Decrease In Utilization Rate Research Articles

Assessing the Impact of 2-Step Clostridioides difficile Testing at the Healthcare Facility Level.

Two-step testing for Clostridioides difficile infection (CDI) aims to improve diagnostic specificity but may also influence reported epidemiology and patterns of treatment. Some providers fear that 2-step testing may result in adverse outcomes if C. difficile is underdiagnosed. Our primary objective was to assess the impact of 2-step testing on reported incidence of hospital-onset CDI (HO-CDI). As secondary objectives, we assessed the impact of 2-step testing on C. difficile-specific antibiotic use and colectomy rates as proxies for harm from underdiagnosis or delayed treatment. This longitudinal cohort study included 2 657 324 patient-days across 8 regional hospitals from July 2017 through March 2022. Impact of 2-step testing was assessed by time series analysis with generalized estimating equation regression models. Two-step testing was associated with a level decrease in HO-CDI incidence (incidence rate ratio, 0.53 [95% confidence interval {CI}, .48-.60]; P < .001), a similar level decrease in utilization rates for oral vancomycin and fidaxomicin (utilization rate ratio, 0.63 [95% CI, .58-.70]; P < .001), and no significant level (rate ratio, 1.16 [95% CI, .93-1.43]; P = .18) or trend (rate ratio, 0.85 [95% CI, .52-1.39]; P = .51) change in emergent colectomy rates. Two-step testing is associated with decreased reported incidence of HO-CDI, likely by improving diagnostic specificity. The parallel decrease in C. difficile-specific antibiotic use offers indirect reassurance against underdiagnosis of C. difficile infections still requiring treatment by clinician assessment. Similarly, the absence of any significant change in colectomy rates offers indirect reassurance against any rise in fulminant C. difficile requiring surgical management.

ANALISIS METODE ANTREAN DAN SIMULASI MONTE CARLO PADA ANTREAN DINAS KEPENDUDUKAN DAN PENCATATAN SIPIL (DISDUKCAPIL) KOTA SALATIGA DILENGKAPI GUI-R

One of the services that often occurs in everyday life is the queue service. Queues can arise due to delays in a service system in providing a service, resulting in a row of a group of people to get a service. The queue analyzed in this study is a queue in The Salatiga City Disdukcapil. The parameters on which this research is based are the number of arrivals (λ) and service time (μ) of visitors who arrive. The methods used are queue analysis and Monte Carlo simulation. The Monte Carlo method provides more effective results at each counter than using queue analysis. The result of this study is a decrease in the utilization rate of service facilities, so that it is accompanied by a decrease in the size of system performance for the calculation of Lq, Ls, Wq, and Ws. Decreases in utilization rates and system performance measures at each counter make an increase in the probability of idle systems at each counter. The model generated by the sample data with the Monte Carlo simulation data tends to be the same, namely for counter 1,2,3,4, counter 5 model (G/G/c):(GD/¥/¥), and for counter 6 with queuing model ( G/M/1):(GD/¥/¥).

Rice Machinery Requirement in La Union, Philippines: A Basis for Prioritizing Deployment

The implementation of the Republic Act No. 11203 mandates the development of a just and appropriate agricultural mechanization strategy. Thus, this study is conceptualized to calculate the rice machinery requirement and the mechanization level of La Union, Philippines. The utilization rate of existing machinery considers 100% and 70% in case the calculation is surplus. Furthermore, this aims to validate if there is no machinery requirement despite the 30% decrease in utilization rate. Hence, the results have revealed a need for 674 units of riding-type transplanters, 31 units of a rice combine harvester, 422 units of recirculating dryers, and 61 units of multi-pass rice mills. The rice mechanization level is moderately mechanized. However, only tillage operation is moderately mechanized; the transplanting, harvesting, drying and milling are low mechanised. These findings could serve as bases in the formulation of policies and strategies prioritizing suitable areas for machinery intervention in the province.

Treatment patterns and costs ofpatients with ankylosing spondylitisinitiating biologic therapy in taiwan - apopulation-based analysis

Objective: To evaluate the real-world treatment patterns and costs of patients initiating their first biologic therapy for the treatment of ankylosing spondylitis (AS) in Taiwan. Methods: Taiwan’s National Health Insurance claims data between 1/1/2014 and 12/31/2017 was used to identify and follow patients with AS initiating their first biologic therapy in 2015. Patients >= 18 years of age, with AS (ICD-9-CM: 720.0), a claim for a biologic therapy in 2015, continuous enrollment for at least one year following index, and no claims for biologics in the previous year were indexed into the study. A matched cohort of non-biologic patients with AS receiving anti-inflammatory drugs was derived. Patients were followed from their index date (first biologic claim) through the end of the study period, death, or they were lost to follow-up. Results: There were 430 as patients included in the biologic-initiators cohort (adalimumab = 191; etanercept = 122; golimumab = 177, etc.). Pre-Index utilization rates were significantly higher for biologic-initiators compared to the matched cohort for corticosteroids, opioids, and csDMARDs (all p<0.0001). Utilization rates of NSAIDs and csDMARDs were lower for biologic initiators and higher for the matched cohort during the follow-up period compared to the pre-index period. Mean total healthcare costs were higher and average non-medication costs were lower for biologic-initiators compared to the matched cohort during the two years post-index. Conclusions: Patients initiating their first biologic therapy for AS had high rates of as-related medication utilization during the pre-index period followed by a decrease in utilization rates after biologic initiation.

The Right to Health and the Health Effects of Denials

We estimate the health costs of supply-side barriers to accessing medical care. The setting is Colombia, where citizens have a constitutional right to health care, but insurance companies that manage delivery impose restrictions on access. We use administrative data on judicial claims for health as a proxy for unmet demand. We validate this using the register recording all health service utilization, estimating that a one standard deviation increase in judicial claims is associated with pervasive decreases in utilization rates of between 0.25 and 0.71 standard deviations, including in medical consultations, procedures, hospitalizations and emergency care. These restrictions on access manifest in population health outcomes. We estimate that a one standard deviation increase in judicial claims increases the all-cause mortality rate by between 0.10 and 0.23 standard deviations. Increases in mortality are pervasive across causes, with the largest increase in deaths from certain cancers. They are also pervasive across the age and sex distribution but larger among individuals over the age of fifty and (weakly) among women and the low-income population.

Episode-based cost reduction for endovascular aneurysm repair

ObjectiveEffective strategies to reduce costs associated with endovascular aneurysm repair (EVAR) remain elusive for many medical centers. In this study, targeted interventions to reduce inpatient EVAR costs were identified and implemented. MethodsFrom June 2015 to February 2016, we analyzed the EVAR practice at a high-volume academic medical center to identify, to rank, and ultimately to reduce procedure-related costs. In this analysis, per-patient direct costs to the hospital were compared before (September 2013-May 2015) and after (March 2016-January 2017) interventions were implemented. Improvement efforts concentrated on three categories that accounted for a majority of costs: implants, rooming costs, and computed tomography scans performed during the index hospitalization. ResultsCosts were compared between 141 EVAR procedures before implementation (PRE period) and 47 EVAR procedures after implementation (POST period). Based on data obtained through the Society for Vascular Surgery EVAR Cost Demonstration Project, it was determined that implantable device costs were higher than those at peer institutions. New purchasing strategies were implemented, resulting in a 30.8% decrease in per-case device costs between the PRE and POST periods. Care pathways were modified to reduce use of and costs for computed tomography scans obtained during the index hospitalization. Compared with baseline, per-case imaging costs decreased by 92.9% (P < .001), including a 99.0% (P = .001) reduction in postprocessing costs. Care pathways were also implemented to reduce preprocedural rooming for patients traveling long distances the day before surgery, resulting in a 50% decrease in utilization rate (35.4% PRE to 17.0% POST; P = .021), without having a significant impact on median postprocedural length of stay (PRE, 2 days [interquartile range, 1-11 days]; POST, 2 days [1-7 days]; P = .185). Medication costs also decreased by 38.2% (P < .001) as a hospital-wide effort. ConclusionsExcessive costs associated with EVAR threaten the sustainability of these procedures in health care organizations. Targeted cost reduction efforts can effectively reduce expenses without compromising quality or limiting patients' access.

Trends in Utilization of Outpatient Respiratory Syncytial Virus Prophylaxis with Palivizumab among Medicaid- and Commercially Insured Infants.

IntroductionPalivizumab is indicated for the prevention of respiratory syncytial virus (RSV) infection in high-risk children. Previous palivizumab utilization studies examined prior authorization claims but did not examine utilization within insured populations as a whole. This study describes outpatient palivizumab utilization trends and characterizes high-risk infants receiving palivizumab within Medicaid- and commercially insured populations.MethodsInfants born July 1, 2003 through June 30, 2013 were identified in the MarketScan® Multistate Medicaid and Commercial claims databases. Infants with ≥ 18 months of continuous medical insurance enrollment with pharmacy benefits after birth and evidence of chronic lung disease of prematurity (CLDP), congenital heart disease (CHD), or preterm birth without CLDP or CHD were studied. Palivizumab use and demographic and clinical characteristics were measured in infant subgroups. Outpatient palivizumab utilization rates were calculated for each seasonal year (July–June) and for each infant subgroup.ResultsIn total, 29,350 (2.1%) Medicaid-insured and 9589 (2.5%) commercially insured infants received palivizumab and had CLDP, CHD, or were born at < 37 weeks gestational age (wGA). Infants with CLDP (82%) and those < 29 wGA (78%) had the highest utilization. Decreases in utilization rates between the 2003–2004 and 2012–2013 seasons were seen among Medicaid-insured infants born at 29–36 wGA (all P < .0001), and commercially insured infants born at 31–32 wGA (P < .0001), 33–34 wGA (P = .055), 35–36 wGA (P < .0001), and with CHD (P = .003). Utilization by month was consistent across subgroups among Medicaid- and commercially insured infants, with most doses administered from November to March.ConclusionPalivizumab use is targeted to a small percentage of infants who are at highest risk of hospitalization for RSV disease. Utilization declined in recent years in both Medicaid- and commercially insured infant groups. Most palivizumab doses were administered from November to March, with most infants receiving ≤ 5 doses.FundingAstraZeneca.Electronic supplementary materialThe online version of this article (10.1007/s40121-017-0178-6) contains supplementary material, which is available to authorized users.

An Antimicrobial Stewardship Initiative within a for-profit hospital: Impact of Criteria for Appropriate Use on Utilization

BackgroundAntimicrobial Stewardship Programs (ASP) have shown improved patient outcomes, reduced adverse events, improved antibiotic susceptibilities, and optimized resource utilization. With the re-introduction of a formal ASP at our for-profit, non-teaching, community hospital in early 2016 in response to both legislative and corporate requirements, we sought to evaluate the impact of one of our ASP initiatives, Criteria for Appropriate Use, on utilization of three specific antimicrobial agents: Daptomycin (DAP), Tigecycline (TIG) and Ertapenem (ERT). The results of this investigation will help characterize various shifts in prescribing practices facilitated by an ASP initiative as well as quantify resultant trends in utilization.MethodsThis single-center, retrospective cohort study included patients who received DAP, TIG, or ERT in matched time periods: July – Sept 2015 (pre-ASP) and July – Sept 2016 (post-ASP). Patients were analyzed based on demographics, antibiotic use, days of therapy (DOT), indication (criteria for use), prescriber, infection type, and antibiotic course. Cost data and adjusted patient-days (APD) were extracted from hospital records.Results644 cases were included. There were 555 pre-ASP cases per 31,884 APD: 128 (DAP), 368 (ERT), and 59 (TIG). In the post-ASP group, there were 89 cases per 30,960 APD: 40 (DAP), 39 (ERT), and 10 (TIG). Significant decreases were realized in the post-ASP period in: restricted antibiotic utilization (17.4 vs.. 2.9 cases/1000 APD, P < 0.0001), duration (58.2 vs. 14.3 DOT/1000 APD, P < 0.0001), off-criteria use (3.6 vs. 0.65 cases/1000 APD, P < 0.0001), and cost ($12.92 vs. $2.88/APD, P < 0.0001).ConclusionThe results of this study show that introduction of ASP, specifically Criteria for Appropriate Use implementation, was associated with not only significant decreases in utilization rates and antimicrobial cost, but significant shifts in prescriber behavior.Disclosures All authors: No reported disclosures.

Brachytherapy plus External Beam Radiation Therapy Utilization Pattern Change between Years 1998-2003 and 2004-2009 Based on SEER Data Analysis

Brachytherapy combined with external beam radiation therapy is an important component of definitive treatment of cervix cancer. Our study estimates how the overall change in incidence rates affects the pattern of brachytherapy utilization for cervix cancer. The SEER*Stat 7.0.0 was accessed to identify trends in treatment of cervix cancer using Surveillance Epidemiology and End Results (SEER) 13. Chi-square tests were performed on rate ratios to determine if differences exist among treatment patterns between the two time periods: 1998-2003 and 2004-2009. The incidence of cervical cancer declined from 1998 - 03 to 2004 - 09, (p<0.0001). The overall brachytherapy plus external beam radiation therapy utilization rate for all stages of cervix cancer has decreased (p<0.0001). Subset analysis shows that there was trend to decline but not statistically significant change in rate for stage 1 (p=0.0599). However, there was a significant decrease in utilization rate for stage II, stage III and stage IV (p<0.001) cases. There was no expected change in utilization rate of surgery in stage I cervix cancer (p=0.27). Incidence of cervix cancer is gradually declining in the United States. Our study of SEER data registry confirms decline in overall incidence of cervix cancer over the examined six year time frames. We find an overall decline in cervix cancer brachytherapy plus external beam radiation therapy utilization rate. This change is noted in stage II to stage IV disease. No significant change in the utilization of brachytherapy plus external beam radiation is demonstrated in stage I cases. Correspondingly, no significant change in utilization rate of surgery is noted in stage I. The pattern of decline in the utilization rate of therapy incorporating brachytherapy in locally advanced stages of cervix cancer where it is most needed, is alarming and needs to be further addressed to ensure its availability and appropriate care of the patient.

The outlook of the Korean petroleum industry and its deregulation process

This paper explores the outlook for the oil product supply and demand balance in Korea and the implications for future refinery market conditions. Forecasts of demand growth are compared with the industry's recent capacity expansion to evaluate potential future market positions. The possible impact of the current deregulation process, started in January 1977, is summarized. In addition, the short-term and long-term uncertainties of the market are discussed. The future business environment for refiners in Korea is likely to be tougher than expected. Although substantial new refining capacity was added recently, the demand for oil products is expected to increase less rapidly. The overall product balance and the threat of imports from outside the region indicate that refiners may suffer from a decrease in utilization rate. Challenges lie ahead if Korean oil refiners are to be part of a successful and mature industry.

Effects of nonparticipation in trauma center system on emergency department utilization

The University of Illinois Hospital (UIH) serves an inner-city urban population in one of the highest crime rate districts in Chicago. On May 20, 1986, the city's Level I Trauma ordinance took effect with the University of Illinois Hospital declining to participate. To measure the impact of the ordinance on a nonparticipating hospital, we undertook a retrospective analysis of our trauma patient utilization statistics. Consecutive monthly patient census data of 71 months was compiled with emphasis on patient presenting complaints and related subspecialty evaluation. We observed significant decreases of patients presenting with head injuries, fractures, and animal bites as well as with major trauma, minor trauma, and general surgery hospital admission. The final disposition of the patients arriving by ambulance was consistent with the observed decrease in major traumatic conditions and in minor traumatic conditions. However, the mean number of patient presentations per day (ppd) admitted to regular medical or surgical beds decreased from 2.70 ppd to 2.30 ppd while the mean number of ppd sent home increased from 2.64 ppd to 3.49 ppd. These data suggest that loss of trauma center status designation has a profound effect on utilization of emergency departments not participating in the trauma system. Nonparticipation appears to be associated with a significant decrease in utilization rates for major and minor trauma patients and a significant increase in the number of patients discharged who had arrived by the Chicago Fire Department Paramedic System (CFD). This effect on the emergency department extends to utilization of inpatient services.