Source Of Payment Research Articles

94 A Review of the Utility of the Readmission Risk Scale in Hospitalized Burn Injured Patients

Abstract Introduction The burden of wound care post-hospitalization is often overwhelming, not only for patients and their families but also for home health nurses and intermediate care facilities. Inadequate wound care following hospital discharge can lead to wound deterioration and hospital readmission. These readmissions impact the patient, as well as healthcare institutions, physicians, payor sources, and policy makers. Readmission Risk Scales (RSS) exist but typically focus on those patients with chronic illness. Our hospital’s RRS consists of 16 items: patient without a primary care physician (PCP), active problem list > 2, past medical history > 2, age ≥ 50, lives alone, high fall risk, length of stay > 10 days, mental health disorder, diabetes, heart failure, COPD, alcohol abuse, drug use, uninsured/Medicaid, > 2 ED visits in previous 6 months and prior readmission within 30 days. The purpose of this study was to evaluate the fit of our current RSS for burn patients and identify other variables that may be predictive of readmission in burn patients. Methods This was a retrospective chart review of burn patients admitted over a 1-year period. Primary outcome measures were RSS scores, individual RSS variables, social determinants of health and incidence of readmission within 30 days of discharge. Readmitted patients were compared to those who did not require readmission. Descriptive statistics were calculated, and bivariate and multivariable logistic regressions (forward LR) were used to identify variables that contributed uniquely to readmission. Results A total of 600 burn patients were admitted over the study period of which 449 met inclusion/exclusion criteria. Thirty-two (7%) of these patients were readmitted within 30 days of their initial hospital discharge. In bivariate analyses, only 4 of the current RRS variables were statistically significant predictors of readmission within 30 days, patient without a PCP (p=.019), active problem list > 2 (p< .001), mental health disorder (p=.004) and drug use (p< .00004). However, when these variables were tested simultaneously in one predictive equation, only drug use remained significantly predictive. The total RSS score accounted for only 1.1% of the variance in readmission within 30 days. Conclusions The national readmission rate is 12%, and our overall rate was substantially below this. However, our current Readmission Risk Scale is not predictive in identifying those patients at risk for being readmitted within 30 days of discharge. Further investigation is warranted to identify additional variables to identify at risk patients. Applicability of Research to Practice A valid readmission risk assessment tool, would be beneficial to identify patients who are at risk for readmission and enhancing discharge planning.

285 Determinants of Mortality Amongst Adult Burn Patients Admitted to a Regional Burn Center: Twenty-year Review

Abstract Introduction Established determinants of morbidity and mortality in burn patients include age and total burn surface area (TBSA), followed by inhalation injuries. We investigated determinants of mortality in burn patients admitted to our unit over the last two decades. The goal of this study was to determine the trends associated with burn mortality. Methods The burn registry was reviewed for the data of 5,401 burn patients admitted to our burn unit from 2002 to 2021. Patient demographics, payer source, burn characteristics, TBSA, injury circumstances, length of stay, ventilator and ICU days, comorbidities, complications, and surgery/procedures data were obtained for all patients. Chart reviews were completed for patients who died to investigate trends in mortality. The chi-square test, Wilcoxon two sample Test, Cochran-Armitage trend test, and Jonckheere-Terptra test will be used to evaluate the difference in risk factors of patients who survived and those who died. Two-sided p values less than 0.05 were considered statistically significant. Results A total of 4093 adult burn patients were hospitalized from 2002 to 2021, of which 155 died. Data showed a significant mortality risk for patients of older age with increased TBSA, higher number of ventilator days, higher ICU Days, and a higher number of complications and smoke inhalation. Male patients had a significantly higher mortality rate. Burn injury by flash-flame represented a higher mortality risk. Accidental burn injury unrelated to employment was significantly more common in all patient populations. The relationship between the number of comorbidities and mortality risk was not clear. There wasn’t a significant difference in the mortality risk based on ethnicity (p=0.1218). Mortality rates did not change significantly over the 20 years (p=0.2027). Conclusions Age, %TBSA, and presence of inhalation injury continue to be major determinants of mortality. Higher incidence of longer stay and ICU/ventilator days, complications, and surgical procedures are associated with burn patients who don’t survive but these may be related to previous parameters. Overall mortality trends have not changed. Applicability of Research to Practice The results of this study can be used to increase accuracy in the triage of burn patients at higher risk of complications and death, to offer patients precise prognostics and better outcomes in terms of morbidity and mortality.

36 A Regional Analysis of Completely Preventable Injuries Sustained from Burning Garbage and Yard Waste

Abstract Introduction Burn injuries due to garbage and yard waste burning account for a high percentage of flame injuries in the south. Understanding the injury pattern and healthcare burden is important for effective prevention of these completely unnecessary burn injuries. Methods This five-year retrospective, single-center, review included patients admitted between 2016 and 2021. Patients included were at least 14 years of age and sustained an open flame burn injury due to burning brush and/or trash. Patients who experienced a burn injury due to gasoline, hazardous material, lighter, fireworks, accelerant/gel, aerosol can, and burning bedding/clothing, were excluded. Results Based primary residence of the 136 patients, 56% had access to free municipal waste disposal, 25% could have had access with additional payment (not included in taxes), and 18% did not have access to municipal waste disposal. The median age was 50 (32, 66.5) years. The majority were burning yard debris, while 32% were burning trash. The majority were male (85%) and Caucasian (71%). The median TBSA was 5 (2.5, 12) percent with 36% having some portion of full-thickness injury. One-third had some form of substance use with 29% tobacco, 5% alcohol, and 4% illicit drugs. There were 151 total operations with a median of 1 (0, 1.5) per patient. There were 1,620 unnecessary hospital days utilized (~6.6% of available bed-days per study period). The median length of stay was 3 (1, 10) days with the majority (85%) being discharged back to their home. Twenty-five percent were discharged with a paired functional status worse than pre-injury. Eighty-eight percent required no assistance prior to injury, while only 67% were discharged without requiring mobility or assistance with ADLs. Patients with some degree of pre-injury function limitations had a three-fold higher LOS (10 vs 3 days; p = 0.023) and associated costs. Although deaths were few in this sample, patients with lower pre-injury functionality had almost 5 times higher mortality (23.1% vs 5.3%; p = 0.083). Therapy data were available for 88 patients totaling 656 occupational and 462 physical therapy sessions, including acute care, inpatient rehabilitation unit, and outpatient. Unfortunately, there were 8 (6%) unnecessary deaths from their injuries with an average 77.3 ± 10.4 years of age and 42.4 ± 21.7% TBSA with 35.1 ± 23.7% being full-thickness. Total hospital charges exceeded $32.6 million with a median $32,952.26 ($8,790.48, $103,113.95) per patient. Payer source at day of discharge was mixed (private 37%, self-pay 26%, Medicare 20%, and Medicaid 17%). Conclusions Injuries from waste burning are completely unnecessary and subsequent mortality, morbidity, and health care burden avoidable. Focusing future outreach efforts on education and resource availability may prevent future debris and trash related injuries. Applicability of Research to Practice This is the first study to utilize repository data to analyze waste burning injuries from a regional perspective.

Prevalence and Risk Factors of Anxiety Among Adult Patients with Chronic Pharyngitis in Wuhu, China.

Chronic pharyngitis (CP) is a common disease, which has a long duration and a wide range of onset. Anxiety is considered to be a common complication in patients with CP. The purpose of this study was to evaluate the anxiety level and potentially influencing factors in patients with CP, to provide insights for the management of anxiety in patients with CP. A total of 104 adult patients with CP meeting the inclusion/exclusion criteria were enrolled from a single center in Wuhu, China between October 2015 and December 2016. A Self-rating Anxiety Scale (SAS) was used to measure the status of anxiety. The relationship between SAS scores and illness period in patients with CP was analyzed by Pearson correlation test. Univariate analysis and binary logistic regression analysis were performed to analyze the risk factors of anxiety in patients with CP. The average SAS score of 104 patients with CP was (44.17 ± 8.38), including 82 cases (78.85%) without anxiety and 22 cases (21.15%) with anxiety. Moreover, the illness period was found to be positively related to SAS scores in patients with CP (r = 0.378, P = 0.001). Furthermore, the results of univariate analysis showed that there were significant differences in anxiety state among CP patients with different age, illness period, source of treatment payment, and marital status (P < 0.05). Additionally, the results of binary logistic regression analysis showed that age, source of treatment payment, and marital status were the independent risk factors affecting the anxiety status of patients with CP (P < 0.05). These results suggested that CP patients with advanced age, self-pay, and unmarried status had higher risk for anxiety.

Alzheimer's Disease Services, Staffing, and Outcomes in Adult Day Health Centers.

Increasing rates of Alzheimer disease and related dementia (ADRD) has resulted in greater reliance on adult day health centers (ADHCs) and their skilled workforce. Little is known about staffing in ADHCs that provide ADRD services compared with ADHCs that do not. This study examines whether there are differences in staffing between ADHCs that offer ADRD services versus those that do not, and whether the percentage of ADHC participants with ADRD is associated with staffing levels. It also examines whether staffing levels and provision of ADRD services are associated with participant outcomes. Cross-sectional analysis of secondary survey data. We used facility-level data from the 2014 National Post-acute and Long-term Care Study Adult Day Services Center module. This survey is completed by administrators of ADHCs, who provide information about their ADHC's organization, services, participants, sources of payment, staffing, and participant outcomes. Bivariate comparisons and multivariate regressions were used to compare scope of services, staffing, and participant outcomes for ADHCs that offered ADRD programs compared with those that did not. ADHCs with ADRD programs had similar average daily attendance, less revenue from Medicaid and self-payment, and greater proportions of Black and female participants. ADHCs with ADRD programs had similar staff hours per participant day for all staff categories; licensed nurse staffing increased and social worker staffing decreased with the proportion of participants with ADRD. Staffing had significant associations with participant outcomes. ADHCs that have more participants with ADRD have greater staffing of licensed nurses but fewer social workers. Participant outcomes are associated with staffing, but the results suggest that there are unmeasured dimensions of participant risk that confound the relationship.

Clinical and epidemiologic features of persons accessing emergency departments for dog and cat bite injuries in California (2005-2019).

To describe the clinical and epidemiologic features of persons with dog and cat bite injuries who presented to emergency departments. Records of 648,492 dog and cat bite-related emergency department visits in California from 2005 to 2019. Visits were selected by standardized International Classification of Diseases, Ninth or Tenth Revision, Clinical Modification codes that indicated a bite as an external cause of injury in the medical record. Incidence rates were calculated for patient demographics, location and month of bite incident, characteristics of bite injury, infection, patient outcome/disposition, and expected source of payment. Cross-sectional descriptive analysis was performed. The average annual incidence of dog bites was highest in children aged < 10 years and males, while that of cat bites was highest in adults aged ≥ 80 years and females. Bites were more likely to occur in rural settings, in private residences, and during the summer. The median household income for zip codes in which animal bite patients resided was lower than the statewide median household income. Both dog and cat bite injuries were more likely to occur to upper limbs. Bacteria were isolated from 3% of dog bite injuries and 21.5% of cat bite injuries at initial presentation. Epidemiologic findings about persons presenting to emergency departments for animal bite injuries can inform bite prevention efforts by identifying at-risk populations. Effective animal bite prevention demands an ongoing multisectoral program of veterinarians and other health professionals, collaborating with community and governmental organizations, to develop and implement integrated strategies within the context of other socially contributory factors.

Biosimilar Use Among 38 ASCO PracticeNET Practices, 2019-2021.

Biosimilars offer increased patient choice and potential cost-savings, compared with originator biologics. We studied 3 years of prescribed biologics among US physician practices to determine the relationship of practice type and payment source to oncology biosimilar use. We acquired biologic utilization data from 38 practices participating in PracticeNET. We focused on six biologics (bevacizumab, epoetin alfa, filgrastim, pegfilgrastim, rituximab, and trastuzumab) for the period from 2019 to 2021. We complemented our quantitative analysis with a survey of PracticeNET participants (prescribers and practice leaders) to reveal potential motivators and barriers to biosimilar use. We implemented logistic regression to evaluate the biosimilar use for each biologic, with covariates including time, practice type, and payment source, and accounted for clusters of practices. Use of biosimilars increased over the 3-year period, reaching between 51% and 80% of administered doses by the fourth quarter of 2021, depending on the biologic. Biosimilar use varied by practice, with independent physician practices having higher use of biosimilars for epoetin alfa, filgrastim, rituximab, and trastuzumab. Compared with commercial health plans, Medicaid plans had lower biosimilar use for four biologics; traditional Medicare had lower use for five biologics. The average cost per dose decreased between 24% and 41%, dependent on the biologic. Biosimilars have, through increased use, lowered the average cost per dose of the studied biologics. Biosimilar use differed by originator biologic, practice type, and payment source. There remains further opportunity for increases in biosimilar use among certain practices and payers.

Predictors of opioid prescription among outpatients with osteoarthritis in the United States.

Osteoarthritis (OA) management targets pain reduction through multimodal strategies to improve functional status. Among pharmaceutical options, opioids have been selected as a treatment option for pain management, without endorsement by evidence-based guidelines. To examine the predictors of opioid prescriptions for OA during outpatient visits in the United States (US). This study was based on the National Ambulatory Medical Care Survey (NAMCS) database (2012-2016), with a retrospective, cross-sectional study design of US adult outpatient visits with OA. The primary outcome was opioid prescription, and socio-demographic and clinical characteristics were independent variables. Weighted descriptive, bivariate, and multivariable logistic regression analyses were utilized to study patient characteristics and to assess the predictors of opioid prescription. Approximately, 51.68 million (95 percent CI = 44.41-58.95 million) OA-related outpatient visits were made between 2012 and 2016. Most patients were established patients (82.32 percent), and 20.58 percent of the visits resulted in opioid prescriptions. Key prescriptions within the opioid analgesic and combination categories were tramadol-based (5.16 percent) and hydrocodone-based (9.10 percent). Patients who paid through Medicaid were three times more likely (aOR = 3.25, 95 percent CI = 1.60-6.61, p = 0.0012) than those who paid through private insurance to receive an opioid prescrip-tion, new patients were 59 percent less likely (aOR = 0.41, 95 percent CI = 0.24-0.68, p = 0.0007) to receive an opioid prescription as compared to established patients, and obese patients were twice as likely (aOR = 1.88, 95 percent CI = 1.11-3.20, p = 0.0199) than nonobese patients to receive an opioid prescription. Payment source, obesity, and patient visit status were associated with the receipt of an opioid prescription among OA outpatients. Further research is needed to establish intrinsic factors that drive opioid prescription in this population.

Disease burden of prostate cancer from 2014 to 2019 in the United States: estimation from the Global Burden of Disease Study 2019 and Medical Expenditure Panel Survey.

The aim of this study was to evaluate the disease burden of prostate cancer (PC) and assess key influencing factors associated with the disease expenditures of PC in the United States. The total deaths, incidence, prevalence, and disability-adjusted life-years of PC were obtained from the Global Burden of Disease Study 2019. The Medical Expenditure Panel Survey was used to estimate healthcare expenditures and productivity loss and to investigate patterns of payment and use of healthcare resources in the United States. A multivariable logistic regression model was conducted to identify key factors influencing expenditures. For patients aged 50 and older, the burden for all age groups showed a modest increase over the 6-year period. Annual medical expenditures were estimated to range from US$24.8 billion to US$39.2 billion from 2014 to 2019. The annual loss in productivity for patients was approximately US$1,200. The top 3 major components of medical costs were hospital inpatient stays, prescription medicines, and office-based visits. Medicare was the largest source of payments for survivors. In terms of drug consumption, genitourinary tract agents (57.0%) and antineoplastics (18.6%) were the main therapeutic drugs. High medical expenditures were positively associated with age (p=0.005), having private health insurance (p=0.016), more comorbidities, not currently smoking (p=0.001), and patient self-perception of fair/poor health status (p<0.001). From 2014 to 2019, the national real-world data of PC revealed that the disease burden in the United States continued to increase, which was partly related to patient characteristics.

High socioeconomic status is associated with stroke severity among stroke patients in the National Brain Centre Hospital, Jakarta, Indonesia

Rapid economic growth has widened the gap between the rich and the poor, contributing to inequalities in socioeconomic status (SES) in Indonesia and possibly inequalities in health care. Here, we aimed to assess the potential association between SES and stroke severity in Indonesia, one of the largest low- and middle-income countries. Patients diagnosed with stroke at National Brain Centre (NBC) Hospital, Jakarta, Indonesia, in 2020 were included in the study. SES was measured based on marital status, occupation, education level, source of payment, and hospitalized class with smoking status and sex as confounder. Stroke severity was classified based on the National Institutes of Health Stroke Scale score into minor stroke (Adams et al., 1993; Amarenco et al., 2014; Andersen and Olsen, 2018; Austin and Steyerberg, 2017) and moderate to severe stroke (>4).A total of 2,443 patients with moderate to severe stroke (58%) were analyzed. Currently employed patients had a lower adjusted OR (aOR) of 0.65 (95% confidence interval [CI], 0.51–0.83) than unemployed patients. Patients with the highest education level, at least a diploma degree, had a lower aOR of 0.67 (95% CI, 0.49–0.92) than those with an elementary or no education. Our findings showed that patients with a higher SES had a lower risk of more severe stroke than those with a lower SES. Hence, we must focus on improving SES as part of stroke management.

Reforming the Tax on the Property of Individuals

The article examines the historical aspects of taxation of the property of individuals in the Soviet Union and the Russian Federation. The issues of determining the object of taxation and its assessment are considered. At all times, immovable property belongs to the object of taxation. This object is almost impossible to hide and evade tax. Property tax has always been calculated based on its value. The procedure for determining the value changed as well as the list of objects subject to tax. It is noted that the tax on the property of individuals has a great impact on the relationship between the tax payer and the state, when making any changes that increase the amount of payment, it is necessary to take into account the interests of not only the state, but also citizens who pay taxes. If there is an object of taxation, the payment of tax does not depend on the availability of the source of payment. The analysis of personal property tax receipts in the Russian Federation and the Irkutsk region was carried out. Based on the analysis, the conclusion is formulated that the tax on the property of individuals is not particularly important in the formation of municipal budget revenues at the present time. According to this tax, there is a large list of benefits that exempt from paying tax in full or reduce the amount of tax. When establishing the procedure for calculating taxes and tax benefits, it is proposed to take into account the location and destination of property owned by individuals.

Mental Health Conditions– and Substance Use—Associated Emergency Department Visits during the COVID-19 Pandemic in Nevada, USA

Background-Mental health conditions and substance use are linked. During the COVID-19 pandemic, mental health conditions and substance use increased, while emergency department (ED) visits decreased in the U.S. There is limited information regarding how the pandemic has affected ED visits for patients with mental health conditions and substance use. Objectives-This study examined the changes in ED visits associated with more common and serious mental health conditions (suicidal ideation, suicide attempts, and schizophrenia) and more commonly used substances (opioids, cannabis, alcohol, and cigarettes) in Nevada during the COVID-19 pandemic in 2020 and 2021 compared with the pre-pandemic period. Methods-The Nevada State ED database from 2018 to 2021 was used (n = 4,185,416 ED visits). The 10th Revision of the International Classification of Diseases identified suicidal ideation, suicide attempts, schizophrenia, and the use of opioids, cannabis, alcohol, and cigarette smoking. Seven multivariable logistic regression models were developed for each of the conditions after adjusting for age, gender, race/ethnicity, and payer source. The reference year was set as 2018. Results-During both of the pandemic years (2020 and 2021), particularly in 2020, the odds of ED visits associated with suicidal ideation, suicide attempts, schizophrenia, cigarette smoking, and alcohol use were all significantly higher than those in 2018. Conclusions-Our findings indicate the impact of the pandemic on mental health- and substance use-associated ED visits and provide empirical evidence for policymakers to direct and develop decisive public health initiatives aimed at addressing mental health and substance use-associated health service utilization, especially during the early stages of large-scale public health emergencies, such as the COVID-19 pandemic.

Oral buprenorphine utilization, concomitant benzodiazepines and opioid analgesics, and payment source: Trends from 2015 to 2019

IntroductionThis study describes utilization patterns of oral buprenorphine products indicated for the treatment of opioid use disorder with a focus on patterns consistent with prescribing guidelines and the safe use conditions during induction and maintenance treatment outlined by the Risk Evaluation and Mitigation Strategy (REMS) Program, including trends over time. MethodsUsing an anonymized longitudinal patient-level dataset that captures information on medical and pharmacy claims in the United States (October 1, 2014 through March 31, 2020), buprenorphine prescriptions, days' supply, and daily dose were described overall and stratified by induction (month 1) vs. maintenance (month 2–6) treatment, along with duration of concomitant benzodiazepines or opioid analgesics. ResultsOverall, there were 1.5 million buprenorphine treatment episodes initiated between January 1, 2015 to September 30, 2019 (2015: 258,899; 2019: 351,378). Treatment episodes included an average of 6.8 buprenorphine prescriptions (standard deviation [SD] = 6.7), 16.8 days' supply per prescription (SD = 10.5), 94.2 total days' supply per treatment episode (SD = 71.4), and a mean daily dose of 13.6 mg (SD = 6.3), with the number of prescriptions and total days' supply per treatment episode declining over the study period. There was a lower mean number of days' supply per prescription in the first month of treatment compared to months 2–6 (month 1: 15.8 [SD = 11.0]; month 2–6: 19.0 [SD = 10.1]) and daily dose per prescription (month 1: 13.3 mg [SD = 6.4]; months 2–6: 14.3 mg [SD = 6.2]), and a higher mean number of prescriptions per month (month 1: 2.5 per month [SD = 1.7]; months 2–6: 1.8 per month [SD = 1.2]). From 2015 to 2019, there appeared to be a shift in payer mix, with increases in Medicaid/Medicare and declines in cash and commercial insurance. Concomitant benzodiazepine and opioid analgesic use declined over time; in 2019, 16.6 % and 14.3 % of treatment episodes had any concomitant benzodiazepine or opioid analgesic, respectively, and <5 % had chronic (>90 overlapping days) concomitant use (3.0 % and 0.4 %, respectively). ConclusionsThe number of oral buprenorphine treatment episodes increased over the study period, and prescribing was generally consistent with the REMS and other treatment guidelines. There was a decline in concomitant buprenorphine and benzodiazepine or opioid analgesics, and chronic concomitant use was rare.

United Network for Organ Sharing (UNOS) Database Analysis of Factors Associated With Kidney Transplant Time on Waiting List.

In the United States (U.S.), African Americans and other minority groups have longer wait times for kidney transplantation than Caucasians. To date, many studies analyzing time spent on the waitlist for each race/ethnicity have been done. However, there are few to no studies examining waitlist time after the 2019 policy changes to the geographic distribution of donated kidneys. Data collected from the National Organ Procurement and Transplantation Network database were used to analyze associations between race and time spent on the waitlist for a kidney transplant in the U.S. Additional sub-categorical data were analyzed to determine further associations and potential covariates, such as gender, age, citizenship, primary source of payment, region of transplant center, BMI, Kidney Donor Profile Index (KDPI), renal diagnosis, and presence/type of diabetes. Data were analyzed using odds ratios and validated by Bonferroni-Holm's corrected chi-square tests at confidence intervals of 95% to determine if there are statistically significant differences between transplant time spent on the waitlist and ethnicity, as well as age, diagnosis category, region of transplant center, and KDPI. Statistically significant increased odds of remaining on the transplant list at two years existed for all non-white races/ethnicities, except those identifying as multiracial. Asian American candidateshad the greatest odds of remaining on the waitlist greater than two years in comparison to white candidates: 1.51 times that of a patient categorized as white (odds ratio [OR] 1.51, confidence interval [CI] 1.44-1.57).African American/Black, (OR 1.38, CI 1.34-1.43) Pacific Islander (OR 1.38, CI 1.17-1.63), Hispanic candidates (OR 1.37, CI 1.32-1.41), and American Indian or Native Alaskan candidates(OR 1.23, CI 1.12-1.46) also had increased odds of remaining on the transplant waitlist greater than two years compared to white candidates. In this study, ethnic disparities persisted as a barrier for non-white individuals receiving treatment for end-stage kidney disease, specifically in the context of time spent on the waitlist for a kidney transplant. Further research is needed regarding the causes of these disparities in time spent on the waitlist, such as cultural restrictions in organ donation, racial differences in parameters for organ match, and institutionalized racism in health care practitioners.

Racial Disparities and Pressure Injuries Among Hospitalized Patients.

To describe the demographic factors, hospitalization-related factors, comorbid states, and social determinants of health among racial groups in a sample of patients with a primary or secondary diagnosis of pressure injury (PI) admitted to New Jersey hospitals during the year 2018. Researchers conducted a retrospective analysis of the Health Care Utilization Project's 2018 New Jersey State Inpatient Database. Patients with a primary or secondary diagnosis of PI (sacrum, buttocks, or heels; N = 17,781) were included in the analytic sample. Analysis compared patients who identified as Black (n = 3,515) with all other racial groups combined (n = 14,266). A higher proportion of Black patients were admitted for a PI (P < .001) and had higher proportions of stage 4 PIs (P < .001) but a lower proportion of stage 1 PIs (P < .001). Higher proportions of Black patients were younger, resided in lower income communities, and identified Medicaid as their primary payor source. Results highlight the racial disparities that exist among patients with PIs in this diverse state and may represent a much larger problem. Clinical research examining the impact of skin tone rather than by racial group is needed. The impact of racial disparities on social determinants of health with regard to PIs remains largely unknown, but its importance cannot be underestimated.

Analysis of Caesarean Section Rates and Source of Payment Using the Robson Classification System

Analysis of Caesarean Section Rates and Source of Payment Using the Robson Classification System

Cost Analysis and Reimbursement of Weightbearing Computed Tomography.

Weightbearing computed tomography (WBCT) is becoming a valuable tool in the evaluation of foot and ankle pathology. Currently, cost analyses of WBCT scanners in private practice are lacking in the literature. This study evaluated the costs of acquisition, utilization, and reimbursements for a WBCT at a tertiary referral center, information of particular interest to practices considering obtaining such equipment. All WBCT scans performed at a tertiary referral center over the 55-month period (August 2016 to February 2021) were retrospectively evaluated. Patient demographics, pathology location, etiology, subspecialty of the ordering provider, and whether the study was unilateral or bilateral were collected. Reimbursement was calculated based on payor source as a percentage of Medicare reimbursement for lower extremity CT. The number of total scans performed per month was evaluated to determine revenue generated per month. Over the study period, 1903 scans were performed. An average of 34.6 scans were performed each month. Forty-one providers ordered WBCT scans over the study period. Foot and ankle fellowship-trained orthopaedic surgeons ordered 75.5% of all scans. The most common location of pathology was the ankle, and the most common etiology was trauma. The device was cost neutral at 44.2 months, assuming reimbursement for each study was commensurate with Medicare rates. The device became cost neutral at approximately 29.9 months when calculating reimbursement according to mixed-payor source. As WBCT scan becomes more widely used for evaluation of foot and ankle pathology, practices may be interested in understanding the financial implications of such an investment. To the authors' knowledge, this study is the only cost-effectiveness analysis of WBCT based in the United States. We found that in a large, multispecialty orthopaedic group, WBCT can be a financially viable asset and a valuable diagnostic tool for a variety of pathologies. Level III, diagnostic.

Temperature and mental health-related emergency department and hospital encounters among children, adolescents and young adults.

We examine the association between high ambient temperature and acute mental health-related healthcare encounters in New York City for children, adolescents and young adults. This case-crossover study included emergency department (ED) visits and hospital encounters with a primary diagnosis of any mental health disorder during warm-season months (June-August) in New York City from 2005 to 2011 from patients of three age groups (6-11, 12-17 and 18-25years). Using a distributed lag non-linear model over 0-5 lag days, by fitting a conditional logistic regression for each age group, we calculated the cumulative odds ratios of mental health encounters associated with an elevated temperature. Analyses were stratified by race/ethnicity, payment source and mental health categories to elucidate vulnerable subpopulations. In New York City, there were 82,982 mental health-related encounters for young people aged 6 to 25years during our study period months. Elevated temperature days were associated with higher risk of mental health-related ED and hospital encounters for the 6- to 11-year-olds (odds ratio [OR]: 1.28, 95% confidence interval [CI]: 1.13-1.46), for the 12- to 17-year-olds (OR: 1.17, 95% CI: 1.09-1.25) and for the 18- to 25-year-olds (OR: 1.09, 95% CI: 1.04-1.15). Children with reaction disorders, adolescents with anxiety and bipolar disorders, young adults with psychosis and reaction disorders and Black and non-Hispanic children and adolescents showed vulnerability to elevated temperature. We found that elevated ambient temperatures were associated with acute mental health ED or hospital encounters across childhood, adolescence and young adulthood.

Сучасний стан пенсійного страхування в Україні

The current state of pension insurance in Ukraine constantly requires additional research that would update its development indicators, reveal new trends in its development, justify the feasibility of its reform, and take into account the influence of various factors. The purpose of the study is that based on the assessment of the current state of the pension insurance system in Ukraine, it is necessary to identify the main problems of its development and substantiate practical recommendations on the directions of reforming the social policy of the state regarding pension provision. The compulsory state pension insurance indicators in Ukraine, conducted by the Pension Fund of Ukraine for 2018-2022, were evaluated, which revealed the main trends of development and outlined the main problems. The performance indicators dynamics of non-state pension funds in Ukraine over the past five years has been investigated, trends in the development of accumulative non-state pension insurance have been outlined. The life insurance market in Ukraine is investigated and the voluntary pension insurance indicators are analyzed separately, which provides for the achievement by the insured person of the retirement age determined by the contract. The bank deposits dynamics of households in Ukraine as the potential of additional pension provision of the population is considered. It is proposed to motivate by the state creating corporate non-state pension funds. The practice spread of concluding pension insurance contracts with insurance companies by employers would create an additional source of pension payments and reduce the financial burden on the budget of Ukraine. The existing proposals for reforming pension insurance in Ukraine will contribute to increasing the confidence of the country’s population in both state pension provision and non-state pension insurance.

Affordability impacts therapeutic intensity of acute management of severe traumatic brain injury patients: An exploratory study in Tanzania

IntroductionQuality health care in low and middle-income countries (LMICs) is constrained by financing of care. Research questionWhat is the effect of ability to pay on critical care management of patients with severe traumatic brain injury (sTBI)? Material and MethodsData on sTBI patients admitted to a tertiary referral hospital in Dar-es-Salaam, Tanzania, were collected between 2016 and 2018, and included payor mechanisms for hospitalization costs. Patients were grouped as those who could afford care and those who were unable to pay. ResultsSixty-seven patients with sTBI were included. Of those enrolled, 44 (65.7%) were able to pay and 15 (22.3%) were unable to pay costs of care upfront. Eight (11.9%) patients did not have a documented source of payment (unknown identity or excluded from further analysis). Overall mechanical ventilation rates were 81% (n=36) in the affordable group and 100% (n=15) in the unaffordable group (p=0.08). Computed tomography (CT) rates were 71.6% (n=48) overall, 100% (n=44) and 0% respectively (p<0.01); Surgical rates were 16.4% (n=11) overall, 18.2% (n=8) vs. 13.3% (n=2) (p=0.67) respectively. Two-week mortality was 59.7% overall (n=40), 47.7% (n=21) in the affordable group and 73.3% (n=11) in the unaffordable group (p=0.09) (adjusted OR 0.4; 95% CI: 0.07-2.41, p=0.32). Discussion and ConclusionAbility to pay appears to have a strong association with the use of head CT and a weak association with mechanical ventilation in the management of sTBI. Inability to pay increases redundant or sub-optimal care, and imposes a financial burden on patients and their relatives.