Search

Objectives: To assess the main features and determining factors of inappropriate admission and hospital stay in relationship with a new clinical management model., Methods: Study population included all patients discharged from the Hospital Clinic-University of Barcelona. The review tool was the medical and surgical Appropriateness Evaluation Protocol (AEP). We reviewed the clinical records of a representative sample of all discharged patients. Two independent and well trained AEP reviewers were used for each record review. A multivariate analysis was performed, using admission and inappropriate hospital stay as independent variables., Results: A total of 401 admissions were reviewed. Twenty-eight (6.9%) were deemed to be inappropriate. Elective admission, admission over the week-end and being admitted to a medical ward were the predictive variables identified for inappropriate admissions. Of all 2,187 hospital stays reviewed, 267 (12.2%) were deemed to be inappropriate. An inappropriate admission, total length of stay, type of insurance coverage and discharge type were the predictive variables identified for inappropriate hospital stays., Conclusions: The new organization and clinical management model, developed by the Patient Focused Care Institutes, showed very acceptable levels of inappropriate admissions and hospital stays. Surgical services have benefited most from this new organization. Care provided to patients with medical conditions, notably those patients with multiple and chronic conditions, make up most of the inappropriateness identified., (Copyright © 2008 Sociedad Española de Calidad Asistencial. Published by Elsevier Espana. All rights reserved.)

Background and Objective: Heart transplant requires a heavy use of high cost resources. Economic data related to this procedure had not been specifically addressed and there are very few publications which analyze this topic. The aim of this study was to analyze the costs related to heart transplant in a series of patients from a single institution., Patients and Method: Data from all patients included in the Hospital Clínic heart transplant programme in which a cardiac transplant was effectively performed between 1999 and 2000 were analyzed, including one year of follow-up. Patients who died within this first year were also included. Organ procurement costs were excluded. Cost analysis was performed by micro-costing techniques., Results: A total of 21 patients undergoing a heart transplant were included. One year survival rate was 76%. Mean (standard deviation) of total cost (procedure costs + one year follow-up cost) was 59,349 (18,881) euros (range: 29,380-113,470 euros). Procedure mean cost was 41,724 (17,584) euros (70% of total costs) and one year follow up mean cost was 17,625 (10,096) euros (30% of total costs) per patient. When the initial episode (heart transplant procedure) was analyzed, main cost drivers were personnel costs euros 59% of all costs; mean: 24,795 (7,633) euros and treatment costs -20% of all costs; mean: 8,386 (7,250) euros., Conclusions: Costs of heart transplant in Barcelona (Spain) are similar to those published for other European Union countries, and well below the costs related to the procedure in the United States.