respective unit costs. Average annual HCRU and medical costs were modelled for SMA versus reference cohorts to estimate differences attributable to the disease (i.e., average treatment effect estimand). The trajectory of direct costs over time were assessed using synthetic cohorts. We identified 290 SMA patients. Annualised HCRU was higher in SMA patients compared with reference cohorts. Highest risk ratios were observed for inpatient overnight stays for type 1 (risk ratio [RR]: 29.2; 95% confidence interval [CI]: 16.0, 53.5) and type 2 (RR: 23.3; 95% CI: 16.4,33.1). Mean annual direct medical costs per patient for each year since first diagnosis were greatest for type 1 (€114,185 and SMA-attributable: €113,380), type 2 (€61,876 and SMA-attributable: €61,237), type 3 (€45,518 and SMA-attributable: €44,556), and UAO (€4046 and SMA-attributable: €2098). Costs were greatest in the 2-3years after the first diagnosis for all types. The economic burden attributable to SMA is significant. Further research is needed to understand the burden in other European countries and the impact of new treatments.

Cost of childhood severe pneumonia management in selected public inpatient care facilities in Bangladesh: a provider perspective

ObjectiveTo estimate inpatient care costs of childhood severe pneumonia and its urban–rural cost variation, and to predict cost drivers.DesignThe study was nested within a cluster randomised trial of childhood severe...

Hospital Capital Assets, Community Health, and the Utilization and Cost of Inpatient Care: A Population-Based Study of US Counties.

The provision of high-quality hospital care requires adequate space, buildings, and equipment, although redundant infrastructure could also drive service overprovision. To explore the distribution of physical hospital resources-that is, capital assets-in the United States; its correlation with indicators of community health and nonhealth factors; and the association between hospital capital density and regional hospital utilization and costs. We created a dataset of n=1733 US counties by analyzing the 2019 Medicare Cost Reports; 2019 State Inpatient Database Community Inpatient Statistics; 2020-2021 Area Health Resource File; 2016-2020 American Community Survey; 2022 PLACES; and 2019 CDC WONDER. We first calculated aggregate hospital capital assets and investment at the county level. Next, we examined the correlation between community's medical need (eg, chronic disease prevalence), ability to pay (eg, insurance), and supply factors with 4 metrics of capital availability. Finally, we examined the association between capital assets and hospital utilization/costs, adjusted for confounders. Counties with older and sicker populations generally had less aggregate hospital capital per capita, per hospital day, and per hospital discharge, while counties with higher income or insurance coverage had more hospital capital. In linear regressions controlling for medical need and ability to pay, capital assets were associated with greater hospital utilization and costs, for example, an additional $1000 in capital assets per capita was associated with 73 additional discharges per 100,000 population (95% CI: 45-102) and $19 in spending per bed day (95% CI: 12-26). The level of investment in hospitals is linked to community wealth but not population health needs, and may drive use and costs.

Virtual ward: The future in the management of neutropenic sepsis in the NHS

Virtual ward offers patients with neutropenic sepsis a unique opportunity to receive hospital level of care in the comfort of their home, especially for patients who would otherwise be admitted to hospital because of their acute treatment. On the virtual ward, patients can receive hospital level of care with a significant opportunity to mitigate any risk of hospital-acquired infection in this subset of patients who are already immunocompromised amongst other benefits. Additionally, hospital length of stay can be shortened leading to reduced admission pressure in hospitals, increasing hospital admission avoidance, and encouraging safe discharge from hospital while still providing the best care for the patients. We report a case of a 76-year-old cancer patient who presented with neutropenic sepsis and was successfully managed on the virtual ward in a district hospital. This case highlights the importance of virtual wards an evolving innovation that can define the future management of cancer patients in NHS. It is safe and reduces the cost of inpatient care in healthcare.

A Randomized Controlled Trial of a Pay-for-Performance Initiative to Reduce Costs of Care for High-Need Psychiatric Patients.

Pay-for-performance (P4P) initiatives hold promise for improving health care delivery but are rarely applied to behavioral health or tested in randomized controlled trials (RCTs). This RCT examined the effectiveness of a P4P initiative to reduce total cost of 24-hour care among patients with high needs for psychiatric care in a large county in California. From August 2016 to March 2022, a total of 652 adult residents of Santa Clara County, California, were enrolled in a P4P initiative (mean±SD age=46.7±13.3 years, 61% male, 51% White, and 60% diagnosed as having a bipolar or psychotic disorder). Participants were randomly assigned to usual full-service partnerships from the county (N=327) or a comparable level of care from a contractor who agreed to a schedule of financial penalties and rewards based on whether enrollees (N=325) used more or less care than a historical cohort of similar county patients. The primary outcome was total cost of 24-hour psychiatric services. Secondary outcomes were costs of each of the 24-hour care services. The proportion of the total sample that used 24-hour psychiatric services decreased over the 36-month study period. Intent-to-treat analyses revealed no differences between the two study conditions in total care costs during the follow-up period. No significant care utilization differences were observed between the two conditions in most of the individual 24-hour services. A P4P initiative for high-need patients was no more effective than usual care for reducing costs of 24-hour psychiatric care.

Clinical Decision Making in Inflammatory Bowel Disease Mimics: Practice Management from Inflammatory Bowel Disease LIVE.

Since 2009, inflammatory bowel disease (IBD) specialists have utilized "IBD LIVE," a weekly live video conference with a global audience, to discuss the multidisciplinary management of their most challenging cases. While most cases presented were confirmed IBD, a substantial number were diseases that mimic IBD. We have categorized all IBD LIVE cases and identified "IBD-mimics" with consequent clinical management implications. Cases have been recorded/archived since May 2018; we reviewed all 371 cases from May 2018-February 2023. IBD-mimics were analyzed/categorized according to their diagnostic and therapeutic workup. Confirmed IBD cases made up 82.5% (306/371; 193 Crohn's disease, 107 ulcerative colitis, and 6 IBD-unclassified). Sixty-five (17.5%) cases were found to be mimics, most commonly medication-induced (n = 8) or vasculitis (n = 7). The evaluations that ultimately resulted in correct diagnosis included additional endoscopic biopsies (n = 13, 21%), surgical exploration/pathology (n = 10, 16.5%), biopsies from outside the GI tract (n = 10, 16.5%), genetic/laboratory testing (n = 8, 13%), extensive review of patient history (n = 8, 13%), imaging (n = 5, 8%), balloon enteroscopy (n = 5, 8%), and capsule endoscopy (n = 2, 3%). Twenty-five patients (25/65, 38%) were treated with biologics for presumed IBD, 5 of whom subsequently experienced adverse events requiring discontinuation of the biologic. Many patients were prescribed steroids, azathioprine, mercaptopurine, or methotrexate, and 3 were trialed on tofacitinib. The diverse presentation of IBD and IBD-mimics necessitates periodic consideration of the differential diagnosis, and reassessment of treatment in presumed IBD patients without appropriate clinical response. The substantial differences and often conflicting treatment approaches to IBD versus IBD-mimics directly impact the quality and cost of patient care.

THE COST OF ACUTE LYMPHOBLASTIC LEUKEMIA TREATMENT IN CHILDREN USING COMBINED CHEMOTHERAPY AND IMMUNOTHERAPY: COMPARISON OF ESTIMATED AND REAL VALUES

Acute lymphoblastic leukemia is the most common pediatric cancer. The effectiveness of modern therapy protocols makes it possible to cure over 80% of children, and one of the advanced treatment methods is the use of monoclonal antibodies. Using the example of adult patients in the United States, the economic effectiveness of this innovative treatment strategy was proven, while no similar studies have been conducted in children with primary acute lymphoblastic leukemia. The aim of the study was to determine the real cost of therapy for children and adolescents with acute lymphoblastic leukemia according to the protocol using combined chemotherapy and immunotherapy at the stages of induction and consolidation. Materials and methods. The study included data from 54 patients (the study group) who received therapy using this method, taking into account indicators of direct medical and non-medical costs. The control group included 54 patient models corresponding to the initial estimated parameters when planning the protocol (body weight 30 kg, body surface area 1 m2). Research results. The median of real cost for providing medical care to one patient in the study group was 22% lower than the estimated cost. In its structure, the values of the median costs for inpatient stay, for instrumental and laboratory studies, as well as for drug therapy turned out to be lower. Since younger patients were included in the study group, the cost of drug therapy was recalculated to the calculated patient model, which equalized the median cost of drug therapy for the study and control groups. In a situation with equal characteristics of patients, as well as with the same cost of a day of inpatient stay, the median real cost of providing medical care to one patient in the study group corresponded to the estimated values. Conclusions. The median cost of medical care for patients with acute lymphoblastic leukemia according to the protocol using combined chemotherapy and immunotherapy in the study group was 22% lower than the estimated values. The actual practice of using the protocol for an average patient model with an equal cost of inpatient stay fully corresponded to the estimated values of the protocol.

Effect of Ferric Carboxymaltose Versus Low-Dose Intravenous Iron Therapy and Iron Sucrose on the Total Cost of Care in Patients with Iron Deficiency Anemia: A US Claims Database Analysis.

Iron deficiency is the most common cause of anemia. We compared the effect of ferric carboxymaltose (FCM), low-dose intravenous (IV) iron (LDI), and iron sucrose on total cost of care in patients with iron-deficiency anemia (IDA) from a US health plan perspective. We conducted a retrospective claims analysis using the IQVIA PharMetrics Plus database. Patients with index (first) claims of FCM and LDI and a medical claim associated with IDA between 1 January 2017 and 31 December 2019 were included. Monthly total healthcare and inpatient and outpatient costs after receiving index IV iron for patients in the treatment cohorts were compared using a generalized linear model with gamma distribution and log-link. The overall study cohort included 37,655 FCM, 44,237 LDI, and 27,461 iron sucrose patients. Mean per-patient-per-month numbers of IV iron infusions for FCM, LDI, and iron sucrose were 0.20, 0.34, and 0.37, respectively. Compared with baseline, the FCM group had greater reductions in the number of hospital admissions and smaller increases in the number of outpatient visits in the 12 months post-IV iron therapy than LDI and iron sucrose, translating to significantly lower total healthcare cost (post-index adjusted cost ratio for total cost: 0.96 and 0.92, respectively; both P < 0.0001). Higher drug acquisition cost of FCM relative to LDI and iron sucrose was offset by significantly lower inpatient and outpatient costs in the 12 months post-IV iron therapy. These results support the economic value of FCM for patients with IDA receiving IV iron therapy.

Risk Factors for Oronasal Fistula in Primary Palatoplasty: A Case-Control Study From a Reference Center in Medellín, Colombia.

Oronasal fistula is one of the most critical complications in primary palatoplasty, with a reported incidence between 5% and 46% with multiple associated risk factors described previously. In addition, in more than half of the patients, it implies additional surgeries, increasing risks for the patient and health care costs. In this case-control study, the authors aim to determine the specific risk factors for oronasal fistula after primary palatoplasty in the study population. A retrospective review was undertaken to identify all patients undergoing primary palatoplasty between 2017 and 2019. Patients who developed oronasal fistula were included (cases) and compared with patients from the same cohort without fistula (controls). Demographic, clinical, and perioperative variables and their association with postoperative fistula presentation were explored through crude and adjusted analysis. One hundred thirty-nine patients with a median age of 6 years (5-6) who underwent primary palatoplasty were found. Forty-five presented an oronasal fistula, corresponding to 32% of the population, and 64% required subsequent repair of an oronasal fistula. In the crude analysis, the surgeon's experience (OR: 0.44) was associated significantly with the outcome. Adjusted analysis showed an association between surgical site infection and syndromic presentation. The experience of the surgeon is a protective factor for the oronasal fistula presentation; in addition, the presentation of infection of the operative site, the syndromic presentation, and the clinical follow-up at 1 year were also relevant; the latter, possibly due to the social context of our patients.

The Lack of a Standardized Definition of Chronic Dialysis Treatment in German Statutory Health Insurance Claims Data.

Chronic kidney failure (CKF) is often treated with dialysis, which is invasive and costly and carries major medical risks. The existing studies of patients with CKF requiring dialysis that are based on claims data from German statutory health insurance (SHI) carriers employ varying definitions of this entity, with unclear consequences for the resulting statistical estimates. We carried out a cohort study on four random samples, each consisting of 62 200 persons aged 70 or above, from among the insurees of the SHI AOK Nordost, with one sample for each of the years 2012, 2014, 2016, and 2018. The prevalence, incidence, mortality, and direct health care costs of CKF requiring dialysis were estimated and compared on the basis of four different definitions from literature and a new definition developed by the authors in reference to billing data. The different definitions led to variation in 12-month prevalences (range: 0.33-0.61%) and 6-month incidences (0.058-0.100%). The percentage of patients with prior acute kidney injury (AKI) ranged from 27.6% to 61.8%. Among incident patients, three-month survival ranged from 70.2% to 88.1%, and six-month survival from 60.5% to 81.3%. In CKF patients without prior AKI, the survival curves differed less across definitions (80.2-91.8% at three months, 70.7-84.4% at six months). The monthly health care costs ranged from €6010 to €9606, with marked variability across definitions in the costs of inpatient and outpatient care. The lack of a standardized definition of CKF requiring dialysis in German SHI claims data leads to variability in the estimated case numbers, mortality, and health care costs. These differences are most probably in part due to the variable inclusion of inpatients who received short-term dialysis after AKI.

Economic Burden of Healthcare Utilisation by Older Persons Living in the Community in Malaysia

Objective: The aim of the study is to estimate the economic burden of healthcare utilisation by older persons in Malaysia at a national scale. The specific objectives are to: (1) identify the healthcare utilisation behaviour of older persons; (2) estimate the direct and indirect healthcare costs at the community setting, and (3) estimate the economic burden of healthcare utilisation by older persons. Methods: The survey utilised multi-stage random sampling techniques to recruit a total of 2,274 elderly respondents aged 60 years and above. The economic burden of healthcare utilisation by an older person was estimated using multiple sources of data, namely administrative cost and healthcare cost from both institutional and community settings. Results: The prevalence of outpatient and inpatient care was 60.5% and 5.6%, respectively. Older persons generally chose government facilities for both inpatient and outpatient services. The average direct cost for outpatient and inpatient care were RM 141.24 and RM 2,527, respectively. The average indirect costs for outpatient and inpatient care were RM 31.44 and RM 524.07, respectively. The economic burden of healthcare utilisation by an older person was estimated at RM 3,807,481,491, which represent 0.34% of the total GDP in 2014 or 8% of the total health expenditure in the same year. By 2040, the burden is projected to reach a staggering RM 21 billion, or around 1.08% of the total GDP. The economic burden of healthcare utilisation by older persons is expected to increase as Malaysia is moving towards an aged nation by 2045. Conclusion: The utilization of outpatient care for older persons was estimated at 60% and most of the sought-after services were heavily subsidized government facilities. This study highlights the needs for the government to embark on preventive health and comprehensive education to decrease the prevalence and severity of non-communicable diseases (NCDs) among both the future aged and existing elderly in Malaysia. Alternatively, health care reform may be timely to ease the burden of healthcare utilisation by an even bigger percentage of older persons, once we become an aged nation.

Engaging Interdisciplinary Innovation Teams in Federally Qualified Health Centers.

To foster bottom-up innovations, health care organizations are leveraging interdisciplinary frontline innovation teams. These teams include workers across hierarchical levels and professional backgrounds, pooling diverse knowledge sources to develop innovations that improve patient and worker experiences and care quality, equity, and costs. Yet, these frontline innovation teams experience barriers, such as time constraints, being new to innovation, and team-based role hierarchies. We investigated the practices that such teams in federally qualified health centers (FQHCs) used to overcome these barriers. Our 20-month study of two FQHC innovation teams provides one of the first accounts of how practices that sustained worker engagement in innovation and supported their ideas to implementation evolve over time. We also show the varied quantity of engagement practices used at different stages of the innovation process. At a time when FQHCs face pressure to innovate amid staff shortages, our study provides recommendations to support their work.

The Economic Burden of the COVID-19 Pandemic in State of Kuwait.

The main aim of this study is to estimate the provider's cost, patients' cost (home and institutional quarantine cost) and the total economic burden of COVID-19 for patients with PCR positive in Kuwait. This cross-sectional and retrospective study identified the cost incurred for treating COVID-19 inpatients admitted to a General Hospital in Kuwait, a designated COVID-19 treatment center by the Kuwait Government during pandemic. A total of 485 COVID-19 patients were randomly selected from May 1st to September 31st, 2021. Data on sociodemographic information, length of stay (LOS), discharge status, and comorbidities were obtained from the patients' medical records. A step-down approach was done to estimate the healthcare provider cost per patient per admission. Patient cost (loss of productivity due to hospitalization, institutional and home quarantine) was calculated using human capital approach. The national economic burden of COVID-19 was estimated using costing data from a general hospital for the entire nation. The data were analyzed using the statistical software package SPSS version 25. In all, 485 COVID-19 patients were involved in the research. KD 2216 (USD 7,344) was the average cost per patient per admission. The ICU accounted for 20.6% of the total cost, the physician and nursing staff for 42.1%, and the laboratory services for 10.2%. The estimated annual cost of care for COVID-19 patients in Kuwait was KD 147.4 (USD 488.5) million, or 5.5% of the MOH budget for 2021, given that 9.03% (383,731) of the population had positive COVID-19 PCR results in 2021. The range of the estimated national economic burden, considering both the best and worst-case scenarios, is KD 73.6 (USD 244.2) million to KD 221.0 (USD 732.7) million. COVID-19 poses a substantial financial strain on the healthcare system, estimated at 5.9% to 8.8% of the MOH's annual budget and 0.2% to 0.7% of Kuwait's GDP in 2021. To mitigate costs, prioritizing prevention and health education is crucial. Targeted strategies, such as workforce optimization, are needed to address high expenses. Policymakers and administrators should leverage these insights for enhanced efficiency and sustainability in future epidemic responses.

Faktor-Faktor Penyebab Pending Klaim BPJS Rawat Inap Di RSUD Dr. Pirngadi Kota Medan Tahun 2022

BPJS claims are submissions for patient care costs for BPJS participants in claiming that there are problems pending claims which are influenced by several factors. The implementation of BPJS claims in submitting files is still delayed so it must be pending, and there are still patient BPJS claim files that are returned for repair, as a result of delays in submitting BPJS claims causing delays in disbursing funds that should be received by the hospital. the factors that cause pending BPJS claims at RSUD Dr. Pirngadi Medan City. The purpose of this study was to determine the factors causing pending claims of BPJS Inpatients at RSUD Dr. Pirngadi Medan City in 2022. This type of research uses a qualitative descriptive method, in this study the population used by officers in the medical record amounted to 4 people and 49 pending files. The results of this study indicate that the cause of pending BPJS claims is caused by differences in perceptions between INA CBG's officers and Verifiers in filling out patient diagnoses, causing obstacles for hospitals, incomplete BPJS claim requirements, diagnoses that are not in accordance with the action, drugs that are not in accordance with diagnostics and the hospital network which is sometimes slow, resulting in errors in the INA-CBGs application and the computer takes a long time to load. Suggestions from this study should be routine checking of the completeness of medical record documents, so that the requirements for submitting BPJS claims have been filled out correctly. The hospital network is further developed so that the work using computer networks is more effective. To equate the perception between the coder and the verifier, it is recommended that officers collaborate more often with doctors regarding diagnosis and disease codes.

Optimizing pectoralis major tendon repair: a modified knotless suture anchor technique using high-strength suture and tape

BackgroundRupture of the pectoralis major tendon is infrequent but has shown an increased incidence in athletes, particularly weightlifters during bench presses. Various techniques for repair exist, yet no established gold standard has been defined. MethodsWe present a modified surgical technique utilizing knotless suture anchors for pectoralis major tendon repair. The technique involves bringing the tendon end superiorly and inferiorly to the decorticated bone surface, ensuring broader tendon-to-bone contact. Knotless anchors with a unique suture locking mechanism facilitate tension adjustment. Additionally, the repair's strength is reinforced by employing both surgical tape and high-strength suture. ResultsThe utilization of both surgical tape and high-strength suture in conjunction with knotless suture anchors provides a secure and stable construct. This approach minimizes the risk of failure, reduces the potential for neurovascular injury associated with bicortical drilling, preserves imaging quality due to the absence of metal artifacts, and helps avoid the risk of fracture associated with traditional methods. However, surgeons should be aware of a potential disadvantage of increased surgical costs compared to traditional techniques. ConclusionsOur modified technique offers multiple advantages, including increased tendon-to-bone contact, enhanced stability, reduced neurovascular risks, and avoidance of potential fractures. This makes it a valuable option for successful pectoralis major tendon repairs. Surgeons should consider its benefits and weigh them against the associated costs for optimal patient care.

Optimizing patient transitions to skilled nursing facilities

Hospital inpatient care costs is the largest component of health care expenditures in the US. At the same time, the number of non-hospital rehabilitative settings, such as Skilled Nursing Facilities (SNFs), has increased. Lower costs and increased availability have made SNFs and other non-hospital rehabilitation settings a promising care alternative to hospitalization. To maximize their benefits, transitions to SNFs require special attention, since poorly coordinated transitions can lead to worse outcomes and higher costs via unnecessary hospital readmissions. This study presents a framework to improve care transitions based on the premise that certain SNFs may provide better care for some patients. We estimate 30-day readmission rates by SNF and patient types using observational data from a tertiary teaching hospital and nearby SNFs. We then analyze and solve a stochastic model optimizing patient transfer decisions to minimize 30-day readmissions. Our model accounts for patient discharge patterns and SNF capacity availability. We provide conditions for when an easy-to-use myopic policy, which assigns discharged patients to the SNF with the lowest readmission rate that is available, is optimal. We also show when an optimal policy has a threshold-like structure. Using estimated readmission rates, we compare the performance of the myopic policy and a proposed policy that depends on the discharge process, readmission rates, and future SNF availability. We evaluate when the myopic policy may be beneficial to use and when the proposed transfer heuristic provides a better alternative. Otherwise, we contend that using a stochastic optimization model for guiding transfer decisions may help reduce readmissions.

Prediction of treatment response in major depressive disorder using a hybrid of convolutional recurrent deep neural networks and effective connectivity based on EEG signal.

In this study, we have developed a novel method based on deep learning and brain effective connectivity to classify responders and non-responders to selective serotonin reuptake inhibitors (SSRIs) antidepressants in major depressive disorder (MDD) patients prior to the treatment using EEG signal. The effective connectivity of 30 MDD patients was determined by analyzing their pretreatment EEG signals, which were then concatenated into delta, theta, alpha, and beta bands and transformed into images. Using these images, we then fine tuned a hybrid Convolutional Neural Network that is enhanced with bidirectional Long Short-Term Memory cells based on transfer learning. The Inception-v3, ResNet18, DenseNet121, and EfficientNet-B0 models are implemented as base models. Finally, the models are followed by BiLSTM and dense layers in order to classify responders and non-responders to SSRI treatment. Results showed that the EfficiencyNet-B0 has the highest accuracy of 98.33, followed by DensNet121, ResNet18 and Inception-v3. Therefore, a new method was proposed in this study that uses deep learning models to extract both spatial and temporal features automatically, which will improve classification results. The proposed method provides accurate identification of MDD patients who are responding, thereby reducing the cost of medical facilities and patient care.