Together in Care: An Enhanced Meals on Wheels Intervention Designed to Reduce Rehospitalizations among Older Adults with Cardiopulmonary Disease—Preliminary Findings

Rehospitalizations in the Medicare population may be influenced by many diverse social factors, such as, but not limited to, access to food, social isolation, and housing safety. Rehospitalizations result in significant cost in this population, with an expected increase as Medicare enrollment grows. We designed a pilot study based upon a partnership between a hospital and a local Meals on Wheels agency to support patients following an incident hospitalization to assess impact on hospital utilization. Patients from an urban medical center who were 60 years or older, had a prior hospitalization in the past 12 months, and had a diagnosis of diabetes, hypertension, heart failure, and/or chronic obstructive pulmonary disease were recruited. Meals on Wheels provided interventions over 3 months of the patient’s transition to home: food delivery, home safety inspection, social engagement, and medical supply allocation. Primary outcome was reduction of hospital expenditure. In regard to the results, 84 participants were included in the pilot cohort, with the majority (54) having COPD. Mean age was 74.9 ± 10.5 years; 33 (39.3%) were female; 62 (73.8%) resided in extreme socioeconomically disadvantaged neighborhoods. Total hospital expenditures while the cohort was enrolled in the transition program were $435,258 ± 113,423, a decrease as compared to $1,445,637 ± 325,433 (p < 0.01) of the cohort’s cost during the three months prior to enrollment. In conclusion, the initiative for patients with advanced chronic diseases resulted in a significant reduction of hospitalization expenditures. Further investigations are necessary to define the impact of this intervention on a larger cohort of patients as well as its generalizability across diverse geographic regions.

Together In Care: An Enhanced Meals on Wheels Intervention Designed To Reduce Rehospitalizations Among Older Adults – Preliminary Findings

Rehospitalizations in the Medicare population may be influenced by many social factors, such as access to food, social isolation, and housing safety. Rehospitalizations result in significant cost in this population, with an expected increase as Medicare enrollment grows. We designed a pilot study based upon a partnership between a hospital and a local Meals on Wheels agency to support patients following an incident hospitalization to assess impact on hospital utilization. Patients from an urban medical center who were 60 years or older, had a prior hospitalization in the past 12-months and had a diagnosis of diabetes, hypertension, heart failure, and/or chronic obstructive pulmonary disease were recruited. Meals on Wheels provided interventions over 3-months of the patient’s transition to home: food delivery, home safety inspection, social engagement, and medical supply allocation. Primary outcome was reduction of hospital utilization. In regards to the results, 84 participants comprised the pilot cohort. Their mean age was 74.9 ± 10.5 years; 33 (39.3%) were female; 62 (73.8%) resided in extreme socioeconomically disadvantaged neighborhoods. Total hospital expenditures while the cohort was enrolled in the transition program were $435,258 ± 113,423, a decrease as compared to $1,445,637 ± 325,433 (p<0.01) of the cohort’s cost during the three months prior to enrollment. In conclusion, the initiative for patients with advanced chronic diseases resulted in a significant reduction of hospitalization expenditures. Further investigations are necessary to define the impact of this intervention on a larger cohort of patients as well as the generalizability across diverse geographic regions.

Geographic Variations in Stroke Inpatient Healthcare Utilization and Hospital Expenditure Equity in China

Background: Stroke is a devastating disease that imposes a heavy financial burden on patients and their families and a significant economic cost on a nation’s healthcare system. Under China’s fragmented health insurance system, it was unclear whether geographic variations in healthcare utilization and hospital expenditures lead to healthcare inequities for stroke inpatients. This study assesses the geographic variations in stroke patients’ healthcare utilization and hospital expenses and the potential geographical influencing factors. Methods: Covering all municipalities and provinces in mainland China, our main data were a 5% random sample of stroke claims from the Urban Employees Basic Medical Insurance (UEBMI) and Urban Residents Basic Medical Insurance (URBMI) schemes from 2013 to 2016, totaling 217969 inpatients and 280804 admissions. The Theil index was employed to evaluate the (in)equity in healthcare utilization and hospital expenditures across all 31 mainland Chinese provinces. Using multiple linear regression analysis, the geographic influencing factors, comprising ability to deliver healthcare, geographical accessibility of health services, healthcare-seeking and economic factors, were explored.Results: UEBMI stroke inpatients had higher hospital costs and longer ALOS, but lower OOP expenses than those with URBMI. UEBMI insurance had a lower Theil index value than the URBMI scheme. Stroke patients’ healthcare utilization and hospital expenditures showed significant differences both within and between regions. The intra-region Theil (in)equality index value was higher than the inter-region Theil index, with the Theil index highest within eastern China, China’s richest and most developed region. The ability to deliver healthcare, the enabling factors and the provincial-level economic factors had significant effects (P<0.05) on healthcare utilization and hospital expenses.Conclusions: Our data revealed significant geographic variation in healthcare utilization and hospital expenditures for stroke patients. In addition to differences in the coverage and reimbursements of the UEBMI-URBMI schemes, disparities within regions were associated with the ability to deliver healthcare (open hospital beds per 100 patients), the enabling factors (regional reimbursement rate and regional education level) and the provincial-level economic factors (GDP per capita). China’s fragmented urban health insurance schemes require further reform to ensure better equity in healthcare utilization and hospital expenses.

Ameliyathanelerde Verimliliğin Çok Ölçütlü Karar Verme Yöntemleri ile Değerlendirilmesi

Purpose: Determining the factors that affect productivity in operating rooms, which make up about one third of hospital expenditures, and developing strategies for these elements is a matter of importance for hospital managers. The fact that operating rooms are among the highest expenditure items and at the same time being among the highest sources of income has been the main factor in determining the factors affecting the efficiency of the operating room. Material and Method: Analytical network process method, which is one of the multi-criteria decision-making methods, which enables quantitative evaluation of qualitatively effective factors, was used. Results and Conclusion: In this study, the factors affecting the efficiency of operating rooms were evaluated. According to the results, it is seen that the usage of the operating room comes to the forefront at the same time and the personnel goes through the harmony with the colleagues. In addition, the accuracy of the operation times of the operations on the waiting list directly affects the effective use of the operating rooms. At this point, the cancellation rate of operations can be reduced by making effective plans with the correct estimated operation time. Thus, effective and efficient use of operating rooms can be increased.

Physiotherapeutic Resources in Fibromyalgia

Brazil has around 14 million elderly and, in a certain area of the big cities, this population already exceeds the mark of 20%. As the person ages the risk of falls increases. One in every three people above 65 years of age suffer from some type of fall at least once a year. The objective of this study was to identify the aging factor in humanity, the risk factors in falling in the elderly and consider information about the physiotherapy role in the senior patients treatment who suffer with injuries caused by falls. A bibliographic survey was held with the use of databases of the virtual library SciELO, Pubmed and Redalic from 2007 to 2017. Among the changes resulting from aging, the ones that generate postural instability are the locomotor, sensory and nervous changes, limiting the coordination and control of postural balance, called intrinsic factors. In this sense, physical therapy has been acting in the = prevention, promotion, maintenance, and rehabilitation of pathologies affecting the elderly, extending the functional independence of this group. Based on these definitions it was possible to pinpoint prospects for the health performance in the mitigation of the effects of this event, as well as reduce the high hospital expenditures of the elderly to the public health.Keywords: Physiotherapy. Aging. Accidents caused by Falls. Elderly.ResumoO Brasil tem cerca de 14 milhões de idosos e, em determinada área das grandes cidades, esta população já ultrapassa a marca dos 20%. À medida que a pessoa envelhece o risco de quedas aumenta. Uma em cada três pessoas acima de 65 anos de idade sofrem algum tipo de queda pelo menos uma vez por ano. O objetivo desse estudo foi identificar o fator de envelhecimento na humanidade, os fatores de risco na queda em idosos e considerar informações sobre o papel desempenhado da fisioterapia no tratamento de pacientes sênior que sofrem com lesões causadas por quedas. Realizou-se um levantamento bibliográfico com a utilização dos bancos de dados da biblioteca virtual SciELO, Pubmed e Redalic de 2007 a 2017. Dentre as alterações decorrentes do envelhecimento, as que mais geram instabilidade postural são as alterações no aparelho locomotor, sensorial e nervoso, limitando a coordenação e o controle do equilíbrio postural, chamados de fatores intrínsecos. Nesse sentido, a fisioterapia vem atuando na prevenção, promoção, manutenção e reabilitação de patologias que acometem o idoso, prolongando a independência funcional deste grupo. Com base nessas definições foi possível apontar perspectivas para a atuação da saúde na mitigação dos efeitos deste evento, bem como reduzir o alto gasto hospitalar destes idosos para a saúde pública.Palavras-chave: Fisioterapia. Envelhecimento. Acidente por Quedas. Idoso.

Impacts of Hospital Payment based on Diagnosis Related Groups (DRGs) with Global Budget on Resource Use and Quality of Care: A Case Study in China

Background: China has implemented numerous pilots to shift its hospital payment mechanism from the traditional retrospective cost-based system to prospective diagnosis-related-group (DRG) -based system. This study investigated the impact of the DRG payment reform with global budget in Zhongshan, China. Methods: A total of 2895 patients diagnosed with acute myocardial infarction (AMI) were selected from local two largest tertiary hospitals, among which 727 were discharged prior to the payment reform and 2168 afterwards. Difference-in-difference (DID) regression models were used to evaluate the policy effects on patients’ percutaneous coronary intervention (PCI) use, hospital expenditures, in-hospital mortality, and readmission rates within 30 days after discharge. Results: Patients’ PCI use and hospital expenditures increased quickly after the payment reform. With patients with no local insurance scheme as reference, PCI use for local insured patients decreased significantly by 4.55 percent (95 percent confidence interval [CI]: 0.23, 0.72), meanwhile the total hospital expenses decreased significantly by US$986.10 (b=-0.15, P=0.0037) after reform. No changes were observed with patients’ hospital mortality and readmission rates in our study. Conclusion: The innovative DRG-based payment reform in Zhongshan suggested a positive effect on AMI patient’s cost containment but negative effect on encouraging resource use. It had no impacts on patients’ care quality. Cost shifting consequence from the insured to the uninsured was observed. More evidence of the impacts of the DRG-based payment in China’s health scenario is needed before it is generalized nationwide