Factor In Health Care Costs Research Articles

The practice of defensive medicine among Italian physicians: a cross sectional study in Rome

Abstract Background To identify the perception and the reason of defensive medicine among Italian physicians, and identify the socio-demographic and work-related determinants of the increased practice of defensive medicine. Methods This study is a cross sectional web survey. A questionnaire was sent by e-mail to all the physicians registered to the Order of Physicians and Dentists of the Province of Rome. The collection period was from mar 2024 to may 2024. Descriptive analysis and multivariable linear regression models were conducted to describe differences between groups and to estimate the relationships between variables. Results A total of 291 physicians completed the survey and were included in this analysis. Almost 60% of respondents feel under pressure due to the possibility of legal disputes. 73,8% adopted defensive medicine behaviours during the last year. More than 80% are aware that defensive medicine represents a limitation for their profession and a unfavourable factor for patients. Who answered that they practice defensive medicine think that it is a factor limiting their professional activity (OR: 2.3) and an unfavourable factor for the patient’s health (OR: 1.1). Conclusions Defensive medicine is an important factor in health care costs without increasing the benefits to the patient. The study contributes to a deeper understanding of the perception of defensive medicine among physicians. Defensive medicine practice is common among physicians with concerns about increasing pattern in the future. Key messages • Our study highlights physicians’ awareness of adopting defensive medicine behaviors in their clinical practice. • The study contributes to a deeper understanding of the perception of defensive medicine among physicians.

Tale of the Frail: Understanding Frailty in Cirrhosis.

Frailty is a dynamic condition that results in increased vulnerability to health stressors. Often associated with older adults, frailty is not limited to the geriatric population, although aging and disease burden often go hand in hand. This syndrome is recognized increasingly as an important factor in healthcare costs, rate of adverse outcomes, and overall resource utilization. Frailty may be reversible to a degree, and thus appropriate recognition affords a focus for efficient intervention. Notably, frailty is becoming increasingly relevant in cirrhosis, and has been noted to be an independent predictor of outcomes in patients both before and after liver transplantation. Cirrhosis is currently the 12th leading cause of death in the United States, and its incidence is anticipated to markedly increase in the coming years with the aging of our population. With the anticipated surge in disease prevalence, liver disease care will likely shift from specialist-driven to a multidisciplinary approach between primary care physicians, internists, and hepatologists to adequately care for these patients. This review serves as a guide for clinicians to learn about frailty, its role in cirrhosis, and the current tools to educate patients and families about the importance of nutrition and physical exercise within this population.

Hand Injuries in the Polish Silesian Paediatric Population-An Exploratory Cross-Sectional Study of Post-Traumatic X-rays.

Background and objectives: In the paediatric population, hand injuries are one of the most frequent injuries and the second most frequent area of fracture. It is estimated that hand injuries account for up to 23% of the trauma-related causes of emergency department visits. Not only are they a significant factor in health care costs, but they may also lead to detrimental and long-term consequences for the patient. The discrepancy observed between the published studies suggests a geographical variation in their epidemiology. The aim of this study is to determine the localisation of injuries and fractures involving the hand in the paediatric population of the Polish Silesia region. This exploratory cross-sectional study involved 1441 post-traumatic hand X-ray examinations performed at the Department of Diagnostic Imaging of the John Paul II Upper Silesian Child Health Centre in Katowice between January and December 2014. Materials and Methods: The study group consisted of 656 girls and 785 boys who were 11.65 ± 3.50 and 11.51 ± 3.98 years old, respectively (range: 1–18 years). All examinations were evaluated for the location of the injury and presence of fracture(s). Results: Finger injuries were dominant (n = 1346), with the fifth finger being the most frequently injured (n = 381). The majority of injuries were observed among children who were 11 years old (n = 176), with a visible peak in the 11- to 13-year-old group. A total of 625 bone fractures were detected. Fractures of the proximal phalanges (n = 213) and middle phalanges (n = 159) were most common, and fifth finger (n = 189) predominance was again observed. A gender-independent positive correlation was found between patients’ age and finger injuries (p < 0.01) as well as metacarpal injuries (p < 0.01). There was no correlation between patients’ age and fractures in these locations (p > 0.05). Metacarpal injuries (p < 0.01), finger injuries (p < 0.01), fractures (p = 0.01), and fractures with displacement (p = 0.03) were more common among males regardless of age. Conclusions: The results indicate that 11-year-old boys are at an increased risk of hand injuries and fractures. The distal and middle phalanges of the right hand, especially of the fifth digit, were the most susceptible to fracture localisation. Thus, injuries in these areas should be perceived as most likely to cause fractures and therefore demand careful examination.

Prevalence and costs of defensive medicine: a national survey of Italian physicians.

Objective To identify the prevalence of the practice of defensive medicine among Italian hospital physicians, its costs and the reasons for practising defensive medicine and possible solutions to reduce the practice of defensive medicine. Methods Cross-sectional web survey. Main outcome measures Number of physicians reporting having engaged in any defensive medicine behaviour in the previous year. Results A total of 1313 physicians completed the survey. Ninety-five per cent believed that defensive medicine would increase in the near future. The practice of defensive medicine accounted for approximately 10% of total annual Italian national health expenditure. Conclusions Defensive medicine is a significant factor in health care costs without adding any benefit to patients. The economic burden of defensive medicine on health care systems should provide a substantial stimulus for a prompt review of this situation in a time of economic crisis. Malpractice reform, together with a systematic use of evidence-based clinical guidelines, is likely to be the most effective way to reduce defensive medicine.

Alcohol consumption as an incremental factor in health care costs for traffic accident victims: Evidence in a medium sized Colombian city

ObjectivesIdentify the possibility that alcohol consumption represents an incremental factor in healthcare costs of patients involved in traffic accidents. MethodsData of people admitted into three major health institutions from an intermediate city in Colombia was collected. Socio-demographic characteristics, health care costs and alcohol consumption levels by breath alcohol concentration (BrAC) methodology were identified. Generalized linear models were applied to investigate whether alcohol consumption acts as an incremental factor for healthcare costs. ResultsThe average cost of healthcare was 878 USD. In general, there are differences between health care costs for patients with positive blood alcohol level compared with those who had negative levels. Univariate analysis shows that the average cost of care can be 2.26 times higher (95% CI: 1.20–4.23), and after controlling for patient characteristics, alcohol consumption represents an incremental factor of almost 1.66 times (95% CI: 1.05–2.62). ConclusionsAlcohol is identified as a possible factor associated with the increased use of direct health care resources. The estimates show the need to implement and enhance prevention programs against alcohol consumption among citizens, in order to mitigate the impact that traffic accidents have on their health status. The law enforcement to help reduce driving under the influence of alcoholic beverages could help to diminish the economic and social impacts of this problem.

The Prevalence and Costs of Defensive Medicine Among Orthopaedic Trauma Surgeons

Defensive medicine includes medical practices that exonerate physicians from liability without benefit to patients. The national prevalence of defensive medicine in orthopaedic trauma surgery has not been investigated. In September 2010, 2000 orthopaedic surgeons randomly chosen from the American Academy of Orthopaedic Surgeons registry received invitations to answer a survey on defensive medicine. Among these surgeons, 1214 (61%) completed the survey and 222 (18.5%) identified themselves as nonmilitary orthopaedic traumatologists. Cost analysis was performed using Centers for Medicare and Medicaid data at the 2011 current procedural terminology code level and then aggregated to reflect the 8 domains of care assessed. For orthopaedic traumatologists, on average 22% of all ordered tests were for defensive reasons (radiography, 19%; computed tomographic scanning, 23%; magnetic resonance imaging, 27%; ultrasound, 42%; referrals, 29%; laboratory tests, 23%; and biopsies, 16%). Defensive hospital admissions averaged 9% each month. Orthopaedic traumatologists reported fewer referrals to specialists compared with non-trauma orthopaedists (P = 0.02), with no significant difference in overall monthly defensive expenditures.Using 2011 current procedural terminology code reimbursement data, defensive medicine costs per respondent were calculated to be approximately $7800 monthly or $94,000/y, which is 20% of each physician's spending. Given the approximately 2724 orthopaedic trauma surgeons in practice in the United States according to the 2010 American Academy of Orthopaedic Surgeons Census, the national cost of defensive medicine for orthopaedic trauma surgery is estimated to be $256.3 million annually. Defensive medicine among orthopaedic trauma surgeons is a significant factor in health care costs and of marginal benefit to patients. Policies aimed at managing liability risk may be useful in containing such practices.

The frequency of and associations with hospitalization secondary to lupus flares from the 1000 Faces of Lupus Canadian cohort

Hospitalization is a major factor in health care costs and a surrogate for worse outcomes in chronic disease. The aim of this study was to determine the frequency of hospitalization secondary to lupus flare, the causes of hospitalization, and to determine risk factors for hospitalization in patients with systemic lupus erythematosus (SLE). Data were collected as part of the 1000 Canadian Faces of Lupus, a prospective cohort study, where annual major lupus flares including hospitalizations were recorded over a 3-year period. Of 665 patients with available hospitalization histories, 68 reported hospitalization related to a SLE flare over 3 years of follow-up. The average annual hospitalization rate was 7.6% (range 6.6-8.9%). The most common reasons for hospitalization were: hematologic (22.1%), serositis (20.6%), musculoskeletal (MSK) (16.2%), and renal (14.7%). Univariate risk factors for lupus hospitalization included (OR [95% CI]; p < 0.05): juvenile-onset lupus (2.2 [1.1-4.7]), number of ACR SLE criteria (1.4 [1.1-1.7], baseline body mass index (BMI) (1.1 [1.0-1.1]), psychosis (3.4 [1.2-9.9]), aboriginal race (3.2 [1.5-6.7]), anti-Smith (2.6 [1.2-5.4]), erythrocyte sedimentation rate >25 mm/hr (1.9 [1.1-3.4]), proteinuria >0.5 g/d (4.2 [1.9-9.3], and SLAM-2 score (1.1 [1.0-1.2]). After multivariate regression only BMI, number of ACR criteria, and psychosis were associated with hospitalization for lupus flare. The mean annual rate of hospitalization attributed to lupus was lower than expected. Hematologic, serositis, MSK and renal were the most common reasons. In a regression model elevated BMI, more ACR criteria and psychosis were associated with hospitalization.

Comparative effectiveness research in spine surgery

Degenerative spine disorders are a significant cause of patient morbidity and are a prominent factor in healthcare costs in many countries. Pressure for healthcare cost control and the desire for improved outcomes have led to an expanding emphasis on evidence-based medicine methodologies in spine research. Determination of the optimal treatment paradigm for many common degenerative spinal disorders has proven difficult and comparative effectiveness research is increasingly being employed to examine these clinical dilemmas. The Swedish Spine Registry and the Registry of the Scoliosis Research Society are two of the long-standing databases compiling data for spine patients. Spine surgery professional organizations have recently taken a prominent role in assembling procedural- and diagnosis-based registries, specifically addressing therapeutic outcomes for spine patients. As healthcare systems continue to evolve, comparative effectiveness research driven by spine registries may better elucidate the appropriate clinical choices for patients with these challenging illnesses.

Nontraumatic Amputation

Lower extremity amputation (LEA) is devastating for those affected and a significant factor in health care costs. Although the overall incidence of amputation has been declining, the decline is not universal. The objectives of this study were to identify patients with nontraumatic amputation at Harbor-UCLA Medical Center (HUMC) from January 2000 to January 2007, to calculate their 1-year and 5-year mortality rates after amputation and to estimate the financial cost of those amputations. The authors searched the HUMC electronic database by ICD codes (84.10-84.18) to identify patients with LEA and subsequently searched the National Death Index database for deaths in study subjects to calculate mortality rates. HUMC is a Los Angeles County tertiary teaching medical center that provides medical care to a large percentage of the Los Angeles County population, especially those without health insurance. There were 1169 admissions in 847 patients with nontraumatic LEA with a 1-year mortality rate of 9.1% and 5-year mortality rate of 25.6%. Only major amputation and increasing age were independent risk factors for 1-year mortality rate. At 1 year, the re-amputation rate for nontraumatic LEA was 26.7%. African American and Hispanic females had a significantly higher percentage of major amputations than corresponding males and white females. The average length of hospital stay was more than double for patients with nontraumatic amputation than for all other admissions (12.7 vs 5.3 days). There were 14,846 hospital days for 1169 nontraumatic amputation admissions with an estimated cost of $47,033,767. Amputation remains common at HUMC and the associated mortality rates and economic costs are high. In the authors' opinion, a coordinated and serious campaign by all involved in the health care system is urgently needed to implement proven and effective measures such as establishing multidisciplinary foot care clinics to reduce amputation.

Global Orthopaedics

Technological advances have shrunk the orthopaedic world. Today, more than ever before, there is a need to consider orthopaedics as an international specialty, with research being accomplished in and reported from every part of the globe. Information about new scientific findings and advances in patient care now can readily reach nearly every country and region. Over the past few years, The Journal of Bone and Joint Surgery has received more than half of its manuscript submissions from outside North America, yet it had no international members of its editorial board. In addition, the percentage of reviewers from outside North America has been small. The Journal has now taken important initial steps to begin to remedy the lack of representatives of the global orthopaedic community on our editorial board. Six new members of the editorial board from outside North America have been added. This group of international deputy editors represents not only multiple regions but multiple subspecialties. Plans are in place to add three more international deputy editors each year in 2012 and 2013. Until recently, the majority of the scientific reports from outside North America emanated from Europe, Scandinavia, and Japan. A large number of randomized clinical trials now submitted to The Journal originate in countries with national health systems, enabling patient-tracking to be done more easily than in the United States. More recently, as the economies of countries such as China, South Korea, Brazil, and India have developed, there has been a parallel upward growth in the amount of medical research being accomplished and a marked increase in submissions of scientific reports from these regions to The Journal. We are fortunate that The Journal attracts high-quality submissions from all parts of the world. The Journal and our readers are benefitting from this uptick in research reports submitted to us from outside North America. A simple example relates to information gleaned from the total joint arthroplasty registries that have been established in many countries worldwide. Similar efforts have lagged in the United States, where total joint arthroplasty registries are just now in their early stages. The data from these total joint arthroplasty registries from multiple countries have led to improved patient care not only in the country of the registry but globally, including in arthroplasty practices in the United States. A recent supplement published in JBJS1 addressed several topics related to the establishment of an International Consortium of Orthopaedic Registries (ICOR). By establishing large multinational joint registries and obtaining longitudinal follow-up data, it is expected that small to moderate clinically important differences in patient outcomes between the various arthroplasty devices used can be detected in a way not possible today. An additional example of the benefit that we derive from international research reports is the work that is done on orthopaedic disorders that are found commonly in developing countries and much less often in developed countries, such as tuberculosis involving the musculoskeletal system. With immigration active throughout the world, orthopaedists in developed countries will see conditions that they have rarely seen previously and the recommendations for treatment that come out of developing countries will allow us to establish earlier diagnosis of these uncommon conditions and provide better patient care. In addition, trauma is omnipresent in all countries and has been identified as a major factor in health-care costs in both developed and developing countries. Research in the world of trauma can have an impact on patient care regardless of the region in which the trauma occurs. The mission statement of The Journal is “To provide and disseminate worldwide the highest quality information about the musculoskeletal system.” The continuing commitment of The Journal to publish high-quality articles from around the world is important in fulfilling this global mission.

INITIAL TREATMENT COSTS OF ORGAN‐CONFINED PROSTATE CANCER: A GENERAL PERSPECTIVE

With the increasing prevalence of prostate cancer and evolving methods for the definitive treatment of OCPCa, health economic analyses will be critically important, albeit difficult to carry out. Preliminary studies point to RPP as the most cost-effective treatment for OCPCa. The quickest postoperative recovery, in experienced hands, occurs in RARP and RPP, with ORPP having a slightly, but statistically in significant, shorter hospital stay. It should be stressed that initial treatment costs are not the only important factor in healthcare costs. Readmission for early and late complications and the loss of productivity resulting from variation in time to return to work, need also to be considered. Loss of productivity may also vary in cost between different institutions and countries depending upon the proportion of patients employed. Further large-scale multicentre studies are necessary to assess this.