BACKGROUND Several studies have demonstrated that the coronavirus disease 2019(COVID-19)has affected daily living and the healthcare system.No previous study has described the consequences of COVID-19 on emergency dep...BACKGROUND Several studies have demonstrated that the coronavirus disease 2019(COVID-19)has affected daily living and the healthcare system.No previous study has described the consequences of COVID-19 on emergency department(ED)visits and hospital admission among kidney transplant(KT)recipients.AIM To investigate the impact of the COVID-19 pandemic on ED visits and hospital admissions within 1 year in patients who underwent KT in Thailand.METHODS We conducted a retrospective study at a university hospital in Thailand.We reviewed the hospital records of KT patients who visited the ED during the outbreak of COVID-19(from January 2020 to December 2021).We used the previous 2 years as the control period in the analysis.We obtained baseline demographics and ED visit characteristics for each KT patient.The outcomes of interest were ED visits and ED visits leading to hospital admission within the 1^(st)year following a KT.The rate of ED visits and ED visits leading to hospital admissions between the two periods were compared using the stratified Cox proportional hazards model.RESULTS A total of 263 patients were included in this study:112 during the COVID-19 period and 151 during the control period.There were 34 and 41 ED visits after KT in the COVID-19 and control periods,respectively.The rate of first ED visit at 1 year was not significantly different in the COVID-19 period,compared with the control period[hazard ratio(HR)=1.02,95%confidence interval(CI):0.54-1.92;P=0.96].The hospital admission rate was similar between periods(HR=0.92,95%CI:0.50-1.69;P=0.78).CONCLUSION ED visits and hospital admissions within the 1st year in KT recipients were not affected by the COVID-19 pandemic.Despite these findings,we believe that communication between post-KT patients and healthcare providers is essential to highlight the importance of prompt ED visits for acute health conditions,particularly in post-KT patients.展开更多
The implementation of value based purchasing will bring major changes to the delivery of health care in the United States. This effort is being led by the Medicare Access and CHIP Reauthorization Act (MACRA). Medicaid...The implementation of value based purchasing will bring major changes to the delivery of health care in the United States. This effort is being led by the Medicare Access and CHIP Reauthorization Act (MACRA). Medicaid and private insurance plans are developing similar programs. These programs reflect a change in pay or incentives in the direction of primary and ambulatory care at the community level. This study described the use of nursing case management as a tool for monitoring and coordinating the impact of value based programs at the community level. It suggested that, under these programs, nursing case management can contribute to reduction of hospital admissions/discharges, emergency department visits, and hospital readmissions. This can be accomplished through monitoring of utilization levels for these indicators. These are major objectives of MACRA and related programs. The study also suggested that nursing case management can contribute to the development of new programs, such as Complex Care, as a means of reaching these objectives. The study included estimates of the costs and benefits of using case management to reduce hospital admissions for low severity of illness patients at the community level. It suggested that the service can provide important opportunities for health planning and development in this area.展开更多
Background The new medical insurance policy （JRSYF（2010） No.255） was released by the Beijing Municipal Government and became effective on January 1,2011.Medical expenses incurred during a stay in an emergency depa...Background The new medical insurance policy （JRSYF（2010） No.255） was released by the Beijing Municipal Government and became effective on January 1,2011.Medical expenses incurred during a stay in an emergency department （ED） observation unit can be reimbursed as a hospital admission.The aim of this study was to evaluate the impact of a new charging scheme during stays in ED observation unit under Beijing＇s Basic Medical Insurance.Methods Data for those patients who had stayed in ED observation unit in 2010 （before the implementation of a new charging scheme） and 2012 （after the implementation of this policy） were retrospectively analyzed in terms of length of stay,patients who were observed （PO）,and median medical costs.Results After the implementation of a new charging scheme,compared with the year of 2010,in year of 2012,there were statistically significant longer lengths of stay at the observation unit （6 （4-9） vs.5 （4-7） days; P〈0.001）,more PO （2 257vs.1 783; P〈0.001）,and more median medical costs （RMB 6 026 vs.3 650 Yuan; P〈0.01）.The proportion of elderly patients （≥60 years of age） in 2012 was larger than that in 2010 （70.22% vs.63.71%; P〈0.01）.It was performed on those patients who were admired after the implementation of a new charging scheme.Compared with patients who were not admired had stayed in ED observation units,the patients who were admired had stayed in ED observation units that had a higher proportion for 〉15 days （36.22% vs.5.61%; P〈0.01）; they had higher median medical costs RMB （9 186 vs.5 668Yuan; P〈0.001） and they were more elderly （≥60 years of age） （86.10% vs.66.39%; P〈0.01）.Conclusions The new charging scheme under Beijing＇s Basic Medical Insurance allows patients to get access to inpatient admission more easily.It lowers patients＇ financial burden in ED observation unit.Since more people stay at ED observation unit,it increases ED payments by the insurance system.However,it slows the turnover rate of ED observation unit and causes overcrowding in ED.Hence,the advantages and disadvantages of the new policy are obvious.展开更多
文摘BACKGROUND Several studies have demonstrated that the coronavirus disease 2019(COVID-19)has affected daily living and the healthcare system.No previous study has described the consequences of COVID-19 on emergency department(ED)visits and hospital admission among kidney transplant(KT)recipients.AIM To investigate the impact of the COVID-19 pandemic on ED visits and hospital admissions within 1 year in patients who underwent KT in Thailand.METHODS We conducted a retrospective study at a university hospital in Thailand.We reviewed the hospital records of KT patients who visited the ED during the outbreak of COVID-19(from January 2020 to December 2021).We used the previous 2 years as the control period in the analysis.We obtained baseline demographics and ED visit characteristics for each KT patient.The outcomes of interest were ED visits and ED visits leading to hospital admission within the 1^(st)year following a KT.The rate of ED visits and ED visits leading to hospital admissions between the two periods were compared using the stratified Cox proportional hazards model.RESULTS A total of 263 patients were included in this study:112 during the COVID-19 period and 151 during the control period.There were 34 and 41 ED visits after KT in the COVID-19 and control periods,respectively.The rate of first ED visit at 1 year was not significantly different in the COVID-19 period,compared with the control period[hazard ratio(HR)=1.02,95%confidence interval(CI):0.54-1.92;P=0.96].The hospital admission rate was similar between periods(HR=0.92,95%CI:0.50-1.69;P=0.78).CONCLUSION ED visits and hospital admissions within the 1st year in KT recipients were not affected by the COVID-19 pandemic.Despite these findings,we believe that communication between post-KT patients and healthcare providers is essential to highlight the importance of prompt ED visits for acute health conditions,particularly in post-KT patients.
文摘The implementation of value based purchasing will bring major changes to the delivery of health care in the United States. This effort is being led by the Medicare Access and CHIP Reauthorization Act (MACRA). Medicaid and private insurance plans are developing similar programs. These programs reflect a change in pay or incentives in the direction of primary and ambulatory care at the community level. This study described the use of nursing case management as a tool for monitoring and coordinating the impact of value based programs at the community level. It suggested that, under these programs, nursing case management can contribute to reduction of hospital admissions/discharges, emergency department visits, and hospital readmissions. This can be accomplished through monitoring of utilization levels for these indicators. These are major objectives of MACRA and related programs. The study also suggested that nursing case management can contribute to the development of new programs, such as Complex Care, as a means of reaching these objectives. The study included estimates of the costs and benefits of using case management to reduce hospital admissions for low severity of illness patients at the community level. It suggested that the service can provide important opportunities for health planning and development in this area.
文摘Background The new medical insurance policy （JRSYF（2010） No.255） was released by the Beijing Municipal Government and became effective on January 1,2011.Medical expenses incurred during a stay in an emergency department （ED） observation unit can be reimbursed as a hospital admission.The aim of this study was to evaluate the impact of a new charging scheme during stays in ED observation unit under Beijing＇s Basic Medical Insurance.Methods Data for those patients who had stayed in ED observation unit in 2010 （before the implementation of a new charging scheme） and 2012 （after the implementation of this policy） were retrospectively analyzed in terms of length of stay,patients who were observed （PO）,and median medical costs.Results After the implementation of a new charging scheme,compared with the year of 2010,in year of 2012,there were statistically significant longer lengths of stay at the observation unit （6 （4-9） vs.5 （4-7） days; P〈0.001）,more PO （2 257vs.1 783; P〈0.001）,and more median medical costs （RMB 6 026 vs.3 650 Yuan; P〈0.01）.The proportion of elderly patients （≥60 years of age） in 2012 was larger than that in 2010 （70.22% vs.63.71%; P〈0.01）.It was performed on those patients who were admired after the implementation of a new charging scheme.Compared with patients who were not admired had stayed in ED observation units,the patients who were admired had stayed in ED observation units that had a higher proportion for 〉15 days （36.22% vs.5.61%; P〈0.01）; they had higher median medical costs RMB （9 186 vs.5 668Yuan; P〈0.001） and they were more elderly （≥60 years of age） （86.10% vs.66.39%; P〈0.01）.Conclusions The new charging scheme under Beijing＇s Basic Medical Insurance allows patients to get access to inpatient admission more easily.It lowers patients＇ financial burden in ED observation unit.Since more people stay at ED observation unit,it increases ED payments by the insurance system.However,it slows the turnover rate of ED observation unit and causes overcrowding in ED.Hence,the advantages and disadvantages of the new policy are obvious.
