Treatment Resource Utilization Research Articles

Technology and Application of Salty Slurry Harmlessness Reduction and Resource Utilization Treatment

Salt slurry is a special sludge produced in the process of brine purification in chlor-alkali industry. In order to eliminate the harm of salty slurry to the environment and realize its economic value, a salty slurry harmlessness, reduction and resource utilization treatment method was proposed. Through this method, salty slurry will be transformed into desulfurizer with its water content and Cl- content reduced to 15% and 0.5% respectively. This method has been applied to projects, bringing environmental and economic benefits.

Application of pediatric five-level triage system and resource utilization in emergency department

Objective To explore the resources utilization in emergency under the implementation of pediatric five-level triage system and give reference for large tertiary emergency department (ED) in China. Methods In March 2015, the hospital information system platform was used to screen newly patients who visited internal emergency department, collect diagnosis and treatment items, calculate the cost produced in ED. The resource utilization was compared between the levels in the triage system. Results Out of the enrolled 7 010 cases, the major complaints were fever, cough and vomiting; 5 cases in Level-1 (0.1%), 70 cases in level-2 (1.0%), 3 416 cases in level-3 (48.7%), 3 418 cases in level-4 (48.8%), 101 cases in level-5 (1.4%); the average length of stay in emergency department (1-5 level): 65.6 min, 141.2 min, 73.1 min, 58.5 min, 48.3 min; the total cost in ED was consisted of diagnostic cost and treatment cost, 38.02% and 61.98% respectively. The average costs of 75 cases in level 1 and 2 were 691.14 Yuan, the average costs of 3 416 cases in level 3 were 182.92 Yuan, the average costs of 3 418 cases in level 4 were 187.87 Yuan, the average costs of 101 cases in level 5 were 101.66 Yuan. The ED diagnostic cost and treatment resource were used according to the severity assessed by the five-level triage system. The laboratory investigation costs made the most part of the diagnostic resource utilization, 83.16% children with fever took the blood routine examination. The costs of oral medicine accounted for the most proportion of treatment resource utilization. Conclusions The five-level triage system, not only help triage nurses to screen the critically ill children, but reflect the ED resource utilization. It may indicate that the children with fever in the pediatric emergency department can take routine blood test in advance, in order to reduce the emergency detention time, make more efficient use of emergency resources. Key words: Child; Emergency triage; Resource utilization; Economic cost

Women’s use of online resources and acceptance of e-mental health tools during the perinatal period

ObjectivesThe women’s professional help-seeking rate for perinatal depression is low, despite the prevalent and disabling nature of this condition. Therefore, new approaches should be implemented to increase women’s access and utilization of treatment resources, namely e-mental health tools. This study aimed to characterize women’s current pattern of use of online resources for mental heal issues and women’s acceptance of e-mental health tools during the perinatal period, and to investigate its main determinants. MethodsThis study used an online cross-sectional survey that was completed by 546 women during the perinatal period. Results31.3% had prior knowledge of websites targeting mental health illness. Women presenting an actual need for help (i.e., a positive screen for depression) reported greater use of online resources and greater engagement in e-health behaviors related to mental health (d=0.46–0.61), and being more accepting of e-mental health tools, particularly of informative websites. Women’s perceptions concerning the e-mental tools were found to predict their intentions to use them. ConclusionsThe results seem to globally support Portuguese women’s acceptance of e-mental health tools. To improve the level of acceptance, women should be involved as stakeholders in the development of new e-mental health tools and provided with specific information before their utilization.

The cost-effectiveness and public health benefit of nalmefene added to psychosocial support for the reduction of alcohol consumption in alcohol-dependent patients with high/very high drinking risk levels: a Markov model.

ObjectivesTo determine whether nalmefene combined with psychosocial support is cost-effective compared with psychosocial support alone for reducing alcohol consumption in alcohol-dependent patients with high/very high drinking risk levels (DRLs) as defined by the WHO, and to evaluate the public health benefit of reducing harmful alcohol-attributable diseases, injuries and deaths.DesignDecision modelling using Markov chains compared costs and effects over 5 years.SettingThe analysis was from the perspective of the National Health Service (NHS) in England and Wales.ParticipantsThe model considered the licensed population for nalmefene, specifically adults with both alcohol dependence and high/very high DRLs, who do not require immediate detoxification and who continue to have high/very high DRLs after initial assessment.Data sourcesWe modelled treatment effect using data from three clinical trials for nalmefene (ESENSE 1 (NCT00811720), ESENSE 2 (NCT00812461) and SENSE (NCT00811941)). Baseline characteristics of the model population, treatment resource utilisation and utilities were from these trials. We estimated the number of alcohol-attributable events occurring at different levels of alcohol consumption based on published epidemiological risk-relation studies. Health-related costs were from UK sources.Main outcome measuresWe measured incremental cost per quality-adjusted life year (QALY) gained and number of alcohol-attributable harmful events avoided.ResultsNalmefene in combination with psychosocial support had an incremental cost-effectiveness ratio (ICER) of £5204 per QALY gained, and was therefore cost-effective at the £20 000 per QALY gained decision threshold. Sensitivity analyses showed that the conclusion was robust. Nalmefene plus psychosocial support led to the avoidance of 7179 alcohol-attributable diseases/injuries and 309 deaths per 100 000 patients compared to psychosocial support alone over the course of 5 years.ConclusionsNalmefene can be seen as a cost-effective treatment for alcohol dependence, with substantial public health benefits.Trial registration numbersThis cost-effectiveness analysis was developed based on data from three randomised clinical trials: ESENSE 1 (NCT00811720), ESENSE 2 (NCT00812461) and SENSE (NCT00811941).

Resource utilization of pediatric patients exposed to venom.

Treating envenomation with antivenom is costly. Many patients being treated with antivenom are in observation status, a billing designation for patients considered to need care that is less resource-intensive, and less expensive, than inpatient care. Observation status is also associated with lower hospital reimbursements and higher patient cost-sharing. The goal of this study was to examine resource utilization for treatment of envenomation under observation and inpatient status, and to compare patients in observation status receiving antivenom with all other patients in observation status. This was a retrospective study of patients with a primary diagnosis of toxic effect of venom seen during 2009 at 33 freestanding children's hospitals in the Pediatric Health Information System. Data on age, length of stay, adjusted costs (ratio cost to charges), ICU flags, and antivenom utilization were collected. Comparisons were conducted according to admission status (emergency department only, observation status, and inpatient status), and between patients in observation status receiving antivenom and patients in observation status with other diagnoses. A total of 2755 patients had a primary diagnosis of toxic effect of venom. Of the 335 hospitalized, either under observation (n = 124) or inpatient (n = 211) status, 107 (31.9%) received antivenom. Of those hospitalized patients receiving antivenom, 24 (22.4%) were designated as observation status. Costs were substantially higher for patients who received antivenom and were driven by pharmacy costs (mean cost: $17 665 for observation status, $20 503 for inpatient status). Mean costs for the 47 162 patients in observation status with other diagnoses were $3001 compared with $17 665 for observation-status patients who received antivenom. Treatment of envenomation with antivenom represents a high-cost outlier within observation-status hospitalizations. Observation status can have financial consequences for hospitals and patients.

Hyperglycemic Emergencies in Adults

Hyperglycemic Emergencies in Adults

Factors Associated with Pretreatment and Treatment Dropouts Among Clients Admitted to Medical Withdrawal Management

The aims of this study were to identify factors associated with pretreatment and treatment dropouts among individuals accessing an inpatient medical withdrawal management program (Vancouver Detox). Two thousand five hundred sixty-six unique clients, who were referred to Vancouver Detox over two-year period, were assessed. Demographic and drug related variables were analyzed as possible risk factors, and two multivariate logistic regression analyses were conducted. We found that being male, being aboriginal, having no children, no fixed address, alcohol as a preferred substance, and being on methadone maintenance treatment at referral were significantly associated with high pretreatment dropout. Significant risk factors for treatment dropout were: being younger, having HCV infection, having a preferred substance other than alcohol, having opiates as a preferred substance, and being discharged on welfare check issue periods or weekends. These findings may help clinicians and decision-makers to initiate corresponding preventive measures to decrease unnecessary attritions and improve utilization of treatment resources.

Predictors of Efficacy and Health Resource Utilization in Treatment of Complicated Intra-abdominal Infections: Evidence for Pooled Clinical Studies Comparing Tigecycline with Imipenem–Cilastatin

Duration of intravenous (IV) treatment, surgical/radiologic interventions for infection control, and hospital length of stay (LOS) are important cost considerations in complicated intra-abdominal infections (cIAIs). Data were pooled from two multinational, double-blind studies conducted in hospitalized adults with cIAIs who were randomized (1:1) to receive tigecycline (100 mg IV initial dose then 50 mg IV every 12 h) or imipenem-cilastatin (500 mg IV every 6 h) for 5 to 14 days in order to assess tigecycline safety and efficacy. This report focuses on developing predictors of cure and health care resource utilization, including the need for repeat surgical/radiologic interventions, duration of IV antibiotic therapy, and hospital LOS. Multiple regression models were applied for each of the above outcomes, incorporating both baseline and on-treatment potential covariates. Logistic modeling was used for categorical outcomes (cure; repeat surgical/radiologic interventions) and least squares modeling for continuous outcomes (duration of IV antibiotic therapy; LOS). Stepwise selection was used to retain only those predictors found to be significant (p < 0.05) independent risk factors. The most common causative pathogen was Escherichia coli (63.0%), with 63.3% of the patients exhibiting polymicrobial infections. The most common cIAI diagnosis was complicated appendicitis (51.9%). Lack of clinical cure (+ 6.1 days; p < 0.0001), perforation of the intestine (+3.7 days; p < 0.0001), an Acute Physiology and Chronic Health Evaluation (APACHE) score >15 (+3.1 days; p=0.039), abnormal plasma sodium concentration (+3.7 days; p=0.026), and repeat surgical/radiologic intervention (+2.2 days; p=0.0097) were identified as key risk factors for longer LOS. Inadequate source control was associated with reduced odds of cure, longer IV treatment duration (+1.5 days; p=0.007), and longer LOS. The treatment groups did not differ in terms of LOS, IV treatment duration, or clinical cure. Tigecycline was similar to imipenem-cilastatin in terms of both efficacy and health resource utilization. Risk factors identified in this study for both outcome measures are offered as support for guiding clinical practice.

Project ASSERT: An ED-Based Intervention to Increase Access to Primary Care, Preventive Services, and the Substance Abuse Treatment System

Study objective: To test the feasibility and effectiveness of Project ASSERT, an innovative program developed by us to facilitate access to the substance abuse treatment system and to primary care and preventive services for emergency department patients with drug- and alcohol-related health problems. Methods: Multicultural health promotion advocates (HPAs) were trained by ED personnel to screen patients using a health needs history, to administer a brief negotiated interview based on readiness-to-change principles, and to use an active referral process to capture the marginal capacity of the substance abuse treatment system. Outcome measures included (1) number of referrals to the substance abuse treatment system, (2) patient self-report of satisfaction with services received from Project ASSERT and utilization of treatment resources, and (3) changes in self-reported frequency of drug and alcohol use and in Drug Abuse Screening Test scores between enrollment and follow-up at 60 to 90 days. Results: Between March 1, 1995, and February 29, 1996, 7,118 adult ED patients were screened. Substance abuse was detected among 2,931 patients (41%), and 1,096 (37% of detected patients) were enrolled. A total of 8,848 referrals were made: 3,189 to primary care, 2,018 to a variety of substance abuse treatment services, 2,253 for smoking cessation, 339 for mammography, and 689 to other support services (eg, psychiatric nurse, social worker, battered women's advocate or shelter). Comparison of enrollment and follow-up scores for the 245 enrollees who kept a follow-up appointment demonstrated significant reductions, including a 45% reduction in severity of drug problem, a 56% reduction in alcohol use, and a 64% reduction in the frequency of drinking six or more drinks at one sitting. At follow-up, patients expressed satisfaction with Project ASSERT: 91% were satisfied with their referrals; 93% thought the HPAs explained things well; and 99% thought the HPAs respected them as individuals. Among the follow-up group, 50% self-reported that they had kept an appointment for treatment. Conclusion: Project ASSERT is an innovative approach to link ED patients with the substance abuse treatment system and with primary care and other preventive services. Its success is further demonstrated by its adoption by Boston Medical Center as a funded ED value-added service. [Bernstein E, Bernstein J, Levenson S: Project ASSERT: An ED-based intervention to increase access to primary care, preventive services, and the substance abuse treatment system. Ann Emerg Med August 1997;30:181-189.]

Resource utilization in treatment of acute myocardial infarction: staff-model health maintenance organization versus fee-for-service hospitals

Objectives. This study sought to compare the use of invasive procedures and length of stay for patients admitted with acute myocardial infarction to health maintenance organization (HMO) and fee-for-service hospitals.Background. The HMOs have reduced costs compared with fee-for-service systems by reducing discretionary admissions and decreasing hospital length of stay. It has not been established whether staff-model HMO hospitals also reduce the rate of procedure utilization.Methods. Using data from a retrospective cohort, we performed univariate and multivariate comparisons of the use of cardiac procedures, length of stay and hospital mortality in 998 patients admitted to two staff-model HMO hospitals and 7,036 patients admitted to 13 fee-for-service hospitals between January 1988 and December 1992.Results. The odds of undergoing coronary angiography were 1.5 times as great for patients admitted to fee-for-service hospitals than for those admitted to HMO hospitals (odds ratio 1.5, 95% confidence interval [CI] 1.3 to 1.9). Similarly, the odds of undergoing coronary revascularization were two times greater in fee-for-service hospitals (odds ratio 2.0, 95% Cl 1.6 to 2.5). However, higher utilization was strongly associated with the greater availability of on-site cardiac catheterization facilities in fee-for-service hospitals. The length of hospital stay, by contrast, was ∼1 day shorter in the fee-for-service cohort (7.3 vs. 8.0 days, p < 0.05).Conclusions. Physicians in staff-model HMO hospitals use fewer invasive procedures and longer lengths of stay to treat patients with acute myocardial infarction than physicians in fee-for-service hospitals. This finding, however, appears to be associated with the lack of on-site catheterization facilities at HMO hospitals.

Resource Utilization in Treatment of Diabetic Ketoacidosis in Adults

This study defines determinants of cost of treatment of diabetic ketoacidosis. A chart review for 92 cases of ketoacidosis from 1988 to 1992 in 40 females and 25 males (age range 18 to 81) showed a length of stay of 5.7 +/- 4.9 d. Length of stay did not correlate with the level of nursing care or any other component of the initial order set. Length of stay was shorter in cases managed by diabetologists. Length of stay was inversely proportional to the interval from arrival to the first shot of intermediate or long-acting insulin. Length of stay was longer in subjects with a positive bacterial culture (mean, 9.1 d) and was longer in subjects who arrived in the evening. There was a female predominance in total and recurrent cases of ketoacidosis. Female patients received fewer educational sessions than males. The grade of acidosis affected the duration of acidemia, but the grade of acidosis, APACHE scores, and admission lab values did not correlate with length of stay. The use of an intensive care unit (ICU) included more testing and expense without uniform clear benefit. Optimal transition from intensive to routine management includes resumption of long-acting insulins as soon as possible. Optimization of hospital care and reduction of incidence of ketoacidosis in females would have a marked effect on health care costs.

Homeless persons readmitted to an urban state hospital.

This survey revealed that staff perceptions about the reasons for homelessness among recidivists were basically correct. However, it found that all recidivists, even those with stable housing, did not comply well with aftercare plans. In their stories of how they became homeless, the patients expressed strong desires for autonomy and independence, which were thwarted by economic factors. Finally, low compliance with aftercare suggests the need for continuity of care for recidivists as well as the need to educate both them and their families about the management of mental illness and utilization of treatment resources.