Medical care
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In-hospital cardiopulmonary resuscitation (CPR) is associated with substantial costs beyond those of the resuscitation itself. These costs are important to understand because health care resources are limited. To that end, a model of CPR is proposed, including an examination of the effect of several variables on the cost per patient surviving to discharge. ⋯ This cost was $117,000 for a rate of survival to discharge of 10%, $248,271 for a rate of 1%, and $544,521 for a rate of 0.2%. Analysis of the model shows that health care costs related to CPR could be reduced most by decreasing the hospital length of stay and charges for patients who survive the initial resuscitation event, by increases in the overall survival rate, and by the prospective stratification of hospitalized patients according to their anticipated response to resuscitation efforts. The model allows the marginal cost-effectiveness of CPR to be quantitatively evaluated relative to survival rate.
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Randomized Controlled Trial Comparative Study Clinical Trial
Outpatient internal medicine preoperative evaluation: a randomized clinical trial.
The purpose of this study was to evaluate the effect on resource use of a program outpatient internal medicine preoperative evaluation in a two arm parallel design randomized clinical trial. In a tertiary care teaching Veterans Affairs hospital, 355 patients (179 inpatient arm, 176 outpatient arm)(mean age 65.5 years) were referred for internal medicine preoperative evaluation before elective surgery. Outpatient internist preoperative evaluation was performed 2 to 3 weeks before admission for surgery in the experimental arm with preoperative laboratory and radiology testing performed during the visit. ⋯ Patients health status after discharge and satisfaction with care were not different between the two arms of the investigation. A program of outpatient internal medicine preoperative evaluation significantly reduced preoperative length of stay with a lesser effect on total length of stay. Unnecessary admission of patients for elective surgery were reduced by this program.
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A significant portion of health care resources are spent in intensive care units with, historically, up to two-fold variation in risk-adjusted mortality. Technological, demographic, and social forces are likely to lead to an increased volume of intensive care in the future. Thus, it is important to identify ways of more efficiently managing intensive care units and reducing the variation in patient outcomes. ⋯ Furthermore, units with greater technological availability are significantly more likely to be associated with hospitals that are more profitable, involved in teaching activities, and have unit leaders actively participating in hospital-wide quality improvement activities. The findings hold a number of important managerial and policy implications regarding technological adoption, specialization, and the quality of interaction among ICU team members. They suggest intervention "leverage points" for care givers, managers, and external policy makers in efforts to continuously improve the outcomes of intensive care.
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Because of a shortage of usable organs, many who require heart or liver transplants for survival will not have access to them. Access to care may reflect demographic factors and ability to pay, as well as medical considerations. Receipt of an organ may be influenced by expected survival with and without a transplant, age, gender, race, ability to pay, and distance to a transplant center. ⋯ Existing regulatory incentives and biological, medical, and cultural reasons may justify the age-, sex-, race-, and prognosis-related differences in the odds of receiving a transplant. The importance of ability to pay may not have been adequately observed in previous studies restricted to the patients screened at major transplant centers. Hospital discharge records with personal identifiers, linkage to official waiting lists, and better patient level socioeconomic information would permit more definitive analysis.