Diagnosis-related Groups Research Articles

Surgical treatment of posttraumatic spinal cord tethering and syringomyelia: a retrospective cohort investigation of cost, reimbursement, and financial sustainability.

Posttraumatic spinal cord tethering and syringomyelia are considered disabling diseases in patients with spinal cord injury. In symptomatic patients, surgical management can achieve promising clinical outcomes. As the raising economic pressure might jeopardize optimal and thus personalized patient care, we aimed to exemplify expenses of surgical treatment in contrast to reimbursement by the Swiss diagnosis related group (DRG) system. This retrospective investigation includes 60 patients who underwent surgery for spinal cord tethering and syringomyelia. The duration of surgeries was used to estimate the costs of care in the operating room (OR) considering established bench marks. Coverage of costs was calculated by comparing Swiss DRG reimbursements with the expenses from the investigated cases. The mean duration of surgeries was 251.0 ± 93.5min while 2.8 ± 1.4 vertebral segments were treated by spinal cord untethering. The mean OR costs (in USD) were $9,401.2±$3,500.2 (range $4,119.5 to $20,223.0). The mean reimbursement and the ratio of OR costs to reimbursement (in USD) were $24,122.5±$7,409.3 (range $17,249.8 to $31,977.1) and 0.41 ± 0.15 (range 0.14 to 0.74) for standard, and $39,106.0±$4,028.6 (range $35,369.1 to $43,376.8) and 0.24 ± 0.08 (range 0.10 to 0.47) for complex cases, respectively. The estimated costs of surgeries were different from reimbursements (p = 0.005). Although the cost of surgical management of patients with posttraumatic spinal cord tethering and syringomyelia are principally covered, it remains questionable if total hospital expenses are sufficiently outweighed by the current reimbursement system. This could potentially limit the availability of best medical care and might endanger personalized patient management.

Correlation between Diagnosis-related Group Weights and Nursing Time in the Cardiology Department: A Cross-sectional Study.

Diagnosis-related group (DRG) payment has become the main way of medical expenses settlement, and its application is more and more extensive. This study aimed to explore the correlation between DRG weights and nursing time and to develop a predictive model for nursing time in the cardiology department based on DRG weights and other factors. The convenience sampling method was used to select patients who were hospitalised in the cardiology ward of our hospital between April 2023 and April 2024 as the study participants. Nursing time was measured by direct and indirect nursing time. For the distribution of nursing time with different demographic characteristics, Pearson correlation was used to analyse the relationship between DRG weights and nursing time and multiple linear regression was used to analyse the influencing factors of total nursing time. A total of 103 subjects were included in this study. The DRG weights were positively correlated with ln(direct nursing time), ln(indirect nursing time) and ln(total nursing time) (r = 0.480, r = 0.394, r = 0.448, all P < .001). Moreover, age was positively correlated with the three nursing times (r = 0.235, r = 0.192, r = 0.235, all P < .001); activities of daily living (ADL) on admission was negatively correlated with the three nursing times (r = -0.316, r = -0.252, r = -0.301, all P < .001); and nursing level on the first day of admission was positively correlated with the three nursing times (r = 0.333, r = 0.332, r = 0.352, all P < .001). Furthermore, the multivariate analysis found that nursing levels on the first day of admission, complications or comorbidities, DRG weights and ADL on admission were the influencing factors of the nursing time of patients (R2 = 0.328, F = 69.58, P < .001). Diagnosis-related group weights showed a strong correlation with nursing time and can be used to predict nursing time, which may assist in nursing resource allocation in cardiology departments.

Emergency hand surgery in the course of time : Clinical and economic aspects of inpatient and outpatient cases at auniversity hospital in the last decade

Hand surgery departments nowadays face the challenge of operating profitably, training new specialists, managing increasing case numbers and implementing the required shift towards outpatient care in clinical practice. The aim of this study was to describe the demographic and economic indicators of auniversity hospital and to examine the development of inpatient and outpatient case numbers over the past decade. Aretrospective data analysis was carried out for patients treated for hand injuries in the period from 2013 to 2023. The main diagnoses of cases were identified and descriptively analyzed using the International Classification of Diseases (ICD). In order to demonstrate acorrelation, alinear regression model was calculated and ap-value <0.05 was considered significant. In total, 2918 cases were included over adecade starting in 2013. Out of these 776 cases were treated on an outpatient basis and two thirds of the patients were male. The patients were generally healthy with an average American Society of Anesthesiologists (ASA) status of 1.6 ± 0.6 and with apatient clinical complexity level (PCCL) of 0 in 79% of cases. Patient numbers increased continuously from 161 cases in 2013 to 393 cases in 2022 (p < 0.001). The most common main diagnosis was infectious hand diseases (L02.4-M65.14). This resulted in the most frequently assigned diagnosis-related group (DRG) being I32E (319 cases). For inpatient cases the average incision-to-suture time was 51:51 min and for outpatient cases 26:03 min. The revenue was on average 4372.90 € per inpatient case and 300.77 € per outpatient case. The rate of examinations by the German Medical Service of Health Funds (Medizinischer Dienst) was 19% over the entire observational period. The increasing case numbers in the outpatient and inpatient sectors indicate acentralization and consolidation of hand surgical expertise in the region. There are significant revenue differences between outpatient and inpatient cases.

The influence of policy advocacy and education on medical staff’s adaptation to diagnosis related groups payment reform in China: an analysis of the mediating effect of policy cognition

IntroductionIn recent years, China has been carrying out the Diagnosis Related Groups (DRGs) payment reform, which has an impact not only on payment methods and medical expenses, but also on the behaviors of medical staff. Some of these behaviors are unexpected by policymakers, such as turning away critically ill patients, disaggregating hospitalization costs, setting up disease groups with higher points, and so on. This phenomenon attracted the attention of some scholars, who put forward a few positive intervention measures, mainly including policy advocacy and system improvement. The scholars believed that the former was more feasible. However, there is a lack of research on the effects and influencing processes of these interventions. Therefore, this study aims to explore the influence of policy advocacy and education on medical staff’s adaptation to DRGs payment reform in China and the role of policy cognition in this process, in order to provide experiences for the smooth implementation and sustainable development of DRGs payment system.MethodsA questionnaire survey was conducted among 650 medical staff in five large general hospitals in Zhejiang Province, China, to understand their participation and feedback on policy advocacy and education, their adaptation to the current DRGs payment reform, and their cognition of relevant policies. After descriptive statistical analysis, partial correlation analysis, multiple linear regression models and bias correction Bootstrap sampling method were used to analyze the mediating effect of policy cognition factors.ResultsAll respondents had participated in organized collective policy advocacy and education activities in the past year, but the degree of satisfaction and recognition was not very high. 59.5 percent said their adaptation to the DRGs payment reform was average. Nearly half did not regularly pay attention to and participate in the management of the medical costs of patients with DRGs through compliance. And they had a low understanding of the specific rules of DRGs payment and did not form a high policy identity. The mediating effect values of policy cognition were 0.148, 0.152, 0.108, and 0.057, respectively, when the frequency and quality of policy advocacy and education influenced medical staff’s adaptive perception and adaptive behaviors.DiscussionThe organized collective policy advocacy and education can promote medical staff’s adaptation to DRGs payment reform by improving their policy cognition, and the action paths are diverse. Policymakers and hospital managers need pay attention to this phenomenon, and formulate demand-centered, value-oriented whole-process advocacy and education strategies while constantly improving the DRGs payment system. All of these provided a basis for further research and practice of positive intervention in DRGs payment reform.

Hybrid diagnosis-related groups-The challenge

The introduction of hybrid diagnosis-related groups (DRG) presents new challenges for healthcare providers and health insurances. The same applied in 2023 to the institute designated by the Federal Ministry of Health (BMG) to extract medical procedures and calculate remuneration levels for the first hybrid DRGs. Aresponsible calculation methodology and arealistic data basis are required as the result of the calculation can lead to controversy, even to a splitting among specialist groups and constructs. There is also the threat of mismanagement with subsequent supply problems. In this context, aloss of quality can occur due to the use of simple surgical procedures that are less complex and not expensive with respect to material costs and are economical but not state of the art and thus directly worsen the medical care of patients in the statutory health insurance (GKV). Furthermore, it is already becoming apparent that procedures that are uneconomical due to the miscalculation are partially no longer being comprehensively rendered by healthcare providers due to adjustment of the service portfolio. An appropriate compensation of procedures is only possible based on a remuneration that adequately covers the costs. In this respect, this article is not intended to be understood as a"solution to the problem of the internal distribution of the remuneration in hybrid DRGs" but more to offer suggestions for solutions for the required further development of the hybrid DRG compensation level calculation to prevent a threat to the treatment of GKV patients due to mismanagement. As required in §115fof the SozialgesetzbuchV (SGBV), the recalculation of an economic remuneration must be carried out urgently and promptly using an empirical calculation basis and methodology and this must be regularly adapted.

Approaches to developing mechanisms for medical care centralization at the interterritorial level

Background. As new high-tech methods of treatment and diagnostics are introduced into the basic compulsory health insurance program, the focus on creating separate regional healthcare systems is becoming less effective. The creation of the necessary infrastructure requires disproportionately large investments, while the needs of the population in most regions do not provide adequate loading of newly created facilities. A promising solution to these problems is the centralization of delivering certain types of medical care (MC) on the basis of interregional medical centers.Objective: development of approaches to identifying medical interventions that are appropriate to provide in specialized interregional centers.Material and methods. The criteria for selection of medical interventions including MC profiles and diagnosis-related groups (DRGs) of diseases, which potentially require centralization were developed. On the basis of statistical analysis, data on specialized MC provided in inpatient settings by “Pediatric surgery” and “Traumatology and orthopedics” profiles were analyzed to identify regions with low and high levels of hospitalizations in order to determine the need for centralization or the creation of interregional centers.Results. The analysis enabled to identify the territorial subjects of the Russian Federation (RF) where the issue of MC centralization would be relevant to increase its availability to the insured population in the territory of certain subject. Besides, the study identified regions, in which the number of hospitalizations significantly exceeded the average indicators in the RF. It is advisable to create interregional MC centers on the basis of such subjects.Conclusion. The presented analysis of individual profiles and DRGs across the territorial subjects of the RF showed the objective differences in the extent of provided MC. The proposed methodology for determining DRGs and identifying subjects of the RF that have a surplus or deficit in the provision of MC can form the basis for approaches to identifying “MC centralization points”.

National Health Insurance Claim of Pediatric Appendectomy With Mandatory Diagnosis-Related Group Payment System in Korea

IntroductionEnforcement of diagnosis-related group system for appendectomy under the National Health Insurance Service has gradually widened and since July 2013 it has been enforced in all medical institutions in Korea. We have analyzed Health Insurance Review & Assessment Service data to observe changes in claim patterns of pediatric appendectomy during this period. MethodsAll claims data for appendectomy of patients younger than 18 y from 2011 to 2015 were collected. We analyzed the following factors of all cases: age, gender, length of hospital stay, medical cost, method of insurance claim and region. ResultsA total of 112,143 claims were made for appendectomy during the study period. In that, 66,510 (59.3%) were boys and 45,633 (40.7%) were girls. Median length of stay was 5 d and median sum of reimbursement of each claim was 2,198,630 won. Annual number of claims for appendectomy showed a steady decline from 24,888 in 2011 to 19,070 in 2015. Median sum of reimbursement of each claim was 1,862,615, 1,975,500, 2,233,360, 2,376,700, and 2,468,000 won, respectively from 2011 to 2015. Reimbursement for complicated appendectomy increased from 4400 out of 24,888 cases (17.7%) in 2011 to 3865 out of 19,070 cases (20.3%) in 2015. Overall medical cost of all reimbursement for pediatric appendectomy increased from 46,113,202,580 to 47,572,253,300 won. ConclusionsFollowing the universal enforcement of the diagnosis-related group claim system for appendectomy by the National Health Insurance Service, we observed an increase in the median sum of reimbursement per claim and a rise in the rate of claims for complicated appendectomies. These changes were associated with an overall increase in national medical costs.

Outcomes of Enterococcus faecalis infective endocarditis according to MIC of amoxicillin: a multicentric study.

The incidence of Enterococcus faecalis infective endocarditis is increasing over time. Data on the impact of minimum inhibitory concentration (MIC) of amoxicillin on treatment outcomes are scarce. The objective of this study was to describe the epidemiology of E. faecalis infective endocarditis and to evaluate whether the MIC of amoxicillin might influence mortality. We retrospectively included all consecutive patients diagnosed with definite E. faecalis infective endocarditis between 2013 and 2020 in 11 French hospitals. We extracted data from the local diagnosis-related group (DRG) database and matched these data with microbiological results. Amoxicillin MIC was determined by Etest strip. The primary endpoints were endocarditis-related mortality and risk factors for endocarditis-related mortality including amoxicillin MIC. A total of 403 patients with definite E. faecalis infective endocarditis were included. Patients were predominantly male (76.4%) with a median age of 74 years (67-82). Embolic complications occurred in 170 (42.1%) patients. Cardiac surgery was performed in 158 (61.5%) patients. The endocarditis-related mortality rate was 28.3% and the median delay between mortality and onset of hospitalization was 24 (9; 41) days. E. faecalis MIC of amoxicillin was available for 246 (61%) patients. The median MIC was 0.5 mg/L (0.4-0.7). Amoxicillin MIC was not found to be associated with in-hospital mortality. None of the variables included in the multivariate model were identified as a risk factor for mortality and there was no correlation between mortality and the duration of treatment for 4 weeks versus 6 weeks. Higher amoxicillin MIC was not a risk factor leading to endocarditis-related mortality in definite E. faecalis infective endocarditis. However, further studies are needed to assess the effect of amoxicillin MIC on relapse.

Inter-regional Hospital Patients’ mobility: Is co-operation better than competition?

Abstract Background According to Italian law, citizens are free to choose their preferred place of care across the national territory. This study aims to analyze the associations between patients’ mobility between Tuscany (Italy) and other Italian regions and the complexity of Diagnosis Related Groups (DRGs) provided for these hospitalizations. Methods A retrospective study was conducted using 2019 Hospital Discharge Cards data of Tuscany provided by the Italian Ministry of Health. The surgical DRGs of each Major Diagnostic Categories (MDCs) were considered according to high specialty (HS) and non-high specialty (N-HS). For each MDCs, patients’ attractions, and escapes to bordering and non-bordering regions with Tuscany were associated with HS and N-HS surgical discharge DRGs by using the Odds Ratio. The analysis was performed using STATA software, and the significance level was set at 95%. Results For Digestive Diseases, patients from non-border regions were more likely to be attracted to Tuscan hospitals for HS DRGs (OR: 1.37 95%CI: 1.08-1.74; p &amp;lt; 0,05), while for Musculoskeletal Diseases those from non-border regions were less likely to be attracted for HS DRGs (OR: 0.51 95%CI: 0.47-0.56; p &amp;lt; 0,05). For Nervous Diseases (OR: 3.08 95%CI: 2.18-4.37; p &amp;lt; 0,05), for Ear, Nose, Mouth And Throat Diseases (OR: 2.41 95%CI: 1.52-5.03; p &amp;lt; 0,05) and for Hepatobiliary And Pancreas Diseases (OR: 4.55 95%CI: 2.71-7.68; p &amp;lt; 0,05), Tuscan patients were more likely to escape to non-border regions for HS DRGs, while for Musculoskeletal Diseases (OR: 0.76 95%CI: 0.68-0.84; p &amp;lt; 0,05) they were less likely to be admitted to non-border regions for HS DRGs. Conclusions The results suggest the necessity of establishing mobility agreements between regions, particularly for high-specialty DRGs. In fact, the provision of mobility care economically benefits the receiving (creditor) region, which provides the medical service, but is not advantageous to the patient’s region of residence (debtor). Key messages • Monitoring mobility flows is critical to improve identify possible lack of supply of resources. • There is a need to develop interregional mobility agreements to ensure better cooperation between different regional health systems.

Investigation of age-related in-hospital outcomes of left atrial appendage occlusion in germany

Abstract Background The aim of this study was to assess demographics, in-hospital mortality and baseline characteristics of hospital cases with a left atrial appendage occlusion (LAAO) procedure in relation to patient age. Methods This is a retrospective observational analysis of all German in-hospital cases from 2016 to 2022 with a coded LAAO procedure using the Diagnose Related Groups (DRG) statistics database of the Research Data Center of the Federal Statistical Office. Results In total 40435 cases were observed in the investigated time period. Over the 5 years studied we found a significant shift towards an older patient collective. Compared to 28,3% in 2016, in 2022 40,1% of all patients were over 80 years of age (a rise of 152 %). Cases of patients with over 85 years of age increased from 7.7 % to 11.4 % during the same time period. We observed an in-hospital death rate for patients &amp;lt;70, 70-75, 80-85 and &amp;gt;85 years of age in 0.8, 1.0, 1.4 and 2.2 % respectively. Further we saw significant higher rates of intensified care treatment, pericardial effusion, acute kidney injury and red blood cell transfusion for patients &amp;gt;80 years of age. In unadjusted and adjusted logistic regression models age was significantly associated with a higher rate of in-hospital death. Conclusions In this study we present real world data from a health-care-system level. Our main findings were an increasing age in patients undergoing LAAO procedures and an independent association of age with in-house mortality and complications. This data provides a further basis to balance risks and benefits of LAAO procedure as a preventive treatment.

Health burden and economic costs of vector-borne diseases in Italy: the AUSL Romagna case

Abstract Introduction Vector-borne diseases (VBDs) are a serious threat for global health, representing around 17% of communicable diseases and more than 700.000 deaths every year. In Europe, and especially in Italy, this is a subject of growing concern, due to the increase of VBDs outbreaks that need vector control plans. Objectives Evaluate the 2013-2022 trend of VBD outbreaks within the AUSL Romagna area (provinces of Ravenna, Rimini, and Forlì-Cesena, in Emilia-Romagna Region, Italy) and the economic impact caused by hospitalizations and local prevention/disinfestation treatments. Methods We used aggregated and anonymized data from 3 informative systems: communicable disease system (SMI) for VBD prevalence; hospital discharge records (SDO) for hospitalizations, with a contribution of the VBD-related Diagnosis Related Groups (DRG); municipality records regarding the cost of dedicated interventions for vector prevention and disinfestation, communicated to the Emilia-Romagna Region. Results For the area of interest, 479 cases of VBDs were notified from 2013 to 2022, with a slight increasing trend over the years. Through hospital SDOs, 252 cases were identified with a diagnosis of VBD, plus 283 with a VBD-related DRG, with a total expenditure of €9.587.777. The distribution was not uniform between the provinces, Ravenna having the highest expense. The municipality records highlighted expenses for €95.443 for prevention and control interventions against mosquitoes, with a very variable trend over the period considered. Forlì had the highest expense. Conclusions VBDs show a highly variable trend and distribution during time, also in relatively small, sub-regional areas. The Emilia-Romagna regional plan against arboviruses, annually updated, can contribute to reduce this specific health and economic burden, lowering transmission among the population and resulting hospital pressure, thanks to prevention and timely interventions. Key messages • The use of information systems enables monitoring of the impact of arboviruses, as well as the related cost for hospital care and local treatments. • Putting in place an effective and updated plan against arboviruses, like the Emilia-Romagna Region one, helps managing VBDs and mitigating economic costs.

Using Atrial Fibrillation Burden Trends and Machine Learning to Predict Near-Term Risk of Cardiovascular Hospitalization.

Atrial fibrillation is associated with an increased risk of cardiovascular hospitalization (CVH), which may be triggered by changes in daily burden. Machine learning of dynamic trends in atrial fibrillation burden, as measured by insertable cardiac monitors (ICMs), may be useful in predicting near-term CVH. Using Optum's deidentified Clinformatics Data Mart Database (2007-2019), linked with the Medtronic CareLink ICM database, we identified patients with >1 days of ICM-detected atrial fibrillation. ICM-detected diagnostic parameters were transformed into simple moving averages over different periods for daily follow-up. A diagnostic trend was defined as the comparison of 2 simple moving averages of different periods for each diagnostic parameter. CVH was defined as any hospital, emergency department, or ambulatory surgical center encounter with a cardiovascular diagnosis-related group or diagnosis code. Machine learning was used to determine which diagnostic trends could best predict patient risk 5 days before CVH. A total of 2616 patients with ICMs met the inclusion criteria (71±11 years; 55% male). Among them, 1998 (76%) had a planned or unplanned CVH over 605 363 days. Machine learning revealed distinct groups: (A) sinus rhythm (reference), (B) below-average burden, (C) above-average burden, and (D) above-average burden with decreasing patient activity. The relative risk was increased in all groups versus the reference (B, 4.49 [95% CI, 3.74-5.40]; C, 8.41 [95% CI, 7.00-10.11]; D, 11.15 [95% CI, 9.10-13.65]), including a 21% increase in CVH detection over prespecified burden thresholds of duration (≥1 hour) and quantity (≥5%). The area under the receiver operating characteristic curve increased from 0.55 when using hourly burden amounts to 0.66 when using burden trends and decreasing patient activity (P<0.001), a 20% increase in predictive power. Trends in atrial fibrillation were strongly associated with near-term CVH, especially above-average burden coupled with low patient activity. This approach could provide actionable information to guide treatment and reduce CVH.

A retrospective analysis using comorbidity detecting algorithmic software to determine the incidence of International Classification of Diseases (ICD) code omissions and appropriateness of Diagnosis-Related Group (DRG) code modifiers

BackgroundThe mechanism for recording International Classification of Diseases (ICD) and diagnosis related groups (DRG) codes in a patient’s chart is through a certified medical coder who manually reviews the medical record at the completion of an admission. High-acuity ICD codes justify DRG modifiers, indicating the need for escalated hospital resources. In this manuscript, we demonstrate that value of rules-based computer algorithms that audit for omission of administrative codes and quantifying the downstream effects with regard to financial impacts and demographic findings did not indicate significant disparities.MethodsAll study data were acquired via the UCLA Department of Anesthesiology and Perioperative Medicine’s Perioperative Data Warehouse. The DataMart is a structured reporting schema that contains all the relevant clinical data entered into the EPIC (EPIC Systems, Verona, WI) electronic health record. Computer algorithms were created for eighteen disease states that met criteria for DRG modifiers. Each algorithm was run against all hospital admissions with completed billing from 2019. The algorithms scanned for the existence of disease, appropriate ICD coding, and DRG modifier appropriateness. Secondarily, the potential financial impact of ICD omissions was estimated by payor class and an analysis of ICD miscoding was done by ethnicity, sex, age, and financial class.ResultsData from 34,104 hospital admissions were analyzed from January 1, 2019, to December 31, 2019. 11,520 (32.9%) hospital admissions were algorithm positive for a disease state with no corresponding ICD code. 1,990 (5.8%) admissions were potentially eligible for DRG modification/upgrade with an estimated lost revenue of $22,680,584.50. ICD code omission rates compared against reference groups (private payors, Caucasians, middle-aged patients) demonstrated significant p-values < 0.05; similarly significant p-value where demonstrated when comparing patients of opposite sexes.ConclusionsWe successfully used rules-based algorithms and raw structured EHR data to identify omitted ICD codes from inpatient medical record claims. These missing ICD codes often had downstream effects such as inaccurate DRG modifiers and missed reimbursement. Embedding augmented intelligence into this problematic workflow has the potential for improvements in administrative data, but more importantly, improvements in administrative data accuracy and financial outcomes.

Clinical characteristics associated with hospital-onset bacteremia and fungemia among cancer and transplant patients.

This study quantified the burden of hospital-onset bacteremia and fungemia (HOB) among cancer and transplant patients compared to other patients. A retrospective cross-sectional study used data from 41 hospitals between October 2015 and June 2019. Hospitalizations were segmented into categories using diagnosis-related groups (DRG): myeloproliferative (MP) cancer, solid tumor cancer, transplant, and non-cancer/non-transplant ("reference group"). To quantify the association between DRG and HOB, multivariable adjusted Poisson regression models were fit. Analyses were stratified by length of stay (LOS). Of 645,315 patients, 59% were female and the majority 41 years of age or older (76%). Hospitalizations with MP cancer and transplant demonstrated higher HOB burden compared to the reference group, regardless of LOS category. For all hospitalizations, the >30 days LOS category had a higher burden of HOB. The median time to reportable HOB was within 30 days regardless of duration of hospitalization (reference, 8 days; solid tumor cancer, 8 days; transplant, 12 days; MP cancer, 13 days). MP cancer and transplant patients had a higher burden of HOB compared to other hospitalized patients regardless of LOS. Whether these infections are preventable should be further evaluated to inform quality metrics involving reportable bacteremia and fungemia.

Pneumonia-Related Hospitalizations among the Elderly: A Retrospective Study in Northeast Italy.

Background: In both the elderly and children, pneumonia remains one of the leading causes of hospitalization. This study aimed to assess the impact of pneumonia-related hospitalizations in the population over 65 years of age in the Veneto Region. Methods: This retrospective study analyzed hospital discharge records for patients aged 65 and older who resided in the Veneto Region and had a diagnosis of pneumonia from 2007 to 2023. The hospitalizations were identified using specific ICD-9-CM codes for pneumonia as a discharge diagnosis. Hospitalization rates, mortality rates, the prevalence of complications and comorbidities, the length of stay, and associated costs were calculated by age and year. Results: From 2007 to 2023, there were 139,201 hospitalizations for pneumonia. Emergency admissions accounted for 92.1% of these cases, and only 2.0% had a specific diagnosis of pneumococcal pneumonia. The median length of stay was 10 days, and the median diagnosis-related group (DRG) tariff per hospitalization was EUR 3307. Excluding the pandemic years, the hospitalization rates remained stable at approximately 850 cases per 100,000 inhabitants before 2019. After 2022, the rates started to increase again. Overall, in the investigated period, the results showed a negative trend (average Annual Percentage Change (AAPC) of -1.931, p < 0.0001). However, when only considering the pre-pandemic years, the trend was stable, while a decline was observed starting in 2020 (AAPC of -19.697, p = 0.001). The overall discharge mortality rates ranged from 13% to 19.3% but were significantly higher in those over 85 years of age (20.6% compared with 6.5% and 12.0% in the 65-74 and 75-84 age groups, respectively). Conclusions: This study highlights the substantial burden of pneumonia in individuals over 65 years of age, showing the impacts on public health.

How Are Diagnosis-Related Groups and Staffing Allocation Systems Associated with the Complexity of Nursing Care? An Observational Study.

In Italy, Diagnosis-Related Groups (DRGs) have been adopted for hospital services reimbursement. In some Italian regions, nurse staffing allocation is purely volume-based, with different minutes/patient/day categories determined by the type of hospital ward. The Information System of Nursing Performance (SIPI) is a valid and reliable tool assessing nursing care complexity as an indicator of the actual nursing care demand. Evidence is lacking about the ability of current resource allocation methods to account for the nursing care demand. To evaluate the association between (1) DRG rates and nursing care complexity and (2) hospital ward categories of nurse staffing and nursing care complexity. All patients discharged from the medical department of an Italian hospital over a data collection period were eligible. To assess the association between nursing care complexity (SIPI) and DRGs, the distribution of the DRG rate (median and first-third quartile) was compared for cases with high or low complexity. To evaluate the association between nursing care complexity (SIPI) and nurse staffing, the frequency of high complexity within nurse staffing categories (120/180/240 min/patient/day) was compared. Because the sample was very large, methods of statistical inference were not applied, and only descriptive measures were reported. 6872 hospitalizations were included. The median DRG rate for high and low complexity admissions were very similar (EUR 3536 and EUR 3285, respectively). The proportion of admissions with high complexity decreased for wards with higher staffing allocation rates. DRG reimbursement and the nurse staffing allocation systems were ineffective in accounting for nursing care complexity. The SIPI could help identify areas requiring more financial and staffing resources for nursing care.

A Retrospective Analysis of Disease Epidemiology, Comorbidity Burden, Treatment Patterns, and Healthcare Resource Utilization of Migraine in the United Arab Emirates.

Migraine is a recurrent, disabling neurological disorder with a substantial global disease burden. However, limited real-world data are available on the patient characteristics, treatment patterns, comorbidities, and economic burden of migraine in the United Arab Emirates (UAE). In this study, we evaluated the disease burden, comorbidities, treatment patterns, specialties involved in migraine diagnosis, and healthcare resource utilization (HCRU) and associated costs in patients with migraine in Dubai, UAE. A retrospective, secondary database cohort study was conducted from 01 January 2014 to 31 March 2022 using the Dubai Real-World Database. Patients aged ≥ 18years with at least one diagnosis claim for migraine with continuous enrollment during the study period were included. Patients were stratified into treatment sub-cohorts. Outcomes were evaluated in terms of clinical characteristics, comorbidities, specialists visited, treatment patterns, and HCRU. The study included 203,222 patients (mean age: 40years), with male predominance (55.4%). About 13.4% of patients had specific cardiovascular comorbidities. Frequently prescribed drug classes were nonsteroidal anti-inflammatory drugs (84.4%), triptans (29.8%), and beta-blockers (12.8%), while only 1.0% of patients with migraine were prescribed newer medications like calcitonin gene-related peptide antagonists. General medicine was the most frequently visited specialty on the index date (51.5%). The all-cause and migraine-specific median gross costs during the 12-month post-index period were US $1252.6 (2.4-564,740.7) and US $198.1 (0-168,903.3) respectively, with maximum contribution from inpatients. The contribution of migraine-specific median costs to all-cause median costs was highest for the diagnosis-related group (64.9%), followed by consumables (35.2%), medications (32.0%), procedures (24.5%), and services (24.5%). Migraine significantly impacts healthcare costs in the UAE. The role of newer therapies in migraine management should be explored to reduce the associated socioeconomic burden and improve patients' quality of life.

Waiting for surgery after hip fracture-Health and/or economic risk?

Waiting for surgery is a disconcerting experience. It can have a negative impact on patients' outcomes and length of stay (LOS) as driver for treatment costs. Process-optimisation may be a strategy to improve quality and cost-efficacy. The study investigates the correlation between waiting for hip fracture surgery and patient characteristics, organisational variables, outcomes, LOS, and the distribution of waiting times and LOS over time, including cost estimates. Thereby the study aims to identify the potential for organisational improvements with respect to managing the waiting time. Ten-year routine health data (patient characteristics and follow-up information) and process-indicators that is, waiting time and LOS from a Swiss trauma-centre were analysed retrospectively. Cost-estimates were calculated based on Swiss diagnosis related groups and daily costs to evaluate hospital revenues. In total, 2572 patients aged ≥60years with low-energy hip fractures were included. Waiting times >48h were associated with sub-optimal outcomes. Over the years long waiting times decreased. This reduction was not reflected by a reduction in LOS which remained stable around 10days, primarily driven by late discharge to in-patient rehabilitation. Reimbursement persisted at an average revenue in the low 4-5-digit range, depending on implant costs. While there has been a reduction of waiting times, this has not translated into a reduction of LOS or potential savings in health care costs, due to the various dependencies along the patient journey. Managing waiting times may be an area for improvement, increasing cost-efficacy, especially since long waiting times are still associated with inferior outcomes and LOS.

Cryptogenic Organizing Pneumonia Is Associated With Increased Mortality Risk in Hospitalizations for Systemic Lupus Erythematosus (SLE): A National Inpatient Sample Analysis.

Background This study analyzed the incidence, characteristics, and mortality risk associated with cryptogenic organizing pneumonia (COP) among hospitalizations for systemic lupus erythematosus (SLE) with lung involvement. Methods Adult hospitalizations from the 2016-2020 nationwide inpatient sample were analyzed using relevantInternational Classification of Diseases (ICD)-10 codes for SLE with lung involvement (M32.13) and COP (J84.116). We compared baseline characteristics of individuals with SLE and COP to those of other lung involvements using Chi-square tests for categorical variables and the Wilcoxon rank sum test for continuous variables. A Cox proportional hazards model was used to assess the risk of developing COP in the pooled cohort of SLE patients. The impact of COP on SLE mortality was assessed using multivariate logistic regression adjusting forillness severity, baseline risk of mortality at admission, and patient- and hospital-level covariates. Results Of 40,356 admissions for SLE, 3,175 (7.9%) were due to lung involvement, with COP identified in 570 cases (17.9%). Compared with otherlung involvement in SLE, individuals with COP were significantly older (mean age: 65 vs. 44.3 years; p<0.001), mostly female (515; 90.4% vs. 2,305 males; 88.5%; p=0.572), had a greater baseline risk of mortality [diagnosis-related groups (DRG) major or extreme likelihood of dying: 360; 63.1% vs. 1,133; 43.5%; p<0.001], and had a higher prevalence of peripheral vascular disease (25; 4.4% vs. 39; 1.5%; p<0.001), and lower prevalence of lymphocytopenia (45; 7.9% vs. 359; 13.8%; p=0.001), and hypothyroidism (44; 7.8% vs. 357; 13.7%; p=0.001). Predictors of COP included female sex [adjusted hazard ratio (AHR): 1.46; 95% confidence interval (CI): 1.12-2.96; p=0.022]; hospitalizations occurring in the third quarter of the year (AHR: 1.37; 95% CI: 1.05-2.23; p=0.038); hospital stays of six days or longer (AHR: 1.71; 95% CI: 1.06-2.77; p=0.029); undergoing five or more procedures during the same hospitalization (AHR: 1.56; 95% CI: 1.26-3.56; p=0.041); coexisting lymphocytopenia (AHR: 1.92; 95% CI: 1.16-3.19; p=0.011); need for mechanical ventilation (AHR: 1.60; 95% CI: 1.48-3.93; p=0.049), presence of another autoimmune disorder (AHR: 1.37; 95% CI: 1.15-4.29; p=0.040), and being hospitalized at private, investor-owned hospitals (AHR: 2.62; 95% CI: 1.03-6.64; p=0.043). Mortality in SLE with lung involvement was correlated with age ≥ 60 years [hazard ratio (HR) (95% CI) 1.16 (1.05-1.56); p=0.012], coexisting lupus nephritis [HR (95% CI), 2.44 (2.04-3.49); p=0.031], cancer [HR (95% CI), 3.49 (2.19-5.79); p<0.001], liver disease [HR (95% CI), 9.82 (4.79-12.57); p<0.001]; immune deficiency [HR (95% CI), 2.22 (2.02-3.11); p=0.031], hypothyroidism [HR (95% CI), 4.67 (1.47-7.75); p=0.009], and high blood pressure [HR (95% CI), 3.15 (2.83-4.51); p<0.001]. In the multivariable analysis, COP remained significantly associated with an increased risk of mortality [AHR (95% CI), 1.43 (1.16-2.74); p=0.031]. The incidence of COP did not significantly impact hospitalization costs ($US 94,772 ± 14,759 vs. 95,982 ± 32,625; p=0.954) or length of stay (mean length of hospital stay: 8.3 vs.6.8 days; p=0.147). Conclusion Cryptogenic organizing pneumoniawas associated with 1% of all hospitalizations for SLE and 18% of cases involving lung complications in SLE. The presence of COP significantly increased the risk of mortality in SLE patients with lung involvement.

Evaluating a Natural Language Processing-Driven, AI-Assisted International Classification of Diseases, 10th Revision, Clinical Modification, Coding System for Diagnosis Related Groups in a Real Hospital Environment: Algorithm Development and Validation Study.

International Classification of Diseases codes are widely used to describe diagnosis information, but manual coding relies heavily on human interpretation, which can be expensive, time consuming, and prone to errors. With the transition from the International Classification of Diseases, Ninth Revision, to the International Classification of Diseases, Tenth Revision (ICD-10), the coding process has become more complex, highlighting the need for automated approaches to enhance coding efficiency and accuracy. Inaccurate coding can result in substantial financial losses for hospitals, and a precise assessment of outcomes generated by a natural language processing (NLP)-driven autocoding system thus assumes a critical role in safeguarding the accuracy of the Taiwan diagnosis related groups (Tw-DRGs). This study aims to evaluate the feasibility of applying an International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM), autocoding system that can automatically determine diagnoses and codes based on free-text discharge summaries to facilitate the assessment of Tw-DRGs, specifically principal diagnosis and major diagnostic categories (MDCs). By using the patient discharge summaries from Kaohsiung Medical University Chung-Ho Memorial Hospital (KMUCHH) from April 2019 to December 2020 as a reference data set we developed artificial intelligence (AI)-assisted ICD-10-CM coding systems based on deep learning models. We constructed a web-based user interface for the AI-assisted coding system and deployed the system to the workflow of the certified coding specialists (CCSs) of KMUCHH. The data used for the assessment of Tw-DRGs were manually curated by a CCS with the principal diagnosis and MDC was determined from discharge summaries collected at KMUCHH from February 2023 to April 2023. Both the reference data set and real hospital data were used to assess performance in determining ICD-10-CM coding, principal diagnosis, and MDC for Tw-DRGs. Among all methods, the GPT-2 (OpenAI)-based model achieved the highest F1-score, 0.667 (F1-score 0.851 for the top 50 codes), on the KMUCHH test set and a slightly lower F1-score, 0.621, in real hospital data. Cohen κ evaluation for the agreement of MDC between the models and the CCS revealed that the overall average κ value for GPT-2 (κ=0.714) was approximately 12.2 percentage points higher than that of the hierarchy attention network (κ=0.592). GPT-2 demonstrated superior agreement with the CCS across 6 categories of MDC, with an average κ value of approximately 0.869 (SD 0.033), underscoring the effectiveness of the developed AI-assisted coding system in supporting the work of CCSs. An NLP-driven AI-assisted coding system can assist CCSs in ICD-10-CM coding by offering coding references via a user interface, demonstrating the potential to reduce the manual workload and expedite Tw-DRG assessment. Consistency in performance affirmed the effectiveness of the system in supporting CCSs in ICD-10-CM coding and the judgment of Tw-DRGs.