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Background: The surgical treatment of bony non-unions is traditionally performed with additional bone grafts when atrophic and/or stronger implants when hypertrophic. In the case of the clavicle shaft, however, in our experience, a more controversial method where no additional bone graft is needed leads to equally good consolidation rates, independent of the non-union morphology. This method requires the meticulous anatomical reconstruction of the initial fracture and fixation according to the AO principle of relative stability. Methods: A retrospective review following the STROBE guidelines was performed on a consecutive cohort of all patients who received surgical treatment of a midshaft clavicle non-union at the Medical Center of the University of Freiburg between January 2003 and December 2023. Patients were identified using a retrospective systematical query in the Hospital Information System (HIS) using the International Statistical Classification of Diseases and Related Health Problems Version 10 (ICD-10) codes of the German Diagnosis Related Groups (G-DRG). Two groups were formed to compare the consolidation rates of patients who received additional bone grafting from the iliac crest with those of patients who did not. A 3.5 mm reconstruction LCP plate was used in all patients. Consolidation rates were evaluated using follow-up radiographs and outcomes after material removal with a mean follow-up of 31.5 ± 44.3 months (range 0–196). Results: Final data included 50 patients, predominantly male (29:21); age: 46.0 ± 13.0 years, BMI 26.1 ± 3.7. Autologous bone grafts from the iliac crest were used in 38.0% (n = 19), while no bone addition was used in 62.0% (n = 30). Six patients were lost to follow-up. Radiological consolidation was documented after a mean of 15.1 ± 8.0 months for the remaining 44 patients. Consolidation rates were 94.4% (n = 17) in patients for whom additional bone grafting was used and 96.2% (n = 25) in patients for whom no graft was used. There was no relevant difference in the percentage of atrophic or hypertrophic non-unions between both groups (p = 0.2425). Differences between groups in the rate of consolidation were not significant (p = 0.7890). The complication rate was low, with 4.5% (n = 2). Conclusions: Independent of the non-union morphology, non-unions of the clavicle midshaft can be treated successfully with 3.5 mm locking reconstruction plates without the use of additional bone grafting in most cases. [ABSTRACT FROM AUTHOR]

Hospitals account for about 40% of all healthcare expenditure in high-income countries and play a central role in healthcare provision. The ways in which they are paid, therefore, has major implications for the care they provide. However, our knowledge about reforms that have been made to the various payment schemes and their country-level effects is surprisingly thin. This study examined the uniquely comprehensive introduction of diagnosis-related groups (DRGs) in Germany, where DRGs function as the sole pricing, billing, and budgeting system for hospitals and almost exclusively determine hospital revenue. The introduction of DRGs, therefore, completely overhauled the previous system based on per diem rates, offering a unique opportunity for analysis. Using aggregate data from the Organisation for Economic Co-operation and Development and recent advances in econometrics, we analyzed how hospital activity and efficiency changed in response to the reform. We found that DRGs in Germany significantly increased hospital activity by around 20%. In contrast to earlier studies, we found that DRGs have not necessarily shortened the average length of stay. [ABSTRACT FROM AUTHOR]

Aims Design Setting Participants Measurements Findings Conclusions Our study aimed to a) describe the distribution of hospital discharges with primary and secondary alcohol‐specific diagnoses by sex and age group, and b) describe how the number of hospital discharges with primary and secondary alcohol‐specific diagnoses have changed across different diagnostic groups (categorized by primary International Classification of Diseases, 10th Revision [ICD‐10] diagnosis) over time.Retrospective cross‐sectional analysis.German hospital settings between 2012 and 2021.All persons aged 15–69 admitted to hospitals as registered in a nationwide data set.We counted a) the number of all hospital discharges and b) the number of hospital discharges with at least one alcohol‐specific secondary diagnosis (secondary alcohol‐specific diagnosis) by year, sex, age group, and diagnostic group. One diagnostic group included all primary alcohol‐specific diagnoses, while 13 additional groups aligned with ICD‐10 chapters (e.g., neoplasms). Alcohol‐involvement was defined as either a primary or secondary alcohol‐specific diagnosis.Of 95 417 204 recorded hospital discharges between 2012 and 2021, 3 828 917 discharges (4.0%; 2 913 903 men (6.4%); 915 014 women (1.8%)) involved either a primary or at least one secondary diagnosis related to alcohol. Of all alcohol‐involved hospital discharges, 56.8% (1 654 736 discharges) had no primary but only a secondary alcohol‐specific diagnosis. Secondary alcohol‐specific diagnoses were particularly prevalent in hospital discharges due to injuries. With rising age, alcohol‐involvement in hospital discharges due to digestive or cardiovascular diseases increased. Between 2012 and 2021, the rate of alcohol‐involved hospital discharges has decreased more in younger as compared with older adults (average change between 2012 and 2021: 15–24: −55%; 25–34: −41%; 35–44: −23%; 45–54: −31%; 55–64: −21%; 65–69: −8%).The number of alcohol‐involved hospital discharges in Germany from 2012 to 2021 more than doubles (from 1 654 736 to 3 828 917) when including secondary alcohol‐specific diagnoses. More pronounced declines among younger adults may be attributed to unequal changes in alcohol consumption patterns across the population and to the hazardous effects of long‐term alcohol use. [ABSTRACT FROM AUTHOR]

This study investigates the factors influencing the lack of Braille-embossed labels in Chinese pharmaceutical product packaging. To this end, this study constructs an evolutionary game model of multi-participant behaviour in drug production regulation and conducts simulation based on the perspective of stakeholders in order to study the evolutionary steady state of regulatory authorities, pharmaceutical companies, and visually impaired individuals and the influence of each parameter variable on the choice of strategic behaviour of the participants. The simulation results show that in the legal framework of China, administrative penalties, the production subsidy rate, and the Basic Medical Insurance (BMI) reimbursement rate are the main drivers of the system's evolution towards a steady state. Reduced costs of drugs with Braille-embossed packaging is a prerequisite for the visually impaired to purchase such drugs, and the key for the whole system to converge to a stable state therefore lies in the BMI reimbursement rate for drugs with Braille-embossed packaging. This paper suggests that the Chinese government should improve the law enforcement mechanism for the regulation of the production of drugs with Braille-embossed packaging; increase the type and intensity of administrative penalties as well as production subsidies, tax incentives, and compliance incentives for pharmaceutical companies; and provide higher BMI reimbursement rates for the visually impaired. The results of the study provide valuable insights to improve accessibility to drugs and build a barrier-free environment for ensuring medication safety in China and other developing countries. [ABSTRACT FROM AUTHOR]

Recent studies show declining trends in hysterectomy rates in several countries. The objective of this study was to analyse hysterectomy time trends in Germany over a fifteen-year period using an age-period-cohort approach. Using an ecological study design, inpatient data from Diagnoses Related Group on hysterectomies by subtype performed in Germany from 2005 to 2019 were retrieved from the German Statistical Office. Descriptive time trends and age-period-cohort analyses were then performed. A total of 1,974,836 hysterectomies were performed over the study period. The absolute number of hysterectomies reduced progressively from 155,680 (365 procedures/100,000 women) in 2005 to 101,046 (257 procedures/100,000 women) in 2019. Total and radical hysterectomy decreased by 49.7% and 44.2%, respectively, whilst subtotal hysterectomy increased five-fold. The age-period-cohort analysis revealed highest hysterectomy rates in women aged 45–49 for total and subtotal hysterectomy with 608.63 procedures/100,000 women (95% CI 565.70, 654.82) and 151.30 procedures/100,000 women (95% CI 138.38, 165.44) respectively. Radical hysterectomy peaked later at 65–69 years with a rate of 40.63 procedures/100,000 women (95% CI 38.84, 42.52). The risk of undergoing total or radical hysterectomy decreased over the study period but increased for subtotal hysterectomy. Although, overall hysterectomy rates have declined, subtotal hysterectomy rates have increased; reflecting changes in clinical practice largely influenced by the availability of uterus-sparing options, evolving guidelines and introduction of newer surgical approaches. [ABSTRACT FROM AUTHOR]

There is growing evidence that differences exist between rural and urban residents in terms of health, access to care and the quality of health care received, especially in low- and middle-income countries (LMICs). To improve health equity and the performance of health systems, a diagnosis-related group (DRG) payment system has been introduced in many LMICs to reduce financial risk and improve the quality of health care. The aim of this study was to examine the impact of DRG payments on the health care received by rural residents in China, and to help policymakers identify and design implementation strategies for DRG payment systems for rural residents in LMICs. Health impact assessment. This study compared the impact of DRG payments on the healthcare received by rural residents in China between the pre- and post-reform periods by applying a difference-in-difference (DID) methodology. The study population included individuals with three common conditions; namely, cerebral infarction, transient ischaemic attack (TIA), and vertebrobasilar insufficiency (VBI). Data on patient medical insurance type were assessed, and those who did not have rural insurance were excluded. This study included 13,088 patients. In total, 33.63% were from Guangdong (n = 4401), 38.21% were from Shandong (n = 5002), and 28.16% were from Guangxi (n = 3685). The DID results showed that the implementation of DRGs was positively associated with hospitalization expense (β 4 = 0.265, P = 0.000), treatment expense (β 4 = 0.343 , P = 0.002), drug expense (β 4 = 0.607, P = 0.000), the spending of medical insurance funds (β 4 = 0.711, P = 0.000) and out-of-pocket costs (β 4 = 0.164, P = 0.000). The findings of this study suggest that the implementation of DRG payments increases health care costs and the financial burden on health systems and rural patients in LMICs. This is contrary to the original intention of implementing the DRG payment system. [ABSTRACT FROM AUTHOR]

Aims: This study aimed to present the Johns Hopkins Adjusted Clinical Groups (ACG) System risk stratification profile of a total adult population of somatic health-care users when using data from either general practitioners (GPs) or hospital services and to compare the number and characteristics of individuals identified as having complex and long-term health-care needs in each data source. Methods: This was a registry-based study that included all adult residents (N =168,285) in four municipalities in Central Norway who received somatic health care during 2013. Risk profiles were generated using the ACG System based on age, sex and diagnoses registered by GPs or the local hospital. ACG output variables on number of chronic conditions, frailty and concurrent resource utilisation were chosen as indicators of complexity. Results: Nearly nine out of 10 (83.9%) of the population had been in contact with a GP, and 35.4% with the hospital. The mean number of diagnoses (3.0) was equal in both sources. A larger proportion of the population had higher risk scores in all variables except frailty when comparing hospital data to GP data. This was also found when comparing individuals identified as having complex and long-term health-care needs. A similar proportion of the population was found to have complex and long-term health-care needs (hospital 6.7%, GP 6.3%), but only one in five (21.5%) were identified in both data sets. Conclusions: As data from GPs and hospitals identified mostly different individuals with complex and long-term health-care needs, combining data sources is likely to be the best option for identifying those most in need of special attention. [ABSTRACT FROM AUTHOR]

Background Under Medicare's fee-for-service and bundled payment models, the basic unit of hospital payment for inpatient hospitalizations is determined by the Medicare Severity Diagnosis Related Group (MS-DRG) coding system. Primary total joint arthroplasties (hip and knee) are coded under MS-DRG code 469 for hospitalizations with a major complication or comorbidity and MS-DRGcode 470 for those without a major complication or comorbidity. However, these codes do not account for the indication for surgery, which may influence the cost of care. Questions/purposes We sought to (1) quantify the differences in hospital costs associated with six of the most common diagnostic indications for THA (osteoarthritis, rheumatoid arthritis, avascular necrosis, hip dysplasia, posttraumatic arthritis, and conversion arthroplasty), (2) assess the primary drivers of cost variation using comparisons of hospital charge data for the diagnostic indications of interest, and (3) analyze the median length of stay, discharge destination, and intensive care unit use associated with these indications. Methods This study used the 2019 Medicare Provider Analysis and Review Limited Data Set. Patients undergoing primary elective THA were identified using MS-DRG codes and International Classification of Diseases, Tenth Revision, Procedure Coding System codes. Exclusion criteria included non-fee-for-service hospitalizations, nonelective procedures, patients with missing data, and THAs performed for indications other than the six indications of interest. A total of 713,535 primary THAs and TKAs were identified in the dataset. After exclusions were applied, a total of 135,194 elective THAs were available for analysis. Hospital costs were estimated using cost-to-charge ratios calculated by the Centers for Medicare and Medicaid Services. The primary benefit of using cost-to-charge ratios was that it allowed us to analyze a large national dataset and to mitigate the random cost variation resulting from unique hospitals' practices and patient populations. As an investigation into matters of health policy, we believe that assessing the surgical cost borne by the "average" hospital was most appropriate. To analyze estimated hospital costs, we performed a multivariable generalized linear model controlling for patient demographics (gender, age, and race), preoperative health status, and hospital characteristics (hospital setting [urban versus rural], geography, size, resident-to-bed ratio, and wage index). We assessed the principal drivers of cost variation by analyzing the median hospital charges arising from 30 different hospital revenue centers using descriptive statistics. Length of stay, intensive care use, and discharge to a nonhome location were analyzed using multivariable binomial logistic regression. Results The cost of THA for avascular necrosis was 1.050 times (95% confidence interval 1.042 to 1.069; p < 0.001), or 5% greater than, the cost of THA for osteoarthritis; the cost of hip dysplasia was 1.132 times (95% CI 1.113 to 1.152; p < 0.001), or 13% greater; the cost of posttraumatic arthritis was 1.220 times (95% CI 1.193 to 1.246; p < 0.001), or 22% greater; and the cost of conversion arthroplasty was 1.403 times (95% CI 1.386 to 1.419; p < 0.001), or 40% greater. Importantly, none of these CIs overlap, indicating a discernable hierarchy of cost associated with these diagnostic indications for surgery. Rheumatoid arthritis was not associated with an increase in cost. Medical or surgical supplies and operating room charges represented the greatest increase in charges for each of the surgical indications examined, suggesting that increased use of medical and surgical supplies and operating room resources were the primary drivers of increased cost. All of the orthopaedic conditions we investigated demonstrated increased odds that a patient would experience a prolonged length of stay and be discharged to a nonhome location compared with patients undergoing THA for osteoarthritis. Avascular necrosis, posttraumatic arthritis, and conversion arthroplasty were also associated with increased intensive care unit use. Posttraumatic arthritis and conversion arthroplasty demonstrated the largest increase in resource use among all the orthopaedic conditions analyzed. Conclusion Compared with THA for osteoarthritis, THA for avascular necrosis, hip dysplasia, posttraumatic arthritis, and conversion arthroplasty is independently associated with stepwise increases in resource use. These cost increases are predominantly driven by greater requirements for medical and surgical supplies and operating room resources. Posttraumatic arthritis and conversion arthroplasty demonstrated substantially increased costs, which can result in financial losses in the setting of fixed prospective payments. These findings underscore the inability of MS-DRG coding to adequately reflect the wide range of surgical complexity and resource use of primary THAs. Hospitals performing a high volume of THAs for indications other than osteoarthritis should budget for an anticipated increase in costs, and orthopaedic surgeons should advocate for improved MS-DRG coding to appropriately reimburse hospitals for the financial and clinical risk of these surgeries. Level of Evidence Level IV, economic and decision analysis. [ABSTRACT FROM AUTHOR]

The management bodies of medical institutions for hospital care organize and direct the compilation and implementation of the financial activity of the medical facility. They develop and approve internal rules and procedures for the organization of accounting reporting in medical institutions for hospital care. The aim of the present study is to investigate the change of costs by types and their structure in the University and national Multiprofile hospitals for active treatment of the public health care system in Bulgaria. The change in costs in general for hospitals and specifically for their inpatients, as well as the capital costs for the acquisition of fixed assets, was studied. All medical institutions under the central authority of the Ministry of Health - including specialized and university hospitals are obliged to work according to the Uniform Methodology for separate reporting of costs in health institutions by types of costs and types of institutions. The costs of hospital care are constantly increasing, following the increase in the number of hospitalizations, and reaching proportions that pose a risk to the fiscal stability of the system. It is a positive fact that with the highest absolute size and relative share, personnel costs are increasing. [ABSTRACT FROM AUTHOR]

Background Objective Methods Results Conclusions Dermatologic conditions are estimated to account worldwide for approximately 8% of all visits at emergency departments (EDs). Although rarely life‐threatening, several dermatologic emergencies may have a high morbidity. Little is known about ED consultations of patients with dermatological emergencies and their subsequent hospital disposal.We explore determinants and clinical variables affecting patients' disposal and hospitalization of people attending the ED at a Swiss University Hospital, over a 56‐month observational period, for a dermatological problem.De‐identified patients' information was extracted from the hospital electronic medical record system. Generalized estimating equations were used to explore determinants of patient's disposition.Out of 5096 consecutive patients with a dermatological main problem evaluated at the ED, 79% of patients were hospitalized after initial assessment. In multivariable analyses, factors which were significantly associated with an increased admission rate included length of ED stay, age ≥ 45 years, male sex, distinct vital signs, high body mass index, low oxygen saturation, admission time in the ED and number and type of dermatological diagnoses. Only 2.2% of the hospitalized patients were admitted to a dermatology ward, despite the fact that they had dermatological diagnoses critically determining the diagnostic related group (DRG) payment. The number of patients managed by dermatologists during in‐patient treatment significantly decreased over the study period.Our study identifies a number of independent predictors affecting the risk of hospital admission for patients with dermatological conditions, which may be useful to improve patients' disposal in EDs. The results indicate that the dermatological specialty is becoming increasingly marginalized in the management of patients in the Swiss hospital setting. This trend may have significant implications for the delivery of adequate medical care, outcomes and cost‐effectiveness. Dermatologists should be more engaged to better position their specialty and to effectively collaborate with nondermatologists to enhance patient care. [ABSTRACT FROM AUTHOR]

Background: Hospital services are typically reimbursed using case-mix tools that group patients according to diagnoses and procedures. We recently developed a case-mix tool (i.e., the Queralt system) aimed at supporting clinicians in patient management. In this study, we compared the performance of a broadly used tool (i.e., the APR-DRG) with the Queralt system. Methods: Retrospective analysis of all admissions occurred in any of the eight hospitals of the Catalan Institute of Health (i.e., approximately, 30% of all hospitalizations in Catalonia) during 2019. Costs were retrieved from a full cost accounting. Electronic health records were used to calculate the APR-DRG group and the Queralt index, and its different sub-indices for diagnoses (main diagnosis, comorbidities on admission, andcomplications occurred during hospital stay) and procedures (main and secondary procedures). The primary objective was the predictive capacity of the tools; we also investigated efficiency and within-group homogeneity. Results: The analysis included 166,837 hospitalization episodes, with a mean cost of € 4,935 (median 2,616; interquartile range 1,011–5,543). The components of the Queralt system had higher efficiency (i.e., the percentage of costs and hospitalizations covered by increasing percentages of groups from each case-mix tool) and lower heterogeneity. The logistic model for predicting costs at pre-stablished thresholds (i.e., 80th, 90th, and 95th percentiles) showed better performance for the Queralt system, particularly when combining diagnoses and procedures (DP): the area under the receiver operating characteristics curve for the 80th, 90th, 95th cost percentiles were 0.904, 0.882, and 0.863 for the APR-DRG, and 0.958, 0.945, and 0.928 for the Queralt DP; the corresponding values of area under the precision-recall curve were 0.522, 0.604, and 0.699 for the APR-DRG, and 0.748, 0.7966, and 0.834 for the Queralt DP. Likewise, the linear model for predicting the actual cost fitted better in the case of the Queralt system. Conclusions: The Queralt system, originally developed to predict hospital outcomes, has good performance and efficiency for predicting hospitalization costs. [ABSTRACT FROM AUTHOR]

AbstractThe COVID-19 pandemic negatively impacted people’s mental health and wellbeing. Using a national dataset of >11,000 Australians collected before and during the first two years of the pandemic, this study examines housing and mental health effects of COVID-19, and the extent to which access to government income support (social security measures, crisis payments and wage subsidy), early superannuation withdrawal, mortgage and rent relief, and tenant eviction moratoriums offered protection. Results show that the mental health gap between private rental and more secure housing tenures and between good- and poor-quality housing widened during the pandemic. Government income support provided a social safety net and was important in buffering housing instability especially when strong eviction moratoriums were lacking. Mortgage relief measures were associated significantly lower risks of housing affordability stress. Strong eviction moratoriums were effective in reducing risks of residential instability and forced moves. The pandemic exposed health vulnerabilities generated from people’s housing circumstances, reinforcing the need for public policies to address these social inequities to improve health and wellbeing. Findings emphasise the importance of tenure security, housing quality and enforcement of rental market interventions during disasters and identify the benefits of policies providing income support and strong eviction protection. [ABSTRACT FROM AUTHOR]

Background: The 2014 expansion of Medicaid under the Affordable Care Act (ACA) reshaped healthcare delivery in the United States. This study assessed how Medicaid expansion affected in-hospital mortality in patients with extreme risk of mortality (EROM) from traumatic injuries. Methods: Data from inpatients aged 18-64 years, registered in the National Inpatient Sample between 2007 and 2020, and identified with trauma-related All-Patient Refined Diagnosis Related Groups (APRDRG) codes, were analyzed. Within this group, a subset of patients was selected based on the APRDRG classification identifying them as at EROM for the principal unit of analysis. The cohort was divided into high-implementation (HIR) and low-implementation (LIR) regions based on Medicaid expansion coverage. In-hospital mortality was assessed using interrupted time-series analysis. Sensitivity analyses considered seasonality, autocorrelation, and exogenous events. Results: Analysis encompassed 70 381 trauma inpatient stays, corresponding to 346 659 patients based on National Inpatient Sample weighting. There was a consistent monthly decline in in-hospital mortality of.08% (95% CI: −.103 to −.048; P <.001) prior to Medicaid expansion, a trend unaffected by expansion. This pattern persisted across both LIR and HIR Medicaid implementation regions. Although Medicaid enrollment increased in HIR, that in LIR remained unchanged. Discussion: Over the study period, the in-hospital mortality among severely injured patients consistently decreased, and this trend was not influenced by Medicaid expansion. The statistical models and results from this study can offer valuable guidance to policymakers and healthcare leaders as they formulate more efficient and effective policies. [ABSTRACT FROM AUTHOR]

Background and Objectives: Obstetric haemorrhage is the leading cause of maternal morbidity and mortality worldwide. We aimed to estimate the economic cost of Major Obstetric Haemorrhage (MOH) and the cost of therapeutic blood components used in the management of MOH in Ireland. Materials and Methods: We performed a nationwide cross‐sectional study utilising top‐down and bottom‐up costing methods on women who experienced MOH during the years 2011–2013. Women with MOH were allocated to Diagnostic Related Groups (DRGs) based on the approach to MOH management (MOH group). The total number of blood components used for MOH treatment and the corresponding costs were recorded. A control group representative of a MOH‐free maternity population was designed with predicted costs. All costs were expressed in Euro (€) using 2022 prices and the incremental cost of MOH to maternity costs was calculated. Cost contributions are expressed as percentages from the estimated total cost. Results: A total of 447 MOH cases were suitable for sorting into DRGs. The estimated total cost of managing women who experienced MOH is approximately €3.2 million. The incremental cost of MOH is estimated as €1.87 million. The estimated total cost of blood components used in MOH management was €1.08 million and was based on an estimated total of 3997 products transfused. Red blood cell transfusions accounted for the highest contribution (20.22%) to MOH total cost estimates compared to other blood components. Conclusions: The total cost of caring for women with MOH in Ireland was approximately €3.2 million with blood component transfusions accounting for between one third and one half of the cost. [ABSTRACT FROM AUTHOR]

This research, based on a review of secondary information, explores how the government of China and the country's leading technological enterprises are working together to develop infrastructure for next-generation digital technologies, e.g. artificial intelligence, cloud computing, quantum computing, 5G networks, navigation satellites, and fiber optic cables; to establish technical norms and standards; and to provide services and digital content, e.g. digital messaging applications, mobile payment systems, and e-commerce platforms, to emergent markets; as well as how digital corporate giants of China like Alibaba, Huawei, Baidu, ZTE, China Telecom, China Mobile, China Unicom, and Tencent have been challenging the prevailing status quo. Beijing seeks to assert its dominant role in world affairs through the Digital Silk Road (DSR) to globally influence and control a sizable part of the digital economy. The DSR has significant potential for enhancement of digital interdependence with the underdeveloped and some advanced economies by bridging the gap created by the absence of a critical infrastructure of global digital technology. There is no viable competitor to the DSR's exciting and long-term vision of a globally connected digital future for facilitating mutual growth and collaboration that will ultimately push for a dependency of other countries on DSR under the Belt and Road Initiative. [ABSTRACT FROM AUTHOR]

Purpose: As one of the pioneering pilot cities in China's extensive Diagnosis Related Groups (DRG) -based prepayment reform, Beijing is leading a comprehensive overhaul of the prepayment system, encompassing hospitals of varying affiliations and tiers. This systematic transformation is rooted in extensive patient group data, with the commencement of actual payments on March 15, 2022. This study aims to evaluate the effectiveness of DRG payment reform by examining how it affects the cost, volume, and utilization of care for patients with neurological disorders. Patients and Methods: Utilizing the exogenous shock resulting from the implementation of the DRG-based prepayment system, we adopted the Difference-in-Differences (DID) approach to discern changes in outcome variables among DRG payment cases, in comparison to control cases, both before and following the enactment of the DRG policy. The analytical dataset was derived from patients diagnosed with neurological disorders across all hospitals in Beijing that underwent the DRG-based prepayment reform. Strict data inclusion and exclusion criteria, including reasonableness tests, were applied, defining the pre-reform timeframe as March 15th through October 31st, 2021, and the post-reform timeframe as the corresponding period in 2022. The extensive dataset encompassed 53 hospitals and encompassed hundreds of thousands of cases. Results: The implementation of DRG-based prepayment resulted in a substantial 12.6% decrease in total costs per case and a reduction of 0.96 days in length of stay. Additionally, the reform was correlated with significant reductions in overall in-hospital mortality and readmission rates. Surprisingly, the study unearthed unintended consequences, including a significant reduction in the proportion of inpatient cases classified as surgical patients and the Case Mix Index (CMI), indicating potential strategic adjustments by providers in response to the introduction of DRG payments. Conclusion: The DRG payment reform demonstrates substantial effects in restraining cost escalation and enhancing quality. Nevertheless, caution must be exercised to mitigate potential issues such as patient selection bias and upcoding. [ABSTRACT FROM AUTHOR]

Objective To offer insights for enhancing the hierarchical medical system and guiding patient healthcare-seeking behaviors systematically, this study analyzes referral willingness and influencing factors of tertiary public hospitals and primary healthcare institutionsamong chronic disease patients in Sichuan Province. Methods A questionnaire survey was conducted on 297 chronic disease patients. Descriptive statistical analysis of the data was performed using SPSS 26.0 software. Chi-square tests were employed to analyze the downward referral willingness of chronic disease patients from tertiary public hospitals and the upward referral willingness to primary healthcare institutions. Results Patients in large public hospitals showed low downward referral willingness (44.2%). Rural residence, prior medical consortium services, and greater distance from tertiary hospitals increased willingness. Primary healthcare patients exhibited a 28.1% upward referral willingness, influenced by occupation, age, and use of outpatient special disease policy services. Conclusion Referral willingness is generally weak in large public hospitals and primary healthcare institutions. Enhancing the comprehensive capacity of primary healthcare institutions, strengthening collaborative mechanisms and the level of medical services within medical consortia, along with expanding reimbursement policies for chronic diseases, contributes to promoting bidirectional patient referrals and advancing the formation of a tiered diagnosis and treatment system. [ABSTRACT FROM AUTHOR]

Background: Previous studies found that documentation of comorbidities differed when Veterans received care within versus outside Veterans Health Administration (VHA). Changes to medical center funding, increased attention to performance reporting, and expansion of Clinical Documentation Improvement programs, however, may have caused coding in VHA to change. Methods: Using repeated cross-sectional data, we compared Elixhauser-van Walraven scores and Medicare Severity Diagnosis Related Group (DRG) severity levels for Veterans' admissions across settings and payers over time, utilizing a linkage of VHA and all-payer discharge data for 2012–2017 in seven US states. To minimize selection bias, we analyzed records for Veterans admitted to both VHA and non-VHA hospitals in the same year. Using generalized linear models, we adjusted for patient and hospital characteristics. Results: Following adjustment, VHA admissions consistently had the lowest predicted mean comorbidity scores (4.44 (95% CI 4.34–4.55)) and lowest probability of using the most severe DRG (22.1% (95% CI 21.4%-22.8%)). In contrast, Medicare-covered admissions had the highest predicted mean comorbidity score (5.71 (95% CI 5.56–5.85)) and highest probability of using the top DRG (35.3% (95% CI 34.2%-36.4%)). Conclusions: More effective strategies may be needed to improve VHA documentation, and current risk-adjusted comparisons should account for differences in coding intensity. [ABSTRACT FROM AUTHOR]

Recent advancements in technology-based payment methods have prompted central banks all over the world to consider the possible advantages and hazards of issuing Central Bank Digital Currencies (CBDC) in order to keep up with the current innovation trend. The Indian payment system is no exception to this fintech innovation trend. As a result, the Reserve Bank of India (RBI) must begin considering related patterns and develop a phased implementation plan that progresses gradually through the pilot project. The present research is proposing a Pilot project on the issuance of retail e-rupee first. The research is primarily based on the normative method presenting a qualitative analysis of the creation of a digital rupee possibly like paper money and its smooth implementation. The study examines the potential effects of retail e-rupee implementation on the banking industry, monetary policy, technology architecture options, potential retail e-rupee applications, issuance methods, etc., as well as privacy issues. Thus, it will assist RBI in making policy decisions. [ABSTRACT FROM AUTHOR]

Background: Adult patients with biliary acute pancreatitis (BAP) or choledocholithiasis who do not undergo cholecystectomy on index admission have worse outcomes. Given the paucity of data on the impact of cholecystectomy during index hospitalization in children, we examined readmission rates among pediatric patients with BAP or choledocholithiasis who underwent index cholecystectomy versus those who did not. Methods: Retrospective study of children (< 18 years old) admitted with BAP, without infection or necrosis (ICD-10 K85.10), or choledocholithiasis (K80.3x–K80.7x) using the 2018 National Readmission Database (NRD). Exclusion criteria were necrotizing pancreatitis with or without infected necrosis and death during index admission. Multivariable logistic regression was performed to identify factors associated with 30-day readmission. Results: In 2018, 1122 children were admitted for index BAP (n = 377, 33.6%) or choledocholithiasis (n = 745, 66.4%). Mean age at admission was 13 (SD 4.2) years; most patients were female (n = 792, 70.6%). Index cholecystectomy was performed in 663 (59.1%) of cases. Thirty-day readmission rate was 10.9% in patients who underwent cholecystectomy during that index admission and 48.8% in those who did not (p < 0.001). In multivariable analysis, patients who underwent index cholecystectomy had lower odds of 30-day readmission than those who did not (OR 0.16, 95% CI 0.11–0.24, p < 0.001). Conclusions: Index cholecystectomy was performed in only 59% of pediatric patients admitted with BAP or choledocholithiasis but was associated with 84% decreased odds of readmission within 30 days. Current guidelines should be updated to reflect these findings, and future studies should evaluate barriers to index cholecystectomy. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To explore the application effect of pathway-based management of recombinant human erythropoietin ( rhEPO) injection during orthopedic perioperative period in orthopedics under the reform of China Healthcare Security Diagnosis Related Groups ( CHS-DRG) payment system. METHODS: Delphi method was employed, and two rounds of plan-do-check-act (PDCA) cycles were conducted to formulate the drug therapy pathway for rhEPO. Patients hospitalized in orthopedics of the hospital from Mar. to Jul. 2022 were extracted as the premanagement group, and patients from Mar. to Jul. 2023 were extracted as the post-management group. Eight DRG categories with the highest use rate of rhEPO were selected, and the improvement degree of benefit indicators (average hospitalization cost, average drug cost, average length of stay, rational use rate of rhEPO, blood transfusion rate) before and after management was compared. RESULTS: Compared with before management, the average hospitalization cost of orthopedic inpatients after management decreased from 58 829. 79 yuan to 48 259. 29 yuan (P<0. 05), the average drug cost decreased from 3 311. 23 yuan to 2 987. 52 yuan (P<0. 05), the average length of stay reduced from 10. 1 d to 8. 05 d (P<0. 01), with statistically significant differences. The rational use rate of rhEPO increased from 26. 27% (62 / 236) to 91. 54% (238 / 260), blood transfusion rate decreased from 34. 66% (165 / 476) to 25. 57% (169 / 661). CONCLUSIONS: By implementing pathway-based management and formulating standardized drug protocols, resource allocation has been optimized, medical quality has been improved, and the benefit indicators of DRG categories have been significantly enhanced. [ABSTRACT FROM AUTHOR]

BACKGROUND: The reform of hospital payment systems is a top priority for policymakers in many countries, including Iran. As knowledge of the current situation and experience with previous reforms are gained, the next phase will focus on improvement. Therefore, this study aims to identify the challenges to hospital payments in the Iranian health system. METHODS: This qualitative study used semi-structured interviews and focus group discussion meetings to collect data from 29 informants, including physicians, hospital administrators, faculty members, supervisors, and executive managers with expertise in hospital payment systems. Purposive sampling was used to recruit participants. Data were analyzed using content analysis. RESULTS: The content analysis resulted in five themes and twenty-two sub-themes. Policy and regulation issues, payment methods, fair payment to providers, infrastructure and systems, and behavior of providers were cited as major challenges and drawbacks of Iran's hospital payment systems. CONCLUSIONS: Understanding the barriers to hospital payments is essential for reforming or alleviating the problem. This research has shed light on the current state of the hospital payment system in the Iranian health system. Knowledge of the issues with the current system and the needs of healthcare providers is essential for effective reform. [ABSTRACT FROM AUTHOR]

Background: The Australian hospital-acquired complication (HAC) policy was introduced to facilitate negative funding adjustments in Australian hospitals using ICD-10-AM codes. Objective: The aim of this study was to determine the positive predictive value (PPV) of the ICD-10-AM codes in the HAC framework to detect hospital-acquired pneumonia in patients with cancer and to describe any change in PPV before and after implementation of an electronic medical record (EMR) at our centre. Method: A retrospective case review of all coded pneumonia episodes at the Peter MacCallum Cancer Centre in Melbourne, Australia spanning two time periods (01 July 2015 to 30 June 2017 [pre-EMR period] and 01 September 2020 to 28 February 2021 [EMR period]) was performed to determine the proportion of events satisfying standardised surveillance definitions. Results: HAC-coded pneumonia occurred in 3.66% (n = 151) of 41,260 separations during the study period. Of the 151 coded pneumonia separations, 27 satisfied consensus surveillance criteria, corresponding to an overall PPV of 0.18 (95% CI: 0.12, 0.25). The PPV was approximately three times higher following EMR implementation (0.34 [95% CI: 0.19, 0.53] versus 0.13 [95% CI: 0.08, 0.21]; p =.013). Conclusion: The current HAC definition is a poor-to-moderate classifier for hospital-acquired pneumonia in patients with cancer and, therefore, may not accurately reflect hospital-level quality improvement. Implementation of an EMR did enhance case detection, and future refinements to administratively coded data in support of robust monitoring frameworks should focus on EMR systems. Implications: Although ICD-10-AM data are readily available in Australian healthcare settings, these data are not sufficient for monitoring and reporting of hospital-acquired pneumonia in haematology-oncology patients. [ABSTRACT FROM AUTHOR]

This study aimed to investigate the associations between provider payment methods and expenditure of depressive patients, stratified by service types and hospital levels. We used a 5 % random sample of urban claims data in China (2013–2017), collected by China Health Insurance Research Association. Provider payment methods (fee-for-services, global budget, capitation, case-based and per-diem payments) were the explanatory variables. A generalized linear model was fitted for the associations between provider payment methods and expenditure. All analyses were adjusted for patient"cioeconomic and health-related characteristics. In total, 64,615 depressive patient visits were included, 59,459 for outpatients and 5156 for inpatients. Female patients accounted for 63.00 %. The total and out-of-pocket (OOP) expenditure significantly differentiated by provider payments. Among outpatient services, when comparing with fee-for-services, capitation payment was associated with substantial marginal reduction in total and OOP expenditure (−$34.18, −$9.71) in primary institutes, yet increases ($27.26, $24.11) in secondary hospitals. Similarly, global budget was associated with lower total and OOP expenditure (−$13.51, −$1.61) in secondary hospitals, while higher total and OOP expenditure ($7.43, $32.27) in tertiary hospitals than fee-for-services. For inpatients, total and OOP expenditures under per-diem (−$857.65, −$283.48) and case-based payments (−$997.93, −$137.56) were remarkably smaller than those under fee-for-services in primary and secondary hospitals, respectively. Besides, case-base payment was only linked with the largest reduction in OOP expense (−$239.39) in inpatient services of tertiary hospitals. Only urban claims data was included in this study, and investigations for rural population still warrant. And updated data are needed for future studies. There were varying correlations between provider payment methods and expenditure, which differed by service types and hospital levels. These findings provided empirical evidence for optimizing the mixed payment methods for depression in China. • There were distinctive associations between provide payment methods and depression-associated expenditure in urban China. • Capitation payment and global budget were related to less outpatient expense in primary and secondary hospitals separately. • Per-diem and case-based payments were linked to less inpatient expense in primary and secondary hospitals, respectively. • Our findings supported to tailor the payment method for depressive patients considering service types and hospital levels. [ABSTRACT FROM AUTHOR]

This study aims to estimate direct health-related costs for victims of intimate partner violence (IPV) using nationwide linked data based on police reports and two healthcare registers in Finland from 2015 to 2020 (N = 21,073). We used a unique register dataset to identify IPV victims from the data based on police reports and estimated the attributable costs by applying econometric models to individual-level data. We used exact matching to create a reference group who had not been exposed to IPV. The mean, unadjusted, attributable healthcare cost for victims of IPV was €6,910 per individual over the 5-year period after being first identified as a victim. When adjusting for gender, age, education, occupation, and mental-health- and pregnancy-related diagnoses, the mean attributable health-related cost for the 5 years was €3,280. The annual attributable costs of the victims were consistently higher than those for nonvictims during the entire study period. Thus, our results suggest that the adverse health consequences of IPV persist and are associated with excess health service use for 5 years after exposure to IPV. Most victims of IPV were women, but men were also exposed to IPV, although the estimates were statistically significant only for female victims. Victims of IPV were over-represented among individuals outside the labor force and lower among those who were educated. The total healthcare costs of victims of IPV varied according to the socioeconomic factors. This study highlights the need for using linked register data to understand the characteristics of IPV and to assess its healthcare costs. The study results suggest that there is a significant socioeconomic gradient in victimization, which could also be useful to address future IPV prevention and resource allocation. [ABSTRACT FROM AUTHOR]

Consumer demand for speed, comfort, and security in financial transactions is rising along with the globalization of the business. As a result, we require a payment method that is dependable and simple for bank clients. A payment system is a set of arrangements that facilitates the exchange of value between individuals and financial institutions on a national and international level in order to deliver payments. A literature review, or literature review, is the research design used here. A literature review is an explanation of the hypotheses, conclusions, and other research materials that are gleaned from reference works and used as the foundation for further study. The literature review includes summaries, reviews, and the author's observations about a variety of literature sources (books, papers, slides, online material, and so forth) that address the subject under discussion. As it stands, Bitcoin is still the most popular cryptocurrency in terms of user base, market value, and popularity. Though certain altcoins are supported due to their better or more sophisticated features than Bitcoin, virtual currencies like Ethereum and Ripple, which are more commonly utilized as other enterprise solutions, are currently growing in popularity. Based on the current trajectory, cryptocurrencies are here to stay, but as time goes on, only a select handful will stand out as leaders in the face of growing competition and more visibility. The world of cryptocurrency may prove to be quite promising in the future as long as the bitcoin options market continues to gain traction, even with all the drawbacks that accompany it. [ABSTRACT FROM AUTHOR]

The article explores the significance of standardized nursing terminologies (SNTs) in clinical nursing information systems. SNTs offer a shared language for nurses to describe nursing phenomena and enhance patient care. However, the adoption of SNTs in clinical practice is limited, and there is a need for greater integration into electronic health records. The implementation of effective clinical nursing information systems, like the Professional Assessment Instrument (PAI), can improve nursing documentation, communication, and patient outcomes. The article emphasizes the importance of nurses advocating for the use of SNTs to enhance care standards. Additionally, the article "Cancer" focuses on the role of nursing in cancer care, emphasizing the need for accurate and comprehensive nursing assessments to provide effective care. It highlights the development and validation of a computerized assessment form that supports nursing diagnosis in cancer care, aiming to improve assessment accuracy and efficiency. This article provides valuable insights for researchers and healthcare professionals interested in cancer nursing. [Extracted from the article]

Background Within Diagnosis Related Groups, based on service capability, efficiency, and quality safety assessment, clinical pharmacists contribute to promoting rational drug utilisation in healthcare institutions. However, a deficiency of pharmacist involvement has been observed in the total parenteral nutrition support to patients following haematopoietic cell transplantation (HCT) within DRGs.Methods This study involved 146 patients who underwent HCT at the Department of Haematology, the Second Affiliated Hospital of Dalian Medical University, spanning from January 2020 to December 2022.Results Patients were allocated equally, with 73 in the control group and 73 in the pharmacist-involved group: baseline characteristics showed no statistics significance, including age, body mass index, nutrition risk screening-2002 score, liver and kidney function, etc. Albumin levels, prealbumin levels were significantly improved after a 7-day TPN support (34.92 ± 4.24 vs 36.25 ± 3.65, P = 0.044; 251.30 ± 95.72 vs 284.73 ± 83.15, P = 0.026). The body weight was increased after a 7-day support and before discharge (58.77 ± 12.47 vs 63.82 ± 11.70, P = 0.013; 57.61 ± 11.85 vs 64.92 ± 11.71, P

Background: The adoption of C-reactive protein point-of-care tests (CRP POCTs) in hospitals varies across Europe. We aimed to understand the factors that contribute to different levels of adoption of CRP POCTs for the management of acute childhood infections in two countries. Methods: Comparative qualitative analysis of the implementation of CRP POCTs in the Netherlands and England. The study was informed by the non-adoption, abandonment, spread, scale-up, and sustainability (NASSS) framework. Data were collected through document analysis and qualitative interviews with stakeholders. Documents were identified by a scoping literature review, search of websites, and through the stakeholders. Stakeholders were sampled purposively initially, and then by snowballing. Data were analysed thematically. Results: Forty-one documents resulted from the search and 46 interviews were conducted. Most hospital healthcare workers in the Netherlands were familiar with CRP POCTs as the tests were widely used and trusted in primary care. Moreover, although diagnostics were funded through similar Diagnosis Related Group reimbursement mechanisms in both countries, the actual funding for each hospital was more constrained in England. Compared to primary care, laboratory-based CRP tests were usually available in hospitals and their use was encouraged in both countries because they were cheaper. However, CRP POCTs were perceived as useful in some hospitals of the two countries in which the laboratory could not provide CRP measures 24/7 or within a short timeframe, and/or in emergency departments where expediting patient care was important. Conclusions: CRP POCTs are more available in hospitals in the Netherlands because of the greater familiarity of Dutch healthcare workers with the tests which are widely used in primary care in their country and because there are more funding constraints in England. However, most hospitals in the Netherlands and England have not adopted CRP POCTs because the alternative CRP measurements from the hospital laboratory are available in a few hours and at a lower cost. [ABSTRACT FROM AUTHOR]

Background: Germany has the highest per capita health care spending among EU member states, but its hospitals face pressure to generate profits independently due to the government's withdrawal of investment cost coverage. The diagnosis related groups (DRG) payment system was implemented to address the cost issue, challenging hospital physicians to provide services within predefined prices and an economic target corridor to reduce costs. This study examines the extent of cost awareness among medical personnel in German hospitals and its influencing factors. Methods: We developed an online survey in which participants across all specialties in hospitals estimated the prices in euros of four common interventions and answered questions about their human capital and perceived stress on the workplace. As a measure of cost awareness, we used the probability of estimating the prices correctly within a reasonable margin. We employed logit logistic regression estimators to identify influencing factors in a sample of 86 participants. Results: The results revealed that most of the respondents were unaware of the costs of common interventions. General human capital, acquired through prior education, and job-specific human capital had no influence on cost awareness, whereas domain-specific human capital, that is, gaining economic knowledge based on self-interest, had a positive nonlinear effect on cost awareness. Furthermore, an increased stress level negatively influenced cost awareness. Conclusions: This paper is the first of its kind for the German health care sector that contributes responses to the question whether health care professionals in German hospitals have cost awareness and if not, what reasons lie behind this lack of knowledge. Our findings show that the cost awareness desired by the introduction of the DRG system has yet to be achieved by medical personnel. [ABSTRACT FROM AUTHOR]

Aimed at advancing the reform of the Paid Use of Residential Land, this study investigates the willingness to pay among farmers and its underlying factors. Based on a Logistic Regression analysis of a micro-survey of 450 pieces of data from the Sichuan Province in 2023, we evaluated the effects of three factors, namely individual, regional and cultural forces. Further, Random Forest analysis and SHAP value interpretation refined our insights into these effects. Firstly, the research reveals a significant willingness to pay, with 83.6% of sample farmers being ready to participate in the reform, and 53.1% of them preferring online payment (the funds are mostly expected to be used for village infrastructure improvements). Secondly, the study implies that Individual Force is the most impactful factor, followed by regional and cultural forces. Thirdly, the three factors show different effects on farmers' willingness to pay from different income groups, i.e., villagers with poorer infrastructure and lower clarity of homestead policy systems tend to be against the reform, whereas farmers with strong urban identity and collective pride support it. Based on these findings, efforts should be made to increase the publicity of Paid Use of Residential Land. Moreover, we should clarify the reform policies, accelerate the development of the online payment platform, use the funds for village infrastructure improvements, and advocate for care-based fee measures for disadvantaged groups. [ABSTRACT FROM AUTHOR]

Background: Persistent disparities in trauma in-hospital mortality owing to insurance status and race remain a prominent issue within healthcare. This study explores the relationships among insurance status, race, length of stay (LOS) in-hospital mortality outcomes in trauma patients at extreme risk of mortality (EROM) trauma patients. Methods: Data was retrieved from the National Inpatient Sample, focusing on high-acuity trauma patients from 2007 to 2020, aged 18–64 years. Patients were identified using specific All Patient Refined Diagnosis Related Groups codes. Emphasis was placed on those with EROM owing to their resource-intensive nature and the potential influence of insurance on outcomes. Patients aged 65 years or older were excluded owing to distinct trauma patterns, as were those diagnosed with burns or non-trauma conditions. Results: The study encompassed 70,381 trauma inpatients with EROM, representing a national estimate of 346,659. Being insured was associated with a 34% decrease in the odds of in-hospital mortality compared to being uninsured. The in-hospital mortality risk associated with insurance status varied over time, with insurance having no impact on in-hospital mortality during hospitalizations of less than 2 days (short LOS). In the overall group, Black patients showed an 8% lower risk of in-hospital mortality compared to White patients, while they experienced a 33% higher risk of in-hospital mortality during short LOS. Conclusion: Insured trauma inpatients demonstrated a significant reduction in the odds of in-hospital mortality compared to their uninsured counterparts, although this advantage was not present in the short LOS group. Black patients experienced lower in-hospital mortality rates compared to White patients, but this trend reversed in the short LOS group. These findings underscore the intricate relationships between insurance status, race, and duration of hospitalization, highlighting the need for interventions to improve patient outcomes. [ABSTRACT FROM AUTHOR]

Numerous potential socioeconomic benefits provided by ginkgo resources have been identified but these have been threatened due to insufficient conservation over recent decades. Economic compensation is essential to induce enthusiasm for conservation. This paper examines the farmers' willingness to accept ginkgo conservation compensation as well as other influencing factors based on survey data from 208 households. The results show that: first, the compensation amounts for the three different ginkgo conservation values are 820.86, 249.03, and 71.29 yuan per tree, respectively. Second, the overall compensation value is 388.17 yuan per tree with an average of 8430.83 yuan per household. Third, factors that influence the conservation compensation values are size-specific. Specifically, for large ginkgoes, a given respondent's age, gender, job, household income, the number of large ginkgoes and arable land area are the most important factors. For medium ginkgoes, the area of arable land and farmers' willingness to protect ginkgo trees are the key determining factors. By contrast, the requisite factors are different for small size ginkgo trees. A given respondent's job, the arable land area and farmers' perception of the importance of conducting conservation for local development are found to have significant impacts. These findings provide a useful base for assessing the conservation value for this endangered and valuable forest resource. Furthermore, the results also indicate that a size-based payment for farmers' ginkgo conservation behaviors can be a useful economic tool to induce and deepen the latter's conservation efforts. [ABSTRACT FROM AUTHOR]

• The Dynamic Silver Code (DSC), based on administrative data, predicts mortality of 75+ subjects visiting the Emergency Department (ED). • In a community hospital in Florence, Italy, we compared ED length of stay (LOS) before and after the DSC was fully implemented and a clinical decision tree was applied. • ED LOS decreased significantly in the post-DSC period. DSC class III (intermediate risk) represented the largest share of admissions to Geriatrics in the post-DSC period. • In patients admitted to Geriatrics, hospital LOS decreased by one day between the two study periods, with greater DRG weight and comparable mortality. • Application of the DSC seemed to ease patient flow and to reduce LOS of older patients in the ED. Older persons accessing the Emergency Department (ED) spend more time and are at increased risk of poor outcomes. The Dynamic Silver Code (DSC), based on administrative data, predicts mortality of 75+ subjects visiting the ED. To evaluate the effects of the implementation of the DSC in the ED. A pre-post comparison was conducted in the ED of a community hospital in Florence, Italy before and after the DSC was fully implemented. In the post-DSC phase, a clinical decision tree was applied: patients at low-mild risk (DSC class I and II) were assigned to Internal Medicine, those at moderate risk (class III) to Geriatrics, and those at high risk (class IV) required geriatric consultation before assignment. Outcome measures were ED length of stay (LOS) and, in patients admitted to Geriatrics, weight of the Diagnosis Related Groups (DRG), hospital LOS, and mortality. 7,270 patients were enrolled in the pre-DSC and 4,725 in the post-DSC phase. ED LOS decreased from a median of 380 [206, 958] in the pre-DSC to 318 [178, 655] min in the post-DSC period (p <0.001). Class III represented the largest share of admissions to Geriatrics in the post-DSC period (57.7 % vs. 38.3 %; p <0.001). In patients admitted to Geriatrics, hospital LOS decreased by one day (p = 0.006) between the two study periods, with greater DRG weight and comparable mortality. Application of the DSC seemed to ease patient flow and to reduce LOS of older patients in the ED and increased appropriateness of admissions to Geriatrics. [ABSTRACT FROM AUTHOR]

Objective. To analyze the epidemiological shifts in the incidence of ascending and arch aortic aneurysms (AA) treated with open surgery in the context of evolving endovascular options on a national basis. Methods. Between 1 January 2009 and 31 December 2018, 4388 cases were admitted to the hospital with either ruptured (r)AA or non-ruptured (nr)AA as the primary or secondary diagnosis. Patients were classified as having AA based on inclusion and exclusion criteria. Results. The age-standardized hospital incidence rates for treatment of nrAA were 7.8 (95% confidence interval (CI): 6.9 to 8.7) in 100,000 men and 2.9 (2.4 to 3.4) in 100,000 women and were stable over time. The overall raw in-hospital mortality rate was 2.0% and was significantly lower in males compared to women (1.6% vs. 2.8%, p = 0.015). Higher van Walraven scores (OR: 1.08 per point; 95%CI: 1.06 to 1.11; p = 0.001) and higher age (OR 1.05 per year; (95%CI: 1.02 to 1.07, p = 0.045) were significantly associated with hospital mortality. Conclusions. Endovascular surgery seems to have no influence on hospital incidence in patients treated with conventional surgery for AA in Switzerland. There was a significant reduction in in-hospital mortality in both men and women, with age and the von Walraven score being independent factors for worse outcomes. [ABSTRACT FROM AUTHOR]

This study aimed to determine total and cardiovascular-specific re-hospitalisation patterns and associated costs within 2 years of index atrial fibrillation (AF) admission in Western Australia (WA). Patients aged 25–94 years, surviving an index (first-in-period) AF hospitalisation (principal diagnosis) from 2011 to 2015 were identified from WA-linked administrative data and followed for 2 years. Person-level hospitalisation costs ($ Australian dollar) were computed using the Australian Refined Diagnosis Related Groups and presented as median with first and third quartile costs. The cohort comprised 17,080 patients, 59.0% men, mean age 69.6±13.3 (standard deviation) years, and 59.0% had a CHA 2 DS 2 -VA (one point for congestive heart failure, hypertension, diabetes mellitus, vascular disease or age 65–74 years; two points for prior stroke/transient ischaemic attack or age ≥75 years) score of 2 or more. Within 2 years, 13,776 patients (80.6%) were readmitted with median of 2 (1–4) readmissions. Among total all-cause readmissions (n=54,240), 40.1% were emergent and 36.6% were cardiovascular-related, led by AF (19.5%), coronary events (5.8%), and heart failure (4.2%). The median index AF admission cost was $3,264 ($2,899–$7,649) while cardiovascular readmission costs were higher, particularly stroke ($10,732 [$4,179–23,390]), AF ablation ($7,884 [$5,283–$8,878]), and heart failure ($6,759 [$6,081–$13,146]). Average readmission costs over 2 years per person increased by $4,746 (95% confidence interval [CI] $4,459–$5,033) per unit increase in baseline CHA 2 DS 2 -VA score. The average 2-year hospitalisation costs per patient, including index admission, was $27,820 (95% CI $27,308–$28,333) and total WA costs were $475.2 million between 2011 and 2017. Patients after index AF hospitalisation have a high risk of cardiovascular and other readmissions with considerable healthcare cost implications. Readmission costs increased progressively with baseline CHA 2 DS 2 -VA score. Better integrated management of AF and coexistent comorbidities is likely key to reducing readmissions and associated costs. [ABSTRACT FROM AUTHOR]

This study examined spending behaviors of U.S. tenants who reported delaying rent payments during federal eviction moratoria in 2020-2021, enacted in response to the Coronavirus Disease-2019 (COVID-19) pandemic. A national sample of 772 middle and low-income tenants who reported delaying rent payments because of the eviction moratoria were assessed from May 2020 to October 2020. Among tenants who delayed paying rent, most rent money was spent on groceries (11-19%), utilities (9-14%), substance use (8-10%), and debt (7%) across two time periods; the remaining rent money was spent on other expenses including recreation and medical care. Sociodemographic and psychiatric characteristics together only explained 2-3% of the variance in spending in major expense categories suggesting the broad impact of the COVID-19 pandemic. Together, these findings provide insight into spending behaviors of tenants during a time of great financial and psychological distress. [ABSTRACT FROM AUTHOR]

To assess changes in treatment modalities for supracondylar humerus fractures (SCHFs) at a large pediatric university hospital, we analyzed patient data from 2014 to 2022. A total of 233 SCHFs treated surgically at our hospital were included. To evaluate postoperative outcome and quality of life, DASH and EuroQol-5D-Y questionnaires were sent to patients. In addition to a significant fluctuation in fracture severity, we found an increase in training interventions (more surgeries were performed by trainees) and a significant decrease in surgery times after 2016. From 2020, there was a significant shift in the type of surgical method away from closed reduction with elastic stable intramedullary nailing (ESIN) and towards closed reduction and crossed K-wire osteosynthesis (CRK). Surgeries performed in the morning and evening hours increased, while those performed in the afternoon and after midnight decreased. After a mean follow-up of 4 years, there was no difference in elbow function between ESIN and open reduction and K-wires (ORK). Treatment with ESIN was equivalent to ORK in terms of function, at least in the medium-term follow-up. In summary, the combination of shifting treatment from SCHF to daytime hours, increasing trainee participation and using cross K-wire fixation instead of ESIN had no negative impact on surgery times. In our setting, these measures have reduced resource utilization and increased efficiency without compromising patient care. [ABSTRACT FROM AUTHOR]

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BackgroundThe National Health Commission and the other relevant departments in China have initiated testing of the Diagnosis Related Groups (DRGs) system in 30 pilot locations since 2019. In the process of DRG payment reform, accounting for the costs of diseases has become a highly challenging issue. The traditional method of disease accounting method overlooks the compensation for the knowledge capital value of medical personnel.ObjectiveThe primary objective of this study is to analyze the cost accounting scheme of China’s Diagnosis Related Groups (C-DRG), focusing on the value of knowledge capital.MethodsThe study initially proposes a measurement index system for the value of knowledge-based capital, including the difficulty of disease treatment, labor intensity of disease treatment, risk of disease treatment, and operation/treatment time for diseases. The Analytic Hierarchy Process (AHP) is then utilized to weigh the features of medical workers’ knowledge capital value. First, pairwise comparisons are conducted in this stage to develop a two-pair judgment matrix of the primary indicators. Second, the eigenvectors corresponding to the maximum eigenvalues of the matrix are calculated to generate the weight coefficient of each feature. The consistency test is carried out after this stage. An empirical analysis is conducted by collecting data, including the full costs of treating three types of diseases—hip replacement, acute simple appendicitis, and heart bypass surgery—from one public medical institution.ResultsThe empirical analysis examines whether this DRG costing accounting can address the issue of neglecting the value of medical workers’ knowledge capital. The methods reconfigure the positive incentive mechanism, stimulate the endogenous motivation of the medical service system, foster independent changes in medical behavior, and achieve the goals of reasonable cost control.ConclusionIn the cost accounting system of C-DRG, the value of medical workers’ knowledge capital is acknowledged. This acknowledgment not only boosts the enthusiasm and creativity of medical workers in optimizing and standardizing the diagnosis and treatment process but also improves the transparency and authenticity of DRG pricing. This is particularly evident in the optimization and standardization of the diagnosis and treatment processes within medical institutions and in monitoring inadequate medical practices within these institutions.

The article discusses the efforts of the Agency for Healthcare Research and Quality (AHRQ) to address health inequities in the United States. AHRQ has published a research and action agenda focused on advancing health equity, with a particular emphasis on five action domains: healthcare delivery system structure, payment, social determinants of health and social needs, implementation science, and access to care. The article highlights the importance of centering patients and communities in efforts to advance equity, emphasizing the need for authentic engagement and participation. It also emphasizes the importance of tailoring solutions to diverse populations, particularly those who are minoritized, and addresses the need to consider historical and present-day systems of oppression in research and interventions. The document discusses the importance of addressing structural racism and other systems of oppression in healthcare to achieve health equity. The authors emphasize the need to recognize and address racism and oppression in dissemination and implementation frameworks, as well as the need for social care and interventions to directly address these issues. The document also highlights the role of payment and financing in advancing health equity, the benefits of whole-person and whole-community approaches, and the need for evidence-based interventions across diverse contexts. Additionally, the authors stress the importance of a diverse and inclusive healthcare workforce in dismantling inequities. The document concludes by stating that the Agency for Healthcare Research and Quality (AHRQ) is committed to advancing health equity and will prioritize research and action based on the insights provided in the document. [Extracted from the article]

Canada spends less of its health budget on primary care compared to other OECD countries. To improve primary care, Canada can learn from countries like the United Kingdom, Norway, Netherlands, and Finland, where over 95% of the population has a regular primary care clinician or place of care. These countries have stronger contractual agreements and accountability for family physicians, utilize capitation or salary payment models, work in interprofessional teams, and have excellent digital tools and information systems. Canada is facing challenges such as a lack of regular primary care clinicians, declining enrollment in family medicine, and retiring family physicians. The text provides data and analysis on primary care attachment in Canada compared to nine other countries, and discusses strategies that enable high primary care attachment in comparator countries. It suggests that Canada can learn from these countries to increase primary care attachment by improving accountability, funding, system organization, information systems, practice organization, and physician payment. [Extracted from the article]