PURPOSE: Readmission and mortality rates of patients with heart failure are good indicators of care quality. To determine whether hospital resources are associated with care quality for cardiac patients, we analyzed the effect of number of physicians and the combined effects of number of physicians and beds on 30-day readmission and 1-year mortality. MATERIALS AND METHODS: We used national cohort sample data of the National Health Insurance Service (NHIS) claims in 2002–2013. Subjects comprised 2345 inpatients (age: >65 years) admitted to acute-care hospitals for heart failure. A multivariate Cox regression was used. RESULTS: Of the 2345 patients hospitalized with heart failure, 812 inpatients (34.6%) were readmitted within 30 days and 190 (8.1%) had died within a year. Heart-failure patients treated at hospitals with low physician volumes had higher readmission and mortality rates than high physician volumes [30-day readmission: hazard ratio (HR)=1.291, 95% confidence interval (CI)=1.020–1.633; 1-year mortality: HR=2.168, 95% CI=1.415–3.321]. Patients admitted to hospitals with low or middle bed and physician volume had higher 30-day readmission and 1-year mortality rates than those admitted to hospitals with high volume (30-day readmission: HR=2.812, 95% CI=1.561–5.066 for middle-volume beds & low-volume physicians, 1-year mortality: HR=8.638, 95% CI=2.072–36.02 for middle-volume beds & low-volume physicians). CONCLUSION: Physician volume is related to lower readmission and mortality for heart failure. Of interest, 30-day readmission and 1-year mortality were significantly associated with the combined effects of physician and institution bed volume.
Aged ; Aged, 80 and over ; Cohort Studies ; Female ; Heart Failure/diagnosis/*mortality/therapy ; Hospitalization ; *Hospitals, High-Volume/statistics & numerical data ; *Hospitals, Low-Volume/statistics & numerical data ; Humans ; Male ; Middle Aged ; Patient Readmission/*statistics & numerical data ; Physicians/economics/*supply & distribution ; Proportional Hazards Models ; Quality Improvement ; Quality Indicators, Health Care/*statistics & numerical data ; Time Factors ; Treatment Outcome

Objective: To investigate the economic burden of hepatitis C patients and related factors in Guangdong province. Methods: In this study, cluster sampling method was used to select cases, including acute hepatitis C, chronic hepatitis C and liver cirrhosis cases from eligible outpatients and inpatients in 1 or 2 large general hospitals in all the 21 cities in Guangdong province. Questionnaire survey was conducted for all the hepatitis C patients to analyze their economic burden, while multivariate linear regression model was used to identify the related influencing factors. Results: A total of 356 hepatitis C patients were enrolled in the study, with 176 outpatients (49.4%) and 180 inpatients (50.6%) respectively. The average age of the study subjects was (44.79±11.73) year-olds. The annual direct economic costs of patients with acute hepatitis C, chronic hepatitis C and liver cirrhosis were 10 703.22 (IQR: 7 396.75-16 891.91), 14 886.63 (IQR: 7 274.00-30 228.25) and 28 874.00 (IQR: 13 093.69-56 350.00) Yuan (RMB) respectively. The annual indirect costs appeared as 2 426.99 (IQR: 1 912.18-7 354.52), 3 235.99 (IQR: 1 323.81-6 619.07) and 5 442.35 (IQR: 3 235.99-10 296.33) Yuan (RMB) respectively. The annual intangible costs were 5 000.00 (IQR:2 000.00-10 000.00), 10 000.00 (IQR: 4 000.00-30 000.00) and 10 000.00 (IQR: 3 000.00-100 000.00) Yuan (RMB) respectively. The annual total costs were 22 306.17 (IQR: 14 581.24-50 569.17), 38 050.33 (IQR: 17 449.57-68 319.62) and 80 152.18 (IQR: 40 856.09-228 460.79) Yuan (RMB) respectively. Results from the multiple linear regression analysis showed that factors as: annual hospitalization days, annual number of outpatient visits, annual number of hospitalization, type of disease and the levels of the hospitals were related to the economic burden of patients with hepatitis C. Conclusion: Patients with HCV-related diseases presented serious economic problem which calls for close attention in Guangdong province.
Adult ; China/epidemiology* ; Cities ; Cost of Illness ; Female ; Health Care Costs/statistics & numerical data* ; Hepatitis B/epidemiology* ; Hepatitis C/economics* ; Hospitalization ; Humans ; Liver Cirrhosis/epidemiology* ; Male ; Surveys and Questionnaires

INTRODUCTIONThe estimated incidence of hip fractures worldwide was 1.26 million in 1990 and is expected to double to 2.6 million by 2025. The cost of care for hip fracture patients is a significant economic burden. This study aimed to look at the inpatient cost of hip fractures among elderly patients placed under a mature orthogeriatric co-managed system.

METHODSThis study was a retrospective analysis of 244 patients who were admitted to the Department of Orthopaedics of Tan Tock Seng Hospital, Singapore, in 2011 for hip fractures under a mature orthogeriatric hip fracture care path. Information regarding costs, surgical procedures performed and patient demographics was collected.

RESULTSThe mean cost of hospitalisation was SGD 13,313.81. The mean cost was significantly higher for the patients who were managed surgically than for the patients who were managed non-surgically (SGD 14,815.70 vs. SGD 9,011.38; p < 0.01). Regardless of whether surgery was performed, the presence of complications resulted in a higher average cost (SGD 2,689.99 more than if there were no complications; p = 0.011). Every additional day from admission to time of surgery resulted in an increased cost of SGD 575.89, and the difference between the average cost of surgery within 48 hours and that of surgery > 48 hours was SGD 2,716.63.

CONCLUSIONReducing the time to surgery and preventing pre- and postoperative complications can help reduce overall costs. A standardised care path that empowers allied health professionals can help to reduce perioperative complications, and a combined orthogeriatric care service can facilitate prompt surgical treatment.

Aged ; Aged, 80 and over ; Female ; Femoral Neck Fractures ; economics ; surgery ; Health Care Costs ; Hip Fractures ; economics ; surgery ; Hospitalization ; Humans ; Inpatients ; Length of Stay ; Male ; Middle Aged ; Orthopedic Procedures ; economics ; Patient Admission ; Retrospective Studies ; Singapore ; Surgical Procedures, Operative ; economics

BACKGROUNDThe New Rural Cooperative Medical Scheme (NCMS) has been further adjusted and optimized to reduce the financial burden of rural residents and to achieve universal coverage for them. In this study, we aimed to explore the impact of NCMS on medical service utilization and medical expense of inpatients in recent years.

METHODSThe research data of Hainan Province were extracted from the Chinese NCMS platform from 2012 to 2014. Detailed information included total expenditure, average inpatients costs, average out-of-pocket payments, actual reimbursement rate, and average annual growth rate of the above indicators. Descriptive analysis was used to gauge the effects of NCMS.

RESULTSIn the utilization of medical services, NCMS inpatients in tertiary hospital decreased from 25.49% in 2012 to 20.39% in 2014, inpatients in county hospitals increased from 39.49% to 55.92%, simultaneously. The total expenditure in county hospitals rose steadily from 28.46% to 46.66%, meanwhile, the total expenditure in tertiary hospitals fell from 60.44% to 44.51%.The average out-of-pocket costs of rural inpatients remained stable over the years. Furthermore, the compensation fund of NCMS inpatients grew significantly. The actual inpatient reimbursement rate at township health centers increased from 76.93% to 84.04%. Meanwhile, the rate at county hospitals and tertiary hospitals increased slightly from 59.37% and 46.10% to 61.25% and 47.71%, respectively.

CONCLUSIONSWith the improvement of the reimbursement ability, especially after the new health care reform in 2009, the NCMS have been playing a prominent role in alleviating the economic burden of farmers' medical treatment. Meanwhile, more patients go to primary hospitals than tertiary hospitals, and the capability of primary hospitals has been greatly improved.

China ; Female ; Health Expenditures ; statistics & numerical data ; Hospitalization ; statistics & numerical data ; Humans ; Inpatients ; statistics & numerical data ; Insurance, Health ; economics ; Male ; Rural Population

Adenolymphoma ; surgery ; Adenoma, Pleomorphic ; surgery ; Compression Bandages ; Drainage ; Facial Nerve Diseases ; epidemiology ; Female ; Fibrin Tissue Adhesive ; therapeutic use ; Health Care Costs ; Hospitalization ; economics ; statistics & numerical data ; Humans ; Length of Stay ; Male ; Middle Aged ; Parotid Gland ; surgery ; Parotid Neoplasms ; surgery ; Postoperative Complications ; epidemiology ; Singapore ; epidemiology ; Tissue Adhesives ; therapeutic use

OBJECTIVETo understand the current status of the disease burden of liver cancer in Jinchang cohort.

METHODSAll the liver cancer death data from 2001 to 2013 and medical records of liver cancer cases from 2001 to 2010 in Jinchang cohort were collected for the analyses of the mortality, standardized mortality, potential years of life lost (PYLL) and working PYLL (WPYLL) associated with liver cancer. Spearman correlation and the average growth rate were used to analyze the trends.

RESULTSA total of 207 liver cancer deaths occurred in Jinchang cohort from 2001 to 2013, accounting for 16.68% of total cancer deaths. There were 259 liver cancer inpatients, accounting for 6.79% of the total cancer cases inpatients, in which 83 died (32.05%). Liver cancer death mainly occurred in males, accounting for 88.89%, and the liver cancer deaths in females accounted for 11.11%. The standardized mortality rate was 42.32/100,000 in males and 15.31/100,000 in females. The growth rate of liver cancer mortality was 5.62% from 2001 to 2013. Liver cancer deaths mainly occurred in age groups 60-69 years (26.57%) and 50-59 years (24.15%). The PYLL was 2906.76 person-years, the average PYLL was 14.04 years. The WPYLL was 1477.00 person-years and the average WPYLL was 7.14 years. The direct economic burden of liver cancer was 6270.78 Yuan per person, 301.75 Yuan per day. The average stay of hospitalization was 21.32 days.

CONCLUSIONThe mortality rate of liver cancer is increasing and the disease burden is still heavy.

Aged ; China ; epidemiology ; Cohort Studies ; Cost of Illness ; Female ; Hospitalization ; economics ; statistics & numerical data ; Humans ; Liver Neoplasms ; economics ; mortality ; Male ; Middle Aged

OBJECTIVETo understand the current status of disease burden caused by gastric cancer in Jinchang cohort.

METHODSIn this historical cohort study, the data of gastric cancer deaths from 2001 to 2013 and the medical records of gastric cancer cases from 2001 to 2010 in Jinchang cohort were collected to analyze the mortality, potential years of life lost (PYLL), working PYLL (WPYLL) associated with gastric cancer, and the medical expenditure data were used to evaluate the direct economic burden. Spearman correlation analysis and the average growth rate were used to describe the change trend of disease burden of gastric cancer.

RESULTSA total of 213 gastric cancer deaths occurred in Jinchang cohort from 2001 to 2013. The average annual crude mortality rate of gastric cancer was 38.30 per 100,000 in Jinchang cohort during 2001-2013 and no obvious change was observed. The crude mortality rate in males was 6.84 times higher than that in females. Gastric cancer death mainly occurred in age group 50-79 years (82.62%), while the mortality rates was increasing among the people under 50 years with an average annual increase rate of 0.77%. The annual average PYLL (APYLL) and average WPYLL (AWPYLL) caused by gastric cancer decreased by 8.43% and 10.46%, respectively. No obvious change in medical expenditure of gastric cancer cases was observed in Jinchang Cohort during 2001-2010, and the medical expenditure and average daily cost of hospitalization were 8102.23 Yuan, and 463.45 Yuan per capita, respectively.

CONCLUSIONSThe burden of disease for gastric cancer was heavy in Jinchang cohort. The PYLL and WPYLL had no change, while the APYLL and AWPYLL showed a increasing trend during the last ten years. Direct economic burden of inpatients with gastric cancer had no change.

Aged ; China ; epidemiology ; Cohort Studies ; Cost of Illness ; Female ; Health Expenditures ; statistics & numerical data ; Hospitalization ; economics ; Humans ; Male ; Middle Aged ; Stomach Neoplasms ; economics ; mortality

OBJECTIVETo understand the disease burden caused by cancers in Jinchang cohort, and develop effective strategies for cancer prevention and control in this population.

METHODSThe cancer mortality data from 2001 to 2013 and the medical records for cancer patients from 2001 to 2010 in Jinchang cohort were collected. The disease burden caused by cancer was analyzed by using mortality rate, potential years of life lost (PYLL), working PYLL (WPYLL), and direct economic burden.

RESULTSDuring 2001-2013, in Jinchang cohort, the five leading cancers ranked by mortality rate were lung cancer (78.06/100,000), gastric cancer (38.03/100,000), liver cancer (37.23/100,000), esophageal cancer (19.06/100,000), and colorectal cancer (9.53/100,000). The five leading cancers in terms of PYLL (person-years) and WPYLL (person-years) were lung cancer (3480.33, 1161.00), liver cancer (2809.03, 1475.00), gastric cancer (2120.54, 844.00), esophageal cancer (949.61, 315.00), and colorectal cancer (539.90, 246.00). From 2001 to 2010, the five leading cancers in term of average daily cost of hospitalization were gastric cancer (8,102.23 Yuan), esophageal cancer (7135.79 Yuan), colorectal cancer (7064.38 Yuan), breast cancer (6723.53 Yuan), and lung cancer (6309.39 Yuan).

CONCLUSIONSThe cancers common causing higher disease burden in Jinchang cohort were lung cancer, gastric cancer, liver cancer, esophageal cancer and colorectal cancer. The lung cancer disease burden was the highest.

Breast Neoplasms ; economics ; mortality ; China ; epidemiology ; Cohort Studies ; Colorectal Neoplasms ; economics ; mortality ; Cost of Illness ; Esophageal Neoplasms ; economics ; mortality ; Female ; Hospitalization ; economics ; Humans ; Liver Neoplasms ; economics ; mortality ; Lung Neoplasms ; economics ; mortality ; Male ; Neoplasms ; economics ; mortality ; Stomach Neoplasms ; economics ; mortality

INTRODUCTIONTrauma is the fifth principal cause of death in Singapore, with traumatic brain injury (TBI) being the leading specific subordinate cause.

METHODSThis study was an eight-year retrospective review of the demographic profiles of patients with severe TBI who were admitted to the neurointensive care unit (NICU) of the National Neuroscience Institute at Tan Tock Seng Hospital, Singapore, between 2004 and 2011.

RESULTSA total of 780 TBI patients were admitted during the study period; 365 (46.8%) patients sustained severe TBI (i.e. Glasgow Coma Scale score ≤ 8), with the majority (75.3%) being male. The ages of patients with severe TBI ranged from 14-93 years, with a bimodal preponderance in young adults (i.e. 21-40 years) and elderly persons (i.e. > 60 years). Motor vehicle accidents (48.8%) and falls (42.5%) were the main mechanisms of injury. Invasive line monitoring was frequently employed; invasive arterial blood pressure monitoring and central venous pressure monitoring were used in 81.6% and 60.0% of the patients, respectively, while intracranial pressure (ICP) measurement was required in 47.4% of the patients. The use of tiered therapy to control ICP (e.g. sedation, osmotherapy, cerebrospinal fluid drainage, moderate hyperventilation and barbiturate-induced coma) converged with international practices.

CONCLUSIONThe high-risk groups for severe TBI were young adults and elderly persons involved in motor vehicle accidents and falls, respectively. In the NICU, the care of patients with severe TBI requires heavy utilisation of resources. The healthcare burden of these patients extends beyond the acute critical care phase.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Brain Injuries, Traumatic ; economics ; epidemiology ; therapy ; Critical Care ; economics ; statistics & numerical data ; Female ; Glasgow Coma Scale ; Hospitalization ; Humans ; Intensive Care Units ; economics ; statistics & numerical data ; Intracranial Pressure ; Male ; Middle Aged ; Monitoring, Physiologic ; Public Health ; Resource Allocation ; Retrospective Studies ; Singapore ; Young Adult

BACKGROUNDThe study was to explore the causes of high inpatient expenditure through analyzing the distribution characteristics as well as the influence factors of high inpatient expenditure cases during 3 years within a Grade-A tertiary hospital through various aspects and multiple angles, thus identifying the major influence factors for high medical expenditure to develop further research.

METHODSWe retrospectively studied 2041 inpatient cases which cost more than RMB 100,000 Yuan per case in a Grade-A tertiary hospital from 2013 to 2015. We analyzed the compositions of the medical cost to evaluate the major factors that cause the high inpatient expenditure. All the data and materials were collected from medical record system, and the statistical methods included t-test, variance of analysis, and multivariate linear regression.

RESULTSThe average cost of the 2,041 cases was RMB 152,173 Yuan for medicines and materials of medical costs, which respectively accounted for 33.03% and 32.32% of the total cost; and the average length of hospital stay was 28.39 days/person. Diseases of skeletal and muscular system, circulatory system, and tumor were the top three disease categories of high inpatient expenditure, which accounted for 39.00%, 33.46%, and 18.03%, respectively. Complications, criticality of the disease, gender of the patients, the occurrence of death, and the excessive length of hospital stay all had great impacts on average medical expenditure, while age, hospital infection, and surgery showed no significant impact on average medical cost.

CONCLUSIONSThe main factors for high inpatient expenditure included the inadequate use of high-value medicines and materials, lacking cost control measures within the hospital, the excessive length of hospital stay for inpatients, and the unnecessary treatment for the patients.

China ; Female ; Health Expenditures ; statistics & numerical data ; Hospitalization ; economics ; Humans ; Inpatients ; statistics & numerical data ; Length of Stay ; economics ; Male ; Multivariate Analysis ; Retrospective Studies