Diagnosis-related Groups Research Articles

Deciphering the Link Between Diagnosis-Related Group Weight and Nursing Care Complexity in Hospitalized Children: An Observational Study

Background/Objectives: The increasing medical and nursing care complexity in hospitalized children represents a significant challenge for healthcare systems. However, the link between these two dimensions remains partially explored. This study aims to decipher the relationship between Diagnosis-Related Group (DRG) weight and nursing care complexity in hospitalized children and to identify the determinants of medical complexity. Methods: This retrospective study, conducted in an Italian university hospital, included children aged 2 to 11 years admitted to the hospital in 2022 with a minimum hospital stay of 2 days. Data were gathered from the Neonatal Pediatric Professional Assessment Instrument and the Hospital Discharge Register. DRG weight was used as an indicator of medical complexity, while the number of nursing diagnoses (NDs) documented in the first 24 h from hospital admission and the nursing actions (NAs) recorded during the patient’s hospital stay were used to measure nursing care complexity. Correlation analyses were conducted to explore the associations between DRG weight, NDs, and NAs. Stepwise regression was run to identify the key determinants of medical complexity across sociodemographic, clinical, organizational, and nursing variables. Results: Among 914 patients (mean age of 6.11 ± 2.90 years), the median DRG weight was 0.6982 (IQR: 0.5522). Patients had an average of 3.89 ± 2.83 NDs and a median of 17 NAs (IQR: 8). Significant correlations were found between NDs and NAs (rs = 0.507; p < 0.001), as well as between DRG weight and the frequency of NDs (rs = 0.232; p < 0.001) and NAs (rs = 0.184; p < 0.001). Stepwise regression indicated that the number of NAs, surgical DRG, scheduled admissions, and ND frequency were significant determinants of DRG weight (R2 = 0.311; adjusted R2 = 0.308; p < 0.001). Conclusions: In children, DRG weight is also influenced by nursing care complexity, alongside clinical and organizational factors. An integrated approach is essential to enhance pediatric care and patient outcomes.

Enlightening Nursing Care: A Protocol for a Multicenter Observational Study Measuring Nursing Work in Hospital Settings

Rising costs and demands for improved quality of care present complex challenges for existing healthcare systems. The strain on healthcare resources is exacerbated by the increasing complexity of patient conditions. The Diagnosis-Related Group (DRG) system classifies inpatients according to clinical and treatment criteria, controls healthcare expenditures, and ensures the sustainability of procedures. The cost of nursing care is included in the DRG system in the same way as other fixed costs of hospital care, but the amount of nursing care provided for the same DRG can vary widely. This study, which is based on this protocol, will aim to assess the variability of nursing costs within and across DRGs and to measure how much variability in nursing care is explained by DRGs by comparing nursing care delivery in acute care hospitals with the DRG reimbursement system in Italy. It is necessary to develop a specific protocol to ensure systematic and consistent data collection at the national level. A multicenter retrospective cross-sectional study will be conducted. A random sample of five public Italian hospitals will be enrolled. Patients included in medical or surgical DRGs, hospitalized and discharged in 2022 will be included. Data will be collected retrospectively from two sources: hospital discharge records and nursing records. Inferential statistics will be used to assess the variability of nursing time and costs across hospitals and DRGs. Nursing costs will be determined by several factors, including time spent on nursing activities and the hourly wages of nursing staff. The time needed to complete each activity will be estimated by a convenience sample of nurses from the hospitals included in this study. The annual salary of nurses will be used to calculate the nursing cost per minute, multipled by the amount of time spent per each nursing activity. The cost per patient per day of hospitalization will be calculated. The results of this study will shed light on the variation in nursing care across different DRGs. This understanding will guide recommendations for optimizing healthcare resource allocation and enhancing the efficiency of the DRG system in Italy.

Left atrial appendage occlusion: trends in demographics and in-hospital outcomes-a German nationwide analysis.

LAAO is an interventional, prophylactic treatment to prevent cardioembolic stroke in patients with non-valvular atrial fibrillation. The aim of this study was to assess gender differences and age-related in-hospital course of all patients undergoing left atrial appendage occlusion (LAAO) in Germany. The Research Data Center of the Federal Statistical Office accessed interrogation of its Diagnosis Related Groups (DRG) statistics database. In a retrospective observational manner, all German in-hospital cases from 2016 to 2022 with a coded LAAO procedure were analyzed. LAAO was performed on a total of 40,435 patients, 39.2% of whom were female. The relative frequency of procedures in the German male population over the age of 60 was twice as high as in the German female population. The median age was 78 (IQR: 72-82) years. Compared to 28.3% in 2016, in 2022 40.1% of all patients were over 80years of age (increased by 152%). Cases of patients over 85years of age increased from 7.7 to 11.4% during the same time period. We found an in-hospital death rate for patients < 70, 70-75, 80-85 and > 85years of age of 0.8, 1.0, 1.4and 2.2% respectively. Further, we saw significantly higher MACE rates (< 75years: 4%, 75-85years: 5%, > 85years: 7%) in patients with a higher age. Gender was not significantly associated with a higher rate of in-hospital mortality. In Germany, LAAO is increasingly performed in older patients with a strong gender imbalance. Age was independently associated with higher in-hospital MACE and mortality rates. This data provides a further basis to balance risks and benefits of LAAO as a preventive procedure and highlights the need for further prospective studies.

Can an increase in nursing care complexity raise the risk of intra-hospital and intensive care unit transfers in children? A retrospective observational study

IntroductionIntra-hospital patient transfers (IPTs) and transfers to intensive care units (ICUs) are high-risk events in pediatric care. Nursing care complexity, reflected by nursing diagnoses (NDs) and nursing actions (NAs), may influence the frequency of these transfers. This study explores the association between nursing care complexity and IPTs, including ICU transfers, in hospitalized children. Materials and methodsA retrospective observational study was conducted at a tertiary care university hospital in Italy. Data from 1013 children aged 2 to 12 years were collected from electronic health records. Sociodemographic, clinical, and nursing data, including NDs and NAs, were analyzed. Latent Class Analysis classified nursing care complexity, while backward elimination regression and binary logistic regression identified predictors of IPTs and ICU transfers. ResultsSignificant positive correlations were found between IPTs and both NDs (rs = 0.326, p < 0.001) and NAs (rs = 0.428, p < 0.001). Key predictors of IPTs included Diagnosis Related Groups (DRG) weight, total comorbidities, surgical DRG, the number of medications used, and high nursing care complexity. ICU-transferred patients had significantly higher nursing care complexity (6.54 vs. 3.46 NDs, p < 0.001; 31 vs. 16 NAs, p < 0.001). High nursing care complexity increased the likelihood of ICU transfer by 18 times (OR = 18.413, p < 0.001). ConclusionNursing care complexity strongly influences IPTs and ICU transfers. Close monitoring of patients with high nursing care complexity is essential to anticipate transfers and reduce clinical risks.

Driving in the Wrong Direction: Exploring the Unintended Consequences of an Early Discharge Program on Length of Stay in Hospital Setting.

Early discharge of patients has become standard work in acute care settings to reduce inpatient length of stay (LOS), improve patient flow, and reduce boarding in the emergency department (ED). Patient-level electronic health record data included discharge order entry time, discharge time, LOS, and diagnosis-related group geometric LOS (GMLOS). Additional unit-level data for ED boarding volumes and hours were included. Analyses were conducted at the hospital and unit levels where indicated. Patients with a discharge order by 9 am have longer mean hours from order to discharge than patients without a discharge order by 9 am (9.04 vs 2.48 hours, P < .001) ED boarding total ( R2 =46.2%, P ≤.001), percentage ( R2 =50.4%, P ≤.001), median minutes ( R2 =24.6%, P =.005), and total minutes ( R2 =40.8%, P ≤.001) all increased as discharge by 11 am performance improved. The mean LOS is longer for the discharge by 11 am group than the non-discharge by 11 am group -1.67; 95% CI, -2.03 to -1.28, P <.001). Discharge by 11 am patients had a LOS/GMLOS ratio 21.9% higher than the non-discharge by 11 am cohort (difference -0.31; 95% CI, -0.36 to -0.26, P < .001). Discharge order entry and release by 9 am and patient physically discharged by 11 am initiatives demonstrate a statistical increase in time from discharge order to discharge time, ED boarding, LOS, and observed-to-expected LOS.

Advancing Patient-Centered Care: A Nationwide Analysis of Hospital Efficiency and Morbidity Using Innovative Propensity Score Techniques.

Introduction The patient-centered care model emphasizes patient autonomy in recovery, acknowledging each individual's unique journey. Despite challenges in the healthcare system, this model has gained traction nationwide. Advances in healthcare technology have highlighted obstacles to independent decision-making. This study addresses these issues by emphasizing the need for consistent access to health information, which is crucial for empowering patients. We aim to proactively identify information gaps and propose new insights for better data precision and synchronization protocols. Our analysis of nationwide hospital length of stay (LOS) data demonstrates data-driven interventions tailored to patients' needs, aiming to improve the hospital experience and reduce care fragmentation. Methods We examined the complex nature of hospital LOS and various variables across nationwide healthcare settings using CMS data from 2011 to 2021. To enhance our national findings, we incorporated a local perspective by analyzing LOS data from Arrowhead Regional Medical Center (ARMC) and its associated diagnosis-related groups (DRGs). We employed a propensity score to adjust for variables and proactively drive realistic predictions of hospital outcomes. This methodological approach emphasizes the importance of using tools that can be scaled from localized settings to a broader national context. Furthermore, our study highlights the critical need for continuous quality assessment of hospital LOS. This includes measuring LOS and developing innovative tools capable of predicting, analyzing, intervening, and prompting actions based on insights gained from data analysis. The study aims to achieve several core objectives by integrating these components: enhancing patient empowerment through improved communication, refining LOS assessment through innovative techniques, and developing predictive tools to inform clinical practice and policy. Ultimately, this research contributes to a more patient-centered approach to managing inpatient care, improving patient outcomes and satisfaction. Results Our study aspires to transform three pivotal domains that can enhance patient autonomy, optimize hospital recovery, and elevate the overall experience. First, the cost of care reveals that prolonged hospital stays and escalating expenses are often linked to more severe health consequences. Second, our analysis uncovers the intricate relationship between hospital outcomes, such as mortality and readmissions, showing that shorter hospital stays can diminish patients' risk of complications. However, we must tread carefully, as this approach may lead to premature discharges. Lastly, providers can gain more precise insights into these interconnected outcomes by leveraging data tools such as propensity scores. We advocate for the dissolution of care fragmentation through robust health information exchange (HIE), and the adoption of innovative strategies such as blockchain and advanced machine learning (ML) techniques that rise to contemporary medicine and adapt to the growing patient needs.

Respiratory Diseases with High Occupational Fraction in Italy: Results from the Italian Hospital Discharge Registry (2010-2021).

Occupational respiratory diseases represent a major public health concern worldwide. This study analyses the hospitalization costs and characteristics of four major occupational respiratory diseases: malignant mesothelioma (MM), sinonasal cancer (SNC), pneumoconiosis (PN), and hypersensitivity pneumonitis (HP). The findings are situated within the context of Italy's population trends and healthcare system, offering insights into the economic and clinical burden of these diseases. This retrospective, population-based study examines Italian hospitalizations for MM, SNC, PN, and HP during the period 2010-2021. The primary outcomes were the number of hospitalizations, length of stay, and associated cost. Costs were derived from charges linked to diagnosis-related groups (version 24) and major diagnostic category coding systems. Though the Italian population is rapidly aging, the annual number and rate of hospitalizations declined by 35% over the study period. SNC hospitalizations aligned with the overall trend, PN and MM experienced faster declines, whereas HP admissions remained steady. MM emerged as the most resource-intensive (EUR 25 million yearly, with 86% attributable to occupation), followed by PN (EUR 10 million, entirely occupational), SNC (EUR 5 million, with EUR 650,000 occupational), and HP (EUR 2 million, with EUR 370,000 occupational). All studied diseases had an average length of stay exceeding the national one. The SNC admissions were the shortest (6.5 days) and least expensive (EUR 3647). In contrast, MM, PN, and HP had a mean length of stay exceeding 10 days, with admission costs averaging EUR 4700 for MM and EUR 4000 for PN and HP. The median age was the highest for PN (78 years) and MM (71 years), while SNC and HP patients had a median age of approximately 65 years. Consistent with their anticipated benefits, Italian workplace health regulations over the last three decades, including the 1992 asbestos ban and D.lgs. 81/2008, are associated with significant reductions in the hospitalization burden and an increased median age at discharge for MM and PN. In contrast, fewer conclusions can be drawn for SNC and HP due to their lower occupational fractions (10-20%). This finding suggests adding an occupational exposure flag in hospital records for acknowledged occupational diseases to enhance surveillance. Finally, this study provides the first estimate of the occupational fraction of hospitalization costs for the studied diseases in Italy.

Patterns of cesarean birth rates in the public and private hospitals of Romania

Caesarean sections (CSs) are essential surgical procedures that can save lives during childbirth, but can also pose health risks for mothers and infants. However, CS rates continue to rise globally beyond recommended values. This study provides a national and regional analysis of CS rates in Romania in 2020 across public and private hospitals, probing the influence of financial incentives on CS overuse, under the Romanian Diagnosis-Related Group (Ro-DRG) payment system. Ro-DRG data was aggregated from all 191 Romanian hospitals (171 public, 20 private) that reported deliveries in 2020, and described using quantitative methods. For each hospital, the Ro-DRG data included the total number of deliveries, the distribution across relevant Ro-DRG codes, and the average length of hospital stay. In 2020, 149,466 childbirth cases were reported through the Ro-DRG system; 89% in public and 11% in private hospitals. The national CS rate was 52.9%, with public hospitals reporting a rate of 49.7% compared to 79.8% in private hospitals. Regionally, CS incidence ranged from 29.89 to 71.42%. The Ro-DRG analysis revealed a high prevalence of high-complexity codes for both CS and natural deliveries, associated with higher payments. Additionally, the average length of hospital stay for CSs was longer in public (5.24 days) than in private hospitals (3.31 days), raising questions about hospital practices and resource utilization. The study suggests that financial incentives might be a contributing factor increasing Romanian CS rates. Targeted policy interventions are essential for aligning financial incentives with clinical necessity and ensuring the efficient use of healthcare resources.

Evaluation of the effect of DRG payment policy based on interrupted time series modeling: evidence from a tertiary hospital in Anhui Province

BackgroundThe payment methodology for diagnosis-related groups (DRG) has implications for both society and medical institutions. Our study aims to analyse the impact of the reform of the payment policy according to the DRG on the operation of a tertiary hospital in Anhui Province.MethodsMonthly data were collected from April 2020 to September 2023 during the reform period for a tertiary hospital on nine types of operational indicators, including average length of stay (ALOS), number of discharges, number of outpatient visits, percentage of discharged patients undergoing level III or IV surgery, bed turnover rate, inpatient essential drug utilization rate, low-risk group mortality, outpatient subaverage cost and inpatient subaverage cost. The data were divided into two phases according to the time of DRG implementation: pre-reform (April 2020–December 2021) and post-reform (January 2022–September 2023), and the segmented regression model with interrupted time series data was used to analyse the changes in the trend of each type of indicator before and after the reform. Statistical analysis was performed using R software (4.3.1).ResultsAfter the implementation of the DRG, the number of discharges increased by 112 800 patients (95% confidence interval [CI] 31.125–194.484, P = 0.008), the bed turnover rate rose by 1.403% (95% CI 1.028–1.778, P = 0.022) and the percentage of discharged patients undergoing level III or IV surgery decreased by 0.098% (95% CI −0.181 to −0.015, P = 0.022). The low-risk group mortality decreased by 0.016% (95% CI −0.027 to −0.005, P = 0.007), and the inpatient subaverage cost decreased by 81.514 CNY (95% CI −121.782 to −41.245, P < 0.001). However, there were no significant differences in the trends of average length of stay, outpatient visits, inpatient essential drug utilization rate and outpatient subaverage cost after the DRG implementation.ConclusionsThe findings show that the DRG reform has positively impacted hospital functioning, including quality, safety, efficiency and costs. Although the average length of stay remained unchanged, there was an increase in discharged patients and outpatient visits, indicating hospitals adapted to the new payment model. The reduction in low-risk group mortality suggests improvements in patient safety and care quality. However, challenges remain, as evidenced by decreased surgical complexity and initial drops in bed turnover rates. While the DRG reform holds promise for enhancing healthcare efficiency and controlling costs, potential negative effects such as patient selection bias and coding changes need to be monitored. Future research should focus on the long-term effects of the DRG policy across different healthcare institutions.

Itemized point cost method in human resource cost accounting in medical service projects

BackgroundThe cost accounting of medical service projects forms the basis for disease cost accounting and DRG (Diagnosis-Related Groups) cost accounting. Among the various costs involved, human resources represent a significant portion and are highly complex, making their accurate accounting a critical and challenging aspect of cost accounting for medical service projects.MethodsThis paper introduces the itemized point cost (IPC) method, a novel cost accounting approach based on the RBRVS (Resource-Based Relative Value Scale) theory. It outlines the core concepts of “points” and “process steps” within the IPC framework and details its application in human cost accounting. An example of impacted tooth extraction in the stomatology department of Hospital A is used to illustrate the IPC method's implementation process.FindingsA comparative analysis with activity-based costing and time-estimation costing methods shows that the IPC method is concise, practical, and operable. It is also aligned with the principles of cost-effectiveness.ConclusionsThe paper proposes strategies to promote the IPC method, including leveraging information technology, enhancing top-level design, and standardizing processes, to improve its adoption and effectiveness in medical cost accounting.

¿En qué áreas podemos mejorar en artroplastia de rodilla en Hospital Clínico Universidad de Chile? Análisis por grupo relacionado a diagnóstico (GRD) 2018 a 2022

Introduction: Knee arthroplasty (TKA) is crucial for treating severe osteoarthritis. The pandemic decreased the number of procedures, leading to significant waiting list. The Hospital Clínico de la Universidad de Chile (HCUCH) is a leader in these surgeries and seeks to optimize its efficiency. Material and Method: Ecological study. Data from Diagnosis Related Groups (DRG) and Ti-Cares from 2018 to 2022 were analyzed. Knee arthroplasty cases were included and hospital stay, use of intermediate beds, surgical time and operating room efficiency were analyzed through exploratory analysis and statistical models. Results: A total of 658 procedures were recorded. The mean age was 66 years and hospital stay was reduced from 4 to 3 days, with a more pronounced decrease after 2020. The use of intermediate beds was frequent (47.87%). Factors such as age, diabetes and comorbidities influenced this usage, with 2019 and 2021 being protective years. Conclusion: Improving management in HCUCH involves reducing hospital stay, optimizing the use of intermediate beds and increasing operating room efficiency. Strategies such as early discharge and use of technology can achieve greater efficiency in procedures, benefiting both patients and the public health system.

Nursing Cost Analysis for Acute Exacerbation of Chronic Obstructive Pulmonary Disease in the Intensive Care Unit.

To determine nursing costs for intensive care unit (ICU) patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD), assess the correlation with diagnosis-related group (DRG) payments and identify cost determinants. Prospective, descriptive and quantitative study. From January to December 2022, we selected ICU patients with AECOPD and used time-driven activity-based costing method to calculate the overall nursing costs. We examined the cost recovery rate, correlations between nursing costs and DRG Relative Weight, and factors influencing nursing costs using nonparametric tests, Spearman's rank correlation and quantile regression. The median nursing charge was US$1001.88, the median nursing cost was US$678.51, and the average cost recovery rate was 68.39%. Nursing costs correlated with the DRG Relative Weight but not with payments. Length of stay, oxygen therapy mode and noninvasive ventilator use days impacted costs. Nursing costs exceeded charges, with a moderate cost recovery rate. DRG payments do not fully reflect nursing cost variations. Our findings indicate the need to enhance the reimbursement system for nursing costs and to manage ICU nursing expenses by addressing the determinants of these costs. The authors adhered to the EQUATOR network guidelines STROBE to report observational cross-sectional studies.

Medical costs of treating myasthenia gravis in patients who need intravenous immunoglobulin (IVIg) – a register-based study

BackgroundSeveral innovative treatments are expected for myasthenia gravis (MG) in the coming years. Healthcare payers usually require cost-effectiveness analyses before reimbursement. We aimed to investigate resource utilization and direct medical costs for patients with MG treated with intravenous immunoglobulin (IVIg) to inform such analyses.MethodsWe identified patients with MG in the Norwegian Patient Registry based on at least two hospital encounters with an MG diagnosis (ICD-10 G70.0) from 1 Jan 2010 to 31 Dec 2021. IVIg treatment was identified by medical procedure and Anatomical Therapeutic Chemical (ATC) codes (RPGM05 and J06BA02). Using Diagnosis-Related Group (DRG) cost weights, we estimated direct medical costs for each year following the first MG diagnosis.ResultsOver the study period, 1083 patients were diagnosed with MG in Norway, of whom 155 (14.3%) were treated with IVIg. No significant differences in age or sex were observed between IVIg and non-IVIg patients. Compared with non-IVIg patients, IVIg-patients had 2.3 times higher direct medical costs during the first year after MG diagnosis (EUR 35,714 vs. EUR 15,457) and 3.1 times higher costs during the second year (EUR 19,119 vs. EUR 6256). In the fifth year after diagnosis, IVIg-patients still had higher costs and resource utilization than non-IVIg patients (EUR 9953 vs. EUR 5634).ConclusionIVIg treatment represents an important marker for high direct medical costs among patients with MG. The costs continue to be high during the first five years after MG diagnosis.

HSD124 Application of Diagnosis-Related Group (DRG) in Measuring the Impact of Clinical Pathway on Resource Utilization for Patients Suspected With Acute Coronary Syndrome in the Emergency Department

HSD124 Application of Diagnosis-Related Group (DRG) in Measuring the Impact of Clinical Pathway on Resource Utilization for Patients Suspected With Acute Coronary Syndrome in the Emergency Department

HPR29 Impact of Diagnosis-Related Groups (DRG) Payment on the Quality and Efficiency of Peripheral Arterial Disease (PAD) Care: A Mixed-Methods Study

HPR29 Impact of Diagnosis-Related Groups (DRG) Payment on the Quality and Efficiency of Peripheral Arterial Disease (PAD) Care: A Mixed-Methods Study

Upcoding Linked To Up To Two-Thirds Of Growth In Highest-Intensity Hospital Discharges In 5 States, 2011-19.

Diagnosis-based payment systems can create incentives to upcode patients to a higher level of severity to increase payment. In some instances, upcoding can be a form of fraud if providers code patients to a higher complexity than is appropriate, whereas in other instances, upcoding can accurately reflect patient acuity. We estimated the increase in Medicare Severity Diagnosis-Related Group (MS-DRG) upcoding during the period 2011-19, using all-payer discharge-level data from five states. During this period, the number of discharges with the highest MS-DRG coding intensity increased by 41percent. Adjusting for changes in patient characteristics, length-of-stay, and hospital characteristics, we estimated that the increase would have been 13percent in the absence of changes in coding behavior. We estimated that in 2019, the increase in upcoding (relative to 2011 coding practices) was associated with $14.6billion in hospital payments, including $5.8billion from private health plans, $4.6billion from Medicare, and $1.8billion from Medicaid. These findings can contribute to the growing body of evidence supporting the design of payment models that limit distortions in payment and resource allocation.

Analysis of the impact of China Healthcare Security diagnosis-related groups payment reform on the hospitalization costs for uvulopalatopharyngoplasty in obstructive sleep apnea patients at Hospital C

BackgroundAs part of China’s medical insurance-related grouping payment reform, public hospitals, which are the primary providers of medical insurance services, face remarkable pressure to control costs. This study examined uvulopalatopharyngoplasty (UPPP) surgery for patients with obstructive sleep apnea (OSA) at Hospital C to identify factors influencing inpatient costs and assess the impact of payment reform on treatment practices.MethodsUsing data from 251 OSA patients undergoing UPPP at Hospital C, the study evaluated changes in cost reduction, cost structure, patient disease severity, and medical quality before and after the payment reform.ResultsInpatient costs for OSA patients undergoing UPPP surgery significantly decreased following the trial implementation of CHS-DRG, with notable reductions in medication and consumable expenses, as well as a shorter length of hospitalization. The CHS-DRG reform did not affect illness severity, patient safety during hospitalization, or long-term surgical outcomes for OSA patients.ConclusionAfter the CHS-DRG reform, Hospital C proactively adjusted clinical pathways to manage costs and improve inpatient turnover efficiency without resorting to cost-shifting, patient refusal, or staged surgeries. Despite the financial pressures, hospitals should aim to establish a win-win mechanism between hospitals, physicians, and patients, enhance internal management, and improve financial performance. Additionally, medical security authorities should explore more precise DRG payments and value-based payment models to promote high-quality hospital development rather than impose constraints.Study approvalThis study was approved by the Ethics Committee of Beijing Tsinghua Changgung Hospital (Approval No. 23418-0-02).

Use of inpatient systemic chemotherapy and/or radiotherapy and related predictive factors, healthcare resource utilization, and direct hospitalization costs for metastatic urothelial cancer: findings from a real-world retrospective observational study derived from the national hospital discharge claims database in Italy

BackgroundRecent real-world studies revealed high proportions of patients with metastatic urothelial cancer (mUC) do not receive any systemic therapy. This study describes the demographics, clinical characteristics, treatment rate and related predictive factors, healthcare resource utilization, and direct medical costs of patients with mUC receiving systemic therapy (or not) in the inpatient setting in Italy.MethodsThis retrospective observational study used the national hospital discharge database (Scheda di Dimissione Ospedaliera) to describe incident adult (≥ 18 years) patients with a first hospitalization for mUC (index) from 2017-2018, identified by a combination of ICD-9-CM (International Classification of Diseases, Ninth Revision, Clinical Modification), medical procedure, and diagnosis-related group codes. A model was fitted to identify factors associated with receiving inpatient chemotherapy and/or radiotherapy.ResultsOf 3674 patients with mUC identified, 1014 (27.6%) were treated with inpatient chemotherapy and/or radiotherapy and 2660 (72.4%) were not treated. The median age at index was 71 and 78 years for treated and untreated patients, and the mean (SD) Charlson Comorbidity Index (CCI) score was 0.3 (0.8) and 0.6 (1.1), respectively. Primary tumor location was the bladder in 87.2% of patients. Cardiovascular disease and renal function impairment were more prevalent in untreated (22.6% and 13.2%) vs treated (16.7% and 7.8%) patients. Older age (odds ratio [p-value]) (0.94 [< 0.001]), female sex (0.82 [0.035]), and higher CCI score (0.82 [< 0.001]) were all associated with a lower likelihood of receiving inpatient systemic treatment. The first year was the costliest: estimated national projected costs during the 36-month follow-up from first hospitalization for mUC were €34.3 million (95% CI, €30.3-€60.0 million) and €31.8 million (95% CI, €28.1-€56.0 million) when estimated after 1 year.ConclusionsOur findings indicate a low rate of inpatient systemic therapy for patients with mUC in Italy (driven by older age, female sex, and high comorbidity burden), with a large economic burden despite a high nontreatment rate. Although this study provides a partial capture of the treatment pathway in Italy, the results are consistent with other European studies with similar designs and highlight the need to better identify the reasons for not administering inpatient systemic chemotherapy and/or radiotherapy.

A little goes a long way: A comparison of enterolithotomy versus single-stage cholecystectomy in the management of gallstone ileus

INTRODUCTION Gallstone ileus is an infrequent complication of cholelithiasis with no specific guidelines for its management. This study aims to compare the outcomes of patients with gallstone ileus managed with both enterolithotomy with cholecystectomy (EL-CCY) versus those managed with enterolithotomy (EL) only. METHODS In this retrospective analysis of 2011–2017 Nationwide Readmissions Database, all patients with an index admission diagnosis of gallstone ileus were included. Patients were stratified based on the type of intervention received for gallstone ileus into those who underwent EL-CCY and those who underwent EL alone and compared. Primary outcomes were in-hospital complications (surgical site infections, sepsis, pneumonia, cardiac arrest, deep vein thrombosis, intestinal obstruction) and mortality. Secondary outcomes were hospital length of stay, hospital costs, and readmissions rate and cause of readmissions. Multivariable logistic regression analysis was performed. RESULTS A total of 1,960 patients were identified. The mean age was 67 years and 67% were female. Two hundred eighty-nine patients (14.7%) were managed with EL-CCY, whereas 1,671 patients (85.3%) underwent EL only. Overall, the readmission rate was 4.8%, whereas mortality was 4.2%. There was no significant difference between groups in terms of index-admission complications (24.8% vs. 21.7%, p = 0.415), mortality (6.2% vs. 3.9%, p = 0.068), rates of readmission (3.5% vs. 5.1%, p = 0.22), and cause of readmission (p &gt; 0.05). Enterolithotomy and cholecystectomy group had significantly longer hospital length of stay (10 vs. 8 days, p &lt; 0.001) and median hospital costs ($70,959 vs. $52,147, p &lt; 0.001). On multivariable logistic regression analysis, female sex was a predictor of undergoing EL-CCY, whereas increasing age and higher grade of all-patient redefined diagnosis-related groups risk of mortality were independently associated with lower odds of undergoing EL-CCY. CONCLUSION Our findings suggest no difference between EL compared with EL-CCY in terms of complications, readmissions, and mortality. However, patients managed with EL-CCY had a longer hospital stay and higher hospital costs compared with EL. Further prospective studies are needed to validate these findings and develop management protocols for gallstone ileus. LEVEL OF EVIDENCE Therapeutic/Care Management; Level III.

Assessing diagnosis-related groups based direct medical expenditures of chronic disease patients in general hospital of lower southern Thailand

BackgroundAssessment of the cost-related burden of chronic diseases is important for making informed decisions. An effective and efficient methodology for examining medical expenditures is one of the most significant challenges for stakeholders. The objective of this study was to examine the role of the variables of diagnosis-related group (DRG) in determining the direct expense of chronic diseases in lower southern Thailand and suggest the determinants having high explainability.MethodsThe records of 6,147 patients admitted to Satun Hospital from 2014 to 2018 and diagnosed with chronic conditions were analyzed in this study. Descriptive analysis was used to summarize the main characteristics. Correlation was used to analyze the strength of the relationship. A log-linear regression model was used to evaluate the adjusted mean cost using determinants of DRG.ResultsThe overall average medical expense for chronic disease was Thailand Baht (THB) 17,985. Chronic kidney and chronic obstructive pulmonary diseases were the most expensive chronic diseases with an average expense of about THB 20,000 and 25,000. All the determinants were significantly contributing to overall expense of chronic disease with a p-value < 0.001. However, the length of stay, number of diagnoses, and number of procedures had high explainability in the expense model.ConclusionsThe expense assessment model plays a significant role in controlling and preventing the medical costs associated with chronic diseases. Healthcare administrators, stakeholders, and researchers need to make strategies by considering the results of this study to improve the DRGs-based hospital cost model.