Financial Burden For Hospitals Research Articles

Automated machine learning for early prediction of acute kidney injury in acute pancreatitis

BackgroundAcute kidney injury (AKI) represents a frequent and grave complication associated with acute pancreatitis (AP), substantially elevating both mortality rates and the financial burden of hospitalization. The aim of our study is to construct a predictive model utilizing automated machine learning (AutoML) algorithms for the early prediction of AKI in patients with AP.MethodsWe retrospectively analyzed patients who were diagnosed with AP in our hospital from January 2017 to December 2021. These patients were randomly allocated into a training set and a validation set at a ratio of 7:3. To develop predictive models for each set, we employed the least absolute shrinkage and selection operator (LASSO) algorithm along with AutoML. A nomogram was developed based on multivariate logistic regression analysis outcomes. The model’s efficacy was assessed using receiver operating characteristic (ROC) curves, calibration curves, and decision curve analysis (DCA). Additionally, the performance of the model constructed via AutoML was evaluated using decision curve analysis (DCA), feature importance, SHapley Additive exPlanations (SHAP) plots, and locally interpretable model-agnostic explanations (LIME).ResultsThis study incorporated a total of 437 patients who met the inclusion criteria. Out of these, 313 were assigned to the training cohort and 124 to the validation cohort. In the training and validation cohorts, AKI occurred in 68 (21.7%) and 29(23.4%) patients, respectively. Comparative analysis revealed that the AutoML models exhibited enhanced performance over traditional logistic regression (LR). Furthermore, the deep learning (DL) model demonstrated superior predictive accuracy, evidenced by an area under the ROC curve of 0.963 in the training set and 0.830 in the validation set, surpassing other comparative models. The key variables identified as significant in the DL model within the training dataset included creatinine (Cr), urea (Urea), international normalized ratio (INR), etiology, smoking, alanine aminotransferase (ALT), hypertension, prothrombin time (PT), lactate dehydrogenase (LDH), and diabetes.ConclusionThe AutoML model, utilizing DL algorithm, offers considerable clinical significance in the early detection of AKI among patients with AP.

The understated issue of caregiver anxiety for pediatric surgical hospital admissions: opening the blindfolds

Hospitalization is a nerve-wrecking experience for patients and their families (Lam et al. in Int J Nurs Stud 43:535-545, 2006). The financial burden of hospitalization is the prime perpetrator, however, multiple other factors also contribute significantly to the underlying problem which can be eliminated by efforts of the doctors and other healthcare workers and by modifying the hospital policies (Bassett et al. in J Hosp Med 15:652-658, 2020). We can reduce the number of outpatient visits and switch to telemedicine for rescheduling the cases. The pre-anaesthetic clearance and all the relevant investigations can be done on a single OPD visit thereby reducing the requirement of repeated commutes to the hospital. The free of charge category of the hospital can be extended to the patient requiring prolonged hospital stay or for solid tumor patients who require repeated hospital admissions for chemotherapy. Association with child welfare Non-government organizations (NGO's) can also solve major monetary issues for parents of patients suffering from complex congenital anomalies and solid tumors. The pre-operative NPO period can be shortened to 2-4h, antibiotic use can be completely avoided or minimized in clean elective cases, children living in the same city requiring dressing/catheter removal after a few days (e.g. hypospadias, posterior sagittal anorectoplasty) can be discharged and called for a OPD visit after 5-7days if the parents are willing to take care of the child at home. Patients undergoing minor elective surgeries can be followed up on telemedicine visits only. Parents of patients suffering from complex congenital anomalies should be referred to a clinical psychologist and receive periodic counseling sessions. A child psychologist should also be included in the management of cases which have social stigma attached as bladder exstrophy, anorectal malformations, spina bifida requiring lifelong follow-up and bowel washes or repeated clean intermittent catheterisation. Anxiety assessment questionnaires must be incorporated in the management of chronic patients and high-risk parents must be identified (Tiedeman in J Pediatr Nurs 12:110-119, 1997). We hereby propose adoption of family centric approach during the management of a patient as this may minimize the overall burden of the hospitalization of the family. Hospital admission of a child leads to a myriad responses in the parents. Thus, we conducted a hospital-based cross-sectional study to determine the prevalence of anxiety and depression among the primary caregivers of hospitalized children and the factors causing it. Parents of 228 children admitted in the pediatric surgery ward at a tertiary care hospital were interviewed using the HADS-A and Hamilton Anxiety Questionnaire to assess the prevalence of anxiety and depression during hospital admission. They were also subjected to a questionnaire comprising of 52 questions spread over 5 segments-demographic details, monetary burden, effect on siblings and other family members, practical problems faced, and surgery-specific concerns. Thirty percent of the parents had severe anxiety and 20% developed depression due to the hospitalization of their child. We tested the association of this depression and anxiety against 56 variables in this study. Exorbitant loan amounts (ra -0.449, rd-0.557), repeated commute to the hospital (ra -0.274, rd -0.231), monetary burden (ra -0.193, rd -0.186), repetitive sampling (ra -0.248, rd -0.203), prolonged absence from work (ra -0.440, rd -0.424) were found to be the chief perpetrators of this anxiety and depression. The burden of anxiety and depression in the primary caregivers of pediatric surgical patients is enormous. Identification of the implicating factors is essential. Simple reforms such as reduction in the number of OPD visits, extension of free of charge category, association with non-governmental organizations and involvement of a clinical psychologist can significantly meliorate the hospital journey of both the patients and their parents. (rd-correlation coefficient of for depression, ra-correlation coefficient of for anxiety).

Change in coronary heart disease hospitalization after chronic disease management: a programme policy in China.

This study aims at examining changes in coronary heart disease (CHD) hospitalization associated with a novel county-scale chronic disease management (CDM) programme policy implemented in March 2019 in China during the 13th Five-Year period (2016-2020). The CDM programme was designed to improve the health of populations with chronic diseases by means of an integrated way involving both county-level public hospitals and primary care institutes. Data originated from the medical files of CHD inpatients discharged from a secondary hospital from January 2017 to December 2020. A total of 6111 CHD patient records were collected. Univariate and multivariate regression analyses were performed to assess changes in hospitalization direct medical costs and length of stay of CHD patients. The mean direct medical cost of CHD hospitalization was 8419.73 Yuan, and the mean length of stay was 7.57 days. Results suggested that the implementation of CDM reduced hospitalization direct medical cost and bed days by about 23% (1956.12 Yuan at means) and 11.5% (almost 1 day at means), respectively. In addition, a further decreasing trend in medical costs over time was associated with chronic disease management. It is implied that chronic disease management is an effective way of relieving the medical and financial burden of hospitalization.

Keeping PAPs down: Implementation of a Nurse-Led Pulmonary Artery Pressure Monitoring Program to Reduce Heart Failure Readmissions

Background Heart Failure (HF) continues to be one of the leading causes of morbidity and mortality in the United States. Even with guideline directed medical therapy, readmission rates for heart failure remain high and are now associated with CMS financial penalties. The CHAMPION study, a randomized trial of an implanted pulmonary artery pressure monitoring device (CardioMEMSTM) which monitored, identified, and transmitted PAP changes to investigators, demonstrating a significant 48% reduction in hospital readmission rates. Despite the success of this device in a clinical trial setting, monitoring and management of daily transmissions can be challenging and resource intense. With physician and nurse practitioner oversight, we developed a nurse-led, protocolized PAP monitoring and management program at the Medical University of South Carolina (MUSC). After the CardioMEMsTM device is implanted, patients go through three monitoring phases during which their PAP thresholds are determined, and a diuretic plan is formulated. The dedicated CardioMEMsTM RN monitors PAPs according to the protocol and consults Advance Practice Nurses as needed (i.e. renal insufficiently, electrolyte imbalance, etc.). CardioMEMsTM team meetings to discuss specific cases and/or revise thresholds are held weekly and routinely include an attending physician. Purpose The aim of this study was to analyze the impact of a nurse-led PAP monitoring device implantation program in hospital admission rates at MUSC. Methods A retrospective chart review of patients who underwent CardioMEMSTMimplantation since the nursing lead protocol was instituted (January 2015) and had at least one year of follow-up. Patients were also included if they received a durable ventricular assist device, cardiac transplant or died within the first year post-implant. In keeping with product labeling, all patients had at least one hospital admission in the setting of HF within one year prior to implantation and New York Heart Failure Class III HF symptoms. A McNemar's test was utilized to compare hospitalizations rates in the year before and after implant. Results Twenty-four patients received a PAP monitoring device during the study period. Eighteen of the 24 patients were not admitted during the year following transplantation (p Conclusion Our nurse-led PAP monitoring program was effective in minimizing hospital admissions among NYHA class III HF patients and CardioMEMSTMdevice. These data support the key role of nurses HF management and optimizing resource utilization. As HF admissions continue to grow, nurse-led PAP monitoring programs are a successful and cost-effective intervention that may be implemented in both metropolitan and rural settings. Nurses play a key role in improving HF management and reducing the financial burden of hospitalizations to both patients and institutions alike.

Applying GRA to analyze influencing factors of patients’ financial burden

Purpose The purpose of this paper is to analyze the influencing factors of patients’ financial burden through a case study of hospital on public‒private partnerships (PPP) model (Chaonan Minsheng Hospital of Guangdong Province) and provide some useful information to policymakers for better development of hospitals on PPP model. Design/methodology/approach There are total six indicators that are defined as patients’ financial burden, basing on the policy of “indicators of medical quality management and control on the third level large general hospital (2011 edition),” issued by Chinese Government. In total, 23 potentially influencing factors of patients’ financial burden for hospital on PPP model were chosen from the above policy. The five-year (2007‒2011) data for the above 29 indicators come from statistic department of hospital on PPP model. Grey relational analysis (GRA) was applied to analyze the influencing factors of patients’ financial burden for hospital on PPP model. Findings A clear rank of influencing factors of patients’ financial burden is obtained and suggestions are provided from results of GRA, which provide reference for policymakers of hospital on PPP model. The five main influencing factors of patients’ financial burden for hospital on PPP model, in sequence, are rescuing critical ill patients on emergency, rescuing critical ill inpatients, inpatient bed occupancy rate, working days per bed and medical building area. Originality/value The study on the influencing factors of patients’ financial burden for hospital on PPP model not only provides decision-making for policymaker of hospital and controlling of medical expenditure but also contributes to release patients’ financial burden for hospitals on PPP model.

Financial Implication of Proposed Legislation on Hospital Reimbursement for the Injured Drunk Driver

The state of Michigan currently has no-fault automobile insurance with personal injury protection, providing anyone injured in motor vehicle collisions with unlimited medical and rehabilitation benefits and lost wage recovery. A new bill proposal, Michigan House Bill 5588, will eliminate hospital reimbursement for those who are found to be intoxicated at the time of a motor vehicle collision. These medical costs will be passed on to patients, which may result in a large reimbursement deficit for hospitals caring for these patients. This retrospective review examines the costs of caring for all intoxicated drivers who were admitted to a Level 1 trauma center after a motor vehicle collision over a 2-year period. Intoxicated drivers were younger (P = 0.0002), had a lower Glasgow Coma Scale (P = 0.0013), and were more likely to meet Level 1 trauma criteria (P = 0.0002). The sum of total charges for injured drunk drivers totaled $5.2 million. When taking into account fixed and variable costs of care, lost hospital net income would be $3 million (21.9%) over a 3-year span whether House Bill 5588 passes. In conclusion, the passage of House Bill 5588 will lead to a large financial burden for hospitals that treat intoxicated drivers.

Actual versus estimated length of stay after colorectal surgery: which factors influence a deviation?

BackgroundThe aim of this study was to determine factors associated with deviation in length of hospital stay (LOS) from that determined by diagnosis-related groups. MethodsA cohort study from a prospectively collected database was conducted, including consecutive patients undergoing surgery in a high-volume colorectal surgery department in 2009. ResultsFor 1,461 included patients, average expected and actual LOS were 8.17 days (interquartile range, 4.7 to 11.9 days) and 8.31 days (interquartile range, 4 to 10 days), respectively. The most prominent factors associated with an increase of LOS from expected were parenteral nutrition (5.11 days), emergency room admittance (3.67 days), and ileus (3.45 days) (P ≤ .001 for all). Other independently associated factors included blood transfusion, anastomotic leak, sepsis, pulmonary embolism, and surgeon. Patients with higher severity illness indexes and longer postoperative intensive care stay had lower than expected LOS. ConclusionsAfter colorectal surgery, several modifiable factors are associated with deviation of LOS from expected. An opportunity hence exists to reduce both LOS and financial burden for hospitals in an era of pay for performance.

Effect of nasal continuous positive airway pressure in prone position on the premature infants with apnea

Objective The aim of this study is to assess the effect of nasal continuous positive airway pressure （ NCPAP） in prone position on the treatment of the premature infants with apnea .Methods Totals of 80 premature infants treated with NCPAP in the NICU from January to December , 20±2 were observed . According to the random number table method , the premature infants were divided into prone position group and supine position group . Each group was treated with NCPAP and aminophylline , and relevant nursing intervention.The changes of their frequencies of apnea , PEEP, FiO2 , PaO2 , and PaCO2 , etc.were observed and compared.Results The effective rate of the prone group was 9±.5% and the effective rate of the supine group was 82.5%.The difference was significant （χ2 =8.4±, P±lt±0.05）.The PaO2 and PaO2/FiO2 in the prone group were （77.24±9.56）,（171.25±31.13）mmHg, respectively, which were higher than （67.52±8.61）,（143.26±26.34）mmHg in the supine group.The differences were significant （t =2.16, 2.14, respectively;P〈0.05）.The time of ventilation, hospital stays and use of aminophylline were （3.65±2.01）,（28.25±3.98）,（10.82±9.08）d, which were lower than （4.83±3.51）,（30.14±12.61）,（12.2±9.37）d in the supine group, the differences were significant （t=0.23, 1.96, 2.37, respectively;P〈0.05）. Conclusions Compared with the traditional supine position , treating the neonate with NCPAP in prone position can not only improve their oxygenation , PaO2 and oxygenation indexes , but also reduce the risk of apnea , as well as shortening the time of ventilation and using of aminophylline .It also reduces the treatment of intubation and ventilation, and relieves the financial burden of hospitalization on the infant ’ parents. Key words: Prone position; Nasal continuous positive airway pressure; Apnea; Premature infants

Multiresistant bacteria and current therapy - the economical side of the story

Severe infections with multiresistant bacteria (MRB) are a medical challenge and a financial burden for hospitals. The adequate antibiotic therapy is a key issue in multiresistant bacteria management. Several major cost drivers have been identified. Remarkably drug acquisition costs are not necessarily included. Most significant are the length of stay in hospital, the hours of mechanical ventilation and the time treated on an intensive care unit.In a systematic review of the literature the following aspects were investigated:- Do generic treatment strategies contribute in cost savings?- Are there specific results for recent antibiotics?Early adequate and effective antimicrobial treatment, switch from i.v. to oral therapy, adjusted duration of therapy and adherence to guidelines have been found to be successful strategies.Looking at specific antibiotics, the best evidence for cost-effectiveness is found for Linezolid in treatment of cSSTI as well as in HAP. Daptomycin shows good economic results in bloodstream infections, so possibly being a cost-effective alternative to vancomycin. Looking at tigecycline the published data show neither higher costs nor savings compared to imipeneme. Doripenem as one of the newest therapy options has proven to be highly cost-saving in HAP when compared with imipenem. However, most analyses are based on pharmacoeconomic modelling rather than on directly analysing trial data or real life clinical populations.ConclusionUsing modern antibiotics in whole is not more expensive than using established therapies. Modern antibiotics are cost-effective and sometimes even cost-saving. This is especially true if an effective therapy is initiated as early as possible.