Is convenience really king?Comparative evaluation of catastrophic costs due to tuberculosis in the public and private healthcare sectors of Viet Nam:a longitudinal patient cost study

Background In Viet Nam,tuberculosis(TB)represents a devastating life-event with an exorbitant price tag,partly due to lost income from daily directly observed therapy in public sector care.Thus,persons with TB may seek care in the private sector for its flexibility,convenience,and privacy.Our study aimed to measure income changes,costs and catastrophic cost incurrence among TB-affected households in the public and private sector.Methods Between October 2020 and March 2022,we conducted 110 longitudinal patient cost interviews,among 50 patients privately treated for TB and 60 TB patients treated by the National TB Program(NTP)in Ha Noi,Hai Phong and Ho Chi Minh City,Viet Nam.Using a local adaptation of the WHO TB patient cost survey tool,participants were interviewed during the intensive phase,continuation phase and post-treatment.We compared income levels,direct and indirect treatment costs,catastrophic costs using Wilcoxon rank-sum and chi-squared tests and associated risk factors between the two cohorts using multivariate regression.Results The pre-treatment median monthly household income was significantly higher in the private sector versus NTP cohort(USD 868 vs USD 578;P=0.010).However,private sector treatment was also significantly costlier(USD 2075 vs USD 1313;P=0.005),driven by direct medical costs which were 4.6 times higher than costs reported by NTP participants(USD 754 vs USD 164;P<0.001).This resulted in no significant difference in catastrophic costs between the two cohorts(Private:55%vs NTP:52%;P=0.675).Factors associated with catastrophic cost included being a single-person household[adjusted odds ratio[(a OR=13.71;95%confidence interval(CI):1.36-138.14;P=0.026)],unemployment during treatment(a OR=10.86;95%CI:2.64-44.60;P<0.001)and experiencing TB-related stigma(a OR=37.90;95%CI:1.72-831.73;P=0.021)].Conclusions Persons with TB in Viet Nam face similarly high risk of catastrophic costs whether treated in the public or private sector.Patient costs could be reduced through expanded insurance reimbursement to minimize direct medical costs in the private sector,use of remote monitoring and multi-week/month dosing strategies to avert economic costs in the public sector and greater access to social protection mechanism in general.

Discharging patients home from the intensive care unit:A new trend

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.

Evaluation of Length of Hospital Stay Joining Educational Programs for Type 2 Diabetes Mellitus Patients: Can We Control Medical Costs in Japan?

Diabetes has become a growing concern in Japan, both medically and financially. The medical cost of diabetes was estimated at 1215 billion yen for fiscal year 2011. We analyzed the length of stay (LOS) in a hospital for type 2 diabetes mellitus patients who participated in educational programs to determine factors affecting LOS. Data on 991 patients obtained from 28 Red Cross hospitals in 2008 were used. For the analysis, we used the Box-Cox transformation model and Hausman test. The results revealed that patients aged 75 years and above and those with comorbidities and complications were prone to longer LOS. The analysis also revealed significant differences in LOS across the hospitals, even after controlling for patient characteristics. Finally, we applied the least squares method to determine the effects of hospital and regional factors and revealed that patients’ LOS was affected by the region’s average LOS. Regional corporations and networks appeared to be important in improving educational programs.

Direct medical cost of radiation therapy for cancer patients in Taiwan

Background and purpose: The rising cost of health care is of concern worldwide, in particular, for cancer care. The costs of treatment, including chemotherapeutic drugs and radiotherapy, are no exceptions. The purpose of this study is to explore the direct medical cost of radiotherapy and the annual increasing trend of expenditures in Taiwan. Methods: This study utilized data retrieving from the original claim data of the reimbursement of the Health Insurance Research Database (HIRD) derived from Taiwan’s Health Insurance (HI) program. Detailed data on the direct medical cost within the radiotherapy process for beneficences were extracted from inpatient expenditures by admissions (DD) and ambulatory care expenditures by visits (CD) database according to the reimbursed expenditure code of radiotherapy from January 1, 2000 to December 31, 2005. Prescriptions for radiotherapy were retrieved and the direct medical costs for radiotherapy were collected based on the NHI reimbursement price list of 2005. The annual increasing trend of expenditures was also explored according to the perspective of Bureau Health Insurance of Taiwan. Results: The total direct medical costs of radiotherapy for cancer patients were increasing from 2000 to 2005, which were estimated to US $7.80 million, US $8.09 million, US $7.58 million, US $10.7 million, US $12.2 million and US $15.9 million in 2000, 2001, 2002, 2003, 2004 and 2005, respectively. The increased percentage corresponded to the total healthcare expenditures claimed was increased substantially from 0.82% in 2000 to 1.22% in 2005. The total direct medical costs within the radiotherapy process were also increased gradually if identified by different types of radiotherapy and teaching hospital levels. The direct medical costs attribute to radiotherapy, compared to total health care expenditures in Taiwan, were similar to the costs of anticancer drugs for cancer patients annually. Conclusions: The direct medical costs of radiation therapy increased substantially each year. Further cost analysis on radiation therapy is needed in years beyond 2005.

Clinical and cost impact of intravenous proton pump inhibitor use in non-ICU patients

AIM:To assess the appropriateness of the indication and route of administration of proton-pump-inhibitors (PPIs) and their associated cost impact. METHODS:Data collection was performed prospec-tively during a 6-mo period on 340 patients who re-ceived omeprazole intravenously during their hospital stay in non-intensive care floors. Updated guidelines were used to assess the appropriateness of the indication and route of administration. RESULTS:Complete data collection was available for 286 patients which were used to assess intravenous (IV) PPIs utilization. Around 88% of patients were receiving PPIs for claimed stress ulcer prophylaxis (SUP) indication; of which,only 17% met the guideline criteria for SUP indication,14% met the criteria for non-steroidal-anti-inflammatory drugs-induced ulcer prophylaxis,while the remaining 69% were identifi ed as having an unjustified indication for PPI use. Theinitiation of IV PPIs was appropriate in 55% of pa-tients. Half of these patients were candidates for switching to the oral dosage form during their hos-pitalization,while only 36.7% of these patients were actually switched. The inappropriate initiation of PPIs via the IV route was more likely to take place on the medical floor than the surgical floor (53% vs 36%,P = 0.003). The cost analysis associated with the appro-priateness of the indication for PPI use as well as the route of administration of PPI revealed a possible saving of up to $17 732.5 and $14 571,respectively. CONCLUSION:This study highlights the over-utili-zation of IV PPIs in non-intensive care unit patients. Restriction of IV PPI use for justified indications and route of administration is recommended.

Development and evaluation of the Directive and Nondirective Support Scale for Patients with Type 2 Diabetes

Objectives:This study aims to develop the Directive and Nondirective Support Scale for Patients with Type 2 Diabetes(DNSS-T2DM)to measure diabetes-specific support and patients’preference as well as evaluate the construct validity and reliability of the DNSS-T2DM.Methods:A cross-sectional study was conducted in Tongzhou District,Beijing,China from July to September 2015.A total of 474 participants who had been diagnosed as type 2 diabetes by physicians and completed the DNSS-T2DM were included.The original 11-item DNSS-T2DM contains five items on nondirective support(Items 1-5)and six items on directive support(Items 6-11).There were two parallel questions for each item with one to measure the preference for support(Preference part)and the other to measure the perception of support in reality(Reality part).The final DNSS-T2DM was determined based on the results of the exploratory factor analysis(EFA).The construct validity of the final DNSS-T2DM was evaluated by the confirmatory factor analysis(CFA).The reliability was evaluated by internal consistency with Cronbach’sαcoefficients.Results:A final 7-item DNSS-T2DM loaded on 2 factors with four items representing nondirective support and three items representing directive support was determined based on the EFA.The CFA indicated a satisfactory construct validity.The internal consistency of the 7-item DNSS-T2DM as well as the nondirective support items was satisfactory with Cronbach’sα≥7.00.70.Conclusions:Our study supported the validity and reliability of the 7-item DNSS-T2DM.Further studies on the application of the DNSS-T2DM in different settings and population are needed.

Utilization Management:Walking the Line Between Patient Needs and Healthcare Economics-Short Communication

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.

Clinical outcomes of Clutch Cutter endoscopic submucosal dissection for older patients with early gastric cancer

AIM To evaluate the clinical outcome of endoscopic submucosal dissection using the Clutch Cutter(ESDCC) in older patients. METHODS We reviewed 232 consecutive patients with early gastric cancer who underwent ESDCC between June 2010 and February 2014 at Aso Iizuka Hospital. We divided patients into two groups according to age: Older patients(> 80 years, n = 64) and non-older patients(≤ 80 years, n = 168). We retrospectively compared the prevalence rates of pre-existing comorbidities, anticoagulant therapy, en bloc resection, mean duration of hospitalization, incidence of ESDCC-related complications, change in performance status(PS) before and after ESDCC, and financial cost of admission. RESULTS The older group comprised 64 patients with a mean age of 84.1 years, and the non-older group comprised 168 patients with a mean age of 69.5 years. Older patients had significantly more pre-existing comorbidities than did non-older patients, specifically heart disease(P < 0.05). The en bloc resection rate in non-older patients was significantly higher than that in older patients(100% vs 95.3%, P = 0.02). There were no significant differences between the older and non-older groups in the incidence of ESDCC-related complications(i.e., postoperative bleeding and perforation) and the post-ESDCC change in PS. There were also no significant differences between the older and non-older groups in the mean duration of hospitalization(11.4 and 10.7 d, respectively) and financial cost of admission(657040 JPY and 574890 JPY, respectively).CONCLUSION ESDCC has a good clinical outcome in older patients.

Estimation of direct and indirect cost of diabetes in Morocco

Due to its chronic nature with severe complications, diabetes needs costly prolonged treatment and care. The high economic burden of diabetes is particularly threatening low and middle income countries. World-wide, studies have shown that the cost of diabetes per person is much higher than the per capita health expenditure. This study is the first to estimate the direct and indirect cost of diabetes in Morocco. The direct cost of diabetes was computed by assuming three scenarios of prices (low, medium and high) due to different prices of insulin, oral drugs and other items used in diabetes treatment and care. Indirect costs of diabetes were estimated by the lifetime forgone earnings caused by premature death and disability due to diabetes. The direct cost of diabetes in Morocco was estimated to be between US $0.47 and US $1.5 billion whereas the indirect cost was estimated to be around US $2 billion accounting for 57% of the total cost of diabetes under the high cost scenario, 69% under the medium scenario and 81% under the low cost scenario. The average per capita indirect cost was estimated to be US $1113, relatively higher than the direct cost of diabetes which was seen to vary from US$ 259 to US $830. The results yielded by this study were compared to those obtained by similar studies in different regions and countries of the world. As a conclusion, the findings of this study indicate a high economic burden of diabetes and stress the importance that Moroccan health decision makers should give to sensitisation, early diagnosis and treatment of diabetes especially with the crucial growing trend of diabetes prevalence.

An Empirical Study on Environmental Regulatory Costs &Environmental TFP

This paper examines the cost of environmental regulation and the environmental total factor productivity （TFP） with directional distance function and the Malmquist-Luenberger （ALL） index respectively, using inputs and output data of 36 two-digit industries over the period 1998- 2010. It finds that Chinese industries incur a relatively high environmental regulatory cost and that China has paid a high price fulfilling its promise to emissions mitigation. A comparison between conventional and environmental TFP shows that the two indicators for all industries declined on average, but a hypothesis test reveals insignificant difference between the two. In addition, the rise in environmental TFP is mainly due to technological progress, which is consistent with findings of many researches; analysis demonstrates signs of absolute convergence of environmental TFP.

Patients’ Involvement in Decision Making at End of Life—A Systematic Review of Literature

Background: involving patient in end of life decision is important to understand their wishes and preferences to help health care providers in improving the quality of dying and minimizing suffering. Aim: the aim of this review was to provide a detailed examination of the available literature related to patients’ involvement in decision making at end of life. Design: a systematic review following the PRISMA protocol was used, the review protocol was registered on PROSPERO: CRD42019128556. Data sources: we conducted a literature search in two electronic databases “CINAHL and Medline” during March-April 2019. The retrieved articles were included if they were: research reports or literature review;examined patient involvement in end-of-life discussions;full text publications, written in English and published from 2000-2019. Results: a total of (22) articles were included in the review;there was diversity in the purposes and design approach of the retrieved studies. The available literature explored patient’s involvement at end-of-life decision making through;describing current practices;understanding perspectives of end of life discussions;investigating the impact and identifying the barriers and facilitators of patients’ involvement in end of life discussions. Conclusion: involvement in end-of-life discussions improved the recognition of patients’ wishes, improved death experience, and decreased posttraumatic stress, depression, and anxiety among family members. Despite the documented benefits, some barriers against patient’s involvement in end-of-life decisions were recognized;lack of awareness;lack of education, training and experience;concerns about ethical and legal issues;and personal preferences of doctors or nurses were among the most commonly identified barriers.

Hepatitis C virus cure with direct acting antivirals: Clinical,economic, societal and patient value for China

About 10 million people in China are infected with hepatitis C virus(HCV),with the seroprevalence of anti-HCV in the general population estimated at 0.6%.Delaying effective treatment of chronic hepatitis C(CHC)is associated with liver disease progression,cirrhosis,hepatocellular carcinoma,and liver-related mortality.The extrahepatic manifestations of CHC further add to the disease burden of patients.Managing CHC-related advanced liver diseases and systemic manifestations are costly for both the healthcare system and society.Loss of work productivity due to reduced well-being and quality of life in CHC patients further compounds the economic burden of the disease.Traditionally,pegylatedinterferon plus ribavirin(PR)was the standard of care.However,a substantial number of patients are ineligible for PR treatment,and only 40%–75%achieved sustained virologic response.Furthermore,PR is associated with impairment of patient-reported outcomes(PROs),high rates of adverse events,and poor adherence.With the advent of direct acting antivirals(DAAs),the treatment of CHC patients has been revolutionized.DAAs have broader eligible patient populations,higher efficacy,better PRO profiles,fewer adverse events,and better adherence rates,thereby making it possible to cure a large proportion of all CHC patients.This article aims to provide a comprehensive evaluation on the value of effective,curative hepatitis C treatment from the clinical,economic,societal,and patient experience perspectives,with a focus on recent data from China,supplemented with other Asian and international experiences where China data are not available.

Direct Cost of Severe Malaria Treatment Borne by the Families of Children Aged 0 - 5 Years at the Fana Reference Health Centre, Mali

Introduction: Malaria is both a disease caused by poverty and a cause of poverty. Malaria is the leading cause of morbidity and mortality in Mali and is among the ten countries with the highest number of malaria cases and deaths. The objective was to estimate the direct economic cost borne by families in the treatment of severe malaria in children aged 0 - 5 years at the CSREF in Fana. Methodology: The study was cross-sectional, conducted from July 2017 to June 2018 with inclusion criteria and prospective data collection. The methodology was based on estimating the direct economic cost of severe malaria. Results: The sample consisted of 109 cases out of a total of 944 hospitalizations;59% of whom were boys and the 25 - 36 month age group was the most affected. The complications frequently encountered were severe anemia (50 cases) or 45.8%;convulsions (35 cases) or 32.1% and finally severe sepsis (8 cases) or 7.3%. The average direct cost was 25,324 Franc CFA (58.95 US Dollars) of which 66% represented the costs of medicines and consumables against 4% for the consultation. This cost was more than half the minimum wage in Mali. Conclusion: Despite the difficulties in estimating the cost in hospitals, the results obtained give us an estimate of the economic burden borne by families in the management of severe malaria cases among children in the district of Fana. Support is needed for parents in the fight against malaria in rural Mali.

A Direct-Indirect Cost Decision Making Assessment Methodology for Seismic Isolation on Bridges

Making decisions of when to intervene on bridges taking into consideration more than owner costs is a growing field of interest in earthquake engineering. In particular, bridges can be considered critical links in highway networks because of their seismic vulnerability in terms of direct and indirect losses. This paper aims at defining a general criteria capable of taking into account both these costs in a simplified and efficient formulation. Indirect losses generally neglected elsewhere, are taken into consideration by applying a formulation that assesses investment efficiency. The presented formulation follows the one proposed for buildings by L. Kantorovich, 1975. Direct costs are computed from a Performance Based Earthquake Engineering （PBEE） methodology by the Pacific Earthquake Engineering Research （PEER） center. The problem considers two competitive objectives （maximizing economic efficiency and minimizing costs） in a multi-objective structural optimization procedure. The formulation has been applied to a case study aimed at strengthening a benchmark bridge. The optimum investment has been assessed between several isolated configurations.

Ammonia Emissions in EuropemCosts, Regulation and Targets with Focus on Denmark

The NEC （National Emission Ceiling） directive has set targets for the 2010 ammonia emissions from a number of European countries. The target will be reached by most EU-countries and the total emission for EU-27 has been reduced by 22% from 1990 to 2007. Denmark is one of the countries with the largest reductions since 1990 and the article aims at the measures and costs involved. The conclusion is that the costs have been under 3ε per kg NH3-N. Measures in several countries are under 5ε per kg NH3-N, which is a likely minimum for the benefits of reducing NH3-N. The findings suggest that the same measures might be cheaper in the Netherlands and Denmark than in the UK and the USA due to technology advances and stricter regulations in the past. The new Danish application procedure, when increasing the animal production, has tried to make the acceptance procedure quicker and dynamic ensuring that new technology is adopted quicker and that the farm has the right location. It is concluded that the new application process so far has not lived up to the high expectations at the outset. Despite this, the paper concludes that Denmark is likely to reduce emission by 50% from 1990 to 2020 and reach the likely 2020 NEC ceiling.

Sugammadex: Role in current anaesthetic practice and its safety benefits for patients

Sugammadex has revolutionized anaesthetic management of reversal of neuromuscular block(NMB) by way of its unique mechanism of action encapsulating the amino steroid neuromuscular blocking drugs rocuroniumand vecuronium. The cholinesterase inhibitors have significant pharmacological and clinical limitations whereas sugammadex allows predictable, safe and rapid reversal from any depth of blockade. The financial cost of sugammadex is significant. Many hospitals in the United Kingdom use clinical guidelines to direct best use of sugammadex in their institutions. Auditing the use of sugammadex provides useful information on which patients are benefiting from sugammadex. The clinical benefits of sugammadex are well understood. No patient should now be subjected to the danger of post-operative residual curarization. Versatility in the ability to reverse NMB has brought opportunities to the anaesthetist in the management of rapid sequence induction using high dose rocuronium with the knowledge that safe reversal of NMB is now possible in the unlikely event of a "can't intubate can't ventilate" situation. Do we still need suxamethonium to be available? The nature of surgery continues to evolve with ever-increasing enthusiasm for minimally invasive laparoscopic techniques. There is evidence to support using a deeper level of NMB to improve the working space and operating conditions in laparoscopic surgery. It is now possible to maintain a deep level of NMB right up until the end of surgery with no concerns about the ability to effect safe reversal of NMB. Vigilance about the possibility of allergic sensitivity to sugammadex needs to be maintained. The increased usage of rocuronium has the potential for rocuroniuminduced anaphylaxis. Conversely, there is a potential role for sugammadex in the treatment of rocuronium anaphylaxis. Clinicians who have used sugammadex are struck with the quality of recovery seen in their patients. It is important that the economic implications of the use of sugammadex are fully understood. This article considers the current role of sugammadex in clinical practice outside of routine reversal of NMB and discusses how the addition of sugammadex to the anaesthetic armamentarium brings safety benefits for patients.

Direct Cost of Primary Open Angle Glaucoma Management

Background: There are few studies on the cost of glaucoma management in developing country, especially in Togo, there are no data on the cost of POAG management. Aims: To determine the annual direct cost of the management of POAG, to evaluate the annual economic weight of the management of POAG and to determine the factors associated with the annual economic weight of the management. Methods: We conducted a retrospective and descriptive study over a period of 12 months from January 1 to December 31, 2019 based on the records of patients followed for POAG in AFIA Eye Clinic in Lomé-Togo. The annual direct cost was defined by the sum of the costs of consultations, explorations and treatments. We defined the direct cost per patient and per year and related to the average annual income. It was said to be catastrophic at 20% or more of the estimated annual income. Chi 2 and Fisher tested the comparison of proportions. We conducted univariate and multivariate logistic regression to search correlations. Results: During the study period, 150 patient records were included. The average age was 47.24 ± 17.09 years and the sex ratio was 0.82. The cost of the diagnosis was 112.18 ± 22.26 €. The average cost of consultations was 19.46 ± 11.35 € and that of explorations was 92.71 ± 10.91 €. The annual cost of treatment per patient was 165.52 ± 110.16 €. The annual global direct cost of POAG management per patient was 277.69 ± 132.42 €. Compared to the annual income of 1166.29 €, the economic weight of the glaucoma management was 23.8%. This direct cost was catastrophic for 32.1% of patients in the study (44/150 of people with no care). Compared to the guaranteed inter-professional minimum wage (SMIG) of 640.30 €, the economic direct cost weight was 43.3%. Risk factors significantly associated with the direct cost were age over 40 (OR = 1.05 and p = 0.032), liberal profession (OR = 4.72 and p = 0.04), the absence of health insurance (OR = 6.68 and p = 0.017) and the use carbonic anhydrase inhibitors (OR = 7.4 and p = 0.012) and prostaglandin analogues (OR of 38.2 and p Conclusion: This first study on the direct cost of POAG management in Lomé showed that the economic burden glaucoma represents for the patient, his family and society. The data from this study will allow health decision-makers to adopt strategies to mitigate the effects of glaucoma on the economy.

The home healthcare nursing services provided to the elderly patients: a systematic review

Background:Home healthcare(HHC)services entail quality and transitional care offered to patients.Doctors recommend HHC to the elderly patients to manage conditions and improve outcomes outside inpatient setting.The systematic review aimed to assess the home health care nurse services to elderly patients.The question of this study is“what are the home nursing care services provided to the elderly patient.Methods:A systematic review methodology was adopted.A search was conducted on PubMed,MEDLINE,and ScienceDirect using keywords such as“home healthcare”,“nurse services”,“home nurses”,“elderly patients”.The search generated 1829 articles,but 16 were selected for qualitative synthesis for meeting the eligibility criteria.Joana Briggs Institute’s critical appraisal tools helped in the assessment of the primary studies.A data extraction matrix generated themes,while a narrative synthesis presented the studies.Results:The review found administration of HHC nursing services in different settings.The studies confirmed varied nature of HHC,types of HHC services,transitional care,challenges,or barriers of offering HHC,relationships,and decision-making process in offering care to the patients and family.The studies presented HHC as a multifaceted component with diverse impact on the patients and family.The analysis revealed that HHC nurses services served elderly persons as the main target group.HHC faces different challenges,barriers,or obstacles such as work,role conflict,organization,elderly patients,and decision-making.Conclusion and Future Research:The assessment of the HHC nursing services provided to the elderly patients reveals different facets of the healthcare process that reduce readmissions and hospital costs.Further studies could explore the provision of care to other target groups such as middle-aged patients to understand the impact of the services.

目标导向模式改善基层血液透析质量的临床研究

目的探讨目标导向模式在提升基层血液透析质量中的效果。方法以2021年10月—2022年3月于郑州大学第一附属医院南院区接受维持性血液透析治疗的基层患者为研究对象,观察目标导向模式管理6 m后,患者血管通路、临床指标、生活质量和卫生经济学指标等的改善情况。结果共纳入85例患者。与基线相比,6 m后带隧道带涤纶套导管的使用比例由42.35%降至27.06%(χ_(2)=6.303,P=0.043),单室尿素清除指数<1.2的患者比例降至7.05%(χ_(2)=21.182,P<0.001),透析间期体质量增加<5%干体质量的患者比例增至70.59%(χ_(2)=43.895,P<0.001),血红蛋白(χ_(2)=15.824,P=0.001)、血钾(χ_(2)=4.541,P=0.033)、血白蛋白(χ_(2)=31.224,P<0.001)、血磷(χ_(2)=17.306,P<0.001)及全段甲状旁腺激素(χ_(2)=17.162,P<0.001)达标率均提高;患者满意度由48.24%上升至100%(χ_(2)=59.365,P<0.001),生活质量评分提高(t=-22.455,P<0.001);直接医疗总成本无明显增加(t=1.387,P=0.167)。结论目标导向模式有效改善了基层患者的血液透析质量,利于患者并发症控制及生活质量提高,且不额外增加医疗花费,具有较强的应用价值。

广州市某医院脑梗死患者疾病经济负担研究

目的分析脑梗死患者次均住院费用,特别是次均住院自负费用的结构以及影响因素,为缓解患者疾病经济负担提供参考依据。方法运用描述性统计分析对广州市某三甲医院2015—2022年脑梗死出院患者的次均费用及费用结构进行比较分析,并采用多重线性分析法研究影响患者次均住院自负费用的因素。结果脑梗死患者次均住院费用增长放缓,年均增长率为2.86%;费用结构逐步优化,2022年次均技术劳务费占比47.41%;脑梗死患者次均住院自负费用呈增长趋势,年均增长率5.96%,且受住院时间、病例分型、付费方式以及患者来源等因素共同影响。结论脑梗死患者的疾病经济负担仍然较重,医疗机构应不断规范诊疗行为,加强临床路径管理,政府应该不断完善社会保障体系,降低患者的疾病经济负担。