Higher Healthcare Costs Research Articles

Estimating the economic impact of comorbidities in patients with MASH and defining high-cost burden in patients with noncirrhotic MASH.

Metabolic dysfunction-associated steatohepatitis (MASH) is associated with high health care costs. This US study investigated the economic burden of MASH, particularly in patients without cirrhosis, and the impact of comorbidities on health care costs. This retrospective, observational study used data from patients diagnosed with MASH aged ≥18 years from October 2015 to March 2022 (IQVIA Ambulatory electronic medical record-US). Patients were stratified by the absence or presence of cirrhosis. Primary outcomes included baseline characteristics and annualized total health care cost after MASH diagnosis during follow-up. In addition, this study defined high costs for the MASH population and identified patient characteristics associated with increased health care costs among those without cirrhosis. Overall, 16,919 patients (14,885 without cirrhosis and 2034 with cirrhosis) were included in the analysis. The prevalence of comorbidities was high in both groups; annual total health care costs were higher in patients with cirrhosis. Patients with a high-cost burden (threshold defined using the United States national estimated annual health care expenditure of $13,555) had a higher prevalence of comorbidities and were prescribed more cardiovascular medications. MASH diagnosis was associated with an increase in cost, largely driven by inpatient costs. In patients without cirrhosis, an increase in cost following MASH diagnosis was associated with the presence and burden of comorbidities and cardiovascular medication utilization. Comorbidities, such as cardiovascular disease and type 2 diabetes, are associated with a higher cost burden and may be aggravated by MASH. Prioritization and active management may benefit patients without cirrhosis with these comorbidities. Clinical care should focus on preventing progression to cirrhosis and managing high-burden comorbidities.

Neuroprotective and Nootropic Evaluation of some Important Medicinal Plants in Dementia: A Review

: Dementia is a devitalising decline in neurological acuity, which burdens both high- and lowincome countries due to poor diagnostic systems and high healthcare costs. A growing population and rises in deleterious environmental and genetic anomalies aggravate new and aggressive cases of dementia and neurodegenerative disorders. The unparalleled capability of medicinal plants is constantly explored in treating neurological disorders, and some of these phytocompounds are used for treating diseases. However, some of these metabolites are neurotoxic and disrupt DNA polymerase functions. They possess lifethreatening side effects and are unable to prevent disease progression. Therefore, it is important to focus on discovering novel compounds from new medicinal plants. Our review encompasses some medicinal plant metabolites recently explored in treating this disease. We also summarized the molecular mechanism of action as determined in in-vitro: the toxic dose, nootropic and neuroprotective effects on neurophysiology and neurotransmitter levels, and the antioxidant effects.

Digital Interventions to reduce hospitalization and hospital readmission for chronic obstructive pulmonary disease (COPD) patient: systematic review

BackgroundThe high readmission rate following chronic obstructive pulmonary disease (COPD) has created a significant global health challenge, with high healthcare costs and a growing burden of care. Digital interventions, including telemonitoring, Telehealth, web, or mobile-based, can address these challenges, but there has yet to be a systematic review of the impact of digital interventions on reducing hospital readmission for patients with COPD. The aim of this systematic review was to assess the effectiveness of digital interventions in lowering hospitalization and rehospitalization for patients with COPD.MethodsWe conducted a systematic literature search from PubMed and Scopus to identify randomized controlled trials (RCTs) published in English with outcomes related to hospital admission or readmission within 30 days of hospital discharge.ResultsThe search and selection process followed PRISMA guidelines and resulted in a final sample of 12 RCTs. We found mixed results. Of the 12 included studies, only four studies [mobile-based (n=1), Telehealth (n=1), Telemonitoring (n=2)] found positive effect of a digital intervention on hospital readmission. Seven studies [mobile-based (n=1), Telehealth (n=1), Telemonitoring (n=3), Web-based (n=2)] did not demonstrate clear evidence of a significant reduction in hospitalization rate. Based on these findings, the primary factors contributing to the outcome variation were differences in intervention components used and their operator, COPD severity, patient age, and sample size.ConclusionsSystematic review provides the first insight into the impact of digital intervention on hospital readmission among patients with COPD . While some studies showed positive results, the evidence is mixed, and further research is needed. COVID-19 has accelerated the use of digital intervention and created the opportunity for comprehensive research and investigation with more updated information and further impact on readmission.

The role of neuropsychology in the care of patients with functional neurological symptom disorder.

Functional neurological symptom disorder (FNSD) is a neuropsychiatric condition characterized by signs/symptoms associated with brain network dysfunction. FNSDs are common and are associated with high healthcare costs. FNSDs are relevant to neuropsychologists, as they frequently present with chronic neuropsychiatric symptoms, subjective cognitive concerns, and/or low neuropsychological test scores, with associated disability and reduced quality of life. However, neuropsychologists in some settings are not involved in care of patients with FNSDs. This review summarizes relevant FNSD literature with a focus on the role of neuropsychologists. A brief review of the literature is provided with respect to epidemiology, public health impact, symptomatology, pathophysiology, and treatment. Two primary areas of focus for this review are the following: (1) increasing neuropsychologists' training in FNSDs, and (2) increasing neuropsychologists' role in assessment and treatment of FNSD patients. Patients with FNSD would benefit from increased involvement of neuropsychologists in their care.

DOSAGE study: protocol for a phase III non-inferiority randomised trial investigating dose-reduced chemotherapy for advanced colorectal cancer in older patients

IntroductionTreating older adults with chemotherapy remains a challenge, given their under-representation in clinical trials and the lack of robust treatment guidelines for this population. Moreover, older patients, especially those with...

Exploring the Relationship between Food Insecurity, Chronic Health Conditions, and Serious Mental Illness in the United States: Implications for Social Work.

Food insecurity (FI) is a modifiable social determinant of health that impacts approximately 10 percent of the U.S. population. FI has been linked to poorer health outcomes and higher healthcare costs. Given the prevalence of chronic health conditions in the United States, including serious mental illness (SMI), the current study aims to better understand the relationship between FI and chronic conditions, including SMI, in a nationally representative sample. Authors analyzed data from the 2016 Medical Expenditure Panel Survey household component and food security supplement. Findings indicate the prevalence of FI among those with diabetes, lung disease, stroke, and SMI is higher than among the general population, with the prevalence for those with SMI being particularly high (43 percent of the sample). Logistic regression models indicate strong, statistically significant relationships between FI and chronic conditions, including SMI, as well as FI and two or more chronic illnesses, even when controlling for sociodemographic and health factors. There are likely bidirectional relationships between FI and chronic conditions. Findings have implications for social workers, in relation to prevention and treatment of SMI and FI through direct care, advocacy, and integrated services in health, mental health, and social services.

Determinants of Late HIV Diagnosis and Advanced HIV Disease Among People Living with HIV in Tanzania.

About half of people infected with Human Immunodeficiency Virus (HIV) often present late for care, resulting in higher healthcare costs, undesired treatment outcomes, and ongoing HIV transmission. This study aimed to assess the prevalence and determinants of late HIV diagnosis and advanced HIV disease (AHD) in Tanzania. Data were obtained from the 2016-17 Tanzania HIV impact survey. We included 677 newly diagnosed people living with HIV. Late HIV diagnosis and AHD were defined as having a CD4 cell count below 350 cells/µL or 200 cells/µL at diagnosis, respectively. Bivariate and multivariable logistic regression models were fitted to identify the determinants of late HIV diagnosis or AHD. The mean age of the participants was 37.8 years (SD, 12.4). About two-thirds were women (62.6%). The prevalence of late HIV diagnosis was 42.4%, whereas the prevalence of AHD was 17.7%. Factors associated with late HIV diagnosis included age 31-40 years (adjusted odds ratio [aOR] = 1.72, 95% confidence interval [CI]: 1.14-2.60), age ≥41 years (aOR = 1.79, 95% CI: 1.16-2.76), male sex (aOR = 1.88, 95% CI: 1.29-2.73), and active syphilis infection (aOR=2.63, 95% CI: 1.20-5.76). Factors associated with AHD were age 31-40 years (aOR = 2.12, 95% CI: 1.18-3.81), age ≥41 years (aOR = 2.42, 95% CI: 1.32-4.41), male sex (aOR = 1.77, 95% CI: 1.09-2.87), formal education (aOR = 0.49, 95% CI: 0.30-0.81) and active syphilis infection (aOR = 2.49, 95% CI: 1.07-5.77). Late HIV diagnosis and AHD are prevalent among newly diagnosed people living with HIV in Tanzania. Specific subgroups are more likely to present late for HIV care, including middle-aged and older adults, men, illiterate individuals, and those with active syphilis and HIV co-infection. Therefore, we recommend expanding HIV testing services and implementing targeted interventions to improve early access and enrollment in HIV care.

Italian healthcare resource consumptions and direct costs of adults with atopic dermatitis before and after dupilumab treatment.

Atopic dermatitis (AD) is a heterogeneous disease, associated with comorbidities, and high healthcare consumptions and costs. This study assessed the burden before and after treatment with dupilumab in adults with severe AD from 2018 to 2020, from the perspective of the Italian National Health Service (SSN). From Fondazione Ricerca e Salute's administrative healthcare database (~5 million inhabitants/year), adults treated with dupilumab from 09/01/2018 to 31/12/2020 (index date) and a five-year lookback were identified. Age, sex and comorbidities at baseline, concomitant drugs, overnight hospitalizations, outpatient specialist services and direct costs charged to the SSN one year before/after index date were assessed. Of 337 adults treated with dupilumab (5.8x100,000 adult inhabitants/2019; 8.0x100,000/2020; 55% males; mean age 43±19), 68% (228/337) had ≥12-month follow-up available. Asthma was a common comorbidity (23% patients). Rates of patients treated with nearly all concomitant AD-related therapies reduced from 12 months before to 12 months after dupilumab treatment: antibacterials (from 59% to 50%), systemic corticosteroids (55% to 29%), antihistamines (54% to 38%) and cyclosporine (52% to 7%). A similar trend was observed among patients with asthma as comorbidity. Within 12 months before/after dupilumab, patients hospitalized halved from 14% to 7%, and patients receiving outpatient specialist care reduced from 72% to 65%. Annual mean direct total costs per patient treated with dupilumab charged to the SSN, net of dupilumab cost, were €1384 and €773, before and after dupilumab dispensation, respectively. Before dupilumab, observed patients had higher healthcare resource consumptions and direct SSN costs than after dupilumab.

Dynamic three-dimensional coculture model: The future of tissue engineering applied to the peripheral nervous system

Traumatic injuries to the peripheral nervous system (PNI) can lead to severe consequences such as paralysis. Unfortunately, current treatments rarely allow for satisfactory functional recovery. The high healthcare costs associated with PNS injuries, worker disability, and low patient satisfaction press for alternative solutions that surpass current standards. For the treatment of injuries with a deficit of less than 30 mm to bridge, the use of synthetic nerve conduits (NGC) is favored. However, to develop such promising therapeutic strategies, in vitro models that more faithfully mimic nerve physiology are needed. The absence of a clinically scaled model with essential elements such as a three-dimension environment and dynamic coculture has hindered progress in this field. The presented research focuses on the development of an in vitro coculture model of the peripheral nervous system (PNS) involving the use of functional biomaterial which microstructure replicates nerve topography. Initially, the behavior of neuron-derived cell lines (N) and Schwann cells (SC) in contact with a short section of biomaterial (5 mm) was studied. Subsequent investigations, using fluorescent markers and survival assays, demonstrated the synergistic effects of coculture. These optimized parameters were then applied to longer biomaterials (30 mm), equivalent to clinically used NGC. The results obtained demonstrated the possibility of maintaining an extended coculture of SC and N over a 7-day period on a clinically scaled biomaterial, observing some functionality. In the long term, the knowledge gained from this work will contribute to a better understanding of the PNS regeneration process and promote the development of future therapeutic approaches while reducing reliance on animal experimentation. This model can be used for drug screening and adapted for personalized medicine trials. Ultimately, this work fills a critical gap in current research, providing a transformative approach to study and advance treatments for PNS injuries.

Factors and Reasons of Self-Medication: For Health Education on Self-Medication Risks and Healthy Safecare Practices

The public has turned to self-medication during the pandemic due to the rising social media influence, the availability of over-the-counter drugs, and the public’s fear of getting the virus. Self-medication is a widespread practice in both developed and developing nations. Self-medication has been noted to be on the rise worldwide. Health professionals are worried on the practice of self-medication by adamant sick persons, and prescription drugs over-the-counter are persisted for the treatment of diseases. This study critically examined the factors and reasons for the self-medication of the elderly in the City of San Jose Del Monte, Bulacan. The results of the study served as a baseline reference to develop health education on self-medication risks to promote healthy safety practices. Furthermore, the objectives of this research were to examine the prevailing opinions of the elderly about the factors of self-medication and to assess the main ideas of the elderly on the reasons for self-medication. The study employed a descriptive research design that determined the nature of the specific occurrences under investigation. [1] The adopted standardized Factors and Reasons of Self-Medication Survey Questionnaire was utilized. It was revealed that age and monthly income were two factors that had a significant impact on the decisions that older people made regarding their self-medication. In terms of reasons, these include: the similarity of symptoms with past illnesses, perceived illness as mild, need for quick relief/urgency, distance of health institutions, drug access to pharmacy, high healthcare cost, long lines or waiting time in the physician’s clinic and hospital, and self-medication is cheaper were the common reasons for self-medication. The findings of the study provided components of health teachings in framing health education on self-medication risks and healthy safety practices.

Demand and Supply Drivers of Medicare and Non-Medicare Health Spending: An Analysis of U.S. States, 1991-2019.

For the last four decades, policymakers have attempted to control the United States's high health care costs by reducing patients' demand for care (e.g., by imposing managed-care restrictions or high costs on patients at the time of use). Yet studies based mostly on data from the public Medicare program, which covers mostly elderly Americans, suggest that supply (e.g., number of physicians or hospital beds) rather than demand drives aggregate service use and, hence, costs. Using variation between U.S. states in per enrollee Medicare spending versus per capita spending of all other (non-Medicare) individuals, we find that greater supply boosts costs for the entire population. Furthermore, we find that factors that suppress demand in the non-Medicare population do reduce non-Medicare health care spending, but simultaneously increase Medicare spending. This suggests that for a given supply of medical resources, suppressing demand for one group of patients may produce a compensatory increase in provision of care to those whose demand has not been suppressed. Health planning to assure adequate medical resources where they are needed while preventing excess supply where it is duplicative and wasteful is likely a more effective cost control strategy than the imposition of managed-care restrictions or imposing higher costs onto patients seeking care.

Environmental economics of green recovery in mineral extraction: Balancing production and conservation

This study examines data from 1995 to 2021 using self-regressive distribution lag modeling to uncover how mineral wealth utilization influences sustainable development in select Central Asian countries. Our findings highlight a critical challenge: increased mineral asset mining significantly hampers the region's ecological growth, both immediately and over time, due to its detrimental environmental impacts. However, there is a beacon of hope: a 1% increase in hydropower output can elevate the sustainability score by 0.19% in the long term and 0.10% in the short term, showcasing the transformative potential of renewable energy. On the flip side, escalating carbon dioxide emissions pose a serious threat, stalling green financial development through ecological harm and higher healthcare costs. Furthermore, urbanization slightly diminishes the long-term sustainability score by 0.06%. This gives a clear confirmation of the necessity of Central Asian countries to embrace the renovation of the state's vectors for conformism towards the idea of ecological sustainability. The necessary legislative measures, the development of renewable power sources, making natural resources trading more effective and integrating eco-friendly finance to support green projects will help the region chart its course toward a sustainable and prosperous development.

Probing the functional magnetic resonance imaging response to psilocybin in functional neurological disorder (PsiFUND): study protocol.

Functional neurological disorder (FND) is a common cause of neurological symptoms including paralysis, seizures, and movement disorders. It is often debilitating, is associated with high health and social care costs, and can have a poor prognosis. Functional magnetic resonance imaging (fMRI) has suggested FND is a multi-network disorder; the default mode network (DMN) may be specifically implicated. Converging evidence suggests that other variable mechanisms including dissociation, interoception, and motor agency may be differentially abnormal in people with FND. Psychedelics are currently under investigation for numerous neuropsychiatric disorders and have been shown to disrupt functional networks such as the DMN. Administering psychedelics to people with FND will help us to probe mechanistic theories of the disorder. In this open-label neuroimaging study, we will administer 25mg oral psilocybin with psychological support to people with chronic FND (target n = 24). Participants will undergo resting-state and task-based (Libet's clock, a measure of motor agency) fMRI sequences which will be compared in a pre-post manner. Additional mechanistic outcomes including measures of interoception (heartbeat tracking task), somatisation, illness perceptions, imaginative suggestibility, and dissociation will be collected. Data on expectancy, preparedness, and subjective experience of the psychedelic experience will also be gathered. Participants will be followed up for three months following psilocybin administration. fMRI changes in networks such as the DMN will be analysed using seed-based approaches, and additional exploratory analysis of resting-state imaging will take place. The study will help us to probe the mechanisms thought to potentially underpin FND. As the first modern study of psychedelics in FND, it will also help us to understand whether psychedelic administration alongside psychological support might be safe and feasible in this patient population.

High Healthcare Costs in Childhood Inflammatory Bowel Disease: Development of a Prediction Model Using Linked Clinical and Health Administrative Data.

The incidence of pediatric-onset inflammatory bowel disease (IBD) and the costs of caring for individuals with IBD are both increasing. We calculated the direct healthcare costs of pediatric IBD in the first year after diagnosis and developed a model to predict children who would have high costs (top 25th percentile). Using data from the Canadian Children IBD Network inception cohort (≤16 years of age, diagnosed between 2013 and 2019) deterministically linked to health administrative data from Ontario, Canada, we estimated direct healthcare and medication costs accrued between 31 and 365 days after diagnosis. Candidate predictors included age at diagnosis, sex, rural/urban residence location, distance to pediatric center, neighborhood income quintile, IBD type, initial therapy, disease activity, diagnostic delay, health services utilization or surgery around diagnosis, regular primary care provider, and receipt of mental health care. Logistic regression with stepwise elimination was used for model building; 5-fold nested cross-validation optimized and improved model accuracy while limiting overfitting. The mean cost among 487 children with IBD was CA$15 168±15 305. Initial treatment (anti-tumor necrosis factor therapy, aminosalicylates, or systemic steroids), having a mental health care encounter, undergoing surgery, emergency department visit at diagnosis, sex, and age were predictors of increased costs, while having a regular primary care provider was a predictor of decreased costs. The C-statistic for our model was 0.71. The cost of caring for children with IBD in the first year after diagnosis is immense and can be predicted based on characteristics at diagnosis. Efforts that mitigate rising costs without compromising quality of care are needed.

Chronic Kidney Disease in a Tertiary Care Hospital in Nepal

Introduction: Chronic kidney disease (CKD) is an increasingly recognized major public health problem globally and in Nepal. It has a high prevalence in the population and is associated with high morbidity, mortality and health care costs. Here, we aimed to study the socio-demographic profiles, etiologies of CKD and associated co-morbidities in patients attending a referral hospital. Methods: We conducted a hospital based, descriptive, observational, cross-sectional study among adult patients with CKD attending Tribhuvan University Teaching Hospital (TUTH), Kathmandu. Patients younger than 16 years and renal allograft recipients were excluded from the study. A diagnosis of CKD was established by the treating nephrologist based on KDIGO 2012 clinical practice guideline. Prior informed consent was taken. Data was collected on clinical features, socio-demographic profiles, major co-morbidities, presumed etiology of CKD and hematological and biochemical parameters of the patients. SPSS version 24 (Chicago, IL, USA) was used for the analysis of data. The study protocol was approved by the Institutional Review Board (IRB) of Institute of Medicine (IOM). Results: A total of 401 patients with CKD were included in the study. The mean age of the patient was 50.92 years (SD=17.98), male to female ratio was 1.8:1. Among these patients, 86% were Hindu, 24.4% were farmers, 57% were from the Hilly region of Nepal, 51% were active smokers, and 51.6% were alcohol consumers. Chronic glomerulonephritis (CGN) (36.2%; n= 145), diabetes mellitus (31.9%; n= 128) and hypertension (21.7%; n=87) were the three most common identified causes of CKD. Among the biopsy proven CGN patients, IgA nephropathy was the most common cause. In a large proportion of patients (68.3%) cause of CGN was not known. Most of the patients were in CKD stage 5 (27%), and stage 5D (55.8%). Coronary artery disease (CAD) (in 7% patients), heart failure (in 2.7%) and stroke (in 2.2%) were the most common comorbidities. Anemia was prevalent in CKD from stage 3 onwards, the severity increased with increasing stage (p <0.001). Hemodialysis was the predominant mode of renal replacement therapy (RRT) used by 98.2% of CKD 5D patients. Conclusion: Nepalese patients of CKD are younger; males are more affected than females. CGN, diabetes and hypertension are three most common causes of CKD; IgA nephropathy is the most common cause of biopsy proven CGN leading to CKD. Anemia is common from CKD stage 3 onwards. The most common associated co-morbidity is CAD.

Clinical efficacy of endovascular revascularization combined with vacuum-assisted closure for the treatment of diabetic foot.

The diabetic foot is a common cause of disability and death, and comorbid foot infections usually lead to prolonged hospitalization, high healthcare costs, and a significant increase in amputation rates. And most diabetic foot trauma is complicated by lower extremity arteriopathy, which becomes an independent risk factor for major amputation in diabetic foot patients. To establish the efficacy and safety of endovascular revascularization (ER) combined with vacuum-assisted closure (VAC) for the treatment of diabetic foot. Clinical data were collected from 40 patients with diabetic foot admitted to the Second Affiliated Hospital of Soochow University from April 2018 to April 2022. Diabetic foot lesions were graded according to Wagner's classification, and blood flow to the lower extremity was evaluated using the ankle-brachial index test and computerized tomography angiography of the lower extremity arteries. Continuous subcutaneous insulin infusion pumps were used to achieve glycemic control. Lower limb revascularization was facilitated by percutaneous tran-sluminal balloon angioplasty (BA) or stenting. Wounds were cleaned by nibbling debridement. Wound granulation tissue growth was induced by VAC, and wound repair was performed by skin grafting or skin flap transplantation. Of the 35 cases treated with lower limb revascularization, 34 were successful with a revascularization success rate of 97%. Of these, 6 cases underwent stenting after BA of the superficial femoral artery, and 1 received popliteal artery stent implantation. In the 25 cases treated with infrapopliteal artery revascularization, 39 arteries were reconstructed, 7 of which were treated by drug-coated BA and the remaining 32 with plain old BA. VAC was performed in 32 wounds. Twenty-four cases of skin grafting and 2 cases of skin flap transplantation were performed. Two patients underwent major amputations, whereas 17 had minor amputations, accounting for a success limb salvage rate of 95%. ER in combination with VAC is a safe and effective treatment for diabetic foot that can significantly improve limb salvage rates. The use of VAC after ER simplifies and facilitates wound repair.

Healthcare costs and medical utilization patterns associated with painful and severe painful diabetic peripheral neuropathy.

Painful diabetic peripheral neuropathy (DPN) is a common complication in patients with diabetes. It is associated with a poor quality of life and high costs of care. This study investigated the impact of painful DPN on healthcare costs and resource utilization. This was a retrospective analysis of administrative claims of adult patients with diabetes (type 1 or 2) from Optum's de-identified Clinformatics® Data Mart Database. Patients were assigned to four cohorts by presence of DPN and pain severity, based on diagnoses and prescription patterns in a one-year baseline. All-cause and diabetes-associated costs were calculated for the year following the index DPN diagnosis. Risk factors associated with presence of severely painful DPN were evaluated. Relative to those without DPN, patients who had DPN without pain, painful DPN (PDPN), or severe PDPN incurred respective increases of $3,093, $9,349, and $20,887 in average annual all-cause costs. More than half of costs from painful/severe DPN were for prescriptions and inpatient hospitalization. Severe PDPN was associated with elevated odds of diabetic amyotrophy (OR: 8.09; 95% CI: 6.84-9.56), diabetic foot ulcers (OR: 6.54, 95% CI: 6.32-6.76), and loss of mobility (OR: 2.54, 95% CI: 2.48-2.60), among other complications. Painful DPN is associated with higher healthcare costs and resource utilization, and a greater risk of debilitating conditions that limit quality of life. Future research should focus on better treatment options and more aggressive pain management strategies to reduce the negative impacts of DPN.

Enhanced Comprehensive Care Programme: a retrospective study of patient empanelment by generalist-led multidisciplinary teams to reduce acute care utilisation.

Singapore faces an increasingly aged population with complex multimorbidity and psychosocial impairment. This change in demographic is challenging for existing healthcare systems. Breaks in care coordination and continuity result in poor health outcomes, increased acute care utilisation and higher healthcare costs. We proposed a patient empanelment approach adapted for the Singapore context based on the University of Chicago Comprehensive Care Physician model. This retrospective quasi-experimental, matched-controlled observational study sought to assess the effectiveness of the Enhanced Comprehensive Care Programme (ECCP) in reducing acute care utilisation at National University Hospital, Singapore. The primary outcomes were the number of hospitalisations and emergency department (ED) visits 6 months pre- and post-enrolment in ECCP. We used propensity score matching to balance prior healthcare utilisation between the intervention and control groups. Fifty-seven participants were recruited in the programme between October 2019 and April 2020. There was a reduction in the mean number of hospitalisations after intervention compared to before intervention (0.58 ± 1.03 vs. 1.90 ± 1.07, P < 0.001). There was also a reduction in the mean number of ED visits (0.77 ± 1.05 vs. 1.96 ± 1.14, P < 0.001). In the propensity-matched cohort, the mean number of hospitalisations was reduced in the intervention group (from 1.92 ± 1.07 to 0.58 ± 1.03, P < 0.001) compared to the control group (from 1.85 ± 0.99 to 1.06 ± 1.17, P = 0.04). This observational study shows the potential benefits of ECCP healthcare redesign to reduce acute care utilisation.

Preoperative in-hospital delay increases postoperative morbidity and mortality in patients with acute appendicitis: A meta-analysis.

Complicated appendicitis is associated with high morbidity, mortality, and healthcare costs. However, the relationship of preoperative in-hospital delay >24 hours with complicated appendicitis and postoperative morbidity remains unclear. This meta-analysis investigated the effects of preoperative in-hospital delay on complicated appendicitis and postoperative morbidity in patients with acute appendicitis. This study adheres to the PRISMA 2020 and AMSTAR 2 guidelines. The PubMed, Embase, Cochrane Library, and Web of Science databases up to October 14, 2023 (updated on March 16, 2024) were searched for randomized controlled trials (RCTs) and observational studies that evaluated the effect of preoperative in-hospital delays of >24 hours on acute appendicitis. Odds ratios (OR) and 95% confidence intervals were also determined. We yielded 18,130 records, of which 28 studies (512,881 patients) were included in the meta-analysis. The risk of bias was considered serious, moderate, and low for 24, 3, and 1 study, respectively. Although preoperative in-hospital delays of >24 hours were not associated with a higher risk of surgical site infection (OR 1.04, 95% CI 0.97, 1.12, P=0.25), in-hospital delays of >24 hours was a risk factor for complicated appendicitis (OR 1.60, 95% CI 1.25, 2.05, P=0.0002), and postoperative complications (OR 1.51, 95% CI 1.30, 1.75, P<0.00001). In addition, an in-hospital delay of >24 hours before surgery increased the OR of postoperative mortality (OR 1.81, 95% CI 1.33, 2.45, P=0.0001). The sensitivity analyses also confirmed the robustness of our results. An in-hospital delay of >24 hours is a risk factor for complicated appendicitis, postoperative complications, and mortality. Given the subsequent adverse outcomes of in-hospital delays, appendectomy should not be delayed for >24 hours.

Costs and healthcare use of patients with chronic kidney disease in the Northern Territory, Australia

BackgroundThe burden of chronic kidney disease (CKD) is high in the Northern Territory (NT), Australia. This study aims to describe the healthcare use and associated costs of people at risk of CKD (e.g. acute kidney injury, diabetes, hypertension, and cardiovascular disease) or living with CKD in the NT, from a healthcare funder perspective.MethodsWe included a retrospective cohort of patients at risk of, or living with CKD, on 1 January 2017. Patients on kidney replacement therapy were excluded from the study. Data from the Territory Kidney Care database, encompassing patients from public hospitals and primary health care services across the NT was used to conduct costing. Annual healthcare costs, including hospital, primary health care, medication, and investigation costs were described over a one-year follow-up period. Factors associated with high total annual healthcare costs were identified with a cost prediction model.ResultsAmong 37,398 patients included in this study, 23,419 had a risk factor for CKD while 13,979 had CKD (stages 1 to 5, not on kidney replacement therapy). The overall mean (± SD) age was 45 years (± 17), and a large proportion of the study cohort were First Nations people (68%). Common comorbidities in the overall cohort included diabetes (36%), hypertension (32%), and coronary artery disease (11%). Annual healthcare cost was lowest in those at risk of CKD (AUD$7,958 per person) and highest in those with CKD stage 5 (AUD$67,117 per person). Inpatient care contributed to the majority (76%) of all healthcare costs. Predictors of increased total annual healthcare cost included more advanced stages of CKD, and the presence of comorbidities. In CKD stage 5, the additional cost per person per year was + $53,634 (95%CI 32,769 to 89,482, p < 0.001) compared to people in the at risk group without CKD.ConclusionThe total healthcare costs in advanced stages of CKD is high, even when patients are not on dialysis. There remains a need for effective primary prevention and early intervention strategies targeting CKD and related chronic conditions.