Objectives:The objectives of this study were to assess the knowledge and practice skills on home-based urinary catheter care among parents of under-five children with urinary catheter.Materials and Methods:This cross-...Objectives:The objectives of this study were to assess the knowledge and practice skills on home-based urinary catheter care among parents of under-five children with urinary catheter.Materials and Methods:This cross-sectional study was conducted from June 1,2021,to September 11,2021,in a tertiary hospital in north India.Purposive sampling was used to select 50 participants.Three instruments were employed for data collection after fulfilling sample criteria;for baseline information demographic tool,knowledge questionnaires,and a practice checklist.Data were analyzed using descriptive and inferential statistics.Results:On assessment of 50 participants,the majority of parents aged above 30 years(74%).Most of the participants were male(82%),graduated(38%),and working in the private sector(58%).Similarly,two-thirds of participants were residing in a nuclear family(64%)with a single child 32(64%)and family income<5000 rupees per month(60%).The mean score of knowledge was 1.94±0.81 and that of practice skills was 1.98±0.85 on home-based care.Regression analysis showed that knowledge of parents was significantly associated with qualification(β:1.821,P=0.002).Similarly,association of practice skills of parents with gender(β:1.235,P=0.050)and qualification(β:1.889,P=0.00)was significant.Conclusion:The general findings of our study showed that parents’education and occupation played a significant role in a child’s care.Parental education and catheter care skills positively affect the child and reduce readmission rates.展开更多
In recent years,under the influence of multiple factors such as traditional ideas and living economic conditions,the aging population in China continues to increase.Most of the elderly are more inclined to aged at hom...In recent years,under the influence of multiple factors such as traditional ideas and living economic conditions,the aging population in China continues to increase.Most of the elderly are more inclined to aged at home,and the first places for elderly activities are communities and the surrounding environment,which greatly affects the convenience of life and happiness of the elderly.In this paper,Changxindian area in Fengtai District of Beijing was as the research object,and detailed calculation and analysis were carried out by using POI data and arcGIS software.The relative location of residential areas and surrounding public toilets was explored,and the best location of public toilets in the daily walking area under the model of community home-based care for the elderly was further studied.展开更多
With the development of urbanization,the problem of neurological diseases brought about by population aging has gradually become a social problem of worldwide concern.Aging leads to gradual degeneration of the central...With the development of urbanization,the problem of neurological diseases brought about by population aging has gradually become a social problem of worldwide concern.Aging leads to gradual degeneration of the central nervous system,shrinkage of brain tissue,and decline in physical function in many elderlies,making them susceptible to neurological diseases such as Alzheimer’s disease(AD),stroke,Parkinson’s and major depressive disorder(MDD).Due to the influence of these neurological diseases,the elderly have troubles such as memory loss,inability to move,falling,and getting lost,which seriously affect their quality of life.Tracking and positioning of elderly with neurological diseases and keeping track of their location in real-time are necessary and crucial in order to detect and treat dangerous and unexpected situations in time.Considering that the elderly with neurological diseases forget to wear a positioning device or have mobility problems due to carrying a positioning device,device-free positioning as a passive positioning technology that detects device-free individuals is more suitable than traditional active positioning for the home-based care of the elderly with neurological diseases.This paper provides an extensive and in-depth survey of device-free indoor positioning technology for home-based care and an in-depth analysis of the main features of current positioning systems,as well as the techniques,technologies andmethods they employ,fromthe perspective of the needs of the elderly with neurological conditions.Moreover,evaluation criteria and possible solutions of positioning techniques for the home-based care of the elderly with neurological conditions are proposed.Finally,the opportunities and challenges for the development of indoor positioning technology in 6G mobile networks for home-based care of the elderly with neurological diseases are discussed.This review has provided comprehensive and effective tracking and positioning techniques,technologies and methods for the elderly,by which we can obtain the location information of the elderly in real-time and make home-based care more comfortable and safer for the elderly with neurological diseases.展开更多
Objective To determine the impact of smoking on disease-specific health care utilization and medical costs in patients with chronic non-communicable diseases(NCDs).Methods Participants were middle-aged and elderly adu...Objective To determine the impact of smoking on disease-specific health care utilization and medical costs in patients with chronic non-communicable diseases(NCDs).Methods Participants were middle-aged and elderly adults with chronic NCDs from a prospective cohort in China.Logistic regressions and linear models were used to assess the relationship between tobacco smoking,health care utilization and medical costs.Results Totally,1020 patients with chronic obstructive pulmonary disease(COPD),3144 patients with coronary heart disease(CHD),and 1405 patients with diabetes were included in the analysis.Among patients with COPD,current smokers(β:0.030,95%CI:−0.032-0.092)and former smokers(β:0.072,95%CI:0.014-0.131)had 3.0%and 7.2%higher total medical costs than never smokers.Medical costs of patients who had smoked for 21-40 years(β:0.028,95%CI:−0.038-0.094)and≥41 years(β:0.053,95%CI:−0.004β0.110)were higher than those of never smokers.Patients who smoked≥21 cigarettes(β:0.145,95%CI:0.051-0.239)per day had more inpatient visits than never smokers.The association between smoking and health care utilization and medical costs in people with CHD group was similar to that in people with COPD;however,there were no significant associations in people with diabetes.Conclusion This study reveals that the impact of smoking on health care utilization and medical costs varies among patients with COPD,CHD,and diabetes.Tobacco control might be more effective at reducing the burden of disease for patients with COPD and CHD than for patients with diabetes.展开更多
Discharging patients directly to home from the intensive care unit(ICU)is becoming a new trend.This review examines the feasibility,benefits,challenges,and considerations of directly discharging ICU patients.By analyz...Discharging patients directly to home from the intensive care unit(ICU)is becoming a new trend.This review examines the feasibility,benefits,challenges,and considerations of directly discharging ICU patients.By analyzing available evidence and healthcare professionals'experiences,the review explores the potential impacts on patient outcomes and healthcare systems.The practice of direct discharge from the ICU presents both opportunities and complexities.While it can potentially reduce costs,enhance patient comfort,and mitigate complications linked to extended hospitalization,it necessitates meticulous patient selection and robust post-discharge support mechanisms.Implementing this strategy successfully mandates the availability of home-based care services and a careful assessment of the patient's readiness for the transition.Through critical evaluation of existing literature,this review underscores the significance of tailored patient selection criteria and comprehensive post-discharge support systems to ensure patient safety and optimal recovery.The insights provided contribute evidence-based recommendations for refining the direct discharge approach,fostering improved patient outcomes,heightened satisfaction,and streamlined healthcare processes.Ultimately,the review seeks to balance patientcentered care and effective resource utilization within ICU discharge strategies.展开更多
BACKGROUND Data from the World Health Organization’s International Agency for Research on Cancer reported that China had the highest prevalence of cancer and cancer deaths in 2022.Liver and pancreatic cancers account...BACKGROUND Data from the World Health Organization’s International Agency for Research on Cancer reported that China had the highest prevalence of cancer and cancer deaths in 2022.Liver and pancreatic cancers accounted for the highest number of new cases.Real-world data(RWD)is now widely preferred to traditional clinical trials in various fields of medicine and healthcare,as the traditional research approach often involves highly selected populations and interventions and controls that are strictly regulated.Additionally,research results from the RWD match global reality better than those from traditional clinical trials.AIM To analyze the cost disparity between surgical treatments for liver and pancreatic cancer under various factors.METHODS This study analyzed RWD 1137 cases within the HB1 group(patients who underwent pancreatectomy,hepatectomy,and/or shunt surgery)in 2023.It distinguished different expenditure categories,including medical,nursing,technical,management,drug,and consumable costs.Additionally,it assessed the contribution of each expenditure category to total hospital costs and performed cross-group comparisons using the non-parametric Kruskal–Wallis test.This study used the Steel–Dwass test for post-hoc multiple comparisons and the Spearman correlation coefficient to examine the relationships between variables.RESULTS The study found that in HB11 and HB13,the total hospitalization costs were significantly higher for pancreaticoduodenectomy than for pancreatectomy and hepatectomy.Although no significant difference was observed in the length of hospital stay between patients who underwent pancreaticoduodenectomy and pancreatectomy,both were significantly longer than those who underwent liver resection.In HB15,no significant difference was observed in the total cost of hospitalization between pancreaticoduodenectomy and pancreatectomy;however,both were significantly higher than those in hepatectomy.Additionally,the length of hospital stay was significantly longer for patients who underwent pancreaticoduodenectomy than for those who underwent pancreatectomy or liver resection.CONCLUSION China Healthcare Security Diagnosis Related Groups payment system positively impacts liver and pancreatic cancer surgeries by improving medical quality and controlling costs.Further research could refine this grouping system and ensure continuous effectiveness and sustainability.展开更多
The sustainability of the healthcare system has been in question for several years. With rising healthcare costs, limited resources and an aging population, society needs to come up with innovative ideas to reduce hea...The sustainability of the healthcare system has been in question for several years. With rising healthcare costs, limited resources and an aging population, society needs to come up with innovative ideas to reduce healthcare spending. This paper attempts to illustrate how addressing goals of care can have a significant impact on healthcare costs.展开更多
The financial crisis has caused a severe limitation of resources for the public health service and rehabilitation. The proposal of integrated diagnosis and treatment in rehabilitation, involving the introduction of ne...The financial crisis has caused a severe limitation of resources for the public health service and rehabilitation. The proposal of integrated diagnosis and treatment in rehabilitation, involving the introduction of new therapeutic models alongside orthodox models, could lead to a reduction in health care costs through better patient compliance. In rehabilitative assistance in health care, the limiting of financial resources can be simplified, given its multifaceted nature and the need to integrate clinical experience with research. In addition, the phases of rehabilitative recovery do not focus on organ damage, but improved participation and the reduction of disability. For this reason, we have considered incorporating narrative based medicine (NBM) and Psycho-Neuro-Immuno-Endocrinology (PNEI) in the rehabilitation process through an empathetic approach, taking evidence based medicine (EBM) into account, thus creating a “framework” of reference. Managing patients through this “framework” would be a move towards an integrated model of care that could lead to a reduction in health care costs, given the aging population and the rise in patients with chronic pain. The decision to modify health care in rehabilitative assistance through a new “framework” will require time, organizational capacity and experimentation, but may represent the appropriate response for an improved quality of life for patients and a better allocation of resources.展开更多
Developments in health care in the United States are changing the delivery of services for providers and payors. This study focused on inpatient hospital discharges in the Syracuse hospitals and other services. It dem...Developments in health care in the United States are changing the delivery of services for providers and payors. This study focused on inpatient hospital discharges in the Syracuse hospitals and other services. It demonstrated that, during the past five years, numbers of inpatient adult medicine discharges had increased while adult surgery discharges had declined. This information suggested that adult medicine discharges could be expected to increase and approach levels of five years ago. It also suggested adult surgery discharges could be expected to remain at previous levels or decline. This information indicated that the combined emergency department visits declined from 238,000 to 202,000 between 2019 and 2020, then increased from 218,000 to 228,000 visits between 2021 and 2023. These developments will probably result in greater efficiency at the community level. With a decline in numbers of inpatient beds, providers will be able to focus on the more efficient management by reducing numbers of staff as well as fewer pharmaceuticals and testing.展开更多
Objective:To develop a home-based care plan for the elderly person with chronic diseases based on the status of their home-based care needs and relevant literature.Methods:The clinical data consisted of 132 patients w...Objective:To develop a home-based care plan for the elderly person with chronic diseases based on the status of their home-based care needs and relevant literature.Methods:The clinical data consisted of 132 patients who were 60-year-old or older with chronic diseases from June 2019 to May 2020 were selected and categorized into control and treatment groups of 66 patients each.For the experimental group,a care team for chronically ill elderly receiving regular post-treatment bome-based care.Meanwhile,a general clinical care team for chronically ill elderly receiving regular treatment for the control group.The effectiveness of these two healthcare models was evaluated and analyzed.Results:Results showed that satisfaction and effectiveness of home-based care among the elderly with chronic diseases were statistically better(P<0.05)than those in the usual care group.Conclusion:Providing home-based care services to elderly patients with chronic illnesses helps them to improve their chronic disease condition,patients are more receptive to home care,and patients have higher rates of recovery and treatment satisfaction.展开更多
Utilization management plays a crucial role in healthcare by optimizing resource allocation,improving patient outcomes,and effectively controlling costs.By balancing patient needs with economic considerations,healthca...Utilization management plays a crucial role in healthcare by optimizing resource allocation,improving patient outcomes,and effectively controlling costs.By balancing patient needs with economic considerations,healthcare institutions can ensure efficient and sustainable service delivery.Utilization management encompasses various strategies,including prior authorization,concurrent review,and clinical pathways,to enhance care quality,manage expenses,and streamline resource use.The benefits of utilization management include cost containment,improved care standards,and the implementation of consistent treatment guidelines,thereby increasing the overall efficiency and effectiveness of healthcare delivery.展开更多
Objective:To systematically evaluate the willingness rate of the community to provide for the aged at home and analyze its influencing factors.Methods:By searching the CNKI,VIP,Wanfang,we collected literature on the w...Objective:To systematically evaluate the willingness rate of the community to provide for the aged at home and analyze its influencing factors.Methods:By searching the CNKI,VIP,Wanfang,we collected literature on the willingness of the elderly in the community to provide for the aged from 2011 to 2021,extracted the data,and evaluated the quality of the included literature.Then,CMA 2.0 software was used for Meta-analysis.Results:A total of 13 articles were included in this study,and 16,402 people over 60 years old were surveyed,1782 people were willing to provide for the aged at home in the community,with a total willingness rate of 11%(95%CI:9%to 26%).The results of subgroup analysis showed that there was a statistically significant difference in the community home care willingness rate of elderly people with different gender,education levels,marital status,monthly income,living alone,the number of children,and residence(P<0.05).There was not any statistically significant difference in the willingness rate of the elderly with different ages,chronic diseases,self-care ability,and loneliness(P>0.05).Conclusion:The overall willingness rate of the elderly in the community of the elderly is relatively low in China.Gender,education level,marital status,monthly income,living alone,number of children,and residence are factors affecting the prediction of community elderly will.展开更多
Background: Considering the importance of getting the right patient at the right location to maintain and optimize quality of life of inflammatory arthritis patients, appropriate referral by general practitioners is e...Background: Considering the importance of getting the right patient at the right location to maintain and optimize quality of life of inflammatory arthritis patients, appropriate referral by general practitioners is essential. This study aims to assess the effect and cost effectiveness of different referral strategies for inflammatory arthritis in primary care patients. Methods: This study follows a cluster randomized controlled trial design. General practitioners from primary care centers in Southwest-The Netherlands are randomly assigned to either one of the two strategic interventions for referring adult patients who are in the opinion of the general practitioner suspected of inflammatory arthritis: 1) Standardized digital referral algorithm based on existing referral models PEST, CaFaSpA and CARE;2) Triage by a rheumatologist in the local primary care center. These interventions will be compared to a control group, e.g. usual care. The primary outcome is the percentage of patients diagnosed with inflammatory arthritis by the rheumatologist. Secondary outcomes are quality of life as a patient reported outcome, work participation and healthcare costs. These data, including demographic and clinical parameters, are prospectively collected at baseline, three, six, and twelve months. Discussion: If this study can demonstrate improvements in appropriate referrals to the rheumatologist, thereby improving cost-effectiveness, there is sufficient supporting evidence to implement one of the referral strategies as a standard of care. Finally, with these optimization strategies a higher quality of care can be achieved, that might be of value for all patients with arthralgia. Trial Registration: NCT03454438, date of registration: March 5, 2018. Retrospectively registered: https://clinicaltrials.gov/ct2/show/NCT03454438?term=NCT03454438&draw=1&rank=1.展开更多
AIM To study the impact of hospital-acquired infections(HAIs) on cost and outcome from intensive care units(ICU) in India. METHODS Adult patients(> 18 years) admitted over 1-year, to a 24-bed medical critical care ...AIM To study the impact of hospital-acquired infections(HAIs) on cost and outcome from intensive care units(ICU) in India. METHODS Adult patients(> 18 years) admitted over 1-year, to a 24-bed medical critical care unit in India, were enrolled prospectively. Treatment cost and outcome data were collected. This cost data was merged with HAI data collected prospectively by the Hospital Infection Control Committee. Only infections occurring during ICU stay were included. The impact of HAI on treatment cost and mortality was assessed. RESULTS The mean(± SD) age of the cohort(n = 499) was42.3 ± 16.5 years. Acute physiology and chronic health evaluation-Ⅱ score was 13.9(95%CI: 13.3-14.5); 86% were ventilated. ICU and hospital length of stay were 7.8 ± 5.5 and 13.9 ± 10 d respectively. Hospital mortality was 27.9%. During ICU stay, 76(15.3%) patients developed an infection(ventilator-associated pneumonia 50; bloodstream infection 35; urinary tract infections 3), translating to 19.7 infections/1000 ICU days. When compared with those who did not develop an infection, an infection occurring during ICU stay was associated with significantly higher treatment cost [median(inter-quartile range, IQR) INR 92893(USD 1523)(IQR 57168-140286) vs INR 180469(USD 2958)(IQR 140030-237525); P < 0.001 and longer duration of ICU(6.7 ± 4.5 d vs 13.4 ± 7.0 d; P < 0.01) and hospital stay(12.4 ± 8.2 d vs 21.8 ± 13.9 d; P < 0.001)]. However ICU acquired infections did not impact hospital mortality(31.6% vs 27.2%; P = 0.49).CONCLUSION An infection acquired during ICU stay was associated with doubling of treatment cost and prolonged hospitalization but did not significantly increase mortality.展开更多
BACKGROUND Postpartum depression is a common mental illness in puerpera,with an incidence of approximately 3.5%-33.0%abroad,and the incidence of postpartum depression in China is higher than the international level,re...BACKGROUND Postpartum depression is a common mental illness in puerpera,with an incidence of approximately 3.5%-33.0%abroad,and the incidence of postpartum depression in China is higher than the international level,reaching 10.0%-38.0%.Providing effective nursing care in clinical nursing activities is one of the key points of obstetrical care.However,little research has been designed to investigate the positive role of home-based nursing in the prevention of postpartum depression.AIM To study the effect of home-based nursing for postpartum depression patients on their quality of life and depression.METHODS The clinical data of 92 patients with postpartum depression treated at our hospital were retrospectively analyzed.The patients were grouped according to the nursing methods used;40 patients receiving basic nursing were included in a basic nursing group,and 52 receiving home-based nursing were included in a home-based nursing group.Depression and anxiety were evaluated and compared between the two groups.The estradiol(E2),serotonin(5-hydroxytryptamine,5-HT),and progesterone(PRGE)levels were measured.RESULTS The SAS and SDS scores of the home-based nursing group were significantly lower than those of the basic nursing group(P<0.05).The E2 and 5-HT levels of the home-based nursing group were significantly higher than those of the basic nursing group,but the PRGE level was significantly lower than that of the basic nursing group.The GQOLI-74 scores(material,social,somatic,and psychological)and nursing satisfaction were significantly higher in the home-based nursing group(P<0.05).CONCLUSION Postpartum depression through home-based nursing can effectively alleviate depression and improve the quality of life of patients,help modulate their serum E2,5-HT,and PRGE levels,and improve their satisfaction with nursing care.展开更多
AIM: To define the cost-effectiveness of strategies, including endoscopy and immunosuppression, to prevent endoscopic recurrence of Crohn’s disease following intestinal resection.METHODS: In the  ...AIM: To define the cost-effectiveness of strategies, including endoscopy and immunosuppression, to prevent endoscopic recurrence of Crohn’s disease following intestinal resection.METHODS: In the “POCER” study patients undergoing intestinal resection were treated with post-operative drug therapy. Two thirds were randomized to active care (6 mo colonoscopy and drug intensification for endoscopic recurrence) and one third to drug therapy without early endoscopy. Colonoscopy at 18 mo and faecal calprotectin (FC) measurement were used to assess disease recurrence. Administrative data, chart review and patient questionnaires were collected prospectively over 18 mo.RESULTS: Sixty patients (active care n = 43, standard care n = 17) were included from one health service. Median total health care cost was $6440 per patient. Active care cost $4824 more than standard care over 18 mo. Medication accounted for 78% of total cost, of which 90% was for adalimumab. Median health care cost was higher for those with endoscopic recurrence compared to those in remission [$26347 (IQR 25045-27485) vs $2729 (IQR 1182-5215), P < 0.001]. FC to select patients for colonoscopy could reduce cost by $1010 per patient over 18 mo. Active care was associated with 18% decreased endoscopic recurrence, costing $861 for each recurrence prevented.CONCLUSION: Post-operative management strategies are associated with high cost, primarily medication related. Calprotectin use reduces costs. The long term cost-benefit of these strategies remains to be evaluated.展开更多
AIM: To calculate cost effectiveness of the treatment of critically ill patients in a medical intensive care unit(ICU) of a middle income country with limited access to ICU resources. METHODS: A prospective cohort stu...AIM: To calculate cost effectiveness of the treatment of critically ill patients in a medical intensive care unit(ICU) of a middle income country with limited access to ICU resources. METHODS: A prospective cohort study and economic evaluation of consecutive patients treated in a recently established medical ICU in Sarajevo, Bosnia and Herzegovina. A cost utility analysis of the intensive care of critically ill patients compared to the hospital ward treatment from the perspective of the health care system was subsequently performed. Incremental cost effectiveness was calculated using estimates of ICU vs non-ICU treatment effectiveness based on a formal systematic review of published studies. Decision analytic modeling was used to compare treatment alternatives. Sensitivity analyses of the key model parameters were performed.RESULTS: Out of 148 patients, seventy patients(47.2%) survived to one year after critical illness with a median quality of life index 0.64 [interquartile range(IQR)0.49-0.76]. Median number of life years gained per patient was 30(IQR 16-40) or 18 quality adjusted life years(QALYs)(IQR 7-28). The cost of treatment of critically ill patients varied between 1820 dollar and20109 dollar per hospital survivor and between 100 dollar and 2514 dollar per QALY saved. Mean factors that influenced costs were: Age, diagnostic category,ICU and hospital length of stay and number and type of diagnostic and therapeutic interventions. The incremental cost effectiveness ratio for ICU treatment was estimated at 3254 dollar per QALY corresponding to35% of per capita GDP or a Very Cost Effective category according to World Health Organization criteria.CONCLUSION: The ICU treatment of critically ill medica patients in a resource poor country is cost effective and compares favorably with other medical interventions.Public health authorities in low and middle income countries should encourage development of critical care services.展开更多
Multidisciplinary community coordinated care programs are widely adopted to optimise care of chronic disease patients, but there is a need for further evaluation in the setting of COPD. This observational study evalua...Multidisciplinary community coordinated care programs are widely adopted to optimise care of chronic disease patients, but there is a need for further evaluation in the setting of COPD. This observational study evaluated 147 patients with severe or very severe COPD who were enrolled in a multidisciplinary community respiratory coordinated care program (RCCP) from 2007 to 2012. Comparison was made of hospitalisation rates and length of stay for 12 months prior to joining the program, and the first 12 months after joining the program. This data was used to inform a cost analysis. Enrolment into RCCP halved the annual hospital admission rate from 1.18 to 0.57 admissions per year (relative risk reduction 51.4%, p < 0.001), and annual total length of stay was reduced from 8.06 to 3.59 days per patient per year (p < 0.001). Hospital admissions were reduced from 5.05 days to 2.00 days (p < 0.001). Accounting for the program’s costs, these changes resulted in a $US 906.94 ($AUD 972.80) cost saving per patient per year. A RCCP program can reduce patient hospitalisation and overall costs in the COPD setting.展开更多
文摘Objectives:The objectives of this study were to assess the knowledge and practice skills on home-based urinary catheter care among parents of under-five children with urinary catheter.Materials and Methods:This cross-sectional study was conducted from June 1,2021,to September 11,2021,in a tertiary hospital in north India.Purposive sampling was used to select 50 participants.Three instruments were employed for data collection after fulfilling sample criteria;for baseline information demographic tool,knowledge questionnaires,and a practice checklist.Data were analyzed using descriptive and inferential statistics.Results:On assessment of 50 participants,the majority of parents aged above 30 years(74%).Most of the participants were male(82%),graduated(38%),and working in the private sector(58%).Similarly,two-thirds of participants were residing in a nuclear family(64%)with a single child 32(64%)and family income<5000 rupees per month(60%).The mean score of knowledge was 1.94±0.81 and that of practice skills was 1.98±0.85 on home-based care.Regression analysis showed that knowledge of parents was significantly associated with qualification(β:1.821,P=0.002).Similarly,association of practice skills of parents with gender(β:1.235,P=0.050)and qualification(β:1.889,P=0.00)was significant.Conclusion:The general findings of our study showed that parents’education and occupation played a significant role in a child’s care.Parental education and catheter care skills positively affect the child and reduce readmission rates.
文摘In recent years,under the influence of multiple factors such as traditional ideas and living economic conditions,the aging population in China continues to increase.Most of the elderly are more inclined to aged at home,and the first places for elderly activities are communities and the surrounding environment,which greatly affects the convenience of life and happiness of the elderly.In this paper,Changxindian area in Fengtai District of Beijing was as the research object,and detailed calculation and analysis were carried out by using POI data and arcGIS software.The relative location of residential areas and surrounding public toilets was explored,and the best location of public toilets in the daily walking area under the model of community home-based care for the elderly was further studied.
基金supported by the National Natural Science Foundation of China under Grant No.61701284the Innovative Research Foundation of Qingdao under Grant No.19-6-2-1-CG+5 种基金the Elite Plan Project of Shandong University of Science and Technology under Grant No.skr21-3-B-048the Sci.&Tech.Development Fund of Shandong Province of China under Grant Nos.ZR202102230289,ZR202102250695,and ZR2019LZH001the Humanities and Social Science Research Project of the Ministry of Education under Grant No.18YJAZH017the Taishan Scholar Program of Shandong Province,the Shandong Chongqing Science and Technology Cooperation Project under Grant No.cstc2020jscx-lyjsAX0008the Sci.&Tech.Development Fund of Qingdao under Grant No.21-1-5-zlyj-1-zc,SDUST Research Fund under Grant No.2015TDJH102the Science and Technology Support Plan of Youth Innovation Team of Shandong higher School under Grant No.2019KJN024.
文摘With the development of urbanization,the problem of neurological diseases brought about by population aging has gradually become a social problem of worldwide concern.Aging leads to gradual degeneration of the central nervous system,shrinkage of brain tissue,and decline in physical function in many elderlies,making them susceptible to neurological diseases such as Alzheimer’s disease(AD),stroke,Parkinson’s and major depressive disorder(MDD).Due to the influence of these neurological diseases,the elderly have troubles such as memory loss,inability to move,falling,and getting lost,which seriously affect their quality of life.Tracking and positioning of elderly with neurological diseases and keeping track of their location in real-time are necessary and crucial in order to detect and treat dangerous and unexpected situations in time.Considering that the elderly with neurological diseases forget to wear a positioning device or have mobility problems due to carrying a positioning device,device-free positioning as a passive positioning technology that detects device-free individuals is more suitable than traditional active positioning for the home-based care of the elderly with neurological diseases.This paper provides an extensive and in-depth survey of device-free indoor positioning technology for home-based care and an in-depth analysis of the main features of current positioning systems,as well as the techniques,technologies andmethods they employ,fromthe perspective of the needs of the elderly with neurological conditions.Moreover,evaluation criteria and possible solutions of positioning techniques for the home-based care of the elderly with neurological conditions are proposed.Finally,the opportunities and challenges for the development of indoor positioning technology in 6G mobile networks for home-based care of the elderly with neurological diseases are discussed.This review has provided comprehensive and effective tracking and positioning techniques,technologies and methods for the elderly,by which we can obtain the location information of the elderly in real-time and make home-based care more comfortable and safer for the elderly with neurological diseases.
基金This work was supported by the National Science and Technology Major Project of the Ministry of Science and Technology of China(No.2017YFC1309401).
文摘Objective To determine the impact of smoking on disease-specific health care utilization and medical costs in patients with chronic non-communicable diseases(NCDs).Methods Participants were middle-aged and elderly adults with chronic NCDs from a prospective cohort in China.Logistic regressions and linear models were used to assess the relationship between tobacco smoking,health care utilization and medical costs.Results Totally,1020 patients with chronic obstructive pulmonary disease(COPD),3144 patients with coronary heart disease(CHD),and 1405 patients with diabetes were included in the analysis.Among patients with COPD,current smokers(β:0.030,95%CI:−0.032-0.092)and former smokers(β:0.072,95%CI:0.014-0.131)had 3.0%and 7.2%higher total medical costs than never smokers.Medical costs of patients who had smoked for 21-40 years(β:0.028,95%CI:−0.038-0.094)and≥41 years(β:0.053,95%CI:−0.004β0.110)were higher than those of never smokers.Patients who smoked≥21 cigarettes(β:0.145,95%CI:0.051-0.239)per day had more inpatient visits than never smokers.The association between smoking and health care utilization and medical costs in people with CHD group was similar to that in people with COPD;however,there were no significant associations in people with diabetes.Conclusion This study reveals that the impact of smoking on health care utilization and medical costs varies among patients with COPD,CHD,and diabetes.Tobacco control might be more effective at reducing the burden of disease for patients with COPD and CHD than for patients with diabetes.
文摘Discharging patients directly to home from the intensive care unit(ICU)is becoming a new trend.This review examines the feasibility,benefits,challenges,and considerations of directly discharging ICU patients.By analyzing available evidence and healthcare professionals'experiences,the review explores the potential impacts on patient outcomes and healthcare systems.The practice of direct discharge from the ICU presents both opportunities and complexities.While it can potentially reduce costs,enhance patient comfort,and mitigate complications linked to extended hospitalization,it necessitates meticulous patient selection and robust post-discharge support mechanisms.Implementing this strategy successfully mandates the availability of home-based care services and a careful assessment of the patient's readiness for the transition.Through critical evaluation of existing literature,this review underscores the significance of tailored patient selection criteria and comprehensive post-discharge support systems to ensure patient safety and optimal recovery.The insights provided contribute evidence-based recommendations for refining the direct discharge approach,fostering improved patient outcomes,heightened satisfaction,and streamlined healthcare processes.Ultimately,the review seeks to balance patientcentered care and effective resource utilization within ICU discharge strategies.
基金Research Center for Capital Health Management and Policy,No.2024JD09.
文摘BACKGROUND Data from the World Health Organization’s International Agency for Research on Cancer reported that China had the highest prevalence of cancer and cancer deaths in 2022.Liver and pancreatic cancers accounted for the highest number of new cases.Real-world data(RWD)is now widely preferred to traditional clinical trials in various fields of medicine and healthcare,as the traditional research approach often involves highly selected populations and interventions and controls that are strictly regulated.Additionally,research results from the RWD match global reality better than those from traditional clinical trials.AIM To analyze the cost disparity between surgical treatments for liver and pancreatic cancer under various factors.METHODS This study analyzed RWD 1137 cases within the HB1 group(patients who underwent pancreatectomy,hepatectomy,and/or shunt surgery)in 2023.It distinguished different expenditure categories,including medical,nursing,technical,management,drug,and consumable costs.Additionally,it assessed the contribution of each expenditure category to total hospital costs and performed cross-group comparisons using the non-parametric Kruskal–Wallis test.This study used the Steel–Dwass test for post-hoc multiple comparisons and the Spearman correlation coefficient to examine the relationships between variables.RESULTS The study found that in HB11 and HB13,the total hospitalization costs were significantly higher for pancreaticoduodenectomy than for pancreatectomy and hepatectomy.Although no significant difference was observed in the length of hospital stay between patients who underwent pancreaticoduodenectomy and pancreatectomy,both were significantly longer than those who underwent liver resection.In HB15,no significant difference was observed in the total cost of hospitalization between pancreaticoduodenectomy and pancreatectomy;however,both were significantly higher than those in hepatectomy.Additionally,the length of hospital stay was significantly longer for patients who underwent pancreaticoduodenectomy than for those who underwent pancreatectomy or liver resection.CONCLUSION China Healthcare Security Diagnosis Related Groups payment system positively impacts liver and pancreatic cancer surgeries by improving medical quality and controlling costs.Further research could refine this grouping system and ensure continuous effectiveness and sustainability.
文摘The sustainability of the healthcare system has been in question for several years. With rising healthcare costs, limited resources and an aging population, society needs to come up with innovative ideas to reduce healthcare spending. This paper attempts to illustrate how addressing goals of care can have a significant impact on healthcare costs.
文摘The financial crisis has caused a severe limitation of resources for the public health service and rehabilitation. The proposal of integrated diagnosis and treatment in rehabilitation, involving the introduction of new therapeutic models alongside orthodox models, could lead to a reduction in health care costs through better patient compliance. In rehabilitative assistance in health care, the limiting of financial resources can be simplified, given its multifaceted nature and the need to integrate clinical experience with research. In addition, the phases of rehabilitative recovery do not focus on organ damage, but improved participation and the reduction of disability. For this reason, we have considered incorporating narrative based medicine (NBM) and Psycho-Neuro-Immuno-Endocrinology (PNEI) in the rehabilitation process through an empathetic approach, taking evidence based medicine (EBM) into account, thus creating a “framework” of reference. Managing patients through this “framework” would be a move towards an integrated model of care that could lead to a reduction in health care costs, given the aging population and the rise in patients with chronic pain. The decision to modify health care in rehabilitative assistance through a new “framework” will require time, organizational capacity and experimentation, but may represent the appropriate response for an improved quality of life for patients and a better allocation of resources.
文摘Developments in health care in the United States are changing the delivery of services for providers and payors. This study focused on inpatient hospital discharges in the Syracuse hospitals and other services. It demonstrated that, during the past five years, numbers of inpatient adult medicine discharges had increased while adult surgery discharges had declined. This information suggested that adult medicine discharges could be expected to increase and approach levels of five years ago. It also suggested adult surgery discharges could be expected to remain at previous levels or decline. This information indicated that the combined emergency department visits declined from 238,000 to 202,000 between 2019 and 2020, then increased from 218,000 to 228,000 visits between 2021 and 2023. These developments will probably result in greater efficiency at the community level. With a decline in numbers of inpatient beds, providers will be able to focus on the more efficient management by reducing numbers of staff as well as fewer pharmaceuticals and testing.
文摘Objective:To develop a home-based care plan for the elderly person with chronic diseases based on the status of their home-based care needs and relevant literature.Methods:The clinical data consisted of 132 patients who were 60-year-old or older with chronic diseases from June 2019 to May 2020 were selected and categorized into control and treatment groups of 66 patients each.For the experimental group,a care team for chronically ill elderly receiving regular post-treatment bome-based care.Meanwhile,a general clinical care team for chronically ill elderly receiving regular treatment for the control group.The effectiveness of these two healthcare models was evaluated and analyzed.Results:Results showed that satisfaction and effectiveness of home-based care among the elderly with chronic diseases were statistically better(P<0.05)than those in the usual care group.Conclusion:Providing home-based care services to elderly patients with chronic illnesses helps them to improve their chronic disease condition,patients are more receptive to home care,and patients have higher rates of recovery and treatment satisfaction.
文摘Utilization management plays a crucial role in healthcare by optimizing resource allocation,improving patient outcomes,and effectively controlling costs.By balancing patient needs with economic considerations,healthcare institutions can ensure efficient and sustainable service delivery.Utilization management encompasses various strategies,including prior authorization,concurrent review,and clinical pathways,to enhance care quality,manage expenses,and streamline resource use.The benefits of utilization management include cost containment,improved care standards,and the implementation of consistent treatment guidelines,thereby increasing the overall efficiency and effectiveness of healthcare delivery.
基金supported by Project of Henan Federation of Social Sciences in 2021(NO.SKL-2021-415)Anyang science and Technology development plan project in 2020(Project No.228).
文摘Objective:To systematically evaluate the willingness rate of the community to provide for the aged at home and analyze its influencing factors.Methods:By searching the CNKI,VIP,Wanfang,we collected literature on the willingness of the elderly in the community to provide for the aged from 2011 to 2021,extracted the data,and evaluated the quality of the included literature.Then,CMA 2.0 software was used for Meta-analysis.Results:A total of 13 articles were included in this study,and 16,402 people over 60 years old were surveyed,1782 people were willing to provide for the aged at home in the community,with a total willingness rate of 11%(95%CI:9%to 26%).The results of subgroup analysis showed that there was a statistically significant difference in the community home care willingness rate of elderly people with different gender,education levels,marital status,monthly income,living alone,the number of children,and residence(P<0.05).There was not any statistically significant difference in the willingness rate of the elderly with different ages,chronic diseases,self-care ability,and loneliness(P>0.05).Conclusion:The overall willingness rate of the elderly in the community of the elderly is relatively low in China.Gender,education level,marital status,monthly income,living alone,number of children,and residence are factors affecting the prediction of community elderly will.
文摘Background: Considering the importance of getting the right patient at the right location to maintain and optimize quality of life of inflammatory arthritis patients, appropriate referral by general practitioners is essential. This study aims to assess the effect and cost effectiveness of different referral strategies for inflammatory arthritis in primary care patients. Methods: This study follows a cluster randomized controlled trial design. General practitioners from primary care centers in Southwest-The Netherlands are randomly assigned to either one of the two strategic interventions for referring adult patients who are in the opinion of the general practitioner suspected of inflammatory arthritis: 1) Standardized digital referral algorithm based on existing referral models PEST, CaFaSpA and CARE;2) Triage by a rheumatologist in the local primary care center. These interventions will be compared to a control group, e.g. usual care. The primary outcome is the percentage of patients diagnosed with inflammatory arthritis by the rheumatologist. Secondary outcomes are quality of life as a patient reported outcome, work participation and healthcare costs. These data, including demographic and clinical parameters, are prospectively collected at baseline, three, six, and twelve months. Discussion: If this study can demonstrate improvements in appropriate referrals to the rheumatologist, thereby improving cost-effectiveness, there is sufficient supporting evidence to implement one of the referral strategies as a standard of care. Finally, with these optimization strategies a higher quality of care can be achieved, that might be of value for all patients with arthralgia. Trial Registration: NCT03454438, date of registration: March 5, 2018. Retrospectively registered: https://clinicaltrials.gov/ct2/show/NCT03454438?term=NCT03454438&draw=1&rank=1.
文摘AIM To study the impact of hospital-acquired infections(HAIs) on cost and outcome from intensive care units(ICU) in India. METHODS Adult patients(> 18 years) admitted over 1-year, to a 24-bed medical critical care unit in India, were enrolled prospectively. Treatment cost and outcome data were collected. This cost data was merged with HAI data collected prospectively by the Hospital Infection Control Committee. Only infections occurring during ICU stay were included. The impact of HAI on treatment cost and mortality was assessed. RESULTS The mean(± SD) age of the cohort(n = 499) was42.3 ± 16.5 years. Acute physiology and chronic health evaluation-Ⅱ score was 13.9(95%CI: 13.3-14.5); 86% were ventilated. ICU and hospital length of stay were 7.8 ± 5.5 and 13.9 ± 10 d respectively. Hospital mortality was 27.9%. During ICU stay, 76(15.3%) patients developed an infection(ventilator-associated pneumonia 50; bloodstream infection 35; urinary tract infections 3), translating to 19.7 infections/1000 ICU days. When compared with those who did not develop an infection, an infection occurring during ICU stay was associated with significantly higher treatment cost [median(inter-quartile range, IQR) INR 92893(USD 1523)(IQR 57168-140286) vs INR 180469(USD 2958)(IQR 140030-237525); P < 0.001 and longer duration of ICU(6.7 ± 4.5 d vs 13.4 ± 7.0 d; P < 0.01) and hospital stay(12.4 ± 8.2 d vs 21.8 ± 13.9 d; P < 0.001)]. However ICU acquired infections did not impact hospital mortality(31.6% vs 27.2%; P = 0.49).CONCLUSION An infection acquired during ICU stay was associated with doubling of treatment cost and prolonged hospitalization but did not significantly increase mortality.
文摘BACKGROUND Postpartum depression is a common mental illness in puerpera,with an incidence of approximately 3.5%-33.0%abroad,and the incidence of postpartum depression in China is higher than the international level,reaching 10.0%-38.0%.Providing effective nursing care in clinical nursing activities is one of the key points of obstetrical care.However,little research has been designed to investigate the positive role of home-based nursing in the prevention of postpartum depression.AIM To study the effect of home-based nursing for postpartum depression patients on their quality of life and depression.METHODS The clinical data of 92 patients with postpartum depression treated at our hospital were retrospectively analyzed.The patients were grouped according to the nursing methods used;40 patients receiving basic nursing were included in a basic nursing group,and 52 receiving home-based nursing were included in a home-based nursing group.Depression and anxiety were evaluated and compared between the two groups.The estradiol(E2),serotonin(5-hydroxytryptamine,5-HT),and progesterone(PRGE)levels were measured.RESULTS The SAS and SDS scores of the home-based nursing group were significantly lower than those of the basic nursing group(P<0.05).The E2 and 5-HT levels of the home-based nursing group were significantly higher than those of the basic nursing group,but the PRGE level was significantly lower than that of the basic nursing group.The GQOLI-74 scores(material,social,somatic,and psychological)and nursing satisfaction were significantly higher in the home-based nursing group(P<0.05).CONCLUSION Postpartum depression through home-based nursing can effectively alleviate depression and improve the quality of life of patients,help modulate their serum E2,5-HT,and PRGE levels,and improve their satisfaction with nursing care.
文摘AIM: To define the cost-effectiveness of strategies, including endoscopy and immunosuppression, to prevent endoscopic recurrence of Crohn’s disease following intestinal resection.METHODS: In the “POCER” study patients undergoing intestinal resection were treated with post-operative drug therapy. Two thirds were randomized to active care (6 mo colonoscopy and drug intensification for endoscopic recurrence) and one third to drug therapy without early endoscopy. Colonoscopy at 18 mo and faecal calprotectin (FC) measurement were used to assess disease recurrence. Administrative data, chart review and patient questionnaires were collected prospectively over 18 mo.RESULTS: Sixty patients (active care n = 43, standard care n = 17) were included from one health service. Median total health care cost was $6440 per patient. Active care cost $4824 more than standard care over 18 mo. Medication accounted for 78% of total cost, of which 90% was for adalimumab. Median health care cost was higher for those with endoscopic recurrence compared to those in remission [$26347 (IQR 25045-27485) vs $2729 (IQR 1182-5215), P < 0.001]. FC to select patients for colonoscopy could reduce cost by $1010 per patient over 18 mo. Active care was associated with 18% decreased endoscopic recurrence, costing $861 for each recurrence prevented.CONCLUSION: Post-operative management strategies are associated with high cost, primarily medication related. Calprotectin use reduces costs. The long term cost-benefit of these strategies remains to be evaluated.
文摘AIM: To calculate cost effectiveness of the treatment of critically ill patients in a medical intensive care unit(ICU) of a middle income country with limited access to ICU resources. METHODS: A prospective cohort study and economic evaluation of consecutive patients treated in a recently established medical ICU in Sarajevo, Bosnia and Herzegovina. A cost utility analysis of the intensive care of critically ill patients compared to the hospital ward treatment from the perspective of the health care system was subsequently performed. Incremental cost effectiveness was calculated using estimates of ICU vs non-ICU treatment effectiveness based on a formal systematic review of published studies. Decision analytic modeling was used to compare treatment alternatives. Sensitivity analyses of the key model parameters were performed.RESULTS: Out of 148 patients, seventy patients(47.2%) survived to one year after critical illness with a median quality of life index 0.64 [interquartile range(IQR)0.49-0.76]. Median number of life years gained per patient was 30(IQR 16-40) or 18 quality adjusted life years(QALYs)(IQR 7-28). The cost of treatment of critically ill patients varied between 1820 dollar and20109 dollar per hospital survivor and between 100 dollar and 2514 dollar per QALY saved. Mean factors that influenced costs were: Age, diagnostic category,ICU and hospital length of stay and number and type of diagnostic and therapeutic interventions. The incremental cost effectiveness ratio for ICU treatment was estimated at 3254 dollar per QALY corresponding to35% of per capita GDP or a Very Cost Effective category according to World Health Organization criteria.CONCLUSION: The ICU treatment of critically ill medica patients in a resource poor country is cost effective and compares favorably with other medical interventions.Public health authorities in low and middle income countries should encourage development of critical care services.
文摘Multidisciplinary community coordinated care programs are widely adopted to optimise care of chronic disease patients, but there is a need for further evaluation in the setting of COPD. This observational study evaluated 147 patients with severe or very severe COPD who were enrolled in a multidisciplinary community respiratory coordinated care program (RCCP) from 2007 to 2012. Comparison was made of hospitalisation rates and length of stay for 12 months prior to joining the program, and the first 12 months after joining the program. This data was used to inform a cost analysis. Enrolment into RCCP halved the annual hospital admission rate from 1.18 to 0.57 admissions per year (relative risk reduction 51.4%, p < 0.001), and annual total length of stay was reduced from 8.06 to 3.59 days per patient per year (p < 0.001). Hospital admissions were reduced from 5.05 days to 2.00 days (p < 0.001). Accounting for the program’s costs, these changes resulted in a $US 906.94 ($AUD 972.80) cost saving per patient per year. A RCCP program can reduce patient hospitalisation and overall costs in the COPD setting.