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Sample records for reduces medical costs

  1. Reducing the cost of headache medication.

    PubMed

    Solomon, Glen D

    2009-06-01

    Although medication costs make up one of the smallest portions of the overall expense of headache care, it is the segment of expense that often impacts the patient most directly. The advent of triptans marked a major advance in migraine therapy, but their high cost has limited their widespread use. Four options can be considered as potential means to reduce the cost of triptans. These include compulsory licensing, exclusive contracting, over-the-counter -availability, and the introduction of generic triptans. Each method impacts the consumer, third-party payer, or pharmaceutical company in a different manner.

  2. Gauging the feasibility of cost-sharing and medical student interest groups to reduce interview costs.

    PubMed

    Lieber, Bryan A; Wilson, Taylor A; Bell, Randy S; Ashley, William W; Barrow, Daniel L; Wolfe, Stacey Quintero

    2014-11-01

    Indirect costs of the interview tour can be prohibitive. The authors sought to assess the desire of interviewees to mitigate these costs through ideas such as sharing hotel rooms and transportation, willingness to stay with local students, and the preferred modality to coordinate this collaboration. A survey link was posted on the Uncle Harvey website and the Facebook profile page of fourth-year medical students from 6 different medical schools shortly after the 2014 match day. There were a total of 156 respondents to the survey. The majority of the respondents were postinterview medical students (65.4%), but preinterview medical students (28.2%) and current residents (6.4%) also responded to the survey. Most respondents were pursuing a field other than neurosurgery (75.0%) and expressed a desire to share a hotel room and/or transportation (77.4%) as well as stay in the dorm room of a medical student at the program in which they are interviewing (70.0%). Students going into neurosurgery were significantly more likely to be interested in sharing hotel/transportation (89.2% neurosurgery vs 72.8% nonneurosurgery; p = 0.040) and in staying in the dorm room of a local student when on interviews (85.0% neurosurgery vs 57.1% nonneurosurgery; p = 0.040) than those going into other specialties. Among postinterview students, communication was preferred to be by private, email identification-only chat room. Given neurosurgery resident candidates' interest in collaborating to reduce interview costs, consideration should be given to creating a system that could allow students to coordinate cost sharing between interviewees. Moreover, interviewees should be connected to local students from neurosurgery interest groups as a resource.

  3. Empowering Employees: How Colleges Can Dramatically Reduce Their Medical Costs.

    ERIC Educational Resources Information Center

    Powell, Bill

    1993-01-01

    A plan that offers college employees an incentive to contain health care insurance costs is outlined. It consists of three parts: the institution's offering of coverage for claims above a certain level; an employee deductible; and an accounting system that rewards employees for keeping health care costs down as well as involving them in management…

  4. Subthalamic Nucleus Deep Brain Stimulation May Reduce Medication Costs in Early Stage Parkinson's Disease.

    PubMed

    Hacker, Mallory L; Currie, Amanda D; Molinari, Anna L; Turchan, Maxim; Millan, Sarah M; Heusinkveld, Lauren E; Roach, Jonathon; Konrad, Peter E; Davis, Thomas L; Neimat, Joseph S; Phibbs, Fenna T; Hedera, Peter; Byrne, Daniel W; Charles, David

    2016-01-01

    Subthalamic nucleus deep brain stimulation (STN-DBS) is well-known to reduce medication burden in advanced stage Parkinson's disease (PD). Preliminary data from a prospective, single blind, controlled pilot trial demonstrated that early stage PD subjects treated with STN-DBS also required less medication than those treated with optimal drug therapy (ODT). The purpose of this study was to analyze medication cost and utilization from the pilot trial of DBS in early stage PD and to project 10 year medication costs. Medication data collected at each visit were used to calculate medication costs. Medications were converted to levodopa equivalent daily dose, categorized by medication class, and compared. Medication costs were projected to advanced stage PD, the time when a typical patient may be offered DBS. Medication costs increased 72% in the ODT group and decreased 16% in the DBS+ODT group from baseline to 24 months. This cost difference translates into a cumulative savings for the DBS+ODT group of $7,150 over the study period. Projected medication cost savings over 10 years reach $64,590. Additionally, DBS+ODT subjects were 80% less likely to require polypharmacy compared with ODT subjects at 24 months (p <  0.05; OR = 0.2; 95% CI: 0.04-0.97). STN-DBS in early PD reduced medication cost over the two-year study period. DBS may offer substantial long-term reduction in medication cost by maintaining a simplified, low dose medication regimen. Further study is needed to confirm these findings, and the FDA has approved a pivotal, multicenter clinical trial evaluating STN-DBS in early PD.

  5. Reducing Medication Costs to Prevent Cardiovascular Disease: A Community Guide Systematic Review.

    PubMed

    Njie, Gibril J; Finnie, Ramona K C; Acharya, Sushama D; Jacob, Verughese; Proia, Krista K; Hopkins, David P; Pronk, Nicolaas P; Goetzel, Ron Z; Kottke, Thomas E; Rask, Kimberly J; Lackland, Daniel T; Braun, Lynne T

    2015-11-25

    Hypertension and hyperlipidemia are major cardiovascular disease risk factors. To modify them, patients often need to adopt healthier lifestyles and adhere to prescribed medications. However, patients' adherence to recommended treatments has been suboptimal. Reducing out-of-pocket costs (ROPC) to patients may improve medication adherence and consequently improve health outcomes. This Community Guide systematic review examined the effectiveness of ROPC for medications prescribed for patients with hypertension and hyperlipidemia. We assessed effectiveness and economics of ROPC for medications to treat hypertension, hyperlipidemia, or both. Per Community Guide review methods, reviewers identified, evaluated, and summarized available evidence published from January 1980 through July 2015. Eighteen studies were included in the analysis. ROPC interventions resulted in increased medication adherence for patients taking blood pressure and cholesterol medications by a median of 3.0 percentage points; proportion achieving 80% adherence to medication increased by 5.1 percentage points. Blood pressure and cholesterol outcomes also improved. Nine studies were included in the economic review, with a median intervention cost of $172 per person per year and a median change in health care cost of -$127 per person per year. ROPC for medications to treat hypertension and hyperlipidemia is effective in increasing medication adherence, and, thus, improving blood pressure and cholesterol outcomes. Most ROPC interventions are implemented in combination with evidence-based health care interventions such as team-based care with medication counseling. An overall conclusion about the economics of the intervention could not be reached with the small body of inconsistent cost-benefit evidence.

  6. An Insurer's Care Transition Program Emphasizes Medication Reconciliation, Reduces Readmissions And Costs.

    PubMed

    Polinski, Jennifer M; Moore, Janice M; Kyrychenko, Pavlo; Gagnon, Michael; Matlin, Olga S; Fredell, Joshua W; Brennan, Troyen A; Shrank, William H

    2016-07-01

    Adverse drug events and the challenges of clarifying and adhering to complex medication regimens are central drivers of hospital readmissions. Medication reconciliation programs can reduce the incidence of adverse drug events after discharge, but evidence regarding the impact of medication reconciliation on readmission rates and health care costs is less clear. We studied an insurer-initiated care transition program based on medication reconciliation delivered by pharmacists via home visits and telephone and explored its effects on high-risk patients. We examined whether voluntary program participation was associated with improved medication use, reduced readmissions, and savings net of program costs. Program participants had a 50 percent reduced relative risk of readmission within thirty days of discharge and an absolute risk reduction of 11.1 percent. The program saved $2 for every $1 spent. These results represent real-world evidence that insurer-initiated, pharmacist-led care transition programs, focused on but not limited to medication reconciliation, have the potential to both improve clinical outcomes and reduce total costs of care. Project HOPE—The People-to-People Health Foundation, Inc.

  7. Managing Medical Costs by Reducing Demand for Services: The Missing Element in Health Care Reform.

    ERIC Educational Resources Information Center

    Kelly, Edward K.; And Others

    1994-01-01

    It is argued that higher education institutions can play a major role in health care reform by providing campus cultures that foster healthy lifestyle choices and in turn reduce medical costs. Specific issues discussed include elimination of unnecessary tests, focus on special high-risk populations, and use of advance directives. (MSE)

  8. Reducing Medication Costs to Prevent Cardiovascular Disease: A Community Guide Systematic Review

    PubMed Central

    Finnie, Ramona K.C.; Acharya, Sushama D.; Jacob, Verughese; Proia, Krista K.; Hopkins, David P.; Pronk, Nicolaas P.; Goetzel, Ron Z.; Kottke, Thomas E.; Rask, Kimberly J.; Lackland, Daniel T.; Braun, Lynne T.

    2015-01-01

    Introduction Hypertension and hyperlipidemia are major cardiovascular disease risk factors. To modify them, patients often need to adopt healthier lifestyles and adhere to prescribed medications. However, patients’ adherence to recommended treatments has been suboptimal. Reducing out-of-pocket costs (ROPC) to patients may improve medication adherence and consequently improve health outcomes. This Community Guide systematic review examined the effectiveness of ROPC for medications prescribed for patients with hypertension and hyperlipidemia. Methods We assessed effectiveness and economics of ROPC for medications to treat hypertension, hyperlipidemia, or both. Per Community Guide review methods, reviewers identified, evaluated, and summarized available evidence published from January 1980 through July 2015. Results Eighteen studies were included in the analysis. ROPC interventions resulted in increased medication adherence for patients taking blood pressure and cholesterol medications by a median of 3.0 percentage points; proportion achieving 80% adherence to medication increased by 5.1 percentage points. Blood pressure and cholesterol outcomes also improved. Nine studies were included in the economic review, with a median intervention cost of $172 per person per year and a median change in health care cost of −$127 per person per year. Conclusion ROPC for medications to treat hypertension and hyperlipidemia is effective in increasing medication adherence, and, thus, improving blood pressure and cholesterol outcomes. Most ROPC interventions are implemented in combination with evidence-based health care interventions such as team-based care with medication counseling. An overall conclusion about the economics of the intervention could not be reached with the small body of inconsistent cost-benefit evidence. PMID:26605708

  9. Surgeon ownership in medical device distribution: does it actually reduce healthcare costs?

    PubMed

    Steinmann, John C; Edwards, Charles; Eickmann, Thomas; Carlson, Angela; Blight, Alexis

    2015-01-01

    Surgeon ownership in medical device distribution is a new model that proposes to reduce the costs associated with surgical implants. In surgeon-owned distributorships (SDs), the surgeon becomes the purchaser through ownership and management of a distributorship. The purpose of this study is to determine whether significant cost savings can result from SDs. Five existing SDs were retrospectively reviewed, and their implant pricing was compared with non-SDs. The hospital pricing for implants supplied by the SDs was compared with 2010 pricing from the best contract/capitated rate for like implants from non-SDs. The average first-year cost savings for the SDs was 36%, with US$2,456,521 total savings in 2010. For distributorships in business for over 2 years, the average annual price from the SDs actually decreased by 1.41%. This study demonstrates that SDs are capable of providing substantial healthcare savings through lower implant costs and reduced annual price escalations.

  10. Fitness costs of animal medication: antiparasitic plant chemicals reduce fitness of monarch butterfly hosts.

    PubMed

    Tao, Leiling; Hoang, Kevin M; Hunter, Mark D; de Roode, Jacobus C

    2016-09-01

    The emerging field of ecological immunology demonstrates that allocation by hosts to immune defence against parasites is constrained by the costs of those defences. However, the costs of non-immunological defences, which are important alternatives to canonical immune systems, are less well characterized. Estimating such costs is essential for our understanding of the ecology and evolution of alternative host defence strategies. Many animals have evolved medication behaviours, whereby they use antiparasitic compounds from their environment to protect themselves or their kin from parasitism. Documenting the costs of medication behaviours is complicated by natural variation in the medicinal components of diets and their covariance with other dietary components, such as macronutrients. In the current study, we explore the costs of the usage of antiparasitic compounds in monarch butterflies (Danaus plexippus), using natural variation in concentrations of antiparasitic compounds among plants. Upon infection by their specialist protozoan parasite Ophryocystis elektroscirrha, monarch butterflies can selectively oviposit on milkweed with high foliar concentrations of cardenolides, secondary chemicals that reduce parasite growth. Here, we show that these antiparasitic cardenolides can also impose significant costs on both uninfected and infected butterflies. Among eight milkweed species that vary substantially in their foliar cardenolide concentration and composition, we observed the opposing effects of cardenolides on monarch fitness traits. While high foliar cardenolide concentrations increased the tolerance of monarch butterflies to infection, they reduced the survival rate of caterpillars to adulthood. Additionally, although non-polar cardenolide compounds decreased the spore load of infected butterflies, they also reduced the life span of uninfected butterflies, resulting in a hump-shaped curve between cardenolide non-polarity and the life span of infected butterflies

  11. Long-Term Care Benefits May Reduce End-of-Life Medical Care Costs

    PubMed Central

    Evered, Sharrilyn R.; Center, Bruce A.

    2014-01-01

    Abstract This study explores whether personal care services for functionally dependent or cognitively impaired individuals paid for by a long-term care (LTC) insurance policy can reduce health care utilization and costs at the end of life. This retrospective study uses propensity score matching methodology, hierarchical multiple regression, and Poisson regression to compare 830 decedents who utilized benefits from a voluntary LTC insurance plan (“claimants”) to 6860 decedents who never purchased coverage but were similar to claimants on 17 variables, including age, sex, frailty, burden of illness markers, and propensity to have needed LTC services. Claimants using LTC benefits experienced significantly lower health care costs at end of life, including 14% lower total medical costs, 13% lower pharmacy costs, 35% lower inpatient admission costs, and 16% lower outpatient visit costs. They also experienced 8% fewer inpatient admissions and 10% fewer inpatient days. The presence of dementia at the end of life moderated these effects. This study suggests that use of insurance-based LTC services measurably reduces health care expenditures at the end of life. (Population Health Management 2014;17:332–339) PMID:24784144

  12. Reducing Clinical Trial Monitoring Resource Allocation and Costs Through Remote Access to Electronic Medical Records

    PubMed Central

    Uren, Shannon C.; Kirkman, Mitchell B.; Dalton, Brad S.; Zalcberg, John R.

    2013-01-01

    Purpose: With electronic medical records (eMRs), the option now exists for clinical trial monitors to perform source data verification (SDV) remotely. We report on a feasibility study of remote access to eMRs for SDV and the potential advantages of such a process in terms of resource allocation and cost. Methods: The Clinical Trials Unit at the Peter MacCallum Cancer Centre, in collaboration with Novartis Pharmaceuticals Australia, conducted a 6-month feasibility study of remote SDV. A Novartis monitor was granted dedicated software and restricted remote access to the eMR portal of the cancer center, thereby providing an avenue through which perform SDV. Results: Six monitoring visits were conducted during the study period, four of which were performed remotely. The ability to conduct two thirds of the monitoring visits remotely in this complex phase III study resulted in an overall cost saving to Novartis. Similarly, remote monitoring eased the strain on internal resources, particularly monitoring space and hospital computer terminal access, at the cancer center. Conclusion: Remote access to patient eMRs for SDV is feasible and is potentially an avenue through which resources can be more efficiently used. Although this feasibility study involved limited numbers, there is no limit to scaling these processes to any number of patients enrolled onto large clinical trials. PMID:23633977

  13. Reducing medical waste.

    PubMed

    Conrardy, Julie; Hillanbrand, Mary; Myers, Sandra; Nussbaum, George F

    2010-06-01

    Medical waste is a necessary by-product of any hospital environment; however, the majority of regulated medical waste is produced in the OR from the use of disposable surgical supplies (eg, drapes, gowns, basins, gloves, sponges). We conducted a concept comparison project in the ORs of two large medical centers in Bethesda, Maryland, and Washington, DC, to evaluate the effects of using reusable surgical basins, gowns, and table and Mayo stand covers in place of disposable products. Survey results indicated that surgeons and surgical technologists found the reusable products to be preferable to the disposable products currently in use. In addition, using reusable products provided a means to decrease regulated medical waste generated in the OR by an average of 65% as well as reduce the cost of waste disposal. AORN recommends evaluating the environmental effects of using reusable, reposable, and disposable products; our findings provide evidence that may be useful to surgical facilities that seek to adopt a "green" approach.

  14. Medical Care Expenditures for Individuals with Prediabetes: The Potential Cost Savings in Reducing the Risk of Developing Diabetes.

    PubMed

    Khan, Tamkeen; Tsipas, Stavros; Wozniak, Gregory

    2017-02-13

    The United States has 86 million adults with prediabetes. Individuals with prediabetes can prevent or delay the development of type 2 diabetes through lifestyle modifications such as participation in the National Diabetes Prevention Program (DPP), thereby mitigating the medical and economic burdens associated with diabetes. A cohort analysis of a commercially insured population was conducted using individual-level claims data from Truven Health MarketScan(®) Lab Database to identify adults with prediabetes, track whether they develop diabetes, and compare medical expenditures for those who are newly diagnosed with diabetes to those who are not. This study then illustrates how reducing the risk of developing diabetes by participation in an evidence-based lifestyle change program could yield both positive net savings on medical care expenditures and return on investment (ROI). Annual expenditures are found to be nearly one third higher for those who develop diabetes in subsequent years relative to those who do not transition from prediabetes to diabetes, with an average difference of $2671 per year. At that cost differential, the 3-year ROI for a National DPP is estimated to be as high as 42%. The results show the importance and economic benefits of participation in lifestyle intervention programs to prevent or delay the onset of type 2 diabetes.

  15. Cost savings from reduced catheter-related bloodstream infection after simulation-based education for residents in a medical intensive care unit.

    PubMed

    Cohen, Elaine R; Feinglass, Joe; Barsuk, Jeffrey H; Barnard, Cynthia; O'Donnell, Anna; McGaghie, William C; Wayne, Diane B

    2010-04-01

    Interventions to reduce preventable complications such as catheter-related bloodstream infections (CRBSI) can also decrease hospital costs. However, little is known about the cost-effectiveness of simulation-based education. The aim of this study was to estimate hospital cost savings related to a reduction in CRBSI after simulation training for residents. This was an intervention evaluation study estimating cost savings related to a simulation-based intervention in central venous catheter (CVC) insertion in the Medical Intensive Care Unit (MICU) at an urban teaching hospital. After residents completed a simulation-based mastery learning program in CVC insertion, CRBSI rates declined sharply. Case-control and regression analysis methods were used to estimate savings by comparing CRBSI rates in the year before and after the intervention. Annual savings from reduced CRBSIs were compared with the annual cost of simulation training. Approximately 9.95 CRBSIs were prevented among MICU patients with CVCs in the year after the intervention. Incremental costs attributed to each CRBSI were approximately $82,000 in 2008 dollars and 14 additional hospital days (including 12 MICU days). The annual cost of the simulation-based education was approximately $112,000. Net annual savings were thus greater than $700,000, a 7 to 1 rate of return on the simulation training intervention. A simulation-based educational intervention in CVC insertion was highly cost-effective. These results suggest that investment in simulation training can produce significant medical care cost savings.

  16. Reducing Life-Cycle Costs.

    ERIC Educational Resources Information Center

    Roodvoets, David L.

    2003-01-01

    Presents factors to consider when determining roofing life-cycle costs, explaining that costs do not tell the whole story; discussing components that should go into the decision (cost, maintenance, energy use, and environmental costs); and concluding that important elements in reducing life-cycle costs include energy savings through increased…

  17. Reducing Life-Cycle Costs.

    ERIC Educational Resources Information Center

    Roodvoets, David L.

    2003-01-01

    Presents factors to consider when determining roofing life-cycle costs, explaining that costs do not tell the whole story; discussing components that should go into the decision (cost, maintenance, energy use, and environmental costs); and concluding that important elements in reducing life-cycle costs include energy savings through increased…

  18. Strategy Reduces Construction Costs.

    ERIC Educational Resources Information Center

    Flynn, Jim; Petters, Walt

    2000-01-01

    Reveals how a Florida school district had success when switching from a design-bid-build approach for school construction to a construction management (CM) at risk. The CM at risk process involving project delivery options, maximum price guarantees, and the school district's benefits in cost savings accrued are addressed. (GR)

  19. Leveraging Technology to Reduce Patient Transaction Costs.

    PubMed

    Edlow, Richard C

    2015-01-01

    Medical practices are under significant pressure to provide superior customer service in an environment of declining or flat reimbursement. The solution for many practices involves the integration of a variety of third-party technologies that conveniently interface with one's electronic practice management and medical records systems. Typically, the applications allow the practice to reduce the cost of each patient interaction. Drilling down to quantify the cost of each individual patient interaction helps to determine the practicality of implementation.

  20. Managing Costs and Medical Information

    Cancer.gov

    People with cancer may face major financial challenges and need help dealing with the high costs of care. Cancer treatment can be very expensive, even when you have insurance. Learn ways to manage medical information, paperwork, bills, and other records.

  1. Controlling Medical Supply Costs.

    DTIC Science & Technology

    1984-09-01

    Biometrics Division Directorate of Health Care Support Office of the Surgeon General (HQ AFMSC /SGSB, Brooks AFB TX) 3. Logistics Division Directorate...of Health Care Support Office of the Surgeon General (HQ AFMSC /SGSL, Brooks AFB TX) 4. Medical Resource Management Office (USAF Hospital, K. I. Sawyer... AFMSC /SGSB. To further define the productivity factors used in this study, the S USAF Hospital, K. I. Savyer/SGM office provided productivity data from

  2. Reducing medical claims cost to Ghana's National Health Insurance scheme: a cross-sectional comparative assessment of the paper- and electronic-based claims reviews.

    PubMed

    Nsiah-Boateng, Eric; Asenso-Boadi, Francis; Dsane-Selby, Lydia; Andoh-Adjei, Francis-Xavier; Otoo, Nathaniel; Akweongo, Patricia; Aikins, Moses

    2017-02-06

    A robust medical claims review system is crucial for addressing fraud and abuse and ensuring financial viability of health insurance organisations. This paper assesses claims adjustment rate of the paper- and electronic-based claims reviews of the National Health Insurance Scheme (NHIS) in Ghana. The study was a cross-sectional comparative assessment of paper- and electronic-based claims reviews of the NHIS. Medical claims of subscribers for the year, 2014 were requested from the claims directorate and analysed. Proportions of claims adjusted by the paper- and electronic-based claims reviews were determined for each type of healthcare facility. Bivariate analyses were also conducted to test for differences in claims adjustments between healthcare facility types, and between the two claims reviews. The electronic-based review made overall adjustment of 17.0% from GHS10.09 million (USD2.64 m) claims cost whilst the paper-based review adjusted 4.9% from a total of GHS57.50 million (USD15.09 m) claims cost received, and the difference was significant (p < 0.001). However, there were no significant differences in claims cost adjustment rate between healthcare facility types by the electronic-based (p = 0.0656) and by the paper-based reviews (p = 0.6484). The electronic-based review adjusted significantly higher claims cost than the paper-based claims review. Scaling up the electronic-based review to cover claims from all accredited care providers could reduce spurious claims cost to the scheme and ensure long term financial sustainability.

  3. Medical abortion and manual vacuum aspiration for legal abortion protect women's health and reduce costs to the health system: findings from Colombia.

    PubMed

    Rodriguez, Maria Isabel; Mendoza, Willis Simancas; Guerra-Palacio, Camilo; Guzman, Nelson Alvis; Tolosa, Jorge E

    2015-02-01

    The majority of abortions in Colombia continue to take place outside the formal health system under a range of conditions, with the majority of women obtaining misoprostol from a thriving black market for the drug and self-administering the medication. We conducted a cost analysis to compare the costs to the health system of three approaches to the provision of abortion care in Colombia: post-abortion care for complications of unsafe abortions, and for legal abortions in a health facility, misoprostol-only medical abortion and vacuum aspiration abortion. Hospital billing records from three institutions, two large maternity hospitals and one specialist reproductive health clinic, were analysed for procedure and complication rates, and costs by diagnosis. The majority of visits (94%) were to the two hospitals for post-abortion care; the other 6% were for legal abortions. Only one minor complication was found among the women having legal abortions, a complication rate of less than 1%. Among the women presenting for post-abortion care, 5% had complications during their treatment, mainly from infection or haemorrhage. Legal abortions were associated not only with far fewer complications for women, but also lower costs for the health system than for post-abortion care. We calculated based on our findings that for every 1,000 women receiving post-abortion care instead of a legal abortion within the health system, 16 women experienced avoidable complications, and the health system spent US $48,000 managing them. Increasing women's access to safe abortion care would not only reduce complications for women, but would also be a cost-saving strategy for the health system. Copyright © 2015 Reproductive Health Matters. Published by Elsevier Ltd. All rights reserved.

  4. Cost analysis of glaucoma medications.

    PubMed

    Rylander, Nathan R; Vold, Steven D

    2008-01-01

    To provide patients and health care providers with calculated yearly costs of topical glaucoma medications. Prospective, experimental, laboratory study. Using the average wholesale price and common dosing patterns, we calculated the theoretical yearly cost of glaucoma medications. Calculated yearly cost ranged from $150.81 for generic timolol maleate 0.5% (Falcon Pharmaceuticals, Ltd, Fort Worth, Texas, USA) to $697.42 for Cosopt (Merck & Co, West Point, Pennsylvania, USA), and as high as $873.98 for a three-times-daily dose of Alphagan P 0.15% (Allergan, Inc, Irvine, California, USA). Among brand name beta-blockers, yearly cost ranged between $203.47 for Timoptic 0.5% (Merck & Co) and $657.24 for Betoptic S (Alcon Laboratories, Fort Worth, Texas, USA). Generic beta-blockers consistently were more economical than their brand-name counterparts. Yearly cost of prostaglandin analogs ranged from $427.69 for Travatan (Alcon) to $577.62 for Lumigan (Allergan). The two carbonic anhydrase inhibitors Azopt (Alcon) and Trusopt (Merck & Co), yielded similar economic profiles. Alphagan P 0.15% had yearly calculated costs of $559.08 for twice daily dosing per eye. The generic selective alpha(2)-agonist brimonidine tartrate 0.2% (Bausch & Lomb Pharmaceuticals, Tampa, Florida, USA) costs approximately $352.89 and $529.34 per year for the respective two and three drops daily per eye regimens. Nonselective beta-blockers remain the most inexpensive class of glaucoma medications. Bottle size may impact yearly glaucoma medication expenditures. Costs of glaucoma medications may impact decision making in the medical management of glaucoma.

  5. Multidisciplinary predialysis education reduced the inpatient and total medical costs of the first 6 months of dialysis in incident hemodialysis patients.

    PubMed

    Yu, Yu-Jen; Wu, I-Wen; Huang, Chun-Yu; Hsu, Kuang-Hung; Lee, Chin-Chan; Sun, Chio-Yin; Hsu, Heng-Jung; Wu, Mai-Szu

    2014-01-01

    The multidisciplinary pre-dialysis education (MPE) retards renal progression, reduce incidence of dialysis and mortality of CKD patients. However, the financial benefit of this intervention on patients starting hemodialysis has not yet been evaluated in prospective and randomized trial. We studied the medical expenditure and utilization incurred in the first 6 months of dialysis initiation in 425 incident hemodialysis patients who were randomized into MPE and non-MPE groups before reaching end-stage renal disease. The content of the MPE was standardized in accordance with the National Kidney Foundation Dialysis Outcomes Quality Initiative guidelines. The mean age of study patients was 63.8±13.2 years, and 221 (49.7%) of them were men. The mean serum creatinine level and estimated glomerular filtration rate was 6.1±4.0 mg/dL and 7.6±2.9 mL⋅min(-1)⋅1.73 m(-2), respectively, at dialysis initiation. MPE patients tended to have lower total medical cost in the first 6 months after hemodialysis initiation (9147.6±0.1 USD/patient vs. 11190.6±0.1 USD/patient, p = 0.003), fewer in numbers [0 (1) vs. 1 (2), p<0.001] and length of hospitalization [0 (15) vs. 8 (27) days, p<0.001], and also lower inpatient cost [0 (2617.4) vs. 1559,4 (5019.6) USD/patient, p<0.001] than non-MPE patients, principally owing to reduced cardiovascular hospitalization and vascular access-related surgeries. The decreased inpatient and total medical cost associated with MPE were independent of patients' demographic characteristics, concomitant disease, baseline biochemistry and use of double-lumen catheter at initiation of hemodialysis. Participation of multidisciplinary education in pre-dialysis period was independently associated with reduction in the inpatient and total medical expenditures of the first 6 months post-dialysis owing to decreased inpatient service utilization secondary to cardiovascular causes and vascular access-related surgeries. ClinicalTrials.gov NCT00644046.

  6. Cost analysis of glaucoma medications.

    PubMed

    Vold, S D; Wiggins, D A; Jackimiec, J

    2000-04-01

    To evaluate the yearly cost in 1998 of glaucoma medications to patients and to the Health Plan at a university-affiliated teaching hospital with its own health maintenance organization. Data concerning Health Plan glaucoma-medication prescriptions for 1998 were retrieved from the hospital pharmacy database. The most costly medication per patient per year was latanoprost (Xalatan; Pharmacia & Upjohn, Kalamazoo, MI [$337]), followed by betaxolol hydrochloride (Betoptic-S; Alcon, Fort Worth, TX [$336]), dorzolamide (Trusopt; Merck & Co., West Point, PA [$288]), brimonidine tartrate (Alphagan; Allergan Pharmaceuticals, Irvine, CA [$260]), timolol maleate 0.5% in a gel-forming solution (Timoptic-XE 0.5%; Merck & Co., West Point, PA [$199]), levobunolol hydrochloride (Betagan; Allergan Pharmaceuticals, Irvine, CA [$195]), and generic timolol maleate 0.5% ($132). Cost per unit was greatest for Betoptic-S ($51), exceeding that of Trusopt ($43) and Xalatan ($43), Alphagan ($42), Betagan ($38), Timoptic-XE 0.5% ($32), and timolol maleate 0.5% ($27). Variability in the cost of medications may influence the long-term medical management of glaucoma patients.

  7. Simulated ward round: reducing costs, not outcomes.

    PubMed

    Ford, Helen; Cleland, Jennifer; Thomas, Ian

    2017-02-01

    Distractions and interruptions on the ward pose substantial patient safety risks, but medical students receive little training on their management. Although there is some evidence that medical students can be taught how to manage distractions and interruptions in a simulated ward environment, the only model to date is based on individual feedback, which is resource-expensive, mitigating curricular integration. Our aim was to assess the educational utility of a cost-efficient approach to a patient safety-focused simulated ward round. Twenty-three of 55 final-year medical students took part in a cost-reduced simulated ward round. Costs were minimised by providing group rather than individualised feedback, thereby shortening the duration of each simulation and reducing the number of interruptions. The utility of the simulation was assessed via student evaluation and performance on a patient safety station of an objective structured clinical examination (OSCE). The direct costs of the simulation were more than 50 per cent lower per student compared with the original study, mostly as a result of a reduction in the time that faculty members took to give feedback. Students managed distractions better and received higher scores in the OSCE station than those who had not undergone the ward round. Group feedback was evaluated positively by most participants: 94 per cent of those who provided feedback agreed or strongly agreed that the simulation would make them a safer doctor and would improve their handling of distractions. Our aim was to assess the educational utility of a cost-efficient approach to a patient safety-focused simulated ward round DISCUSSION: The costs of a simulated ward round can be significantly reduced whilst maintaining educational utility. These findings should encourage medical schools to integrate ward simulation into curricula. © 2016 John Wiley & Sons Ltd.

  8. Tandem motors reduce well costs

    SciTech Connect

    Hooper, M.; Daigle, C.; Crowe, R.

    1995-10-01

    The new generation of tandem mud motors that recently appeared on the drilling scene is significantly affecting drilling efficiency worldwide. These motors provide drillers with increased horsepower at the bit, higher torque, and faster rates of penetration (ROP). With advanced engineering and more durable materials, motor life is being extended, thereby increasing the time between bit trips and reducing drilling costs. This article reviews the performance, design, and operation of these motors.

  9. Bioventing reduces soil cleanup costs

    SciTech Connect

    Leahy, M.C.; Erickson, G.P.

    1995-08-01

    An offshoot technology from soil venting, bioventing offers a win-win solution for soils contaminated with volatile organic compounds (VOCs) and nonvolatile contaminants such as diesel and fuel oil. Using low air flowrates through permeable soils, bioventing injects sufficient oxygen to support naturally-occurring bacteria, which biodegraded the VOCs and other contaminants into benign byproducts. Waste gas can be directly discharged to atmosphere without further treatment. This results in no offgas treatment required. Bioventing is a cost-effective alternative to traditional soil-venting techniques. Soil venting uses air to volatilize organic-compound contamination from the vadose zone, the unsaturated soil layer above groundwater. Unfortunately, this simple-and-fast approach creates a waste offgas that requires further treatment before discharge, thus adding significantly to overall project costs. In contrast, bioventing uses low air flowrates, which require lower capital and operating costs. No offgas treatment further reduces equipment and operating costs and often eliminates air permitting. As in all treatment strategies, the process must meet the cleanup objectives. Bioventing is an alternative technique making inroads into refining and petrochemical soil-remediation applications.

  10. A World Wide Web-based antimicrobial stewardship program improves efficiency, communication, and user satisfaction and reduces cost in a tertiary care pediatric medical center.

    PubMed

    Agwu, Allison L; Lee, Carlton K K; Jain, Sanjay K; Murray, Kara L; Topolski, Jason; Miller, Robert E; Townsend, Timothy; Lehmann, Christoph U

    2008-09-15

    Antimicrobial stewardship programs aim to reduce inappropriate hospital antimicrobial use. At the Johns Hopkins Children's Medical and Surgical Center (Baltimore, MD), we implemented a World Wide Web-based antimicrobial restriction program to address problems with the existing restriction program. A user survey identified opportunities for improvement of an existing antimicrobial restriction program and resulted in subsequent design, implementation, and evaluation of a World Wide Web-based antimicrobial restriction program at a 175-bed, tertiary care pediatric teaching hospital. The program provided automated clinical decision support, facilitated approval, and enhanced real-time communication among prescribers, pharmacists, and pediatric infectious diseases fellows. Approval status, duration, and rationale; missing request notifications; and expiring approvals were stored in a database that is accessible via a secure Intranet site. Before and after implementation of the program, user satisfaction, reports of missed and/or delayed doses, antimicrobial dispensing times, and cost were evaluated. After implementation of the program, there was a $370,069 reduction in projected annual cost associated with restricted antimicrobial use and an 11.6% reduction in the number of dispensed doses. User satisfaction increased from 22% to 68% and from 13% to 69% among prescribers and pharmacists, respectively. There were 21% and 32% reductions in the number of prescriber reports of missed and delayed doses, respectively, and there was a 37% reduction in the number of pharmacist reports of delayed approvals; measured dispensing times were unchanged (P = .24). In addition, 40% fewer restricted antimicrobial-related phone calls were noted by the pharmacy. The World Wide Web-based antimicrobial approval program led to improved communication, more-efficient antimicrobial administration, increased user satisfaction, and significant cost savings. Integrated tools, such as this World

  11. Rotavirus Vaccine Cut Kids' Hospitalization, Medical Costs

    MedlinePlus

    ... fullstory_167720.html Rotavirus Vaccine Cut Kids' Hospitalization, Medical Costs Virus a common cause of diarrhea among ... a savings of more than $1 billion in medical costs, the researchers added. Rotavirus is a common ...

  12. Accounting for future costs in medical cost-effectiveness analysis.

    PubMed

    Meltzer, D

    1997-02-01

    Most medical cost-effectiveness analyses include future costs only for related illnesses, but this approach is controversial. This paper demonstrates that cost-effectiveness analysis is consistent with lifetime utility maximization only if it includes all future medical and non-medical expenditures. Estimates of the magnitude of these future costs suggest that they may substantially alter both the absolute and relative cost-effectiveness of medical interventions, particularly when an intervention increases length of life more than quality of life. In older populations, current methods overstate the cost-effectiveness of interventions which extend life compared to interventions which improve the quality of life.

  13. Cost-effectiveness of medical primary prevention strategies to reduce absolute risk of cardiovascular disease in Tanzania: a Markov modelling study.

    PubMed

    Ngalesoni, Frida N; Ruhago, George M; Mori, Amani T; Robberstad, Bjarne; Norheim, Ole F

    2016-05-17

    Cardiovascular disease (CVD) is a growing cause of mortality and morbidity in Tanzania, but contextualized evidence on cost-effective medical strategies to prevent it is scarce. We aim to perform a cost-effectiveness analysis of medical interventions for primary prevention of CVD using the World Health Organization's (WHO) absolute risk approach for four risk levels. The cost-effectiveness analysis was performed from a societal perspective using two Markov decision models: CVD risk without diabetes and CVD risk with diabetes. Primary provider and patient costs were estimated using the ingredients approach and step-down methodologies. Epidemiological data and efficacy inputs were derived from systematic reviews and meta-analyses. We used disability- adjusted life years (DALYs) averted as the outcome measure. Sensitivity analyses were conducted to evaluate the robustness of the model results. For CVD low-risk patients without diabetes, medical management is not cost-effective unless willingness to pay (WTP) is higher than US$1327 per DALY averted. For moderate-risk patients, WTP must exceed US$164 per DALY before a combination of angiotensin converting enzyme inhibitor (ACEI) and diuretic (Diu) becomes cost-effective, while for high-risk and very high-risk patients the thresholds are US$349 (ACEI, calcium channel blocker (CCB) and Diu) and US$498 per DALY (ACEI, CCB, Diu and Aspirin (ASA)) respectively. For patients with CVD risk with diabetes, a combination of sulfonylureas (Sulf), ACEI and CCB for low and moderate risk (incremental cost-effectiveness ratio (ICER) US$608 and US$115 per DALY respectively), is the most cost-effective, while adding biguanide (Big) to this combination yielded the most favourable ICERs of US$309 and US$350 per DALY for high and very high risk respectively. For the latter, ASA is also part of the combination. Medical preventive cardiology is very cost-effective for all risk levels except low CVD risk. Budget impact analyses and

  14. Direct medical cost of stroke in Singapore.

    PubMed

    Ng, Charmaine Shuyu; Toh, Matthias Paul Han Sim; Ng, Jiaying; Ko, Yu

    2015-10-01

    Globally, stroke is recognized as one of the main causes of long-term disability, accounting for approximately 5·7 million deaths each year. It is a debilitating and costly chronic condition that consumes about 2-4% of total healthcare expenditure. To estimate the direct medical cost associated with stroke in Singapore in 2012 and to determine associated predictors. The National Healthcare Group Chronic Disease Management System database was used to identify patients with stroke between the years 2006 and 2012. Estimated stroke-related costs included hospitalizations, accident and emergency room visits, outpatient physician visits, laboratory tests, and medications. A total of 700 patients were randomly selected for the analyses. The mean annual direct medical cost was found to be S$12 473·7, of which 93·6% were accounted for by inpatient services, 4·9% by outpatient services, and 1·5% by A&E services. Independent determinants of greater total costs were stroke types, such as ischemic stroke (P = 0·005), subarachnoid hemorrhage (P < 0·001) and intracerebral haemorrhage (P < 0·001), shorter poststroke period, more than one complications (P = 0·045), and a greater number of comorbidities (P = 0·001). There is a considerable economic burden associated with stroke in Singapore. The type of stroke, length of poststroke period, and stroke complications and comorbidities are found to be associated with the total costs. Efforts to reduce inpatient costs and to allocate health resources to focus on the primary prevention of stroke should become a priority. © 2015 World Stroke Organization.

  15. Carvedilol reduces the costs of medical care in severe heart failure: an economic analysis of the COPERNICUS study applied to the United Kingdom.

    PubMed

    Stewart, Simon; McMurray, John J V; Hebborn, Ansgar; Coats, Andrew J S; Packer, Milton

    2005-04-08

    The aim of this study was to determine the effects of carvedilol on the costs related to the treatment of severe chronic heart failure (CHF). Costs for the treatment for heart failure within the National Health Service (NHS) in the United Kingdom (UK) were applied to resource utilisation data prospectively collected in all patients randomized into the Carvedilol Prospective Randomized Cumulative Survival (COPERNICUS) Study. Unit-specific, per diem (hospital bed day) costs were used to calculate expenditures due to hospitalizations. We also included costs of carvedilol treatment, general practitioner surgery/office visits, hospital out-patient clinic visits and nursing home care based on estimates derived from validated patterns of clinical practice in the UK. The estimated cost of carvedilol therapy and related ambulatory care for the 1156 patients assigned to active treatment was pound530,771 ( pound44.89 per patient/month of follow-up). However, patients assigned to carvedilol were hospitalised less often and accumulated fewer and less expensive days of admission. Consequently, the total estimated cost of hospital care was pound3.49 million in the carvedilol group compared with pound4.24 million for the 1133 patients in the placebo arm. The cost of post-discharge care was also less in the carvedilol than in the placebo group ( pound479,200 vs. pound548,300). Overall, the cost per patient treated in the carvedilol group was pound3948 compared to pound4279 in the placebo group. This equated to a cost of pound385.98 vs. pound434.18, respectively, per patient/month of follow-up: an 11.1% reduction in health care costs in favour of carvedilol. These findings suggest that not only can carvedilol treatment increase survival and reduce hospital admissions in patients with severe CHF but that it can also cut costs in the process.

  16. Daily cost of glaucoma medications in China.

    PubMed

    Gao, Ying; Wu, Lingling; Li, Aijun

    2007-01-01

    To determine and compare the daily cost of various glaucoma medications in China. The majority of glaucoma medications commercially available in China were included in this research. The total number of drops in 1 bottle of each medication was counted drop by drop. The mean volume per bottle of each medication was calculated. The cost per drop, number of days for both eyes usage per bottle, and daily cost was calculated. (1) The volume per drop ranged from 0.03 mL (brinzolamide 1%, travoprost 0.004%, bimatoprost 0.03%, and latanoprost 0.005%) to 0.05 mL (timolol 0.5%-Chengrui and pilocarpine 0.5% and 2%-Zhenrui). (2) The cost per bottle ranged from $0.69 (US dollar) (timolol 0.5%-Malaisuan Saimaluo'er) to $40.78 (latanoprost 0.005%). (3) The number of days for both eyes usage per bottle ranged from 52 days (bimatoprost 0.03%) to 11 days (pilocarpine nitrate 0.5%-Zhenrui). (4) The daily cost for both eyes usage from expensive to cheap were latanoprost 0.005%-$0.91, travoprost 0.004%-$0.77, brimonidine 0.2%-$0.61, bimatoprost 0.03%-$0.46, D-timolol 1%-$0.36, brinzolamide 1%-$0.34, pilocarpine 2%-Zhenrui-$0.28, levobunolol 0.5%-$0.25, betaxolol 0.25%-$0.24, pilocarpine 0.5%-Zhenrui-$0.18, pilocarpine 2%-Huming-$0.16, carteolol 1%-Mikelan-$0.15, carteolol 2%-Mikelan-$0.15, pilocarpine 1%-Huming-$0.10, timolol 0.5%-Chengrui-$0.08, timolol 0.5%-Malaisuan Saimaluo'er-$0.03. The daily cost of glaucoma medications in China ranged much more wildly than developed countries. These data may be useful in selecting medications for glaucoma therapy. The ophthalmic solution of prostaglandins is powerful in reducing intraocular pressure. However, its high price should be considered when selecting glaucoma medications in China.

  17. A Probabilistic Model for Reducing Medication Errors

    PubMed Central

    Nguyen, Phung Anh; Syed-Abdul, Shabbir; Iqbal, Usman; Hsu, Min-Huei; Huang, Chen-Ling; Li, Hsien-Chang; Clinciu, Daniel Livius; Jian, Wen-Shan; Li, Yu-Chuan Jack

    2013-01-01

    Background Medication errors are common, life threatening, costly but preventable. Information technology and automated systems are highly efficient for preventing medication errors and therefore widely employed in hospital settings. The aim of this study was to construct a probabilistic model that can reduce medication errors by identifying uncommon or rare associations between medications and diseases. Methods and Finding(s) Association rules of mining techniques are utilized for 103.5 million prescriptions from Taiwan’s National Health Insurance database. The dataset included 204.5 million diagnoses with ICD9-CM codes and 347.7 million medications by using ATC codes. Disease-Medication (DM) and Medication-Medication (MM) associations were computed by their co-occurrence and associations’ strength were measured by the interestingness or lift values which were being referred as Q values. The DMQs and MMQs were used to develop the AOP model to predict the appropriateness of a given prescription. Validation of this model was done by comparing the results of evaluation performed by the AOP model and verified by human experts. The results showed 96% accuracy for appropriate and 45% accuracy for inappropriate prescriptions, with a sensitivity and specificity of 75.9% and 89.5%, respectively. Conclusions We successfully developed the AOP model as an efficient tool for automatic identification of uncommon or rare associations between disease-medication and medication-medication in prescriptions. The AOP model helps to reduce medication errors by alerting physicians, improving the patients’ safety and the overall quality of care. PMID:24312659

  18. Non-medical costs of colonoscopy

    PubMed Central

    Kempiński, Radosław; Michałowicz, Jerzy; Poniewierka, Elżbieta

    2014-01-01

    Colorectal cancer is one of the most common malignancies in Europe and North America. Colonoscopy done every 10 years beginning at age 50 is the preferred method of screening. In Poland and some other countries examinations are offered to subjects free of charge. However, as well as direct medical costs there are direct non-medical costs, which include the cost of transportation and costs related to caregivers’ time, and indirect costs, which are costs related to patients’ time. These costs essentially augment the total societal costs of colonoscopy. PMID:25396000

  19. Can disease management reduce health care costs by improving quality?

    PubMed

    Fireman, Bruce; Bartlett, Joan; Selby, Joe

    2004-01-01

    Disease management (DM) promises to achieve cost savings by improving the quality of care for chronic diseases. During the past decade the Permanente Medical Group in Northern California has implemented extensive DM programs. Examining quality indicators, utilization, and costs for 1996-2002 for adults with four conditions, we find evidence of substantial quality improvement but not cost savings. The causal pathway--from improved care to reduced morbidity to cost savings--has not produced sufficient savings to offset the rising costs of improved care. We conclude that the rationale for DM programs, like the rationale for any medical treatments, should rest on their effectiveness and value.

  20. Do hospital mergers reduce costs?

    PubMed

    Schmitt, Matt

    2017-03-01

    Proponents of hospital consolidation claim that mergers lead to significant cost savings, but there is little systematic evidence backing these claims. For a large sample of hospital mergers between 2000 and 2010, I estimate difference-in-differences models that compare cost trends at acquired hospitals to cost trends at hospitals whose ownership did not change. I find evidence of economically and statistically significant cost reductions at acquired hospitals. On average, acquired hospitals realize cost savings between 4 and 7 percent in the years following the acquisition. These results are robust to a variety of different control strategies, and do not appear to be easily explained by post-merger changes in service and/or patient mix. I then explore several extensions of the results to examine (a) whether the acquiring hospital/system realizes cost savings post-merger and (b) if cost savings depend on the size of the acquirer and/or the geographic overlap of the merging hospitals. Copyright © 2017 Elsevier B.V. All rights reserved.

  1. The Costs and Risks of Medical Care

    PubMed Central

    McPhee, Stephen J.; Myers, Lois P.; Schroeder, Steven A.

    1982-01-01

    Understanding the costs and risks of medical care, as well as the benefits, is essential to good medical practice. The literature on this topic transcends disciplines, making it a challenge for clinicians and medical educators to compile information on costs and risks for use in patient care. This annotated bibliography presents summaries of pertinent references on (1) financial costs of care, (2) excessive use of medical services, (3) clinical risks of care, (4) decision analysis, (5) cost-benefit analyses, (6) factors affecting physician use of services and (7) strategies to improve physician ordering patterns. PMID:6814071

  2. House Construction: How To Reduce Costs

    Treesearch

    Jerry O. Newman; Norman C. Teter; Constance D. O' Brien

    1969-01-01

    You're building a house and want to keep down the cost. How can you do it? First, plan carefully "on paper" before you start construction. By doing so, you can avoid costly mistakesinthebuildingandinthe purchase of materials. Careful planning and proper design will reduce not only the initial cost but also the cost of furnishings, utilities, and...

  3. New pharmaceuticals reduce cost of illness.

    PubMed

    Hansen, R W

    1986-06-01

    The cost of illness includes not only the funds required to treat illness, but also the effect on the patient's quality of life. Recent concern about rising health costs have focused on the direct expenditures without noting that the cost of illness in terms of mortality and morbidity has declined significantly. Pharmaceuticals have played a major role in reducing the total cost of illness. Several studies of the cost-effectiveness of past introductions of vaccines and pharmaceuticals reveal large cost savings. Although the focus of most studies has been on major advances, the continuing process of less dramatic therapeutic improvements has significantly trimmed the cost of illness. Cost-benefit studies of new drugs or changes in drug use, while more difficult to perform, make it possible to influence the selection of therapy. Since pharmaceuticals represent less than 10% of total treatment costs, reduction in the cost of pharmaceutical products can only have a minor impact on the total cost of illness. Pharmaceuticals can reduce the cost of illness by providing alternative therapies that reduce direct treatment cost or improve the public health.

  4. RVU costing in a medical group practice.

    PubMed

    Berlin, M F; Faber, B P; Berlin, L M

    1997-10-01

    As risk-and-reward reimbursement arrangements proliferate, medical group practices should use cost accounting to measure costs of services delivered by physicians. The resource-based relative value scale (RBRVS) is a method of determining physicians' fees on the basis of the various resources used to provide procedures or services. Two cost-per-procedure methods can be used in RBRVS cost accounting. One method uses relative value units (RVUs), and the other uses component RVUs, which comprise work, practice, and malpractice costs. Though the two methods produce different calculated costs, using both together can produce a cost range medical practice administrators can use to ensure that the costs of delivering services are reimbursed adequately.

  5. A modified method of activity-based costing for objectively reducing cost drivers in hospitals.

    PubMed

    Cao, P; Toyabe, S; Kurashima, S; Okada, M; Akazawa, K

    2006-01-01

    Activity-based costing (ABC) is widely used to precisely allocate indirect costs to medical services. In the ABC method, the indirect cost is divided among the medical services in proportion to the volume of "cost drivers", for example, labor hours and the number of hours of surgery. However, the workload of data collection of cost drivers can be time-consuming and a considerable burden if there are many cost drivers. The authors aim to develop a method for objectively reducing the cost drivers used in the ABC method. In the ABC method, the cost driver is assigned for each activity. We assume that these activities and cost drivers are the best combination. Our method, that is cost driver reduction (CDR), can objectively select surrogates of the cost drivers for each activity in ABC from candidate cost drivers. Concretely, the total indirect cost of an activity is temporarily allocated to the medical services using each candidate of cost drivers. The difference between the costs calculated by each candidate and the proper cost driver used in ABC is calculated to evaluate the similarity by the evaluation function. We estimated the cost of laboratory tests using our method and revealed that the number of cost drivers could be reduced from seven in the ABC to four. Similarly, the results of cost estimation obtained by our method were as accurate as those calculated using the ABC. Our method provides two advantages compared to the ABC method: 1) it provides results that are as accurate as those of the ABC method, and 2) it is simpler to perform complicated estimation of hospital costs.

  6. Current & future medical costs of childhood obesity in Alaska.

    PubMed

    Guettabi, Mouhcine

    2014-09-01

    This study examines the medical costs of childhood obesity in Alaska, today and in the future. We estimate that 15.2 percent of those ages 2 to 19 in Alaska are obese. Using parameters from published reports and studies, we estimate that the total excess medical costs due to obesity for both adults and children in Alaska in 2012 were $226 million, with medical costs of obese children and adolescents accounting for about $7 million of that total. And those medical costs will get much higher over time, as today's children transition into adulthood. Aside from the 15.2 percent currently obese, another estimated 20 percent of children who aren't currently obese will become obese as adults, if current national patterns continue. We estimate that the 20-year medical costs--discounted to present value--of obesity among the current cohort of Alaska children and adolescents will be $624 million in today's dollars. But those future costs could be decreased if Alaskans found ways to reduce obesity. We consider how reducing obesity in several ways could reduce future medical costs: reducing current rates of childhood obesity, rates of obese children who become obese adults, or rates of non-obese children and adolescents who become obese adults. We undertake modest reductions to showcase the potential cost savings associated with each of these channels. Clearly the financial savings are a direct function of the obesity reductions and therefore the magnitude of the realized savings will vary accordingly. Also keep in mind that these figures are only for the current cohort of children and adolescents; over time more generations of Alaskans will grow from children into adults, repeating the same cycle unless rates of obesity decline. And finally, remember that medical costs are only part of the broader range of social and economic costs obesity creates.

  7. Reducing energy costs in nursing homes

    SciTech Connect

    Not Available

    1981-01-01

    The handbook presents ideas and techniques for energy conservation in nursing homes. Case studies were developed of nursing homes located in different parts of the US. The typical nursing home assessed was proprietary, of intermediate-care level, medicaid-certified, and had less than 200 beds. Specific energy conservation measures were analyzed to determine the energy and dollar savings that could be realized. These include reducing heat loss through the building shell; reducing hot water costs; recovering the heat generated by dryers; reducing lighting costs; reducing heating and cooling costs, and analyzing fuels and fuel rates. A case for converting electric clothes dryers to gas was analyzed. (MCW)

  8. Teaching hospital costs: the effects of medical staff characteristics.

    PubMed Central

    Custer, W S; Willke, R J

    1991-01-01

    This article examines the effect of medical staff behavior on the cost of hospital-based care and graduate medical education, and shows its implications for estimation of hospital costs. The empirical work brings a unique new data source for these characteristics to the estimation process. Our results indicate that there are important economies of scale and scope in hospital production, both for inpatient stays and for residency training. Controlling for medical staff characteristics significantly reduces the estimated costs of residency training. Staff characteristics may be capturing aspects of the quality of inpatient care and residency training provided by the hospital. PMID:1991676

  9. On the cost of educating a medical student.

    PubMed

    Jones, R F; Korn, D

    1997-03-01

    The cost of educating a medical student has been an issue of intermittent public concern for most of the twentieth century, beginning in 1910 with the Flexner Report. The issue is now reemerging as a topic of high public and political interest, for several reasons, including concern about medical schools and their financing. Estimates of medical student education costs appear to vary widely; but such variations derive from the different ways the question has been framed. Costs can be categorized as instructional costs and total educational resource costs. Instructional costs, which can be distinguished further as marginal costs or proportionate-share costs, are those costs that can be related directly to the teaching program and its support. Total educational resource costs are those costs supporting all faculty deemed necessary to conduct undergraduate medical education in all their activities of teaching, research, scholarship, and patient care. The authors review studies spanning a period of more than 20 years and find that instructional cost estimates of medical student education, when adjusted to a standard base year (1996 dollars), fall within a fairly narrow range: most are between $40,000 and $50,000 per student per year. Estimates of total educational resource costs show greater variation, but four of six estimates fall between approximately $72,000 and $93,000 per student per year. The authors note that present directions of curricular innovation-small-group learning, investment in information technology, and clinical education in ambulatory sites-offer little solace to those concerned with mitigating the costs of medical student education. Several proposals have been advanced to restructure medical student education in the name of efficiency and cost-effectiveness, but many are simply maneuvers to transfer responsibility for costs to other entities. Only by a net reduction of the medical school curriculum might costs truly be reduced. Yet the medical

  10. Strategies for Reducing Text Book Costs

    ERIC Educational Resources Information Center

    Board of Governors, State University System of Florida, 2008

    2008-01-01

    In recent years, the price of college textbooks has become a growing concern for students and others who care about keeping college costs affordable. As policymakers and higher education systems explore the issue further, there are actions that can be taken immediately on college campuses to reduce the cost of textbooks. This brief presents…

  11. Reducing arthroplasty costs via vendor contracts

    PubMed Central

    Johnston, D. William C.; Beaupré, Lauren A.; Davies, Donna M.; Hessels, Rick

    1999-01-01

    Objective To describe a method of reducing the costs of implants in hip and knee arthroplasty. Design Implant costs were compared before and after the implementation of a 2-year contract with implant vendors, providing increased volume for decreased implant cost. An additional 20% of arthroplasties could be done outside the contract for research or special purposes. Setting A regional health authority involving 2 acute care hospitals. Method Costs were obtained for 942 hip and knee arthroplasties performed in 1993/94 and compared with costs of 1656 hip and knee arthroplasties performed in 1996/97. Outcome Measures Implant cost and number of joint arthroplasty procedures performed. Results A 40% decrease in the cost per implant for primary knee arthroplasty and an 18% decrease in the cost per implant for primary hip arthroplasty were achieved. A rebate, calculated as a percentage of volume used, was received from the vendor to support general orthopedic research and education. A new contract for 3 years has recently been signed with 3 vendors designated as primary vendors for 80% of the volume. Conclusion The vendor-contract economic strategy effectively reduced the cost of hip and knee arthroplasty and may be useful at other centres looking for cost reduction methods that maintain adequate patient care and support clinical research and education. PMID:10593246

  12. Reducing the cost of HIV antibody testing.

    PubMed

    Tamashiro, H; Maskill, W; Emmanuel, J; Fauquex, A; Sato, P; Heymann, D

    1993-07-10

    Available tests to detect antibody to human immunodeficiency virus (HIV) have a range of applications, and injudicious selection and inappropriate use can add a significant financial burden to budgets for AIDS programmes in developing countries. There are several ways by which the cost of HIV antibody testing can be reduced; they include use of tests appropriate for existing laboratory capabilities; adoption of cost-effective testing strategies; pooling of serum samples before testing; and ensuring best possible purchase prices. Each approach can significantly reduce the cost of HIV antibody testing alone or in combination, which increases the potential sustainability of antibody testing programmes, even in settings of limited resources.

  13. Cost analysis of medical assistance in dying in Canada.

    PubMed

    Trachtenberg, Aaron J; Manns, Braden

    2017-01-23

    The legalization of medical assistance in dying will affect health care spending in Canada. Our aim was to determine the potential costs and savings associated with the implementation of medical assistance in dying. Using published data from the Netherlands and Belgium, where medically assisted death is legal, we estimated that medical assistance in dying will account for 1%-4% of all deaths; 80% of patients will have cancer; 50% of patients will be aged 60-80 years; 55% will be men; 60% of patients will have their lives shortened by 1 month; and 40% of patients will have their lives shortened by 1 week. We combined current mortality data for the Canadian population with recent end-of-life cost data to calculate a predicted range of savings associated with the implementation of medical assistance in dying. We also estimated the direct costs associated with offering medically assisted death, including physician consultations and drug costs. Medical assistance in dying could reduce annual health care spending across Canada by between $34.7 million and $138.8 million, exceeding the $1.5-$14.8 million in direct costs associated with its implementation. In sensitivity analyses, we noted that even if the potential savings are overestimated and costs underestimated, the implementation of mdedical assistance in dying will likely remain at least cost neutral. Providing medical assistance in dying in Canada should not result in any excess financial burden to the health care system, and could result in substantial savings. Additional data on patients who choose medical assistance in dying in Canada should be collected to enable more precise estimates of the impact of medically assisted death on health care spending and to enable further economic evaluation. © 2017 Canadian Medical Association or its licensors.

  14. Reducing robotic prostatectomy costs by minimizing instrumentation.

    PubMed

    Delto, Joan C; Wayne, George; Yanes, Rafael; Nieder, Alan M; Bhandari, Akshay

    2015-05-01

    Since the introduction of robotic surgery for radical prostatectomy, the cost-benefit of this technology has been under scrutiny. While robotic surgery professes to offer multiple advantages, including reduced blood loss, reduced length of stay, and expedient recovery, the associated costs tend to be significantly higher, secondary to the fixed cost of the robot as well as the variable costs associated with instrumentation. This study provides a simple framework for the careful consideration of costs during the selection of equipment and materials. Two experienced robotic surgeons at our institution as well as several at other institutions were queried about their preferred instrument usage for robot-assisted prostatectomy. Costs of instruments and materials were obtained and clustered by type and price. A minimal set of instruments was identified and compared against alternative instrumentation. A retrospective review of 125 patients who underwent robotically assisted laparoscopic prostatectomy for prostate cancer at our institution was performed to compare estimated blood loss (EBL), operative times, and intraoperative complications for both surgeons. Our surgeons now conceptualize instrument costs as proportional changes to the cost of the baseline minimal combination. Robotic costs at our institution were reduced by eliminating an energy source like the Ligasure or vessel sealer, exploiting instrument versatility, and utilizing inexpensive tools such as Hem-o-lok clips. Such modifications reduced surgeon 1's cost of instrumentation to ∼40% less compared with surgeon 2 and up to 32% less than instrumentation used by surgeons at other institutions. Surgeon 1's combination may not be optimal for all robotic surgeons; however, it establishes a minimally viable toolbox for our institution through a rudimentary cost analysis. A similar analysis may aid others in better conceptualizing long-term costs not as nominal, often unwieldy prices, but as percent changes in

  15. Reducing Risks Associated with Medical Device Misconnections

    MedlinePlus

    ... partners, professional societies, advocacy groups, patients and other stakeholders to reduce the chance of medical device misconnections. ... medical device misconnections; Communicating with patients and other stakeholders to understand the impact of new connector designs. ...

  16. Cost analysis of medical assistance in dying in Canada

    PubMed Central

    Trachtenberg, Aaron J.; Manns, Braden

    2017-01-01

    BACKGROUND: The legalization of medical assistance in dying will affect health care spending in Canada. Our aim was to determine the potential costs and savings associated with the implementation of medical assistance in dying. METHODS: Using published data from the Netherlands and Belgium, where medically assisted death is legal, we estimated that medical assistance in dying will account for 1%–4% of all deaths; 80% of patients will have cancer; 50% of patients will be aged 60–80 years; 55% will be men; 60% of patients will have their lives shortened by 1 month; and 40% of patients will have their lives shortened by 1 week. We combined current mortality data for the Canadian population with recent end-of-life cost data to calculate a predicted range of savings associated with the implementation of medical assistance in dying. We also estimated the direct costs associated with offering medically assisted death, including physician consultations and drug costs. RESULTS: Medical assistance in dying could reduce annual health care spending across Canada by between $34.7 million and $138.8 million, exceeding the $1.5–$14.8 million in direct costs associated with its implementation. In sensitivity analyses, we noted that even if the potential savings are overestimated and costs underestimated, the implementation of mdedical assistance in dying will likely remain at least cost neutral. INTERPRETATION: Providing medical assistance in dying in Canada should not result in any excess financial burden to the health care system, and could result in substantial savings. Additional data on patients who choose medical assistance in dying in Canada should be collected to enable more precise estimates of the impact of medically assisted death on health care spending and to enable further economic evaluation. PMID:28246154

  17. Reduce generating costs and eliminate brownouts

    SciTech Connect

    Nogaja, R.; Menezes, M.

    2007-06-15

    Improving the manoeuverability of a coal-fired plant to allow it to participate in primary frequency support will reduce generation cost and minimize brownouts. The challenge is to do so without compromising efficiency or emissions. This article describes an approach - activation of stored energy - that is cost-effective and applicable to both greenfield and brownfield installations. It requires a new control philosophy, plus the correct application of new level and flow measurement 'best practices'. 4 refs., 1 tab.

  18. Direct medical costs attributable to osteoporotic fractures.

    PubMed

    Gabriel, S E; Tosteson, A N A; Leibson, C L; Crowson, C S; Pond, G R; Hammond, C S; Melton, L J

    2002-01-01

    Osteoporotic fractures are a major cause of morbidity in the elderly, the most rapidly growing segment of our population. We characterized the incremental direct medical costs following such fractures in a population-based cohort of men and women in Olmsted County, Minnesota. Cases included all County residents 50 years of age and older with an incident fracture due to minimal or moderate trauma between January 1, 1989 and January 1, 1992. For each case, a control of the same age (+/- 1 year) and sex who was attended in the local medical system in the same year was identified. Total incremental costs (cases - controls) in the year after fracture were estimated. Unit costs for each health service/procedure were obtained through the Mayo Cost Data Warehouse, which provides a standardized, inflation-adjusted estimate reflecting the national average cost of providing the service. Regression analysis was used to identify factors associated with incremental costs. There were 1263 case/control pairs; their average age was 73.8 years and 78% were female. Median total direct medical costs were $761 and $625, respectively, for cases and nonfracture controls in the year prior to fracture, and $3884 and $712, respectively, in the year following fracture. The highest median incremental costs were for distal femur ($11756) and hip fractures ($11241), whereas the lowest were for rib fractures ($213). Although hip fractures resulted in more incremental cost than any other fracture type, this amounted to only 37% of the total incremental cost of all moderate-trauma fractures combined. Regression analyses revealed that age, prior year costs and type of fracture were significant predictors of incremental costs (p<0.03 for all comparisons). The incremental costs of osteoporotic fractures are therefore substantial. Whereas hip fractures contributed disproportionately, they accounted for only one-third of the total incremental cost of fractures in our cohort. The use of incremental

  19. Health costs of a reduced energy supply.

    PubMed

    McCarroll, J R

    1983-10-01

    Health effects associated with electricity production, especially air pollution from fossil fuel combustion, have received much attention in the past 30 years. Virtually no attention has been paid to the health costs of a reduced or overpriced energy supply although these are real and formidable. Stringent regulations mandating control technology on stack emissions and/or burning of low sulfur fuels have been promulgated which cost the American public billions of dollars. These have indeed alleviated some health problems, but pressures to further tighten regulations offer little chance of further health benefits commensurate with their cost and are most likely to produce a new series of problems.

  20. Cost considerations in using simulations for medical training.

    PubMed

    Fletcher, J D; Wind, Alexander P

    2013-10-01

    This article reviews simulation used for medical training, techniques for assessing simulation-based training, and cost analyses that can be included in such assessments. Simulation in medical training appears to take four general forms: human actors who are taught to simulate illnesses and ailments in standardized ways; virtual patients who are generally presented via computer-controlled, multimedia displays; full-body manikins that simulate patients using electronic sensors, responders, and controls; and part-task anatomical simulations of various body parts and systems. Techniques for assessing costs include benefit-cost analysis, return on investment, and cost-effectiveness analysis. Techniques for assessing the effectiveness of simulation-based medical training include the use of transfer effectiveness ratios and incremental transfer effectiveness ratios to measure transfer of knowledge and skill provided by simulation to the performance of medical procedures. Assessment of costs and simulation effectiveness can be combined with measures of transfer using techniques such as isoperformance analysis to identify ways of minimizing costs without reducing performance effectiveness or maximizing performance without increasing costs. In sum, economic analysis must be considered in training assessments if training budgets are to compete successfully with other requirements for funding. Reprint & Copyright © 2013 Association of Military Surgeons of the U.S.

  1. Medical therapy cost considerations for glaucoma.

    PubMed

    Fiscella, Richard G; Green, Amy; Patuszynski, Daniel H; Wilensky, Jacob

    2003-07-01

    To determine the calculated daily patient cost (cost minimization) of medical glaucoma therapy and review cost trends. Experimental, controlled, prospective study. The actual volume of various glaucoma medications or glaucoma medications with redesigned bottles was determined for most commercially available sizes of the tested products. The drops per milliliter based on the actual volume and the daily costs of the dosage schedules recommended by the manufacturers were compared. The cost of each bottle of medication was determined from the average wholesale price (AWP) in the United States. A comparison to 1999 prices where applicable will be analyzed to review costing trends. The generic timolol products (range, US dollars 0.38-US dollars 0.46 per day) were similar on a cost per day basis vs Betimol (Santen, Napa Valley, California, USA), Optipranolol (Bausch and Lomb Pharmaceuticals, Tampa, Florida, USA) and Timoptic (Merck, West Point, Pennsylvania, USA). Their percentage cost increase ranged from 5% to 22% since 1999, except for generic timolol XE gel-forming solution (48%). Betagan (Allergan, Irvine, California, USA), Betoptic S (Alcon Laboratories, Fort Worth, Texas, USA), and Ocupress (Novartis, Duluth, Georgia, USA) ranged from US dollars 0.88 to US dollars 1.11 per day, and their percentage cost increase ranged from 33% to 53%. Some brand-only products have raised their AWPs a greater percentage, including Betoptic S (37%), Iopidine (Alcon, Fort Worth, Texas, USA) (50%), Ocupress (Novartis Ophthalmics, Duluth, Georgia, USA) (53%), and Pilopine gel (Alcon, Fort Worth, Texas, USA) (32%). The mean cost per day for the topical carbonic anhydrase inhibitors Azopt (Alcon Laboratories; US dollars 1.33 per day) and Trusopt (Merck; US dollars 1.05 per day) differed from 1999 when prices were almost identical. Cosopt (Merck; timolol 0.5% plus dorzolamide 2%, US dollars 1.04 per day) was less than the cost of separate bottles of a topical carbonic anhydrase inhibitor

  2. Impact of type 2 diabetes medication cost sharing on patient outcomes and health plan costs.

    PubMed

    Thornton Snider, Julia; Seabury, Seth; Lopez, Janice; McKenzie, Scott; Goldman, Dana P

    2016-06-01

    To study the association between cost sharing for diabetes medications, adherence, hospitalization rates, and healthcare costs, with relationship to patient risk. A retrospective claims analysis of data from 35 large, private, self-insured employers (2004 to 2012). We examined outcomes for 92,410 patients aged 18 to 64 years with a type 2 diabetes (T2D) diagnosis who filled at least 1 T2D prescription. First, we examined the relationship between adherence, measured as the proportion of days covered, and cost sharing, measured as the out-of-pocket cost to purchase a pre-specified bundle of T2D prescriptions. We then examined the association between adherence and hospital days. Simulations showed the effect of increased cost sharing on adherence and inpatient utilization. A $10 increase in out-of-pocket cost was associated with a 1.9% reduction in adherence (P < .01). In turn, a 10% reduction in adherence was associated with a 15% increase in per-patient hospital days (0.17 days; P < .01). For the average plan, switching from low to high cost sharing reduced per-patient medication costs by $242 and increased per-patient hospitalization costs by $342, for a net increase of $100 in plan costs. Increases in per-patient costs were greater for high-risk patients, such as those with heart failure ($1328). Increased cost sharing for T2D medication was associated with reductions in pharmacy costs, but higher total costs for patients with T2D. This problem is particularly acute for patients with 1 or more cardiovascular comorbidities. The results suggest that increased diabetes cost sharing may hamper efforts to lower the total cost of diabetes care.

  3. Reduction of medication costs after detoxification for medication-overuse headache.

    PubMed

    Shah, Asif M; Bendtsen, Lars; Zeeberg, Peter; Jensen, Rigmor H

    2013-04-01

    To examine whether detoxifying patients with medication-overuse headache can reduce long-term medication costs. Direct costs of medications in medication-overuse headache have been reported to be very high but have never been calculated on the basis of exact register data. Long-term economic savings obtained by detoxification have never been investigated. We conducted a registry-based observational retrospective follow-up study on 336 medication-overuse headache patients treated and discharged from the Danish Headache Center over a 2-year period. By means of the Danish Register of Medicinal Product Statistics, we collected information on the costs and use of prescription-only medication 1 year before admission and 1 year after discharge from Danish Headache Center. The average medication costs per patient per year decreased with 24%, from US$971 before treatment to US$737 after (P = .001), and the average medication use decreased with 14.4% (P = .02). Savings were most pronounced for patients overusing triptans. In this group, the average medication costs per patient per year decreased with 43% (P < .001), while the average triptan use decreased with 38% (P < .001). The study demonstrates that detoxification of medication-overuse headache at a tertiary headache center has a long-lasting effect on the medication costs and use, in particular among patients overusing triptans. The results may not be generalizable to all countries and may be sensitive to the costs of triptans. © 2012 American Headache Society.

  4. Weighing the cost of educational inflation in undergraduate medical education.

    PubMed

    Cusano, Ronald; Busche, Kevin; Coderre, Sylvain; Woloschuk, Wayne; Chadbolt, Karen; McLaughlin, Kevin

    2017-08-01

    Despite the fact that the length of medical school training has remained stable for many years, the expectations of graduating medical students (and the schools that train them) continue to increase. In this Reflection, the authors discuss motives for educational inflation and suggest that these are likely innocent, well-intentioned, and subconscious-and include both a propensity to increase expectations of ourselves and others over time, and a reluctance to reduce training content and expectations. They then discuss potential risks of educational inflation, including reduced emphasis on core knowledge and clinical skills, and adverse effects on the emotional, psychological, and financial wellbeing of students. While acknowledging the need to change curricula to improve learning and clinical outcomes, the authors proffer that it is naïve to assume that we can inflate educational expectations at no additional cost. They suggest that before implementing and/or mandating change, we should consider of all the costs that medical schools and students might incur, including opportunity costs and the impact on the emotional and financial wellbeing of students. They propose a cost-effectiveness framework for medical education and advocate prioritization of interventions that improve learning outcomes with no additional costs or are cost-saving without adversely impacting learning outcomes. When there is an additional cost for improved learning outcomes or a decline in learning outcomes as a result of cost saving interventions, they suggest careful consideration and justification of this trade-off. And when there are neither improved learning outcomes nor cost savings they recommend resisting the urge to change.

  5. Hemophilia A Pseudoaneurysm in a Patient with High Responding Inhibitors Complicating Total Knee Arthroplasty: Embolization: A Cost-Reducing Alternative to Medical Therapy

    SciTech Connect

    Kickuth, Ralph Anderson, Suzanne; Peter-Salonen, Kristiina; Laemmle, Bernhard; Eggli, Stefan; Triller, Juergen

    2006-12-15

    Joint hemorrhages are very common in patients with severe hemophilia. Inhibitors in patients with hemophilia are allo-antibodies that neutralize the activity of the clotting factor. After total knee replacement, rare intra-articular bleeding complications might occur that do not respond to clotting factor replacement. We report a 40-year-old male with severe hemophilia A and high responding inhibitors presenting with recurrent knee joint hemorrhage after bilateral knee prosthetic surgery despite adequate clotting factor treatment. There were two episodes of marked postoperative hemarthrosis requiring extensive use of subsititution therapy. Eleven days postoperatively, there was further hemorrhage into the right knee. Digital subtraction angiography diagnosed a complicating pseudoaneurysm of the inferior lateral geniculate artery and embolization was successfully performed. Because clotting factor replacement therapy has proved to be excessively expensive and prolonged, especially in patients with inhibitors, we recommend the use of cost-effective early angiographic embolization.

  6. Cascaded Microinverter PV System for Reduced Cost

    SciTech Connect

    Bellus, Daniel R.; Ely, Jeffrey A.

    2013-04-29

    In this project, a team led by Delphi will develop and demonstrate a novel cascaded photovoltaic (PV) inverter architecture using advanced components. This approach will reduce the cost and improve the performance of medium and large-sized PV systems. The overall project objective is to develop, build, and test a modular 11-level cascaded three-phase inverter building block for photovoltaic applications and to develop and analyze the associated commercialization plan. The system will be designed to utilize photovoltaic panels and will supply power to the electric grid at 208 VAC, 60 Hz 3-phase. With the proposed topology, three inverters, each with an embedded controller, will monitor and control each of the cascade sections, reducing costs associated with extra control boards. This report details the final disposition on this project.

  7. Reducing Financing Costs for Federal ESPCs

    SciTech Connect

    Hughes, P.J.

    2005-01-28

    This report documents the recommendations of a working group commissioned by the Federal Energy Management Program (FEMP) in 2002 to identify ways to reduce financing costs in federal energy savings performance contract (ESPC) projects. The working group is part of continuing efforts launched by FEMP since the award of the Department of Energy's (DOE's) Super ESPCs in 1998 and 1999 to ensure that practical, flexible, and cost-effective alternative financing for energy-efficiency improvements is available to all federal agencies. During FY 2002-2004, the working group pursued extensive fact finding, consulted with government and private-sector finance experts, and analyzed data from federal and local government ESPC programs. The working group observed that both competition and transparency were lacking in federal ESPCs. The working group also found that the government often falls short of full compliance with certain provisions of the final rule that codifies the federal ESPC authority into regulation (10 CFR 436), which speak to due diligence in determining fair and reasonable pricing. Based on these findings, the working group formulated their short-term recommendations of actions that agencies can take immediately to reduce ESPC financing costs. The working group recommended requiring competitive solicitation of offers from prospective financiers of ESPC projects, standardization of processes to keep the playing field level and reduce energy service companies (ESCOs) project development costs, and assuring transparency by specifying that the government will see and review all bids. The reforms are intended to enable the government to determine quickly and reliably whether the portion of price related to financing is fair and reasonable and to provide auditable records of the transaction. The working group's recommendations were incorporated into modifications to the Super ESPCs and requirements to be included in the Super ESPC delivery order request for proposal

  8. Cost considerations of medical therapy for glaucoma.

    PubMed

    Fiscella, R G; Geller, J L; Gryz, L L; Wilensky, J; Viana, M

    1999-10-01

    To determine the calculated daily patient cost (cost minimization) of medical glaucoma therapy. The actual volume of various glaucoma medications was determined for all commercially available sizes of the tested products. The drops per ml on the basis of the actual volume and the daily costs of the dosage schedules recommended by the manufacturers were compared. The cost of each bottle of medication was determined from the average wholesale price in the United States. The generic timolol products dosed twice daily and the once-daily gel-forming solutions (range, $0.30 to $0.46/day) were similar on a cost-per-day basis compared with the brand name metipranolol (Optipranolol; Bausch & Lomb Pharmaceuticals, Tampa, Florida, at $0.43/day) and timolol (Timoptic; Merck, West Point, Pennsylvania, at $0.46/day and Timoptic XE at $0.38/ day). Betaxolol (Betoptic S; Alcon Laboratories, Fort Worth, Texas, at $0.65/day), carteolol (Ocupress; CibaVision, Duluth, Georgia, at $0.57/day), levobunolol ($0.61/day), and brand name levobunolol (Betagan; Allergan, Irvine, California, at $0.81/day) all were dosed twice daily and were more costly on a per-day basis. The topical carbonic anhydrase inhibitors brinzolamide (Azopt; Alcon, at $0.96/day) and dorzolamide (Trusopt; Merck, at $1.02/day) were dosed three times daily and were similar on a cost-per-day basis. The combination product Cosopt (timolol 0.5% + dorzolamide 2.0%, Merck, at $1.12/day) was less costly than separate bottles of a topical carbonic anhydrase inhibitor (three times daily dosing) and a beta-blocker ($1.26 to $1.83/day), often even if the topical carbonic anhydrase inhibitor was dosed two times daily ($0.94 to $1.49). The selective alpha2-agonist brimonidine (Alphagan; Allergan, at $0.90/day) twice daily and the prostaglandin analog latanoprost (Xalatan; Pharmacia & Upjohn, Kalamazoo, Michigan, at $0.92/day) once daily were similarly priced. All generic timolol, Optipranolol, Timoptic, and Timoptic XE ranged between

  9. Using CCSDS Standards to Reduce Mission Costs

    NASA Technical Reports Server (NTRS)

    Wilmot, Jonathan

    2017-01-01

    NASA's open source Core Flight System (cFS) software framework has been using several Consultative Committee for Space Data Systems (CCSDS) standards since its inception. Recently developed CCSDS standards are now being applied by NASA, ESA and other organizations to streamline and automate aspects of mission development, test, and operations, speeding mission schedules and reducing mission costs. This paper will present the new CCSDS Spacecraft Onboard Interfaces Services (SOIS) Electronic Data Sheet (EDS) standards and show how they are being applied to data interfaces in the cFS software framework, tool chain, and ground systems across a range of missions at NASA. Although NASA is focusing on the cFS, it expected that these technologies are well suited for use in other system architectures and can lower costs for a wide range of both large and small satellites.

  10. Reducing home heating and cooling costs

    SciTech Connect

    Not Available

    1994-07-01

    This report is in response to a request from the House Committee on Energy and Commerce that the Energy Information Administration (EIA) undertake a neutral, unbiased analysis of the cost, safety, and health and environmental effects of the three major heating fuels: heating oil, natural gas, and electricity. The Committee also asked EIA to examine the role of conservation in the choice of heating and cooling fuel. To accommodate a wide audience, EIA decided to respond to the Committee`s request in the context of a report on reducing home heating and cooling costs. Accordingly, this report discusses ways to weatherize the home, compares the features of the three major heating and cooling fuels, and comments on the types of heating and cooling systems on the market. The report also includes a worksheet and supporting tables that will help in the selection of a heating and/or cooling system.

  11. Affordable housing: Reducing the energy cost burden

    SciTech Connect

    Lee, A.D.; Chin, R.I.; Marden, C.L.

    1995-01-01

    Residential energy expenditures are a key determinant of housing affordability, particularly for lower Income households. For years, federal, state and local governments and agencies have sought to defray energy expenses and Increase residential energy efficiency for low Income households through legislative and regulatory actions and programs. Nevertheless, household energy costs continue to place a major burden on lower Income families. This issue paper was written to help formulate national energy policy by providing the United States Department of Energy`s (DOE`s) Office of Energy Efficiency and Renewable Energy (EE) with Information to help define the affordable housing issue; Identify major drivers, key factors, and primary stakeholders shaping the affordable housing issue; and review how responding to this Issue may impact EE`s goals and objectives and Influence the strategic direction of the office. Typically, housing affordability is an Issue associated with lower income households. This issue paper adopts this perspective, but it is important to note that reducing energy utility costs can make {open_quotes}better{close_quote} housing affordable to any household regardless of income. As energy efficiency is improved throughout all sectors of the economy, special consideration must be given to low income households. Of all households, low income households are burdened the most by residential energy costs; their residences often are the least energy-efficient and have the greatest potential for efficiency improvements, but the occupants have the fewest resources to dedicate to conservation measures. This paper begins with a definition of {open_quotes}affordability{close_quotes} as it pertains to total housing costs and summarizes several key statistics related to housing affordability and energy use by lower income households.

  12. Health benefits of reduced patient cost sharing in Japan

    PubMed Central

    McWilliams, J Michael; Noguchi, Haruko; Hashimoto, Hideki; Tamiya, Nanako; Kawachi, Ichiro

    2012-01-01

    Abstract Objective To assess the effect on out-of-pocket medical spending and physical and mental health of Japan’s reduction in health-care cost sharing from 30% to 10% when people turn 70 years of age. Methods Study data came from a 2007 nationally-representative cross-sectional survey of 10 293 adults aged 64 to 75 years. Physical health was assessed using a 16-point scale based on self-reported data on general health, mobility, self-care, activities of daily living and pain. Mental health was assessed using a 24-point scale based on the Kessler-6 instrument for nonspecific psychological distress. The effect of reduced cost sharing was estimated using a regression discontinuity design. Findings For adults aged 70 to 75 years whose income made them ineligible for reduced cost sharing, neither out-of-pocket spending nor health outcomes differed from the values expected on the basis of the trend observed in 64- to 69-year-olds. However, for eligible adults aged 70 to 75 years, out-of-pocket spending was significantly lower (P < 0.001) and mental health was significantly better (P < 0.001) than expected. These differences emerged abruptly at the age of 70 years. Moreover, the mental health benefits were similar in individuals who were and were not using health-care services (P = 0.502 for interaction). The improvement in physical health after the age of 70 years in adults eligible for reduced cost-sharing tended to be greater than in non-eligible adults (P = 0.084). Conclusion Reduced cost sharing was associated with lower out-of-pocket medical spending and improved mental health in older Japanese adults. PMID:22690032

  13. Health benefits of reduced patient cost sharing in Japan.

    PubMed

    Nishi, Akihiro; McWilliams, J Michael; Noguchi, Haruko; Hashimoto, Hideki; Tamiya, Nanako; Kawachi, Ichiro

    2012-06-01

    To assess the effect on out-of-pocket medical spending and physical and mental health of Japan's reduction in health-care cost sharing from 30% to 10% when people turn 70 years of age. Study data came from a 2007 nationally-representative cross-sectional survey of 10 293 adults aged 64 to 75 years. Physical health was assessed using a 16-point scale based on self-reported data on general health, mobility, self-care, activities of daily living and pain. Mental health was assessed using a 24-point scale based on the Kessler-6 instrument for nonspecific psychological distress. The effect of reduced cost sharing was estimated using a regression discontinuity design. For adults aged 70 to 75 years whose income made them ineligible for reduced cost sharing, neither out-of-pocket spending nor health outcomes differed from the values expected on the basis of the trend observed in 64- to 69-year-olds. However, for eligible adults aged 70 to 75 years, out-of-pocket spending was significantly lower (P < 0.001) and mental health was significantly better (P < 0.001) than expected. These differences emerged abruptly at the age of 70 years. Moreover, the mental health benefits were similar in individuals who were and were not using health-care services (P = 0.502 for interaction). The improvement in physical health after the age of 70 years in adults eligible for reduced cost-sharing tended to be greater than in non-eligible adults (P = 0.084). Reduced cost sharing was associated with lower out-of-pocket medical spending and improved mental health in older Japanese adults.

  14. Reducing costs through electronic data interchange.

    PubMed

    Chapin-Strike, S

    1994-01-01

    The times have never been riper for an investment in EDI to pay off for healthcare providers. As suppliers attain their implementation goals for electronic purchase orders, they are expanding their EDI capabilities. One area which seems to be attracting considerable attention is the entire contracting cycle, where there are numerous opportunities for reducing administrative costs and improving accuracy. A detailed example using a buying group's contract cycle shows how EDI can be used at every step of the way, from request for quotation to funds transfer and monthly purchase summaries. EDI can be implemented at any level, from PC to mainframe. Implementation is not cheap and integration may not be easy, but the benefits can justify the cost. The first step to successful implementation is to identify and quantify, throughout the entire organization, reengineering opportunities in which EDI can be used. Two industry organizations, the Health Industry Distributors Association (HIDA) and the Healthcare EDI Corporation (HEDIC) have taken leadership roles in simplifying the implementation process.

  15. Reducing the agreement cost of BFT replication

    NASA Astrophysics Data System (ADS)

    Zbierski, Maciej

    2015-09-01

    Byzantine fault-tolerant (BFT) replication is a powerful technique for guaranteeing correctness of distributed services despite arbitrary faults. BFT replication protocols are typically composed of two phases: agreement and execution. Although some monolithic solutions exist that incorporate both phases, providing a clear separation between agreement and execution is often desired, due to for instance higher level of abstraction or better resource utilization. At the same time, however, separation can increase latency and reduce throughput, as an additional communication round is typically required to relay the requests between the phases. In this article we address this issue by proposing an approach that reduces the cost of agreement in BFT replication protocols without sacrificing phase separation. The article presents Otonaru, a dedicated sequencer that achieves around 30% higher performance than solutions usually deployed in the agreement phase of modern BFT replication protocols. As a result, the solutions built using the proposed approach can inherit all benefits of separation, at the same time providing a performance competitive to monolithic BFT protocols.

  16. Factors That Influence the Financing and Cost of Medical Education.

    ERIC Educational Resources Information Center

    McPheeters, Harold L.

    Financing and cost factors in medical education and the effect of the many missions of a medical school on funding issues are discussed. The teaching mission of medical schools includes undergraduate medical education (preparation for the MD degree), graduate medical education (training of resident physicians), biomedical specialist education,…

  17. Uncompensated medical provider costs associated with prior authorization for prescription medications in an HIV clinic.

    PubMed

    Raper, James L; Willig, James H; Lin, Hui-Yi; Allison, Jeroan J; Broner, M Bennet; Mugavero, Michael J; Saag, Michael S

    2010-09-15

    Although prior authorization (PA) for prescription medications is widely employed for cost-containment for third-party insurers, it is a frustrating aspect of outpatient clinical care that imposes uncompensated costs to medical providers. To characterize these costs, we monitored the PA-associated administrative and operational process at the University of Alabama at Birmingham 1917 HIV Clinic over a 2-year period. A total of 288 PAs were processed with a mean (+/- standard deviation [SD]) of 3.1+/-5.8 days delay in the patient's access to medication. A mean (+/-SD) of 26.8+/-18.4 min was spent by the nurse practitioner and 6.5+/-2.9 min was spent by a clerk per PA. Nearly three-quarters (73%) of PAs were approved, 18% were denied, and 10% were voided. The mean (+/-SD) pages of paperwork was 5.8+/-6.5. The overall cost was $41.60 per PA. Although evidence supports that PA reduces third-party expenditures, it significantly delays medication accessibility for patients and imposes high costs that negatively impact operating margins for health care providers.

  18. Autonomous exoskeleton reduces metabolic cost of walking.

    PubMed

    Mooney, Luke M; Rouse, Elliott J; Herr, Hugh M

    2014-01-01

    We developed an autonomous powered leg exoskeleton capable of providing large amounts of positive mechanical power to the wearer during powered plantarflexion phase of walking. The autonomous exoskeleton consisted of a winch actuator fasted to the shin which pulled on fiberglass struts attached to a boot. The fiberglass struts formed a rigid extension of the foot when the proximal end of the strut was pulled in forward by the winch actuator. This lightweight, geometric transmission allowed the electric winch actuator to efficiently produce biological levels of power at the ankle joint. The exoskeleton was powered and controlled by lithium polymer batteries and motor controller worn around the waist. Preliminary testing on two subjects walking at 1.4 m/s resulted in the exoskeleton reducing the metabolic cost of walking by 6-11% as compared to not wearing the device. The exoskeleton provided a peak mechanical power of over 180 W at each ankle (mean standard ± deviation) and an average positive mechanical power of 27 ± 1 W total to both ankles, while electrically using 75-89 W of electricity. The batteries (800 g) used in this experiment are estimated to be capable of providing this level of assistance for up to 7 km of walking.

  19. Malpractice risk and cost are significantly reduced after tort reform.

    PubMed

    Stewart, Ronald M; Geoghegan, Kathy; Myers, John G; Sirinek, Kenneth R; Corneille, Michael G; Mueller, Deborah; Dent, Daniel L; Wolf, Steven E; Pruitt, Basil A

    2011-04-01

    Rising medical malpractice premiums have reached a crisis point in many areas of the United States. In 2003 the Texas legislature passed a comprehensive package of tort reform laws that included a cap at $250,000 on noneconomic damages in most medical malpractice cases. We hypothesized that tort reform laws significantly reduce the risk of malpractice lawsuit in an academic medical center. We compared malpractice prevalence, incidence, and liability costs before and after comprehensive state tort reform measures were implemented. Two prospectively maintained institutional databases were used to calculate and characterize malpractice risk: a surgical operation database and a risk management and malpractice database. Risk groups were divided into pretort reform (1992 to 2004) and post-tort reform groups (2004 to the present). Operative procedures were included for elective, urgent, and emergency general surgery procedures. During the study period, 98,513 general surgical procedures were performed. A total of 28 lawsuits (25 pre-reform, 3 postreform) were filed, naming general surgery faculty or residents. The prevalence of lawsuits filed/100,000 procedures performed is as follows: before reform, 40 lawsuits/100,000 procedures, and after reform, 8 lawsuits/100,000 procedures (p < 0.01, relative risk 0.21 [95% CI 0.063 to 0.62]). Virtually all of the liability and defense cost was in the pretort reform period: $595,000/year versus $515/year in the postreform group (p < 0.01). Implementation of comprehensive tort reform in Texas was associated with a significant decrease in the prevalence and cost of surgical malpractice lawsuits at one academic medical center. Copyright © 2011. Published by Elsevier Inc.

  20. Cost in Medical Education: One Hundred and Twenty Years Ago

    ERIC Educational Resources Information Center

    Walsh, Kieran

    2015-01-01

    The first full paper that is dedicated to cost in medical education appears in the "BMJ" in 1893. This paper "The cost of a medical education" outlines the likely costs associated with undergraduate education at the end of the nineteenth century, and offers guidance to the student on how to make financial planning. Many lessons…

  1. Cost in Medical Education: One Hundred and Twenty Years Ago

    ERIC Educational Resources Information Center

    Walsh, Kieran

    2015-01-01

    The first full paper that is dedicated to cost in medical education appears in the "BMJ" in 1893. This paper "The cost of a medical education" outlines the likely costs associated with undergraduate education at the end of the nineteenth century, and offers guidance to the student on how to make financial planning. Many lessons…

  2. Methods Reduce Cost, Enhance Quality of Nanotubes

    NASA Technical Reports Server (NTRS)

    2009-01-01

    For all the challenges posed by the microgravity conditions of space, weight is actually one of the more significant problems NASA faces in the development of the next generation of U.S. space vehicles. For the Agency s Constellation Program, engineers at NASA centers are designing and testing new vessels as safe, practical, and cost-effective means of space travel following the eventual retirement of the space shuttle. Program components like the Orion Crew Exploration Vehicle, intended to carry astronauts to the International Space Station and the Moon, must be designed to specific weight requirements to manage fuel consumption and match launch rocket capabilities; Orion s gross liftoff weight target is about 63,789 pounds. Future space vehicles will require even greater attention to lightweight construction to help conserve fuel for long-range missions to Mars and beyond. In order to reduce spacecraft weight without sacrificing structural integrity, NASA is pursuing the development of materials that promise to revolutionize not only spacecraft construction, but also a host of potential applications on Earth. Single-walled carbon nanotubes are one material of particular interest. These tubular, single-layer carbon molecules - 100,000 of them braided together would be no thicker than a human hair - display a range of remarkable characteristics. Possessing greater tensile strength than steel at a fraction of the weight, the nanotubes are efficient heat conductors with metallic or semiconductor electrical properties depending on their diameter and chirality (the pattern of each nanotube s hexagonal lattice structure). All of these properties make the nanotubes an appealing material for spacecraft construction, with the potential for nanotube composites to reduce spacecraft weight by 50 percent or more. The nanotubes may also feature in a number of other space exploration applications, including life support, energy storage, and sensor technologies. NASA s various

  3. Processor Units Reduce Satellite Construction Costs

    NASA Technical Reports Server (NTRS)

    2014-01-01

    As part of the effort to build the Fast Affordable Science and Technology Satellite (FASTSAT), Marshall Space Flight Center developed a low-cost telemetry unit which is used to facilitate communication between a satellite and its receiving station. Huntsville, Alabama-based Orbital Telemetry Inc. has licensed the NASA technology and is offering to install the cost-cutting units on commercial satellites.

  4. Estimation of optimal educational cost per medical student.

    PubMed

    Yang, Eunbae B; Lee, Seunghee

    2009-09-01

    This study aims to estimate the optimal educational cost per medical student. A private medical college in Seoul was targeted by the study, and its 2006 learning environment and data from the 2003~2006 budget and settlement were carefully analyzed. Through interviews with 3 medical professors and 2 experts in the economics of education, the study attempted to establish the educational cost estimation model, which yields an empirically computed estimate of the optimal cost per student in medical college. The estimation model was based primarily upon the educational cost which consisted of direct educational costs (47.25%), support costs (36.44%), fixed asset purchases (11.18%) and costs for student affairs (5.14%). These results indicate that the optimal cost per student is approximately 20,367,000 won each semester; thus, training a doctor costs 162,936,000 won over 4 years. Consequently, we inferred that the tuition levels of a local medical college or professional medical graduate school cover one quarter or one-half of the per- student cost. The findings of this study do not necessarily imply an increase in medical college tuition; the estimation of the per-student cost for training to be a doctor is one matter, and the issue of who should bear this burden is another. For further study, we should consider the college type and its location for general application of the estimation method, in addition to living expenses and opportunity costs.

  5. The Direct Cost of Parkinson Disease at Juntendo Medical University Hospital, Japan.

    PubMed

    Yoritaka, Asako; Fukae, Jiro; Hatano, Taku; Oda, Eisei; Hattori, Nobutaka

    2016-01-01

    Objective Many studies on the cost of Parkinson disease (PD) have been published; however, there are limited studies pertaining to this issue in Asia. This study looks to assess the direct medical costs of patients with PD at a university hospital in Japan by calculating the average monthly direct medical costs of PD patients from July to December 2008. Methods We enrolled 724 consecutive patients (411 women and 313 men) with PD who were registered in Japan's "Specified Disease Treatment Research Program" and obtained data on the total direct medical costs of all patients. Results Values are reported as the mean (standard deviation). The major finding of the direct medical cost analysis was that the outpatient clinic cost per subject (n=715) was USD 485.74 (376.31) per month. A multivariate analysis revealed that a younger age, the presence of wearing-off, hallucination, and longer disease duration increased the direct medical cost significantly. Disease severity had no influence on the direct medical costs. A longer disease duration was significantly correlated with higher hospitalization costs. Conclusion The direct medical cost of PD in Japan was found to be similar to that in Western countries. Costs due to productivity loss exceeded the direct costs, and they may be reduced through the better integration of PD patients in the work environment.

  6. Reducing the Cost of Solar Cells

    SciTech Connect

    Scanlon, B.

    2012-04-01

    Solar-powered electricity prices could soon approach those of power from coal or natural gas thanks to collaborative research with solar startup Ampulse Corporation at the National Renewable Energy Laboratory. Silicon wafers account for almost half the cost of today's solar photovoltaic panels, so reducing or eliminating wafer costs is essential to bringing prices down. Current crystalline silicon technology converts energy in a highly efficient manner; however, that technology is manufactured with processes that could stand some improvement. The industry needs a method that is less complex, creates less waste and uses less energy. First, half the refined silicon is lost as dust in the wafer-sawing process, driving module costs higher. Wafers are sawn off of large cylindrical ingots, or boules, of silicon. A typical 2-meter boule loses as many as 6,000 potential wafers during sawing. Second, the wafers produced are much thicker than necessary. To efficiently convert sunlight into electricity, the wafers need be only one-tenth the typical thickness. NREL, the Oak Ridge National Laboratory and Ampulse have partnered on an approach to eliminate this waste and dramatically lower the cost of the finished solar panels. By using a chemical vapor deposition process to grow the silicon on inexpensive foil, Ampulse is able to make the solar cells just thick enough to convert most of the solar energy into electricity. No more sawdust - and no more wasting refined silicon materials. NREL developed the technology to grow high-quality silicon and ORNL developed the metal foil that has the correct crystal structure to support that growth. Ampulse is installing a pilot manufacturing line in NREL's Process Development Integration Laboratory, where solar companies can work closely with lab scientists on integrated equipment to answer pressing questions related to their technology development, as well as rapidly overcoming R and D challenges and risk. NREL's program is focused on

  7. Medical cost impact of intrathecal drug delivery for noncancer pain.

    PubMed

    Guillemette, Scott; Witzke, Susan; Leier, Jacqueline; Hinnenthal, Jennifer; Prager, Joshua P

    2013-04-01

    As healthcare budgets continue to contract, there is increased payer scrutiny on the use of implantable intrathecal drug-infusion devices. This study utilizes claims data to evaluate the economic effects of intrathecal drug delivery (IDD) based on health services utilization and costs of care before and after implantation. We performed a retrospective database study involving 555 noncancer pain patients that received an IDD system implant within a 3-year service period (1/2006-1/2009). IDD patient costs were temporally aligned to implant month and repriced to a standardized, national pricing schedule over a 6-year episode cycle (3 years preimplant, implant month, and 3 years postimplant). Additionally, we made an actuarial projection of postimplant experience, in the absence of IDD intervention, simulating a conventional pain therapy (CPT) protocol by assuming the same slope in costs prior to implantation at standardized, national price levels. Cost projections were produced over a 30-year time horizon at various reimplantation rates. IDD therapy was less costly than the CPT protocol over our baseline implantation cycle. Costs in the month of IDD implantation, and in the year following, are cumulatively $17,317 more than the CPT protocol; however, IDD financial break-even occurs soon after the second year postimplant. The lifetime analysis indicates that IDD per patient per year savings is $3,111 compared with CPT. The authors found that patients receiving an implantable IDD system may experience reduced cumulative future medical costs relative to anticipated costs in the absence of receiving IDD. This finding complements published literature on the cost-effectiveness of IDD. Wiley Periodicals, Inc.

  8. Activity Analysis and Cost Analysis in Medical Schools.

    ERIC Educational Resources Information Center

    Koehler, John E.; Slighton, Robert L.

    There is no unique answer to the question of what an ongoing program costs in medical schools. The estimates of program costs generated by classical methods of cost accounting are unsatisfactory because such accounting cannot deal with the joint production or joint cost problem. Activity analysis models aim at calculating the impact of alternative…

  9. The Cost of Voluntary Medical Male Circumcision in South Africa

    PubMed Central

    Tchuenche, Michel; Palmer, Eurica; Haté, Vibhuti; Thambinayagam, Ananthy; Loykissoonlal, Dayanund; Forsythe, Steven

    2016-01-01

    Given compelling evidence associating voluntary medical male circumcision (VMMC) with men’s reduced HIV acquisition through heterosexual intercourse, South Africa in 2010 began scaling up VMMC. To project the resources needed to complete 4.3 million circumcisions between 2010 and 2016, we (1) estimated the unit cost to provide VMMC; (2) assessed cost drivers and cost variances across eight provinces and VMMC service delivery modes; and (3) evaluated the costs associated with mobilize and motivate men and boys to access VMMC services. Cost data were systematically collected and analyzed using a provider’s perspective from 33 Government and PEPFAR-supported (U.S. President's Emergency Plan for AIDS Relief) urban, rural, and peri-urban VMMC facilities. The cost per circumcision performed in 2014 was US$132 (R1,431): higher in public hospitals (US$158 [R1,710]) than in health centers and clinics (US$121 [R1,309]). There was no substantial difference between the cost at fixed circumcision sites and fixed sites that also offer outreach services. Direct labor costs could be reduced by 17% with task shifting from doctors to professional nurses; this could have saved as much as $15 million (R163.20 million) in 2015, when the goal was 1.6 million circumcisions. About $14.2 million (R154 million) was spent on medical male circumcision demand creation in South Africa in 2014—primarily on personnel, including community mobilizers (36%), and on small and mass media promotions (35%). Calculating the unit cost of VMMC demand creation was daunting, because data on the denominator (number of people reached with demand creation messages or number of people seeking VMMC as a result of demand creation) were not available. Because there are no “dose-response” data on demand creation ($X in demand creation will result in an additional Z% increase in VMMC clients), research is needed to determine the appropriate amount and allocation of demand creation resources. PMID:27783612

  10. Diabetes disease management in Medicare Advantage reduces hospitalizations and costs.

    PubMed

    Rosenzweig, James L; Taitel, Michael S; Norman, Gordon K; Moore, Tim J; Turenne, Wendy; Tang, Pei

    2010-07-01

    To evaluate the effectiveness of a telephonic diabetes disease management intervention in a Medicare Advantage population with comorbid diabetes and coronary artery disease (CAD). Prospective unequal randomization design of 526 members from a Medicare Advantage segment of one region of a large national health plan from May 2005 through April 2007. High-risk and high-cost patients with diabetes and CAD who were enrolled in telephonic diabetes disease management were compared with a randomly selected comparison group receiving usual care. Wilcoxon signed-rank tests were used to compare the groups on all-cause hospital admissions, diabetes-related hospital admissions, all-cause and diabetes-related emergency department (ED) visits, and all-cause medical costs. Changes in self-reported clinical outcomes also were measured in the intervention group. Patients receiving telephonic diabetes disease management had significantly decreased all-cause hospital admissions and diabetes-related hospital admissions (P <.05). The intervention group had decreased all-cause and diabetes-related ED visits, although the difference was not statistically significant. The comparison group had increased ED utilization. The intervention group decreased their all-cause total medical costs by $984.87 per member per year (PMPY) compared with a $4547.06 PMPY increase in the comparison group (P <.05). All clinical measures significantly improved (P <.05) in the intervention group. A disease management program for high-risk patients with diabetes and CAD was effective in reducing hospital inpatient admission and total costs in a Medicare Advantage population.

  11. Manual for Reducing Educational Unit Costs in Latin American Countries.

    ERIC Educational Resources Information Center

    Centro Multinacional de Investigacion Educativa, San Jose (Costa Rica).

    Designed for educational administrators, this manual provides suggestions for reducing educational unit costs in Latin America without reducing the quality of the education. Chapter one defines unit cost concepts and compares the costs of the Latin American countries. Chapter two deals with the different policies which could affect the principal…

  12. Manual for Reducing Educational Unit Costs in Latin American Countries.

    ERIC Educational Resources Information Center

    Centro Multinacional de Investigacion Educativa, San Jose (Costa Rica).

    Designed for educational administrators, this manual provides suggestions for reducing educational unit costs in Latin America without reducing the quality of the education. Chapter one defines unit cost concepts and compares the costs of the Latin American countries. Chapter two deals with the different policies which could affect the principal…

  13. Costs of Common Psoriasis Medications, 2010-2014.

    PubMed

    James, Sara M; Hill, Dane E; Feldman, Steven R

    2016-03-01

    Costs for psoriasis have increased in recent years, in part due to the introduction of biologic agents. To identify the most common and most costly (from the payer perspective) drugs used in the treatment of psoriasis. We analyzed patient data from a large claims-based database in order to identify the most common and most costly medications used in the treatment of psoriasis from 2010 to 2014. The three most common psoriasis medications, accounting for 81.1% of all psoriasis medications, were topical corticosteroids. The three most costly drugs, accounting for only 9.6% of all psoriasis medications, were biologics, accounting for 86% of the cost of psoriasis medications. Biologic agents are used far less commonly in the treatment of psoriasis than topical treatments. Despite the relatively small number of patients using biologic agents, biologics are responsible for a large proportion of the cost of psoriasis pharmacotherapy.

  14. Prescription medication costs: a study of physician familiarity.

    PubMed

    Ernst, M E; Kelly, M W; Hoehns, J D; Swegle, J M; Buys, L M; Logemann, C D; Ford, J K; Kautzman, H A; Sorofman, B A; Pretorius, R W

    2000-01-01

    Studies in the past 25 years have suggested that physicians are not familiar with the costs of common prescription medications. To determine physician familiarity with the cost of common prescription medications and to determine the value physicians place on knowing information regarding the cost of medications. Survey. Seven community-based family medicine residency teaching clinics in Iowa. Two hundred five practicing resident and faculty physicians. From a series of $10 price intervals (range, $0.01-$80.00), physicians were asked to select the interval containing the cash price of the medication to an uninsured patient for 50 medications commonly prescribed in outpatient family medicine clinics. Physicians were also questioned about the value of medication cost information to their practice. The percentage of correct responses and the mean pricing scores were calculated for each respondent and for all medications. One hundred seventy-eight physicians responded (86.8%). Only 22.9% of the responses correctly identified the cost of the medication. More than two thirds (68.3%) of the responses underestimated the correct price interval. Branded drugs were underestimated in 89.9% of responses, while generic drugs were overestimated in 90.2% of responses. Overall, 64.4% of physicians believed they did not receive sufficient information in their practices regarding prescription drug costs, and nearly all (93.6%) reported that regular information on prescription medication costs would help them prescribe more cost-effectively. Physicians are unfamiliar with the costs of medications they commonly prescribe, and they report that regular access to information on prescription medication costs would help them prescribe more cost-effectively. Arch Fam Med. 2000;9:1002-1007

  15. Cost-shifting in the current medical environment

    NASA Astrophysics Data System (ADS)

    Gruber, William H.

    1994-12-01

    `Cost shifting' occurs when there is not a fair or accurate match of the payment and use of medical services. A common `cost shifting' occurs when an insured patient is charged more to cover free services provided to an uninsured patient. This paper documents the multiple negative consequences of the many categories of cost shifting, reviews forces which are leading both to an increase and decrease in the magnitude of cost shifting, and evaluates the consequences of cost shifting on the goals of U.S. health care reform and investment in medical technology. Policy to minimize the negative consequences of cost shifting is recommended.

  16. Cost in medical education: one hundred and twenty years ago.

    PubMed

    Walsh, Kieran

    2015-10-01

    The first full paper that is dedicated to cost in medical education appears in the BMJ in 1893. This paper "The cost of a medical education" outlines the likely costs associated with undergraduate education at the end of the nineteenth century, and offers guidance to the student on how to make financial planning. Many lessons can be gleaned from the paper about the cost and other aspects of nineteenth century medical education. Cost is viewed almost exclusively from the domain of the male gender. Cost is viewed not just from the perspective of a young man but of a young gentleman. There is a strong implication that medicine is a club and that you have to have money to join the club and then to take part in the club's activities. Cost affects choice of medical school and selection into schools. The paper places great emphasis on the importance of passing exams at their first sitting and progressing through each year in a timely manner-mainly to save costs. The subject of cost is viewed from the perspective of the payer-at this time students and their families. The paper encourages the reader to reflect on what has and has not changed in this field since 1893. Modern medical education is still expensive; its expense deters students; and we have only started to think about how to control costs or how to ensure value. Too much of the cost of medical education continues to burden students and their families.

  17. Renewable energy policy: Enumerating costs reduces support

    NASA Astrophysics Data System (ADS)

    Evensen, Darrick

    2017-08-01

    Renewable energy policies enjoy greater support compared to policies focused explicitly on climate change, and thus present a politically plausible path toward carbon emission reduction. However, new research shows that renewable energy policy support declines when people are informed about the policy costs for home energy bills.

  18. Hummingbird: Dramatically Reducing Interplanetary Mission Cost

    NASA Astrophysics Data System (ADS)

    Wertz, J. R.; Van Allen, R. E.; Sarzi-Amade, N.; Shao, A.; Taylor, C.

    2012-06-01

    The Hummingbird interplanetary spacecraft has an available delta V of 2 to 4 km/sec and a recurring cost of 2 to 3 million, depending on the payload and configuration. The baseline telescope has a resolution of 30 cm at a distance of 100 km.

  19. Reduce dimension costs by using WALNUT

    Treesearch

    David G. Martens; David G. Martens

    1986-01-01

    A computer program called WALNUT is described that determines the leastcost combination of lumber grades required to produce a given cutting order of furniture dimension parts. If the least-cost mix is not available, WALNUT can be used to determine the next best alternative. The steps involved in using the program are described.

  20. Mining internal data to reduce clinical costs.

    PubMed

    Teffeteller, Scott L; Kish, Thomas M

    2012-12-01

    Hospitals and health systems should undertake the following steps in pinpointing areas for clinical cost reduction: Identify potential areas of opportunity through an analysis of top discharges. Use severity-adjusted data to review variability by case. Review length of stay and resource consumption at a high level. Examine granular charge data and practice patterns. Determine action steps for improvement.

  1. Integrated Design Tools Reduce Risk, Cost

    NASA Technical Reports Server (NTRS)

    2012-01-01

    Thanks in part to a SBIR award with Langley Research Center, Phoenix Integration Inc., based in Wayne, Pennsylvania, modified and advanced software for process integration and design automation. For NASA, the tool has resulted in lower project costs and reductions in design time; clients of Phoenix Integration are experiencing the same rewards.

  2. A practical framework for understanding and reducing medical overuse

    PubMed Central

    Morgan, Daniel J.; Leppin, Aaron; Smith, Cynthia D.; Korenstein, Deborah

    2017-01-01

    The overuse of medical services is an increasingly recognized driver of poor quality care and high cost. A practical framework is needed to guide clinical decisions and facilitate concrete actions that can reduce overuse and improve care. We used an iterative, expert-informed evidence-based process to develop a framework for conceptualizing interventions to reduce medical overuse. Given the complexity of defining and identifying overused care in nuanced clinical situations and the need to define care appropriateness in the context of an individual patient, this framework conceptualizes the patient-clinician interaction as the nexus of decisions regarding inappropriate care. Other drivers of utilization influence this interaction and include health care system factors, the practice environment, the culture of professional medicine, the culture of health care consumption, and individual patient and clinician factors. The variable strength of evidence in support of these domains highlights important areas for further investigation. PMID:28459906

  3. Can managed care reduce employers' retiree medical liability?

    PubMed

    Taylor, R S; Newton, B

    1991-01-01

    The Financial Accounting Standards Board (FASB) has forced U.S. companies to look squarely at their current retiree health obligations and their future commitments. Accounting Statement No. 106 (FAS 106) requires employers to accrue liabilities for retiree health benefits during employees' active service, rather than record the costs as benefits are paid. Employers are scrambling to find ways to reduce the statement's effect on corporate balance sheets. While managed health care has been increasingly employed to control benefit costs in active employee health plans, it has not been as popular in retiree plans. This article reviews important demographic and health trends in the retiree population and summarizes employers' early responses to FAS 106. It explores why managed health care has thus far played a limited role in reducing employers' postretirement medical liability, and offers insight into how that role could be increased in the future.

  4. Research requirements to reduce maintenance costs of civil helicopters

    NASA Technical Reports Server (NTRS)

    Million, D. J.; Waters, K. T.

    1978-01-01

    The maintenance problems faced by the operators of civil helicopters that result in high costs are documented. Existing technology that can be applied to reduce maintenance costs and research that should be carried out were identified. Good design practice and application of existing technology were described as having a significant impact on reducing maintenance costs immediately. The research and development that have potential for long range reduction of maintenance costs are presented.

  5. Risk management: Reducing brownfield cleanup costs

    SciTech Connect

    Graves, N.

    1997-08-01

    Balancing environmental protection with economic vitality is crucial to maintaining competitiveness in world markets. One key initiative that has been identified as important to both environmental protection and the economy is the redevelopment of brownfields. Brownfield redevelopment can stimulate local economies that have been devastated by lost jobs and can recycle industrial land use, thereby preserving undeveloped lands. Many existing brownfield sites appear on the US Environmental Protection Agency`s (EPA) National Priority List (NPL), which designates over 1200 sites and is expected to grow to more than 2000 by the end of the decade. EPA estimates the cost of remediating the sites on the current list will approach $30 billion, with the average cost of remediating a site close to $25 million. Thousands of additional brownfield sites that do not appear on the NPL are listed under state cleanup programs.

  6. Can automation in radiotherapy reduce costs?

    PubMed

    Massaccesi, Mariangela; Corti, Michele; Azario, Luigi; Balducci, Mario; Ferro, Milena; Mantini, Giovanna; Mattiucci, Gian Carlo; Valentini, Vincenzo

    2015-01-01

    Computerized automation is likely to play an increasingly important role in radiotherapy. The objective of this study was to report the results of the first part of a program to implement a model for economical evaluation based on micro-costing method. To test the efficacy of the model, the financial impact of the introduction of an automation tool was estimated. A single- and multi-center validation of the model by a prospective collection of data is planned as the second step of the program. The model was implemented by using an interactive spreadsheet (Microsoft Excel, 2010). The variables to be included were identified across three components: productivity, staff, and equipment. To calculate staff requirements, the workflow of Gemelli ART center was mapped out and relevant workload measures were defined. Profit and loss, productivity and staffing were identified as significant outcomes. Results were presented in terms of earnings before interest and taxes (EBIT). Three different scenarios were hypothesized: baseline situation at Gemelli ART (scenario 1); reduction by 2 minutes of the average duration of treatment fractions (scenario 2); and increased incidence of advanced treatment modalities (scenario 3). By using the model, predicted EBIT values for each scenario were calculated across a period of eight years (from 2015 to 2022). For both scenarios 2 and 3 costs are expected to slightly increase as compared to baseline situation that is particularly due to a little increase in clinical personnel costs. However, in both cases EBIT values are more favorable than baseline situation (EBIT values: scenario 1, 27%, scenario 2, 30%, scenario 3, 28% of revenues). A model based on a micro-costing method was able to estimate the financial consequences of the introduction of an automation tool in our radiotherapy department. A prospective collection of data at Gemelli ART and in a consortium of centers is currently under way to prospectively validate the model.

  7. Research requirements to reduce civil helicopter life cycle cost

    NASA Technical Reports Server (NTRS)

    Blewitt, S. J.

    1978-01-01

    The problem of the high cost of helicopter development, production, operation, and maintenance is defined and the cost drivers are identified. Helicopter life cycle costs would decrease by about 17 percent if currently available technology were applied. With advanced technology, a reduction of about 30 percent in helicopter life cycle costs is projected. Technological and managerial deficiencies which contribute to high costs are examined, basic research and development projects which can reduce costs include methods for reduced fuel consumption; improved turbine engines; airframe and engine production methods; safety; rotor systems; and advanced transmission systems.

  8. Do Zero-Cost Workers’ Compensation Medical Claims Really Have Zero Costs?

    PubMed Central

    Asfaw, Abay; Rosa, Roger; Mao, Rebecca

    2015-01-01

    Objective Previous research suggests that non–workers’ compensation (WC) insurance systems, such as group health insurance (GHI), Medicare, or Medicaid, at least partially cover work-related injury and illness costs. This study further examined GHI utilization and costs. Methods Using two-part model, we compared those outcomes immediately after injuries for which accepted WC medical claims made zero or positive medical payments. Results Controlling for pre-injury GHI utilization and costs and other covariates, our results indicated that post-injury GHI utilization and costs increased regardless of whether a WC medical claim was zero or positive. The increases were highest for zero-cost WC medical claims. Conclusion Our national estimates showed that zero-cost WC medical claims alone could cost the GHI $212 million per year. PMID:24316724

  9. Increasing Density and Reducing Costs of Data Acquisition

    NASA Technical Reports Server (NTRS)

    Schmalzel, J. L.; Krchnavek, R. R.; Figueroa, J. Fernando; Solano, Wanda

    2001-01-01

    There are a number of reasons why it is important to increase the density of data acquisition functions. Sensor fusion seeks to integrate large numbers of sensors into a decision network. Addition of health monitoring functions may incur additional sensor requirements. But at the same time, it is important to reduce the per-channel costs of data acquisition systems. Often the most significant cost is the management of data acquisition networks, which incurs substantial costs associated with transducer installation, configuration, calibration, and maintenance. Alternatives that lower the cost of the transducer system and reduce the data acquisition system channel count will directly impact initial system costs. Other techniques that affect maintenance and operating costs will contribute to reducing life cycle costs. This paper describes work undertaken to explore alternative architectures for lowering the cost per transducer function using a MEMS-based accelerometer as the model.

  10. Medical cost offsets from prescription drug utilization among Medicare beneficiaries.

    PubMed

    Roebuck, M Christopher

    2014-10-01

    This brief commentary extends earlier work on the value of adherence to derive medical cost offset estimates from prescription drug utilization. Among seniors with chronic vascular disease, 1% increases in condition-specific medication use were associated with significant (P  less than  0.001) reductions in gross nonpharmacy medical costs in the amounts of 0.63% for dyslipidemia, 0.77% for congestive heart failure, 0.83% for diabetes, and 1.17% for hypertension.

  11. Reduce air, reduce compliance cost new patented spray booth technology

    SciTech Connect

    McGinnis, F.

    1997-12-31

    A New Paint Spray Booth System that dramatically reduces air volumes normally required for capturing and controlling paint overspray that contains either Volatile Organic Compounds (VOC) or Hazardous Air Pollutants (HAP), or both. In turn, a substantial reduction in capital equipment expenditures for air abatement systems and air make-up heaters as well as related annual operating expenses is realized.

  12. Cost-reducing multipurpose microfilm card

    NASA Technical Reports Server (NTRS)

    Smith, A. V.

    1970-01-01

    Microfilm-aperture card is printed in the same format on both sides which enables the use of one card for mounting films that are ''right reading'' on both the base side and the emulsion side. This reduces the number of microfilm-card formats.

  13. Reducing fire hazard: balancing costs and outcomes.

    Treesearch

    Valerie. Rapp

    2004-01-01

    Massive wildfires in recent years have given urgency to questions of how to reduce fire hazard in Western forests, how to finance the work, and how to use the wood, especially in forests crowded with small trees. Scientists have already developed tools that estimate fire hazard in a forest stand. But hazard is more difficult to estimate at a landscape scale, involving...

  14. Medical cost-offset following treatment referral for alcohol and other drug use disorders in a group model HMO.

    PubMed

    Polen, Michael R; Freeborn, Donald K; Lynch, Frances L; Mullooly, John P; Dickinson, Daniel M

    2006-07-01

    The purpose of this study was to determine whether specialty alcohol and other drug (AOD) treatment is associated with reduced subsequent medical care costs. AOD treatment costs and medical costs in a group model health maintenance organization (HMO) were collected for up to 6 years on 1,472 HMO members who were recommended for specialty AOD treatment, and on 738 members without AOD diagnoses or treatment. Addiction Severity Index measures were also obtained from a sample of 293 of those recommended for treatment. Changes in medical costs did not differ between treatment and comparison groups. Nor did individuals with improved treatment outcomes have greater reductions in medical costs. AOD treatment costs were not inversely related to subsequent medical costs, except for a subgroup with recent AOD treatment. In the interviewed sample, better treatment outcomes did not predict lower subsequent medical costs. Multiple treatment episodes may hold promise for producing cost-offsets.

  15. An anesthesia medication cost scorecard--concepts for individualized feedback.

    PubMed

    Malapero, Raymond J; Gabriel, Rodney A; Gimlich, Robert; Ehrenfeld, Jesse M; Philip, Beverly K; Bates, David W; Urman, Richard D

    2015-05-01

    There is a growing emphasis on both cost containment and better quality health care. The creation of better methods for alerting providers and their departments to the costs associated with patient care is one tool for improving efficiency. Since anesthetic medications used in the OR setting are one easily monitored factor contributing to OR costs, anesthetic cost report cards can be used to assess the cost and, potentially the quality of care provided by each practitioner. An ongoing challenge is the identification of the most effective strategies to control costs, promote cost awareness and at the same time maximize quality. To test the scorecard concept, we utilized existing informatics systems to gather and analyze drug costs for anesthesia providers in the OR. Drug costs were analyzed by medication class for each provider. Individual anesthesiologist's anesthetic costs were collected and compared to the average costs of the overall group and individual trends over time were noted. We presented drug usage data in an electronic report card format. Real-time individual reports can be provided to anesthesiologists to allow for anesthetic cost feedback. Data provided can include number of cases, average case time, total anesthetic medication costs, and average anesthetic cost per case. Also included can be subcategories of pre-medication, antibiotics, hypnotics, local anesthetics, neuromuscular blocking drugs, analgesics, vasopressors, beta-blockers, anti-emetics, volatile anesthetics, and reversal agents. The concept of anesthetic cost report card should be further developed for individual feedback, and could include many other dimensions. Such a report card can be utilized to encourage lower anesthetic costs, quality improvement among anesthesia providers, and for cost containment in the operating room.

  16. Patient-oncologist cost communication, financial distress, and medication adherence.

    PubMed

    Bestvina, Christine M; Zullig, Leah L; Rushing, Christel; Chino, Fumiko; Samsa, Gregory P; Altomare, Ivy; Tulsky, James; Ubel, Peter; Schrag, Deborah; Nicolla, Jon; Abernethy, Amy P; Peppercorn, Jeffrey; Zafar, S Yousuf

    2014-05-01

    Little is known about the association between patient-oncologist discussion of cancer treatment out-of-pocket (OOP) cost and medication adherence, a critical component of quality cancer care. We surveyed insured adults receiving anticancer therapy. Patients were asked if they had discussed OOP cost with their oncologist. Medication nonadherence was defined as skipping doses or taking less medication than prescribed to make prescriptions last longer, or not filling prescriptions because of cost. Multivariable analysis assessed the association between nonadherence and cost discussions. Among 300 respondents (86% response), 16% (n = 49) reported high or overwhelming financial distress. Nineteen percent (n = 56) reported talking to their oncologist about cost. Twenty-seven percent (n = 77) reported medication nonadherence. To make a prescription last longer, 14% (n = 42) skipped medication doses, and 11% (n = 33) took less medication than prescribed; 22% (n = 66) did not fill a prescription because of cost. Five percent (n = 14) reported chemotherapy nonadherence. To make a prescription last longer, 1% (n = 3) skipped chemotherapy doses, and 2% (n = 5) took less chemotherapy; 3% (n = 10) did not fill a chemotherapy prescription because of cost. In adjusted analyses, cost discussion (odds ratio [OR] = 2.58; 95% CI, 1.14 to 5.85; P = .02), financial distress (OR = 1.64, 95% CI, 1.38 to 1.96; P < .001) and higher financial burden than expected (OR = 2.89; 95% CI, 1.41 to 5.89; P < .01) were associated with increased odds of nonadherence. Patient-oncologist cost communication and financial distress were associated with medication nonadherence, suggesting that cost discussions are important for patients forced to make cost-related behavior alterations. Future research should examine the timing, content, and quality of cost-discussions. Copyright © 2014 by American Society of Clinical Oncology.

  17. Cost Analysis of the STONE Randomized Trial: Can Health Care Costs be Reduced One Test at a Time?

    PubMed

    Melnikow, Joy; Xing, Guibo; Cox, Ginger; Leigh, Paul; Mills, Lisa; Miglioretti, Diana L; Moghadassi, Michelle; Smith-Bindman, Rebecca

    2016-04-01

    Decreasing the use of high-cost tests may reduce health care costs. To compare costs of care for patients presenting to the emergency department (ED) with suspected kidney stones randomized to 1 of 3 initial imaging tests. Patients were randomized to point-of-care ultrasound (POC US, least costly), radiology ultrasound (RAD US), or computed tomography (CT, most costly). Subsequent testing and treatment were the choice of the treating physician. A total of 2759 patients at 15 EDs were randomized to POC US (n=908), RAD US, (n=893), or CT (n=958). Mean age was 40.4 years; 51.8% were male. All medical care documented in the trial database in the 7 days following enrollment was abstracted and coded to estimate costs using national average 2012 Medicare reimbursements. Costs for initial ED care and total 7-day costs were compared using nonparametric bootstrap to account for clustering of patients within medical centers. Initial ED visit costs were modestly lower for patients assigned to RAD US: $423 ($411, $434) compared with patients assigned to CT: $448 ($438, $459) (P<0.0001). Total costs were not significantly different between groups: $1014 ($912, $1129) for POC US, $970 ($878, $1078) for RAD US, and $959 ($870, $1044) for CT. Hospital admissions contributed over 50% of total costs, though only 11% of patients were admitted. Mean total costs (and admission rates) varied substantially by site from $749 to $1239. Assignment to a less costly test had no impact on overall health care costs for ED patients. System-level interventions addressing variation in admission rates from the ED might have greater impact on costs.

  18. Establishing cost centers within libraries of medical centers.

    PubMed Central

    Schultz, C K

    1983-01-01

    Medical centers that educate students, treat patients, and perform medical research usually adopt accounting methods for separating those functions financially--designating each function as a cost center. Faculty members who participate in more than one of the separately charged activities have their salaries apportioned accordingly. Cost-shared services, such as a computer facility or a power plant, may also be apportioned among the cost centers. Given this approach to accounting, the shared services of the medical center's library should be included in such an apportionment. Whether such is the case, why the matter is of concern, and how such accounting can be performed were recently studied. PMID:6860398

  19. Costs of children with medical complexity in Australian public hospitals.

    PubMed

    Srivastava, Rajendu; Downie, James; Hall, Jane; Reynolds, Graham

    2016-05-01

    To describe the hospital costs, hospital types and differences across states and territories for children with medical complexity cared for in Australian public hospitals. Retrospective national administrative database study of 212 Australian public hospitals from six states (excluding Queensland) and two territories that submitted cost data to the National Hospital Costing Data Collection for 2010-2011. Participants included all hospitalised patients with comparisons between adults and children (17 years of age and younger), and adults with chronic diseases and children with medical complexity. Total hospital costs were the main outcome measure. The National Hospital Costing Data Collection contained data from 212 public hospitals; total admissions (adults and children) were 3 519 140 at a total hospital cost of $16 187 400 000. Children accounted for 350 499 (9.9%) of the admissions at a total hospital cost of $1 931 585 123 (11.9%). Of all children, those with medical complexity accounted for 48 758 (13.9%), and their total hospital costs were $620 948 769 (32.1%). Six children's hospitals had 145 213 (41%) of the total children admissions at a total hospital cost of $936 041 843 (48%). Across the states and territories, the number of childhood admissions ranged from 9164 to 146 618 with 4.7-14.8% for children with medical complexity. Total hospital costs ranged from $44 to $592 million with 15.4-39.4% for children with medical complexity. The national burden of hospitalised children is substantial. Children with medical complexity only account for a small percentage of hospitalisations but almost one third of total hospital costs for children, with children's hospitals bearing the major costs. © 2016 Paediatrics and Child Health Division (The Royal Australasian College of Physicians).

  20. Cost-effectiveness analysis of antipsychotics in reducing schizophrenia relapses

    PubMed Central

    2012-01-01

    Background Schizophrenia is a severe form of mental illness which is associated with significant and long-lasting health, social and financial burdens. The aim of this project is to assess the efficiency of the antipsychotics used in Spain in reducing schizophrenia relapses under the Spanish Health System perspective. Material and methods A decision-analytic model was developed to explore the relative cost-effectiveness of five antipsychotic medications, amisulpride, aripiprazole, olanzapine, paliperidone Extended-Release (ER) and risperidone, compared to haloperidol, over a 1-year treatment period among people living in Spain with schizophrenia. The transition probabilities for assessed therapies were obtained from the systemic review and meta-analysis performed by National Institute for Health and Clinical Excellence (NICE). Results Paliperidone ER was the option that yielded more quality-adjusted life years (QALYs) gained per patient (0.7573). In addition, paliperidone ER was the least costly strategy (€3,062), followed by risperidone (€3,194), haloperidol (€3,322), olanzapine (€3,893), amisulpride (€4,247) and aripiprazole (€4,712). In the incremental cost-effectiveness (ICE) analysis of the assessed antipsychotics compared to haloperidol, paliperidone ER and risperidone were dominant options. ICE ratios for other medications were €23,621/QALY gained, €91,584/QALY gained and €94,558/QALY gained for olanzapine, amisulpride and aripiprazole, respectively. Deterministic sensitivity analysis showed that risperidone is always dominant when compared to haloperidol. Paliperidone ER is also dominant apart from the exception of the scenario with a 20% decrease in the probability of relapses. Conclusions Our findings may be of interest to clinicians and others interested in outcomes and cost of mental health services among patients with schizophrenia. Paliperidone ER and risperidone were shown to be dominant therapies compared to haloperidol in Spain

  1. Frequency, types, and direct related costs of medication errors in an academic nephrology ward in Iran.

    PubMed

    Gharekhani, Afshin; Kanani, Negin; Khalili, Hossein; Dashti-Khavidaki, Simin

    2014-09-01

    Medication errors are ongoing problems among hospitalized patients especially those with multiple co-morbidities and polypharmacy such as patients with renal diseases. This study evaluated the frequency, types and direct related cost of medication errors in nephrology ward and the role played by clinical pharmacists. During this study, clinical pharmacists detected, managed, and recorded the medication errors. Prescribing errors including inappropriate drug, dose, or treatment durations were gathered. To assess transcription errors, the equivalence of nursery charts and physician's orders were evaluated. Administration errors were assessed by observing drugs' preparation, storage, and administration by nurses. The changes in medications costs after implementing clinical pharmacists' interventions were compared with the calculated medications costs if the medication errors were continued up to patients' discharge time. More than 85% of patients experienced medication error. The rate of medication errors was 3.5 errors per patient and 0.18 errors per ordered medication. More than 95% of medication errors occurred at prescription nodes. Most common prescribing errors were omission (26.9%) or unauthorized drugs (18.3%) and low drug dosage or frequency (17.3%). Most of the medication errors happened on cardiovascular drugs (24%) followed by vitamins and electrolytes (22.1%) and antimicrobials (18.5%). The number of medication errors was correlated with the number of ordered medications and length of hospital stay. Clinical pharmacists' interventions decreased patients' direct medication costs by 4.3%. About 22% of medication errors led to patients' harm. In conclusion, clinical pharmacists' contributions in nephrology wards were of value to prevent medication errors and to reduce medications cost.

  2. Functional Limitations, Medication Support, and Responses to Drug Costs among Medicare Beneficiaries.

    PubMed

    Whaley, Christopher; Reed, Mary; Hsu, John; Fung, Vicki

    2015-01-01

    Standard Medicare Part D prescription drug benefits include substantial and complex cost-sharing. Many beneficiaries also have functional limitations that could affect self-care capabilities, including managing medications, but also have varying levels of social support to help with these activities. We examined the associations between drug cost responses, functional limitations, and social support. We conducted telephone interviews in a stratified random sample of community-dwelling Medicare Advantage beneficiaries (N = 1,201, response rate = 70.0%). Participants reported their functional status (i.e., difficulty with activities of daily living) and social support (i.e., receiving help with medications). Drug cost responses included cost-reducing behaviors, cost-related non-adherence, and financial stress. We used multivariate logistic regression to assess associations among functional status, help with medications, and drug cost responses, adjusting for patient characteristics. Respondents with multiple limitations who did not receive help with their medications were more likely to report cost-related non-adherence (OR = 3.2, 95% CI: 1.2-8.5) and financial stress (OR = 2.4, 95% CI: 1.3-4.5) compared to subjects with fewer limitations and no help; however, those with multiple limitations and with medication help had similar odds of unfavorable cost responses as those with fewer limitations. The majority of beneficiaries with functional limitations did not receive help with medications. Support with medication management for beneficiaries who have functional limitations could improve adherence and outcomes.

  3. Analysis of the Children's Hospital Graduate Medical Education Program Fund Allocations for Indirect Medical Education Costs.

    ERIC Educational Resources Information Center

    Wynn, Barbara O.; Kawata, Jennifer

    This study analyzed issues related to estimating indirect medical education costs specific to pediatric discharges. The Children's Hospital Graduate Medical Education (CHGNE) program was established to support graduate medical education in children's hospitals. This provision authorizes payments for both direct and indirect medical education…

  4. Clinical outcomes and incremental costs from a medication adherence pilot intervention targeting low-income patients with diabetes at risk of cost-related medication nonadherence.

    PubMed

    Ryan, John G; Fedders, Mark; Jennings, Terri; Vittoria, Isabel; Yanes, Melissa

    2014-12-01

    The extent to which reducing cost-related barriers affects diabetes outcomes and medication adherence among uninsured patients is not known. The purpose of these analyses was to understand the clinical impact and cost considerations of a prescription assistance program targeting low-income, minority patients with diabetes and at high risk for cost-related medication nonadherence. Patients received diabetes medications without copayments for 12 months. Change in diabetes control was calculated by using glycosylated hemoglobin (HbA1c) level at follow-up compared with baseline. Clinical data were collected from the electronic health record. Medication adherence for diabetes medications was estimated by using proportion of days covered (PDC). Incremental acquisition and per-patient costs, based on actual hospital medication costs, were calculated for different baseline HbA1c levels. Patients with baseline HbA1c levels ≥7%, ≥8%, and ≥9% experienced mean HbA1c reductions of 0.82% (P = 0.008), 1.02% (P = 0.010), and 1.47% (P = 0.010), respectively, during the 12-month period. The average PDC was 70.55%; 45.24% had a PDC ≥80%, indicating an adequate level of medication adherence. Medication adherence ≥80% was associated with ethnicity (P = 0.015), whereas mean PDC was associated with number of diabetes medication classes used (P = 0.031). Acquisition cost for 1242 prescriptions filled by 103 patients was $13,365.82, representing per-patient costs of $132.39; however, as baseline targets increased, acquisition costs decreased and per-patient costs increased from $10,682.59 and $169.56 to $6509.91 and $192.27, respectively. Clinically significant reductions in HbA1c levels were achieved for all patients, although greater reductions were achieved with modest per-patient cost increases when considering patients with uncontrolled diabetes. Incorporating a multifactorial intervention to address cost-related medication nonadherence with a behavior change component may

  5. Opportunity costs of ambulatory medical care in the United States.

    PubMed

    Ray, Kristin N; Chari, Amalavoyal V; Engberg, John; Bertolet, Marnie; Mehrotra, Ateev

    2015-08-01

    The typical focus in discussions of healthcare spending is on direct medical costs such as physician reimbursement. The indirect costs of healthcare-patient opportunity costs associated with seeking care, for example-have not been adequately quantified. We aimed to quantify the opportunity costs for adults seeking medical care for themselves or others. Secondary analysis of the 2003-2010 American Time Use Survey (ATUS). We used the nationally representative 2003-2010 ATUS to estimate opportunity costs associated with ambulatory medical visits. We estimated opportunity costs for employed adults using self-reported hourly wages and for unemployed adults using a Heckman selection model. We used the Medical Expenditure Panel Survey to compare opportunity costs with direct costs (ie, patient out-of-pocket, provider reimbursement) in 2010. Average total time per visit was 121 minutes (95% CI, 118-124), with 37 minutes (95% CI, 36-39) of travel time and 84 minutes (95% CI, 81-86) of clinic time. The average opportunity cost per visit was $43, which exceeds the average patient's out-of-pocket payment. Total opportunity costs per year for all physician visits in the United States were $52 billion in 2010. For every dollar spent in visit reimbursement, an additional 15 cents were spent in opportunity costs. In the United States, opportunity costs associated with ambulatory medical care are substantial. Accounting for patient opportunity costs is important for examining US healthcare system efficiency and for evaluating methods to improve the efficient delivery of patient-centered care.

  6. Increasing Medicare part D enrollment in medication therapy management could improve health and lower costs.

    PubMed

    Stuart, Bruce; Loh, F Ellen; Roberto, Pamela; Miller, Laura M

    2013-07-01

    Targeting efforts to improve medication adherence, especially among people with high health needs, can improve health and lower health care spending. To this end, Medicare requires that insurance plans that provide prescription drug (Part D) coverage offer specialized medication therapy management services to optimize medication use for enrollees with high drug costs, multiple chronic diseases, and multiple covered drugs. We analyzed a large random sample of Part D enrollees with diabetes, heart failure, and chronic obstructive pulmonary disease, to see whether poor adherence to recommended drugs was associated with higher Medicare costs. We found that beneficiaries with poor adherence had higher costs, ranging from $49 to $840 per month for patients with diabetes, for example. However, such beneficiaries were not uniformly more likely than others to be eligible for medication therapy management services. Aligning medication therapy management eligibility with a metric such as potentially preventable future costs holds promise for both improving the quality of care and reducing spending.

  7. The cost of implementing inpatient bar code medication administration.

    PubMed

    Sakowski, Julie Ann; Ketchel, Alan

    2013-02-01

    To calculate the costs associated with implementing and operating an inpatient bar-code medication administration (BCMA) system in the community hospital setting and to estimate the cost per harmful error prevented. This is a retrospective, observational study. Costs were calculated from the hospital perspective and a cost-consequence analysis was performed to estimate the cost per preventable adverse drug event averted. Costs were collected from financial records and key informant interviews at 4 not-for profit community hospitals. Costs included direct expenditures on capital, infrastructure, additional personnel, and the opportunity costs of time for existing personnel working on the project. The number of adverse drug events prevented using BCMA was estimated by multiplying the number of doses administered using BCMA by the rate of harmful errors prevented by interventions in response to system warnings. Our previous work found that BCMA identified and intercepted medication errors in 1.1% of doses administered, 9% of which potentially could have resulted in lasting harm. The cost of implementing and operating BCMA including electronic pharmacy management and drug repackaging over 5 years is $40,000 (range: $35,600 to $54,600) per BCMA-enabled bed and $2000 (range: $1800 to $2600) per harmful error prevented. BCMA can be an effective and potentially cost-saving tool for preventing the harm and costs associated with medication errors.

  8. Developments in medical care costs: an update.

    PubMed

    Vincenzino, J V

    1993-01-01

    The nation spent roughly $830 billion on all categories of medical care in 1992. Available data for personal health care expenditures and prices indicate that their increases slightly slowed last year, but the burden placed on the economy by the total health care sector continues to mount. Although the uncertainty of the Presidential election is over, the debate on health care reform will continue.

  9. Money for nothing? The net costs of medical training.

    PubMed

    Barros, Pedro P; Machado, Sara R

    2010-09-01

    One of the stages of medical training is the residency programme. Hosting institutions often claim compensation for the training provided. How much should this compensation be? According to our results, given the benefits arising from having residents among the house staff, no transfer (either tuition fee or subsidy) should be set to compensate the hosting institution for providing medical training. This paper quantifies the net costs of medical training, defined as the training costs over and above the wage paid. We jointly consider two effects. On the one hand, residents take extra time and resources from both the hosting institution and the supervisor. On the other hand, residents can be regarded as a less expensive substitute to nurses and/or graduate physicians, in the production of health care, both in primary care centres and hospitals. The net effect can be either positive or negative. We use the fact that residents, in Portugal, are centrally allocated to National Health Service hospitals to treat them as a fixed exogenous production factor. The data used comes from Portuguese hospitals and primary care centres. Cost function estimates point to a small negative marginal impact of residents on hospitals' (-0.02%) and primary care centres' (-0.9%) costs. Nonetheless, there is a positive relation between size and cost to the very large hospitals and primary care centres. Our approach to estimation of residents' costs controls for other teaching activities hospitals might have (namely undergraduate Medical Schools). Overall, the net costs of medical training appear to be quite small.

  10. Costs of venous thromboembolism associated with hospitalization for medical illness.

    PubMed

    Cohoon, Kevin P; Leibson, Cynthia L; Ransom, Jeanine E; Ashrani, Aneel A; Petterson, Tanya M; Long, Kirsten Hall; Bailey, Kent R; Heit, Johm A

    2015-04-01

    To determine population-based estimates of medical costs attributable to venous thromboembolism (VTE) among patients currently or recently hospitalized for acute medical illness. Population-based cohort study conducted in Olmsted County, Minnesota. Using Rochester Epidemiology Project (REP) resources, we identified all Olmsted County residents with objectively diagnosed incident VTE during or within 92 days of hospitalization for acute medical illness over the 18-year period of 1988 to 2005 (n=286). One Olmsted County resident hospitalized for medical illness without VTE was matched to each case for event date (±1 year), duration of prior medical history, and active cancer status. Subjects were followed forward in REP provider-linked billing data for standardized, inflation-adjusted direct medical costs (excluding outpatient pharmaceutical costs) from 1 year before their respective event or index date to the earliest of death, emigration from Olmsted County, or December 31, 2011 (study end date). We censored follow-up such that each case and matched control had similar periods of observation. We used generalized linear modeling (controlling for age, sex, preexisting conditions, and costs 1 year before index) to predict costs for cases and controls. Adjusted mean predicted costs were 2.5-fold higher for cases ($62,838) than for controls ($24,464) (P<.001) from index to up to 5 years post index. Cost differences between cases and controls were greatest within the first 3 months after the event date (mean difference=$16,897) but costs remained significantly higher for cases compared with controls for up to 3 years. VTE during or after recent hospitalization for medical illness contributes a substantial economic burden.

  11. Costs of Venous Thromboembolism Associated with Hospitalization for Medical Illness

    PubMed Central

    Cohoon, Kevin P.; Leibson, Cynthia L.; Ransom, Jeanine E.; Ashrani, Aneel A.; Petterson, Tanya M.; Long, Kirsten Hall; Bailey, Kent R.; Heit, John A.

    2015-01-01

    Objective To determine population-based estimates of medical costs attributable to venous thromboembolism (VTE) among patients currently or recently hospitalized for acute medical illness. Study Design Population-based cohort study conducted in Olmsted County, Minn. Methods Using Rochester Epidemiology Project (REP) resources, we identified all Olmsted County, MN residents with objectively-diagnosed incident VTE within 92 days of hospitalization for acute medical illness over the 18-year period, 1988–2005 (n=286). One Olmsted County resident hospitalized for medical illness without VTE was matched to each case on event date (± 1 year), duration of prior medical history and active cancer status. Subjects were followed forward in REP provider-linked billing data for standardized, inflation-adjusted direct medical costs (excluding outpatient pharmaceutical costs) from 1 year before their respective event or index date to the earliest of death, emigration from Olmsted County, or 12/31/2011 (study end date). We censored follow-up such that each case and match control had similar periods of observation. We also controlled for length of follow-up from index to up to 5-years post-index. We used generalized linear modeling (controlling for age, sex, pre-existing conditions and costs 1 year before index) to predict costs for cases and controls. Results Adjusted mean predicted costs were 2.5-fold higher for cases ($62,838) than for controls ($24,464) (P=<0.001) from index to up to 5-years post-index. Cost differences between cases and controls were greatest within the first 3 months after the event date (mean difference=$16,897) but costs remained significantly higher for cases compared to controls for up to 3 years. Conclusions VTE during or after recent hospitalization for medical illness contributes a substantial economic burden. PMID:26244788

  12. [Cost dynamics, demographic development and medical progress].

    PubMed

    Breyer, F

    1995-01-01

    The drastic increase in the proportion of the elderly in the Germany population in the coming 30 to 40 years and the rapid technological progress in medicine form a vast potential for a rise of health care expenditures as a fraction of gross national product. Three possible strategies to cope with this development are discussed. It is shown that the predominant strategy of stabilizing the rate of contribution to the sickness funds will soon lead to a sharp rationing even of life-prolonging medical services. As an alternative, a strategy of "freedom of choice" is presented.

  13. Medical Tourism: A Cost or Benefit to the NHS?

    PubMed Central

    Hanefeld, Johanna; Horsfall, Daniel; Lunt, Neil; Smith, Richard

    2013-01-01

    Medical Tourism’ – the phenomenon of people travelling abroad to access medical treatment - has received increasing attention in academic and popular media. This paper reports findings from a study examining effect of inbound and outbound medical tourism on the UK NHS, by estimating volume of medical tourism and associated costs and benefits. A mixed methods study it includes analysis of the UK International Passenger Survey (IPS); interviews with 77 returning UK medical tourists, 63 policymakers, NHS managers and medical tourism industry actors policymakers, and a review of published literature. These informed costing of three types of treatments for which patients commonly travel abroad: fertility treatment, cosmetic and bariatric surgery. Costing of inbound tourism relied on data obtained through 28 Freedom-of-Information requests to NHS Foundation Trusts. Findings demonstrate that contrary to some popular media reports, far from being a net importer of patients, the UK is now a clear net exporter of medical travellers. In 2010, an estimated 63,000 UK residents travelled for treatment, while around 52,000 patients sought treatment in the UK. Inbound medical tourists treated as private patients within NHS facilities may be especially profitable when compared to UK private patients, yielding close to a quarter of revenue from only 7% of volume in the data examined. Costs arise where patients travel abroad and return with complications. Analysis also indicates possible savings especially in future health care and social costs averted. These are likely to be specific to procedures and conditions treated. UK medical tourism is a growing phenomenon that presents risks and opportunities to the NHS. To fully understand its implications and guide policy on issues such as NHS global activities and patient safety will require investment in further research and monitoring. Results point to likely impact of medical tourism in other universal public health systems

  14. Medical tourism: a cost or benefit to the NHS?

    PubMed

    Hanefeld, Johanna; Horsfall, Daniel; Lunt, Neil; Smith, Richard

    2013-01-01

    'Medical Tourism' - the phenomenon of people travelling abroad to access medical treatment - has received increasing attention in academic and popular media. This paper reports findings from a study examining effect of inbound and outbound medical tourism on the UK NHS, by estimating volume of medical tourism and associated costs and benefits. A mixed methods study it includes analysis of the UK International Passenger Survey (IPS); interviews with 77 returning UK medical tourists, 63 policymakers, NHS managers and medical tourism industry actors policymakers, and a review of published literature. These informed costing of three types of treatments for which patients commonly travel abroad: fertility treatment, cosmetic and bariatric surgery. Costing of inbound tourism relied on data obtained through 28 Freedom-of-Information requests to NHS Foundation Trusts. Findings demonstrate that contrary to some popular media reports, far from being a net importer of patients, the UK is now a clear net exporter of medical travellers. In 2010, an estimated 63,000 UK residents travelled for treatment, while around 52,000 patients sought treatment in the UK. Inbound medical tourists treated as private patients within NHS facilities may be especially profitable when compared to UK private patients, yielding close to a quarter of revenue from only 7% of volume in the data examined. Costs arise where patients travel abroad and return with complications. Analysis also indicates possible savings especially in future health care and social costs averted. These are likely to be specific to procedures and conditions treated. UK medical tourism is a growing phenomenon that presents risks and opportunities to the NHS. To fully understand its implications and guide policy on issues such as NHS global activities and patient safety will require investment in further research and monitoring. Results point to likely impact of medical tourism in other universal public health systems.

  15. A Flexible Model for Correlated Medical Costs, with Application to Medical Expenditure Panel Survey Data

    PubMed Central

    Chen, Jinsong; Liu, Lei; Shih, Ya-Chen T.; Zhang, Daowen; Severini, Thomas A.

    2016-01-01

    We propose a flexible model for correlated medical cost data with several appealing features. First, the mean function is partially linear. Second, the distributional form for the response is not specified. Third, the covariance structure of correlated medical costs has a semiparametric form. We use extended generalized estimating equations to simultaneously estimate all parameters of interest. B-splines is used to estimate unknown functions, and a modification to Akaike Information Criterion is proposed for selecting knots in spline bases. We apply the model to correlated medical costs in the Medical Expenditure Panel Survey (MEPS) dataset. Simulation studies are conducted to assess the performance of our method. PMID:26403805

  16. A flexible model for correlated medical costs, with application to medical expenditure panel survey data.

    PubMed

    Chen, Jinsong; Liu, Lei; Shih, Ya-Chen T; Zhang, Daowen; Severini, Thomas A

    2016-03-15

    We propose a flexible model for correlated medical cost data with several appealing features. First, the mean function is partially linear. Second, the distributional form for the response is not specified. Third, the covariance structure of correlated medical costs has a semiparametric form. We use extended generalized estimating equations to simultaneously estimate all parameters of interest. B-splines are used to estimate unknown functions, and a modification to Akaike information criterion is proposed for selecting knots in spline bases. We apply the model to correlated medical costs in the Medical Expenditure Panel Survey dataset. Simulation studies are conducted to assess the performance of our method.

  17. The relationship between medical care costs and personal bankruptcy.

    PubMed

    Brotman, Billie Ann

    2006-01-01

    The number of personal bankruptcy filings has broken records over the last few years. Filings for nonbusiness bankruptcy protection totaled 1,650,279 in 2003, an increase of 9.6 percent between the years 2002 and 2003. This article examines the relationship in the United States between personal bankruptcy filings, and medical care costs and coverage. There seems to be a positive, statistically significant relationship between medical care costs and nonbusiness bankruptcy numbers; however, medical care coverage has limited or no explanatory value as a factor explaining total nonbusiness bankruptcy filings. The regression models suggest a weak or no relationship between the number of nonbusiness bankruptcy filings and health insurance coverage.

  18. Selective Herbicides Reduce Weeding Costs in Two Mississippi Nurseries

    Treesearch

    W. B. Smyly; T. H. Filer

    1979-01-01

    In tests conducted from 1974 to 1977, the preemergence herbicides, Treflan, Eptam, Dymid, and Dectun reduced weeds and weeding costs in seedling beds of loblolly, slash, and short leaf pine. Velpar and Roundup controlled weeds along riser lines.

  19. Unit Cost of Medical Services at Different Hospitals in India

    PubMed Central

    Chatterjee, Susmita; Levin, Carol; Laxminarayan, Ramanan

    2013-01-01

    Institutional care is a growing component of health care costs in low- and middle-income countries, but local health planners in these countries have inadequate knowledge of the costs of different medical services. In India, greater utilisation of hospital services is driven both by rising incomes and by government insurance programmes that cover the cost of inpatient services; however, there is still a paucity of unit cost information from Indian hospitals. In this study, we estimated operating costs and cost per outpatient visit, cost per inpatient stay, cost per emergency room visit, and cost per surgery for five hospitals of different types across India: a 57-bed charitable hospital, a 200-bed private hospital, a 400-bed government district hospital, a 655-bed private teaching hospital, and a 778-bed government tertiary care hospital for the financial year 2010–11. The major cost component varied among human resources, capital costs, and material costs, by hospital type. The outpatient visit cost ranged from Rs. 94 (district hospital) to Rs. 2,213 (private hospital) (USD 1 = INR 52). The inpatient stay cost was Rs. 345 in the private teaching hospital, Rs. 394 in the district hospital, Rs. 614 in the tertiary care hospital, Rs. 1,959 in the charitable hospital, and Rs. 6,996 in the private hospital. Our study results can help hospital administrators understand their cost structures and run their facilities more efficiently, and we identify areas where improvements in efficiency might significantly lower unit costs. The study also demonstrates that detailed costing of Indian hospital operations is both feasible and essential, given the significant variation in the country’s hospital types. Because of the size and diversity of the country and variations across hospitals, a large-scale study should be undertaken to refine hospital costing for different types of hospitals so that the results can be used for policy purposes, such as revising payment rates

  20. Reducing medical errors through better documentation.

    PubMed

    Edwards, Marie; Moczygemba, Jackie

    2004-01-01

    Preventable medical errors occur with alarming frequency in US hospitals. Questions to address include what is a medical error, what errors occur most often, and what solutions can health information technologies offer with better documentation. Preventable injuries caused by mismanagement of treatment happen in all areas of care. Some result from human fallibility and some from system failures. Most errors stem from a combination of the two. Examples of combination errors include wrong-site surgeries, scrambled laboratory results, medication mishaps, misidentification of patients, and equipment failures. Unavailable patient information and illegible handwriting lead to diagnosing and ordering errors. Recent technology offers viable solutions to many of these medical errors. Computer-based medical records, integration with the pharmacy, decision support software, Computerized Physician Order Entry Systems, and bar coding all offer ways to avoid tragic treatment outcomes. Persuading and training hospital staff to use the technology poses a problem, as does budgeting for the new equipment. However, the technology would prove its worth in time. The Institute of Medicine and coalition groups such as Leapfrog Group have recognized the problem that permeates the health care industry, manifests in many ways, and requires the many solutions that information technology offer.

  1. Medical employment growth, unemployment, and the opportunity cost of health care.

    PubMed

    Pauly, Mark; Nimgaonkar, Vivek

    2016-12-01

    This policy note examines the relationship between the growth in the share of the workforce in medical care and the shares of workers who are unemployed, working in services or government employment, or working elsewhere in the economy. These changes provide measures of the opportunity cost of higher medical care spending, the majority of which is on labor. Using state data over the period 1990-2010, we find that, in years of high economy-wide unemployment, growth in medical employment in a state reduces the unemployment rate significantly; it does not appear to displace employment in other services or government employment. In periods of low economy wide-unemployment, the growth in the medical employment share does not reduce unemployment. We argue that the opportunity cost of higher medical care employment may sometimes not be so high in terms of real labor resources, nor in terms of employment for needed government services.

  2. Reducing biosolids disposal costs using land application in forested areas

    SciTech Connect

    Huffines, R.L.

    1995-11-01

    Switching biosolids land application from a reclamation site to a forested site significantly reduced the cost of biosolids disposal at the Savannah River Site. Previous beneficial reuse programs focused on reclamation of existing borrow pits. While extremely beneficial, this program became very costly due to the regulatory requirements for groundwater monitoring, soil monitoring and frequent biosolids analyses. A new program was developed to reuse biosolids in forested areas where the biosolids could be used as a soil conditioner and fertilizer to enhance timber yield. The forested land application site was designed so that groundwater monitoring and soil monitoring could be eliminated while biosolids monitoring and site maintenance were minimized. Monitoring costs alone were reduced by 80%. Capital costs for site preparation were also significantly reduced since there was no longer a need for expensive groundwater monitoring wells.

  3. Reducing Design Cycle Time and Cost Through Process Resequencing

    NASA Technical Reports Server (NTRS)

    Rogers, James L.

    2004-01-01

    In today's competitive environment, companies are under enormous pressure to reduce the time and cost of their design cycle. One method for reducing both time and cost is to develop an understanding of the flow of the design processes and the effects of the iterative subcycles that are found in complex design projects. Once these aspects are understood, the design manager can make decisions that take advantage of decomposition, concurrent engineering, and parallel processing techniques to reduce the total time and the total cost of the design cycle. One software tool that can aid in this decision-making process is the Design Manager's Aid for Intelligent Decomposition (DeMAID). The DeMAID software minimizes the feedback couplings that create iterative subcycles, groups processes into iterative subcycles, and decomposes the subcycles into a hierarchical structure. The real benefits of producing the best design in the least time and at a minimum cost are obtained from sequencing the processes in the subcycles.

  4. Brand Medications and Medicare Part D: How Eye Care Providers' Prescribing Patterns Influence Costs.

    PubMed

    Newman-Casey, Paula Anne; Woodward, Maria A; Niziol, Leslie M; Lee, Paul P; De Lott, Lindsey B

    2017-06-16

    providers prescribe more brand medications by volume than any other provider group. Efforts to reduce prescription expenditures by eye care providers should focus on increasing the use of generic medications, primarily through therapeutic substitutions. Policy changes enabling Medicare to negotiate prescription drug prices could decrease costs to Medicare. Copyright © 2017 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

  5. Trend of cost and utilization of COPD medication in Korea.

    PubMed

    Lee, Jongmin; Lee, Jae Ha; Kim, Jee-Ae; Rhee, Chin Kook

    2017-01-01

    There are only a few longitudinal studies regarding medical utilization and costs for patients with COPD. The purpose of this study was to analyze the trend of medical utilization and costs on a long-term basis. Using the Korean Health Insurance Review and Assessment Service (HIRA) data from 2008 to 2013, COPD patients were identified. The trend of medical utilization and costs was also analyzed. The number of COPD patients increased by 13.9% from 2008 to 2013. During the same period, the cost of COPD medication increased by 78.2%. Methylxanthine and systemic beta agonists were most widely prescribed between 2008 and 2013. However, inhaled medications such as long-acting beta-2 agonist (LABA), long-acting muscarinic agonist, and inhaled corticosteroid plus LABA were dispensed to a relatively low proportion of patients with COPD. The number of patients who were prescribed inhaled medications increased gradually from 2008 to 2013, while the number of patients prescribed systemic beta agonist and methylxanthine has decreased since 2010. This study shows that there is a large gap between the COPD guidelines and clinical practice in Korea. Training programs for primary care physicians on diagnosis and guideline-based treatment are needed to improve the management of COPD.

  6. Trend of cost and utilization of COPD medication in Korea

    PubMed Central

    Lee, Jongmin; Lee, Jae Ha; Kim, Jee-Ae; Rhee, Chin Kook

    2017-01-01

    Background There are only a few longitudinal studies regarding medical utilization and costs for patients with COPD. The purpose of this study was to analyze the trend of medical utilization and costs on a long-term basis. Methods Using the Korean Health Insurance Review and Assessment Service (HIRA) data from 2008 to 2013, COPD patients were identified. The trend of medical utilization and costs was also analyzed. Results The number of COPD patients increased by 13.9% from 2008 to 2013. During the same period, the cost of COPD medication increased by 78.2%. Methylxanthine and systemic beta agonists were most widely prescribed between 2008 and 2013. However, inhaled medications such as long-acting beta-2 agonist (LABA), long-acting muscarinic agonist, and inhaled corticosteroid plus LABA were dispensed to a relatively low proportion of patients with COPD. The number of patients who were prescribed inhaled medications increased gradually from 2008 to 2013, while the number of patients prescribed systemic beta agonist and methylxanthine has decreased since 2010. Conclusion This study shows that there is a large gap between the COPD guidelines and clinical practice in Korea. Training programs for primary care physicians on diagnosis and guideline-based treatment are needed to improve the management of COPD. PMID:28031708

  7. How Are the Costs of Care for Medical Falls Distributed? The Costs of Medical Falls by Component of Cost, Timing, and Injury Severity

    ERIC Educational Resources Information Center

    Bohl, Alex A.; Phelan, Elizabeth A.; Fishman, Paul A.; Harris, Jeffrey R.

    2012-01-01

    Purpose of the Study: To examine the components of cost that drive increased total costs after a medical fall over time, stratified by injury severity. Design and Methods: We used 2004-2007 cost and utilization data for persons enrolled in an integrated care delivery system. We used a longitudinal cohort study design, where each individual…

  8. How Are the Costs of Care for Medical Falls Distributed? The Costs of Medical Falls by Component of Cost, Timing, and Injury Severity

    ERIC Educational Resources Information Center

    Bohl, Alex A.; Phelan, Elizabeth A.; Fishman, Paul A.; Harris, Jeffrey R.

    2012-01-01

    Purpose of the Study: To examine the components of cost that drive increased total costs after a medical fall over time, stratified by injury severity. Design and Methods: We used 2004-2007 cost and utilization data for persons enrolled in an integrated care delivery system. We used a longitudinal cohort study design, where each individual…

  9. Auditing medical records helps reduce liability.

    PubMed

    Ganguli, G; Winfrey, S

    1990-10-01

    An internal audit of a hospital's medical records department compares the department to standards developed by the hospital and to benchmarks set by accrediting organizations. An auditor can review the department's economy and effectiveness through employee surveys, direct observation, and interviews. By uncovering deficiencies and making recommendations for their correction, an internal audit can help limit a hospital's liability exposure.

  10. How To Reduce the Cost of Vandalism Losses.

    ERIC Educational Resources Information Center

    Edwards, L. F.

    This speech discusses security measures that could be implemented in school buildings to reduce vandalism and its associated costs. Some suggested methods for reducing vandalism include (1) employment of security guards, (2) 24-hour deployment of custodial staff, (3) installation of unbreakable doors and tamper-proof locks, and (4) use of an…

  11. Multivariate analysis of factors influencing medical costs of acute pancreatitis hospitalizations based on a national administrative database.

    PubMed

    Murata, Atsuhiko; Matsuda, Shinya; Mayumi, Toshihiko; Okamoto, Kohji; Kuwabara, Kazuaki; Ichimiya, Yukako; Fujino, Yoshihisa; Kubo, Tatsuhiko; Fujimori, Kenji; Horiguchi, Hiromasa

    2012-02-01

    Little information is available on the analysis of medical costs of acute pancreatitis hospitalizations. This study aimed to determine the factors affecting medical costs of patients with acute pancreatitis during hospitalization using a Japanese administrative database. A total of 7193 patients with acute pancreatitis were referred to 776 hospitals. We defined "patients with high medical costs" as patients whose medical costs exceeded the 90th percentile in medical costs during hospitalization and identified the independent factors for patients with high medical costs with and without controlling for length of stay. Multiple logistic regression analysis demonstrated that necrosectomy was the most significant factor for medical costs of acute pancreatitis during hospitalization. The odds ratio of necrosectomy was 33.64 (95% confidence interval, 14.14-80.03; p<0.001). Use of an intensive care unit was the most significant factor for medical costs after controlling for LOS. The OR of an ICU was 6.44 (95% CI, 4.72-8.81; p<0.001). This study demonstrated that necrosectomy and use of an ICU significantly affected the medical costs of acute pancreatitis hospitalization. These results highlight the need for health care implementations to reduce medical costs whilst maintaining the quality of patient care, and targeting patients with severe acute pancreatitis. Copyright © 2011 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.

  12. Reducing costs while maintaining quality in endovascular neurosurgical procedures.

    PubMed

    Kashlan, Osama N; Wilson, Thomas J; Chaudhary, Neeraj; Gemmete, Joseph J; Stetler, William R; Dunnick, N Reed; Thompson, B Gregory; Pandey, Aditya S

    2014-11-01

    As medical costs continue to rise during a time of increasing medical resource utilization, both hospitals and physicians must attempt to limit superfluous health care expenses. Neurointerventional treatment has been shown to be costly, but it is often the best treatment available for certain neuropathologies. The authors studied the effects of 3 policy changes designed to limit the costs of performing neurointerventional procedures at the University of Michigan. The authors retrospectively analyzed the costs of performing neurointerventional procedures during the 6-month periods before and after the implementation of 3 cost-saving policies: 1) the use of an alternative, more economical contrast agent, 2) standardization of coil prices through negotiation with industry representatives to receive economies of scale, and 3) institution of a feedback method to show practitioners the costs of unused products per patient procedure. The costs during the 6-month time intervals before and after implementation were also compared with costs during the most recent 6-month time period. The policy requiring use of a more economical contrast agent led to a decrease in the cost of contrast usage of $42.79 per procedure for the first 6 months after implementation, and $137.09 per procedure for the most current 6-month period, resulting in an estimated total savings of $62,924.31 for the most recent 6-month period. The standardized coil pricing system led to savings of $159.21 per coil after the policy change, and $188.07 per coil in the most recent 6-month period. This yielded total estimated savings of $76,732.56 during the most recent 6-month period. The feedback system for unused items decreased the cost of wasted products by approximately $44.36 per procedure in the 6 months directly after the policy change and by $48.20 per procedure in the most recent 6-month period, leading to total estimated savings of $22,123.80 during the most recent 6-month period. According to

  13. Strategies to Prevent Opioid Misuse, Abuse, and Diversion That May Also Reduce the Associated Costs

    PubMed Central

    Hahn, Kathryn L.

    2011-01-01

    Background The use of prescription opioid drugs has the potential to lead to patient abuse of these medications, addiction, and diversion. Such an abuse is associated with increased costs because of excessive healthcare utilization. Finding ways to minimize the risk for abuse and addiction can enhance patient outcomes and reduce costs to patients and to payers. Objective To review current strategies that may reduce the risk for misuse and abuse of opioid medications, which in turn can enhance patient outcomes and lower costs to health insurers and patients. Discussion Implementing approaches that will encourage the use of safe practices (universal precautions) in pain management by providers can reduce the risk for abuse and misuse associated with chronic pain medications, especially opioids. These approaches include, but are not limited to, extensive physician and patient education regarding these medications and their associated risks for abuse; the development of prescription monitoring programs to detect physician or pharmacy shopping; the detection of inappropriate prescribing and medical errors; the use of physician-patient contracts concerning opioid treatment; the requirement of presenting a photo identification to pick up an opioid prescription at the pharmacy; urine drug toxicology screening; provisions for safe disposal of unused opioids; referrals to pain and addiction specialists; and potentially encouraging the use of opioid formulations aimed at reducing abuse. Conclusion Supporting such approaches by health insurers and educating providers and patients on the risks associated with chronic pain medications can help minimize the risk of prescription opioid abuse, addiction, and diversion; reduce health services utilization associated with opioid abuse; improve patient outcomes; and reduce overall costs. PMID:25126342

  14. Prospects for reducing the processing cost of lithium ion batteries

    DOE PAGES

    Wood III, David L.; Li, Jianlin; Daniel, Claus

    2014-11-06

    A detailed processing cost breakdown is given for lithium-ion battery (LIB) electrodes, which focuses on: elimination of toxic, costly N-methylpyrrolidone (NMP) dispersion chemistry; doubling the thicknesses of the anode and cathode to raise energy density; and, reduction of the anode electrolyte wetting and SEI-layer formation time. These processing cost reduction technologies generically adaptable to any anode or cathode cell chemistry and are being implemented at ORNL. This paper shows step by step how these cost savings can be realized in existing or new LIB manufacturing plants using a baseline case of thin (power) electrodes produced with NMP processing and amore » standard 10-14-day wetting and formation process. In particular, it is shown that aqueous electrode processing can cut the electrode processing cost and energy consumption by an order of magnitude. Doubling the thickness of the electrodes allows for using half of the inactive current collectors and separators, contributing even further to the processing cost savings. Finally wetting and SEI-layer formation cost savings are discussed in the context of a protocol with significantly reduced time. These three benefits collectively offer the possibility of reducing LIB pack cost from $502.8 kWh-1-usable to $370.3 kWh-1-usable, a savings of $132.5/kWh (or 26.4%).« less

  15. Prospects for reducing the processing cost of lithium ion batteries

    NASA Astrophysics Data System (ADS)

    Wood, David L.; Li, Jianlin; Daniel, Claus

    2015-02-01

    A detailed processing cost breakdown is given for lithium-ion battery (LIB) electrodes, which focuses on: 1) elimination of toxic, costly N-methylpyrrolidone (NMP) dispersion chemistry; 2) doubling the thicknesses of the anode and cathode to raise energy density; and 3) reduction of the anode electrolyte wetting and SEI-layer formation time. These processing cost reduction technologies generically adaptable to any anode or cathode cell chemistry and are being implemented at ORNL. This paper shows step by step how these cost savings can be realized in existing or new LIB manufacturing plants using a baseline case of thin (power) electrodes produced with NMP processing and a standard 10-14-day wetting and formation process. In particular, it is shown that aqueous electrode processing can cut the electrode processing cost and energy consumption by an order of magnitude. Doubling the thickness of the electrodes allows for using half of the inactive current collectors and separators, contributing even further to the processing cost savings. Finally wetting and SEI-layer formation cost savings are discussed in the context of a protocol with significantly reduced time. These three benefits collectively offer the possibility of reducing LIB pack cost from 502.8 kW h-1-usable to 370.3 kW h-1-usable, a savings of 132.5/kWh (or 26.4%).

  16. Patient cost sharing and medical expenditures for the Elderly.

    PubMed

    Fukushima, Kazuya; Mizuoka, Sou; Yamamoto, Shunsuke; Iizuka, Toshiaki

    2016-01-01

    Despite the rapidly aging population, relatively little is known about how cost sharing affects the elderly's medical spending. Exploiting longitudinal claims data and the drastic reduction of coinsurance from 30% to 10% at age 70 in Japan, we find that the elderly's demand responses are heterogeneous in ways that have not been previously reported. Outpatient services by orthopedic and eye specialties, which will continue to increase in an aging society, are particularly price responsive and account for a large share of the spending increase. Lower cost sharing increases demand for brand-name drugs but not for generics. These high price elasticities may call for different cost-sharing rules for these services. Patient health status also matters: receiving medical services appears more discretionary for the healthy than the sick in the outpatient setting. Finally, we found no evidence that additional medical spending improved short-term health outcomes. Copyright © 2015 Elsevier B.V. All rights reserved.

  17. Analyzing the costs to deliver medication therapy management services.

    PubMed

    Rupp, Michael T

    2011-01-01

    To provide pharmacy managers and consultant pharmacists with a step-by-step approach for analyzing of the costs of delivering medication therapy management (MTM) services and to describe use of a free online software application for determining costs of delivering MTM. The process described is applicable to community pharmacies and consultant pharmacists who provide MTM services from nonpharmacy settings. The PharmAccount Service Cost Calculator is an Internet- based software application that uses a guided online interview to collect information needed to conduct a comprehensive cost analysis of any specialized pharmacy service. In addition to direct variable and fixed costs, the software automatically allocates indirect and overhead costs to the service and generates an itemized report that details the components of service delivery costs. The service cost calculator is sufficiently flexible to support the analysis of virtually any specialized pharmacy service, irrespective of whether the service is being delivered from a physical pharmacy. The software application allows users to perform sensitivity analysis to quickly determine the potential impact that alternate scenarios would have on service delivery cost. It is therefore particularly well suited to assist in the design and planning of a new pharmacy service. Good management requires that the cost implications of service delivery decisions are known and considered. Analyzing the cost of an MTM service is an important step in developing a sustainable business model.

  18. Potential impact of pharmacist interventions to reduce cost for Medicare Part D beneficiaries.

    PubMed

    Thatcher, Erin E; Vanwert, Elizabeth M; Erickson, Steven R

    2013-06-01

    The objective was to determine the impact of simulated pharmacist interventions on out-of-pocket cost, time to coverage gap, and cost per patient to the Medicare Part D program using actual patient cases from an adult general medicine clinic. Medication profiles of 100 randomly selected Medicare-eligible patients from a university-affiliated general internal medicine clinic were reviewed by a pharmacist to identify opportunities to cost-maximize the patients' therapies based on the plan. An online Part-D calculator, Aetna Medicare Rx Essentials, was used as the standard plan to determine medication cost and time to gap. The primary analysis was comparison of the patients' pre-review and post-review out-of-pocket cost, time to coverage gap, and cost to Medicare. A total of 65 patients had at least 1 simulated pharmacist cost intervention. The most common intervention was substituting for a less costly generic, followed by substituting a generic for a brand name. Projected patient cost savings was $476 per year. The average time to coverage gap was increased by 0.7 ±1.2 months. This study illustrates that the pharmacists may be able to reduce cost to some patients as well as to the Medicare Part D program.

  19. Direct medical cost of type 2 diabetes in singapore.

    PubMed

    Shuyu Ng, Charmaine; Toh, Matthias Paul Han Sim; Ko, Yu; Yu-Chia Lee, Joyce

    2015-01-01

    Due to the chronic nature of diabetes along with their complications, they have been recognised as a major health issue, which results in significant economic burden. This study aims to estimate the direct medical cost associated with type 2 diabetes mellitus (T2DM) in Singapore in 2010 and to examine both the relationship between demographic and clinical state variables with the total estimated expenditure. The National Healthcare Group (NHG) Chronic Disease Management System (CDMS) database was used to identify patients with T2DM in the year 2010. DM-attributable costs estimated included hospitalisations, accident and emergency (A&E) room visits, outpatient physician visits, medications, laboratory tests and allied health services. All charges and unit costs were provided by the NHG. A total of 500 patients with DM were identified for the analyses. The mean annual direct medical cost was found to be $2,034, of which 61% was accounted for by inpatient services, 35% by outpatient services, and 4% by A&E services. Independent determinants of total costs were DM treatments such as the use of insulin only (p<0.001) and the combination of both oral medications and insulin (p=0.047) as well as having complications such as cerebrovascular disease (p<0.001), cardiovascular disease (p=0.002), peripheral vascular disease (p=0.001), and nephropathy (p=0.041). In this study, the cost of DM treatments and DM-related complications were found to be strong determinants of costs. This finding suggests an imperative need to address the economic burden associated with diabetes with urgency and to reorganise resources required to improve healthcare costs.

  20. Cost of hospital care for older adults with heart failure: medical, pharmaceutical, and nursing costs.

    PubMed

    Titler, Marita G; Jensen, Gwenneth A; Dochterman, Joanne McCloskey; Xie, Xian-Jin; Kanak, Mary; Reed, David; Shever, Leah L

    2008-04-01

    To determine the impact of patient characteristics, clinical conditions, hospital unit characteristics, and health care interventions on hospital cost of patients with heart failure. Data for this study were part of a larger study that used electronic clinical data repositories from an 843-bed, academic medical center in the Midwest. This retrospective, exploratory study used existing administrative and clinical data from 1,435 hospitalizations of 1,075 patients 60 years of age or older. A cost model was tested using generalized estimating equations (GEE) analysis. Electronic databases used in this study were the medical record abstract, the financial data repository, the pharmacy repository; and the Nursing Information System repository. Data repositories were merged at the patient level into a relational database and housed on an SQL server. The model accounted for 88 percent of the variability in hospital costs for heart failure patients 60 years of age and older. The majority of variables that were associated with hospital cost were provider interventions. Each medical procedure increased cost by $623, each unique medication increased cost by $179, and the addition of each nursing intervention increased cost by $289. One medication and several nursing interventions were associated with lower cost. Nurse staffing below the average and residing on 2-4 units increased hospital cost. The model and data analysis techniques used here provide an innovative and useful methodology to describe and quantify significant health care processes and their impact on cost per hospitalization. The findings indicate the importance of conducting research using existing clinical data in health care.

  1. Medical education, cost and policy: what are the drivers for change? Commentary.

    PubMed

    Walsh, Kieran

    2014-01-01

    Medical education is expensive. Its expense has led many stakeholders to speculate on how costs could be reduced. In an ideal world such decisions would be made on sound evidence; however this is impossible in the absence of evidence. Sometimes practice will be informed by policy, but policy will not always be evidence based. So how is policy in the field of cost and value in medical education actually developed? The foremost influence on policy in cost and value should be evidence-based knowledge. Unfortunately policy is sometimes influenced by what might at best be termed tradition and at worst inertia. Another influence on policy will be people--but some individuals may have more influence than others. A further influence on policy in this field is events, and mainly events that have gone wrong. One final influence on emerging policy in medical education cost analysis is that of the media.

  2. Surgical Cost Disclosure May Reduce Operating Room Expenditures.

    PubMed

    Austin, Luke S; Tjoumakaris, Fotios P; Ong, Alvin C; Lombardi, Nicholas J; Wowkanech, Charles D; Mehnert, Michael J

    2017-03-01

    Health care expenditures are rising in the United States. Recent policy changes are attempting to reduce spending through the development of value-based payment systems that rely heavily on cost transparency. This study was conducted to investigate whether cost disclosure influences surgeons to reduce operating room expenditures. Beginning in 2012, surgeon scorecards were distributed at a regional health care system. The scorecard reported the actual direct supply cost per case for a specific procedure and compared each surgeon's data with those of other surgeons in the same subspecialty. Rotator cuff repair was chosen for analysis. Actual direct supply cost per case was calculated quarterly and collected over a 2-year period. Surgeons were given a questionnaire to determine their interest in the scorecard. Actual direct supply cost per rotator cuff repair procedure decreased by $269 during the study period. A strong correlation (R(2)=0.77) between introduction of the scorecards and cost containment was observed. During the study period, a total of $39,831 was saved. Of the surgeons who were queried, 89% were interested in the scorecard and 56% altered their practice as a result. Disclosure of surgical costs may be an effective way to control operating room spending. The findings suggest that providing physicians with knowledge about their surgical charges can alter per-case expenditures. [Orthopedics. 2017; 40(2):e269-e274.]. Copyright 2016, SLACK Incorporated.

  3. FMEA: a model for reducing medical errors.

    PubMed

    Chiozza, Maria Laura; Ponzetti, Clemente

    2009-06-01

    Patient safety is a management issue, in view of the fact that clinical risk management has become an important part of hospital management. Failure Mode and Effect Analysis (FMEA) is a proactive technique for error detection and reduction, firstly introduced within the aerospace industry in the 1960s. Early applications in the health care industry dating back to the 1990s included critical systems in the development and manufacture of drugs and in the prevention of medication errors in hospitals. In 2008, the Technical Committee of the International Organization for Standardization (ISO), licensed a technical specification for medical laboratories suggesting FMEA as a method for prospective risk analysis of high-risk processes. Here we describe the main steps of the FMEA process and review data available on the application of this technique to laboratory medicine. A significant reduction of the risk priority number (RPN) was obtained when applying FMEA to blood cross-matching, to clinical chemistry analytes, as well as to point-of-care testing (POCT).

  4. Multi-faceted case management: reducing compensation costs of musculoskeletal work injuries in Australia.

    PubMed

    Iles, Ross Anthony; Wyatt, M; Pransky, G

    2012-12-01

    This study aimed to determine whether a multi-faceted model of management of work related musculoskeletal disorders reduced compensation claim costs and days of compensation for injured workers. An intervention including early reporting, employee centred case management and removal of barriers to return to work was instituted in 16 selected companies with a combined remuneration over $337 million. Outcomes were evaluated by an administrative dataset from the Victorian WorkCover Authority database. A 'quasi experimental' pre-post design was employed with 492 matched companies without the intervention used as a control group and an average of 21 months of post-intervention follow-up. Primary outcomes were average number of days of compensation and average cost of claims. Secondary outcomes were total medical costs and weekly benefits paid. Information on 3,312 claims was analysed. In companies where the intervention was introduced the average cost of claims was reduced from $6,019 to $3,913 (estimated difference $2,329, 95 % CI $1,318-$3,340) and the number of days of compensation decreased from 33.5 to 14.1 (HR 0.77, 95 % CI 0.67-0.88). Medical costs and weekly benefits costs were also lower after the intervention (p < 0.05). Reduction in claims costs were noted across industry types, injury location and most employer sizes. The model of claims management investigated was effective in reducing the number of days of compensation, total claim costs, total medical costs and the amount paid in weekly benefits. Further research should investigate whether the intervention improves non-financial outcomes in the return to work process.

  5. Pattern and cost of medical care for workers with schistosomiasis.

    PubMed

    Kamel, M I; Ghafar, Y A; Foda, N; Moemen, M

    2001-04-01

    This study describes the pattern of medical care provided to workers with schistosomiasis, estimate the total medical cost and to identify the proportional rates of sickness retirement attributed to schistosomiasis. The observational approach was adopted for this study 170 schistosomiasis workers and a similar number of controls were included in this study. An interviewing schedule and a special format were designed for collecting personal, medical and early retirement data. The results revealed that the mean total cost in the outpatient clinics was significantly higher for schistosomiasis workers than their controls (320.2 " 330.11 versus 210.8 " 260.01 L.E). The hospital cost was also higher for schistosomiasis workers compared with their controls (265.9 " 674.47 vs 195.8 " 629.72 L.E) but this differencewas not statistically significant. More than 80% of the total hospital cost was spent on bed cost. The average operative cost/worker was significantly higher among the schistosomiasis workers than the control workers (7.08 " 22.07 vs 2.35 " 5.2 L.E). The total medical cost (outpatient and hospital) was significantly higher for workers with schistosomiasis compared with their controls (586.02" 845.77 vs 406.57 " 694.34). The total number of workers who retired because of sickness disability other than schistosomiasis increased from 1994 to 1998 with a ratio of 2.54 while those who retired because of schistosomiasis and its complications increased with a ratio of 3.64.

  6. Direct medical costs of accidental falls for adults with transfemoral amputations.

    PubMed

    Mundell, Benjamin; Maradit Kremers, Hilal; Visscher, Sue; Hoppe, Kurtis; Kaufman, Kenton

    2017-06-01

    Active individuals with transfemoral amputations are provided a microprocessor-controlled knee with the belief that the prosthesis reduces their risk of falling. However, these prostheses are expensive and the cost-effectiveness is unknown with regard to falls in the transfemoral amputation population. The direct medical costs of falls in adults with transfemoral amputations need to be determined in order to assess the incremental costs and benefits of microprocessor-controlled prosthetic knees. We describe the direct medical costs of falls in adults with a transfemoral amputation. This is a retrospective, population-based, cohort study of adults who underwent transfemoral amputations between 2000 and 2014. A Bayesian structural time series approach was used to estimate cost differences between fallers and non-fallers. The mean 6-month direct medical costs of falls for six hospitalized adults with transfemoral amputations was US$25,652 (US$10,468, US$38,872). The mean costs for the 10 adults admitted to the emergency department was US$18,091 (US$-7,820, US$57,368). Falls are expensive in adults with transfemoral amputations. The 6-month costs of falls resulting in hospitalization are similar to those reported in the elderly population who are also at an increased risk of falling. Clinical relevance Estimates of fall costs in adults with transfemoral amputations can provide policy makers with additional insight when determining whether or not to cover a prescription for microprocessor-controlled prosthetic knees.

  7. Direct medical costs for partial refractory epilepsy in Mexico.

    PubMed

    García-Contreras, Fernando; Constantino-Casas, Patricia; Castro-Ríos, Angélica; Nevárez-Sida, Armando; Estrada Correa, Gloria del Carmen; Carlos Rivera, Fernando; Guzmán-Caniupan, Jorge; Torres-Arreola, Laura del Pilar; Contreras-Hernández, Iris; Mould-Quevedo, Joaquin; Garduño-Espinosa, Juan

    2006-04-01

    The aim was to determine the direct medical costs in patients with partial refractory epilepsy at the Mexican Institute of Social Security (IMSS) in Mexico. We carried out a multicenter, retrospective-cohort partial-economic evaluation study of partial refractory epilepsy (PRE) diagnosed patients and analyzed patient files from four secondary- and tertiary-level hospitals. PRE patients >12 years of age with two or more antiepileptic drugs and follow-up for at least 1 year were included. The perspective was institutional (IMSS). Only direct healthcare costs were considered, and the timeline was 1 year. Cost techniques were microcosting, average per-service cost, and per-day cost, all costs expressed in U.S. dollars (USD, 2004). We reviewed 813 files of PRE patients: 133 had a correct diagnosis, and only 72 met study inclusion criteria. Fifty eight percent were females, 64% were <35 years of age, 47% were students, in 73% maximum academic level achieved was high school, and 53% were single. Fifty one percent of cases experienced simple partial seizures and 94% had more than one monthly seizure. Annual healthcare cost of the 72 patients was 190,486 USD, ambulatory healthcare contributing 76% and hospital healthcare with 24%. Annual mean healthcare cost per PRE patient was 2,646 USD; time of disease evolution and severity of the patient's illness did not affect costs significantly.

  8. MEDICAL COSTS OF OSTEOPOROSIS IN THE ELDERLY MEDICARE POPULATION

    PubMed Central

    Blume, Steven W; Curtis, JR

    2013-01-01

    Introduction National cost estimates of osteoporosis and fractures in the U.S. have been based on diverse sets of provider data or selected commercial insurance claims. We sought to characterize prevalence and costs for osteoporosis using a random population-based sample of older adults. Methods A cross-sectional estimate of medical cost was made with 2002 data from the Medicare Current Beneficiary Survey (MCBS). MCBS combines health interviews with claims information from all payers to profile a random sample of 12,700 Medicare recipients. Three cohorts aged 65 or over were defined: 1) patients experiencing a fracture-related claim in 2002; 2) patients with a diagnosis, medication, or self-report for osteoporosis or past hip fracture; and 3) non-case controls. The total cost of patient claims was compared to that of controls using multivariate regression. Results Of 30.2 million elderly Medicare recipients in 2002, 1.6 million (5%) were treated for a fracture that year and an additional 7.2 million (24%) have osteoporosis without a fracture. The estimated mean impact of fractures on annual medical cost was $8600 (95%CI: $6400 to $10,800), implying a U.S. cost of $14 billion ($10 to $17 billion). Half of the non-fracture osteoporosis patients received drug treatment, averaging $500 per treated patient, or $2 billion nationwide. Conclusions The annual cost of osteoporosis and fractures in the U.S. elderly was estimated at $16 billion, using a national 2002 population-based sample. This amount corroborates previous estimates based on substantially different methodologies. Projected to 2008, the national cost of osteoporosis and fractures was $22 billion. PMID:21165602

  9. Medical Student Attitudes about Mental Illness: Does Medical-School Education Reduce Stigma?

    ERIC Educational Resources Information Center

    Korszun, Ania; Dinos, Sokratis; Ahmed, Kamran; Bhui, Kamaldeep

    2012-01-01

    Background: Reducing stigma associated with mental illness is an important aim of medical education, yet evidence indicates that medical students' attitudes toward patients with mental health problems deteriorate as they progress through medical school. Objectives: Authors examined medical students' attitudes to mental illness, as compared with…

  10. Medical Student Attitudes about Mental Illness: Does Medical-School Education Reduce Stigma?

    ERIC Educational Resources Information Center

    Korszun, Ania; Dinos, Sokratis; Ahmed, Kamran; Bhui, Kamaldeep

    2012-01-01

    Background: Reducing stigma associated with mental illness is an important aim of medical education, yet evidence indicates that medical students' attitudes toward patients with mental health problems deteriorate as they progress through medical school. Objectives: Authors examined medical students' attitudes to mental illness, as compared with…

  11. Cost-Effectiveness Analysis of an Automated Medication System Implemented in a Danish Hospital Setting.

    PubMed

    Risør, Bettina Wulff; Lisby, Marianne; Sørensen, Jan

    To evaluate the cost-effectiveness of an automated medication system (AMS) implemented in a Danish hospital setting. An economic evaluation was performed alongside a controlled before-and-after effectiveness study with one control ward and one intervention ward. The primary outcome measure was the number of errors in the medication administration process observed prospectively before and after implementation. To determine the difference in proportion of errors after implementation of the AMS, logistic regression was applied with the presence of error(s) as the dependent variable. Time, group, and interaction between time and group were the independent variables. The cost analysis used the hospital perspective with a short-term incremental costing approach. The total 6-month costs with and without the AMS were calculated as well as the incremental costs. The number of avoided administration errors was related to the incremental costs to obtain the cost-effectiveness ratio expressed as the cost per avoided administration error. The AMS resulted in a statistically significant reduction in the proportion of errors in the intervention ward compared with the control ward. The cost analysis showed that the AMS increased the ward's 6-month cost by €16,843. The cost-effectiveness ratio was estimated at €2.01 per avoided administration error, €2.91 per avoided procedural error, and €19.38 per avoided clinical error. The AMS was effective in reducing errors in the medication administration process at a higher overall cost. The cost-effectiveness analysis showed that the AMS was associated with affordable cost-effectiveness rates. Copyright © 2017 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

  12. Are critical pathways and implant standardization programs effective in reducing costs in total knee replacement operations?

    PubMed

    Ho, David M; Huo, Michael H

    2007-07-01

    Total knee replacement (TKR) operation is one of the most effective procedures, both clinically and in terms of cost. Because of increased volume and cost for this procedure during the past 3 decades, TKRs are often targeted for cost reduction. The purpose of this study was to evaluate the efficacy of two cost reducing methodologies, establishment of critical clinical pathways, and standardization of implant costs. Ninety patients (90 knees) were randomly selected from a population undergoing primary TKR during a 2-year period at a tertiary teaching hospital. Patients were assigned to three groups that corresponded to different strategies implemented during the evolution of the joint-replacement program. Medical records were reviewed for type of anesthesia, operative time, length of stay, and any perioperative complications. Financial information for each patient was compared among the three groups. Data analysis demonstrated that the institution of a critical pathway significantly shortened length of hospital stay and was effective in reducing the hospital costs by 18% (p < 0.05). In addition, standardization of surgical techniques under the care of a single surgeon substantially reduced the operative time. Selection of implants from a single vendor did not have any substantial effect in additionally reducing the costs. Standardized postoperative management protocols and critical clinical pathways can reduce costs and operative time. Future efforts must focus on lowering the costs of the prostheses, particularly with competitive bidding or capitation of prostheses costs. Although a single-vendor approach was not effective in this study, it is possible that a cost reduction could have been realized if more TKRs were performed, because the pricing contract was based on projected volume of TKRs to be done by the hospital.

  13. Medical Logistics Functional Integration Management Activity Based Costing and Data Modeling Workshop. Volume 1

    DTIC Science & Technology

    1993-04-02

    approved in December 1992. The FEA focused on savings through reduced inventories, adoption of electronic commerce, and Just-In-Time (JQM. supply management...Hospital Bird, Chuck Defense Medical Standardization Board Cadena , John USAF Medical Center, Wright-Paterson Davenport, Bonnie Portsmouth Naval Hospital...Materiel Cost of materiel is composed of four categories: management and support, stock fund holding, replenishment, and transportation . Each of these

  14. Cost analysis of glaucoma medications: a 3-year review.

    PubMed

    Vold, Steven D; Riggs, William L; Jackimiec, John

    2002-08-01

    To evaluate yearly cost of glaucoma medications at a university-affiliated teaching hospital with its own health maintenance organization from 1998 through 2000. We retrieved data from the Scott and White prescription claims file for 1,484 patients concerning Health Plan glaucoma-medication prescriptions for the years 1998 through 2000. Patient inclusion criteria were as follows: 1) use of a single or fixed-combination topical glaucoma medication during all four quarters of at least one full-year, 2) treatment of both eyes, 3) participation in the Health Plan prescription program, and 4) prescriptions filled at pharmacies participating in the Health Plan prescription program. Over this 3-year period, the most costly medication per patient per year was dorzolamide hydrochloride-timolol maleate (Cosopt; Merck, West Point, PA [$470]), followed by betaxolol hydrochloride (Betoptic-S; Alcon, Fort Worth, TX [$370]), latanoprost (Xalatan; Pharmacia and Upjohn, Kalamazoo, MI [$352]), dorzolamide hydrochloride (Trusopt; Merck, West Point, PA [$288]), brimonidine tartrate (Alphagan; Allergan Pharmaceuticals, Irvine, CA [$273]), brinzolamide (Azopt; Alcon, Fort Worth, TX [$243]), timolol maleate 0.5% in a gel-forming solution (Timoptic-XE 0.5%; Merck, West Point, PA [$190]), carteolol hydrochloride (Ocupress; Otsuka Pharmaceutical, Rockville, MD [$183]), generic levobunolol hydrochloride 0.5% ($138), metipranolol (Optipranolol; Bausch and Lomb Pharmaceuticals, Tampa, FL [$135]), and generic timolol maleate 0.5% ($133). Differences in yearly cost exist among topical glaucoma medications.

  15. Optimizing Ice Thermal Storage to Reduce Energy Cost

    NASA Astrophysics Data System (ADS)

    Hall, Christopher L.

    Energy cost for buildings is an issue of concern for owners across the U.S. The bigger the building, the greater the concern. A part of this is due to the energy required to cool the building and the way in which charges are set when paying for energy consumed during different times of the day. This study will prove that designing ice thermal storage properly will minimize energy cost in buildings. The effectiveness of ice thermal storage as a means to reduce energy costs lies within transferring the time of most energy consumption from on-peak to off-peak periods. Multiple variables go into the equation of finding the optimal use of ice thermal storage and they are all judged with the final objective of minimizing monthly energy costs. This research discusses the optimal design of ice thermal storage and its impact on energy consumption, energy demand, and the total energy cost. A tool for optimal design of ice thermal storage is developed, considering variables such as chiller and ice storage sizes and charging and discharge times. The simulations take place in a four-story building and investigate the potential of Ice Thermal Storage as a resource in reducing and minimizing energy cost for cooling. The simulations test the effectiveness of Ice Thermal Storage implemented into the four-story building in ten locations across the United States.

  16. Medical therapy v. PCI in stable coronary artery disease: a cost-effectiveness analysis.

    PubMed

    Wijeysundera, Harindra C; Tomlinson, George; Ko, Dennis T; Dzavik, Vladimir; Krahn, Murray D

    2013-10-01

    Percutaneous coronary intervention (PCI) with either drug-eluting stents (DES) or bare metal stents (BMS) reduces angina and repeat procedures compared with optimal medical therapy alone. It remains unclear if these benefits are sufficient to offset their increased costs and small increase in adverse events. Cost utility analysis of initial medical therapy v. PCI with either BMS or DES. . Markov cohort decision model. Data Sources. Propensity-matched observational data from Ontario, Canada, for baseline event rates. Effectiveness and utility data obtained from the published literature, with costs from the Ontario Case Costing Initiative. Patients with stable coronary artery disease, confirmed after angiography, stratified by risk of restenosis based on diabetic status, lesion size, and lesion length. Time Horizon. Lifetime. Perspective. Ontario Ministry of Health and Long Term Care. Interventions. Optimal medical therapy, PCI with BMS or DES. Lifetime costs, quality-adjusted life years (QALYs), and the incremental cost-effectiveness ratio (ICER). of Base Case Analysis. In the overall population, medical therapy had the lowest lifetime costs at $22,952 v. $25,081 and $25,536 for BMS and DES, respectively. Medical therapy had a quality-adjusted life expectancy of 10.1 v. 10.26 QALYs for BMS, producing an ICER of $13,271/QALY. The DES strategy had a quality-adjusted life expectancy of only 10.20 QALYs and was dominated by the BMS strategy. This ranking was consistent in all groups stratified by restenosis risk, except diabetic patients with long lesions in small arteries, in whom DES was cost-effective compared with medical therapy (ICER of $18,826/QALY). Limitations. There is the possibility of residual unobserved confounding. In patients with stable coronary artery disease, an initial BMS strategy is cost-effective.

  17. Estimation of immunization providers' activities cost, medication cost, and immunization dose errors cost in Iraq.

    PubMed

    Al-lela, Omer Qutaiba B; Bahari, Mohd Baidi; Al-abbassi, Mustafa G; Salih, Muhannad R M; Basher, Amena Y

    2012-06-06

    The immunization status of children is improved by interventions that increase community demand for compulsory and non-compulsory vaccines, one of the most important interventions related to immunization providers. The aim of this study is to evaluate the activities of immunization providers in terms of activities time and cost, to calculate the immunization doses cost, and to determine the immunization dose errors cost. Time-motion and cost analysis study design was used. Five public health clinics in Mosul-Iraq participated in the study. Fifty (50) vaccine doses were required to estimate activities time and cost. Micro-costing method was used; time and cost data were collected for each immunization-related activity performed by the clinic staff. A stopwatch was used to measure the duration of activity interactions between the parents and clinic staff. The immunization service cost was calculated by multiplying the average salary/min by activity time per minute. 528 immunization cards of Iraqi children were scanned to determine the number and the cost of immunization doses errors (extraimmunization doses and invalid doses). The average time for child registration was 6.7 min per each immunization dose, and the physician spent more than 10 min per dose. Nurses needed more than 5 min to complete child vaccination. The total cost of immunization activities was 1.67 US$ per each immunization dose. Measles vaccine (fifth dose) has a lower price (0.42 US$) than all other immunization doses. The cost of a total of 288 invalid doses was 744.55 US$ and the cost of a total of 195 extra immunization doses was 503.85 US$. The time spent on physicians' activities was longer than that spent on registrars' and nurses' activities. Physician total cost was higher than registrar cost and nurse cost. The total immunization cost will increase by about 13.3% owing to dose errors. Copyright © 2012 Elsevier Ltd. All rights reserved.

  18. Development of hospital data warehouse for cost analysis of DPC based on medical costs.

    PubMed

    Muranaga, F; Kumamoto, I; Uto, Y

    2007-01-01

    To develop a data warehouse system for cost analysis, based on the categories of the diagnosis procedure combination (DPC) system, in which medical costs were estimated by DPC category and factors influencing the balance between costs and fees. We developed a data warehouse system for cost analysis using data from the hospital central data warehouse system. The balance data of patients who were discharged from Kagoshima University Hospital from April 2003 to March 2005 were determined in terms of medical procedure, cost per day and patient admission in order to conduct a drill-down analysis. To evaluate this system, we analyzed cash flow by DPC category of patients who were categorized as having malignant tumors and whose DPC category was reevaluated in 2004. The percentages of medical expenses were highest in patients with acute leukemia, non-Hodgkin's lymphoma, and particularly in patients with malignant tumors of the liver and intrahepatic bile duct. Imaging tests degraded the percentages of medical expenses in Kagoshima University Hospital. These results suggested that cost analysis by patient is important for hospital administration in the inclusive evaluation system using a case-mix index such as DPC.

  19. Reduced cost and improved figure of sapphire optical components

    NASA Astrophysics Data System (ADS)

    Walters, Mark; Bartlett, Kevin; Brophy, Matthew R.; DeGroote Nelson, Jessica; Medicus, Kate

    2015-10-01

    Sapphire presents many challenges to optical manufacturers due to its high hardness and anisotropic properties. Long lead times and high prices are the typical result of such challenges. The cost of even a simple 'grind and shine' process can be prohibitive. The high precision surfaces required by optical sensor applications further exacerbate the challenge of processing sapphire thereby increasing cost further. Optimax has demonstrated a production process for such windows that delivers over 50% time reduction as compared to traditional manufacturing processes for sapphire, while producing windows with less than 1/5 wave rms figure error. Optimax's sapphire production process achieves significant improvement in cost by implementation of a controlled grinding process to present the best possible surface to the polishing equipment. Following the grinding process is a polishing process taking advantage of chemical interactions between slurry and substrate to deliver excellent removal rates and surface finish. Through experiments, the mechanics of the polishing process were also optimized to produce excellent optical figure. In addition to reducing the cost of producing large sapphire sensor windows, the grinding and polishing technology Optimax has developed aids in producing spherical sapphire components to better figure quality. In addition to reducing the cost of producing large sapphire sensor windows, the grinding and polishing technology Optimax has developed aids in producing spherical sapphire components to better figure quality. Through specially developed polishing slurries, the peak-to-valley figure error of spherical sapphire parts is reduced by over 80%.

  20. The blood parasite Haemoproteus reduces survival in a wild bird: a medication experiment

    PubMed Central

    la Puente, Josué Martínez-de; Merino, Santiago; Tomás, Gustavo; Moreno, Juan; Morales, Judith; Lobato, Elisa; García-Fraile, Sonia; Belda, Eduardo Jorge

    2010-01-01

    While avian chronic haemoparasite infections induce reproductive costs, infection has not previously been shown to affect survival. Here, we experimentally reduced, through medication, the intensity of infection by Haemoproteus parasites in wild-breeding female blue tits Cyanistes caeruleus. However, this treatment did not reduce the intensity of infection in males or the intensity of infection by Leucocytozoon. Medicated females, but not males, showed increased local survival until the next breeding season compared with control birds. To our knowledge, this is the first empirical evidence showing long-term direct survival costs of chronic Haemoproteus infections in wild birds. PMID:20181556

  1. Effect of costing methods on unit cost of hospital medical services.

    PubMed

    Riewpaiboon, Arthorn; Malaroje, Saranya; Kongsawatt, Sukalaya

    2007-04-01

    To explore the variance of unit costs of hospital medical services due to different costing methods employed in the analysis. Retrospective and descriptive study at Kaengkhoi District Hospital, Saraburi Province, Thailand, in the fiscal year 2002. The process started with a calculation of unit costs of medical services as a base case. After that, the unit costs were re-calculated based on various methods. Finally, the variations of the results obtained from various methods and the base case were computed and compared. The total annualized capital cost of buildings and capital items calculated by the accounting-based approach (averaging the capital purchase prices throughout their useful life) was 13.02% lower than that calculated by the economic-based approach (combination of depreciation cost and interest on undepreciated portion over the useful life). A change of discount rate from 3% to 6% results in a 4.76% increase of the hospital's total annualized capital cost. When the useful life of durable goods was changed from 5 to 10 years, the total annualized capital cost of the hospital decreased by 17.28% from that of the base case. Regarding alternative criteria of indirect cost allocation, unit cost of medical services changed by a range of -6.99% to +4.05%. We explored the effect on unit cost of medical services in one department. Various costing methods, including departmental allocation methods, ranged between -85% and +32% against those of the base case. Based on the variation analysis, the economic-based approach was suitable for capital cost calculation. For the useful life of capital items, appropriate duration should be studied and standardized. Regarding allocation criteria, single-output criteria might be more efficient than the combined-output and complicated ones. For the departmental allocation methods, micro-costing method was the most suitable method at the time of study. These different costing methods should be standardized and developed as

  2. Standardization - A method of reducing auxiliary propulsion systems costs

    NASA Technical Reports Server (NTRS)

    Jones, L. W.

    1977-01-01

    This paper deals with the efforts of the National Aeronautics and Space Administration to take advantage of the economies made possible by the Space Shuttle by reducing the costs of acquiring and flying payloads for the Shuttle. Specifically, the paper addresses the route that NASA's Low Cost Systems Office is following in order to reduce the cost of auxiliary propulsion systems. This approach emphasizes the establishment of standard hardware items, which will be used on as many spacecraft as possible. The method by which a standard is selected and how it is maintained as a standard are discussed. The process by which the 5 Newton hydrazine thruster was adopted is described, as a typical example.

  3. Rising medical liability cost and patient access to care in Puerto Rico: public survey.

    PubMed

    Cruz, Norma I; Korchin, Leo; Castro, Gilberto

    2011-09-01

    The high cost of medical liability increases healthcare expenditure and decreases healthcare services. To understand the public perception of medical liability issues in Puerto Rico, a survey was made with the assistance of Gaither International. Five hundred interviews were made in a representative sample of all six US Census demographic regions in Puerto Rico. Respondents were selected randomly by age, gender, socioeconomic level and region of residence. All had visited an Emergency Room in the past two years, either for their medical needs or those of a family member. This study requested information on general demographics, use of emergency medical services, insurance coverage, access to medical care, and perception of the medical liability issues. All results had a margin of error of +/- 4.4 with a 95% confidence level. When rating areas of concern in healthcare, "cost of health insurance and services" was greatest, followed by "difficulty finding a specialist". One-third of respondents experienced difficulty or failed to obtain a specialist, orthopedic surgeons topping the list. When asked who benefits most from lawsuits, 63% of the public believed that lawyers benefit most, while only 33% believed that the patient (plaintiff) benefits most. In the interviews, 84% of respondents supported establishing government limits on professional liability awards as part of the effort to reduce healthcare cost. The public appears to be aware of how medical liability raises the cost and limits access to healthcare.

  4. Direct non-medical costs double the total direct costs to patients undergoing cataract surgery in Zamfara state, Northern Nigeria: a case series.

    PubMed

    Ibrahim, Nazaradden; Pozo-Martin, Francisco; Gilbert, Clare

    2015-04-16

    Cost is frequently reported as a barrier to cataract surgery, but few studies have reported costs of accessing surgery in Africa. The purpose of this prospective, facility based study was to compare direct non-medical cost with total direct cost of cataract surgery to patients, and to assess how money was found to cover costs. Participants were those aged 17 years and above attending their first post-operative visit after first eye, subsidised, day case cataract surgery. Systematic random sampling was used to select participants who were interviewed to obtain data on socio-demographic details, and on expenditure during the assessment visit, the surgical visit, and the first follow-up visit. Costs were a) direct medical costs (patients' costs for registration, investigations, surgery, medication), and b) direct non-medical costs (patients' and escorts' costs for transport, accommodation, meals). The source of funds to pay for the services received was also assessed. Almost two thirds (63%) of the 104 participants were men. The mean age of men was 64 (± 12.5) years, being 63 (± 12.9) years for women. All men were married and 35% of women were widows. 84% of men were household heads compared with 6% of women. The median total direct cost for all visits by all participants was N8,245 (US$51), being higher for men than women (N9,020; US$56 and N7,620; US$47) (p < 0.09) respectively. Direct non-medical cost constituted 49% of total direct cost. 92% of participants had adequate money to pay, but 8% had to sell possessions to raise the money. 20% of unmarried women sold possessions or took out a loan. Despite the subsidy, cost is still likely to be a barrier to accessing cataract surgery, as the total direct costs represented at least 50 days income for 70% of the local population. Provision of transport would reduce direct non-medical costs.

  5. Wellness Programs: Preventive Medicine to Reduce Health Care Costs.

    ERIC Educational Resources Information Center

    Martini, Gilbert R., Jr.

    1991-01-01

    A wellness program is a formalized approach to preventive health care that can positively affect employee lifestyle and reduce future health-care costs. Describes programs for health education, smoking cessation, early detection, employee assistance, and fitness, citing industry success figures. (eight references) (MLF)

  6. Square tubing reduces cost of telescoping bridge crane hoist

    NASA Technical Reports Server (NTRS)

    Bernstein, G.; Graae, J.; Schraidt, J.

    1967-01-01

    Using standard square tubing in a telescoping arrangement reduces the cost of a bridge crane hoist. Because surface tolerances of square tubing need not be as accurate as the tubing used previously and because no spline is necessary, the square tubing is significantly less expensive than splined telescoping tubes.

  7. Rightsizing HVAC Systems to Reduce Capital Costs and Save Energy

    ERIC Educational Resources Information Center

    Sebesta, James

    2010-01-01

    Nearly every institution is faced with the situation of having to reduce the cost of a construction project from time to time through a process generally referred to as "value engineering." Just the mention of those words, however, gives rise to all types of connotations, thoughts, and memories (usually negative) for those in the…

  8. What Strategies Do Physicians and Patients Discuss to Reduce Out-of-Pocket Costs?

    PubMed Central

    Hunter, Wynn G.; Zhang, Cecilia Z.; Hesson, Ashley; Davis, J. Kelly; Kirby, Christine; Williamson, Lillie D.; Barnett, Jamison A.; Ubel, Peter A.

    2015-01-01

    Background More than 1 in 4 Americans report difficulty paying medical bills. Cost-reducing strategies discussed during outpatient physician visits remain poorly characterized. Objective We sought to determine how often patients and physicians discuss healthcare costs during outpatient visits and what strategies, if any, they discussed to lower patient out-of-pocket costs. Design Retrospective analysis of dialogue from 1,755 outpatient visits in community-based practices nationwide from 2010–2014. The study population included 677 patients with breast cancer, 422 with depression, and 656 with rheumatoid arthritis visiting 56 oncologists, 36 psychiatrists, and 26 rheumatologists, respectively. Results Thirty percent of visits contained cost conversations (95% confidence interval [CI], 28 to 32). Forty-four percent of cost conversations involved discussion of cost-saving strategies (95% CI, 40 to 48; median duration, 68 seconds). We identified 4 strategies to lower costs without changing the care plan – in order of overall frequency, (1) Changing logistics of care; (2) Facilitating copay assistance; (3) Providing free samples; (4) Changing/adding insurance plans – and 4 strategies to reduce costs by changing the care plan – (1) Switching to lower-cost alternative therapy/diagnostic; (2) Switching from brand name to generic; (3) Changing dosage/frequency; (4) Stopping/withholding interventions. Strategies were relatively consistent across health conditions, except for switching to lower-cost alternative (more common in breast oncology), and providing free samples (more common in depression). Limitation Focus on three conditions with potentially high out-of-pocket costs. Conclusions Despite price opacity, physicians and patients discuss a variety of out-of-pocket cost reduction strategies during clinic visits. Almost half of cost discussions mention one or more cost-saving strategies, with more frequent mention of those not requiring care-plan changes. PMID

  9. Using a Cost-Construction Model To Assess the Cost of Educating Undergraduate Medical Students at the University of Texas-Houston Medical School.

    ERIC Educational Resources Information Center

    Franzini, Luisa; And Others

    1997-01-01

    Using a cost-construction model, cost of the University of Texas-Houston Medical School program, instructional costs, educational costs, and milieu costs were calculated. Sensitivity analysis revealed the financial effects of various factors, some of which increased and some of which decreased cost. Despite inherent complexities of the method and…

  10. Appropriate VTE prophylaxis is associated with lower direct medical costs.

    PubMed

    Amin, Alpesh; Hussein, Mohamed; Battleman, David; Lin, Jay; Stemkowski, Stephen; Merli, Geno J

    2010-11-01

    To calculate and compare the direct medical costs of guideline-recommended prophylaxis with prophylaxis that does not fully adhere with guideline recommendations in a large, real-world population. Discharge records were retrieved from the US Premier Perspective™ database (January 2003-December 2003) for patients aged≥40 years with a primary diagnosis of cancer, chronic heart failure, lung disease, or severe infectious disease who received some form of thromboprophylaxis. Univariate analysis and multivariate regression modeling were performed to compare direct medical costs between discharges who received appropriate prophylaxis (correct type, dose, and duration based on sixth edition American College of Chest Physicians [ACCP] recommendations) and partial prophylaxis (not in full accordance with ACCP recommendations). Market segmentation analysis was used to compare costs stratified by hospital and patient characteristics. Of the 683 005 discharges included, 148,171 (21.7%) received appropriate prophylaxis and 534,834 (78.3%) received partial prophylaxis. The total direct unadjusted costs were $15,439 in the appropriate prophylaxis group and $17,763 in the partial prophylaxis group. After adjustment, mean adjusted total costs per discharge were lower for those receiving appropriate prophylaxis ($11,713; 95% confidence interval [CI], $11,675-$11,753) compared with partial prophylaxis ($13,369; 95% CI, $13,332-$13 406; P<0.01). Appropriate prophylaxis appeared to be associated with numerically lower unadjusted costs than partial prophylaxis, regardless of hospital size, rural/urban location, teaching status, and patient age and gender. This large, real-world analysis suggests that appropriate prophylaxis, in adherence with ACCP guidelines, is potentially cost-saving compared with partial prophylaxis in at-risk medical patients.

  11. Total Direct Medical Expenses and Characteristics of Privately Insured Adolescents Who Incur High Costs.

    PubMed

    Gray, Susan H; Trudell, Emily K; Emans, S Jean; Woods, Elizabeth R; Berry, Jay G; Vernacchio, Louis

    2015-10-01

    Accountable care payment models aim to reduce total direct medical expenses for high-cost patients through improved quality of care and preventive health services. Little is known about health care expenditures of privately insured adolescents, especially those who incur high costs. To assess health care expenditures for high-cost adolescents and to describe the patient characteristics associated with high medical costs. A retrospective cohort analysis was conducted of data from January 1 to December 31, 2012, of 13,103 privately insured adolescents aged 13 to 21 years (mean [SD] age, 16.3 [2.4] years; 6764 [51.6%] males) at 82 independent pediatric primary care practices in Massachusetts. Analysis was conducted from April 1, 2014, to April 1, 2015. We compared demographic (age, sex, median income by zip code) and clinical (obesity, behavioral health problem, complex chronic condition) characteristics between high-cost (top 1%) and non-high-cost adolescents. We assigned high-cost adolescents to clinical categories using software from the Agency for Healthcare Research and Quality to describe clinically relevant patterns of spending. Total direct medical expenses were $41.2 million for the entire cohort and a median $1167 per patient. A total of 132 (1.0%) patients with the highest costs accounted for 23.6% of expenses of the cohort, with a median $52,577 per patient. Mental health disorders were the most common diagnosis in high-cost patients; 78 (59.1%) of these patients had at least 1 behavioral health diagnosis. Pharmacy costs accounted for 28.4% of total direct medical expenses of high-cost patients; primary care accounted for 1.0%. Characteristics associated with being a high-cost patient included having 1 complex chronic condition (relative risk [RR], 6.5; 95% CI, 4.7-9.0), having 2 or more complex chronic conditions (RR, 23.5; 95% CI, 14.2-39.1), having any behavioral health diagnosis (RR, 3.6; 95% CI, 2.6-5.1), and obesity (RR, 2.0; 95% CI, 1.3-3.0). Total

  12. With the advent of domestic 3-dimensional (3D) printers and their associated reduced cost, is it now time for every medical school to have their own 3D printer?

    PubMed

    Balestrini, Christopher; Campo-Celaya, Tatiana

    2016-01-01

    Anatomy is the backbone of medical education and new techniques to improve learning are frequently explored. With the introduction of 3D printers specifically for the home market, the price of this technology has reached affordable levels. Using patient scan data, accurate 3D models can be printed that represent real human variation in anatomy to provide an innovative, inexpensive and valuable adjunct to anatomical teaching. Is it now time for every medical school to have their own 3D printer?

  13. Reducing healthcare costs facilitated by surgical auditing: a systematic review.

    PubMed

    Govaert, Johannes Arthuur; van Bommel, Anne Charlotte Madeline; van Dijk, Wouter Antonie; van Leersum, Nicoline Johanneke; Tollenaar, Robertus Alexandre Eduard Mattheus; Wouters, Michael Wilhemus Jacobus Maria

    2015-07-01

    Surgical auditing has been developed in order to benchmark and to facilitate quality improvement. The aim of this review is to determine if auditing combined with systematic feedback of information on process and outcomes of care results in lower costs of surgical care. A systematic search of published literature before 21-08-2013 was conducted in Pubmed, Embase, Web of Science, and Cochrane Library. Articles were selected if they met the inclusion criteria of describing a surgical audit with cost-evaluation. The systematic search resulted in 3608 papers. Six studies were identified as relevant, all showing a positive effect of surgical auditing on quality of healthcare and therefore cost savings was reported. Cost reductions ranging from $16 to $356 per patient were seen in audits evaluating general or vascular procedures. The highest potential cost reduction was described in a colorectal surgical audit (up to $1,986 per patient). All six identified articles in this review describe a reduction in complications and thereby a reduction in costs due to surgical auditing. Surgical auditing may be of greater value when high-risk procedures are evaluated, since prevention of adverse events in these procedures might be of greater clinical and therefore of greater financial impact. This systematic review shows that surgical auditing can function as a quality instrument and therefore as a tool to reduce costs. Since evidence is scarce so far, further studies should be performed to investigate if surgical auditing has positive effects to turn the rising healthcare costs around. In the future, incorporating (actual) cost analyses and patient-related outcome measures would increase the audits' value and provide a complete overview of the value of healthcare.

  14. Comparative Cost-Effectiveness of Interventions to Improve Medication Adherence after Myocardial Infarction

    PubMed Central

    Ito, Kouta; Shrank, William H; Avorn, Jerry; Patrick, Amanda R; Brennan, Troyen A; Antman, Elliot M; Choudhry, Niteesh K

    2012-01-01

    Objective To evaluate the comparative cost-effectiveness of interventions to improve adherence to evidence-based medications among postmyocardial infarction (MI) patients. Data Sources/Study Setting Cost-effectiveness analysis. Study Design We developed a Markov model simulating a hypothetical cohort of 65-year-old post-MI patients who were prescribed secondary prevention medications. We evaluated mailed education, disease management, polypill use, and combinations of these interventions. The analysis was performed from a societal perspective over a lifetime horizon. The main outcome was an incremental cost-effectiveness ratio (ICER) as measured by cost per quality-adjusted life year (QALY) gained. Data Collection/Extraction Methods Model inputs were extracted from published literature. Principal Findings Compared with usual care, only mailed education had both improved health outcomes and reduced spending. Mailed education plus disease management, disease management, polypill use, polypill use plus mailed education, and polypill use plus disease management cost were $74,600, $69,200, $133,000, $113,000, and $142,900 per QALY gained, respectively. In an incremental analysis, only mailed education had an ICER of less than $100,000 per QALY and was therefore the optimal strategy. Polypill use, particularly when combined with mailed education, could be cost effective, and potentially cost saving if its price decreased to less than $100 per month. Conclusions Mailed education and a polypill, once available, may be the cost-saving strategies for improving post-MI medication adherence. PMID:22998129

  15. Cost-effectiveness of reducing sulfur emissions from ships.

    PubMed

    Wang, Chengfeng; Corbett, James J; Winebrake, James J

    2007-12-15

    We model cost-effectiveness of control strategies for reducing SO2 emissions from U.S. foreign commerce ships traveling in existing European or hypothetical U.S. West Coast SO(x) Emission Control Areas (SECAs) under international maritime regulations. Variation among marginal costs of control for individual ships choosing between fuel-switching and aftertreatment reveals cost-saving potential of economic incentive instruments. Compared to regulations prescribing low sulfur fuels, a performance-based policy can save up to $260 million for these ships with 80% more emission reductions than required because least-cost options on some individual ships outperform standards. Optimal simulation of a market-based SO2 control policy for approximately 4,700 U.S. foreign commerce ships traveling in the SECAs in 2002 shows that SECA emissions control targets can be achieved by scrubbing exhaust gas of one out of ten ships with annual savings up to $480 million over performance-based policy. A market-based policy could save the fleet approximately $63 million annually under our best-estimate scenario. Spatial evaluation of ship emissions reductions shows that market-based instruments can reduce more SO2 closer to land while being more cost-effective for the fleet. Results suggest that combining performance requirements with market-based instruments can most effectively control SO2 emissions from ships.

  16. Cost-Effectiveness of Pharmacotherapy to Reduce Obesity

    PubMed Central

    Veerman, J. Lennert; Barendregt, Jan J.; Forster, Megan; Vos, Theo

    2011-01-01

    Aims Obesity causes a high disease burden in Australia and across the world. We aimed to analyse the cost-effectiveness of weight reduction with pharmacotherapy in Australia, and to assess its potential to reduce the disease burden due to excess body weight. Methods We constructed a multi-state life-table based Markov model in Excel in which body weight influences the incidence of stroke, ischemic heart disease, hypertensive heart disease, diabetes mellitus, osteoarthritis, post-menopausal breast cancer, colon cancer, endometrial cancer and kidney cancer. We use data on effectiveness identified from PubMed searches, on mortality from Australian Bureau of Statistics, on disease costs from the Australian Institute of Health and Welfare, and on drug costs from the Department of Health and Ageing. We evaluate 1-year pharmacological interventions with sibutramine and orlistat targeting obese Australian adults free of obesity-related disease. We use a lifetime horizon for costs and health outcomes and a health sector perspective for costs. Incremental Cost-Effectiveness Ratios (ICERs) below A$50 000 per Disability Adjusted Life Year (DALY) averted are considered good value for money. Results The ICERs are A$130 000/DALY (95% uncertainty interval [UI] 93 000–180 000) for sibutramine and A$230 000/DALY (170 000–340 000) for orlistat. The interventions reduce the body weight-related disease burden at the population level by 0.2% and 0.1%, respectively. Modest weight loss during the interventions, rapid post-intervention weight regain and low adherence limit the health benefits. Conclusions Treatment with sibutramine or orlistat is not cost-effective from an Australian health sector perspective and has a negligible impact on the total body weight-related disease burden. PMID:22046255

  17. Cost-effectiveness of pharmacotherapy to reduce obesity.

    PubMed

    Veerman, J Lennert; Barendregt, Jan J; Forster, Megan; Vos, Theo

    2011-01-01

    Obesity causes a high disease burden in Australia and across the world. We aimed to analyse the cost-effectiveness of weight reduction with pharmacotherapy in Australia, and to assess its potential to reduce the disease burden due to excess body weight. We constructed a multi-state life-table based Markov model in Excel in which body weight influences the incidence of stroke, ischemic heart disease, hypertensive heart disease, diabetes mellitus, osteoarthritis, post-menopausal breast cancer, colon cancer, endometrial cancer and kidney cancer. We use data on effectiveness identified from PubMed searches, on mortality from Australian Bureau of Statistics, on disease costs from the Australian Institute of Health and Welfare, and on drug costs from the Department of Health and Ageing. We evaluate 1-year pharmacological interventions with sibutramine and orlistat targeting obese Australian adults free of obesity-related disease. We use a lifetime horizon for costs and health outcomes and a health sector perspective for costs. Incremental Cost-Effectiveness Ratios (ICERs) below A$50 000 per Disability Adjusted Life Year (DALY) averted are considered good value for money. The ICERs are A$130 000/DALY (95% uncertainty interval [UI] 93 000-180 000) for sibutramine and A$230 000/DALY (170 000-340 000) for orlistat. The interventions reduce the body weight-related disease burden at the population level by 0.2% and 0.1%, respectively. Modest weight loss during the interventions, rapid post-intervention weight regain and low adherence limit the health benefits. Treatment with sibutramine or orlistat is not cost-effective from an Australian health sector perspective and has a negligible impact on the total body weight-related disease burden.

  18. Small Habitat Commonality Reduces Cost for Human Mars Missions

    NASA Technical Reports Server (NTRS)

    Griffin, Brand N.; Lepsch, Roger; Martin, John; Howard, Robert; Rucker, Michelle; Zapata, Edgar; McCleskey, Carey; Howe, Scott; Mary, Natalie; Nerren, Philip (Inventor)

    2015-01-01

    Most view the Apollo Program as expensive. It was. But, a human mission to Mars will be orders of magnitude more difficult and costly. Recently, NASA's Evolvable Mars Campaign (EMC) mapped out a step-wise approach for exploring Mars and the Mars-moon system. It is early in the planning process but because approximately 80% of the total life cycle cost is committed during preliminary design, there is an effort to emphasize cost reduction methods up front. Amongst the options, commonality across small habitat elements shows promise for consolidating the high bow-wave costs of Design, Development, Test and Evaluation (DDT&E) while still accommodating each end-item's functionality. In addition to DDT&E, there are other cost and operations benefits to commonality such as reduced logistics, simplified infrastructure integration and with inter-operability, improved safety and simplified training. These benefits are not without a cost. Some habitats are sub-optimized giving up unique attributes for the benefit of the overall architecture and because the first item sets the course for those to follow, rapidly developing technology may be excluded. The small habitats within the EMC include the pressurized crew cabins for the ascent vehicle,

  19. Costs of an Intervention for Primary Care Patients With Medically Unexplained Symptoms: A Randomized Controlled Trial

    PubMed Central

    Luo, Zhehui; Goddeeris, John; Gardiner, Joseph C.; Smith, Robert C.

    2009-01-01

    Objective This study sought to determine whether an intervention for patients with medically unexplained symptoms in primary care reduced total costs, components of cost, and longer-term costs and whether it led to decreased service use outside the health maintenance organization (HMO). Methods A randomized controlled trial involving 206 patients with medically unexplained symptoms was conducted in a staff-model HMO. The protocol emphasized the provider-patient relationship and included cognitive-behavioral therapy and pharmacological management. Cost data for medical treatments were derived from the HMO's electronic database. Patients were interviewed about work days lost and out-of-pocket expenses for medical care outside the HMO. Results The difference in total costs ($1,071) for the 12-month intervention was not significant. The treatment group had significantly higher costs for antidepressants than the usual-care group ($192 higher) during the intervention, and a larger proportion received antidepressants. The intervention group used less medical care outside the HMO and missed one less work day per month on average (1.23 days), indicating a slight improvement in productivity, but the difference was not significant. The between-group difference in estimated total cost was smaller in the year after the intervention (difference of $341) but were not significant. Conclusions The total costs for the intervention group were not significantly different, but the group had greater use of antidepressants. Coupled with findings of improved mental health outcomes for this group in a previous study, the results indicate that the intervention may be cost-effective. The longer-term impact needs to be further studied. PMID:17664519

  20. End-of-Life Medical Costs of Medicaid Cancer Patients.

    PubMed

    Tangka, Florence K L; Subramanian, Sujha; Sabatino, Susan A; Howard, David H; Haber, Susan; Hoover, Sonja; Richardson, Lisa C

    2015-06-01

    To quantify end-of-life (EOL) medical costs for adult Medicaid beneficiaries diagnosed with cancer. We linked Medicaid administrative data with 2000-2003 cancer registry data to identify 3,512 adult Medicaid beneficiaries who died after a cancer diagnosis and matched them to a cohort of beneficiaries without cancer who died during the same period. We used multivariable regression analysis to estimate incremental per-person EOL cost after controlling for beneficiaries' age, race/ethnicity, sex, cancer site, and state of residence. End-of-life costs during the final 4 months of life were about $10,000 higher for Medicaid cancer patients than for those without cancer. Medicaid cancer patients are more intensive users of inpatient and ambulatory services than are Medicaid patients without cancer. Medicaid cancer patients who die soon after diagnosis have higher costs of care and use inpatient services more intensely than do Medicaid patients without cancer. Medicaid cancer patients incur substantially higher EOL costs than noncancer patients. This increased cost may reflect the cost of palliative care. Future studies should assess the types and timing of services provided to Medicaid cancer patients at the EOL. © Health Research and Educational Trust.

  1. End-of-Life Medical Costs of Medicaid Cancer Patients

    PubMed Central

    Tangka, Florence KL; Subramanian, Sujha; Sabatino, Susan A; Howard, David H; Haber, Susan; Hoover, Sonja; Richardson, Lisa C

    2015-01-01

    Objectives To quantify end-of-life (EOL) medical costs for adult Medicaid beneficiaries diagnosed with cancer. Data Sources We linked Medicaid administrative data with 2000–2003 cancer registry data to identify 3,512 adult Medicaid beneficiaries who died after a cancer diagnosis and matched them to a cohort of beneficiaries without cancer who died during the same period. Study Design We used multivariable regression analysis to estimate incremental per-person EOL cost after controlling for beneficiaries' age, race/ethnicity, sex, cancer site, and state of residence. Principal Findings End-of-life costs during the final 4 months of life were about $10,000 higher for Medicaid cancer patients than for those without cancer. Medicaid cancer patients are more intensive users of inpatient and ambulatory services than are Medicaid patients without cancer. Medicaid cancer patients who die soon after diagnosis have higher costs of care and use inpatient services more intensely than do Medicaid patients without cancer. Conclusions Medicaid cancer patients incur substantially higher EOL costs than noncancer patients. This increased cost may reflect the cost of palliative care. Future studies should assess the types and timing of services provided to Medicaid cancer patients at the EOL. PMID:25424134

  2. Centralized distribution: reducing ownership costs by streamlining hospital logistics.

    PubMed

    Laurin, Chantal S

    2011-01-01

    All Quebecers have access to a public health system that enables them to receive high-quality healthcare, regardless of their individual ability to pay. With the aim of improving effectiveness and efficiency and achieving cost savings in managing public funds allotted to the healthcare network, SigmaSanté intends implementing a central distribution of medical supplies needed by healthcare facilities in Montréal and Laval, Québec, as has been done in many other jurisdictions for numerous years.

  3. Health care costs of medical patients at an urban care center.

    PubMed

    Smith, D M; Roberts, S D; Gross, T L

    1981-01-01

    Many cost containment strategies advocate that physicians should use fewer or less costly resources. In order to place these strategies in perspective, components of charges (costs) for medical patients at an urban center were examined to ascertain their contribution to the total health care bill. Contributions to total costs by location of service were: inpatient, 77.9%; outpatient, 17.1%; emergency room, 5.0%. Contributions by cost category were: facility charge, 52.8%; tests, 25.6%; pharmaceuticals, 11.0%. A goal to reduce total costs by 5% would require reducing pharmaceuticals by 45.4% or tests by 19.5%. In contrast, the same goal could be accomplished by reducing hospitalization by only 6.4%. If a strategy increased ambulatory costs by 5%, but resulted in a 7.5% decrease in hospitalization, the total health care costs would still decrease by 5%. Thus, rather than using fewer and less costly resources, physicians are encouraged to use more resources in ambulatory care to prevent morbidity requiring hospitalization.

  4. Direct medical costs and source of cost differences across the spectrum of cognitive decline: A population-based study

    PubMed Central

    Leibson, Cynthia L.; Long, Kirsten Hall; Ransom, Jeanine E.; Roberts, Rosebud O.; Hass, Steven L.; Duhig, Amy M.; Smith, Carin Y.; Emerson, Jane A.; Pankratz, V. Shane; Petersen, Ronald C.

    2015-01-01

    BACKGROUND Objective cost estimates and source of cost differences are needed across the spectrum of cognition, including cognitively normal (CN), mild-cognitive-impairment (MCI), newly-discovered dementia, and prevalent dementia. METHODS Subjects were a subset of the Mayo Clinic Study of Aging stratified-random sampling of Olmsted County, MN, residents aged 70-89 years. A neurologist reviewed provider-linked medical records to identify prevalent-dementia (review date=index). Remaining subjects were invited to participate in prospective clinical/neuropsychological assessments; participants were categorized as CN, MCI, or newly-discovered-dementia (assessment date=index). Costs for medical services/procedures 1-year pre-index (excluding indirect and long-term care costs) were estimated using line-item provider-linked administrative data. We estimated contributions of care-delivery site and comorbid conditions (including and excluding neuropsychiatric diagnoses) to between-category cost differences. RESULTS Annual mean medical costs for CN, MCI, newly-discovered-dementia, and prevalent-dementia were $6,042, $6,784, $9,431, $11,678 respectively. Hospital inpatient costs contributed 70% of total costs for prevalent dementia and accounted for differences between CN and both prevalent and newly-discovered dementia. Ambulatory costs accounted for differences between CN and MCI. Age-, sex-, education-adjusted differences reached significance for CN versus newly-discovered and prevalent-dementia and for MCI versus prevalent-dementia. After considering all comorbid diagnoses, between-category differences were reduced (e.g., prevalent-dementia minus MCI (from $4,842 to $3,575); newly-discovered-dementia minus CN (from $3,578 to$711). Following exclusion of neuropsychiatric diagnoses from comorbidity adjustment, between-category differences tended to revert to greater differences. CONCLUSIONS Cost estimates did not differ significantly between CN and MCI. Substantial

  5. Can Weight Loss Reduce the Need for Blood Pressure Medication?

    MedlinePlus

    ... Can weight loss reduce the need for blood pressure medication? Answers from Sheldon G. Sheps, M.D. If you're ... pounds (2.3 kilograms) can lower your blood pressure. As you slim down, it may be possible ...

  6. Leveraging metal matrix composites to reduce costs in space mechanisms

    NASA Technical Reports Server (NTRS)

    Nye, Ted; Claridge, Rex; Walker, Jim

    1994-01-01

    Advanced metal matrix composites may be one of the most promising technologies for reducing cost in structural components without compromise to strength or stiffness. A microlight 12.50 N (2.81 lb), two-axis, solar array drive assembly (SADA) was made for the Advanced Materials Applications to Space Structures (AMASS) Program flight experiment. The SADA had both its inner and outer axis housings fabricated from silicon carbide particulate reinforced alumimun. Two versions of the housings were made. The first was machined from a solid billet of material. The second was plaster cast to a near net shape that required minimal finish machining. Both manufacturing methods were compared upon completion. Results showed a cost savings with the cast housing was possible for quantities greater than one and probable for quantities greater than two. For quantities approaching ten, casting resulted in a reduction factor of almost three in the cost per part.

  7. Cost containment and computerized medical imaging. Meeting one another's needs?

    PubMed

    Wagner, J L

    1987-01-01

    Today, computers are used in several important and fast-growing medical imaging modalities, such as digital subtraction angiography, positron emission tomography, magnetic resonance imaging, nuclear medicine, and diagnostic ultrasound. The ultimate test for the computer in medical imaging will be its ability to replace traditional film-based radiography as the mechanism for displaying, communicating, and storing imaging information. This transition will require radiologists and other imagers to accept information in digital form. The speed of that acceptance depends on the economic incentives of the health care system. These are changing as a result of cost containment, which is moving away from fee-for-service toward bundled payment. The increase in capitated health plans will encourage the development of digital radiography systems that realistically trade-off the perceived quality needs of radiologists with the costs of producing and operating such systems.

  8. Cost-effectiveness of shared medical appointments for neuromuscular patients.

    PubMed

    Seesing, Femke M; Groenewoud, Hans J; Drost, Gea; van Engelen, Baziel G M; van der Wilt, Gert Jan

    2015-08-18

    To assess whether shared medical appointments (SMAs) for neuromuscular patients represent a way of using clinicians' time efficiently without compromising quality of care for patients. Patients with a chronic neuromuscular disease (NMD) (n = 272) were randomly allocated to either an SMA or a regular individual annual appointment and followed up for a period of 6 months. Data on resource utilization and quality of life (EQ-5D) were collected prospectively, using a health care perspective. Incremental costs and changes in quality-adjusted life-years (QALYs) were computed using a probabilistic decision model. Factors critical to the incremental cost-effectiveness of SMAs were explored in sensitivity analyses. No substantial differences between SMAs and individual visits in terms of costs per QALY were found (incremental cost-effectiveness ratio €-960.00; 95% confidence interval €-34,600.00, €+36,800.00). Sensitivity analyses showed that the cost-effectiveness ratio was particularly sensitive to SMA group size and proportion of patients seeing their treating neurologist. Cost-effectiveness of SMAs did not show a significant difference vs that of individual appointments based on data from our randomized controlled trial. On the other hand, we were able to show that a minimum of 6 patients per SMA and 75% of patients attending their treating neurologist are specific conditions under which SMAs qualify as a cost-effective alternative. This implies that SMAs may be a means to increase productivity of the physician without compromising quality of care. This study provides Class III evidence that SMAs are not significantly more cost-effective than individual appointments for patients with NMDs. The study lacks the precision to exclude important differences in cost-effectiveness between SMAs and individual appointments. © 2015 American Academy of Neurology.

  9. Copper-nickel piping reduces costs, biofouling/corrosion

    SciTech Connect

    Albaugh, E.K.

    1984-11-01

    Seawater piping systems for offshore drilling rigs and platforms are typically plagued by biofouling and/or corrosion, with piping failures occurring in only a few years. Discussed are alternate pipe materials with the emphasis on the testing of a copper-nickel alloy in the Gulf of Mexico. Results show that although initially more expensive, use of this alloy can extend system life to 20 years or more while improving productivity and reducing overall costs when compared to a comparable steel system.

  10. Advanced transfer chute reduces dust at lower cost

    SciTech Connect

    Blazek, C.

    2005-10-01

    Dominion Resources' Kincaid Generating Station in Illinois is recognized as a leader in handling and burning PRB coal. Since being named the Powder Plant of the Year in 2001 and 2004 by the PRB Coal Users' Group, Kincaid has improved its coal handling by installing an InteliFlo controlled-flow transfer chute from Benetech. The InteliFlo design eliminates the need for skirt boards, conveyor discharge hoods, and complex load bed designs, and reduces O & M costs. 4 figs.

  11. Adapting smartphones for low-cost optical medical imaging

    NASA Astrophysics Data System (ADS)

    Pratavieira, Sebastião.; Vollet-Filho, José D.; Carbinatto, Fernanda M.; Blanco, Kate; Inada, Natalia M.; Bagnato, Vanderlei S.; Kurachi, Cristina

    2015-06-01

    Optical images have been used in several medical situations to improve diagnosis of lesions or to monitor treatments. However, most systems employ expensive scientific (CCD or CMOS) cameras and need computers to display and save the images, usually resulting in a high final cost for the system. Additionally, this sort of apparatus operation usually becomes more complex, requiring more and more specialized technical knowledge from the operator. Currently, the number of people using smartphone-like devices with built-in high quality cameras is increasing, which might allow using such devices as an efficient, lower cost, portable imaging system for medical applications. Thus, we aim to develop methods of adaptation of those devices to optical medical imaging techniques, such as fluorescence. Particularly, smartphones covers were adapted to connect a smartphone-like device to widefield fluorescence imaging systems. These systems were used to detect lesions in different tissues, such as cervix and mouth/throat mucosa, and to monitor ALA-induced protoporphyrin-IX formation for photodynamic treatment of Cervical Intraepithelial Neoplasia. This approach may contribute significantly to low-cost, portable and simple clinical optical imaging collection.

  12. Direct medical costs of hospitalizations for cardiovascular diseases in Shanghai, China: trends and projections.

    PubMed

    Wang, Shengnan; Petzold, Max; Cao, Junshan; Zhang, Yue; Wang, Weibing

    2015-05-01

    Few studies in China have focused on direct expenditures for cardiovascular diseases (CVDs), making cost trends for CVDs uncertain. Epidemic modeling and forecasting may be essential for health workers and policy makers to reduce the cost burden of CVDs.To develop a time series model using Box-Jenkins methodology for a 15-year forecasting of CVD hospitalization costs in Shanghai.Daily visits and medical expenditures for CVD hospitalizations between January 1, 2008 and December 31, 2012 were analyzed. Data from 2012 were used for further analyses, including yearly total health expenditures and expenditures per visit for each disease, as well as per-visit-per-year medical costs of each service for CVD hospitalizations. Time series analyses were performed to determine the long-time trend of total direct medical expenditures for CVDs and specific expenditures for each disease, which were used to forecast expenditures until December 31, 2030.From 2008 to 2012, there were increased yearly trends for both hospitalizations (from 250,354 to 322,676) and total costs (from US $ 388.52 to 721.58 million per year in 2014 currency) in Shanghai. Cost per CVD hospitalization in 2012 averaged US $ 2236.29, with the highest being for chronic rheumatic heart diseases (US $ 4710.78). Most direct medical costs were spent on medication. By the end of 2030, the average cost per visit per month for all CVDs was estimated to be US $ 4042.68 (95% CI: US $ 3795.04-4290.31) for all CVDs, and the total health expenditure for CVDs would reach over US $1.12 billion (95% CI: US $ 1.05-1.19 billion) without additional government interventions.Total health expenditures for CVDs in Shanghai are estimated to be higher in the future. These results should be a valuable future resource for both researchers on the economic effects of CVDs and for policy makers.

  13. Direct Medical Costs of Hospitalizations for Cardiovascular Diseases in Shanghai, China

    PubMed Central

    Wang, Shengnan; Petzold, Max; Cao, Junshan; Zhang, Yue; Wang, Weibing

    2015-01-01

    Abstract Few studies in China have focused on direct expenditures for cardiovascular diseases (CVDs), making cost trends for CVDs uncertain. Epidemic modeling and forecasting may be essential for health workers and policy makers to reduce the cost burden of CVDs. To develop a time series model using Box–Jenkins methodology for a 15-year forecasting of CVD hospitalization costs in Shanghai. Daily visits and medical expenditures for CVD hospitalizations between January 1, 2008 and December 31, 2012 were analyzed. Data from 2012 were used for further analyses, including yearly total health expenditures and expenditures per visit for each disease, as well as per-visit-per-year medical costs of each service for CVD hospitalizations. Time series analyses were performed to determine the long-time trend of total direct medical expenditures for CVDs and specific expenditures for each disease, which were used to forecast expenditures until December 31, 2030. From 2008 to 2012, there were increased yearly trends for both hospitalizations (from 250,354 to 322,676) and total costs (from US $ 388.52 to 721.58 million per year in 2014 currency) in Shanghai. Cost per CVD hospitalization in 2012 averaged US $ 2236.29, with the highest being for chronic rheumatic heart diseases (US $ 4710.78). Most direct medical costs were spent on medication. By the end of 2030, the average cost per visit per month for all CVDs was estimated to be US $ 4042.68 (95% CI: US $ 3795.04–4290.31) for all CVDs, and the total health expenditure for CVDs would reach over US $1.12 billion (95% CI: US $ 1.05–1.19 billion) without additional government interventions. Total health expenditures for CVDs in Shanghai are estimated to be higher in the future. These results should be a valuable future resource for both researchers on the economic effects of CVDs and for policy makers. PMID:25997060

  14. Children with medical complexity and Medicaid: spending and cost savings.

    PubMed

    Berry, Jay G; Hall, Matt; Neff, John; Goodman, Denise; Cohen, Eyal; Agrawal, Rishi; Kuo, Dennis; Feudtner, Chris

    2014-12-01

    A small but growing population of children with medical complexity, many of whom are covered by Medicaid, accounts for a high proportion of pediatric health care spending. We first describe the expenditures for children with medical complexity insured by Medicaid across the care continuum. We report the increasingly large amount of spending on hospital care for these children, relative to the small amount of primary care and home care spending. We then present a business case that estimates how cost savings might be achieved for children with medical complexity from potential reductions in hospital and emergency department use and shows how the savings could underwrite investments in outpatient and community care. We conclude by discussing the importance of these findings in the context of Medicaid's quality of care and health care reform.

  15. Effect of Continued Medical Therapy on Productivity Costs for Refractory Chronic Rhinosinusitis.

    PubMed

    Rudmik, Luke; Soler, Zachary M; Smith, Timothy L; Mace, Jess C; Schlosser, Rodney J; DeConde, Adam S

    2015-11-01

    It is estimated that lost productivity related to chronic rhinosinusitis (CRS) costs society in excess of $13 billion per year in the United States. Given this tremendous cost to society, it is important to evaluate the effect of current interventions on improving this productivity loss. To define the change in productivity costs in patients with refractory CRS who select continued medical therapy. Observational cohort study. Thirty-eight patients with a guideline-based diagnosis of CRS whose initial appropriate medical therapy failed were enrolled from 4 tertiary-level rhinology clinics. The study was conducted from December 6, 2010, to April 23, 2013, and data analysis was performed from December 6, 2010, to June 1, 2015. Continued medical therapy for CRS. The human capital approach was applied to quantify productivity costs. Absenteeism, presenteeism, and lost leisure time were quantified to define annual lost productive time, which was measured at enrollment (baseline) and at a minimum of 6 months after treatment. Lost productive time was monetized using the annual daily wage rates obtained from the 2012 US National Census and the 2013 US Department of Labor statistics. Thirty-eight patients with refractory CRS who selected continued medical therapy had a mean (SD) baseline annual productivity cost of $3464 ($4900) per patient. After continued medical therapy for a mean of 12.8 (4.8) months, productivity costs were $2730 ($3720) (before vs after continued medical therapy productivity cost, P = .74). Mean annual absenteeism was reduced from 5 (12) days to 2 (8) days (P = .02). Mean annual presenteeism (17 [27] days reduced to 15 [23] days; P = .93) and mean annual household days lost (7 [7] days reduced to 6 [6] days; P = .51) were maintained at baseline levels. There were no significant differences in productivity outcomes based on endoscopy, the 22-item Sinonasal Outcome Test score, age, or polyp status (all P ≥ .11). Patients with

  16. Reducing medication errors in critical care: a multimodal approach

    PubMed Central

    Kruer, Rachel M; Jarrell, Andrew S; Latif, Asad

    2014-01-01

    The Institute of Medicine has reported that medication errors are the single most common type of error in health care, representing 19% of all adverse events, while accounting for over 7,000 deaths annually. The frequency of medication errors in adult intensive care units can be as high as 947 per 1,000 patient-days, with a median of 105.9 per 1,000 patient-days. The formulation of drugs is a potential contributor to medication errors. Challenges related to drug formulation are specific to the various routes of medication administration, though errors associated with medication appearance and labeling occur among all drug formulations and routes of administration. Addressing these multifaceted challenges requires a multimodal approach. Changes in technology, training, systems, and safety culture are all strategies to potentially reduce medication errors related to drug formulation in the intensive care unit. PMID:25210478

  17. The impact of medication adherence on coronary artery disease costs and outcomes: a systematic review.

    PubMed

    Bitton, Asaf; Choudhry, Niteesh K; Matlin, Olga S; Swanton, Kellie; Shrank, William H

    2013-04-01

    Given the huge burden of coronary artery disease and the effectiveness of medication therapy, understanding and quantifying known impacts of poor medication adherence for primary and secondary prevention is crucial. We sought to systematically review the literature on this topic area with a focus on quantified cost and clinical outcomes related to adherence. We conducted a systematic review of the literature between 1966 and November 2011 using a fixed search strategy, multiple reviewers, and a quality rating scale. We found 2636 articles using this strategy, eventually weaning them down to 25 studies that met our inclusion criteria. Three reviewers independently reviewed the studies and scored them for quality using the Newcastle Ottawa Scoring Scale. We found 5 studies (4 of which focused on statins) that measured the impact of medication adherence on primary prevention of coronary artery disease and 20 articles that focused on the relationship between medication adherence to costs and outcomes related to secondary prevention of coronary artery disease. Most of these latter studies focused on antihypertensive medications and aspirin. All controlled for confounding comorbidities and sociodemographic characteristics, but few controlled for likelihood of adherent patients to have healthier behaviors ("healthy adherer effect"). Three studies found that high adherence significantly improves health outcomes and reduces annual costs for secondary prevention of coronary artery disease (between $294 and $868 per patient, equating to 10.1%-17.8% cost reductions between high- and low-adherence groups). The studies were all of generally of high quality on the Newcastle Ottawa Scale (median score 8 of 9). Increased medication adherence is associated with improved outcomes and reduced costs, but most studies do not control for a "healthy adherer" effect. Copyright © 2013 Elsevier Inc. All rights reserved.

  18. A review article of the reduce errors in medical laboratories.

    PubMed

    Mohammedsaleh, Zuhair M; Mohammedsaleh, Fayez

    2014-07-29

    The current article examines the modern practices of reducing errors in medical laboratories. The paper sought to examine the methods that different countries are applying to reduce errors in medical laboratories. In addition, the paper examines the relationship between inadequate training of laboratory personnel and error causation in medical laboratories. A total of 17 research articles have been reviewed. The paper has done a comparison of pathology laboratory practices in the US, Canada, the UK and Australia, regarding laboratory staff skills and error reduction. The paper finds out that; although some of the developed countries have employed advanced technology to reduce errors, there is still a great need to use sophisticated medical equipment to reduce errors. In addition, the levels of training for the medical technicians are still low. They are not equipped enough to reduce the errors to the required levels. The article recommends application of advanced technology in the reduction of errors, and training of technicians on the best practices to reduce errors.

  19. A Review Article of the Reduce Errors in Medical Laboratories

    PubMed Central

    Mohammedsaleh, Zuhair M.; Mohammedsaleh, Fayez

    2015-01-01

    The current article examines the modern practices of reducing errors in medical laboratories. The paper sought to examine the methods that different countries are applying to reduce errors in medical laboratories. In addition, the paper examines the relationship between inadequate training of laboratory personnel and error causation in medical laboratories. A total of 17 research articles have been reviewed. The paper has done a comparison of pathology laboratory practices in the US, Canada, the UK and Australia, regarding laboratory staff skills and error reduction. The paper finds out that; although some of the developed countries have employed advanced technology to reduce errors, there is still a great need to use sophisticated medical equipment to reduce errors. In addition, the levels of training for the medical technicians are still low. They are not equipped enough to reduce the errors to the required levels. The article recommends application of advanced technology in the reduction of errors, and training of technicians on the best practices to reduce errors. PMID:25560334

  20. Predictive models reduce talent development costs in female gymnastics.

    PubMed

    Pion, Johan; Hohmann, Andreas; Liu, Tianbiao; Lenoir, Matthieu; Segers, Veerle

    2017-04-01

    This retrospective study focuses on the comparison of different predictive models based on the results of a talent identification test battery for female gymnasts. We studied to what extent these models have the potential to optimise selection procedures, and at the same time reduce talent development costs in female artistic gymnastics. The dropout rate of 243 female elite gymnasts was investigated, 5 years past talent selection, using linear (discriminant analysis) and non-linear predictive models (Kohonen feature maps and multilayer perceptron). The coaches classified 51.9% of the participants correct. Discriminant analysis improved the correct classification to 71.6% while the non-linear technique of Kohonen feature maps reached 73.7% correctness. Application of the multilayer perceptron even classified 79.8% of the gymnasts correctly. The combination of different predictive models for talent selection can avoid deselection of high-potential female gymnasts. The selection procedure based upon the different statistical analyses results in decrease of 33.3% of cost because the pool of selected athletes can be reduced to 92 instead of 138 gymnasts (as selected by the coaches). Reduction of the costs allows the limited resources to be fully invested in the high-potential athletes.

  1. Testing new submersible pumps for proper sizing and reduced costs

    SciTech Connect

    O'Toole, W.P.; O'Brien, J.B.

    1986-01-01

    This paper describes an ongoing program to improve overall submersible pump performance by Thums Long Beach Company, acting as Contractor of the City of Long Beach, Operator of the Long Beach Unit. Thums Long Beach Company currently operates 700 submersible pump installations located on four man-made islands and one land fill pier location. The program began with spot testing of submersible pumps for Thums' use. It has evolved to 100 percent pump testing and the stipulation that only pumps with newly manufactured parts are acceptable. The primary goals of this program are to increase well production and lower lifting costs. Critical to these goals is increasing the average length of run by using accurate pump performance data to design equipment and by rejecting defective pumps before they are run. Increased production is realized from better designs. Lower lifting costs result from utilizing higher efficiency pumps and a reduced frequency of pulling submersible equipment.

  2. Testing new submersible pumps for proper sizing and reduced costs

    SciTech Connect

    O'Toole, W.P.; O'Brien, J.B.

    1989-02-01

    This paper describes an ongoing program to improve overall submersible pump performance by Thums Long Beach Co., acting as contractor for the City of Long Beach, operator of the Long Beach Unit. Thums Long Beach Co. currently operates 700 submersible pump installations located on four manmade islands and one landfill pier location. The program began with spot testing of submersible pumps for Thums' use. It has evolved to 100% pump testing and the stipulation that only pumps with newly manufactured parts are acceptable. The primary goals of this program are to increase well production and to lower lifting costs. Critical to these goals is increasing the average length of run by using accurate pump-performance data to design equipment and by rejecting defective pumps before they are run. Increased production is realized from better designs. Lower lifting costs result from using more efficient pumps and a reduced frequency of pulling submersible equipment.

  3. Reducing costs in aircraft: The metals affordability initiative consortium

    NASA Astrophysics Data System (ADS)

    Martin, Rick; Evans, Daniel

    2000-03-01

    Emerging metallic materials, processing, and manufacturing technologies offer an important opportunity to meet current aircraft-airframe and jet-engine affordability goals, due to their inherent low material costs and excellent producibility characteristics. But to successfully meet systems goals within this new affordability-driven scenario, a consolidation ofindustry and military-agency development resources and technology-implementation activities is necessary to positively impact the military-aircraft production and sustainment infrastructure. To address this need, a consortium of aircraft and engine manufacturers and key material-and engine manufacturers and key material-and component-supplier companies has been formed to identify critical affordable metal technologies, develop a strategic roadmap for accelerated development and insertion of these technologies, and oversee execution of development activities by integrated industry teams. the goal of the Metals Affordability Initiative is to reduce the cost of metallic components by 50 percent while accelerating the implementation time.

  4. Reducing Development and Operations Costs using NASA's "GMSEC" Systems Architecture

    NASA Technical Reports Server (NTRS)

    Smith, Dan; Bristow, John; Crouse, Patrick

    2007-01-01

    This viewgraph presentation reviews the role of Goddard Mission Services Evolution Center (GMSEC) in reducing development and operation costs in handling the massive data from NASA missions. The goals of GMSEC systems architecture development are to (1) Simplify integration and development, (2)Facilitate technology infusion over time, (3) Support evolving operational concepts, and (4) All for mix of heritage, COTS and new components. First 3 missions (i.e., Tropical Rainforest Measuring Mission (TRMM), Small Explorer (SMEX) missions - SWAS, TRACE, SAMPEX, and ST5 3-Satellite Constellation System) each selected a different telemetry and command system. These results show that GMSEC's message-bus component-based framework architecture is well proven and provides significant benefits over traditional flight and ground data system designs. The missions benefit through increased set of product options, enhanced automation, lower cost and new mission-enabling operations concept options .

  5. Reducing costs with well tractors for horizontal wells

    SciTech Connect

    Hallundbaek, J.

    1995-12-31

    The Well Tractor is a new concept for a down hole tool that significantly reduces operation costs for servicing horizontal wells. The Well Tractor is a cost effective alternative to the very expensive and time consuming conventional drill pipe conveyed operations. The Well Tractor is capable of pulling coiled tubing and/or wireline horizontally beyond 10,000 ft. The Well Tractor is capable of pulling more then 25,000 ft of coiled tubing and/or wireline into a highly deviated well. Furthermore the tool is designed for pushing other tools into the hole, e.g. logging tools, video cameras. The lateral reach capacity with coiled tubing is therefore increased considerably. Time consuming production logging operations of horizontal wells utilizing jointed pipe can be carried out by the Well Tractor as a wireline job.

  6. Do Statins Reduce the Health and Health Care Costs of Obesity?

    PubMed

    Gaudette, Étienne; Goldman, Dana P; Messali, Andrew; Sood, Neeraj

    2015-07-01

    Obesity impacts both individual health and, given its high prevalence, total health care spending. However, as medical technology evolves, health outcomes for a number of obesity-related illnesses improve. This article examines whether medical innovation can mitigate the adverse health and spending associated with obesity, using statins as a case study. Because of the relationship between obesity and hypercholesterolaemia, statins play an important role in the medical management of obese individuals and the prevention of costly obesity-related sequelae. Using well-recognized estimates of the health impact of statins and the Future Elderly Model (FEM)-an established dynamic microsimulation model of the health of Americans aged over 50 years-we estimate the changes in life expectancy, functional status and health care costs of obesity due to the introduction and widespread use of statins. Life expectancy gains of statins are estimated to be 5-6 % greater for obese individuals than for healthy-weight individuals, but most of these additional gains are associated with some level of disability. Considering both medical spending and the value of quality-adjusted life-years, statins do not significantly alter the costs of class 1 and 2 obesity (body mass index [BMI] ≥30 and ≥35 kg/m(2), respectively) and they increase the costs of class 3 obesity (BMI ≥40 kg/m(2)) by 1.2 %. Although statins are very effective medications for lowering the risk of obesity-associated illnesses, they do not significantly reduce the costs of obesity.

  7. Did Statins Reduce the Health and Health Care Costs of Obesity?

    PubMed Central

    Gaudette, Étienne; Goldman, Dana P.; Messali, Andrew; Sood, Neeraj

    2015-01-01

    Context Obesity impacts both individual health and, given its high prevalence, total health care spending. However, as medical technology evolves, health outcomes for a number of obesity-related illnesses improve. This article examines whether medical innovation can mitigate the adverse health and spending associated with obesity, using statins as a case study. Due to the relationship between obesity and hypercholesterolemia, statins play an important role in the medical management of obese individuals and the prevention of costly obesity-related sequelae. Methods Using well-recognized estimates of the health impact of statins and the Future Elderly Model (FEM) – an established dynamic microsimulation model of health of Americans aged over 50 – we estimate the changes in life expectancy, functional status and health care cost of obesity due to the introduction and widespread use of statins. Results Life expectancy gains of statins are estimated to be 5%–6% higher for obese than healthy-weight individuals, but most of this additional gain is associated with some level of disability. Considering both medical spending and the value of quality-adjusted life-years, statins do not significantly alter the costs of class 1 and 2 obesity (BMI larger or equal to 30 and 35 kg/m2), and increase the costs of class 3 obesity (BMI larger or equal to 40 kg/m2) by 1.2%. Conclusions Although statins are very effective medications for lowering the risk of obesity-associated illnesses, they do not significantly reduce the costs of obesity. PMID:25576147

  8. Zinc supplementation reduced cost and duration of acute diarrhea in children.

    PubMed

    Gregorio, Germana V; Dans, Leonila F; Cordero, Cynthia P; Panelo, Carlo A

    2007-06-01

    To determine whether zinc with oral rehydration solution (ORS) is more cost effective than ORS alone in the treatment of acute diarrhea. Cost-effectiveness analysis among patients consulting the emergency room of a government institution. Cost of treatment and outcome of participants of a randomized trial of zinc+ORS vs. ORS alone for acute diarrhea were investigated. Included were subjects 2-59 months with diarrhea <7 days and no dehydration. The direct medical, nonmedical and indirect costs were obtained, using the societal perspective. The incremental cost-effectiveness ratio (ICER) was calculated. Sixty patients were given zinc+ORS and 57 were given ORS alone. Mean duration of diarrhea was 17 hours shorter and mean total cost of treatment was 5% cheaper in the zinc than ORS group . The ICER showed that with use of zinc, the society saves $ 2.4 per day of diarrhea <4 days and spends $ 0.03 per case of diarrhea averted <4 days from consult, although the confidence interval included the null value of zero. Use of zinc with ORS reduced the total cost and duration of acute diarrhea. The ICER suggests cost effectiveness of zinc supplementation but there is a need to further assess the role of zinc supplementation in a larger population.

  9. Trends in medical care costs--evolving market forces.

    PubMed

    Vincenzino, J V

    1998-01-01

    Slower growth in medical care costs has been the culmination of lower inflation and significant changes to the U.S. health care system, primarily the movement toward managed care. National health expenditures rose just 4.4 percent in 1996 - the smallest growth since the beginning of the national health expenditure data series. This is also true for the 35 percent gain recorded during 1992-96. The medical care Consumer Price Index (CPI) rose just 2.8 percent in 1997 and was only one-half of a percentage point above the overall CPI. The reduction in spending growth is most evident in hospital expenditures, which clearly reflects the expansion of HMO enrollment in both the private and public sectors. While the issue of quality of care is receiving more attention, this is unlikely to alter the basic direction of health care in the near-term. Cost is likely to remain a dominant factor in shaping the market forces that have significantly changed the delivery and financing of health care. Although trending upward, growth in medical spending is expected to remain relatively moderate as we move into the next century.

  10. Reducing the Time and Cost of Testing Engines

    NASA Technical Reports Server (NTRS)

    2004-01-01

    Producing a new aircraft engine currently costs approximately $1 billion, with 3 years of development time for a commercial engine and 10 years for a military engine. The high development time and cost make it extremely difficult to transition advanced technologies for cleaner, quieter, and more efficient new engines. To reduce this time and cost, NASA created a vision for the future where designers would use high-fidelity computer simulations early in the design process in order to resolve critical design issues before building the expensive engine hardware. To accomplish this vision, NASA's Glenn Research Center initiated a collaborative effort with the aerospace industry and academia to develop its Numerical Propulsion System Simulation (NPSS), an advanced engineering environment for the analysis and design of aerospace propulsion systems and components. Partners estimate that using NPSS has the potential to dramatically reduce the time, effort, and expense necessary to design and test jet engines by generating sophisticated computer simulations of an aerospace object or system. These simulations will permit an engineer to test various design options without having to conduct costly and time-consuming real-life tests. By accelerating and streamlining the engine system design analysis and test phases, NPSS facilitates bringing the final product to market faster. NASA's NPSS Version (V)1.X effort was a task within the Agency s Computational Aerospace Sciences project of the High Performance Computing and Communication program, which had a mission to accelerate the availability of high-performance computing hardware and software to the U.S. aerospace community for its use in design processes. The technology brings value back to NASA by improving methods of analyzing and testing space transportation components.

  11. Cost of medical education, financial assistance and medical school demographics in Singapore.

    PubMed

    Ng, C L; Tambyah, P A; Wong, C Y

    2009-05-01

    Medical tuition fees have been rising in many countries, including in Singapore. No formal study has been conducted to evaluate the financial situation of medical students in relation to the cost of medical education in Singapore. This study was conducted to determine the financial profile of Singaporean medical students and the financial expenses they incur over the five-year duration of their undergraduate medical course. A questionnaire study was conducted among Year one to Year five medical students in the Yong Loo Lin School of Medicine, National University of Singapore. The following quantifiable parameters were analysed: monthly household income, financial assistance, monthly allowances and expenses. 64.3 percent (735) of the 1,143 undergraduates completed the survey. 21.9 percent came from families with a monthly income of less than S$3,000, with another 26.2 percent from families with monthly incomes of S$3,000-S$5,000. The total tuition fees for a five-year medical course amounted to S$87,450. The average annual expenditure of medical students amounted to S$4,470. 31.1 percent of respondents were on loans. 14.6 percent received scholarships or bursaries. A five-year medical course can cost more than S$100,000 and pose a significant financial burden for students. The proportion of students who came from lower-income families was lower in medical school than at the national level, while the proportion from high-income families was significantly higher than at the national level. A significant proportion of students took loans to pay for tuition, and a smaller percentage was under scholarships and bursaries. More substantial financial assistance is required, particularly for students from lower-income families.

  12. Reducing Wildlife Damage with Cost-Effective Management Programmes

    PubMed Central

    Krull, Cheryl R.; Stanley, Margaret C.; Burns, Bruce R.; Choquenot, David; Etherington, Thomas R.

    2016-01-01

    Limiting the impact of wildlife damage in a cost effective manner requires an understanding of how control inputs change the occurrence of damage through their effect on animal density. Despite this, there are few studies linking wildlife management (control), with changes in animal abundance and prevailing levels of wildlife damage. We use the impact and management of wild pigs as a case study to demonstrate this linkage. Ground disturbance by wild pigs has become a conservation issue of global concern because of its potential effects on successional changes in vegetation structure and composition, habitat for other species, and functional soil properties. In this study, we used a 3-year pig control programme (ground hunting) undertaken in a temperate rainforest area of northern New Zealand to evaluate effects on pig abundance, and patterns and rates of ground disturbance and ground disturbance recovery and the cost effectiveness of differing control strategies. Control reduced pig densities by over a third of the estimated carrying capacity, but more than halved average prevailing ground disturbance. Rates of new ground disturbance accelerated with increasing pig density, while rates of ground disturbance recovery were not related to prevailing pig density. Stochastic simulation models based on the measured relationships between control, pig density and rate of ground disturbance and recovery indicated that control could reduce ground disturbance substantially. However, the rate at which prevailing ground disturbance was reduced diminished rapidly as more intense, and hence expensive, pig control regimes were simulated. The model produced in this study provides a framework that links conservation of indigenous ecological communities to control inputs through the reduction of wildlife damage and suggests that managers should consider carefully the marginal cost of higher investment in wildlife damage control, relative to its marginal conservation return. PMID

  13. Reducing Wildlife Damage with Cost-Effective Management Programmes.

    PubMed

    Krull, Cheryl R; Stanley, Margaret C; Burns, Bruce R; Choquenot, David; Etherington, Thomas R

    2016-01-01

    Limiting the impact of wildlife damage in a cost effective manner requires an understanding of how control inputs change the occurrence of damage through their effect on animal density. Despite this, there are few studies linking wildlife management (control), with changes in animal abundance and prevailing levels of wildlife damage. We use the impact and management of wild pigs as a case study to demonstrate this linkage. Ground disturbance by wild pigs has become a conservation issue of global concern because of its potential effects on successional changes in vegetation structure and composition, habitat for other species, and functional soil properties. In this study, we used a 3-year pig control programme (ground hunting) undertaken in a temperate rainforest area of northern New Zealand to evaluate effects on pig abundance, and patterns and rates of ground disturbance and ground disturbance recovery and the cost effectiveness of differing control strategies. Control reduced pig densities by over a third of the estimated carrying capacity, but more than halved average prevailing ground disturbance. Rates of new ground disturbance accelerated with increasing pig density, while rates of ground disturbance recovery were not related to prevailing pig density. Stochastic simulation models based on the measured relationships between control, pig density and rate of ground disturbance and recovery indicated that control could reduce ground disturbance substantially. However, the rate at which prevailing ground disturbance was reduced diminished rapidly as more intense, and hence expensive, pig control regimes were simulated. The model produced in this study provides a framework that links conservation of indigenous ecological communities to control inputs through the reduction of wildlife damage and suggests that managers should consider carefully the marginal cost of higher investment in wildlife damage control, relative to its marginal conservation return.

  14. Reducing Mission Costs by Leveraging Previous Investments in Space

    NASA Technical Reports Server (NTRS)

    Miller, Ron; Adams, W. James

    1999-01-01

    The Rapid Spacecraft Development Office (RSDO) at NASA's Goddard Space Flight Center has been charged with the responsibility to reduce mission cost by allowing access to previous developments on government and commercial space missions. RSDO accomplishes this responsibility by implementing two revolutionary contract vehicles, the Rapid Spacecraft Acquisition (RSA) and Quick Ride. This paper will describe the concept behind these contracts, the current capabilities available to missions, analysis of pricing trends to date using the RSDO processes, and future plans to increase flexibility and capabilities available to mission planners.

  15. Reducing Mission Costs by Leveraging Previous Investments in Space

    NASA Technical Reports Server (NTRS)

    Miller, Ron; Adams, W. James

    1999-01-01

    The Rapid Spacecraft Development Office (RSDO) at NASA's Goddard Space Flight Center has been charged with the responsibility to reduce mission cost by allowing access to previous developments on government and commercial space missions. RSDO accomplishes this responsibility by implementing two revolutionary contract vehicles, the Rapid Spacecraft Acquisition (RSA) and Quick Ride. This paper will describe the concept behind these contracts, the current capabilities available to missions, analysis of pricing trends to date using the RSDO processes, and future plans to increase flexibility and capabilities available to mission planners.

  16. The role of risk management in reducing costs and increasing patient safety.

    PubMed

    Wendin, S Robert

    2006-01-01

    In the last few years risk managers have been very frustrated with the high costs, or sheer unavailability, of medical malpractice insurance. The frustration is very understandable, given the rising financial costs of litigation for medical negligence. This presentation will aim to recommend a way out of this conundrum which works equally well regardless of whether the prevailing litigation environment be high or low, or one which is a fault-based or no-fault based compensation system, or whether a conventional insurance, self-insurance, or pooled risk insurance scheme. This paper will seek further to recommend that it's time risk managers took more responsibility themselves for reducing medical errors and optimising their control of risk. By understanding the concept of Total Cost of Risk, risk managers would be able to reduce losses, relying less on the insurance market, and accept responsibility for risk themselves, and, as a result, lowering insurance premiums in the process as the risk will have been taken away from insurance underwriters.

  17. Retail medical clinics: increasing access to low cost medical care amongst a developing legal environment.

    PubMed

    Schleiter, Kristin E

    2010-01-01

    Retail medical clinics are an innovation in health care with the potential to increase access to low-cost basic health care services while changing the delivery model for routine, non-urgent medical care. However, the few states that attempted to directly regulate retail medical clinics have been met with criticism by the FTC due to the proposed legislations' anticompetitive undertones. The relationship between retail medical clinics and the host stores or pharmacies that house them has the potential to spark fraud and abuse concerns. Retail medical clinics must abide by state-specific regulation on scope of practice of the various mid-level practitioners who work for the clinics, particularly to minimize exposure to litigation and keep within the clinics' intended purpose of a supplement to primary care physician offices. The author concludes that the consumer benefits of cost and convenience, combined with the potential for growth and expanded consumer base from a retailers' perspective, make the legal challenge inherent in running a retail medical clinic well worth the effort.

  18. Population-based medical and disease management: an evaluation of cost and quality.

    PubMed

    Wise, Christopher G; Bahl, Vinita; Mitchell, Rita; West, Brady T; Carli, Thomas

    2006-02-01

    Reports by the Institute of Medicine and the Health Care Financing Administration have emphasized that the integration of medical care delivery, evidence-based medicine, and chronic care disease management may play a significant role in improving the quality of care and reducing medical care costs. The specific aim of this project is to assess the impact of an integrated set of care coordination tools and chronic disease management interventions on utilization, cost, and quality of care for a population of beneficiaries who have complementary health coverage through a plan designed to apply proactive medical and disease management processes. The utilization of health care services by the study population was compared to another population from the same geographic service area and covered by a traditional fee-for-service indemnity insurance plan that provided few medical or disease management services. Evaluation of the difference in utilization was based on the difference in the cost per-member-per-month (PMPM) in a 1-year measurement period, after adjusting for differences in fee schedules, case-mix and healthcare benefit design. After adjustments for both case-mix and benefit differences, the study group is $63 PMPM less costly than the comparison population for all members. Cost differences are largest in the 55-64 and 65 and above age groups. The study group is $115 PMPM lower than the comparison population for the age category of 65 years and older, after adjustments for case-mix and benefits. Health Plan Employer and Data Information Set (HEDIS)-based quality outcomes are near the 90th percentile for most indications. The cost outcomes of a population served by proactive, population-based disease management and complex care management, compared to an unmanaged population, demonstrates the potential of coordinated medical and disease management programs. Further studies utilizing appropriate methodologies would be beneficial.

  19. Effectiveness of an electronic inpatient medication record in reducing medication errors in Singapore.

    PubMed

    Choo, Janet; Johnston, Linda; Manias, Elizabeth

    2014-06-01

    This study examined the effectiveness of an inpatient electronic medication record system in reducing medication errors in Singaporean hospitals. This pre- and post-intervention study involving a control group was undertaken in two Singaporean acute care hospitals. In one hospital the inpatient electronic medication record system was implemented while in another hospital the paper-based medication record system was used. The mean incidence difference in medication errors of 0.06 between pre-intervention (0.72 per 1000 patient days) and post-intervention (0.78 per 1000 patient days) for the two hospitals was not statistically significant (95%, CI: [0.26, 0.20]). The mean incidence differences in medication errors relating to prescription, dispensing, and administration were also not statistically different. Common system failures involved a lack of medication knowledge by health professionals and a lack of a systematic approach in identifying correct dosages. There was no difference in the incidence of medication errors following the introduction of the electronic medication record system. More work is needed on how this system can reduce medication error rates and improve medication safety. © 2013 Wiley Publishing Asia Pty Ltd.

  20. Economical evolution: microbes reduce the synthetic cost of extracellular proteins.

    PubMed

    Smith, Daniel R; Chapman, Matthew R

    2010-08-24

    Protein evolution is not simply a race toward improved function. Because organisms compete for limited resources, fitness is also affected by the relative economy of an organism's proteome. Indeed, many abundant proteins contain relatively high percentages of amino acids that are metabolically less taxing for the cell to make, thus reducing cellular cost. However, not all abundant proteins are economical, and many economical proteins are not particularly abundant. Here we examined protein composition and found that the relative synthetic cost of amino acids constrains the composition of microbial extracellular proteins. In Escherichia coli, extracellular proteins contain, on average, fewer energetically expensive amino acids independent of their abundance, length, function, or structure. Economic pressures have strategically shaped the amino acid composition of multicomponent surface appendages, such as flagella, curli, and type I pili, and extracellular enzymes, including type III effector proteins and secreted serine proteases. Furthermore, in silico analysis of Pseudomonas syringae, Mycobacterium tuberculosis, Saccharomyces cerevisiae, and over 25 other microbes spanning a wide range of GC content revealed a broad bias toward more economical amino acids in extracellular proteins. The synthesis of any protein, especially those rich in expensive aromatic amino acids, represents a significant investment. Because extracellular proteins are lost to the environment and not recycled like other cellular proteins, they present a greater burden on the cell, as their amino acids cannot be reutilized during translation. We hypothesize that evolution has optimized extracellular proteins to reduce their synthetic burden on the cell.

  1. An Application of Six Sigma to Reduce Supplier Quality Cost

    NASA Astrophysics Data System (ADS)

    Gaikwad, Lokpriya Mohanrao; Teli, Shivagond Nagappa; Majali, Vijay Shashikant; Bhushi, Umesh Mahadevappa

    2016-01-01

    This article presents an application of Six Sigma to reduce supplier quality cost in manufacturing industry. Although there is a wider acceptance of Six Sigma in many organizations today, there is still a lack of in-depth case study of Six Sigma. For the present research the case study methodology was used. The company decided to reduce quality cost and improve selected processes using Six Sigma methodologies. Regarding the fact that there is a lack of case studies dealing with Six Sigma especially in individual manufacturing organization this article could be of great importance also for the practitioners. This paper discusses the quality and productivity improvement in a supplier enterprise through a case study. The paper deals with an application of Six Sigma define-measure-analyze-improve-control methodology in an industry which provides a framework to identify, quantify and eliminate sources of variation in an operational process in question, to optimize the operation variables, improve and sustain performance viz. process yield with well-executed control plans. Six Sigma improves the process performance (process yield) of the critical operational process, leading to better utilization of resources, decreases variations and maintains consistent quality of the process output.

  2. Using collaborative work groups to reduce O&M costs

    SciTech Connect

    Francoeur, R.; Jones, J.N.

    1995-12-31

    Commonwealth Edison Company (ComEd) entered the nineties burdened with external distractions from its core business of power generation. Its unresolved 1987 rate case continued to face intervention in the courts. Some of its largest industrial and municipal customers were exploring more economical alternatives. The new convention facility in Chicago actually engaged an independent energy supplier. Retail wheeling was the hot topic, and internal problems were present. Operations and Maintenance (O&M) costs were steadily increasing. Two of their six nuclear stations were on the Nuclear Regulatory Commission`s Watch List. Immediate changes had to occur if ComEd was to ensure its future competitiveness. At ComEd Braidwood Nuclear Power Station some untraditional work methodologies were embarked upon to help the parent company reduce its O&M costs. Various types of collaborative work groups were formed, and have succeeded in lowering O&M costs through shorter refueling outages and the use of fewer contracted personnel. These collaborative work groups are listed below and are described in detail in the remainder of this paper: (1) A core group of Maintenance Modification Contractor (MMC) supervision integrated into the Owner`s Maintenance Staff, (2) A Corporate Outage Support Group of supervisory personnel which supplements the site`s Maintenance Staff, (3) The Integrated Outage and Turbine Overhaul Contractor using a mixture of its own and Maintenance Staff supervisory personnel during outages with the Owner supplementing craft support using a third-party, (4) Six nuclear stations sharing key MMC personnel to insure experienced individuals are used effectively, and (5) Composite teams of maintenance personnel working across defined disciplines Braidwood Station has capitalized on the strategy of positive collaboration to become one of the lowest cost producers of nuclear power. Its use has enabled the Station to successfully complete the last refueling outage in 40 days.

  3. Fixed-point image orthorectification algorithms for reduced computational cost

    NASA Astrophysics Data System (ADS)

    French, Joseph Clinton

    Imaging systems have been applied to many new applications in recent years. With the advent of low-cost, low-power focal planes and more powerful, lower cost computers, remote sensing applications have become more wide spread. Many of these applications require some form of geolocation, especially when relative distances are desired. However, when greater global positional accuracy is needed, orthorectification becomes necessary. Orthorectification is the process of projecting an image onto a Digital Elevation Map (DEM), which removes terrain distortions and corrects the perspective distortion by changing the viewing angle to be perpendicular to the projection plane. Orthorectification is used in disaster tracking, landscape management, wildlife monitoring and many other applications. However, orthorectification is a computationally expensive process due to floating point operations and divisions in the algorithm. To reduce the computational cost of on-board processing, two novel algorithm modifications are proposed. One modification is projection utilizing fixed-point arithmetic. Fixed point arithmetic removes the floating point operations and reduces the processing time by operating only on integers. The second modification is replacement of the division inherent in projection with a multiplication of the inverse. The inverse must operate iteratively. Therefore, the inverse is replaced with a linear approximation. As a result of these modifications, the processing time of projection is reduced by a factor of 1.3x with an average pixel position error of 0.2% of a pixel size for 128-bit integer processing and over 4x with an average pixel position error of less than 13% of a pixel size for a 64-bit integer processing. A secondary inverse function approximation is also developed that replaces the linear approximation with a quadratic. The quadratic approximation produces a more accurate approximation of the inverse, allowing for an integer multiplication calculation

  4. The (paper) work of medicine: understanding international medical costs.

    PubMed

    Cutler, David M; Ly, Dan P

    2011-01-01

    This paper draws on international evidence on medical spending to examine what the United States can learn about making its healthcare system more efficient. We focus primarily on understanding contemporaneous differences in the level of spending, generally from the 2000s. Medical spending differs across countries either because the price of services differs (for example, a coronary bypass surgery operation may cost more in the United States than in other countries) or because people receive more services in some countries than in others (for example, more bypass surgery operations). Within the price category, there are two further issues: whether factors earn different returns across countries and whether more clinical or administrative personnel are required to deliver the same care in different countries. We first present the results of a decomposition of healthcare spending along these lines in the United States and in Canada. We then delve into each component in more detail—administrative costs, factor prices, and the provision of care received—bringing in a broader range of international evidence when possible. Finally, we touch upon the organization of primary and chronic disease care and discuss possible gains in that area.

  5. Cost-effectiveness analysis of a hospital electronic medication management system

    PubMed Central

    Gospodarevskaya, Elena; Li, Ling; Richardson, Katrina L; Roffe, David; Heywood, Maureen; Day, Richard O; Graves, Nicholas

    2015-01-01

    Objective To conduct a cost–effectiveness analysis of a hospital electronic medication management system (eMMS). Methods We compared costs and benefits of paper-based prescribing with a commercial eMMS (CSC MedChart) on one cardiology ward in a major 326-bed teaching hospital, assuming a 15-year time horizon and a health system perspective. The eMMS implementation and operating costs were obtained from the study site. We used data on eMMS effectiveness in reducing potential adverse drug events (ADEs), and potential ADEs intercepted, based on review of 1 202 patient charts before (n = 801) and after (n = 401) eMMS. These were combined with published estimates of actual ADEs and their costs. Results The rate of potential ADEs following eMMS fell from 0.17 per admission to 0.05; a reduction of 71%. The annualized eMMS implementation, maintenance, and operating costs for the cardiology ward were A$61 741 (US$55 296). The estimated reduction in ADEs post eMMS was approximately 80 actual ADEs per year. The reduced costs associated with these ADEs were more than sufficient to offset the costs of the eMMS. Estimated savings resulting from eMMS implementation were A$63–66 (US$56–59) per admission (A$97 740–$102 000 per annum for this ward). Sensitivity analyses demonstrated results were robust when both eMMS effectiveness and costs of actual ADEs were varied substantially. Conclusion The eMMS within this setting was more effective and less expensive than paper-based prescribing. Comparison with the few previous full economic evaluations available suggests a marked improvement in the cost–effectiveness of eMMS, largely driven by increased effectiveness of contemporary eMMs in reducing medication errors. PMID:25670756

  6. Do zero-cost workers' compensation medical claims really have zero costs? The impact of workplace injury on group health insurance utilization and costs.

    PubMed

    Asfaw, Abay; Rosa, Roger; Mao, Rebecca

    2013-12-01

    Previous research suggests that non-workers' compensation (WC) insurance systems, such as group health insurance (GHI), Medicare, or Medicaid, at least partially cover work-related injury and illness costs. This study further examined GHI utilization and costs. Using two-part model, we compared those outcomes immediately after injuries for which accepted WC medical claims made zero or positive medical payments. Controlling for pre-injury GHI utilization and costs and other covariates, our results indicated that post-injury GHI utilization and costs increased regardless of whether a WC medical claim was zero or positive. The increases were highest for zero-cost WC medical claims. Our national estimates showed that zero-cost WC medical claims alone could cost the GHI $212 million per year.

  7. Urban water infrastructure optimization to reduce environmental impacts and costs.

    PubMed

    Lim, Seong-Rin; Suh, Sangwon; Kim, Jung-Hoon; Park, Hung Suck

    2010-01-01

    Urban water planning and policy have been focusing on environmentally benign and economically viable water management. The objective of this study is to develop a mathematical model to integrate and optimize urban water infrastructures for supply-side planning and policy: freshwater resources and treated wastewater are allocated to various water demand categories in order to reduce contaminants in the influents supplied for drinking water, and to reduce consumption of the water resources imported from the regions beyond a city boundary. A case study is performed to validate the proposed model. An optimal urban water system of a metropolitan city is calculated on the basis of the model and compared to the existing water system. The integration and optimization decrease (i) average concentrations of the influents supplied for drinking water, which can improve human health and hygiene; (ii) total consumption of water resources, as well as electricity, reducing overall environmental impacts; (iii) life cycle cost; and (iv) water resource dependency on other regions, improving regional water security. This model contributes to sustainable urban water planning and policy.

  8. Improving Physicians' Knowledge of the Costs of Common Medications and Willingness to Consider Costs When Prescribing

    PubMed Central

    Korn, Lisa M; Reichert, Steven; Simon, Todd; Halm, Ethan A

    2003-01-01

    OBJECTIVES To determine the effectiveness of an educational intervention designed to improve physicians' knowledge of drug costs and foster willingness to consider costs when prescribing. DESIGN Pre- and post-intervention evaluation, using physicians as their own controls. SETTING Four teaching hospitals, affiliated with 2 residency programs, in New York City and northern New Jersey. PARTICIPANTS One hundred forty-six internal medicine house officers and attendings evaluated the intervention (71% response rate). Of these, 109 had also participated in a pre-intervention survey. INTERVENTION An interactive teaching conference and distribution of a pocket guide, which listed the average wholesale prices of over 100 medications commonly used in primary care MEASUREMENTS AND MAIN RESULTS We administered a written survey, before and 6 months after the intervention. Changes in attitudes and knowledge were assessed, using physicians as their own controls, with Wilcoxon matched-pairs signed-rank tests. Eighty-five percent of respondents reported receiving the pocket guide and 46% reported attending 1 of the teaching conferences. Of those who received the pocket guide, nearly two thirds (62%) reported using it once a month or more, and more than half (54%) rated it as moderately or very useful. Compared to their baseline responses, physicians after the intervention were more likely to ask patients about their out-of-pocket drug costs (22% before vs 27% after; P < .01) and less likely to feel unaware of drug costs (78% before vs 72% after; P = .02). After the intervention, physicians also reported more concern about the cost of drugs when prescribing for patients with Medicare (58% before vs 72% after; P < .01) or no insurance (90% before vs 98% after; P < .01). Knowledge of the costs of 33 drugs was more accurate after the intervention than before (P < .05). CONCLUSION Our brief educational intervention led to modest improvements in physicians' knowledge of medication costs

  9. Strategies to reduce medication errors in pediatric ambulatory settings.

    PubMed

    Mehndiratta, S

    2012-01-01

    Worldwide, a large number of children are prescribed drugs on an outpatient basis. Medication errors are fairly common in these settings. Though this matter has been well recognized as a cause of concern, limited data is available from ambulatory settings. Medication errors can be defined as errors that may occur at any step, starting from ordering a medication, to dispensing, administration of the drug and the subsequent monitoring. The outcomes of such errors are variable and may range between those that are clinically insignificant to a life-threatening event. The reasons for these medication errors are multi-factorial. Children are unable to administer medications to themselves and also require a strict weight-based dosing regimen. The risk factors associated with medication errors include complex regimens with multiple medications. Overdosing and under-dosing (10-fold calculation errors), an increased or a decreased frequency of dosing or an inappropriate duration of administration of the medication, are frequently detected errors. The lack of availability of proper formulations adds to the confusion. The low level of literacy among the caregivers can aggravate this problem. There is a lack of proper reporting and monitoring mechanisms in most ambulatory settings, hence these errors remain unrecognized and often go unreported. This article summarizes the current available literature on medication errors in ambulatory settings and the possible strategies that can be adopted to reduce the burden of these errors in order to improve child care and patient safety. Voluntary, anonymous reporting can be introduced in the healthcare institutions to determine the incidence of these errors.

  10. Losartan reduces the costs of diabetic end-stage renal disease: an Asian perspective.

    PubMed

    Seng, Wong Kok; Hwang, Shang-Jyh; Han, Dong Cheol; Teong, Chua Chin; Chan, Juliana; Burke, Thomas A; Carides, George W; Choi, Yon Jong

    2005-10-01

    To evaluate losartan and conventional antihypertensive therapy (CT) compared with CT alone on the cost associated with end-stage renal disease (ESRD) in Hong Kong, Japan, Korea, Malaysia, Singapore and Taiwan. Reduction of end-points in non-insulin-dependent diabetes mellitus with the angiotensin II antagonist losartan (RENAAL) was a multinational, double-blind, randomized, placebo-controlled trial to evaluate the renal protective effects of losartan on a background of CT in patients with type 2 diabetes and nephropathy. The primary composite end-point was a doubling of serum creatinine, ESRD or death. Data on the duration of ESRD for the Asian subgroup of patients enrolled in RENAAL were used to estimate the economic benefits of slowing the progression of nephropathy. The cost associated with ESRD was estimated by combining the number of days each patient experienced ESRD with the average daily cost of dialysis from the third-party payer perspective in Hong Kong, Japan, Korea, Malaysia, Singapore and Taiwan. Total cost, converted to US dollars, was the sum of ESRD and losartan costs. Losartan plus CT reduced the number of days with ESRD by 37.9 per patient over 3.5 years compared with CT alone. This reduction in ESRD days resulted in a decrease in the cost associated with ESRD, which ranges from $910 to $4346 per patient over 3.5 years across the six countries or regions. After accounting for the cost of losartan, the reduction in ESRD days resulted in net savings in each of the six countries or regions, ranging from $55 to $515 per patient. Treatment with losartan in patients with type 2 diabetic nephropathy not only reduced the incidence of ESRD among Asian patients, but resulted in direct medical cost savings in countries or regions representing Asia.

  11. Service company alliance reduces tight sands frac costs

    SciTech Connect

    Hunter, J.L. ); Stuchly, S.G. )

    1994-08-15

    Smaller, multiple-stage fracture treatments, worked out by an alliance between a producing and a service company, were a significant element in reducing costs for fracturing Carthage Cotton Valley infill wells in Panola County, Texas. Pennzoil's infill drilling program takes advantage of the Texas Railroad Commission's (RRC) ruling that allows optional 80-acre well spacing in this tight gas-sand reservoir. Pennzoil spudded 29 wells between September 1992 and December 1993 and expects to spud 20 more in 1994. The Pennzoil-Halliburton alliance began in September 1992 for the purpose of drilling and completing Cotton Valley infill wells through 1993. The two companies share the cost of new technology development, with Pennzoil providing the rig times to test Halliburton technology. To date, the alliance has experimented with an elastic strain relaxation, a six-arm extensometer, and a water-recovery surfactant. Some of the features of the alliance are: Halliburton guarantees the availability of crews and equipment to meet Pennzoil's drilling and completion schedule; Halliburton technical advisor studies existing wells to find candidates for workover or refracture; the technical advisor analyzes, plants, and evaluates the ongoing program; and the alliance is not rigidly structured, and other service companies perform part of the work. Both parties have benefited financially from the alliance and well performance has met or exceeded expectations. The alliance has enabled Pennzoil to stay on a rigid and aggressive drilling schedule and through efforts of the alliance, fracture orientation has been confirmed.

  12. Global cost estimates of reducing carbon emissions through avoided deforestation.

    PubMed

    Kindermann, Georg; Obersteiner, Michael; Sohngen, Brent; Sathaye, Jayant; Andrasko, Kenneth; Rametsteiner, Ewald; Schlamadinger, Bernhard; Wunder, Sven; Beach, Robert

    2008-07-29

    Tropical deforestation is estimated to cause about one-quarter of anthropogenic carbon emissions, loss of biodiversity, and other environmental services. United Nations Framework Convention for Climate Change talks are now considering mechanisms for avoiding deforestation (AD), but the economic potential of AD has yet to be addressed. We use three economic models of global land use and management to analyze the potential contribution of AD activities to reduced greenhouse gas emissions. AD activities are found to be a competitive, low-cost abatement option. A program providing a 10% reduction in deforestation from 2005 to 2030 could provide 0.3-0.6 Gt (1 Gt = 1 x 10(5) g) CO(2).yr(-1) in emission reductions and would require $0.4 billion to $1.7 billion.yr(-1) for 30 years. A 50% reduction in deforestation from 2005 to 2030 could provide 1.5-2.7 Gt CO(2).yr(-1) in emission reductions and would require $17.2 billion to $28.0 billion.yr(-1). Finally, some caveats to the analysis that could increase costs of AD programs are described.

  13. Problems paying out-of-pocket medication costs among older adults with diabetes.

    PubMed

    Piette, John D; Heisler, Michele; Wagner, Todd H

    2004-02-01

    To identify problems faced by older adults with diabetes due to out-of-pocket medication costs. In this cross-sectional national survey of 875 adults with diabetes treated with hypoglycemic medication, respondents reported whether they had underused prescription medications due to cost pressures or had experienced other financial problems associated with medication costs such as forgoing basic necessities. Respondents also described their interactions with clinicians about medication costs. A total of 19% of respondents reported cutting back on medication use in the prior year due to cost, 11% reported cutting back on their diabetes medications, and 7% reported cutting back on their diabetes medications at least once per month. Moreover, 28% reported forgoing food or other essentials to pay medication costs, 14% increased their credit card debt, and 10% borrowed money from family or friends to pay for their prescriptions. Medication cost problems were especially common among respondents who were younger, had higher monthly out-of-pocket costs, and had no prescription drug coverage. In general, few respondents, including those reporting medication cost problems, reported that their health care providers had given them information or other assistance to address medication cost pressures. Out-of-pocket medication costs pose a significant burden to many adults with diabetes and contribute to decreased treatment adherence. Clinicians should actively identify patients with diabetes who are facing medication cost pressures and assist them by modifying their medication regimens, helping them understand the importance of each prescribed medication, providing information on sources of low-cost drugs, and linking patients with coverage programs.

  14. Reducing workers' compensation costs for latex allergy and litigation against glove manufacturing companies.

    PubMed

    Edlich, Richard F; Mason, Shelley S; Swainston, Erin; Dahlstrom, Jill J; Gubler, K; Long, William B

    2009-01-01

    It has been well documented in the medical literature that powdered medical gloves can have serious consequences to patients and health-care workers. Adverse reactions to natural latex gloves, such as contact dermatitis and urticaria, occupational asthma, and anaphylaxis, have been documented as a significant cause of Workers' Compensation claims among health-care workers. While the cost of examination and surgical gloves is significant, this factor must be considered with the total cost of Workers' Compensation claims and possible litigation bestowed upon hospitals and glove manufacturing companies. In the United States, Canada, Belgium, and Germany, medical leaders have documented the dangers of powdered latex gloves and have implemented transition programs that are reducing Workers' Compensation claims filed by health-care workers. While attorneys view litigation against powdered glove manufacturers as the "next big tort", the authors of this article were not able to document all compensation costs to disabled workers because many settlements do not allow the claimant to disclose this information.

  15. The SmokingPaST Framework: illustrating the impact of quit attempts, quit methods, and new smokers on smoking prevalence, years of life saved, medical costs saved, programming costs, cost effectiveness, and return on investment.

    PubMed

    O'Donnell, Michael P; Roizen, Michael F

    2011-01-01

    Describe the specifications of the Smoking Prevalence, Savings, and Treatment (SmokingPaST) Framework and show how it can illustrate the impact of quit attempts, quit method, number of new smokers, smoking rates of immigrants and emigrants, and death rates of smokers and nonsmokers on future smoking prevalence rates, program costs, years of life saved, medical costs saved, cost effectiveness of programs, and return on investment (ROI). FRAMEWORK SPECIFICATIONS: Mathematical relationships among factors in SmokingPaST are described. Input variables include baseline smoking rates among current adults, new adults, immigrants, and emigrants; population counts for these groups; annual quit attempts; and distribution of quit methods. Assumption variables include success rate by quit method, death rates of smokers and nonsmokers, annual medical costs of smoking, costs per person for four tobacco treatment methods, age distribution of quitters, and distribution of medical cost funding by source. Output variables include year-end adult smoking rates, successful quitters, years of life saved by quitting, medical costs saved by quitting and by not hiring smokers, total costs of smoking treatment programs, cost per quitter, cost per life-year saved, distribution of medical cost savings from quitting, and ROI of treatment costs. The Framework was applied at the employer, county, state, and national levels. The SmokingPaST Framework provides a conceptually simple framework that can be applied to any population. It illustrates that significant drops in smoking rates can be achieved and significant savings in medical costs can be captured by employers as well as state and federal governments through tobacco treatment and prevention programs. Savings are especially important for reducing state and federal government deficits and enhancing job competitiveness.

  16. Wikipedia vs peer-reviewed medical literature for information about the 10 most costly medical conditions.

    PubMed

    Hasty, Robert T; Garbalosa, Ryan C; Barbato, Vincenzo A; Valdes, Pedro J; Powers, David W; Hernandez, Emmanuel; John, Jones S; Suciu, Gabriel; Qureshi, Farheen; Popa-Radu, Matei; San Jose, Sergio; Drexler, Nathaniel; Patankar, Rohan; Paz, Jose R; King, Christopher W; Gerber, Hilary N; Valladares, Michael G; Somji, Alyaz A

    2014-05-01

    Since its launch in 2001, Wikipedia has become the most popular general reference site on the Internet and a popular source of health care information. To evaluate the accuracy of this resource, the authors compared Wikipedia articles on the most costly medical conditions with standard, evidence-based, peer-reviewed sources. The top 10 most costly conditions in terms of public and private expenditure in the United States were identified, and a Wikipedia article corresponding to each topic was chosen. In a blinded process, 2 randomly assigned investigators independently reviewed each article and identified all assertions (ie, implication or statement of fact) made in it. The reviewer then conducted a literature search to determine whether each assertion was supported by evidence. The assertions found by each reviewer were compared and analyzed to determine whether assertions made by Wikipedia for these conditions were supported by peer-reviewed sources. For commonly identified assertions, there was statistically significant discordance between 9 of the 10 selected Wikipedia articles (coronary artery disease, lung cancer, major depressive disorder, osteoarthritis, chronic obstructive pulmonary disease, hypertension, diabetes mellitus, back pain, and hyperlipidemia) and their corresponding peer-reviewed sources (P<.05) and for all assertions made by Wikipedia for these medical conditions (P<.05 for all 9). Most Wikipedia articles representing the 10 most costly medical conditions in the United States contain many errors when checked against standard peer-reviewed sources. Caution should be used when using Wikipedia to answer questions regarding patient care.

  17. Unique Tuft Test Facility Dramatically Reduces Brush Seal Development Costs

    NASA Technical Reports Server (NTRS)

    Fellenstein, James A.

    1997-01-01

    Brush seals have been incorporated in the latest turbine engines to reduce leakage and improve efficiency. However, the life of these seals is limited by wear. Studies have shown that optimal sealing characteristics for a brush seal occur before the interference fit between the brush and shaft is excessively worn. Research to develop improved tribopairs (brush and coating) with reduced wear and lower friction has been hindered by the lack of an accurate, low-cost, efficient test methodology. Estimated costs for evaluating a new material combination in an engine company seal test program are on the order of $100,000. To address this need, the NASA Lewis Research Center designed, built, and validated a unique, innovative brush seal tuft tester that slides a single tuft of brush seal wire against a rotating shaft under controlled loads, speeds, and temperatures comparable to those in turbine engines. As an initial screening tool, the brush seal tuft tester can tribologicaly evaluate candidate seal materials for 1/10th the cost of full-scale seal tests. Previous to the development of the brush seal tuft tester facility, most relevant tribological data had been obtained from full-scale seal tests conducted primarily to determine seal leakage characteristics. However, from a tribological point of view, these tests included the confounding effects of varying contact pressures, bristle flaring, high-temperature oxidation, and varying bristle contact angles. These confounding effects are overcome in tuft testing. The interface contact pressures can be either constant or varying depending on the tuft mounting device, and bristle wear can be measured optically with inscribed witness marks. In a recent cooperative program with a U.S. turbine engine manufacturer, five metallic wire candidates were tested against a plasma-sprayed Nichrome-bonded chrome carbide. The wire materials used during this collaboration were either nickel-chrome- or cobaltchrome-based superalloys. These

  18. The Effects of Cost Sharing on Adherence to Medications Prescribed for Concurrent Use: Do Definitions Matter?

    PubMed

    Sacks, Naomi C; Burgess, James F; Cabral, Howard J; McDonnell, Marie E; Pizer, Steven D

    2015-08-01

    Accurate estimates of the effects of cost sharing on adherence to medications prescribed for use together, also called concurrent adherence, are important for researchers, payers, and policymakers who want to reduce barriers to adherence for chronic condition patients prescribed multiple medications concurrently. But measure definition consensus is lacking, and the effects of different definitions on estimates of cost-related nonadherence are unevaluated. To (a) compare estimates of cost-related nonadherence using different measure definitions and (b) provide guidance for analyses of the effects of cost sharing on concurrent adherence. This is a retrospective cohort study of Medicare Part D beneficiaries aged 65 years and older who used multiple oral antidiabetics concurrently in 2008 and 2009. We compared patients with standard coverage, which contains cost-sharing requirements in deductible (100%), initial (25%), and coverage gap (100%) phases, to patients with a low-income subsidy (LIS) and minimal cost-sharing requirements. Data source was the IMS Health Longitudinal Prescription Database. Patients with standard coverage were propensity matched to controls with LIS coverage. Propensity score was developed using logistic regression to model likelihood of Part D standard enrollment, controlling for sociodemographic and health status characteristics. For analysis, 3 definitions were used for unadjusted and adjusted estimates of adherence: (1) patients adherent to All medications; (2) patients adherent on Average; and (3) patients adherent to Any medication. Analyses were conducted using the full study sample and then repeated in analytic subgroups where patients used (a) 1 or more costly branded oral antidiabetics or (b) inexpensive generics only. We identified 12,771 propensity matched patients with Medicare Part D standard (N = 6,298) or LIS (N = 6,473) coverage who used oral antidiabetics in 2 or more of the same classes in 2008 and 2009. In this sample

  19. Direct medical costs and its predictors in EMAR-II cohort.

    PubMed

    Leon, Leticia; Abasolo, Lydia; Fernandez-Gutierrez, Benjamin; Jover, Juan Angel; Hernandez-Garcia, Cesar

    2016-10-31

    To analyze the resource utilization in rheumatoid arthritis (RA) patients and predictive factors in and patients treated with biological drugs and biologic-naïve. A cross-sectional study was performed in a sample including all regions and hospitals throughout the country. Sociodemographic data, disease activity parameters and treatment data were obtained. Resource utilization for two years of study was recorded and we made costs imputation. Correlation analyzes were performed on all RA patients and those treated with biological and biological naïve, to estimate the differences in resource utilization. Factors associated with increased resources utilization (costs) attending to treatment was analyzed by linear regression models. We included 1,095 RA patients, 26% male, mean age of 62±14 years. Mean of direct medical costs per patient was €24,291±€45,382. Excluding biological drugs, the average cost per patient was €3,742±€3,711. After adjustment, factors associated with direct medical costs for all RA patients were biologic drugs (P=.02) and disease activity (P=.004). In the biologic-naïve group, the predictor of direct medical costs was comorbidity (P<.001). In the biologic treatment group predictors were follow-up length of the disease (P=.04), age (P=.02) and disease activity (P=.007). Our data show a remarkable economic impact of RA. It is important to identify and estimate the economic impact of the disease, compare data from other geographic samples and to develop improvement strategies to reduce these costs and increase the quality of care. Copyright © 2016 Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología. All rights reserved.

  20. The cost-saving effect and prevention of medication errors by clinical pharmacist intervention in a nephrology unit.

    PubMed

    Chen, Chia-Chi; Hsiao, Fei-Yuan; Shen, Li-Jiuan; Wu, Chien-Chih

    2017-08-01

    Medication errors may lead to adverse drug events (ADEs), which endangers patient safety and increases healthcare-related costs. The on-ward deployment of clinical pharmacists has been shown to reduce preventable ADEs, and save costs. The purpose of this study was to evaluate the ADEs prevention and cost-saving effects by clinical pharmacist deployment in a nephrology ward.This was a retrospective study, which compared the number of pharmacist interventions 1 year before and after a clinical pharmacist was deployed in a nephrology ward. The clinical pharmacist attended ward rounds, reviewed and revised all medication orders, and gave active recommendations of medication use. For intervention analysis, the numbers and types of the pharmacist's interventions in medication orders and the active recommendations were compared. For cost analysis, both estimated cost saving and avoidance were calculated and compared.The total numbers of pharmacist interventions in medication orders were 824 in 2012 (preintervention), and 1977 in 2013 (postintervention). The numbers of active recommendation were 40 in 2012, and 253 in 2013. The estimated cost savings in 2012 and 2013 were NT$52,072 and NT$144,138, respectively. The estimated cost avoidances of preventable ADEs in 2012 and 2013 were NT$3,383,700 and NT$7,342,200, respectively. The benefit/cost ratio increased from 4.29 to 9.36, and average admission days decreased by 2 days after the on-ward deployment of a clinical pharmacist.The number of pharmacist's interventions increased dramatically after her on-ward deployment. This service could reduce medication errors, preventable ADEs, and costs of both medications and potential ADEs.

  1. MELATONIN - WORKING IN COLLABERATION WITH THE CCG TO REDUCE COSTS.

    PubMed

    Haley, Helen

    2016-09-01

    To reduce the overall expenditure on melatonin for the local health economy by working collaboratively with the CCG's. To ensure that all paediatric patients prescribed melatonin have been clinically assessed by a specialist and the most appropriate formulation is dispensed. Evaluation of GP melatonin prescribing cost across CCG using ePACT data and extrapolation of equivalent cost of prescribing and dispensing within secondary care. This initial data was then refined to exclude patients 16 years and over on unlicensed formulations of melatonin and all patients on licensed formulations. This was used to estimate the net potential saving achieved by repatriating the prescribing of melatonin for children for the local CCG's. A six month pilot was initiated to establish if the predicted savings translated into reality for the local health economy. It was estimated that approximately 100 patients under 16 years were prescribed melatonin by GP's in the local CCG's, 60 of these patients were on unlicensed formulations hence eligible for the pilot. To date we have received 42 referrals from GP's to review the prescribing of melatonin unlicensed formulations. 32 patients had been initiated melatonin by the child development team or paediatric specialist 16 (50%) of whom were currently under the care of the team and being reviewed every six months. 10 of the referrals were for patients under the care of CAMHs who were happy to provide ongoing treatment to avoid duplicated appointments. From the remainder of the referrals 6 patients when contacted had advised that they were no longer using melatonin. The remaining 10 patients have an appointment to review treatment and if deemed appropriate provide ongoing prescriptions using formulations approved by pharmacy. There are still 18 patients prescribed melatonin by Gp's who have not been referred and the medicines management team are chasing. A review of ePACT data for the CCG at the end of the six month pilot compared with the

  2. Collaborative DTM reduces hospitalization and healthcare costs in patients with diabetes treated with polypharmacy.

    PubMed

    Brophy, Lauren; Williams, Amanda; Berman, Eric J; Keleti, David; Michael, Karen E; Shepherd, Margaret; Fox, Scott A; Jacobs, Christine; Tan-Torres, Susan; Gelzer, Andrea D; Tegenu, Mesfin

    2014-03-01

    To evaluate the effects of a collaborative pharmacy benefits manager (PBM)/ health plan-administered drug therapy management (DTM) program on healthcare utilization and costs in patients with diabetes treated with polypharmacy. Retrospective quasi-experimental design with comparison group. This DTM program was a collaborative effort between the PBM, PerformRx, and the care management departments of Keystone First (KF) and AmeriHealth Caritas Pennsylvania (ACP) care management departments, targeting patients with diabetes using >15 medications. Pharmacists reviewed member profiles and made evidencebased prescriber and patient interventions, working directly with prescribers and indirectly with members, via care managers. Care managers provided additional services not otherwise within the scope of DTM. The study group consisted of 954 DTM participants reviewed by a pharmacist between November 1, 2010, and July 31, 2011. The control group consisted of 810 matched DTM participants not reviewed by a pharmacist. Intervention acceptance rates for KF and ACP were 33% and 26%, respectively. The study group demonstrated lower inpatient admissions and emergency department utilization rates, although only the KF study group inpatient admission rate achieved statistical significance (76.4%; P = .0002). The study groups realized statistically significant total cost savings (pharmacy + medical) compared with their corresponding control groups (47.8% KF, P = .0039; 50.7% ACP, P = .0497) despite non-statistically significant increases in pharmacy costs. A collaborative pharmacist-driven DTM program with a care manager-executed patient outreach component results in reduced hospital utilization and significant healthcare cost savings.

  3. Does tranexamic acid reduce blood transfusion cost for primary total hip arthroplasty? A case-control study.

    PubMed

    Harris, Ryan N; Moskal, Joseph T; Capps, Susan G

    2015-02-01

    Peri-operative tranexamic acid (TXA) significantly reduces the need for allogeneic blood transfusion in total hip arthroplasty (THA) and thus hospital costs are reduced. Before employing TXA in primary THA at our institution, facility costs were $286.90/THA for blood transfusion and required 0.45 man-hours/THA (transfusion rate 19.87%). After incorporating TXA, the cost for intravenous application was $123.38/THA for blood transfusion and TXA medication and 0.07 man-hours/THA (transfusion rate 4.39%) and the cost for topical application was $132.41/THA for blood transfusion and TXA and 0.14 man-hours/THA (transfusion rate 12.86%). TXA has the potential to reduce the facility cost per THA and the man-hours/THA from blood transfusions.

  4. Maternal antibodies reduce costs of an immune response during development.

    PubMed

    Grindstaff, Jennifer L

    2008-03-01

    Young vertebrates are dependent primarily on innate immunity and maternally derived antibodies for immune defense. This reliance on innate immunity and the associated inflammatory response often leads to reduced growth rates after antigenic challenge. However, if offspring have maternal antibodies that recognize an antigen, these antibodies should block stimulation of the inflammatory response and reduce growth suppression. To determine whether maternal and/or offspring antigen exposure affect antibody transmission and offspring growth, female Japanese quail (Coturnix japonica) and their newly hatched chicks were immunized. Mothers were immunized with lipopolysaccharide (LPS), killed avian reovirus vaccine (AR), or were given a control, phosphate-buffered saline, injection. Within each family, one-third of offspring were immunized with LPS, one-third were immunized with AR, and one-third were given the control treatment. Maternal immunization significantly affected the specific types of antibodies that were transmitted. In general, immunization depressed offspring growth. However, offspring immunized with the same antigen as their mother exhibited elevated growth in comparison to siblings immunized with a different antigen. This suggests that the growth suppressive effects of antigen exposure during development can be partially ameliorated by the presence of maternal antibodies, but in the absence of specific maternal antibodies, offspring are dependent on more costly innate immune defenses. Together, the results suggest that the local disease environment of mothers prior to reproduction significantly affects maternal antibody transmission and these maternal antibodies may allow offspring to partially maintain growth during infection in addition to providing passive humoral immune defense.

  5. The Role of Patient Financial Assistance Programs in Reducing Costs for Cancer Patients.

    PubMed

    Zullig, Leah L; Wolf, Steven; Vlastelica, Lisa; Shankaran, Veena; Zafar, S Yousuf

    2017-04-01

    Limited transparency exists regarding eligibility and benefits for patient financial assistance programs (PAPs). To describe oral anticancer medication costs, insurance coverage, and the degree of financial assistance provided by PAPs. This was a retrospective study of prescription anticancer medication costs and PAP coverage. The study used data from an academic cancer center's specialty pharmacy. Medication, cost, and coverage data were collected from the specialty pharmacy database for prescriptions filled from January 2013 to November 2015. Prescriptions with missing copayments, insurance, or financial assistance amounts were excluded. Descriptive statistics summarized prescription characteristics. Of 9,388 anticancer medication prescriptions filled, 8,212 (87%) had complete cost data and were included. The 5 most common medications prescribed were capecitabine (20%), temozolomide (13%), enzalutamide (10%), letrozole (6%), and tamoxifen (4%). Most prescriptions were covered by commercial insurance or Part D (41.6%, n = 3,418). The median copayment was $20 per prescription (interquartile range [IQR] = $10.00-$80.30). When considering all prescriptions that received PAP assistance, the median amount of financial assistance provided by PAPs per prescription was $411.0 (IQR = $302.80-$523.40), amounting to 15% of the median prescription cash price. When considering all prescriptions, the median amount of financial assistance provided by PAPs per prescription was $0, and the mean was $79.30 (SD = $389.90). A minority of prescriptions received financial assistance from PAPs. The proportion of financial assistance was small relative to the price billed to insurance. PAPs play a modest role in reducing anticancer prescription-related costs. Support of this project by The Duke Biostatistics Core was made possible by Grant Number UL1TR001117 from the National Center for Advancing Translational Sciences (NCATS), a component of the National Institutes of Health (NIH), and

  6. Economic Utility: Combinatorial Pharmacogenomics and Medication Cost Savings for Mental Health Care in a Primary Care Setting.

    PubMed

    Brown, Lisa C; Lorenz, Raymond A; Li, James; Dechairo, Bryan M

    2017-03-01

    This study was an analysis based on a previously completed prospective study investigating medication costs of patients with mental illness guided by using the GeneSight proprietary combinatorial pharmacogenomic (PGx) test. The primary objective of this study was to determine potential cost savings of combinatorial PGx testing over the course of 1 year in patients with mental illness treated by primary care providers (PCPs) and psychiatrists who had switched or added a new psychiatric medication after patients failed to respond to monotherapy. The current evaluation details cost savings of treatment decisions congruent and incongruent with the combinatorial PGx test recommendations specific to PCPs and psychiatrists. This study was a subanalysis of a 1-year, prospective trial comparing medication costs of 2168 patients undergoing GeneSight testing. Pharmacy claims were provided by a pharmacy benefits manager, comparing medication costs 6 months before combinatorial PGx testing and followed up for 1 year after the testing. This analysis compared congruence and cost savings per patient based on the type of health care provider administering care. Using data from a large pharmacy benefits manager, we found that PCPs treat the majority of mental health patients receiving psychotropic medication prescriptions, including treatment-resistant patients. PCPs congruent with combinatorial PGx testing provided the most medication cost savings for payers and patients at $3988 per member per year (P < 0.001). Health care providers treating patients with mental illness can significantly reduce medication costs by following the combinatorial PGx report recommendations. PCPs, who treat the majority of patients with mental illness, reported a significant reduction in medication costs for both central nervous system and non-central nervous system drugs. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

  7. Reducing long-term remedial costs by transport modeling optimization.

    PubMed

    Becker, David; Minsker, Barbara; Greenwald, Robert; Zhang, Yan; Harre, Karla; Yager, Kathleen; Zheng, Chunmiao; Peralta, Richard

    2006-01-01

    The Department of Defense (DoD) Environmental Security Technology Certification Program and the Environmental Protection Agency sponsored a project to evaluate the benefits and utility of contaminant transport simulation-optimization algorithms against traditional (trial and error) modeling approaches. Three pump-and-treat facilities operated by the DoD were selected for inclusion in the project. Three optimization formulations were developed for each facility and solved independently by three modeling teams (two using simulation-optimization algorithms and one applying trial-and-error methods). The results clearly indicate that simulation-optimization methods are able to search a wider range of well locations and flow rates and identify better solutions than current trial-and-error approaches. The solutions found were 5% to 50% better than those obtained using trial-and-error (measured using optimal objective function values), with an average improvement of approximately 20%. This translated into potential savings ranging from 600,000 dollars to 10,000,000 dollars for the three sites. In nearly all cases, the cost savings easily outweighed the costs of the optimization. To reduce computational requirements, in some cases the simulation-optimization groups applied multiple mathematical algorithms, solved a series of modified subproblems, and/or fit "meta-models" such as neural networks or regression models to replace time-consuming simulation models in the optimization algorithm. The optimal solutions did not account for the uncertainties inherent in the modeling process. This project illustrates that transport simulation-optimization techniques are practical for real problems. However, applying the techniques in an efficient manner requires expertise and should involve iterative modification to the formulations based on interim results.

  8. Innovative approaches to reducing nurses' distractions during medication administration.

    PubMed

    Pape, Tess M; Guerra, Denise M; Muzquiz, Marguerite; Bryant, John B; Ingram, Michelle; Schranner, Bonnie; Alcala, Armando; Sharp, Johanna; Bishop, Dawn; Carreno, Estella; Welker, Jesusita

    2005-01-01

    Contributing factors to medication errors include distractions, lack of focus, and failure to follow standard operating procedures. The nursing unit is vulnerable to a multitude of interruptions and distractions that affect the working memory and the ability to focus during critical times. Methods that prevent these environmental effects on nurses can help avert medication errors. A process improvement study examined the effects of standard protocols and visible signage within a hospital setting. The project was patterned after another study using similar techniques. Rapid Cycle Testing was used as one of the strategies for this process improvement project. Rapid Cycle Tests have become a part of the newly adopted Define, Measure, Analyze, Improve, and Control steps at this particular hospital. As a result, a medication administration check-list improved focus and standardized practice. Visible signage also reduced nurses' distractions and improved focus. The results provide evidence that protocol checklists and signage can be used as reminders to reduce distractions, and are simple, inexpensive tools for medication safety.

  9. Short-Term Medical Costs of a VHA Health Information Exchange: A CHEERS-Compliant Article.

    PubMed

    French, Dustin D; Dixon, Brian E; Perkins, Susan M; Myers, Laura J; Weiner, Michael; Zillich, Allan J; Haggstrom, David A

    2016-01-01

    The Virtual Lifetime Electronic Record (VLER) Health program provides the Veterans Health Administration (VHA) a framework whereby VHA providers can access the veterans' electronic health record information to coordinate healthcare across multiple sites of care. As an early adopter of VLER, the Indianapolis VHA and Regenstrief Institute implemented a regional demonstration program involving bi-directional health information exchange (HIE) between VHA and non-VHA providers.The aim of the study is to determine whether implementation of VLER HIE reduces 1 year VHA medical costs.A cohort evaluation with a concurrent control group compared VHA healthcare costs using propensity score adjustment. A CHEERs compliant checklist was used to conduct the cost evaluation.Patients were enrolled in the VLER program onsite at the Indianapolis VHA in outpatient clinics or through the release-of-information office.VHA cost data (in 2014 dollars) were obtained for both enrolled and nonenrolled (control) patients for 1 year prior to, and 1 year after, the index date of patient enrollment.There were 6104 patients enrolled in VLER and 45,700 patients in the control group. The annual adjusted total cost difference per patient was associated with a higher cost for VLER enrollees $1152 (95% CI: $807-1433) (P < 0.01) (in 2014 dollars) than VLER nonenrollees.Short-term evaluation of this demonstration project did not show immediate reductions in healthcare cost as might be expected if HIE decreased redundant medical tests and treatments. Cost reductions from shared health information may be realized with longer time horizons.

  10. What Strategies Do Physicians and Patients Discuss to Reduce Out-of-Pocket Costs? Analysis of Cost-Saving Strategies in 1,755 Outpatient Clinic Visits.

    PubMed

    Hunter, Wynn G; Zhang, Cecilia Z; Hesson, Ashley; Davis, J Kelly; Kirby, Christine; Williamson, Lillie D; Barnett, Jamison A; Ubel, Peter A

    2016-10-01

    More than 1 in 4 Americans report difficulty paying medical bills. Cost-reducing strategies discussed during outpatient physician visits remain poorly characterized. We sought to determine how often patients and physicians discuss health care costs during outpatient visits and what strategies, if any, they discussed to lower patient out-of-pocket costs. Retrospective analysis of dialogue from 1,755 outpatient visits in community-based practices nationwide from 2010 to 2014. The study population included 677 patients with breast cancer, 422 with depression, and 656 with rheumatoid arthritis visiting 56 oncologists, 36 psychiatrists, and 26 rheumatologists, respectively. Thirty percent of visits contained cost conversations (95% confidence interval [CI], 28 to 32). Forty-four percent of cost conversations involved discussion of cost-saving strategies (95% CI, 40 to 48; median duration, 68 s). We identified 4 strategies to lower costs without changing the care plan. They were, in order of overall frequency: 1) changing logistics of care, 2) facilitating co-pay assistance, 3) providing free samples, and 4) changing/adding insurance plans. We also identified 4 strategies to reduce costs by changing the care plan: 1) switching to lower-cost alternative therapy/diagnostic, 2) switching from brand name to generic, 3) changing dosage/frequency, and 4) stopping/withholding interventions. Strategies were relatively consistent across health conditions, except for switching to a lower-cost alternative (more common in breast oncology) and providing free samples (more common in depression). Focus on 3 conditions with potentially high out-of-pocket costs. Despite price opacity, physicians and patients discuss a variety of out-of-pocket cost reduction strategies during clinic visits. Almost half of cost discussions mention 1 or more cost-saving strategies, with more frequent mention of those not requiring care-plan changes. © The Author(s) 2016.

  11. Regional collaborative quality improvement for trauma reduces complications and costs.

    PubMed

    Hemmila, Mark R; Cain-Nielsen, Anne H; Wahl, Wendy L; Vander Kolk, Wayne E; Jakubus, Jill L; Mikhail, Judy N; Birkmeyer, Nancy J

    2015-01-01

    Although evidence suggests that quality improvement to reduce complications for trauma patients should decrease costs, studies have not addressed this question directly. In Michigan, trauma centers and a private payer have created a regional collaborative quality initiative (CQI). This CQI program began as a pilot in 2008 and expanded to a formal statewide program in 2010. We examined the relationship between outcomes and expenditures for trauma patients treated in collaborative participant and nonparticipant hospitals. Payer claims and collaborative registry data were analyzed for 30-day episode payments and serious complications in patients admitted with trauma diagnoses. Patients were categorized as treated in hospitals that had different CQI status: (1) never participated (Never-CQI); (2) collaborative participant, but patient treated before CQI initiation (Pre-CQI); or (3) active collaborative participant (Post-CQI). DRG International Classification of Diseases--9th Rev. codes were crosswalked to Abbreviated Injury Scale (AIS) 2005 codes. Episode payment data were risk adjusted (age, sex, comorbidities, type/severity of injury, and year of treatment), and price was standardized. Outcome data were risk adjusted. A serious complication consisted of one or more of the following occurrences: acute lung injury/adult respiratory distress syndrome, acute kidney injury, cardiac arrest with cardiopulmonary resuscitation, decubitus ulcer, deep vein thrombosis, enterocutaneous fistula, extremity compartment syndrome, mortality, myocardial infarction, pneumonia, pulmonary embolism, severe sepsis, stroke/cerebral vascular accident, unplanned intubation, or unplanned return to operating room. The risk-adjusted rate of serious complications declined from 14.9% to 9.1% (p < 0.001) in participating hospitals (Post-CQI, n = 26). Average episode payments decreased by $2,720 (from $36,043 to $33,323, p = 0.08) among patients treated in Post-CQI centers, whereas patients treated

  12. Reducing Medical Errors in Primary Care Using a Pragmatic Complex Intervention.

    PubMed

    Khoo, Ee Ming; Sararaks, Sondi; Lee, Wai Khew; Liew, Su May; Cheong, Ai Theng; Abdul Samad, Azah; Maskon, Kalsom; Hamid, Maimunah A

    2015-09-01

    This study aimed to develop an intervention to reduce medical errors and to determine if the intervention can reduce medical errors in public funded primary care clinics. A controlled interventional trial was conducted in 12 conveniently selected primary care clinics. Random samples of outpatient medical records were selected and reviewed by family physicians for documentation, diagnostic, and management errors at baseline and 3 months post intervention. The intervention package comprised educational training, structured process change, review methods, and patient education. A significant reduction was found in overall documentation error rates between intervention (Pre 98.3% [CI 97.1-99.6]; Post 76.1% [CI 68.1-84.1]) and control groups (Pre 97.4% [CI 95.1-99.8]; Post 89.5% [85.3-93.6]). Within the intervention group, overall management errors reduced from 54.0% (CI 49.9-58.0) to 36.6% (CI 30.2-43.1) and medication error from 43.2% (CI 39.2-47.1) to 25.2% (CI 19.9-30.5). This low-cost intervention was useful to reduce medical errors in resource-constrained settings. © 2015 APJPH.

  13. Empirical analysis shows reduced cost data collection may be an efficient method in economic clinical trials.

    PubMed

    Seidl, Hildegard; Meisinger, Christa; Wende, Rupert; Holle, Rolf

    2012-09-15

    Data collection for economic evaluation alongside clinical trials is burdensome and cost-intensive. Limiting both the frequency of data collection and recall periods can solve the problem. As a consequence, gaps in survey periods arise and must be filled appropriately. The aims of our study are to assess the validity of incomplete cost data collection and define suitable resource categories. In the randomised KORINNA study, cost data from 234 elderly patients were collected quarterly over a 1-year period. Different strategies for incomplete data collection were compared with complete data collection. The sample size calculation was modified in response to elasticity of variance. Resource categories suitable for incomplete data collection were physiotherapy, ambulatory clinic in hospital, medication, consultations, outpatient nursing service and paid household help. Cost estimation from complete and incomplete data collection showed no difference when omitting information from one quarter. When omitting information from two quarters, costs were underestimated by 3.9% to 4.6%.With respect to the observed increased standard deviation, a larger sample size would be required, increased by 3%. Nevertheless, more time was saved than extra time would be required for additional patients. Cost data can be collected efficiently by reducing the frequency of data collection. This can be achieved by incomplete data collection for shortened periods or complete data collection by extending recall windows. In our analysis, cost estimates per year for ambulatory healthcare and non-healthcare services in terms of three data collections was as valid and accurate as a four complete data collections. In contrast, data on hospitalisation, rehabilitation stays and care insurance benefits should be collected for the entire target period, using extended recall windows. When applying the method of incomplete data collection, sample size calculation has to be modified because of the increased

  14. Empirical analysis shows reduced cost data collection may be an efficient method in economic clinical trials

    PubMed Central

    2012-01-01

    Background Data collection for economic evaluation alongside clinical trials is burdensome and cost-intensive. Limiting both the frequency of data collection and recall periods can solve the problem. As a consequence, gaps in survey periods arise and must be filled appropriately. The aims of our study are to assess the validity of incomplete cost data collection and define suitable resource categories. Methods In the randomised KORINNA study, cost data from 234 elderly patients were collected quarterly over a 1-year period. Different strategies for incomplete data collection were compared with complete data collection. The sample size calculation was modified in response to elasticity of variance. Results Resource categories suitable for incomplete data collection were physiotherapy, ambulatory clinic in hospital, medication, consultations, outpatient nursing service and paid household help. Cost estimation from complete and incomplete data collection showed no difference when omitting information from one quarter. When omitting information from two quarters, costs were underestimated by 3.9% to 4.6%. With respect to the observed increased standard deviation, a larger sample size would be required, increased by 3%. Nevertheless, more time was saved than extra time would be required for additional patients. Conclusion Cost data can be collected efficiently by reducing the frequency of data collection. This can be achieved by incomplete data collection for shortened periods or complete data collection by extending recall windows. In our analysis, cost estimates per year for ambulatory healthcare and non-healthcare services in terms of three data collections was as valid and accurate as a four complete data collections. In contrast, data on hospitalisation, rehabilitation stays and care insurance benefits should be collected for the entire target period, using extended recall windows. When applying the method of incomplete data collection, sample size calculation has

  15. Cost effectiveness of a computer-delivered intervention to improve HIV medication adherence

    PubMed Central

    2013-01-01

    Background High levels of adherence to medications for HIV infection are essential for optimal clinical outcomes and to reduce viral transmission, but many patients do not achieve required levels. Clinician-delivered interventions can improve patients’ adherence, but usually require substantial effort by trained individuals and may not be widely available. Computer-delivered interventions can address this problem by reducing required staff time for delivery and by making the interventions widely available via the Internet. We previously developed a computer-delivered intervention designed to improve patients’ level of health literacy as a strategy to improve their HIV medication adherence. The intervention was shown to increase patients’ adherence, but it was not clear that the benefits resulting from the increase in adherence could justify the costs of developing and deploying the intervention. The purpose of this study was to evaluate the relation of development and deployment costs to the effectiveness of the intervention. Methods Costs of intervention development were drawn from accounting reports for the grant under which its development was supported, adjusted for costs primarily resulting from the project’s research purpose. Effectiveness of the intervention was drawn from results of the parent study. The relation of the intervention’s effects to changes in health status, expressed as utilities, was also evaluated in order to assess the net cost of the intervention in terms of quality adjusted life years (QALYs). Sensitivity analyses evaluated ranges of possible intervention effectiveness and durations of its effects, and costs were evaluated over several deployment scenarios. Results The intervention’s cost effectiveness depends largely on the number of persons using it and the duration of its effectiveness. Even with modest effects for a small number of patients the intervention was associated with net cost savings in some scenarios and for

  16. Australia's pharmaceutical cost sharing policy: reducing waste or affordability?

    PubMed

    Doran, Evan; Robertson, Jane

    2009-05-01

    In this paper we argue that Australia's pharmaceutical cost sharing policy has been applied as if cost sharing is unproblematic for medicine affordability and good health outcomes. Australian and international experience with pharmaceutical cost sharing strongly suggests a negative impact on affordability and quality use of medicines, disproportionately affecting low income patients. We argue that Australia's use of cost sharing reflects the currency of a cognitively powerful and morally charged idea - moral hazard. Moral hazard refers to the change in behaviour induced by insurance coverage. Applied to pharmaceuticals, this means that low out-of-pocket cost will lead to waste. Moral hazard mixes the explanatory power of price with the intuitively cogent notion that if people do not experience consequences they will behave irresponsibly. Cost sharing policy has gone unscrutinised and uncontested not because cost sharing is unproblematic, but because in the light of the idea of moral hazard it has all the question-deadening weight of common sense.

  17. Autonomous exoskeleton reduces metabolic cost of human walking.

    PubMed

    Mooney, Luke M; Rouse, Elliott J; Herr, Hugh M

    2014-11-03

    Passive exoskeletons that assist with human locomotion are often lightweight and compact, but are unable to provide net mechanical power to the exoskeletal wearer. In contrast, powered exoskeletons often provide biologically appropriate levels of mechanical power, but the size and mass of their actuator/power source designs often lead to heavy and unwieldy devices. In this study, we extend the design and evaluation of a lightweight and powerful autonomous exoskeleton evaluated for loaded walking in (J Neuroeng Rehab 11:80, 2014) to the case of unloaded walking conditions. The metabolic energy consumption of seven study participants (85 ± 12 kg body mass) was measured while walking on a level treadmill at 1.4 m/s. Testing conditions included not wearing the exoskeleton and wearing the exoskeleton, in both powered and unpowered modes. When averaged across the gait cycle, the autonomous exoskeleton applied a mean positive mechanical power of 26 ± 1 W (13 W per ankle) with 2.12 kg of added exoskeletal foot-shank mass (1.06 kg per leg). Use of the leg exoskeleton significantly reduced the metabolic cost of walking by 35 ± 13 W, which was an improvement of 10 ± 3% (p = 0.023) relative to the control condition of not wearing the exoskeleton. The results of this study highlight the advantages of developing lightweight and powerful exoskeletons that can comfortably assist the body during walking.

  18. National Burden of Preventable Adverse Drug Events Associated with Inpatient Injectable Medications: Healthcare and Medical Professional Liability Costs

    PubMed Central

    Lahue, Betsy J.; Pyenson, Bruce; Iwasaki, Kosuke; Blumen, Helen E.; Forray, Susan; Rothschild, Jeffrey M.

    2012-01-01

    Background Harmful medication errors, or preventable adverse drug events (ADEs), are a prominent quality and cost issue in healthcare. Injectable medications are important therapeutic agents, but they are associated with a greater potential for serious harm than oral medications. The national burden of preventable ADEs associated with inpatient injectable medications and the associated medical professional liability (MPL) costs have not been previously described in the literature. Objective To quantify the economic burden of preventable ADEs related to inpatient injectable medications in the United States. Methods Medical error data (MedMarx 2009–2011) were utilized to derive the distribution of errors by injectable medication types. Hospital data (Premier 2010–2011) identified the numbers and the types of injections per hospitalization. US payer claims (2009–2010 MarketScan Commercial and Medicare 5% Sample) were used to calculate the incremental cost of ADEs by payer and by diagnosis-related group (DRG). The incremental cost of ADEs was defined as inclusive of the time of inpatient admission and the following 4 months. Actuarial calculations, assumptions based on published literature, and DRG proportions from 17 state discharge databases were used to derive the probability of preventable ADEs per hospitalization and their annual costs. MPL costs were assessed from state- and national-level industry reports, premium rates, and from closed claims databases between 1990 and 2011. The 2010 American Hospital Association database was used for hospital-level statistics. All costs were adjusted to 2013 dollars. Results Based on this medication-level analysis of reported harmful errors and the frequency of inpatient administrations with actuarial projections, we estimate that preventable ADEs associated with injectable medications impact 1.2 million hospitalizations annually. Using a matched cohort analysis of healthcare claims as a basis for evaluating incremental

  19. National burden of preventable adverse drug events associated with inpatient injectable medications: healthcare and medical professional liability costs.

    PubMed

    Lahue, Betsy J; Pyenson, Bruce; Iwasaki, Kosuke; Blumen, Helen E; Forray, Susan; Rothschild, Jeffrey M

    2012-11-01

    Harmful medication errors, or preventable adverse drug events (ADEs), are a prominent quality and cost issue in healthcare. Injectable medications are important therapeutic agents, but they are associated with a greater potential for serious harm than oral medications. The national burden of preventable ADEs associated with inpatient injectable medications and the associated medical professional liability (MPL) costs have not been previously described in the literature. To quantify the economic burden of preventable ADEs related to inpatient injectable medications in the United States. Medical error data (MedMarx 2009-2011) were utilized to derive the distribution of errors by injectable medication types. Hospital data (Premier 2010-2011) identified the numbers and the types of injections per hospitalization. US payer claims (2009-2010 MarketScan Commercial and Medicare 5% Sample) were used to calculate the incremental cost of ADEs by payer and by diagnosis-related group (DRG). The incremental cost of ADEs was defined as inclusive of the time of inpatient admission and the following 4 months. Actuarial calculations, assumptions based on published literature, and DRG proportions from 17 state discharge databases were used to derive the probability of preventable ADEs per hospitalization and their annual costs. MPL costs were assessed from state- and national-level industry reports, premium rates, and from closed claims databases between 1990 and 2011. The 2010 American Hospital Association database was used for hospital-level statistics. All costs were adjusted to 2013 dollars. Based on this medication-level analysis of reported harmful errors and the frequency of inpatient administrations with actuarial projections, we estimate that preventable ADEs associated with injectable medications impact 1.2 million hospitalizations annually. Using a matched cohort analysis of healthcare claims as a basis for evaluating incremental costs, we estimate that inpatient

  20. Effectiveness and costs of implementation strategies to reduce acid suppressive drug prescriptions: a systematic review

    PubMed Central

    Smeets, Hugo M; Hoes, Arno W; de Wit, Niek J

    2007-01-01

    Background Evaluation of evidence for the effectiveness of implementation strategies aimed at reducing prescriptions for the use of acid suppressive drugs (ASD). Methods A systematic review of intervention studies with a design according to research quality criteria and outcomes related to the effect of reduction of ASD medication retrieved from Medline, Embase and the Cochrane Library. Outcome measures were the strategy of intervention, quality of methodology and results of treatment to differences of ASD prescriptions and costs. Results The intervention varied from a single passive method to multiple active interactions with GPs. Reports of study quality had shortcomings on subjects of data-analysis. Not all outcomes were calculated but if so rction of prescriptions varied from 8% up to 40% and the cost effectiveness was in some cases negative and in others positive. Few studies demonstrated good effects from the interventions to reduce ASD. Conclusion Poor quality of some studies is limiting the evidence for effective interventions. Also it is difficult to compare cost-effectiveness between studies. However, RCT studies demonstrate that active interventions are required to reduce ASD volume. Larger multi-intervention studies are necessary to evaluate the most successful intervention instruments. PMID:17983477

  1. [Measures to reduce lighting-related energy use and costs at hospital nursing stations].

    PubMed

    Su, Chiu-Ching; Chen, Chen-Hui; Chen, Shu-Hwa; Ping, Tsui-Chu

    2011-06-01

    Hospitals have long been expected to deliver medical services in an environment that is comfortable and bright. This expectation keeps hospital energy demand stubbornly high and energy costs spiraling due to escalating utility fees. Hospitals must identify appropriate strategies to control electricity usage in order to control operating costs effectively. This paper proposes several electricity saving measures that both support government policies aimed at reducing global warming and help reduce energy consumption at the authors' hospital. The authors held educational seminars, established a website teaching energy saving methods, maximized facility and equipment use effectiveness (e.g., adjusting lamp placements, power switch and computer saving modes), posted signs promoting electricity saving, and established a regularized energy saving review mechanism. After implementation, average nursing staff energy saving knowledge had risen from 71.8% to 100% and total nursing station electricity costs fell from NT$16,456 to NT$10,208 per month, representing an effective monthly savings of 37.9% (NT$6,248). This project demonstrated the ability of a program designed to slightly modify nursing staff behavior to achieve effective and meaningful results in reducing overall electricity use.

  2. Interventions to reduce medication errors in pediatric intensive care.

    PubMed

    Manias, Elizabeth; Kinney, Sharon; Cranswick, Noel; Williams, Allison; Borrott, Narelle

    2014-10-01

    To systematically examine the research literature to identify which interventions reduce medication errors in pediatric intensive care units. Databases were searched from inception to April 2014. Studies were included if they involved the conduct of an intervention with the intent of reducing medication errors. In all, 34 relevant articles were identified. Apart from 1 study, all involved single-arm, before-and-after designs without a comparative, concurrent control group. A total of 6 types of interventions were utilized: computerized physician order entry (CPOE), intravenous systems (ISs), modes of education (MEs), protocols and guidelines (PGs), pharmacist involvement (PI), and support systems for clinical decision making (SSCDs). Statistically significant reductions in medication errors were achieved in 7/8 studies for CPOE, 2/5 studies for ISs, 9/11 studies for MEs, 1/2 studies for PGs, 2/3 studies for PI, and 3/5 studies for SSCDs. The test for subgroup differences showed that there was no statistically significant difference among the 6 subgroups of interventions, χ(2)(5) = 1.88, P = 0.87. The following risk ratio results for meta-analysis were obtained: CPOE: 0.47 (95% CI = 0.28, 0.79); IS: 0.37 (95% CI = 0.19, 0.73); ME: 0.36 (95% CI = 0.22, 0.58); PG: 0.82 (95% CI = 0.21, 3.25); PI: 0.39 (95% CI = 0.10, 1.51), and SSCD: 0.49 (95% CI = 0.23, 1.03). Available evidence suggests some aspects of CPOE with decision support, ME, and IS may help in reducing medication errors. Good quality, prospective, observational studies are needed for institutions to determine the most effective interventions. © The Author(s) 2014.

  3. Finding Low-Cost Medical Care (For Teens)

    MedlinePlus

    ... company before you go to one. previous continue Teaching Hospitals and Medical Centers Teaching hospitals and medical centers are the final step ... mentioned may offer specialist care at set times. Teaching hospitals and medical schools usually have clinics for ...

  4. Effect of reducing cost sharing for outpatient care on children's inpatient services in Japan.

    PubMed

    Kato, Hirotaka; Goto, Rei

    2017-08-15

    Assessing the impact of cost sharing on healthcare utilization is a critical issue in health economics and health policy. It may affect the utilization of different services, but is yet to be well understood. This paper investigates the effects of reducing cost sharing for outpatient services on hospital admissions by exploring a subsidy policy for children's outpatient services in Japan. Data were extracted from the Japanese Diagnosis Procedure Combination database for 2012 and 2013. A total of 366,566 inpatients from 1390 municipalities were identified. The impact of expanding outpatient care subsidy on the volume of inpatient care for 1390 Japanese municipalities was investigated using the generalized linear model with fixed effects. A decrease in cost sharing for outpatient care has no significant effect on overall hospital admissions, although this effect varies by region. The subsidy reduces the number of overall admissions in low-income areas, but increases it in high-income areas. In addition, the results for admissions by type show that admissions for diagnosis increase particularly in high-income areas, but emergency admissions and ambulatory-care-sensitive-condition admissions decrease in low-income areas. These results suggest that outpatient and inpatient services are substitutes in low-income areas but complements in high-income ones. Although the subsidy for children's healthcare would increase medical costs, it would not improve the health status in high-income areas. Nevertheless, it could lead to some health improvements in low-income areas and, to some extent, offset costs by reducing admissions in these regions.

  5. Strategies to reduce medication errors in ambulatory practice.

    PubMed Central

    Adubofour, Kwabena O. M.; Keenan, Craig R.; Daftary, Ashok; Mensah-Adubofour, Josepha; Dachman, William D.

    2004-01-01

    Medication errors generally refer to mistakes made in the processes of ordering, transcribing, dispensing, administering or monitoring of pharmaceutical agents used in clinical practice. The Institute of Medicine report, To Err Is Human: Building a Safer Health System, has helped raise public awareness surrounding the issue of patient safety within our hospitals. A number of legislative and regulatory steps have resulted in hospital authorities putting in place various systems to allow for error reporting and prevention. Medication errors are being closely scrutinized as part of these hospital-based efforts. Most Americans, however, receive their healthcare in the ambulatory primary care setting. Primary care physicians are involved in the writing of several million prescriptions annually. The steps underway in our hospitals to reduce medication errors should occur concurrently with steps to increase awareness of this problem in the out-patient setting. This article provides an overview of strategies that can be adopted by primary care physicians to decrease medication errors in ambulatory practice. PMID:15622685

  6. Cost and value in medical education--what we can learn from the past.

    PubMed

    Walsh, K

    2014-01-01

    What lessons can be learned from the history of cost and value in medical education? First, the issue of cost and value in medical education has been around for a long time. Rising costs and an economic recession have made us focus on the subject more, but the issue has been just below the surface for over 200 years. A problem like this will not go away by itself - we must tackle it now. Second, the history of cost and value in medical education makes us look critically at who should pay. Should it be students, institutions or governments? We can see from the past that several different models have been tried; that all have their advantages and disadvantages; and that none are perfect. Third, looking at the past should make us realise that the issue of cost in medical education cannot be viewed in isolation. Medical educators throughout history have looked at how cost can affect selection for medical school, how costs can be related to benefits, and the effect of rising costs on career choices. Cost in medical education has always had far reaching consequences and implications. It probably always will. Looking at issues in medical education from the perspective of cost often makes them more stark and explicit - this in turn may help us to start to find solutions. In the future our solutions must be evidence based and must take account of cost.

  7. Federal Family Education Loans: Reduced Costs, Direct Lending, and National Income.

    ERIC Educational Resources Information Center

    Miles, Barbara; Zimmerman, Dennis

    This congressional report argues that the costs of the current guaranteed lending program for postsecondary education can be reduced in three ways: (1) by eliminating more-than-competitive returns to private lenders; (2) by reducing administrative costs; and (3) by reducing default costs. It is suggested that the first solution can be accomplished…

  8. How employers can reduce the cost of their disability programs.

    PubMed

    Nemeth, J M; Borgenicht, L

    1997-01-01

    The rapid rate at which disability costs are rising is fueling the need to cut costs. This article details some strategies that employers can utilize to help keep disability costs under control. The authors discuss many difficult issues that need to be addressed to make productive changes to the existing status quo, which needs to be assessed for current strengths and weaknesses before changes can be made. Case studies are presented and many alternative plan designs are discussed that could involve varying cost savings depending upon the individual plan characteristics.

  9. Impact of a patient-centered medical home on access, quality, and cost.

    PubMed

    Christensen, Eric W; Dorrance, Kevin A; Ramchandani, Suneil; Lynch, Sean; Whitmore, Christine C; Borsky, Amanda E; Kimsey, Linda G; Pikulin, Linda M; Bickett, Thomas A

    2013-02-01

    Patient-centered medical homes (PCMHs) are intended to actively provide effective care by physician-led teams, where patients take a leading role and responsibility. To determine whether the Walter Reed PCMH has reduced costs while at least maintaining if not improving access to and quality of care, and to determine whether access, quality, and cost impacts differ by chronic condition status. This study conducted a retrospective analysis using a patient-level utilization database to determine the impact of the Walter Reed PCMH on utilization and cost metrics, and a survey of enrollees in the Walter Reed PCMH to address access to care and quality of care. Inpatient and outpatient utilization, per member per quarter costs, Healthcare Effectiveness Data and Information Set metrics, and composite measures for access, patient satisfaction, provider communication, and customer service are included. Costs were 11% lower for those with chronic conditions compared to 7% lower for those without. Since treating patients with chronic conditions is 4 times more costly than treating patients without such conditions, the vast majority of dollar savings are attributable to chronic care. Results suggest focusing first on patients with chronic conditions given the greater potential for early gains.

  10. Graphic Warning Labels and the Cost Savings from Reduced Smoking among Pregnant Women.

    PubMed

    Tauras, John A; Peck, Richard M; Cheng, Kai-Wen; Chaloupka, Frank J

    2017-02-08

    Introduction: The U.S. Food and Drug Administration (FDA) has estimated the economic impact of Graphic Warning Labels (GWLs). By omitting the impact on tobacco consumption by pregnant women, the FDA analysis underestimates the economic benefits that would occur from the proposed regulations. There is a strong link between the occurrence of low birth weight babies and smoking while pregnant. Low birth weight babies in turn generate much higher hospital costs than normal birth weight babies. This study aims to fill the gap by quantifying the national hospital cost savings from the reductions in prenatal smoking that will arise if GWLs are implemented in the U.S. Data and Methods: This study uses several data sources. It uses Natality Data from the National Vital Statistics System of the National Center for Health Statistics (NCHS) in 2013 to estimate the impact of prenatal smoking on the likelihood of having a low-birth-weight baby, controlling for socio-economic and demographic characteristics as well as medical and non-medical risk factors. Using these estimates, along with the estimates of Huang et al. (2014) regarding the effect of GWLs on smoking, we calculate the change in the number of LBW (low birth weight) babies resulting from decreased prenatal smoking due to GWLs. Using this estimated change and the estimates from Russell et al. (2007) and AHRQ (2013) on the excess hospital costs of LBW babies, we calculate cost saving that arises from reduced prenatal smoking in response of GWLs. Results and Conclusions: Our results indicated that GWLs for this population could lead to hospital cost savings of 1.2 billion to 2.0 billion dollars over a 30 year horizon.

  11. Graphic Warning Labels and the Cost Savings from Reduced Smoking among Pregnant Women

    PubMed Central

    Tauras, John A.; Peck, Richard M.; Cheng, Kai-Wen; Chaloupka, Frank J.

    2017-01-01

    Introduction: The U.S. Food and Drug Administration (FDA) has estimated the economic impact of Graphic Warning Labels (GWLs). By omitting the impact on tobacco consumption by pregnant women, the FDA analysis underestimates the economic benefits that would occur from the proposed regulations. There is a strong link between the occurrence of low birth weight babies and smoking while pregnant. Low birth weight babies in turn generate much higher hospital costs than normal birth weight babies. This study aims to fill the gap by quantifying the national hospital cost savings from the reductions in prenatal smoking that will arise if GWLs are implemented in the U.S. Data and Methods: This study uses several data sources. It uses Natality Data from the National Vital Statistics System of the National Center for Health Statistics (NCHS) in 2013 to estimate the impact of prenatal smoking on the likelihood of having a low-birth-weight baby, controlling for socio-economic and demographic characteristics as well as medical and non-medical risk factors. Using these estimates, along with the estimates of Huang et al. (2014) regarding the effect of GWLs on smoking, we calculate the change in the number of LBW (low birth weight) babies resulting from decreased prenatal smoking due to GWLs. Using this estimated change and the estimates from Russell et al. (2007) and AHRQ (2013) on the excess hospital costs of LBW babies, we calculate cost saving that arises from reduced prenatal smoking in response of GWLs. Results and Conclusions: Our results indicated that GWLs for this population could lead to hospital cost savings of 1.2 billion to 2.0 billion dollars over a 30 year horizon. PMID:28208749

  12. Medical costs attributable to child maltreatment a systematic review of short- and long-term effects.

    PubMed

    Brown, Derek S; Fang, Xiangming; Florence, Curtis S

    2011-12-01

    Child maltreatment is a serious and prevalent public health problem, which has been shown to be associated with numerous short- and long-term effects on mental and physical health. Few estimates of the medical costs of these effects have been published to date. To determine the range and quality of currently available estimates and identify the gaps and needs for future research, this article reviews research on medical costs of child maltreatment. Peer-reviewed literature on child maltreatment and medical costs was identified by searching major databases. Twelve articles on the medical costs of child maltreatment were identified. Eight studies describe short-term costs among children; four describe adult, long-term costs. Most studies used convenience samples, captured a partial share of the total costs, and did not follow best practices for econometric analysis of medical costs. Child maltreatment is associated with substantial medical costs in childhood and adulthood, but estimates vary widely because of differences in research designs, types of cost data, and study quality. Econometric estimates of the annual medical costs in adulthood range from zero to about $800. Per-episode estimates of child costs, based on mean comparisons, range from $0 to >$24,000. Copyright © 2011 American Journal of Preventive Medicine. All rights reserved.

  13. Advanced Fuels Can Reduce the Cost of Getting Into Space

    NASA Technical Reports Server (NTRS)

    Palaszewski, Bryan A.

    1998-01-01

    Rocket propellant and propulsion technology improvements can reduce the development time and operational costs of new space vehicle programs, and advanced propellant technologies can make space vehicles safer and easier to operate, and can improve their performance. Five major areas have been identified for fruitful research: monopropellants, alternative hydrocarbons, gelled hydrogen, metallized gelled propellants, and high-energy-density propellants. During the development of the NASA Advanced Space Transportation Plan, these technologies were identified as those most likely to be effective for new NASA vehicles. Several NASA research programs had fostered work in fuels under the topic Fuels and Space Propellants for Reusable Launch Vehicles in 1996 to 1997. One component of this topic was to promote the development and commercialization of monopropellant rocket fuels, hypersonic fuels, and high-energy-density propellants. This research resulted in the teaming of small business with large industries, universities, and Government laboratories. This work is ongoing with seven contractors. The commercial products from these contracts will bolster advanced propellant research. Work also is continuing under other programs, which were recently realigned under the "Three Pillars" of NASA: Global Civil Aviation, Revolutionary Technology Leaps, and Access to Space. One of the five areas is described below, and its applications and effect on future missions is discussed. This work is being conducted at the NASA Lewis Research Center with the assistance of the NASA Marshall Space Flight Center. The regenerative cooling of spacecraft engines and other components can improve overall vehicle performance. Endothermic fuels can absorb energy from an engine nozzle and chamber and help to vaporize high-density fuel before it enters the combustion chamber. For supersonic and hypersonic aircraft, endothermic fuels can absorb the high heat fluxes created on the wing leading edges and

  14. Medical student attitudes about mental illness: does medical-school education reduce stigma?

    PubMed

    Korszun, Ania; Dinos, Sokratis; Ahmed, Kamran; Bhui, Kamaldeep

    2012-05-01

    Reducing stigma associated with mental illness is an important aim of medical education, yet evidence indicates that medical students' attitudes toward patients with mental health problems deteriorate as they progress through medical school. Authors examined medical students' attitudes to mental illness, as compared with attitudes toward other medical illness, and the influence of the number of years spent in medical school, as well as of several key socio-demographic, ethnic, and cultural variables. A group of 760 U.K. medical students completed a nationwide on-line survey examining their attitudes toward patients with five conditions (pneumonia, depression, psychotic symptoms, intravenous drug use, long-standing unexplained abdominal complaints), using the Medical Condition Regard Scale (MCRS). Students were also asked whether they had completed the psychiatry rotation or had personal experience of mental disorders themselves or among their friends or family members. They were also asked about their ethnic group (using U.K. national census categories), religious affiliation, and how important religion was in their lives. Independent-samples t-tests and one-way ANOVA were used to compare differences between groups on the MCRS. Students showed the highest regard for patients with pneumonia and lowest regard for patients with long-standing, unexplained abdominal complaints. Although attitudes toward pneumonia were more positive in fifth-year students than in first-year students, attitudes toward unexplained chronic abdominal pain were worse in fifth-year students than in first-year students. Personal experience of mental health treatment, or that among family and friends, were associated with less stigmatizing attitudes. Men showed more stigmatization than women for nearly all conditions; Chinese and South Asian students showed more stigmatizing attitudes toward delusions and hallucinations than their white British counterparts. Medical students in this survey

  15. [Telemetric monitoring reduces visits to the emergency room and cost of care in patients with chronic heart failure].

    PubMed

    Pérez-Rodríguez, Gilberto; Brito-Zurita, Olga Rosa; Sistos-Navarro, Enrique; Benítez-Aréchiga, Zaria Margarita; Sarmiento-Salazar, Gloria Leticia; Vargas-Lizárraga, José Feliciano

    2015-01-01

    Tele-cardiology is the use of information technologies that help prolong survival, improve quality of life and reduce costs in health care. Heart failure is a chronic disease that leads to high care costs. To determine the effectiveness of telemetric monitoring for controlling clinical variables, reduced emergency room visits, and cost of care in a group of patients with heart failure compared to traditional medical consultation. A randomized, controlled and open clinical trial was conducted on 40 patients with Heart failure in a tertiary care centre in north-western Mexico. The patients were divided randomly into 2 groups of 20 patients each (telemetric monitoring, traditional medical consultation). In each participant was evaluated for: blood pressure, heart rate and body weight. The telemetric monitoring group was monitored remotely and traditional medical consultation group came to the hospital on scheduled dates. All patients could come to the emergency room if necessary. The telemetric monitoring group decreased their weight and improved control of the disease (P=.01). Systolic blood pressure and cost of care decreased (51%) significantly compared traditional medical consultation group (P>.05). Admission to the emergency room was avoided in 100% of patients in the telemetric monitoring group. In patients with heart failure, the telemetric monitoring was effective in reducing emergency room visits and saved significant resources in care during follow-up. Copyright © 2015 Academia Mexicana de Cirugía A.C. Published by Masson Doyma México S.A. All rights reserved.

  16. A conceptually based approach to understanding chronically ill patients' responses to medication cost pressures.

    PubMed

    Piette, John D; Heisler, Michele; Horne, Robert; Caleb Alexander, G

    2006-02-01

    Prescription medications enhance the well-being of most chronically ill patients. Many individuals, however, struggle with how to pay for their treatments and as a result experience problems with self-care and health maintenance. Although studies have documented that high out-of-pocket costs are associated with medication non-adherence, little research on prescription cost sharing has been theoretically grounded in knowledge of the more general determinants of patients' self-management behaviors and chronic disease outcomes. We present a conceptual framework for understanding the influence of patient, medication, clinician, and health system factors on individuals' responses to medication costs. We review what is known about how these factors influence medication adherence, identify possible strategies through which clinicians, health systems, and policy-makers may assist patients burdened by their medication costs, and highlight areas in need of further research. Although medication costs represent a burden to chronically ill patients worldwide, most patients report using their medication as prescribed despite the costs, and others report cost-related underuse despite an apparent ability to afford those treatments. The cost-adherence relationship is modified by contextual factors, including patients' characteristics (e.g., age, ethnicity, and attitudes toward medications), the type of medications they are using (e.g., the complexity of dosing and the drug's clinical target), clinician factors (e.g., choice of first-line agent and communication about medication costs), and health system factors (e.g., efforts to influence clinicians' prescribing and to help patients apply for financial assistance programs). Understanding these relationships will enable clinicians and policy-makers to better design pharmacy benefits and assist patients in taking their medication as prescribed. The next generation of studies examining the consequences of prescription drug costs

  17. Reduce Operating Costs with an EnergySmart School Project

    ERIC Educational Resources Information Center

    US Department of Energy, 2008

    2008-01-01

    Energy costs are a school district's second highest expenditure after personnel. Public schools currently spend more than $8 billion per year for energy. School energy expenditures rose, on average, 20 percent per year between 2000 and 2002--and the costs continue to rise. Natural gas prices alone increased 14 percent annually between 2003 and…

  18. Improving Learning and Reducing Costs: Fifteen Years of Course Description

    ERIC Educational Resources Information Center

    Twigg, Carol A.

    2015-01-01

    Recognizing that tuition increases can no longer be used as a safety valve to avoid dealing with the underlying issues of why costs increase so much, campuses have begun the hard work of cost containment. After sharpening priorities, sometimes making tough choices in light of those priorities, campuses are still groping for ways to wrestle costs…

  19. Improving Learning and Reducing Costs: Fifteen Years of Course Description

    ERIC Educational Resources Information Center

    Twigg, Carol A.

    2015-01-01

    Recognizing that tuition increases can no longer be used as a safety valve to avoid dealing with the underlying issues of why costs increase so much, campuses have begun the hard work of cost containment. After sharpening priorities, sometimes making tough choices in light of those priorities, campuses are still groping for ways to wrestle costs…

  20. Association of prescription abandonment with cost share for high-cost specialty pharmacy medications.

    PubMed

    Gleason, Patrick P; Starner, Catherine I; Gunderson, Brent W; Schafer, Jeremy A; Sarran, H Scott

    2009-10-01

    In 2008, specialty medications accounted for 15.1% of total pharmacy benefit medication spending, and per member expenditures have increased by 11.1% annually from 2004 to 2008 within a commercially insured population of 8 million members. Insurers face increasing pressure to control specialty medication expenditures and to rely on increasing member cost share through creation of a fourth copayment tier within the incentive-based formulary pharmacy benefit system. Data are needed on the influence that member out-of-pocket (OOP) expense may have on prescription abandonment (defined as the patient never actually taking possession of the medication despite evidence of a written prescription generated by a prescriber). To explore the relationship between prescription abandonment and OOP expense among individuals newly initiating high-cost medication therapy with a tumor necrosis factor (TNF) blocker or multiple sclerosis (MS) biologic agent. This observational cross-sectional study queried a midwestern and southern U.S. database of 13,172,480 commercially insured individuals to find members with a pharmacy benefit-adjudicated claim for a TNF blocker or MS specialty medication during the period from July 2006 through June 2008. Prescription abandonment was assessed among continuously enrolled members newly initiating TNF blocker or MS therapy. Prescription abandonment was defined as reversal of the adjudicated claim with no evidence of a subsequent additional adjudicated paid claim in the ensuing 90 days. Separate analyses for MS and TNF blocker therapy were performed to assess the association between member OOP expense and abandonment rate using the Cochran-Armitage test for trend and multivariate logistic regression. Members were placed into 1 of the 7 following OOP expense groups per claim: $0-$100, $101-$150, $151-$200, $201-$250, $251-$350, $351-$500, or more than $500. The association of MS or TNF blocker abandonment rate with OOP expense was tested with logistic

  1. Bedtime Dosing of Antihypertensive Medications Reduces Cardiovascular Risk in CKD

    PubMed Central

    Ayala, Diana E.; Mojón, Artemio; Fernández, José R.

    2011-01-01

    Time of ingestion of hypertension medications can affect circadian patterns of BP, but whether this translates into an effect on clinical outcomes is unknown. Here, in an open-label trial, we randomly assigned 661 patients with CKD either to take all prescribed hypertension medications upon awakening or to take at least one of them at bedtime. We measured 48-hour ambulatory BP at baseline and 3 months after any adjustment in treatment or, at the least, annually. After a median follow-up of 5.4 years, patients who took at least one BP-lowering medication at bedtime had an adjusted risk for total cardiovascular events (a composite of death, myocardial infarction, angina pectoris, revascularization, heart failure, arterial occlusion of lower extremities, occlusion of the retinal artery, and stroke) that was approximately one-third that of patients who took all medications upon awakening (adjusted HR 0.31; 95% CI 0.21 to 0.46; P < 0.001). Bedtime dosing demonstrated a similar significant reduction in risk for a composite outcome of cardiovascular death, myocardial infarction, and stroke (adjusted HR 0.28; 95% CI 0.13 to 0.61; P < 0.001). Furthermore, patients on bedtime treatment had a significantly lower mean sleep-time BP and a greater proportion demonstrated control of their ambulatory BP (56% versus 45%, P = 0.003). Each 5-mmHg decrease in mean sleep-time systolic BP was associated with a 14% reduction in the risk for cardiovascular events during follow-up (P < 0.001). In conclusion, among patients with CKD and hypertension, taking at least one antihypertensive medication at bedtime improves control of BP and reduces the risk for cardiovascular events. PMID:22025630

  2. Endometriosis in Italy: from cost estimates to new medical treatment.

    PubMed

    Luisi, Stefano; Lazzeri, Lucia; Ciani, Valentina; Petraglia, Felice

    2009-11-01

    Endometriosis is defined as the presence of endometrial-like tissue outside the uterus, which induced a chronic inflammatory reaction. The data collected from Italy showed that around 3 million women are affected by endoemtriosis and the condition was predominantly found in women of reproductive age (50% of women were in the 29-39 age range), only 25% of women were asymptomatic. The associated symptoms can create an impact in general physical, mental, and social well-being. Endometriosis is associated with severe dysmenorrhea, deep dyspareunia, chronic pelvic pain, ovulation pain, cyclical, or perimenstrual symptoms, with or without abnormal bleeding, infertility, and chronic fatigue. The annual cost for hospital admission can be estimated to be in a total around 54 million euros. The average time for right diagnosis is around 9 years still today and it follows a long and expensive diagnostic search. Therapies can be useful to relieve and sometimes solve the symptoms, encourage fertility, eliminate endometrial lesions, and restore the anatomy of the pelvis. For medical therapy, several different preparations (oral contraceptives, progestogenics, gestrinone, danazol, and GnRHa) and new options (GnRH antagonists, aromatase inhibitors, estrogen receptor beta agoinist, progesterone receptor modulators, angiogenesis inhibitors, and COX-2 selective inhibitors) are available.

  3. The health law partnership: adding a lawyer to the health care team reduces system costs and improves provider satisfaction.

    PubMed

    Pettignano, Robert; Caley, Sylvia B; McLaren, Susan

    2012-01-01

    Addressing the legal issues of patients of low socioeconomic status can be useful in increasing organizational reimbursements, reducing costs and improving access to care. Medical-legal partnership is an addition to the health care armamentarium that directly addresses this goal. A medical-legal partnership is an interdisciplinary collaboration between a medical entity such as a hospital or clinic and a legal entity such as a law school or legal aid society that addresses barriers to access to care and limitations to well-being experienced by patients of low socioeconomic status. The Health Law Partnership is one such medical legal partnership that provides a holistic, interdisciplinary approach to health care. An evaluation of the legal and educational services provided by Health Law Partnership showed that Health Law Partnership secured otherwise unreimbursed Medicaid payments for services over a 4-year period from 2006 to 2010, increased physician satisfaction, and saved hospital employers approximately $10 000 in continuing education costs annually.

  4. Using clinically nuanced cost sharing to enhance consumer access to specialty medications.

    PubMed

    Buxbaum, Jason; de Souza, Jonas; Fendrick, A Mark

    2014-06-01

    With specialty pharmaceutical prices on the rise, patients are often expected to pay anywhere from 30% to 50% of the specialty-tier drug price through co-insurance-based cost sharing. As these prices continue to climb, patients may choose lower-value medications for their medical needs or become nonadherent for cost-related reasons. Value-based insurance design implementations for specialty medications connect cost sharing and clinical value by moving high-value medications into lower-priced tiers, adjusting cost-sharing based on patient-specific variables, applying the "reward the good soldier" strategy, and encouraging patients to seek high-performing providers.

  5. Direct medical costs and their predictors in South Korean patients with systemic lupus erythematosus.

    PubMed

    Park, So-Yeon; Joo, Young Bin; Shim, Jeeseon; Sung, Yoon-Kyoung; Bae, Sang-Cheol

    2015-11-01

    We aimed to estimate the annual direct medical costs of South Korean systemic lupus erythematosus (SLE) patients, and their predictors. The 2010 annual direct medical costs of SLE patients in the Hanyang BAE Lupus cohort in South Korea were assessed. The information was taken directly from the hospital database and medical records, and included clinical characteristics, disease activity, organ damage, and healthcare utilization. Cost predictors were estimated with a multivariate linear regression model. A total of 749 SLE patients (92.7 % female, mean age 35.7 ± 11.3 years, mean disease duration 9.6 ± 4.9 years) were studied. Their mean annual direct medical costs amounted to USD 3305. The largest component of these costs was the cost of medication (USD 1269, 38.4 %), followed by those of diagnostic procedures and tests (USD 1177, 35.6 %). Regression analysis showed that adjusted mean SLE disease activity index score (p < 0.0001), systemic damage index (p < 0.0001), and renal (p = 0.0039) and hematologic (p = 0.0353) involvement were associated with increased direct medical costs, whereas longer disease duration was associated with lower direct medical costs. Greater disease activity and greater organ damage predict higher costs for South Korean SLE patients. Major organ involvement such as renal disorder and hematologic involvement also predicts higher costs, whereas longer duration of disease predicts lower costs.

  6. Impact of Out-of-Pocket Pharmacy Costs on Branded Medication Adherence Among Patients with Type 2 Diabetes.

    PubMed

    Bibeau, Wendy S; Fu, Haoda; Taylor, April D; Kwan, Anita Y M

    2016-11-01

    Medication adherence is pivotal for the successful treatment of diabetes. However, medication adherence remains a major concern, as nonadherence is associated with poor health outcomes. Studies have indicated that increasing patients' share of medication costs significantly reduces adherence. Little is known about a potential out-of-pocket (OOP) cost threshold where substantial reduction in adherence may occur. To examine the impact of diabetes OOP pharmacy costs on antihyperglycemic medication adherence and identify the potential threshold at which significant reduction in adherence may occur among patients with type 2 diabetes mellitus (T2DM). This was an observational, retrospective cohort study using longitudinal U.S. pharmacy and medical claims data from the IMS Health Medical Claims (Dx) database. Patients with T2DM who initiated therapy with a branded antihyperglycemic medication during the index period (January 1, 2011, to December 31, 2011) and had 3 years of follow-up data were included. The primary outcome was adherence to antihyperglycemic medications, measured as the number of days covered. Propensity scores were calculated using baseline sociodemographic and clinical characteristics to control for potential confounding factors. Four strata were created based on mean propensity scores. Across each stratum, patients were assigned to 5 diabetes OOP pharmacy (including generics) cost levels: $0-$10, $11-$40, $41-$50, $51-$75, and > $75. Multivariate regression models were used to estimate association of diabetes OOP pharmacy costs and adherence for each stratum. Sensitivity analyses were conducted to assess the impact of total OOP pharmacy costs and index drug category OOP costs on adherence. A total of 15,416 patients were assessed. Across each stratum in the diabetes OOP pharmacy cost analysis group, mean patient age ranged from 52.3 to 56.1 years, mean number of antihyperglycemic medication classes ranged from 1.5 to 3.2, and mean household income

  7. [Analysis of cost and efficiency of a medical nursing unit using time-driven activity-based costing].

    PubMed

    Lim, Ji Young; Kim, Mi Ja; Park, Chang Gi

    2011-08-01

    Time-driven activity-based costing was applied to analyze the nursing activity cost and efficiency of a medical unit. Data were collected at a medical unit of a general hospital. Nursing activities were measured using a nursing activities inventory and classified as 6 domains using Easley-Storfjell Instrument. Descriptive statistics were used to identify general characteristics of the unit, nursing activities and activity time, and stochastic frontier model was adopted to estimate true activity time. The average efficiency of the medical unit using theoretical resource capacity was 77%, however the efficiency using practical resource capacity was 96%. According to these results, the portion of non-added value time was estimated 23% and 4% each. The sums of total nursing activity costs were estimated 109,860,977 won in traditional activity-based costing and 84,427,126 won in time-driven activity-based costing. The difference in the two cost calculating methods was 25,433,851 won. These results indicate that the time-driven activity-based costing provides useful and more realistic information about the efficiency of unit operation compared to traditional activity-based costing. So time-driven activity-based costing is recommended as a performance evaluation framework for nursing departments based on cost management.

  8. [Direct costs of medical care for patients with type 2 diabetes mellitus in Mexico micro-costing analysis].

    PubMed

    Rodríguez Bolaños, Rosibel de Los Ángeles; Reynales Shigematsu, Luz Myriam; Jiménez Ruíz, Jorge Alberto; Juárez Márquezy, Sergio Arturo; Hernández Ávila, Mauricio

    2010-12-01

    Estimate the direct cost of medical care incurred by the Mexican Social Security Institute (IMSS, Instituto Mexicano del Seguro Social) for patients with type 2 diabetes mellitus (DM2). The clinical files of 497 patients who were treated in secondary and tertiary medical care units in 2002-2004 were reviewed. Costs were quantified using a disease costing approach (DCA) from the provider's perspective, a micro-costing technique, and a bottom-up methodology. Average annual costs by diagnosis, complication, and total cost were estimated. Total IMSS DM2 annual costs were US$452 064 988, or 3.1% of operating expenses. The annual average cost per patient was US$3 193.75, with US$2 740.34 per patient without complications and US$3 550.17 per patient with complications. Hospitalization and intensive care bed-days generated the greatest expenses. The high cost of providing medical care to patients with DM2 and its complications represents an economic burden that health institutions should consider in their budgets to enable them to offer quality service that is both adequate and timely. Using the micro-costing methodology allows an approximation to real data on utilization and management of the disease.

  9. Reducing annotation cost and uncertainty in computer-aided diagnosis through selective iterative classification

    NASA Astrophysics Data System (ADS)

    Riely, Amelia; Sablan, Kyle; Xiaotao, Thomas; Furst, Jacob; Raicu, Daniela

    2015-03-01

    Medical imaging technology has always provided radiologists with the opportunity to view and keep records of anatomy of the patient. With the development of machine learning and intelligent computing, these images can be used to create Computer-Aided Diagnosis (CAD) systems, which can assist radiologists in analyzing image data in various ways to provide better health care to patients. This paper looks at increasing accuracy and reducing cost in creating CAD systems, specifically in predicting the malignancy of lung nodules in the Lung Image Database Consortium (LIDC). Much of the cost in creating an accurate CAD system stems from the need for multiple radiologist diagnoses or annotations of each image, since there is rarely a ground truth diagnosis and even different radiologists' diagnoses of the same nodule often disagree. To resolve this issue, this paper outlines an method of selective iterative classification that predicts lung nodule malignancy by using multiple radiologist diagnoses only for cases that can benefit from them. Our method achieved 81% accuracy while costing only 46% of the method that indiscriminately used all annotations, which achieved a lower accuracy of 70%, while costing more.

  10. An innovative approach to reducing medical care utilization and expenditures.

    PubMed

    Orme-Johnson, D W; Herron, R E

    1997-01-01

    In a retrospective study, we assessed the impact on medical utilization and expenditures of a multicomponent prevention program, the Maharishi Vedic Approach to Health (MVAH). We compared archival data from Blue Cross/Blue Shield Iowa for MVAH (n = 693) with statewide norms for 1985 through 1995 (n = 600,000) and with a demographically matched control group (n = 4,148) for 1990, 1991, 1994, and 1995. We found that the 4-year total medical expenditures per person in the MVAH group were 59% and 57% lower than those in the norm and control groups, respectively; the 11-year mean was 63% lower than the norm. The MVAH group had lower utilization and expenditures across all age groups and for all disease categories. Hospital admission rates in the control group were 11.4 times higher than those in the MVAH group for cardiovascular disease, 3.3 times higher for cancer, and 6.7 times higher for mental health and substance abuse. The greatest savings were seen among MVAH patients older than age 45, who had 88% fewer total patients days compared with control patients. Our results confirm previous research supporting the effectiveness of MVAH for preventing disease. Our evaluation suggests that MVAH can be safely used as a cost-effective treatment regimen in the managed care setting.

  11. Global Medical Device Nomenclature: The Concept for Reducing Device-Related Medical Errors

    PubMed Central

    Anand, K; Saini, SK; Singh, BK; Veermaram, C

    2010-01-01

    In the medical device field, there are a number of players, having quite different responsibilities and levels of understanding of the processes, but all with one common interest, that of ensuring the availability of sound medical devices to the general public. To assist in this very important process, there is a need for a common method for describing and identifying these medical devices in an unambiguous manner. The Global Medical Device Nomenclature (GMDN) now provides, for the first time, an international tool for identifying all medical devices, at the generic level, in a meaningful manner that can be understood by all users. Prior to the GMDN, many nomenclature systems existed, all built upon different structures, and used locally or nationally for special purposes, with unusual approaches. These diverse systems, although often workable in their own right, have had no impact on improving the overall situation of providing a common platform, whereby, medical devices could be correctly identified and the related data safely exchanged between the involved parties. Work by standard organizations such as, CEN (European Committee for Standardization) and ISO (International Organization for Standardization), from 1993 to 1996, resulted in a standard that specified a structure for a new nomenclature, for medical devices. In this article we are trying to explain GMDN as the prime method to reduce medical device errors, and to understand the concept of GMDN, to regulate the medical device throughout the globe. Here we also make an attempt to explain various aspects of the GMDN system, such as, the process of development of the GMDN-CEN report, purpose, benefits, and their structural considerations. In addition, there will be an explanation of the coding system, role of the GMDN agency, and their utilization in the unique device identification (UDI) System. Finally, the current area of focus and vision for the future are also mentioned. PMID:21264103

  12. Reducing Operating Costs and Energy Consumption at Water Utilities

    EPA Pesticide Factsheets

    Due to their unique combination of high energy usage and potential for significant savings, utilities are turning to energy-efficient technologies to help save money. Learn about cost and energy saving technologies from this brochure.

  13. Improving Quality and Reducing Cost: Designs for Effective Learning.

    ERIC Educational Resources Information Center

    Twigg, Carol A.

    2003-01-01

    Discusses 30 institutions participating in a program exploring how large-enrollment introductory courses can be redesigned using technology to extend access to a new population of students without trading quality for cost savings. (EV)

  14. Improving Quality and Reducing Cost: Designs for Effective Learning.

    ERIC Educational Resources Information Center

    Twigg, Carol A.

    2003-01-01

    Discusses 30 institutions participating in a program exploring how large-enrollment introductory courses can be redesigned using technology to extend access to a new population of students without trading quality for cost savings. (EV)

  15. Direct medical costs attributable to peripheral fractures in Canadian post-menopausal women.

    PubMed

    Bessette, L; Jean, S; Lapointe-Garant, M-P; Belzile, E L; Davison, K S; Ste-Marie, L G; Brown, J P

    2012-06-01

    This study determined the cost of treating fractures at osteoporotic sites (except spine fractures) for the year following fracture. While the average cost of treating a hip fracture was the highest of all fractures ($46,664 CAD per fracture), treating other fractures also accounted for significant expenditures ($5,253 to $10,410 CAD per fracture). This study aims to determine the mean direct medical cost of treating fractures at peripheral osteoporotic sites in the year post-fracture (through 2 years post-hip fracture). Health administrative databases from the province of Quebec, Canada were used to estimate the cost of treating peripheral fractures at osteoporotic sites for the year following fracture (through 2 years for hip fractures). Included in costs analyses were physician claims, emergency and outpatient clinic costs, hospitalization costs, and subsequent costs for treatment of complications. A total of 15,827 patients (mean age 72 years) who suffered one fracture at an osteoporotic site had data for analyses. Hip/femur fractures had the highest rate of hospital stays related to fracture (91%) and the highest rate of hospital stays associated with a post-fracture complication (8%). In the year following fracture, the mean (SD) costs (2009 Canadian dollars) of treating acute fractures and post-fracture complications were: hip/femur fracture $46,664 ($43,198), wrist fracture $5,253 ($18,982), and fractures at other peripheral sites $10,410 ($27,641). The average (SD) cost of treating post-fracture complications at the hip/femur in the second year post-fracture was $1,698 ($12,462). Hospitalizations associated with the fracture accounted for 88% of the total cost of fracture treatment. The treatment of hip fractures accounts for a significant proportion of the costs associated with the treatment of peripheral osteoporotic fractures. Interventions to reduce the incidence of fractures, particularly hip fractures, would result in significant cost savings to the

  16. Medical care costs of newly diagnosed children with structural-metabolic epilepsy: a one year prevalence-based approached.

    PubMed

    Salih, Muhannad R M; Bahari, Mohd Baidi; Shafie, Asrul Akmal; Hassali, Mohamed Azmi Ahmad; Al-lela, Omer Qutaiba B; Abd, Arwa Y; Ganesan, Vigneswari M

    2012-12-01

    Aims of this study were to estimate the first-year medical care costs of newly diagnosed children with structural-metabolic epilepsy and to determine the cost-driving factors in the selected population. This was a prevalence-based retrospective chart review that included patients who attended a pediatric neurology clinic in a tertiary referral center in Malaysia. The total first-year medical care costs were estimated from the provider (i.e., hospital) perspective, using a bottom-up, microcosting analysis. Medical chart/billing data (i.e., case reports) obtained from the hospital (i.e., provider) were collected to determine the resources used. Prices or cost data were standardized for the year 2010 (One Malaysian Ringgit MYR is equivalent to 0.26 Euro or 0.32 USD). The most expensive item in the costs list was antiepileptic drugs, whereas ultrasound examination represented the cheapest item. Hospitalization and the use of non-antiepileptic drugs were the second and third most costly items, respectively. The cost of therapeutic drug monitoring comprised only a small proportion of the total annual expenditure. None of the demographic variables (i.e., gender, race, and age) significantly impacted the first-year medical care costs. Similarly, child development, seizure type, therapy type (i.e., polytherapy versus monotherapy), and therapeutic drug monitoring utilization were also not associated with the cost of management. The first-year medical care costs positively correlated with seizure frequency (r(s)=0.294, p=0.001). However, the only variable that significantly predict the first-year medical care costs was the type of antiepileptic drugs (R(2)=0.292, F=7.772, p<0.001). This investigation was the first cost analysis study of epilepsy in Malaysia. The total first-year medical care costs for 120 patients with structural-metabolic epilepsy were MYR 202,816 (i.e., MYR 1690.13 per patient per year). The study findings highlight the importance of optimizing seizure

  17. 77 FR 69504 - Calendar Year 2012 Cost of Outpatient Medical and Dental Services Furnished by Department of...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-11-19

    ... the cost of outpatient medical and dental services furnished by military treatment facilities through... BUDGET Calendar Year 2012 Cost of Outpatient Medical and Dental Services Furnished by Department of Defense Medical Treatment Facilities; Certain Rates Regarding Recovery From Tortiously Liable...

  18. Medical Costs and Healthcare Utilization among Cancer Decedents in the Last Year of Life in 2009

    PubMed Central

    Hwang, Inuk; Shin, Dong Wook; Kang, Kyoung Hee; Yang, Hyung Kook; Kim, So Young; Park, Jong-Hyock

    2016-01-01

    Purpose The purpose of this study was to evaluate the cancer care cost during the last year of life of patients in Korea. Materials and Methods We studied the breakdown of spending on the components of cancer care. Cancer decedents in 2009 were identified from the Korean Central Cancer Registry and linked with the Korean National Health Insurance Claims Database. The final number of patients included in the study was 70,558. Results In 2009, the average cancer care cost during the last year of life was US $15,720. Patients under age 20 spent US $53,890 while those 70 or over spent US $11,801. Those with leukemia incurred the highest costs (US $43,219) while bladder cancer patients spent the least (US $13,155). General costs, drugs other than analgesics, and test fees were relatively high (29.7%, 23.8%, and 20.7% of total medical costs, respectively). Analgesic drugs, rehabilitation, and psychotherapy were still relatively low (4.3%, 0.7%, and 0.1%, respectively). Among the results of multiple regression analysis, few were notable. Age was found to be negatively related to cancer care costs while income level was positively associated. Those classified under distant Surveillance, Epidemiology, and End Results stages of cancer and higher comorbidity level also incurred higher cancer care costs. Conclusion Average cancer care costs varied significantly by patient characteristics. However, the study results suggest an underutilization of support services likely due to lack of alternative accommodations for terminal cancer patients. Further examination of utilization patterns of healthcare resources will help provide tailored evidence for policymakers in efforts to reduce the burdens of cancer care. PMID:25761472

  19. Medical Costs and Healthcare Utilization among Cancer Decedents in the Last Year of Life in 2009.

    PubMed

    Hwang, Inuk; Shin, Dong Wook; Kang, Kyoung Hee; Yang, Hyung Kook; Kim, So Young; Park, Jong-Hyock

    2016-01-01

    The purpose of this study was to evaluate the cancer care cost during the last year of life of patients in Korea. We studied the breakdown of spending on the components of cancer care. Cancer decedents in 2009 were identified from the Korean Central Cancer Registry and linked with the Korean National Health Insurance Claims Database. The final number of patients included in the study was 70,558. In 2009, the average cancer care cost during the last year of life was US $15,720. Patients under age 20 spent US $53,890 while those 70 or over spent US $11,801. Those with leukemia incurred the highest costs (US $43,219) while bladder cancer patients spent the least (US $13,155). General costs, drugs other than analgesics, and test fees were relatively high (29.7%, 23.8%, and 20.7% of total medical costs, respectively). Analgesic drugs, rehabilitation, and psychotherapy were still relatively low (4.3%, 0.7%, and 0.1%, respectively). Among the results of multiple regression analysis, few were notable. Age was found to be negatively related to cancer care costs while income level was positively associated. Those classified under distant Surveillance, Epidemiology, and End Results stages of cancer and higher comorbidity level also incurred higher cancer care costs. Average cancer care costs varied significantly by patient characteristics. However, the study results suggest an underutilization of support services likely due to lack of alternative accommodations for terminal cancer patients. Further examination of utilization patterns of healthcare resources will help provide tailored evidence for policymakers in efforts to reduce the burdens of cancer care.

  20. The short-term effect of interdisciplinary medication review on function and cost in ambulatory elderly people.

    PubMed

    Williams, Mark E; Pulliam, Charles C; Hunter, Rebecca; Johnson, Ted M; Owens, Justine E; Kincaid, Jean; Porter, Carol; Koch, Gary

    2004-01-01

    To determine whether a medication review by a specialized team would promote regimen changes in elders taking multiple medications and to measure the effect of regimen changes on monthly cost and functioning. A randomized-controlled trial. Health center ambulatory clinic. Community-dwelling older adults taking five or more medications were assessed at baseline and 6 weeks. A medication-change intervention group of 57 elders was compared with a control group of 76 elder adults. The primary intervention was a comprehensive review and recommended modification of a patient's medication regimen. Changes were endorsed by each patient's primary physician and discussed with each patient. Measures were the Timed Manual Performance Test, Physical Performance Test, Functional Reach Assessment, subtests from the Wechsler Adult Intelligence Scale, a modified Randt Memory Test, the Center for Epidemiological Studies-Depression Scale, the Self-Rating Anxiety Scale, and the Rand 36-item Health Survey 1.0. Comorbidity was determined using the International Classification of Diseases, Ninth Revision, Clinical Modification. Medication usage was determined using brown bag review. Intervention subjects decreased their medications by an average of 1.5 drugs. No differences in functioning were observed between groups. Intervention subjects saved an average $26.92 per month in wholesale medication costs; control subjects saved $6.75 per month (P<.006). Although the intervention significantly reduced the medications taken and monthly cost, most patients were resistant to reducing medications to the recommended level. Further study is needed to understand patient resistance to reducing adverse polypharmacy and to devise better strategies for addressing this important problem in geriatric health. Greater focus on prescriber behavior is recommended.

  1. Direct medical cost associated with diabetic retinopathy severity in type 2 diabetes in Singapore

    PubMed Central

    Zhang, Xiao; Low, Serena; Kumari, Neelam; Wang, Jiexun; Ang, Keven; Yeo, Darren; Yip, Chee Chew; Tavintharan, Subramaniam; Sum, Chee Fang

    2017-01-01

    Diabetic retinopathy (DR) is a leading cause of vision-loss globally among type 2 diabetes (T2DM) patients. Information on the economic burden of DR in Singapore is limited. We aim to identify the total annual direct medical costs of DR at different stages, and to examine factors influencing the costs. Four hundreds and seventy T2DM patients who attended the Diabetes Centre in a secondary hospital in Singapore in 2011–2014 were included. Digital color fundus photographs were assessed for DR in a masked fashion. Retinopathy severity was further categorized into non-proliferative DR (NPDR), including mild, moderate and severe NPDR, and proliferative DR (PDR). Medical costs were assessed using hospital administrative data. DR was diagnosed in 172 (39.5%) patients, including 51 mild, 62 moderate and 18 severe NPDR, and 41 PDR. The median cost in DR [2012.0 (1111.2–4192.3)] was significantly higher than that in non-DR patients [1158.1 (724.1–1838.9)] (p<0.001). The corresponding costs for mild, moderate, severe NPDR and PDR were [1167.1 (895.4–2012.0)], [2212.0 (1215.5–3825.5)], [2717.5 (1444.0–6310.7)], and [3594.8.1 (1978.4–8427.7)], respectively. After adjustment, the corresponding cost ratios for mild, moderate, severe NPDR, and PDR relative to non-DR were 1.1 (p = 0.827), 1.8 (p = 0.003), 2.0 (p = 0.031) and 2.3 (p<0.001), respectively. The other factors affecting the total cost include smoking (ratio = 1.7, p = 0.019), neuropathy (ratio = 1.9, p = 0.001) and chronic kidney disease (CKD) (ratio = 1.4, p = 0.019). The presence and severity of DR was associated with increased direct medical costs in T2DM. Our results suggest that preventing progression of DR may reduce the economic burden of DR. PMID:28700742

  2. Psychiatric correlates of medical care costs among veterans receiving mental health care.

    PubMed

    Simpson, Tracy L; Moore, Sally A; Luterek, Jane; Varra, Alethea A; Hyerle, Lynne; Bush, Kristen; Mariano, Mary Jean; Liu, Chaun-Fen; Kivlahan, Daniel R

    2012-04-01

    Research on increased medical care costs associated with posttraumatic sequelae has focused on posttraumatic stress disorder (PTSD). However, the provisional diagnosis of Disorders of Extreme Stress Not Otherwise Specified (DESNOS) encompasses broader trauma-related difficulties and may be uniquely related to medical costs. We investigated whether DESNOS severity was associated with greater nonmental health medical care costs in veterans receiving mental health care. Participants were 106 men and 105 women receiving VA outpatient mental health treatment. A standardized interview assessed DESNOS severity. The dependent variables consisted of primary and specialty medical treatment costs. Sequential zero-inflated negative binomial regression was used to evaluate the variance in medical costs accounted for by DESNOS severity, controlling for PTSD severity and established predisposing, enabling, and need-based health care factors. Contrary to our hypothesis, in fully adjusted models, DESNOS severity independently added a significant amount of variance to lower specialty medical care costs, whereas PTSD did not consistently account for significant variance in medical care costs. Greater DESNOS severity appears to be associated with lower specialty medical care costs but not primary care costs. These findings may indicate that patients with DESNOS symptoms are at risk for being underreferred for specialty care.

  3. Reducing hospital noise: a review of medical device alarm management.

    PubMed

    Konkani, Avinash; Oakley, Barbara; Bauld, Thomas J

    2012-01-01

    Increasing noise in hospital environments, especially in intensive care units (ICUs) and operating rooms (ORs), has created a formidable challenge for both patients and hospital staff. A major contributing factor for the increasing noise levels in these environments is the number of false alarms generated by medical devices. This study focuses on discovering best practices for reducing the number of false clinical alarms in order to increase patient safety and provide a quiet environment for both work and healing. The researchers reviewed Pub Med, Web of Knowledge and Google Scholar sources to obtain original journal research and review articles published through January 2012. This review includes 27 critically important journal articles that address different aspects of medical device alarms management, including the audibility, identification, urgency mapping, and response time of nursing staff and different solutions to such problems. With current technology, the easiest and most direct method for reducing false alarms is to individualize alarm settings for each patient's condition. Promoting an institutional culture change that emphasizes the importance of individualization of alarms is therefore an important goal. Future research should also focus on the development of smart alarms.

  4. Association of increased emergency rooms costs for patients without access to necessary medications.

    PubMed

    Watanabe, Jonathan Hirohiko; Ney, John P

    2015-01-01

    Prescription medications are an important component of chronic disease management. They are vital in preventing unnecessary ER visits. However, few studies have examined the association between patients' self-reported inability to receive necessary medications and emergency room costs. The study objectives were to: 1) determine differences in ER costs based on self-reported ability to obtain necessary medications. 2) identify differences in ER costs based on self-reported ability to obtain necessary medications among medication users. The association was also examined by insurance category. Respondent data from 10 years (2002-2011) of the U.S. Medical Expenditure Panel Survey was analyzed. The models employed estimated the association of respondents reporting being 'unable to receive necessary medications' on ER expenditures. Secondarily, the relationship was assessed by insurance category: private, public, and uninsured. Two-part cost regression models with bootstrapped estimates to produce 95% confidence intervals of cost differences were applied for these analyses. Significance was set at α = 0.05. Analyses were completed using SAS 9.4 (Cary, NC) and Stata 13 (College Station, TX). Estimates were in 2011 US dollars. People unable to receive necessary medications experienced increased average annual ER costs of $46.62 with 95% a confidence interval [CI] of 34.76-58.49) compared to patients able to receive necessary medications. By insurance category, respondents unable to receive necessary medications experienced increased ER costs of $104.80 (95% CI: 60.57-149.03), $42.16 (95% CI: 24.65-59.68), and $33.18 (95% CI: 18.54-47.82), for Publically Insured, Privately Insured, and Uninsured, respectively. Findings were similar for those already using medications. Inability to obtain necessary medications is associated with increased emergency room costs. Those with public insurance have a larger increase in ER costs if they are without necessary medications compared

  5. Medical costs and economic production losses due to injuries in the Netherlands.

    PubMed

    van Beeck, E F; van Roijen, L; Mackenbach, J P

    1997-06-01

    To support injury control, we assessed the direct medical costs and indirect costs of injuries in the Netherlands, making use of recent advances in health economics. We estimated the direct medical costs with the help of available data on health care utilization as a consequence of injuries. In our calculations of indirect costs, we used two alternative approaches. We used the traditional human-capital approach, which estimates the potential economic production losses caused by diseases or injuries. In addition, we applied the friction-costs method, which was recently developed as an attempt to measure the actual economic production losses to society. Injuries are an important source of medical costs and economic production losses. Almost two-thirds of the medical costs are the result of injuries among females (mainly domestic injuries of elderly women). On the contrary, independent of the method used, more than 80% of the indirect costs are the result of injuries among males (mainly caused by a high frequency of traffic injuries, occupational injuries, and sports injuries among young males). The application of the friction-costs method confirms the importance of injuries as a source of production losses in comparison with other diseases, showing that they belong to the main three causes of indirect costs to society. Estimates of the medical costs and both the potential and actual economic production losses to society clearly demonstrate that injuries should be a major concern for health policy makers and the medical profession.

  6. Emergency department outpatient treatment of alcohol-intoxicated bicyclists increases the cost of medical care in Japan

    PubMed Central

    Yamauchi, Sunao; Mizobe, Michiko; Nakashima, Yoshiyuki; Takahashi, Jin; Funakoshi, Hiraku; Urayama, Kevin Y.; Ohde, Sachiko; Takahashi, Osamu; Shiga, Takashi

    2017-01-01

    Riding a bicycle under the influence of alcohol is illegal in Japan. Nevertheless, intoxicated bicyclists are frequently treated at hospital emergency departments for bicycle-related injuries. This patient population usually requires more hospital resources, even for relatively minor injuries. Therefore, we hypothesized that bicycle-related crashes involving bicyclists under the influence of alcohol cost more to treat than those that do not involve alcohol intoxication. The aim of the present study was to examine the costs associated with bicycle-related minor injuries and alcohol intoxication of the bicyclist. The study was conducted at the Tokyo Bay Urayasu Ichikawa Medical Center Emergency Department, Japan. All minor bicycle crashes involving 217 individuals aged ≥20 years treated from September 1, 2012 to August 31, 2013 were included in the analysis of data obtained from medical records. Variables included alcohol intoxication, sex, age, collision with a motor vehicle, Glasgow Coma Scale, injury severity score (ISS), laboratory tests, treatment of wounds, number of X-ray images, number of computed tomography scans, and medical costs. Multiple linear regression analysis was performed to evaluate the association between alcohol intoxication and medical costs. Seventy (32%) patients consumed alcohol, and the median medical cost was 253 USD (interquartile range [IQR], 164–330). Multivariable analysis showed that alcohol intoxication was independently associated with higher medical costs (p = 0.030, adjusted R-square value = 0.55). These findings support our hypothesis and should encourage authorities to implement comprehensive measures to prohibit bicycling under the influence of alcohol to prevent injuries and to reduce medical costs. PMID:28329002

  7. Effectiveness and cost of failure mode and effects analysis methodology to reduce neurosurgical site infections.

    PubMed

    Hover, Alexander R; Sistrunk, William W; Cavagnol, Robert M; Scarrow, Alan; Finley, Phillip J; Kroencke, Audrey D; Walker, Judith L

    2014-01-01

    Mercy Hospital Springfield is a tertiary care facility with 32 000 discharges and 15 000 inpatient surgeries in 2011. From June 2009 through January 2011, a stable inpatient elective neurosurgery infection rate of 2.15% was observed. The failure mode and effects analysis (FMEA) methodology to reduce inpatient neurosurgery infections was utilized. Following FMEA implementation, overall elective neurosurgery infection rates were reduced to 1.51% and sustained through May 2012. Compared with baseline, the post-FMEA deep-space and organ infection rate was reduced by 41% (P = .052). Overall hospital inpatient clean surgery infection rates for the same time frame did not decrease to the same extent, suggesting a specific effect of the FMEA. The study team believes that the FMEA interventions resulted in 14 fewer expected infections, $270 270 in savings, a 168-day reduction in expected length of stay, and 22 fewer readmissions. Given the serious morbidity and cost of health care-associated infections, the study team concludes that FMEA implementation was clinically cost-effective. © 2013 by the American College of Medical Quality.

  8. Owner-controlled insurance programs: Reducing O&M costs

    SciTech Connect

    Charette, M.; Brady, N.

    1994-02-01

    The economic recession, increased competition from nonutility generators, and escalating Workers` Compensation costs are forcing electric utilities to reexamine how they finance the cost of risk. In addition to managed care programs, larger deductibles, and aggressive safety campaigns, utility risk and insurance executives are turning more than ever to Owner-Controlled Insurance Programs (OCIPs) to lower operation and maintenance (O&M) expenses. While electric utilities long have used OCIPs to control insurance costs during generating station and office building construction, this approach is now being employed for other projects. In the last few years, utilities have expanded the use of OCIPs to include scrubber installation, plant retrofit, and, more recently, for ongoing contract and maintenance work at operating fossil and nuclear plants. These OCIPs are also known as {open_quotes}gate{close_quotes} or {open_quotes}maintenance{close_quotes} wrap-ups.

  9. Improving Readiness and Reducing Costs: An Analysis of Factors That Influence Site Selection for Army Outpatient Surgical Services.

    PubMed

    Little, Katherine E; Martinez, Katie M; Forman, Jessica L; Richter, Jason P; Wade, Michael L

    The variable costs of providing surgical procedures for military beneficiaries are greater when care is rendered in the civilian purchased care network than when provided at a direct care military treatment facility (MTF). To reduce healthcare-related costs, retaining surgical services is a priority at MTFs across the U.S. Army Medical Command. This study is the first to identify factors significantly associated with outpatient surgical service site selection in the military health system (MHS). We analyzed 1,000,305 patient encounters in fiscal year 2014, of which 970,367 were direct care encounters and 29,938 were purchased care encounters. We used multiple binomial logistic regression to assess and compare the odds of site selection at a purchased care facility and an MTF. We found that an increase in provider administrative time (OR = 1.024, p < .001) and an increase in case complexity (OR = 1.334, p < .001) were associated with increased odds that an outpatient surgical service was provided in a purchased care setting. The increased odds that highly complex cases were seen in purchased care has the potential to affect the medical readiness of military providers and the efficacy of graduate medical education programs. Healthcare administrators can use the results of this study to develop and implement MTF level policies to enhance outpatient surgical service practices in the Army medical system. These efforts may reduce costs and increase military provider medical readiness.

  10. Financial costs and patients' perceptions of medical tourism in bariatric surgery.

    PubMed

    Kim, David H; Sheppard, Caroline E; de Gara, Christopher J; Karmali, Shahzeer; Birch, Daniel W

    2016-02-01

    Many Canadians pursue surgical treatment for severe obesity outside of their province or country - so-called "medical tourism." We have managed many complications related to this evolving phenomenon. The costs associated with this care seem substantial but have not been previously quantified. We surveyed Alberta general surgeons and postoperative medical tourists to estimate costs of treating complications related to medical tourism in bariatric surgery and to understand patients' motivations for pursuing medical tourism. Our analysis suggests more than $560 000 was spent treating 59 bariatric medical tourists by 25 surgeons between 2012 and 2013. Responses from medical tourists suggest that they believe their surgeries were successful despite some having postoperative complications and lacking support from medical or surgical teams. We believe that the financial cost of treating complications related to medical tourism in Alberta is substantial and impacts existing limited resources.

  11. Reducing maintenance costs in agreement with CNC machine tools reliability

    NASA Astrophysics Data System (ADS)

    Ungureanu, A. L.; Stan, G.; Butunoi, P. A.

    2016-08-01

    Aligning maintenance strategy with reliability is a challenge due to the need to find an optimal balance between them. Because the various methods described in the relevant literature involve laborious calculations or use of software that can be costly, this paper proposes a method that is easier to implement on CNC machine tools. The new method, called the Consequence of Failure Analysis (CFA) is based on technical and economic optimization, aimed at obtaining a level of required performance with minimum investment and maintenance costs.

  12. Centralized contracting an imperative for reducing health system costs.

    PubMed

    Baskel, Christopher

    2014-03-01

    As a health system expands, there is a concomitant need for its leaders to take steps to ensure that redundancies in purchasing processes do not drive up costs to unsustainable levels. Spectrum Health in Grand Rapids, Mich., tackled this challenge by instituting a revenue-driven, patient-care-focused value analysis process that centralized contracting processes in several areas of nonsalary expense. Spectrum went on to uncover opportunities for cutting costs in its decentralized, non-purchase order expenses, saving 24 percent in the first of four arenas.

  13. Leasing strategies reduce the cost of financing healthcare equipment.

    PubMed

    Bayless, M E; Diltz, J D

    1985-10-01

    Prospective payment has increased the importance of controlling capital costs. One area where this may be possible is lease financing. Reasons commonly cited in favor of leasing may be of questionable validity, but, under an easily identified set of circumstances, lease financing can be cost effective. Recent developments in finance make it possible to not only evaluate the financial attractiveness of a given lease, but also to accurately predict bounds within which the terms of the lease must fall. Hospital administrators armed with this information should be able to negotiate more favorable lease terms under given tax and economic environments.

  14. Impact of a Cost Visibility Tool in the Electronic Medical Record on Antibiotic Prescribing in an Academic Medical Center

    PubMed Central

    Fargo, Kelly L.; Johnston, Jessica; Stevenson, Kurt B.; Deutscher, Meredith

    2015-01-01

    Background: Studies evaluating the impact of passive cost visibility tools on antibiotic prescribing are lacking. Objective: The objective of this study was to evaluate whether the implementation of a passive antibiotic cost visibility tool would impact antibiotic prescribing and decrease antibiotic spending. Methods: An efficiency and effectiveness initiative (EEI) was implemented in October 2012. To support the EEI, an antibiotic cost visibility tool was created in June 2013 displaying the relative cost of antibiotics. Using an observational study of interrupted time series design, 3 time frames were studied: pre EEI, post EEI, and post cost visibility tool implementation. The primary outcome was antibiotic cost per 1,000 patient days. Secondary outcomes included case mix index (CMI)–adjusted antibiotic cost per 1,000 patient days and utilization of the cost visibility tool. Results: Initiation of the EEI was associated with a $4,675 decrease in antibiotic cost per 1,000 patient days (P = .003), and costs continued to decrease in the months following EEI (P = .009). After implementation of the cost visibility tool, costs remained stable (P = .844). Despite CMI increasing over time, adjustment for CMI had no impact on the directionality or statistical significance of the results. Conclusion: Our study demonstrated a significant and sustained decrease in antibiotic cost per 1,000 patient days when focused medication cost reduction efforts were implemented, but passive cost visibility tool implementation was not associated with additional cost reduction. Antibiotic cost visibility tools may be of most benefit when prior medication cost reduction efforts are lacking or when an active intervention is incorporated. PMID:26405341

  15. The Association of Adherence to Antiretroviral Therapy with Healthcare Utilization and Costs for Medical Care

    PubMed Central

    Gardner, Edward M.; Maravi, Moises E.; Rietmeijer, Cornelis; Davidson, Arthur J.; Burman, William J.

    2009-01-01

    Background The association between antiretroviral adherence, healthcare utilization and medical costs has not been well studied. Objective To examine the relationship of adherence to antiretroviral medications to healthcare utilization and healthcare costs. Methods A retrospective cohort study was conducted using data from 325 previously antiretroviral medication-naive HIV-infected individuals initiating first antiretroviral therapy from 1997 through 2003. The setting was an inner-city safety net hospital and HIV clinic in the US. Adherence was assessed using pharmacy refill data. The average wholesale price was used for prescription costs. Healthcare utilization data and medical costs were obtained from the hospital billing database, and differences according to quartile of adherence were compared using analysis of variance (ANOVA). Multivariate logistic regression was used to assess predictors of higher annual medical costs. Sensitivity analyses were used to examine alternative antiretroviral pricing schemes. The perspective was that of the healthcare provider, and costs were in year 2005 values. Results In 325 patients followed for a mean (± SD) 3.2 (1.9) years, better adherence was associated with lower healthcare utilization but higher total medical costs. Annual non-antiretroviral medical costs were $US7612 in the highest adherence quartile versus $US10 190 in the lowest adherence quartile. However, antiretroviral costs were significantly higher in the highest adherence quartile ($US17 513 vs $US8690), and therefore the total annual medical costs were also significantly higher in the highest versus lowest adherence quartile ($US25 125 vs $US18 880). In multivariate analysis, for every 10% increase in adherence, the odds of having annual medical costs in the highest versus lowest quartile increased by 87% (odds ratio 1.87; 95% CI 1.45, 2.40). In sensitivity analyses, very low antiretroviral prices (as seen in resource-limited settings) inverted this

  16. The association of adherence to antiretroviral therapy with healthcare utilization and costs for medical care.

    PubMed

    Gardner, Edward M; Maravi, Moises E; Rietmeijer, Cornelis; Davidson, Arthur J; Burman, William J

    2008-01-01

    The association between antiretroviral adherence, healthcare utilization and medical costs has not been well studied. To examine the relationship of adherence to antiretroviral medications to healthcare utilization and healthcare costs. A retrospective cohort study was conducted using data from 325 previously antiretroviral medication-naive HIV-infected individuals initiating first antiretroviral therapy from 1997 through 2003. The setting was an inner-city safety net hospital and HIV clinic in the US. Adherence was assessed using pharmacy refill data. The average wholesale price was used for prescription costs. Healthcare utilization data and medical costs were obtained from the hospital billing database, and differences according to quartile of adherence were compared using analysis of variance (ANOVA). Multivariate logistic regression was used to assess predictors of higher annual medical costs. Sensitivity analyses were used to examine alternative antiretroviral pricing schemes. The perspective was that of the healthcare provider, and costs were in year 2005 values. In 325 patients followed for a mean (+/- SD) 3.2 (1.9) years, better adherence was associated with lower healthcare utilization but higher total medical costs. Annual non-antiretroviral medical costs were $US 7,612 in the highest adherence quartile versus $US 10,190 in the lowest adherence quartile. However, antiretroviral costs were significantly higher in the highest adherence quartile ($US 17,513 vs $US 8,690), and therefore the total annual medical costs were also significantly higher in the highest versus lowest adherence quartile ($US 25,125 vs $US 18,880). In multivariate analysis, for every 10% increase in adherence, the odds of having annual medical costs in the highest versus lowest quartile increased by 87% (odds ratio 1.87; 95% CI 1.45, 2.40). In sensitivity analyses, very low antiretroviral prices (as seen in resource-limited settings) inverted this relationship - excellent adherence

  17. Low cost RFID real lightweight binding proof protocol for medication errors and patient safety.

    PubMed

    Yu, Yao-Chang; Hou, Ting-Wei; Chiang, Tzu-Chiang

    2012-04-01

    An Institute of Medicine Report stated there are 98,000 people annually who die due to medication related errors in the United States, and hospitals and other medical institutions are thus being pressed to use technologies to reduce such errors. One approach is to provide a suitable protocol that can cooperate with low cost RFID tags in order to identify patients. However, existing low cost RFID tags lack computational power and it is almost impossible to equip them with security functions, such as keyed hash function. To address this issue, a so a real lightweight binding proof protocol is proposed in this paper. The proposed protocol uses only logic gates (e.g. AND, XOR, ADD) to achieve the goal of proving that two tags exist in the field simultaneously, without the need for any complicated security algorithms. In addition, various scenarios are provider to explain the process of adopting this binding proof protocol with regard to guarding patient safety and preventing medication errors.

  18. Psychiatric Correlates of Medical Care Costs among Veterans Receiving Mental Health Care

    ERIC Educational Resources Information Center

    Simpson, Tracy L.; Moore, Sally A.; Luterek, Jane; Varra, Alethea A.; Hyerle, Lynne; Bush, Kristen; Mariano, Mary Jean; Liu, Chaun-Fen; Kivlahan, Daniel R.

    2012-01-01

    Research on increased medical care costs associated with posttraumatic sequelae has focused on posttraumatic stress disorder (PTSD). However, the provisional diagnosis of Disorders of Extreme Stress Not Otherwise Specified (DESNOS) encompasses broader trauma-related difficulties and may be uniquely related to medical costs. We investigated whether…

  19. Psychiatric Correlates of Medical Care Costs among Veterans Receiving Mental Health Care

    ERIC Educational Resources Information Center

    Simpson, Tracy L.; Moore, Sally A.; Luterek, Jane; Varra, Alethea A.; Hyerle, Lynne; Bush, Kristen; Mariano, Mary Jean; Liu, Chaun-Fen; Kivlahan, Daniel R.

    2012-01-01

    Research on increased medical care costs associated with posttraumatic sequelae has focused on posttraumatic stress disorder (PTSD). However, the provisional diagnosis of Disorders of Extreme Stress Not Otherwise Specified (DESNOS) encompasses broader trauma-related difficulties and may be uniquely related to medical costs. We investigated whether…

  20. Cost analyses approaches in medical education: there are no simple solutions.

    PubMed

    Walsh, Kieran; Levin, Henry; Jaye, Peter; Gazzard, James

    2013-10-01

    Medical education is expensive. Although we have made progress in working out 'what works' in medical education, there are few data on whether medical education offers value relative to cost. Research into cost and value in medical education is beset by problems. One of the major problems is the lack of clear definitions for many of the terms commonly used. Phrases such as cost-effectiveness analysis, cost-benefit analysis, cost-utility analysis and cost-feasibility analysis are used without authors explaining to readers what they mean (and sometimes without authors themselves understanding what they mean). Sometimes such terms are used interchangeably and sometimes they are used as rhetorical devices without any real evidence that backs up such rhetoric as to the cost-effectiveness or otherwise of educational interventions. The frequent misuse of these terms is surprising considering the importance of the topics under consideration and the need for precision in many aspects of medical education. Here we define commonly used terms in cost analyses and give examples of their usage in the context of medical education. Cost-effectiveness analysis refers to the evaluation of two or more alternative educational approaches or interventions according to their costs and their effects in producing a certain outcome. Cost-benefit analysis refers to 'the evaluation of alternatives according to their costs and benefits when each is measured in monetary terms'. Cost-utility analysis is the examination of two or more alternatives according to their cost and their utility. In this context, utility means the satisfaction among individuals as a result of one or more outcome or the perceived value of the expected outcomes to a particular constituency. Cost-feasibility analysis involves simply measuring the cost of a proposed intervention in order to decide whether it is feasible. © 2013 John Wiley & Sons Ltd.

  1. EOS Operations Systems: EDOS Implemented Changes to Reduce Operations Costs

    NASA Technical Reports Server (NTRS)

    Cordier, Guy R.; Gomez-Rosa, Carlos; McLemore, Bruce D.

    2007-01-01

    The authors describe in this paper the progress achieved to-date with the reengineering of the Earth Observing System (EOS) Data and Operations System (EDOS), the experience gained in the process and the ensuing reduction of ground systems operations costs. The reengineering effort included a major methodology change, applying to an existing schedule driven system, a data-driven system approach.

  2. Reducing Building HVAC Costs with Site-Recovery Energy

    ERIC Educational Resources Information Center

    Pargeter, Stephen J.

    2012-01-01

    Building owners are caught between two powerful forces--the need to lower energy costs and the need to meet or exceed outdoor air ventilation regulations for occupant health and comfort. Large amounts of energy are wasted each day from commercial, institutional, and government building sites as heating, ventilation, and air conditioning (HVAC)…

  3. RAM - A concept for reducing space payload costs.

    NASA Technical Reports Server (NTRS)

    Powell, D. J.

    1972-01-01

    The post-Apollo era in manned space flight will be dominated in the short term by development of the space shuttle as an economical transportation system for payloads to low earth orbit. Research and Applications Modules (RAM) are a related group of shuttle-launched carriers for such payloads which can be used many times over, thus effecting great savings over currently conventional methods of implementing a program of this type. In order to maximize the potential savings, development and unit costs of the RAM vehicles must be minimized. All of the mission and operating modes can be covered in an economical fashion by the use of only three basic RAM elements - a pressurized module, an unpressurized pallet, and a pressurizable free-flying unit utilized in several combinations. These have been developed as a least cost approach through the consideration of such cost/weight related drivers as available crew size, separability of costly subsystems for multiple use, easy accessibility for maintenance/refurbishment for reuse, and a maximum commonality of hardware with existing and projected space projects.

  4. 25 Ways to Reduce the Cost of College

    ERIC Educational Resources Information Center

    Vedder, Richard; Gillen, Andrew; Bennett, Daniel; Denhart, Matthew; Robe, Jonathan; Holbrook, Todd; Neiger, Peter; Coleman, James; Templeton, Jordan; Leirer, Jonathan; Myers, Luke; Brady, Ryan; Malesick, Michael

    2010-01-01

    The Center for College Affordability and Productivity (CCAP) is an independent, nonprofit research center based in Washington, DC that is dedicated to researching public policy and economic issues relating to postsecondary education. CCAP aims to facilitate a broader dialogue that challenges conventional thinking about costs, efficiency and…

  5. Target Context Specification Can Reduce Costs in Nonfocal Prospective Memory

    ERIC Educational Resources Information Center

    Lourenço, Joana S.; White, Katherine; Maylor, Elizabeth A.

    2013-01-01

    Performing a nonfocal prospective memory (PM) task results in a cost to ongoing task processing, but the precise nature of the monitoring processes involved remains unclear. We investigated whether target context specification (i.e., explicitly associating the PM target with a subset of ongoing stimuli) can trigger trial-by-trial changes in task…

  6. Improving Learning and Reducing Costs: New Models for Online Learning.

    ERIC Educational Resources Information Center

    Twigg, Carol A.

    2003-01-01

    Describes five course redesign models (supplemental, replacement, emporium, fully online, and buffet) used by grantees of the Program in Course Redesign sponsored by the Pew Charitable Trusts. The grants helped colleges redesign instruction using technology to achieve quality enhancements as well as cost savings. (EV)

  7. Reducing High Absenteeism through Low-Cost Incentives.

    ERIC Educational Resources Information Center

    North Chaplik, Barbara D.; Engel, Ross A.

    1984-01-01

    Describes a study of the effects of a low-cost incentive program--including daily, weekly, and monthly reinforcements such as attention, approval, and inexpensive awards--on the absenteeism of high-absence employees in an urban school district's transportation department. A 20-percent reduction in absenteeism was achieved. (TE)

  8. Improving Benefits and Reducing Costs: Managing Educational Secondments.

    ERIC Educational Resources Information Center

    McMichael, Paquita; And Others

    1995-01-01

    A (British) educational "secondment" involves resource allocation from one institution to another and new forms of employee accountability and commitment. This article examines management implications of educational secondments, exploring costs and benefits accruing to 50 secondees, their seconding organizations, and those to which they…

  9. Management Science/Industrial Engineering Techniques to Reduce Food Costs.

    ERIC Educational Resources Information Center

    Greenberg, Murray

    This paper examines the contributions of Industrial Engineering and Management Science toward reduction in the cost of production and distribution of food. Food processing firms were requested to respond to a questionnaire which asked for examples of their use of various operations research tools and information on the number of operations…

  10. Target Context Specification Can Reduce Costs in Nonfocal Prospective Memory

    ERIC Educational Resources Information Center

    Lourenço, Joana S.; White, Katherine; Maylor, Elizabeth A.

    2013-01-01

    Performing a nonfocal prospective memory (PM) task results in a cost to ongoing task processing, but the precise nature of the monitoring processes involved remains unclear. We investigated whether target context specification (i.e., explicitly associating the PM target with a subset of ongoing stimuli) can trigger trial-by-trial changes in task…

  11. Medical costs of smoking in the United States: estimates, their validity, and their implications

    PubMed Central

    Warner, K.; Hodgson, T.; Carroll, C.

    1999-01-01

    OBJECTIVE—To compare estimates of the medical costs of smoking in the United States and to consider their relevance to assessing the costs of smoking in developing countries and the net economic burden of smoking.
DATA SOURCES—A Medline search through early 1999 using keywords "smoking" and "cost", with review of article reference lists.
STUDY SELECTION—Peer-reviewed papers examining medical costs in a single year, covering the non-institutionalised American population.
DATA EXTRACTION—Methods underlying study estimates were identified, described, and compared with attributable expenditure methodology in the literature dealing with costs of illness. Differences in methods were associated with implied differences in findings.
DATA SYNTHESIS—With one exception, the studies find the annual medical costs of smoking to constitute approximately 6-8% of American personal health expenditures. The exception, a recent study, found much larger attributable expenditures. The lower estimates may reflect the limitation of analysis to costs associated with the principal smoking-related diseases. The higher estimate derives from analysis of smoking-attributable differences in all medical costs. However, the finding from the most recent study, also considering all medical costs, fell in the 6-8% range.
CONCLUSIONS—The medical costs of smoking in the United States equal, and may well exceed, the commonly referenced figure of 6-8%. This literature has direct methodological relevance to developing countries interested in assessing the magnitude of their current cost-of-smoking burden and their future burdens, with differences in tobacco use histories and the availability of chronic disease treatment affecting country-specific estimates. The debate over the use of gross or net medical cost estimates is likely to intensify with the proliferation of lawsuits against the tobacco industry to recover expenditures on tobacco-produced disease.


Keywords: medical

  12. Prescription patterns and costs of acne/rosacea medications in Medicare patients vary by prescriber specialty.

    PubMed

    Zhang, Myron; Silverberg, Jonathan I; Kaffenberger, Benjamin H

    2017-09-01

    Prescription patterns for acne/rosacea medications have not been described in the Medicare population, and comparisons across specialties are lacking. To describe the medications used for treating acne/rosacea in the Medicare population and evaluate differences in costs between specialties. A cross-sectional study was performed of the 2008 and 2010 Centers for Medicare and Medicaid Services Prescription Drug Profiles, which contains 100% of Medicare part D claims. Topical antibiotics accounted for 63% of all prescriptions. Patients ≥65 years utilized more oral tetracycline-class antibiotics and less topical retinoids. Specialists prescribed brand name drugs for the most common topical retinoids and most common topical antibiotics more frequently than family medicine/internal medicine (FM/IM) physicians by 6%-7%. Topical retinoids prescribed by specialists were, on average, $18-$20 more in total cost and $2-$3 more in patient cost than the same types of prescriptions from FM/IM physicians per 30-day supply. Specialists (60%) and IM physicians (56%) prescribed over twice the rate of branded doxycycline than FM doctors did (27%). The total and patient costs for tetracycline-class antibiotics were higher from specialists ($18 and $4 more, respectively) and IM physicians ($3 and $1 more, respectively) than they were from FM physicians. The data might contain rare prescriptions used for conditions other than acne/rosacea, and suppression algorithms might underestimate the number of specialist brand name prescriptions. Costs of prescriptions for acne/rosacea from specialists are higher than those from primary care physicians and could be reduced by choosing generic and less expensive options. Copyright © 2017 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.

  13. Patient-centered medical homes in Louisiana had minimal impact on Medicaid population's use of acute care and costs.

    PubMed

    Cole, Evan S; Campbell, Claudia; Diana, Mark L; Webber, Larry; Culbertson, Richard

    2015-01-01

    The patient-centered medical home model of primary care has received considerable attention for its potential to improve outcomes and reduce health care costs. Yet little information exists about the model's ability to achieve these goals for Medicaid patients. We sought to evaluate the effect of patient-centered medical home certification of Louisiana primary care clinics on the quality and cost of care over time for a Medicaid population. We used a quasi-experimental pre-post design with a matched control group to assess the effect of medical home certification on outcomes. We found no impact on acute care use and modest support for reduced costs and primary care use among medical homes serving higher proportions of chronically ill patients. These findings provide preliminary results related to the ability of the patient-centered medical home model to improve outcomes for Medicaid beneficiaries. The findings support a case-mix-adjusted payment policy for medical homes going forward. Project HOPE—The People-to-People Health Foundation, Inc.

  14. Medical costs of war in 2035: long-term care challenges for veterans of Iraq and Afghanistan.

    PubMed

    Geiling, James; Rosen, Joseph M; Edwards, Ryan D

    2012-11-01

    War-related medical costs for U.S. veterans of Iraq and Afghanistan may be enormous because of differences between these wars and previous conflicts: (1) Many veterans survive injuries that would have killed them in past wars, and (2) improvised explosive device attacks have caused "polytraumatic" injuries (multiple amputations; brain injury; severe facial trauma or blindness) that require decades of costly rehabilitation. In 2035, today's veterans will be middle-aged, with health issues like those seen in aging Vietnam veterans, complicated by comorbidities of posttraumatic stress disorder, traumatic brain injury, and polytrauma. This article cites emerging knowledge about best practices that have demonstrated cost-effectiveness in mitigating the medical costs of war. We propose that clinicians employ early interventions (trauma care, physical therapy, early post-traumatic stress disorder diagnosis) and preventive health programs (smoking cessation, alcohol-abuse counseling, weight control, stress reduction) to treat primary medical conditions now so that we can avoid treating costly secondary and tertiary complications in 2035. (We should help an amputee reduce his cholesterol and maintain his weight at age 30, rather than treating his heart disease or diabetes at age 50.) Appropriate early interventions for primary illness should preserve veterans' functional status, ensure quality clinical care, and reduce the potentially enormous cost burden of their future health care.

  15. Medical Abortion Provided by Nurse-Midwives or Physicians in a High Resource Setting: A Cost-Effectiveness Analysis.

    PubMed

    Sjöström, Susanne; Kopp Kallner, Helena; Simeonova, Emilia; Madestam, Andreas; Gemzell-Danielsson, Kristina

    2016-01-01

    The objective of the present study is to calculate the cost-effectiveness of early medical abortion performed by nurse-midwifes in comparison to physicians in a high resource setting where ultrasound dating is part of the protocol. Non-physician health care professionals have previously been shown to provide medical abortion as effectively and safely as physicians, but the cost-effectiveness of such task shifting remains to be established. A cost effectiveness analysis was conducted based on data from a previously published randomized-controlled equivalence study including 1180 healthy women randomized to the standard procedure, early medical abortion provided by physicians, or the intervention, provision by nurse-midwifes. A 1.6% risk difference for efficacy defined as complete abortion without surgical interventions in favor of midwife provision was established which means that for every 100 procedures, the intervention treatment resulted in 1.6 fewer incomplete abortions needing surgical intervention than the standard treatment. The average direct and indirect costs and the incremental cost-effectiveness ratio (ICER) were calculated. The study was conducted at a university hospital in Stockholm, Sweden. The average direct costs per procedure were EUR 45 for the intervention compared to EUR 58.3 for the standard procedure. Both the cost and the efficacy of the intervention were superior to the standard treatment resulting in a negative ICER at EUR -831 based on direct costs and EUR -1769 considering total costs per surgical intervention avoided. Early medical abortion provided by nurse-midwives is more cost-effective than provision by physicians. This evidence provides clinicians and decision makers with an important tool that may influence policy and clinical practice and eventually increase numbers of abortion providers and reduce one barrier to women's access to safe abortion.

  16. Reinforcement of emergency department reduces acute admissions to medical department.

    PubMed

    Dawood, Mansoor Ahmed; Ertner, Gideon; Hansen-Schwartz, Jacob

    2016-12-01

    The medical decision capacity of emergency departments (ED) may rest within the department itself or depend on external consultation. The stepwise development of the ED at Zealand University Hospital, Køge, was used to analyse the influence of medical organisation in the ED on the hospital admission pattern. Data were recorded for the month of September of 2009, 2012 and 2014. These periods corresponded to the establishment of the department in 2009 and the 2012-period before organisational change was initiated in 2013, with a substantial increase in the number of senior physicians directly in charge of clinical decisions and the establishment of a limited bedding capacity. In 2014, the changes had been fully implemented. We analysed the number of patients admitted and their length of stay (LOS) in the ED and in the Department of Internal Medicine (DoM). The 30-day readmission and mortality rates were used as quality indicators. A total of 1,106, 1,354 and 1,470 patients were admitted to the ED in 2009, 2012 and 2014, respectively. In 2009 and 2012, 42% of the patients were admitted to the DoM. In 2014, only 22% were admitted. The mean LOS for long-term admission at the DoM increased by 1.4 days from 2009 to 2014. Readmission and mortality rates did not change in three periods analysed. Independent medical decision capacity and bed resources in the ED effectively change hospital logistics and reduce the number of admissions without negatively affecting patient safety in terms of readmission or short-term mortality. none. not relevant.

  17. Court ruling demonstrates ACA's power to reduce future medical expenses.

    PubMed

    Jenny, Leslie M

    2016-04-01

    Industry insiders who handle litigation involving catastrophic injury cases have eagerly awaited the first rulings to address the impact, if any, of the Affordable Care Act (ACA), often referred to as Obamacare, on claims for future damages. Before the ACA, it was uncertain whether injured individuals would have health insurance to cover ever-growing health care costs in the future. Consequently, in most jurisdictions, the applicable rule of law has prevented the argument that future damages should be reduced because of the availability of health insurance. Because of this, damages have remained essentially unrebutted, and the law has permitted such unrebutted damage projections to be calculated into the future. These projections, primarily in the form of life care plans, are generally the single largest financial component of damage claims. Such plans often project massive expenses that can drive equally massive jury verdicts. © 2016 American Society for Healthcare Risk Management of the American Hospital Association.

  18. Reducing costly zebra mussel infestations at power plants

    SciTech Connect

    Smythe, G.

    1994-10-01

    The fast-spreading-zebra mussel has significant potential to foul intakes and other water systems at North American hydro projects. Chemical controls can be effective in reducing infestations, but most have environmental and other drawbacks. Several non-chemical methods promise to help project operators reduce problems associated with the mussels.

  19. Evaluation of specialized medication packaging combined with medication therapy management: adherence, outcomes, and costs among Medicaid patients.

    PubMed

    Zillich, Alan J; Jaynes, Heather A W; Snyder, Margie E; Harrison, Jeff; Hudmon, Karen Suchanek; de Moor, Carl; French, Dustin D

    2012-06-01

    This study evaluates the effect of a program combing specialized medication packaging and telephonic medication therapy management on medication adherence, health care utilization, and costs among Medicaid patients. A retrospective cohort design compared Medicaid participants who voluntarily enrolled in the program (n = 1007) compared with those who did not (n = 13,614). Main outcome measures were medication adherence at 12 months, hospital admissions and emergency department visits at 6 and 12 months, and total paid claim costs at 6 and 12 months. Multivariate regression models were used to adjust for the effect of age, sex, race, comorbidities, and 12-month preenrollment health care utilization. Measures of medication adherence were significantly improved in the program cohort compared with the usual care cohort. At 6 months, adjusted all-cause hospitalization was marginally less in the program cohort compared with the usual care cohort [odds ratio = 0.73, 95% confidence interval (CI), 0.54-1.0, P = 0.05]. No statistically significant differences were observed between the 2 cohorts for any of the other adjusted utilization endpoints at 6 or 12 months. Adjusted total cost at 6 and 12 months were higher in the program cohort (6-month cost ratio = 1.76, 95% CI,1.65-1.89; 12-month cost ratio = 1.84, 95% CI,1.72-1.97), primarily because of an increase in prescription costs. Emergency department visits and hospitalization costs did not differ between groups. : The program improved measures of medication adherence, but the effect on health care utilization and nonpharmacy costs at 6 and 12 months was not different from the usual care group. Reasons for these findings may reflect differences in the delivery of the specialized packaging and the medication therapy management program, health care behaviors in this Medicaid cohort, unadjusted confounding, or time required for the benefit of the intervention to manifest.

  20. A method for reducing software life cycle costs

    NASA Technical Reports Server (NTRS)

    Paine, W. O.; Holland, J. C.

    1977-01-01

    The advent of new hardware and software tools permits a new approach to preparing, presenting, and maintaining software specifications and corresponding source programs. Any real reduction in software life cycle costs must make highly skilled human effort more efficient especially on large, complex, and long-lasting software projects. When these skilled human functions are examined closely, it is seen that critical factors include the way one communicates with oneself and then with others and finally with computers. Thus, there has been a long and active proliferation of programming languages and, more recently, a number of programming design languages to supplement older methods, such as flowcharting. One way to achieve cost reduction is to provide documentation tools whose use increases the effectiveness of skilled humans.

  1. Action video game experience reduces the cost of switching tasks.

    PubMed

    Cain, Matthew S; Landau, Ayelet N; Shimamura, Arthur P

    2012-05-01

    Video game expertise has been shown to have beneficial effects for visual attention processes, but the effects of action video game playing on executive functions, such as task switching and filtering out distracting information, are less well understood. In the main experiment presented here, video game players (VGPs) and nonplayers (nVGPs) switched between two tasks of unequal familiarity: a familiar task of responding in the direction indicated by an arrow, and a novel task of responding in the opposite direction. nVGPs had large response time costs for switching from the novel task to the familiar task, and small costs for switching from the familiar task to the novel task, replicating prior findings. However, as compared to the nVGPs, VGPs were more facile in switching between tasks, producing overall smaller and more symmetric switching costs, suggesting that experience with action video games produces improvements in executive functioning. In contrast, VGPs and nVGPs did not differ in filtering out the irrelevant flanking stimuli or in remembering details of aurally presented stories. The lack of global differences between the groups suggests that the improved task-switching performance seen in VGPs was not due to differences in global factors, such as VGPs being more motivated than nVGPs.

  2. Using the Army Medical Cost Avoidance Model to prioritize preventive medicine initiatives.

    PubMed

    Smith, Cindy; McCoskey, Kelsey; Clasing, Jay; Kluchinsky, Timothy A

    2014-01-01

    The MCAM's ICD-9 Analysis Tool provides preventive medicine program developers with a powerful tool to demonstrate ROI. Previously disjointed cost components have been brought together in the MCAM to calculate the total medical cost avoided. Users are required to make 4 data entries. In response, the user receives the highly coveted medical cost avoidance that should be realized. The SPHMP example demonstrates how simple it is to use the MCAM to determine the expected ROI.

  3. Utilization of UV Curing Technology to Significantly Reduce the Manufacturing Cost of LIB Electrodes

    SciTech Connect

    Voelker, Gary; Arnold, John

    2015-11-30

    Previously identified novel binders and associated UV curing technology have been shown to reduce the time required to apply and finish electrode coatings from tens of minutes to less than one second. This revolutionary approach can result in dramatic increases in process speeds, significantly reduced capital (a factor of 10 to 20) and operating costs, reduced energy requirements, and reduced environmental concerns and costs due to the virtual elimination of harmful volatile organic solvents and associated solvent dryers and recovery systems. The accumulated advantages of higher speed, lower capital and operating costs, reduced footprint, lack of VOC recovery, and reduced energy cost is a reduction of 90% in the manufacturing cost of cathodes. When commercialized, the resulting cost reduction in Lithium batteries will allow storage device manufacturers to expand their sales in the market and thereby accrue the energy savings of broader utilization of HEVs, PHEVs and EVs in the U.S., and a broad technology export market is also envisioned.

  4. A multidisciplinary intervention for reducing readmissions among older adults in a patient-centered medical home.

    PubMed

    Stranges, Paul M; Marshall, Vincent D; Walker, Paul C; Hall, Karen E; Griffith, Diane K; Remington, Tami

    2015-02-01

    To evaluate the effectiveness of a multidisciplinary practice model consisting of medical providers, clinical pharmacists, and social workers on reducing 30-day all-cause readmissions. Retrospective cohort study. This study included adults 60 years or older discharged from a large academic medical center. Patients were grouped as either receiving the primary care-based transitional care program (intervention group) or usual care (control group) after an index hospitalization. Only 1 index hospitalization was included per patient. All-cause 30-day readmission rates between propensity score matched study groups were analyzed by intention-to-treat, per protocol, and as-treated methods. Secondary outcomes included time to readmission, subgroup analysis, process measures, and cost avoidance influence of covariates on chance of readmission measured by logistic regression. Over 27 months, 19,169 unique patients had 18,668 index hospitalizations and 572 interventions scheduled after discharge. Among matched subjects, 30-day readmission rates were not significantly different between those scheduled for the intervention and those never scheduled (21% vs 17.3%, respectively; P = .133). However, when those completing the intervention (n = 217) were examined, readmission rates were significantly reduced (11.7% vs 17.3%, respectively; P < .001). Likewise, time to readmission was significantly longer among those receiving the intervention (18 ± 9 days compared with 12 ± 9 days with usual care; P = .015) and potential cost avoidance was observed only when the intervention was completed. A community-based multidisciplinary transitional care program may reduce hospital readmissions among older adults.

  5. Food Insecurity and Cost-Related Medication Underuse Among Nonelderly Adults in a Nationally Representative Sample

    PubMed Central

    Afulani, Patience; Coleman-Jensen, Alisha; Harrison, Gail G.

    2015-01-01

    Objectives. We investigated whether nonelderly US adults (aged 18–64 years) in food-insecure households are more likely to report cost-related medication underuse than the food-secure, and whether the relationship between food insecurity and cost-related medication underuse differs by gender, chronic disease, and health insurance status. Methods. We analyzed data from the 2011 and 2012 National Health Interview Survey (n = 67 539). We examined the relationship between food insecurity and cost-related medication underuse with the χ2 test and multivariate logistic regression with interaction terms. Results. Bivariate and multivariate analyses showed a dose–response relationship between food insecurity and cost-related medication underuse, with an increasing likelihood of cost-related medication underuse with increasing severity of food insecurity (P < .001). This association was conditional on health insurance status, but not substantially different by gender or chronic disease status. Being female, low-income, having no or partial health insurance, chronic conditions, functional limitations, or severe mental illness were positively associated with cost-related medication underuse. Conclusions. Using food insecurity as a risk factor to assess cost-related medication underuse could help increase identification of individuals who may need assistance purchasing medications and improve health for those in food-insecure households. PMID:26270308

  6. Comparison of United States and Canadian Glaucoma Medication Costs and Price Change from 2006 to 2013

    PubMed Central

    Schlenker, Matthew B.; Trope, Graham E.; Buys, Yvonne M.

    2015-01-01

    Objective. Compare glaucoma medication costs between the United States (USA) and Canada. Methods. We modelled glaucoma brand name and generic medication annual costs in the USA and Canada based on October 2013 Costco prices and previously reported bottle overfill rates, drops per mL, and wastage adjustment. We also calculated real wholesale price changes from 2006 to 2013 based on the Average Wholesale Price (USA) and the Ontario Drug Benefit Price (Canada). Results. US brand name medication costs were on average 4x more than Canadian medication costs (range: 1.9x–6.9x), averaging a cost difference of $859 annually. US generic costs were on average the same as Canadian costs, though variation exists. US brand name wholesale prices increased from 2006 to 2013 more than Canadian prices (US range: 29%–349%; Canadian range: 9%–16%). US generic wholesale prices increased modestly (US range: −23%–58%), and Canadian wholesale prices decreased (Canadian range: −38%–0%). Conclusions. US brand name glaucoma medications are more expensive than Canadian medications, though generic costs are similar (with some variation). The real prices of brand name medications increased more in the USA than in Canada. Generic price changes were more modest, with real prices actually decreasing in Canada. PMID:25922760

  7. Comparison of United States and canadian glaucoma medication costs and price change from 2006 to 2013.

    PubMed

    Schlenker, Matthew B; Trope, Graham E; Buys, Yvonne M

    2015-01-01

    Objective. Compare glaucoma medication costs between the United States (USA) and Canada. Methods. We modelled glaucoma brand name and generic medication annual costs in the USA and Canada based on October 2013 Costco prices and previously reported bottle overfill rates, drops per mL, and wastage adjustment. We also calculated real wholesale price changes from 2006 to 2013 based on the Average Wholesale Price (USA) and the Ontario Drug Benefit Price (Canada). Results. US brand name medication costs were on average 4x more than Canadian medication costs (range: 1.9x-6.9x), averaging a cost difference of $859 annually. US generic costs were on average the same as Canadian costs, though variation exists. US brand name wholesale prices increased from 2006 to 2013 more than Canadian prices (US range: 29%-349%; Canadian range: 9%-16%). US generic wholesale prices increased modestly (US range: -23%-58%), and Canadian wholesale prices decreased (Canadian range: -38%-0%). Conclusions. US brand name glaucoma medications are more expensive than Canadian medications, though generic costs are similar (with some variation). The real prices of brand name medications increased more in the USA than in Canada. Generic price changes were more modest, with real prices actually decreasing in Canada.

  8. Learning to improve medical decision making from imbalanced data without a priori cost.

    PubMed

    Wan, Xiang; Liu, Jiming; Cheung, William K; Tong, Tiejun

    2014-12-05

    In a medical data set, data are commonly composed of a minority (positive or abnormal) group and a majority (negative or normal) group and the cost of misclassifying a minority sample as a majority sample is highly expensive. This is the so-called imbalanced classification problem. The traditional classification functions can be seriously affected by the skewed class distribution in the data. To deal with this problem, people often use a priori cost to adjust the learning process in the pursuit of optimal classification function. However, this priori cost is often unknown and hard to estimate in medical decision making. In this paper, we propose a new learning method, named RankCost, to classify imbalanced medical data without using a priori cost. Instead of focusing on improving the class-prediction accuracy, RankCost is to maximize the difference between the minority class and the majority class by using a scoring function, which translates the imbalanced classification problem into a partial ranking problem. The scoring function is learned via a non-parametric boosting algorithm. We compare RankCost to several representative approaches on four medical data sets varying in size, imbalanced ratio, and dimension. The experimental results demonstrate that unlike the currently available methods that often perform unevenly with different priori costs, RankCost shows comparable performance in a consistent manner. It is a challenging task to learn an effective classification model based on imbalanced data in medical data analysis. The traditional approaches often use a priori cost to adjust the learning of the classification function. This work presents a novel approach, namely RankCost, for learning from medical imbalanced data sets without using a priori cost. The experimental results indicate that RankCost performs very well in imbalanced data classification and can be a useful method in real-world applications of medical decision making.

  9. 42 CFR 422.324 - Payments to MA organizations for graduate medical education costs.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... reasonable compensation to the non-hospital site for teaching activities. (c) An MA organization's allowable direct graduate medical education costs, subject to the redistribution and community support principles... teaching activities related to the training of medical residents. (d) The direct graduate medical education...

  10. Teaching Students the Relationship Between Quality and Cost of Medical Care

    ERIC Educational Resources Information Center

    Garg, Mohan; And Others

    1975-01-01

    The usefulness of hospital charges as a means of teaching medical students the relationship between the quality and the cost of medical care provided by primary care physicians (internists and family physicians) is presented. It is believed that such case studies can aid medical students in understanding their developing role as "generators of…

  11. Providing Medical Services to Undocumented Immigrants: Costs and Public Policy.

    ERIC Educational Resources Information Center

    Arnold, Fred

    1979-01-01

    Reviews cost estimates for treating illegal aliens made by hospitals and county governments. Discusses patterns of utilization of health services by illegal immigrant groups and the difficulties in arriving at accurate cost estimates. Describes the current status of legislative programs that address this issue. (Author/GC)

  12. The Ethics of Drone Strikes: Does Reducing the Cost of Conflict Encourage War?

    DTIC Science & Technology

    2015-09-01

    THE ETHICS OF DRONE STRIKES: UNITED STATES ARMY WAR COLLEGE PRESS Carlisle Barracks,PA .., ST R ENGTH.-W I SDOM DOES REDUCING THE COST OF...COVERED 00-00-2015 to 00-00-2015 4. TITLE AND SUBTITLE The Ethics of Drone Strikes: Does Reducing the Cost of Conflict Encourage War? 5a...Press THE ETHICS OF DRONE STRIKES: DOES REDUCING THE COST OF CONFLICT ENCOURAGE WAR? James Igoe Walsh and Marcus Schulzke September 2015 The views

  13. Prevalence and cost of hospital medical errors in the general and elderly United States populations.

    PubMed

    Mallow, Peter J; Pandya, Bhavik; Horblyuk, Ruslan; Kaplan, Harold S

    2013-12-01

    The primary objective of this study was to quantify the differences in the prevalence rate and costs of hospital medical errors between the general population and an elderly population aged ≥65 years. Methods from an actuarial study of medical errors were modified to identify medical errors in the Premier Hospital Database using data from 2009. Visits with more than four medical errors were removed from the population to avoid over-estimation of cost. Prevalence rates were calculated based on the total number of inpatient visits. There were 3,466,596 total inpatient visits in 2009. Of these, 1,230,836 (36%) occurred in people aged ≥ 65. The prevalence rate was 49 medical errors per 1000 inpatient visits in the general cohort and 79 medical errors per 1000 inpatient visits for the elderly cohort. The top 10 medical errors accounted for more than 80% of the total in the general cohort and the 65+ cohort. The most costly medical error for the general population was postoperative infection ($569,287,000). Pressure ulcers were most costly ($347,166,257) in the elderly population. This study was conducted with a hospital administrative database, and assumptions were necessary to identify medical errors in the database. Further, there was no method to identify errors of omission or misdiagnoses within the database. This study indicates that prevalence of hospital medical errors for the elderly is greater than the general population and the associated cost of medical errors in the elderly population is quite substantial. Hospitals which further focus their attention on medical errors in the elderly population may see a significant reduction in costs due to medical errors as a disproportionate percentage of medical errors occur in this age group.

  14. Total medical costs of treating femoral neck fracture patients with hemi- or total hip arthroplasty: a cost analysis of a multicenter prospective study.

    PubMed

    Burgers, P T P W; Hoogendoorn, M; Van Woensel, E A C; Poolman, R W; Bhandari, M; Patka, P; Van Lieshout, E M M

    2016-06-01

    The aim of this study was to determine the total medical costs for treating displaced femoral neck fractures with hemi- or total hip arthroplasty in fit elderly patients. The mean total costs per patient at 2 years of follow-up were €26,399. These results contribute to cost awareness. The absolute number of hip fractures is rising and increases the already significant burden on society. The aim of this study was to determine the mean total medical costs per patient for treating displaced femoral neck fractures with hemi- or total hip arthroplasty in fit elderly patients. The population was the Dutch sample of an international randomized controlled trial consisting of femoral neck fracture patients treated with hemi- or total hip arthroplasty. Patient data and health care utilization were prospectively collected during a total follow-up period of 2 years. Costs were separated into costs for hospital care during primary stay, hospital costs for clinical follow-up, and costs generated outside the hospital during rehabilitation. Multiple imputations were used to account for missing data. Data of 141 participants (mean age 81 years) were included in the analysis. The 2-year mortality rate was 19 %. The mean total cost per patient after 10 weeks of follow-up was €15,216. After 1 and 2 years of follow-up the mean total costs were €23,869 and €26,399, respectively. Rehabilitation was the main cost determinant, and accounted for 46 % of total costs. Primary hospital admission days accounted for 22 % of the total costs, index surgery for 11 %, and physical therapy for 7 %. The main cost determinants for hemi- or total hip arthroplasty after treatment of displaced femoral neck fractures (€26,399 per patient until 2 years) were rehabilitation and nursing homes. Most of the costs were made in the first year. Reducing costs after hip fracture surgery should focus on improving the duration and efficiency of the rehabilitation phase.

  15. Reducing the burden of suffering from eating disorders: Unmet treatment needs, cost of illness, and the quest for cost-effectiveness.

    PubMed

    Striegel Weissman, Ruth; Rosselli, Francine

    2017-01-01

    Eating disorders are serious mental disorders as reflected in significant impairments in health and psychosocial functioning and excess mortality. Despite the clear evidence of clinical significance and despite availability of evidence-based, effective treatments, research has shown a paradox of elevated health services use and, yet, infrequent treatment specifically targeting the eating disorder (i.e., high unmet treatment need). This review paper summarizes key studies conducted in collaboration with G. Terence Wilson and offers an update of the research literature published since 2011 in three research areas that undergirded our collaborative research project: unmet treatment needs, cost of illness, and cost-effectiveness of treatments. In regards to unmet treatment needs, epidemiological studies find that the number of individuals with an eating disorder who do not receive disorder-specific treatment continues to remain high. Cost-of-illness show that eating disorders are associated with substantial financial burdens for individuals, their family, and society, yet comprehensive examination of costs across public sectors is lacking. Cost measures vary widely, making it difficult to draw firm conclusions. Hospitalization is a major driver of medical costs incurred by individuals with an eating disorder. Only a handful of cost-effectiveness studies have been conducted, leaving policy makers with little information on which to base decisions about allocation of resources to help reduce the burden of suffering attributable to eating disorders. Copyright © 2016 Elsevier Ltd. All rights reserved.

  16. Direct medical cost of overweight and obesity in the United States: a quantitative systematic review

    PubMed Central

    Tsai, Adam Gilden; Williamson, David F.; Glick, Henry A.

    2010-01-01

    Objectives To estimate per-person and aggregate direct medical costs of overweight and obesity and to examine the effect of study design factors. Methods PubMed (1968–2009), EconLit (1969–2009), and Business Source Premier (1995–2009) were searched for original studies. Results were standardized to compute the incremental cost per overweight person and per obese person, and to compute the national aggregate cost. Results A total of 33 U.S. studies met review criteria. Among the 4 highest quality studies, the 2008 per-person direct medical cost of overweight was $266 and of obesity was $1723. The aggregate national cost of overweight and obesity combined was $113.9 billion. Study design factors that affected cost estimate included: use of national samples versus more selected populations; age groups examined; inclusion of all medical costs versus obesity-related costs only; and BMI cutoffs for defining overweight and obesity. Conclusions Depending on the source of total national health care expenditures used, the direct medical cost of overweight and obesity combined is approximately 5.0% to 10% of U.S. health care spending. Future studies should include nationally representative samples, evaluate adults of all ages, report all medical costs, and use standard BMI cutoffs. PMID:20059703

  17. NASA operations: An agency wide approach to reduce cost

    NASA Technical Reports Server (NTRS)

    Squibb, Gael F.

    1996-01-01

    The NASA Space Operations Management Office (SOMO) is presented. The SOMO concept is based on continuing the distributed participation of the various NASA field centers and agencies, while employing consolidated management through a single lead center. The aim is to determine the duplicity and the overlap between the different agencies that independently developed their own operations management approaches in order to enable more cost effective mission operations by providing common services to the NASA programs. The space operations management will be performed in a distributed manner with a greater degree of contractor involvement than in the past. The changes, approaches and anticipated benefits of this approach to operations are discussed.

  18. Revisiting the cost of medical student education: a measure of the experience of UT Medical School-Houston.

    PubMed

    Gammon, Elizabeth; Franzini, Luisa

    2011-01-01

    This study uses a cost construction model to estimate the cost of a four-year undergraduate medical education at the University of Texas-Houston Medical School (UT-Houston) in 2006-2007 compared to 1994-1995. The model computes the cost by measuring increasingly inclusive definitions of the educational mission: instructional (direct-contact teaching), educational (instructional plus general supervision), and milieu (educational plus research costs). Using the model and adjusting for inflation, annual cost per student enrolled decreased by 16 percent in 2006-2007 compared to 1994-1995 and total cost decreased by 9 percent. Additionally, the model predicted 190 full-time equivalent (FTE) faculty and 187 FTE residents for 2006-2007 compared to 201 FTE faculty and 258 FTE residents for 1994-1995. Decreases in the cost of educating medical students were driven by (1) the reduction in the number of educator contact hours required for curriculum delivery; (2) change in the mix of educators; and (3) an increase in medical school class size.

  19. A shared random effects model for censored medical costs and mortality.

    PubMed

    Liu, Lei; Wolfe, Robert A; Kalbfleisch, John D

    2007-01-15

    In this paper, we propose a model for medical costs recorded at regular time intervals, e.g. every month, as repeated measures in the presence of a terminating event, such as death. Prior models have related monthly medical costs to time since entry, with extra costs at the final observations at the time of death. Our joint model for monthly medical costs and survival time incorporates two important new features. First, medical cost and survival may be correlated because more 'frail' patients tend to accumulate medical costs faster and die earlier. A joint random effects model is proposed to account for the correlation between medical costs and survival by a shared random effect. Second, monthly medical costs usually increase during the time period prior to death because of the intensive care for dying patients. We present a method for estimating the pattern of cost prior to death, which is applicable if the pattern can be characterized as an additive effect that is limited to a fixed time interval, say b units of time before death. This 'turn back time' method for censored observations censors cost data b units of time before the actual censoring time, while keeping the actual censoring time for the survival data. Time-dependent covariates can be included. Maximum likelihood estimation and inference are carried out through a Monte Carlo EM algorithm with a Metropolis-Hastings sampler in the E-step. An analysis of monthly outpatient EPO medical cost data for dialysis patients is presented to illustrate the proposed methods.

  20. Adaptive pacing, cognitive behaviour therapy, graded exercise, and specialist medical care for chronic fatigue syndrome: a cost-effectiveness analysis.

    PubMed

    McCrone, Paul; Sharpe, Michael; Chalder, Trudie; Knapp, Martin; Johnson, Anthony L; Goldsmith, Kimberley A; White, Peter D

    2012-01-01

    The PACE trial compared the effectiveness of adding adaptive pacing therapy (APT), cognitive behaviour therapy (CBT), or graded exercise therapy (GET), to specialist medical care (SMC) for patients with chronic fatigue syndrome. This paper reports the relative cost-effectiveness of these treatments in terms of quality adjusted life years (QALYs) and improvements in fatigue and physical function. Resource use was measured and costs calculated. Healthcare and societal costs (healthcare plus lost production and unpaid informal care) were combined with QALYs gained, and changes in fatigue and disability; incremental cost-effectiveness ratios (ICERs) were computed. SMC patients had significantly lower healthcare costs than those receiving APT, CBT and GET. If society is willing to value a QALY at £30,000 there is a 62.7% likelihood that CBT is the most cost-effective therapy, a 26.8% likelihood that GET is most cost effective, 2.6% that APT is most cost-effective and 7.9% that SMC alone is most cost-effective. Compared to SMC alone, the incremental healthcare cost per QALY was £18,374 for CBT, £23,615 for GET and £55,235 for APT. From a societal perspective CBT has a 59.5% likelihood of being the most cost-effective, GET 34.8%, APT 0.2% and SMC alone 5.5%. CBT and GET dominated SMC, while APT had a cost per QALY of £127,047. ICERs using reductions in fatigue and disability as outcomes largely mirrored these findings. Comparing the four treatments using a health care perspective, CBT had the greatest probability of being the most cost-effective followed by GET. APT had a lower probability of being the most cost-effective option than SMC alone. The relative cost-effectiveness was even greater from a societal perspective as additional cost savings due to reduced need for informal care were likely.

  1. Estimating Client Out-of-Pocket Costs for Accessing Voluntary Medical Male Circumcision in South Africa

    PubMed Central

    Tchuenche, Michel; Haté, Vibhuti; McPherson, Dacia; Palmer, Eurica; Thambinayagam, Ananthy; Loykissoonlal, Dayanund; Forsythe, Steven

    2016-01-01

    In 2010, South Africa launched a countrywide effort to scale up its voluntary medical male circumcision (VMMC) program on the basis of compelling evidence that circumcision reduces men’s risk of acquiring HIV through heterosexual intercourse. Even though VMMC is free there, clients can incur indirect out-of-pocket costs (for example transportation cost or foregone income). Because these costs can be barriers to increasing the uptake of VMMC services, we assessed them from a client perspective, to inform VMMC demand creation policies. Costs (calculated using a bottom-up approach) and demographic data were systematically collected through 190 interviews conducted in 2015 with VMMC clients or (for minors) their caregivers at 25 VMMC facilities supported by the government and the President’s Emergency Plan for AIDS Relief in eight of South Africa’s nine provinces. The average age of VMMC clients was 22 years and nearly 92% were under 35 years of age. The largest reported out-of-pocket expenditure was transportation, at an average of US$9.20 (R 100). Only eight clients (4%) reported lost days of work. Indirect expenditures were childcare costs (one client) and miscellaneous items such as food or medicine (20 clients). Given competing household expense priorities, spending US$9.20 (R100) per person on transportation to access VMMC services could be a significant burden on clients and households, and a barrier to South Africa’s efforts to create demand for VMMC. Thus, we recommend a more focused analysis of clients’ transportation costs to access VMMC services. PMID:27783635

  2. The environmental cost of reducing agricultural fine particulate matter emissions.

    PubMed

    Funk, Paul A

    2010-06-01

    The U.S. Environmental Protection Agency (EPA) revised the National Ambient Air Quality Standards (NAAQS) in 2006, reducing acceptable fine particulate matter (PM2.5) levels; state environmental protection agencies in states with nonattainment areas are required to draft State Implementation Plans (SIPs) detailing measures to reduce regional PM2.5 levels by reducing PM2.5 and PM2.5 precursor emissions. These plans need to account for increases in emissions caused by operating control technologies. Potential PM2.5 emissions reductions realized by adding a second set of dust cyclones were estimated for the cotton ginning industry. Increases in energy consumption were calculated based on dust cyclone air pressure drop. Additional energy required was translated into increased emissions using published emission factors and state emissions inventories. Reductions in gin emissions were compared with increases in emissions at the power plant. Because of the electrical energy required, reducing one unit of agricultural PM2.5 emissions at a cotton gin results in emitting 0.11-2.67 units of direct PM2.5, 1.39-69.1 units of PM2.5 precursors, 1.70-76.8 units of criteria pollutants, and 692-15,400 units of greenhouse gases at the point where electricity is produced. If regulations designed to reduce rural PM2.5 emissions increase electrical power consumption, the unintended net effect may be more emissions, increased environmental damage, and a greater risk to public health.

  3. Stress cardiac magnetic resonance imaging with observation unit care reduces cost for patients with emergent chest pain: a randomized trial.

    PubMed

    Miller, Chadwick D; Hwang, Wenke; Hoekstra, James W; Case, Doug; Lefebvre, Cedric; Blumstein, Howard; Hiestand, Brian; Diercks, Deborah B; Hamilton, Craig A; Harper, Erin N; Hundley, W Gregory

    2010-09-01

    We determine whether imaging with cardiac magnetic resonance imaging (MRI) in an observation unit would reduce medical costs among patients with emergent non-low-risk chest pain who otherwise would be managed with an inpatient care strategy. Emergency department patients (n=110) at intermediate or high probability for acute coronary syndrome without electrocardiographic or biomarker evidence of a myocardial infarction provided consent and were randomized to stress cardiac MRI in an observation unit versus standard inpatient care. The primary outcome was direct hospital cost calculated as the sum of hospital and provider costs. Estimated median cost differences (Hodges-Lehmann) and distribution-free 95% confidence intervals (Moses) were used to compare groups. There were 110 participants with 53 randomized to cardiac MRI and 57 to inpatient care; 8 of 110 (7%) experienced acute coronary syndrome. In the MRI pathway, 49 of 53 underwent stress cardiac MRI, 11 of 53 were admitted, 1 left against medical advice, 41 were discharged, and 2 had acute coronary syndrome. In the inpatient care pathway, 39 of 57 patients initially received stress testing, 54 of 57 were admitted, 3 left against medical advice, and 6 had acute coronary syndrome. At 30 days, no subjects in either group experienced acute coronary syndrome after discharge. The cardiac MRI group had a reduced median hospitalization cost (Hodges-Lehmann estimate $588; 95% confidence interval $336 to $811); 79% were managed without hospital admission. Compared with inpatient care, an observation unit strategy involving stress cardiac MRI reduced incident cost without any cases of missed acute coronary syndrome in patients with emergent chest pain. Copyright (c) 2010 American College of Emergency Physicians. Published by Mosby, Inc. All rights reserved.

  4. Stress Cardiac Magnetic Resonance Imaging With Observation Unit Care Reduces Cost for Patients With Emergent Chest Pain: A Randomized Trial

    PubMed Central

    Miller, Chadwick D.; Hwang, Wenke; Hoekstra, James W.; Case, Doug; Lefebvre, Cedric; Blumstein, Howard; Hiestand, Brian; Diercks, Deborah B.; Hamilton, Craig A.; Harper, Erin N.; Hundley, W. Gregory

    2013-01-01

    Study objective We determine whether imaging with cardiac magnetic resonance imaging (MRI) in an observation unit would reduce medical costs among patients with emergent non-low-risk chest pain who otherwise would be managed with an inpatient care strategy. Methods Emergency department patients (n=110) at intermediate or high probability for acute coronary syndrome without electrocardiographic or biomarker evidence of a myocardial infarction provided consent and were randomized to stress cardiac MRI in an observation unit versus standard inpatient care. The primary outcome was direct hospital cost calculated as the sum of hospital and provider costs. Estimated median cost differences (Hodges-Lehmann) and distribution-free 95% confidence intervals (Moses) were used to compare groups. Results There were 110 participants with 53 randomized to cardiac MRI and 57 to inpatient care; 8 of 110 (7%) experienced acute coronary syndrome. In the MRI pathway, 49 of 53 underwent stress cardiac MRI, 11 of 53 were admitted, 1 left against medical advice, 41 were discharged, and 2 had acute coronary syndrome. In the inpatient care pathway, 39 of 57 patients initially received stress testing, 54 of 57 were admitted, 3 left against medical advice, and 6 had acute coronary syndrome. At 30 days, no subjects in either group experienced acute coronary syndrome after discharge. The cardiac MRI group had a reduced median hospitalization cost (Hodges-Lehmann estimate $588; 95% confidence interval $336 to $811); 79% were managed without hospital admission. Conclusion Compared with inpatient care, an observation unit strategy involving stress cardiac MRI reduced incident cost without any cases of missed acute coronary syndrome in patients with emergent chest pain. PMID:20554078

  5. Can delivery systems use cost-effectiveness analysis to reduce healthcare costs and improve value?

    PubMed Central

    Savitz, Lucy A.; Savitz, Samuel T.

    2016-01-01

    Understanding costs and ensuring that we demonstrate value in healthcare is a foundational presumption as we transform the way we deliver and pay for healthcare in the U.S. With a focus on population health and payment reforms underway, there is increased pressure to examine cost-effectiveness in healthcare delivery. Cost-effectiveness analysis (CEA) is a type of economic analysis comparing the costs and effects (i.e. health outcomes) of two or more treatment options. The result is expressed as a ratio where the denominator is the gain in health from a measure (e.g. years of life or quality-adjusted years of life) and the numerator is the incremental cost associated with that health gain. For higher cost interventions, the lower the ratio of costs to effects, the higher the value. While CEA is not new, the approach continues to be refined with enhanced statistical techniques and standardized methods. This article describes the CEA approach and also contrasts it to optional approaches, in order for readers to fully appreciate caveats and concerns. CEA as an economic evaluation tool can be easily misused owing to inappropriate assumptions, over reliance, and misapplication. Twelve issues to be considered in using CEA results to drive healthcare delivery decision-making are summarized. Appropriately recognizing both the strengths and the limitations of CEA is necessary for informed resource allocation in achieving the maximum value for healthcare services provided. PMID:27830055

  6. Interventions for reducing medication errors in children in hospital.

    PubMed

    Maaskant, Jolanda M; Vermeulen, Hester; Apampa, Bugewa; Fernando, Bernard; Ghaleb, Maisoon A; Neubert, Antje; Thayyil, Sudhin; Soe, Aung

    2015-03-10

    Many hospitalised patients are affected by medication errors (MEs) that may cause discomfort, harm and even death. Children are at especially high risk of harm as the result of MEs because such errors are potentially more hazardous to them than to adults. Until now, interventions to reduce MEs have led to only limited improvements. To determine the effectiveness of interventions aimed at reducing MEs and related harm in hospitalised children. The Effective Practice and Organisation of Care Group (EPOC) Trials Search Co-ordinator searched the following sources for primary studies: The Cochrane Library, including the Cochrane Central Register of Controlled Trials (CENTRAL), the Economic Evaluation Database (EED) and the Health Technology Assessments (HTA) database; MEDLINE, EMBASE, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, Proquest Dissertations & Theses, Web of Science (citation indexes and conference proceedings) and the EPOC Register of Studies. Related reviews were identified by searching the Cochrane Database of Systematic Reviews and the Database of Abstracts of Reviews of Effects (DARE). Review authors searched grey literature sources and trial registries. They handsearched selected journals, contacted researchers in the field and scanned reference lists of relevant reviews. They conducted searches in November 2013 and November 2014. They applied neither language nor date limits. Randomised controlled trials, controlled before-after studies and interrupted time series investigating interventions to improve medication safety in hospitalised children (≤ 18 years). Participants were healthcare professionals authorised to prescribe, dispense or administer medications. Outcome measures included MEs, (potential) patient harm, resource utilisation and unintended consequences of the interventions. Two review authors independently selected studies, extracted data and assessed study quality using the EPOC data collection

  7. Cost of reducing aromatics and sulfur levels in motor-vehicle fuels. Volume 2. Final report

    SciTech Connect

    Felten, J.R.; McCarthy, K.M.

    1988-08-01

    Linear-programming (LP) models were developed for five refineries representative of the California refining industry and validated against historic operation. Process options to reduce gasoline and diesel contaminants were selected and represented in the LP models. Costs were estimated to separately reduce aromatics levels in automotive gasoline, aromatics in diesel, and sulfur in diesel for 1991 and 1995. Cost impacts were scaled up to obtain the overall cost impact in California. Estimates were made of total aromatics and benzene levels in gasoline and of sulfur, aromatics, and cetane levels in diesel. Estimates were made of the impact on refinery emissions, automotive emissions, and automotive performance. The cost to reduce diesel sulfur level to .05% was 6.3 cents/gallon. The cost to reduce diesel aromatics level to 10% was 27.6 cents/gallon. The cost to reduce gasoline aromatics levels by 18% was 7.0 cents/gallon.

  8. Low-cost medical image storage and manipulation using optical disk subsystems

    NASA Astrophysics Data System (ADS)

    Glenn, William V., Jr.; Marx, Peter S.

    1990-08-01

    Traditionally, medical imaging has required large capital investments into workstations and storage subsystems. Many vendors have chosen to offer proprietary systems which are expensive to develop and costly to the institutions which purchase them. Our experience has been that this is unnecessary; most traditional imaging functions in the digital modalities of computed tomography (CT) and magnetic resonance imaging (MM) can be performed using off-the-shelf hardware with relatisely inexpensive software. In order to reduce the cost of medical imaging, our approach has been to choose computers and storage subsystems that are efficient, inexpensive, and easy-to-use (after all, the users are interested in practicing medicine, not computer science.) With these goals in mind, we chose to use a general purpose computer (the Apple Macintosh Ilci) with two types of high-capacity optical storage devices (both magneto-optical and write once, read multiple (WORM) disc subsystems.) We have developed a powerful, yet user-friendly medical imaging workstation oriented towards radiologists, orthopadic surgeons, neurosurgeons, and other users of medical images. In addition to providing inexpensive storage, the workstation is capable of multiplanar reformatting (MPR), 3D MM angiography, and other image processing functions. The resulting images may be annotated, windowed, and filmed on to 14x17" radiology film for presentation to the referring physicians and their patients. This system can be considered to be a picture archiving and communication system (PACS) for private physicians and small clinics; further, it is small enough for desktop environments and inexpensive enough for clinicians to purchase.

  9. Direct medical costs of COPD--an excess cost approach based on two population-based studies.

    PubMed

    Menn, Petra; Heinrich, Joachim; Huber, Rudolf M; Jörres, Rudolf A; John, Jürgen; Karrasch, Stefan; Peters, Annette; Schulz, Holger; Holle, Rolf

    2012-04-01

    While it is known that severe COPD has substantial economic consequences, evidence on resource use and costs in mild disease is scarce. The objective of this study was to investigate excess costs of early stages of COPD. Using data from two population-based studies in Southern Germany, current GOLD criteria were applied to pre-bronchodilator spirometry for COPD diagnosis and staging in 2255 participants aged 41 to 89. Utilization of physician visits, hospital stays and medication was compared between participants with COPD stage I, stage II+ (II or higher) and controls. Costs per year were calculated by applying national unit costs. In controlling for confounders, two-part generalized regression analyses were used to account for the skewed distribution of costs and the high proportion of subjects without costs. Utilization in all categories was significantly higher in COPD patients than in controls. After adjusting for confounders, these differences remained present in physician visits and medication, but not in hospital days. Adjusted annual costs did not differ between stage I (€ 1830) and controls (€ 1822), but increased by about 54% to € 2812 in stage II+. The finding that utilization and costs are considerably higher in moderate but not in mild COPD highlights the economic importance of prevention and of interventions aiming at early diagnosis and delayed disease progression. Copyright © 2011 Elsevier Ltd. All rights reserved.

  10. A cost analysis of an internet based medication adherence intervention for people living with HIV

    PubMed Central

    Page, Timothy F.; Horvath, Keith J.; Danilenko, Gene P.; Williams, Mark

    2012-01-01

    The purpose of the study was to document development costs and estimate implementation costs of an internet based medication adherence intervention for people living with HIV in the US. Participants (n=61) were enrolled in the 8 week study in 2011 and entered the intervention website remotely in the setting of their choice. Development costs were obtained from a feasibility and acceptability study of an internet based medication adherence intervention. Implementation costs were estimated based on an 8 week trial period during the feasibility and acceptability study. Results indicated that although developing an internet based medication adherence intervention is expensive, the monthly cost of implementing and delivering the intervention is low. If the efficacy of similar interventions can be established, these results suggest the internet could be an effective method for delivering medication adherence interventions to persons residing in areas with limited access to in-person adherence services. PMID:22362156

  11. Interdisciplinary Coordination Reviews: A Process to Reduce Construction Costs.

    ERIC Educational Resources Information Center

    Fewell, Dennis A.

    1998-01-01

    Interdisciplinary Coordination design review is instrumental in detecting coordination errors and omissions in construction documents. Cleansing construction documents of interdisciplinary coordination errors reduces time extensions, the largest source of change orders, and limits exposure to liability claims. Improving the quality of design…

  12. Strategic planning to reduce medical errors: Part I--diagnosis.

    PubMed

    Waldman, J Deane; Smith, Howard L

    2012-01-01

    Despite extensive dialogue and a continuing stream of proposed medical practice revisions, medical errors and adverse impacts persist. Connectivity of vital elements is often underestimated or not fully understood. This paper analyzes medical errors from a systems dynamics viewpoint (Part I). Our analysis suggests in Part II that the most fruitful strategies for dissolving medical errors include facilitating physician learning, educating patients about appropriate expectations surrounding treatment regimens, and creating "systematic" patient protections rather than depending on (nonexistent) perfect providers.

  13. Cost effectiveness of percutaneous closure versus medical therapy for cryptogenic stroke in patients with a patent foramen ovale.

    PubMed

    Pickett, Christopher A; Villines, Todd C; Ferguson, Michael A; Hulten, Edward A

    2014-11-15

    In patients with patent foramen ovales (PFOs) and cryptogenic stroke, observational studies have demonstrated reductions in recurrent neurologic events with transcatheter PFO closure compared with medical therapy. Randomized controlled trials and meta-analyses have shown a trend toward benefit with device closure. The cost-effectiveness of PFO closure has not been described. Therefore, a detailed cost analysis was performed using pooled weighted outcome and complication rates from published randomized controlled trials, Medicare cost tables, and wholesale medication prices. Incremental cost per life-year gained and per quality-adjusted life-year (QALY) gained by PFO closure was calculated. The commonly accepted cost-effectiveness threshold of <$50,000/quality-adjusted life-year gained was used. At 2.6 years (the mean duration of randomized controlled trial follow-up), PFO closure was more costly ($16,213, 95% confidence interval [CI] $15,753 to $16,749) per patient, with a cost of $103,607 (95% CI $5,826 to $2,544,750) per life-year gained. The expenditure to prevent 1 combined end point (transient ischemic attack, stroke, and death) at 2.6 years was $1.09 million (95% CI $1.04 million to $1.20 million). Modeling the costs of medical treatment prospectively, PFO closure reached cost-effectiveness (<$50,000/quality-adjusted life-year gained) at 2.6 years (95% CI 1.5 to 44.2). At 30.2 years (95% CI 28.2 to 36.2), the per patient mean cost of medical therapy exceeded that of PFO closure. In conclusion, PFO closure is associated with higher expenditures related to procedural costs; however, this increase may be offset over time by reduced event rates and costs of long-term medical treatment in patients who undergo transcatheter PFO closure. In younger patients typical of cryptogenic stroke, PFO closure may be cost effective in the long term. Published by Elsevier Inc.

  14. Health care resource use and direct medical costs for patients with schizophrenia in Tianjin, People's Republic of China.

    PubMed

    Wu, Jing; He, Xiaoning; Liu, Li; Ye, Wenyu; Montgomery, William; Xue, Haibo; McCombs, Jeffery S

    2015-01-01

    Information concerning the treatment costs of schizophrenia is scarce in People's Republic of China. The aims of this study were to quantify health care resource utilization and to estimate the direct medical costs for patients with schizophrenia in Tianjin, People's Republic of China. Data were obtained from the Tianjin Urban Employee Basic Medical Insurance (UEBMI) database. Adult patients with ≥1 diagnosis of schizophrenia and 12-month continuous enrollment after the first schizophrenia diagnosis between 2008 and 2009 were included. Both schizophrenia-related, psychiatric-related, and all-cause related resource utilization and direct medical costs were estimated. A total of 2,125 patients were included with a mean age of 52.3 years, and 50.7% of the patients were female. The annual mean all-cause costs were $2,863 per patient with psychiatric-related and schizophrenia-related costs accounting for 84.1% and 62.0% respectively. The schizophrenia-related costs for hospitalized patients were eleven times greater than that of patients who were not hospitalized. For schizophrenia-related health services, 60.8% of patients experienced at least one hospitalization with a mean (median) length of stay of 112.1 (71) days and a mean cost of $1,904 per admission; 59.0% of patients experienced at least one outpatient visit with a mean (median) number of visits of 6.2 (4) and a mean cost of $42 per visit during the 12-month follow-up period. Non-medication treatment costs were the most important element (45.7%) of schizophrenia-related costs, followed by laboratory and diagnostic costs (19.9%), medication costs (15.4%), and bed fees (13.3%). The costs related to the treatment of patients with schizophrenia were considerable in Tianjin, People's Republic of China, driven mainly by schizophrenia-related hospitalizations. Efforts focusing on community-based treatment programs and appropriate choice of drug treatment have the potential to reduce the use of inpatient services and

  15. Offshore technology aims for reduced costs, greater safety

    SciTech Connect

    Dempsey, P.

    1985-04-01

    OFFSHORE TECHNOLOGY continued to make headway last year, although dramatic breakthroughs were few and far between. Major oil companies have been spending heavily on acquisitions and the service companies, which historically have done much innovative work, have been forced to curtail their engineering budgets. The Weir hydraulic pump has been vetted for offshore service and a production model is being installed on a North Sea platform. A CO/sub 2/ fire-control system has been developed for both offshore and onshore applications, and Drilco's Trans-Wate pipe promises to extend drillstring life. And, perhaps most significantly, the Poseidon project is healthy and flourishing. If successful, Poseidon could cut development costs by more than half.

  16. Streamlining: Reducing costs and increasing STS operations effectiveness

    NASA Technical Reports Server (NTRS)

    Petersburg, R. K.

    1985-01-01

    The development of streamlining as a concept, its inclusion in the space transportation system engineering and operations support (STSEOS) contract, and how it serves as an incentive to management and technical support personnel is discussed. The mechanics of encouraging and processing streamlining suggestions, reviews, feedback to submitters, recognition, and how individual employee performance evaluations are used to motivation are discussed. Several items that were implemented are mentioned. Information reported and the methodology of determining estimated dollar savings are outlined. The overall effect of this activity on the ability of the McDonnell Douglas flight preparation and mission operations team to support a rapidly increasing flight rate without a proportional increase in cost is illustrated.

  17. Streamlining: Reducing costs and increasing STS operations effectiveness

    NASA Technical Reports Server (NTRS)

    Petersburg, R. K.

    1985-01-01

    The development of streamlining as a concept, its inclusion in the space transportation system engineering and operations support (STSEOS) contract, and how it serves as an incentive to management and technical support personnel is discussed. The mechanics of encouraging and processing streamlining suggestions, reviews, feedback to submitters, recognition, and how individual employee performance evaluations are used to motivation are discussed. Several items that were implemented are mentioned. Information reported and the methodology of determining estimated dollar savings are outlined. The overall effect of this activity on the ability of the McDonnell Douglas flight preparation and mission operations team to support a rapidly increasing flight rate without a proportional increase in cost is illustrated.

  18. Phase correlator reduces mm-wave radar cost

    NASA Astrophysics Data System (ADS)

    Weiss, R., Sr.; Hobbs, P.; Locatelli, J.

    1986-03-01

    A technique involving the IC storage of magnetron phase for reference has been developed to make possible the use of the low-cost efficient magnetron in obtaining phase coherent signals for pulse Doppler radar. In the new external coherence method, the recorded random midpulse-region phase is compared with the frequency of the echo allowing Doppler information, free of phase noise, to be extracted. The gated magnetron was tested at Ka-band in a 35-GHz radar, and good agreement with the CP-4 5.5 GHz radar was shown. With good accuracy down to 10 cm/s, the present system, especially in the mm-wave region, has important applications to meteorological and military radar.

  19. Reduce the cost of producing TAME. [Tertiary Amyl Methyl Ethers

    SciTech Connect

    Rock, K.L.; Gildert, G.R. )

    1994-01-01

    The high atmospheric reactivity and resulting high ozone formation have been previously documented for C5 olefins. Other features such as low octane number and high vapor pressure limit their usefulness as gasoline blendstocks. Conversion of C[sub 5] olefins to TAME is a good way to upgrade these components into high value gasoline blendstocks. The TAME product has high octane and low vapor pressure as well as contained oxygen. The other option is to alkylate the C[sub 5] olefins. This route produces greater volume but with higher vapor pressure and lower octane value. The TAME route also achieves lower capital and operating cost than alkylation. The paper describes a process in which reactive Isoamylenes can be converted to TAME by etherification with methanol. The reactive isoamylenes include 2-methyl butene-1 and 2-methyl butene-2.

  20. Processing, compliance options can reduce cost of producing new gasoline

    SciTech Connect

    Not Available

    1994-07-11

    The price difference between US conventional and reformulated gasolines is expected to be 3.1[cents]/gal higher, less than the 4[cents]/gal difference indicated in May by the New York Mercantile Exchange. The difference will be set by the central Atlantic and New England areas, which Bonner Moore projects to be significantly short on reformulated gasoline and long on conventional gasoline. Bonner Moore consultants, in an unpublished report, say refiners in the central Atlantic will not be able to economically convert much more than 70% of their gasoline output to reformulated gasoline. As a result, gasoline movements through the pipeline system supplying Petroleum Administration for Defense District (PADD) 1-the US East Coast-will have to increase to deliver reformulated gasoline produced on the Gulf Coast to New England and the Central Atlantic region. The paper discusses production costs, processing options, price differential, compliance, and benefits from averaging both oxygen and benzene parameters.

  1. Reducing The Operating Costs Of An Apartment Building

    NASA Astrophysics Data System (ADS)

    Takács, Ján; Rácz, Lukáš

    2015-09-01

    Circulation pumps are mechanical devices, which are used to create the overpressure required for the transportation of a heat-transfer medium in heating technology as well as in other related technologies. In a circulation pump the mechanical energy generated by the drive machine - an electric motor is transformed to hydraulic energy, which consists of kinetic and static energy. In the pipeline of a heating system circulation pumps represent a source of hydraulic energy (positive differential pressure), which is consumed to transport the heat-transfer medium. During the flow, the heat-transfer medium puts up resistance to the so-called passive resistors, which consist of pressure losses from friction in the pipes and pressure losses due to local resistance. In this article the authors analyze the effect of a circulation pump on the operating costs in an apartment building. Different types of circulating pumps, ranging from the most unfavorable to the optimal, were selected.

  2. An Analysis of Medical Imaging Costs in Military Treatment Facilities

    DTIC Science & Technology

    2014-09-01

    authority to completely control the medical systems of each service, the DHA 7 was given management responsibility for specific shared services , functions...efficient health operations through enhanced enterprise-wide shared services . • Deliver more comprehensive primary care and integrated health...of shared services that will fall under central control: • facility planning • medical logistics • health information technology • Tricare health

  3. Leg exoskeleton reduces the metabolic cost of human hopping.

    PubMed

    Grabowski, Alena M; Herr, Hugh M

    2009-09-01

    During bouncing gaits such as hopping and running, leg muscles generate force to enable elastic energy storage and return primarily from tendons and, thus, demand metabolic energy. In an effort to reduce metabolic demand, we designed two elastic leg exoskeletons that act in parallel with the wearer's legs; one exoskeleton consisted of a multiple leaf (MLE) and the other of a single leaf (SLE) set of fiberglass springs. We hypothesized that hoppers, hopping on both legs, would adjust their leg stiffness while wearing an exoskeleton so that the combination of the hopper and exoskeleton would behave as a linear spring-mass system with the same total stiffness as during normal hopping. We also hypothesized that decreased leg force generation while wearing an exoskeleton would reduce the metabolic power required for hopping. Nine subjects hopped in place at 2.0, 2.2, 2.4, and 2.6 Hz with and without an exoskeleton while we measured ground reaction forces, exoskeletal compression, and metabolic rates. While wearing an exoskeleton, hoppers adjusted their leg stiffness to maintain linear spring-mass mechanics and a total stiffness similar to normal hopping. Without accounting for the added weight of each exoskeleton, wearing the MLE reduced net metabolic power by an average of 6% and wearing the SLE reduced net metabolic power by an average of 24% compared with hopping normally at frequencies between 2.0 and 2.6 Hz. Thus, when hoppers used external parallel springs, they likely decreased the mechanical work performed by the legs and substantially reduced metabolic demand compared with hopping without wearing an exoskeleton.

  4. Cost Effectiveness of a Novel Attempt to Reduce Readmission after Ileostomy Creation

    PubMed Central

    Raza, Ahsan; Huang, Emina; Goldstein, Lindsey; Hughes, Steven J.; Tan, Sanda A.

    2017-01-01

    Background and Objectives: Dehydration is a common complication after ileostomy creation and is the most frequent reason for postoperative readmission to the hospital. We sought to determine the clinical and economic impact of an outpatient intervention to decrease readmissions for dehydration after ileostomy creation. Methods: All new ileostomates from 09/2011 through 10/2012 at the University of Florida were enrolled to receive an ileostomy education and management protocol and a daily telephone call for 3 weeks after discharge. Counseling and medication adjustments were provided, with a satisfaction survey at the end. Outcomes of these patients were compared to those in a historical control cohort. A cost analysis was conducted to calculate the savings to the hospital. Results: Thirty-eight patients were enrolled. All patients required telephone counseling, and the mean satisfaction score rating was 4.69, on a scale of 1 to 5. The readmission rate for dehydration within 30 days of discharge decreased significantly from 65% before intervention to 16% (5/32 patients) after intervention (P = .002). The length of readmission hospital stay decreased from a mean of 4.2 days before the introduction of the intervention to 3 days after. Cost analysis revealed that the actual total hospital cost of dehydration-specific readmission decreased from $88,858 to $25,037, a saving of $63,821. Conclusion: A standardized ileostomy pathway with comprehensive patient education and outpatient telephone follow-up is cost effective, has a positive influence on patient satisfaction, and reduces dehydration-related readmission rates. PMID:28144122

  5. 75 FR 33629 - Developing Guidance on Naming, Labeling, and Packaging Practices to Reduce Medication Errors...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-06-14

    ... Practices to Reduce Medication Errors; Public Workshop; Change of Meeting Location AGENCY: Food and Drug... Practices to Reduce Medication Errors.'' A new address is given for those attending the workshop. DATES: The... on describing practices for naming, labeling, and packaging drugs and biologics to reduce medication...

  6. Changes in the costs of antihypertensive medications in a developing country: a study in Mexico comparing 1990 and 1996.

    PubMed

    Calvo-Vargas, C G; Parra Carrillo, J Z; Grover Páez, F; Fonseca Reyes, S

    1998-04-01

    In developing countries, the cost of antihypertensive medications is one of the principal limiting factors when trying to treat patients with high blood pressure. To determine the changes in cost (in US dollars) of these medications and in the percentage of the minimum wage needed to purchase them, two cost studies (1990 and 1996) done in Mexico were compared. The yearly cost of a treatment with hydrochlorothiazide was US $13.80 in 1990; in 1996 it was US $10.92. Both figures represent 1.1% of the minimum wage that was in effect at the time. Propranolol hydrochloride cost US $50.52 for a year's treatment in 1990, and US $66.12 for the same in 1996. These figures represented, respectively, 4.2% and 6.7% of the minimum wage of 1990 and 1996. The annual cost for nifedipine was US $176.76 in 1990 (14.7% of the minimum wage) and US $242.16 in 1996 (24.8% of the minimum wage). The yearly cost of enalapril was US $233.04 in 1990 and US $433.20 in 1996; these costs represented, respectively, 19.4% and 44.2% of the minimum wage. The comparison of these two cost studies (1990 and 1996) shows why Mexico's population is finding it more difficult to purchase antihypertensive medications. Higher costs and reduced purchasing power seem to be the two principal factors causing this. This is probably affecting the population's health, as it is more difficult to control high blood pressure without proper treatment.

  7. Cost of discarded medication in Indiana long-term care facilities.

    PubMed

    Brown, C H; Kirk, K W

    1984-04-01

    The cost of discarded medication was studied in 17 Indiana intermediate-care and skilled-nursing facilities with varying bed capacities and drug-distribution systems. During visits to each facility, one or two pharmacists collected data on patients' drug regimens and the quantities of medication dispensed and discarded over periods of one to seven months. A total of $ 5,620 worth of medication ($ 4,472 excluding topical medications) was destroyed in the facilities during the study period. The projected annual cost of discarded medication was approximately $ 15,800 ($ 12,460 excluding topical medications). In the 13 facilities using some type of unit dose drug distribution system, the mean projected annual cost of discarded medication per patient ($ 4.07) was significantly less than for the four facilities using traditional drug-distribution systems ($ 23.54). There was an inverse relationship between bed capacity and mean projected annual cost of discarded medication per patient. The use of unit dose drug distribution systems in all long-term care facilities would be expected to result in substantial savings in the costs of discarded medications.

  8. Study of the cost-benefit analysis of electronic medical record systems in general hospital in China.

    PubMed

    Li, Kai; Naganawa, Shinji; Wang, Kai; Li, Ping; Kato, Ken; Li, Xiu; Zhang, Jie; Yamauchi, Kazunobu

    2012-10-01

    Electronic medical record (EMR) systems have been proposed as technology to improve the quality of patient care, decrease medical errors, control and reduce medical expenditure, however the financial effects have not yet been as well documented in China. We presented a net financial cost-benefit analysis of implementing electronic medical record systems in general hospital in China. The data, which were obtained from studies of the general hospital and the published literature, collected from 15 consecutive fiscal months from May 1, 2009 to August 30, 2010. We performed a perspective cost-benefit study to analyze the financial effects of EMR system implementing. The reference strategy for comparisons was the traditional paper-based medical record. The net financial benefits or costs for a 6-year period were calculated. All data were adjusted for inflation. The totally assessed net benefit from implementing an EMR system for a 6-year period was $559,025 in the general hospital. Benefits accrue primarily from savings in new medical record creation, decreased full-time-equivalent (FTE) employees, saving of adverse drug events (ADEs) and dose errors, improved charge capture and decreased billing errors. In this model, the time of return on investment is 3.00 years. In one-way sensitivity analysis, the model was most sensitive in new medical record creation; the net benefit varied from $398,057 to $719,992. The five-way sensitivity analysis with the most pessimistic and optimistic assumptions showed results ranging from a $76,970 net cost to a $1,062,122 net benefit; the pessimistic time of return on investment is 5.38 years. An EMR system cost-benefit analysis can rapidly demonstrate a positive return on investment when implemented in hospitals. The magnitude of the return is sensitive to several key factors.

  9. A Summary of: 25 Ways to Reduce the Cost of College

    ERIC Educational Resources Information Center

    Center for College Affordability and Productivity (NJ1), 2010

    2010-01-01

    Almost everyone agrees that colleges have become costly to attend and are a growing burden on society to finance. Rising tuition costs threaten the ability and desire of students to attend college. Are there things that can be done to significantly reduce the cost of college? The answer is an emphatic "yes." The Center for College Affordability…

  10. Cost of Transformation among Primary Care Practices Participating in a Medical Home Pilot.

    PubMed

    Martsolf, Grant R; Kandrack, Ryan; Gabbay, Robert A; Friedberg, Mark W

    2016-07-01

    Medical home initiatives encourage primary care practices to invest in new structural capabilities such as patient registries and information technology, but little is known about the costs of these investments. To estimate costs of transformation incurred by primary care practices participating in a medical home pilot. We interviewed practice leaders in order to identify changes practices had undertaken due to medical home transformation. Based on the principles of activity-based costing, we estimated the costs of additional personnel and other investments associated with these changes. The Pennsylvania Chronic Care Initiative (PACCI), a statewide multi-payer medical home pilot. Twelve practices that participated in the PACCI. One-time and ongoing yearly costs attributed to medical home transformation. Practices incurred median one-time transformation-associated costs of $30,991 per practice (range, $7694 to $117,810), equivalent to $9814 per clinician ($1497 to $57,476) and $8 per patient ($1 to $30). Median ongoing yearly costs associated with transformation were $147,573 per practice (range, $83,829 to $346,603), equivalent to $64,768 per clinician ($18,585 to $93,856) and $30 per patient ($8 to $136). Care management activities accounted for over 60% of practices' transformation-associated costs. Per-clinician and per-patient transformation costs were greater for small and independent practices than for large and system-affiliated practices. Error in interviewee recall could affect estimates. Transformation costs in other medical home interventions may be different. The costs of medical home transformation vary widely, creating potential financial challenges for primary care practices-especially those that are small and independent. Tailored subsidies from payers may help practices make these investments. Agency for Healthcare Research and Quality.

  11. Healthcare cost reductions associated with the use of LAI formulations of antipsychotic medications versus oral among patients with schizophrenia.

    PubMed

    Lin, Jay; Wong, Bruce; Offord, Steve; Mirski, Dario

    2013-07-01

    Real-world medication adherence and healthcare costs of patients with schizophrenia initiating long-acting injectable (LAI) vs. oral antipsychotics were compared. Patients with schizophrenia initiating LAI or oral antipsychotics (index event) were identified from MarketScan Commercial and Medicare claims databases and their medication possession ratios (MPR), pre- and post-index costs for inpatient/outpatient care were compared. Of 3,004 patients, 394 initiated LAI antipsychotics and 2,610 oral antipsychotics. Post-index, the mean MPR was greater for the LAI cohort (0.67 ± 0.34 vs. 0.56 ± 0.35; p < 0.001). Schizophrenia-related hospital costs for LAI users were reduced during the follow-up period in comparison to the pre-index period, but were increased for patients using oral antipsychotics (-$5,981 ± $16,554 vs. 758 ± 14,328, p < 0.001). The change in costs of outpatient care also favored LAI medications ($134 ± 8,280 vs. 658 ± 3,260, p = 0.023). Drug costs of LAI antipsychotics were higher ($4,132 ± 4,533 vs. 2,562 ± 2,714, p < 0.001). Schizophrenia patients initiating LAI antipsychotics incur less healthcare costs in comparison to patients initiating oral antipsychotics.

  12. Cost-effectiveness Analysis of Treatment Sequence Initiating With Etanercept Compared With Leflunomide in Rheumatoid Arthritis: Impact of Reduced Etanercept Cost With Patent Expiration in South Korea.

    PubMed

    Park, Sun-Kyeong; Park, Seung-Hoo; Lee, Min-Young; Park, Ji-Hyun; Jeong, Jae-Hong; Lee, Eui-Kyung

    2016-11-01

    robustness of the base-case analysis was confirmed using sensitivity analyses. When the unreduced medication cost of ETN was applied in a subanalysis, the ICER for strategy A versus B was ₩20,909,572 (US$17,556) per QALY and that for strategy A versus C was ₩22,334,713 (US$18,753) per QALY. This study indicated that a treatment strategy initiated with ETN was more cost-effective in patients with active RA and MTX-IR than 2 sequences initiated with LFN. The results also indicate that the reduced price of ETN affected the cost-effectiveness associated with its earlier use. Copyright © 2016 Elsevier HS Journals, Inc. All rights reserved.

  13. Aircraft Geared Architecture Reduces Fuel Cost and Noise

    NASA Technical Reports Server (NTRS)

    2015-01-01

    In an effort to increase fuel efficiency and reduce noise in commercial airplanes, NASA aeronautics teamed up with East Hartford, Connecticut-based Pratt & Whitney through a Space Act Agreement to help the company increase the efficiency of its turbofan engine. The company's new PurePower line of engines is 15 percent more fuel-efficient and up to 75 percent quieter than its competitors.

  14. Improving the Defense Acquisition System and Reducing System Costs

    DTIC Science & Technology

    1981-03-30

    Reliability Bendix Corporation Mr. Arnold Pazomik Assistant Vice President and Director of Contracts ARINC Research Corporation Mr. Harvey Kishner...Acquisition Executive 4 8 E. DSARC Review Criteria 49 F. DSARC-PPBS Interface 50 G. Program Manager Control 52 H. Improving Reliability and Support 54... Reliability and Support X X USDRE X X 17. Reduce DSARC Briefing and Data Requirements X X USDRE X XX XX 18. Budgeting for Inflation X X ASD(C

  15. Measuring costs of guideline-driven mental health care: the Texas Medication Algorithm Project.

    PubMed

    Kashner, Michael T.; Rush, John A.; Altshuler, Kenneth Z.

    1999-09-01

    BACKGROUND: Algorithms describe clinical choices to treat a specific disorder. To many, algorithms serve as important tools helping practitioners make informed choices about how best to treat patients, achieving better outcomes more quickly and at a lower cost. Appearing as flow charts and decision trees, algorithms are developed during consensus conferences by leading experts who explore the latest scientific evidence to describe optimal treatment for each disorder. Despite a focus on "optimal" care, there has been little discussion in the literature concerning how costs should be defined and measured in the context of algorithm-based practices. AIMS OF THE STUDY: This paper describes the strategy to measure costs for the Texas Medication Algorithm project, or TMAP. Launched by the Texas Department of Mental Health and Mental Retardation and the University of Texas Southwestern Medical Center at Dallas, this multi-site study investigates outcomes and costs of medication algorithms for bipolar disorder, schizophrenia and depression. METHODS: To balance costs with outcomes, we turned to cost-effectiveness analyses as a framework to define and measure costs. Alternative strategies (cost-benefit, cost-utility, cost-of-illness) were inappropriate since algorithms are not intended to guide resource allocation across different diseases or between health- and non-health-related commodities. "Costs" are operationalized consistent with the framework presented by the United States Public Health Service Panel on Cost Effectiveness in Medicine. Patient specific costs are calculated by multiplying patient units of use by a unit cost, and summing over all service categories. Outpatient services are counted by procedures. Inpatient services are counted by days classified into diagnosis groups. Utilization information is derived from patient self-reports, medical charts and administrative file sources. Unit costs are computed by payer source. Finally, hierarchical modeling is used

  16. New combustion technology reduces pollutant emissions and operating costs

    SciTech Connect

    Not Available

    1988-11-01

    The new system, called PEP-99, is used to produce an emulsified fuel. This new fuel is being used in an 850 megawatt boiler used to generate electric power by the Niagara Mohawk Power Corporation in Oswego, NY, where it has reduced pollutant levels and maintained the boiler peak thermal efficiency for longer periods of time as compared to performance with conventional No. 6 fuel oil. Hydroflow's PEP-99 products are designed for the on-site production of water-in-oil fuel emulsions. Very small droplets of water are mixed uniformly throughout the fuel oil and are contained within larger droplets of oil. When the fuel is sprayed into the hot combustion chamber, the water is flashed to steam, creating an explosive force that shatters each individual oil droplet. These smaller particles of oil burn much more cleanly and completely than standard residual fuels. This reduces particulate emissions or unburned carbon which is discharged to the atmosphere. The presence of water in the fuel emulsion slightly reduces the combustion temperature resulting in a significant reduction in nitrogen oxides. PEP-99 emulsified fuels typically provide 40 to 50 percent reduction in nitrogen oxides, 30-40 percent reduction in SO/sub 3/ and up to 50 percent cut in particulate emissions.

  17. The cost of postgraduate medical education and continuing medical education: re-examining the status fifty years back.

    PubMed

    Walsh, Kieran

    2015-03-01

    The subject of the cost and value of medical education is becoming increasingly important. However, this subject is not a new one. Fifty years ago, Mr. DH Patey, Dr. OF Davies, and Dr. John Ellis published a report on the state of postgraduate medical education in the UK. The report was wide-ranging, but it made a considerable mention of cost. In this short article, I have presented the documentary research that I conducted on their report. I have analyzed it from a positivist perspective and have concentrated on the subject of cost, as it appears in their report. The authors describe reforms within postgraduate medical education; however, they are clear from the start that the issue of cost can often be a barrier to such reforms. They state the need for basic facilities for medical education, but then outline the financial barriers to their development. The authors then discuss the costs of library services for education. They state that the "annual spending on libraries varies considerably throughout the country." The authors also describe the educational experiences of newly graduated doctors. According to them, the main problem is that these doctors do not have time to attend formal educational events, and that this will not be possible until there is "a more graduated approach to responsible clinical work," something which is not possible without financial investment. While concluding their report, the authors state that the limited money invested in postgraduate medical education and continuing medical education has been well spent, and that this has had a dual effect on improving medical education as well as the standards of medical care.

  18. The Cost of Postgraduate Medical Education and Continuing Medical Education: Re-Examining the Status Fifty Years Back

    PubMed Central

    2015-01-01

    The subject of the cost and value of medical education is becoming increasingly important. However, this subject is not a new one. Fifty years ago, Mr. DH Patey, Dr. OF Davies, and Dr. John Ellis published a report on the state of postgraduate medical education in the UK. The report was wide-ranging, but it made a considerable mention of cost. In this short article, I have presented the documentary research that I conducted on their report. I have analyzed it from a positivist perspective and have concentrated on the subject of cost, as it appears in their report. The authors describe reforms within postgraduate medical education; however, they are clear from the start that the issue of cost can often be a barrier to such reforms. They state the need for basic facilities for medical education, but then outline the financial barriers to their development. The authors then discuss the costs of library services for education. They state that the "annual spending on libraries varies considerably throughout the country." The authors also describe the educational experiences of newly graduated doctors. According to them, the main problem is that these doctors do not have time to attend formal educational events, and that this will not be possible until there is "a more graduated approach to responsible clinical work," something which is not possible without financial investment. While concluding their report, the authors state that the limited money invested in postgraduate medical education and continuing medical education has been well spent, and that this has had a dual effect on improving medical education as well as the standards of medical care. PMID:25802685

  19. Patterns of Daily Costs Differ for Medical and Surgical Intensive Care Unit Patients.

    PubMed

    Gershengorn, Hayley B; Garland, Allan; Gong, Michelle N

    2015-12-01

    Published studies suggest hospital costs on Day 1 in the intensive care unit (ICU) far exceed those of subsequent days, when costs are relatively stable. Yet, no study stratified patients by ICU type. To determine whether daily cost patterns differ by ICU type. We performed a retrospective study of adults admitted to five ICUs (two surgical: quaternary surgical ICU [SICU quat] and quaternary cardiac surgical ICU [CSICU quat]; two medical: tertiary medical ICU [MICU tertiary] and quaternary medical ICU [MICU quat]; one general: community medical surgical ICU [MSICU comm]) at Montefiore Medical Center in the Bronx, New York during 2013. After excluding costs clearly accrued outside the ICU, daily hospital costs were merged with clinical data. Patterns of daily unadjusted costs were evaluated in each ICU using median regression. Generalized estimating equations with first-order autocorrelation were used to identify factors independently associated with daily costs. Unadjusted daily costs were higher on Day 1 than on subsequent days only for surgical ICUs-SICU quat (median [interquartile range], $2,636 [$1,834-$4,282] on Day 1 vs. $1,840 [$1,501-$2,332] on Day 2; P < 0.001) and CSICU quat ($5,166 [$3,136-$9,493] on Day 1 vs. $2,060 [$1,336-$2,528] on Day 2; P < 0.001). In nonsurgical ICUs, there was no change (MICU tertiary P = 0.12) or a small increase (MSICU comm P = 0.03; MICU quat P = 0.01) in cost from Days 1 to 2. After multivariate adjustment, there remained a significant decrease in cost from ICU Day 1 to 2 in surgical units with statistically similar Day 1 and 2 costs for other ICUs. Higher Day 1 costs are not seen in patients admitted to medical/nonsurgical ICUs.

  20. Soil Segregation Methods for Reducing Transportation and Disposal Costs - 13544

    SciTech Connect

    Frothingham, David; Andrews, Shawn; Barker, Michelle; Boyle, James; Buechi, Stephen; Graham, Marc; Houston, Linda; Polek, Michael; Simmington, Robert; Spector, Harold; Elliott, Robert 'Dan'; Durham, Lisa

    2013-07-01

    At Formerly Utilized Sites Remedial Action Program (FUSRAP) sites where the selected alternative for contaminated soil is excavation and off-site disposal, the most significant budget items of the remedial action are the costs for transportation and disposal of soil at an off-site facility. At these sites, the objective is to excavate and dispose of only those soils that exceed derived concentration guideline levels. In situ soil segregation using gross gamma detectors to guide the excavation is often challenging at sites where the soil contamination is overlain by clean soil or where the contaminated soil is located in isolated, subsurface pockets. In addition, data gaps are often identified during the alternative evaluation and selection process, resulting in increased uncertainty in the extent of subsurface contamination. In response, the U.S. Army Corps of Engineers, Buffalo District is implementing ex situ soil segregation methods. At the remediated Painesville Site, soils were excavated and fed through a conveyor-belt system, which automatically segregated them into above- and below-cleanup criteria discharge piles utilizing gamma spectroscopy. At the Linde Site and the Shallow Land Disposal Area (SLDA) Site, which are both in the remediation phase, soils are initially segregated during the excavation process using gross gamma detectors and then transported to a pad for confirmatory manual surveying and sampling. At the Linde Site, the ex situ soils are analyzed on the basis of a site-specific method, to establish compliance with beneficial reuse criteria that were developed for the Linde remediation. At the SLDA Site, the ex situ soils are surveyed and sampled based on Multi-Agency Radiation Survey and Site Investigation Manual (MARSSIM) final status survey guidance to demonstrate compliance with the derived concentration guideline levels. At all three sites, the ex situ soils that meet the site- specific DCGLs are retained on-site and used as backfill

  1. Nisin Production Utilizing Skimmed Milk Aiming to Reduce Process Cost

    NASA Astrophysics Data System (ADS)

    Jozala, Angela Faustino; de Andrade, Maura Sayuri; de Arauz, Luciana Juncioni; Pessoa, Adalberto; Penna, Thereza Christina Vessoni

    Nisin is a natural additive for conservation of food, pharmaceutical, and dental products and can be used as a therapeutic agent. Nisin inhibits the outgrowth of spores, the growth of a variety of Gram-positive and Gram-negative bacteria. This study was performed to optimize large-scale nisin production in skimmed milk and subproducts aiming at low-costs process and stimulating its utilization. Lactococcus lactis American Type Culture Collection (ATCC) 11454 was developed in a rotary shaker (30°C/36 h/100 rpm) in diluted skimmed milk and nisin activity, growth parameters, and media components were also studied. Nisin activity in growth media was expressed in arbitrary units (AU/mL) and converted to standard nisin concentration (Nisaplin®, 25 mg of pure nisin is 1.0×106 AU/mL). Nisin activity in skimmed milk 2.27 gtotal solids was up to threefold higher than transfers in skimmed milk 4.54 gtotal solids and was up to 85-fold higher than transfers in skimmed milk 1.14 gtotal solids. L. lactis was assayed in a New Brunswick fermentor with 1.5 L of diluted skimmed milk (2.27 gtotal solids) and airflow of 1.5 mL/min (30°C/36/200 rpm), without pH control. In this condition nisin activity was observed after 4 h (45.07 AU/mL) and in the end of 36 h process (3312.07 AU/mL). This work shows the utilization of a low-cost growth medium (diluted skimmed milk) to nisin production with wide applications. Furthermore, milk subproducts (milk whey) can be exploited in nisin production, because in Brazil 50% of milk whey is disposed with no treatment in rivers and because of high organic matter concentrations it is considered an important pollutant. In this particular case an optimized production of an antimicrobial would be lined up with industrial disposal recycling.

  2. Fiber Optic Sensing Monitors Strain and Reduces Costs

    NASA Technical Reports Server (NTRS)

    2008-01-01

    In applications where stress on a structure may vary widely and have an unknown impact on integrity, a common engineering strategy has been overbuilding to ensure a sufficiently robust design. While this may be appropriate in applications where weight concerns are not paramount, space applications demand a bare minimum of mass, given astronomical per-pound launch costs. For decades, the preferred solution was the tactic of disassembly and investigation between flights. Knowing there must be a better way, Dr. Mark Froggatt, of Langley Research Center, explored alternate means of monitoring stresses and damage to the space shuttle. While a tear-it-apart-and-have-a-look strategy was effective, it was also a costly and time consuming process that risked further stresses through the very act of disassembly and reassembly. An alternate way of monitoring the condition of parts under the enormous stresses of space flight was needed. Froggatt and his colleagues at Langley built an early-warning device to provide detailed information about even minuscule cracks and deformations by etching a group of tiny lines, or grating, on a fiber optic cable five-thousandths of an inch thick with ultraviolet light. By then gluing the fiber to the side of a part, such as a fuel tank, and shining a laser beam down its length, reflected light indicated which gratings were under stress. Inferring this data from measurements in light rather than in bonded gauges saved additional weight. Various shuttle components now employ the ultrasonic dynamic vector stress sensor (UDVSS), allowing stress detection by measuring light beamed from a built-in mini-laser. By measuring changes in dynamic directional stress occurring in a material or structure, and including phase-locked loop, synchronous amplifier, and contact probe, the UDVSS proved especially useful among manufacturers of aerospace and automotive structures for stress testing and design evaluation. Engineers could ensure safety in airplanes

  3. Cost of Medications Recommended by Canadian Acne Clinical Practice Guidelines.

    PubMed

    Czilli, Tiffany; Tan, Jerry; Knezevic, Sanja; Peters, Colin

    2016-11-01

    Acne affects a large proportion of the Canadian population and has psychosocial and financial consequences. We provide cost information for treatments recommended by the Canadian acne guidelines. Highest level recommendations were selected for 3-month usage cost. Three-month estimated treatment costs were as follows: topical retinoids ($14.40-$73.80), benzoyl peroxide (BPO; $6.75), fixed-dose BPO-clindamycin ($40.95-$44.10) and BPO-adapalene ($73.80), oral antibiotics ($25.20 for tetracycline 250 mg qid; $52.20 and $52.74 for doxycycline 50 mg bid and 100 mg od, respectively), and hormonal therapy ($26.46-$37.80 for ethinyl estradiol [EE] 0.030 mg/drospirenone 3mg and $75.60-108.99 for EE 0.035 mg/cyproterone acetate 2 mg). Oral isotretinoin 3-month costs ranged from $393.96 to $478.80. Awareness of costs of recommended treatments may facilitate improved outcomes by increasing procurement and adherence. © The Author(s) 2016.

  4. Reducing Memory Cost of Exact Diagonalization using Singular Value Decomposition

    SciTech Connect

    Weinstein, Marvin; Auerbach, Assa; Chandra, V.Ravi; /Technion

    2011-11-04

    We present a modified Lanczos algorithm to diagonalize lattice Hamiltonians with dramatically reduced memory requirements. The lattice of size N is partitioned into two subclusters. At each iteration the Lanczos vector is projected into a set of n{sub svd} smaller subcluster vectors using singular value decomposition. For low entanglement entropy S{sub ee}, (satisfied by short range Hamiltonians), we expect the truncation error to vanish as exp(-n{sup 1/S{sub ee}}{sub svd}). Convergence is tested for the Heisenberg model on Kagome clusters of up to 36 sites, with no symmetries exploited, using less than 15GB of memory. Generalization to multiple partitioning is discussed.

  5. [Medical cost of cardiovascular risk factors prevention in France].

    PubMed

    Marques-Vidal, P; Bongard, V; Arveiler, D; Amouyel, Ph; Ducimetière, P; Ferrières, J

    2002-04-01

    To assess the cost of the preventive measures against hypertension and dyslipidemia in French subjects aged 35-64 years. Cross-sectional study conducted in 433 men and 424 women from the three French centres participating in the WHO-MONICA Project and receiving antihypertensive and/or hypolipidemic drug therapy. In both genders, beta-blockers and ACE inhibitors were the most frequently prescribed antihypertensive drugs, and half of treated hypertensive subjects still had blood pressure levels beyond the normal limits, this percentage being lower in men and in Bas-Rhin. Daily cost of antihypertensive treatment ranged between 0.58 (minimum) and 1.72 [symbol: see text] (maximum) in men and between 0.54 and 1.46 [symbol: see text] in women, with no differences between centers. Fibrates were the most frequently prescribed hypolipidemic drug, and daily cost of treatment ranged between 0.33 and 1.33 [symbol: see text] in men and between 0.36 and 1.26 [symbol: see text] in women; in men, costs were lower in the Communauté Urbaine de Lille. Slightly more than half of the hyperlipidemic subjects had their LDL levels within normal values; no differences were found between centers or genders. Finally, the daily cost of "therapeutic inefficiency" for hypertension and dyslipidemia for age group 35-64 years in France was estimated to be over one million [symbol: see text]. The cost of the antihypertensive and hypolipidemic drug treatment is high and efforts should be undertaken in order to increase the efficiency of prevention.

  6. Sound stabilizes locomotor-respiratory coupling and reduces energy cost.

    PubMed

    Hoffmann, Charles P; Torregrosa, Gérald; Bardy, Benoît G

    2012-01-01

    A natural synchronization between locomotor and respiratory systems is known to exist for various species and various forms of locomotion. This Locomotor-Respiratory Coupling (LRC) is fundamental for the energy transfer between the two subsystems during long duration exercise and originates from mechanical and neurological interactions. Different methodologies have been used to compute LRC, giving rise to various and often diverging results in terms of synchronization, (de-)stabilization via information, and associated energy cost. In this article, the theory of nonlinear-coupled oscillators was adopted to characterize LRC, through the model of the sine circle map, and tested it in the context of cycling. Our specific focus was the sound-induced stabilization of LRC and its associated change in energy consumption. In our experimental study, participants were instructed during a cycling exercise to synchronize either their respiration or their pedaling rate with an external auditory stimulus whose rhythm corresponded to their individual preferential breathing or cycling frequencies. Results showed a significant reduction in energy expenditure with auditory stimulation, accompanied by a stabilization of LRC. The sound-induced effect was asymmetrical, with a better stabilizing influence of the metronome on the locomotor system than on the respiratory system. A modification of the respiratory frequency was indeed observed when participants cycled in synchrony with the tone, leading to a transition toward more stable frequency ratios as predicted by the sine circle map. In addition to the classical mechanical and neurological origins of LRC, here we demonstrated using the sine circle map model that information plays an important modulatory role of the synchronization, and has global energetic consequences.

  7. Simple calculator to estimate the medical cost of diabetes in sub-Saharan Africa

    PubMed Central

    Alouki, Koffi; Delisle, Hélène; Besançon, Stéphane; Baldé, Naby; Sidibé-Traoré, Assa; Drabo, Joseph; Djrolo, François; Mbanya, Jean-Claude; Halimi, Serge

    2015-01-01

    AIM: To design a medical cost calculator and show that diabetes care is beyond reach of the majority particularly patients with complications. METHODS: Out-of-pocket expenditures of patients for medical treatment of type-2 diabetes were estimated based on price data collected in Benin, Burkina Faso, Guinea and Mali. A detailed protocol for realistic medical care of diabetes and its complications in the African context was defined. Care components were based on existing guidelines, published data and clinical experience. Prices were obtained in public and private health facilities. The cost calculator used Excel. The cost for basic management of uncomplicated diabetes was calculated per person and per year. Incremental costs were also computed per annum for chronic complications and per episode for acute complications. RESULTS: Wide variations of estimated care costs were observed among countries and between the public and private healthcare system. The minimum estimated cost for the treatment of uncomplicated diabetes (in the public sector) would amount to 21%-34% of the country’s gross national income per capita, 26%-47% in the presence of retinopathy, and above 70% for nephropathy, the most expensive complication. CONCLUSION: The study provided objective evidence for the exorbitant medical cost of diabetes considering that no medical insurance is available in the study countries. Although the calculator only estimates the cost of inaction, it is innovative and of interest for several stakeholders. PMID:26617974

  8. Examining the medical resource utilization and costs of relapsed and refractory chronic lymphocytic leukemia in Ontario

    PubMed Central

    Hassan, S.; Seung, S.J.; Cheung, M.C.; Fraser, G.; Kuriakose, B.; Trambitas, C.; Mittmann, N.

    2017-01-01

    Purpose The purpose of the present study was to collect medical resource utilization data and costs in Ontario for the management of patients with relapsed or refractory chronic lymphocytic lymphoma (cll) who have undergone at least 1 treatment course and have been stratified by Rai staging. Methods This retrospective longitudinal cohort study, conducted by chart review, analyzed anonymized patient records from two cancer centres in Ontario. Comprehensive records of 86 patients meeting the inclusion criteria were used to obtain resource utilization, which, multiplied by unit costs, were used to determine overall and mean costs. Descriptive statistics are presented for patient demographics, medical resource utilization, and costing data. Results The total cost for the cohort was $2.2 million over a mean follow-up period of 4.7 years. The mean total cost per patient (regardless of follow-up) was $25,736. In terms of Rai staging, overall mean costs were highest for stage iv patients. Almost 50% of the total cost was attributable to cll treatments, among which fludarabine-based treatments had the highest utilization. Conclusions For this Canadian cll cohort, medical resource utilization and costs were determined to be $2.2 million, with cll treatments accounting for about half the cost. Costs generally increased with Rai stage. PMID:28270732

  9. Direct medical costs associated with Parkinson's disease: a population-based study.

    PubMed

    Leibson, Cynthia L; Long, Kirsten Hall; Maraganore, Demetrius M; Bower, James H; Ransom, Jeanine E; O'Brien, Peter C; Rocca, Walter A

    2006-11-01

    The objective was to provide population-based estimates of incremental medical costs associated with Parkinson's disease (PD) from onset forward. All Olmsted County, Minnesota, residents with confirmed PD onset from 1987 through 1995 (n = 92) and one age- and sex-matched non-PD referent subject per case were identified with retrospective record review and followed in provider-linked billing data for direct medical costs (excluding outpatient pharmaceutical costs) from 1 year before index (i.e., year of symptom onset) through 10 years after index. Costs for each referent subject were subtracted from those for his/her matched case. Tests for statistical significance used Wilcoxon signed ranks. Preindex costs were similar [median difference in annual costs (MD) = -3 dollars; P = 0.59]. One year post index, PD subjects exhibited borderline significantly higher costs compared to referent subjects (MD = 581 dollars; P = 0.052); the difference diminished over 5 years (MD = 118 dollars; P = 0.82). By 5 to 10 years, however, PD subjects exhibited significantly higher costs (MD = 1,146 dollars; P = 0.01). Over the full 10 years, excess costs were concentrated among PD subjects without rest tremor (MD = 2,261 dollars, P < 0.01, for those without tremor and -229 dollars, P = 0.99, for those with tremor). These population-based estimates of PD-associated direct medical costs from onset forward can uniquely inform policy decisions and cost-effectiveness research.

  10. Reduce, reuse and recycle: a green solution to Canada's medical isotope shortage.

    PubMed

    Galea, R; Ross, C; Wells, R G

    2014-05-01

    Due to the unforeseen maintenance issues at the National Research Universal (NRU) reactor at Chalk River and coincidental shutdowns of other international reactors, a global shortage of medical isotopes (in particular technetium-99m, Tc-99m) occurred in 2009. The operation of these research reactors is expensive, their age creates concerns about their continued maintenance and the process results in a large amount of long-lived nuclear waste, whose storage cost has been subsidized by governments. While the NRU has since revived its operations, it is scheduled to cease isotope production in 2016. The Canadian government created the Non-reactor based medical Isotope Supply Program (NISP) to promote research into alternative methods for producing medical isotopes. The NRC was a member of a collaboration looking into the use of electron linear accelerators (LINAC) to produce molybdenum-99 (Mo-99), the parent isotope of Tc-99m. This paper outlines NRC's involvement in every step of this process, from the production, chemical processing, recycling and preliminary animal studies to demonstrate the equivalence of LINAC Tc-99m with the existing supply. This process stems from reusing an old idea, reduces the nuclear waste to virtually zero and recycles material to create a green solution to Canada's medical isotope shortage. © 2013 Published by Elsevier Ltd.

  11. Reducing Memory Cost of Exact Diagonalization using Singular Value Decomposition

    NASA Astrophysics Data System (ADS)

    Weinstein, Marvin; Chandra, Ravi; Auerbach, Assa

    2012-02-01

    We present a modified Lanczos algorithm to diagonalize lattice Hamiltonians with dramatically reduced memory requirements. In contrast to variational approaches and most implementations of DMRG, Lanczos rotations towards the ground state do not involve incremental minimizations, (e.g. sweeping procedures) which may get stuck in false local minima. The lattice of size N is partitioned into two subclusters. At each iteration the rotating Lanczos vector is compressed into two sets of nsvd small subcluster vectors using singular value decomposition. For low entanglement entropy See, (satisfied by short range Hamiltonians), the truncation error is bounded by (-nsvd^1/See). Convergence is tested for the Heisenberg model on Kagom'e clusters of 24, 30 and 36 sites, with no lattice symmetries exploited, using less than 15GB of dynamical memory. Generalization of the Lanczos-SVD algorithm to multiple partitioning is discussed, and comparisons to other techniques are given. Reference: arXiv:1105.0007

  12. Reducing memory cost of exact diagonalization using singular value decomposition.

    PubMed

    Weinstein, Marvin; Auerbach, Assa; Chandra, V Ravi

    2011-11-01

    We present a modified Lanczos algorithm to diagonalize lattice Hamiltonians with dramatically reduced memory requirements, without restricting to variational ansatzes. The lattice of size N is partitioned into two subclusters. At each iteration the Lanczos vector is projected into two sets of n(svd) smaller subcluster vectors using singular value decomposition. For low entanglement entropy S(ee), (satisfied by short-range Hamiltonians), the truncation error is expected to vanish as exp(-n(svd)(1/S(ee))). Convergence is tested for the Heisenberg model on Kagomé clusters of 24, 30, and 36 sites, with no lattice symmetries exploited, using less than 15 GB of dynamical memory. Generalization of the Lanczos-SVD algorithm to multiple partitioning is discussed, and comparisons to other techniques are given.

  13. The estimated direct medical cost of selected sexually transmitted infections in the United States, 2008.

    PubMed

    Owusu-Edusei, Kwame; Chesson, Harrell W; Gift, Thomas L; Tao, Guoyu; Mahajan, Reena; Ocfemia, Marie Cheryl Bañez; Kent, Charlotte K

    2013-03-01

    Millions of cases of sexually transmitted infections (STIs) occur in the United States each year, resulting in substantial medical costs to the nation. Previous estimates of the total direct cost of STIs are quite dated. We present updated direct medical cost estimates of STIs in the United States. We assembled recent (i.e., 2002-2011) cost estimates to determine the lifetime cost per case of 8 major STIs (chlamydia, gonorrhea, hepatitis B virus, human immunodeficiency virus (HIV), human papillomavirus, genital herpes simplex virus type 2, trichomoniasis and syphilis). The total direct cost for each STI was computed as the product of the number of new or newly diagnosed cases in 2008 and the estimated discounted lifetime cost per case. All costs were adjusted to 2010 US dollars. Results indicated that the total lifetime direct medical cost of the 19.7 million cases of STIs that occurred among persons of all ages in 2008 in the United States was $15.6 (range, $11.0-$20.6) billion. Total costs were as follows: chlamydia ($516.7 [$258.3-$775.0] million), gonorrhea ($162.1 [$81.1-$243.2] million), hepatitis B virus ($50.7 [$41.3-$55.6] million), HIV ($12.6 [$9.5-$15.7] billion), human papillomavirus ($1.7 [$0.8-$2.9] billion), herpes simplex virus type 2 ($540.7 [$270.3-$811.0] million), syphilis ($39.3 [$19.6-$58.9] million), and trichomoniasis ($24.0 [$12.0-$36.0] million). Costs associated with HIV infection accounted for more than 81% of the total cost. Among the nonviral STIs, chlamydia was the most costly infection. Sexually transmitted infections continue to impose a substantial cost burden on the payers of medical care in the United States. The burden of STIs would be even greater in the absence of STI prevention and control efforts.

  14. Brand name versus generic drugs: the ethical quandary in caring for our sophisticated patients while trying to reduce health-care costs: facts and controversies.

    PubMed

    Payette, Michael; Grant-Kels, Jane M

    2013-01-01

    Medical ethics are the values and guidelines that govern decisions made in medical practice. Four prima facie moral principles can serve as a framework to help physicians analyze problems and make ethical decisions: (1) respect for autonomy, (2) beneficence, (3) non-maleficence, and (4) justice. With the cost of health care rising, all parties involved in the delivery of health care need to work to reduce costs, while continuing to provide quality care to our patients. One mechanism to reduce costs is to increase utilization of generic medications in daily practice, but there are many ethical issues inherent in utilizing brand name versus generic medications in dermatology. © 2013 Elsevier Inc. All rights reserved.

  15. Current pulse: can a production system reduce medical errors in health care?

    PubMed

    Printezis, Antonios; Gopalakrishnan, Mohan

    2007-01-01

    One of the reasons for rising health care costs is medical errors, a majority of which result from faulty systems and processes. Health care in the past has used process-based initiatives such as Total Quality Management, Continuous Quality Improvement, and Six Sigma to reduce errors. These initiatives to redesign health care, reduce errors, and improve overall efficiency and customer satisfaction have had moderate success. Current trend is to apply the successful Toyota Production System (TPS) to health care since its organizing principles have led to tremendous improvement in productivity and quality for Toyota and other businesses that have adapted them. This article presents insights on the effectiveness of TPS principles in health care and the challenges that lie ahead in successfully integrating this approach with other quality initiatives.

  16. "Green Oncology": the Italian medical oncologists' challenge to reduce the ecological impact of their clinical activity.

    PubMed

    Bretti, Sergio; Porcile, Gianfranco; Romizi, Roberto; Palazzo, Salvatore; Oliani, Cristina; Crispino, Sergio; Labianca, Roberto

    2014-01-01

    For decades Western medicine has followed a biomedical model based on linear thinking and an individualized, disease-oriented doctor-patient relationship. Today this framework must be replaced by a biopsychosocial model based on complexity theory and a person-oriented medical team-patient relationship, taking into account the psychological and social determinants of health and disease. However, the new model is already proving no longer adequate or appropriate, and current events are urging us to develop an ecological model in which the medical team takes into account both individual illness and population health as a whole, since we are all part of the biosphere. In recent years, the rising costs of cancer treatment have raised a serious issue of economic sustainability. As the population of our planet, we now need to rapidly address this issue, and everyone of us must try to reduce their ecological footprint, measured as CO2 production. Medical oncologists need to reduce the ecological footprint of their professional activity by lowering the consumption of economic resources and avoiding environmental damage as much as possible. This new paradigm is endorsed by the Italian College of Hospital Medical Oncology Directors (CIPOMO). A working group of this organization has drafted the "Green Oncology Position Paper": a proposal of Italian medical oncology (in accordance with international guidelines) that oncologists, while aiming for the same end results, make a commitment toward the more appropriate management of health care and the careful use of resources in order to protect the environment and the ecosphere during the daily exercise of their professional activities.

  17. [Analysis of direct medical cost on pneumoconiosis patients with questionnaires in an iron & steel enterprise].

    PubMed

    Qiu, Bing; Li, Tao; Zhang, Min; Wang, Zhong-xu; Lin, Han; Shu, Ping

    2009-04-01

    To study the distribution of the direct medical cost for the pneumoconiosis and provide a clue for the compensation. According to the electronic records for the medical cost of pneumoconiosis, 237 patients were investigated with questionnaires. Their medical cost was described by disability levels, types of work, the categories of tuberculosis, ages and length of work. In the 237 cases of questionnaires, there were 161 cases with complications, accounting for 67.9%, and the proportion of the emphysema in the complication cases was 21.1%. The proportion of the disability level IV for pneumoconiosis patients was about 55.7% in all cases. Their total medical cost ranged from 3946.5 yuan RMB to 8819.3 yuan RMB per patient per year, and the median was 6954.2 yuan RMB per patient per year. The disability levels can be considered as the standard for the pneumoconiosis compensation to a certain extent.

  18. Vital signs: health burden and medical costs of nonfatal injuries to motor vehicle occupants - United States, 2012.

    PubMed

    Bergen, Gwen; Peterson, Cora; Ederer, David; Florence, Curtis; Haileyesus, Tadesse; Kresnow, Marcie-jo; Xu, Likang

    2014-10-10

    Motor vehicle crashes are a leading cause of death and injury in the United States. The purpose of this study was to describe the current health burden and medical and work loss costs of nonfatal crash injuries among vehicle occupants in the United States. CDC analyzed data on emergency department (ED) visits resulting from nonfatal crash injuries among vehicle occupants in 2012 using the National Electronic Injury Surveillance System – All Injury Program (NEISS-AIP) and the Healthcare Cost and Utilization Project National Inpatient Sample (HCUP-NIS). The number and rate of all ED visits for the treatment of crash injuries that resulted in the patient being released and the number and rate of hospitalizations for the treatment of crash injuries were estimated, as were the associated number of hospital days and lifetime medical and work loss costs. In 2012, an estimated 2,519,471 ED visits resulted from nonfatal crash injuries, with an estimated lifetime medical cost of $18.4 billion (2012 U.S. dollars). Approximately 7.5% of these visits resulted in hospitalizations that required an estimated 1,057,465 hospital days in 2012. Nonfatal crash injuries occur frequently and result in substantial costs to individuals, employers, and society. For each motor vehicle crash death in 2012, eight persons were hospitalized, and 100 were treated and released from the ED. Public health practices and laws, such as primary seat belt laws, child passenger restraint laws, ignition interlocks to prevent alcohol impaired driving, sobriety checkpoints, and graduated driver licensing systems have demonstrated effectiveness for reducing motor vehicle crashes and injuries. They might also substantially reduce associated ED visits, hospitalizations, and medical costs.

  19. Cost of medication adherence and persistence in type 2 diabetes mellitus: a literature review

    PubMed Central

    Kennedy-Martin, Tessa; Boye, Kristina S; Peng, Xiaomei

    2017-01-01

    Purpose To explore published evidence on health care costs associated with adherence or persistence to antidiabetes medications in adults with type 2 diabetes mellitus (T2DM). Methods Primary research studies published between January 2006 and December 2015 on compliance, adherence, or persistence and treatment in patients with T2DM that document a link with health care costs were identified through literature searches in bibliographic databases and 2015 abstract books for relevant DM congresses. Results were assessed for relevance by two reviewers. The review was part of a larger overview evaluating the impact of adherence and persistence on a range of clinical and economic outcomes; only findings from the cost element are reported herein. Results A total of 4,662 de-duplicated abstracts were identified and 110 studies included in the wider review. Of these, 19 reported an association between adherence (n=13), persistence (n=5), or adherence and persistence (n=1), and health care costs. All studies were retrospective, with sample sizes ranging from 301 to 740,195. Medication possession ratio was the most commonly employed adherence measure (n=11). The majority of adherence studies (n=9) reported that medication adherence was associated with lower total health care costs. Pharmacy costs were often increased in adherent patients but this was offset by beneficial effects on other costs. Findings were more variable in persistence studies; three reported that higher pharmacy costs in persistent patients were not sufficiently offset by savings in other areas to result in a reduction in total health care costs. Conclusions Few studies have evaluated the relationship between adherence, persistence, and health care costs in T2DM. However, it has been consistently shown that medication nonadherence increases health care costs, suggesting that cost savings from better adherence could be substantial. Available data support the economic case for identification of strategies

  20. Cost of medication adherence and persistence in type 2 diabetes mellitus: a literature review.

    PubMed

    Kennedy-Martin, Tessa; Boye, Kristina S; Peng, Xiaomei

    2017-01-01

    To explore published evidence on health care costs associated with adherence or persistence to antidiabetes medications in adults with type 2 diabetes mellitus (T2DM). Primary research studies published between January 2006 and December 2015 on compliance, adherence, or persistence and treatment in patients with T2DM that document a link with health care costs were identified through literature searches in bibliographic databases and 2015 abstract books for relevant DM congresses. Results were assessed for relevance by two reviewers. The review was part of a larger overview evaluating the impact of adherence and persistence on a range of clinical and economic outcomes; only findings from the cost element are reported herein. A total of 4,662 de-duplicated abstracts were identified and 110 studies included in the wider review. Of these, 19 reported an association between adherence (n=13), persistence (n=5), or adherence and persistence (n=1), and health care costs. All studies were retrospective, with sample sizes ranging from 301 to 740,195. Medication possession ratio was the most commonly employed adherence measure (n=11). The majority of adherence studies (n=9) reported that medication adherence was associated with lower total health care costs. Pharmacy costs were often increased in adherent patients but this was offset by beneficial effects on other costs. Findings were more variable in persistence studies; three reported that higher pharmacy costs in persistent patients were not sufficiently offset by savings in other areas to result in a reduction in total health care costs. Few studies have evaluated the relationship between adherence, persistence, and health care costs in T2DM. However, it has been consistently shown that medication nonadherence increases health care costs, suggesting that cost savings from better adherence could be substantial. Available data support the economic case for identification of strategies that facilitate improved medication

  1. Epidemiology and direct medical costs of osteoporotic fractures in men and women in Switzerland.

    PubMed

    Lippuner, Kurt; Golder, Matthias; Greiner, Roger

    2005-03-01

    the age of 65 years. The direct medical cost of hospitalization of patients with osteoporosis and/or related fractures was 357 million CHF. Hip fractures accounted for approximately half of these costs in women and men. Among other common diseases in women and men, osteoporosis ranked number 1 in women and number 2 (behind COPD) in men. When compared with data from 1992, the average length of stay had shortened by 8.4 days for women and 4.7 days for men, leading to a decrease of almost 40% in direct medical costs related to acute hospitalizations. This apparent decrease in cost might result from a shift into the ambulatory cost segment, for which the assessment and management tools need to be developed. We conclude that, in 2000, osteoporosis continued to be a heavy burden on the Swiss healthcare system. Lack of awareness of the disease and its consequences prevents widespread use of drugs with anti-fracture efficacy. This limits their potential to reduce costs.

  2. Reducing Medication Administration Errors in Acute and Critical Care: Multifaceted Pilot Program Targeting RN Awareness and Behaviors.

    PubMed

    Durham, Marianne L; Suhayda, Rosemarie; Normand, Patricia; Jankiewicz, Ann; Fogg, Louis

    2016-02-01

    The aim of this medication safety pilot program was to increase RN sensitivity to potential error risk, improve behaviors, and reduce observed medication administration errors (MAEs). MAEs are common and preventable and may lead to adverse drug events, costing the patient and organization. MAEs are low visibility, rarely intercepted, and underreported. An interprofessional team used process improvement methodology to develop a human factors-based medication safety pilot program to address identified issues. An observational time-series design study monitored the effect of the program. After the program, error interception practices during administration increased, and some nurses reported using a mindfulness strategy to gain situational awareness before administration. Process behaviors were performed more consistently, and the risk of MAE decreased. Familiarity and complexity were identified as additional variables affecting MAE outcome. Strategies to support safe medication administration may reduce error and be of interest to nurse leaders.

  3. Reduced acute inpatient care was largest savings component of Geisinger Health System's patient-centered medical home.

    PubMed

    Maeng, Daniel D; Khan, Nazmul; Tomcavage, Janet; Graf, Thomas R; Davis, Duane E; Steele, Glenn D

    2015-04-01

    Early evidence suggests that the patient-centered medical home has the potential to improve patient outcomes while reducing the cost of care. However, it is unclear how this care model achieves such desirable results, particularly its impact on cost. We estimated cost savings associated with Geisinger Health System's patient-centered medical home clinics by examining longitudinal clinic-level claims data from elderly Medicare patients attending the clinics over a ninety-month period (2006 through the first half of 2013). We also used these data to deconstruct savings into its main components (inpatient, outpatient, professional, and prescription drugs). During this period, total costs associated with patient-centered medical home exposure declined by approximately 7.9 percent; the largest source of this savings was acute inpatient care ($34, or 19 percent savings per member per month), which accounts for about 64 percent of the total estimated savings. This finding is further supported by the fact that longer exposure was also associated with lower acute inpatient admission rates. The results of this study suggest that patient-centered medical homes can lead to sustainable, long-term improvements in patient health outcomes and the cost of care.

  4. Strategies for reducing medication errors in the emergency department

    PubMed Central

    Weant, Kyle A; Bailey, Abby M; Baker, Stephanie N

    2014-01-01

    Medication errors are an all-too-common occurrence in emergency departments across the nation. This is largely secondary to a multitude of factors that create an almost ideal environment for medication errors to thrive. To limit and mitigate these errors, it is necessary to have a thorough knowledge of the medication-use process in the emergency department and develop strategies targeted at each individual step. Some of these strategies include medication-error analysis, computerized provider-order entry systems, automated dispensing cabinets, bar-coding systems, medication reconciliation, standardizing medication-use processes, education, and emergency-medicine clinical pharmacists. Special consideration also needs to be given to the development of strategies for the pediatric population, as they can be at an elevated risk of harm. Regardless of the strategies implemented, the prevention of medication errors begins and ends with the development of a culture that promotes the reporting of medication errors, and a systematic, nonpunitive approach to their elimination. PMID:27147879

  5. Costs and Their Assessment to Users of a Medical Library, Part III: Allocating Fixed Joint Costs.

    ERIC Educational Resources Information Center

    Bres, E.; And Others

    Part III of the study describes a model for completing the cost assessment (justification) process by accounting for the fixed joint costs; a "fair" and equitable mechanism is developed in the context of game-theoretic approach. An n-person game is constructed in which the "players" are the institutions served by the library,…

  6. Trends in the prescription and cost of diabetic medications and monitoring equipment in England 1991-2004.

    PubMed

    Patel, Hitesh; Srishanmuganathan, Janakan; Car, Josip; Majeed, Azeem

    2007-03-01

    To report the trend in prescriptions and cost of antidiabetic drugs and glucose monitoring equipment in England from 1991 to 2004. We analysed data on all community antidiabetic drug prescriptions in England collated from the Prescription Cost Analysis system. The total number of diabetes prescriptions (medicines and monitoring) rose from 7,613,000 (1991) to 24,325,640 (2004) (>300% increase). Meanwhile, total costs increased by 650%. Insulins are the biggest contributor to cost followed by monitoring equipment and then oral medications. Three times as many items of oral tablets are prescribed than insulins. Metformin accounts for 40% of all diabetic drug dispensations but only 7% of the costs. More is spent on glitazones now than on either metformin or sulphonylureas. There has been a substantial increase in the cost of managing diabetes in the community. Costs are likely to continue to rise in the future, as the prevalence of diabetes increases and through more aggressive identification and management of patients with diabetes in the hope of reducing the even more costly complications. The cost implications of glucose monitoring merits further study.

  7. It Ain't Necessarily So: The Electronic Health Record And The Unlikely Prospect Of Reducing Health Care Costs.

    PubMed

    Sidorov, Jaan

    2006-01-01

    Electronic health record (EHR) advocates argue that EHRs lead to reduced errors and reduced costs. Many reports suggest otherwise. The EHR often leads to higher billings and declines in provider productivity with no change in provider-to-patient ratios. Error reduction is inconsistent and has yet to be linked to savings or malpractice premiums. As interest in patient-centeredness, shared decision making, teaming, group visits, open access, and accountability grows, the EHR is better viewed as an insufficient yet necessary ingredient. Absent other fundamental interventions that alter medical practice, it is unlikely that the U.S. health care bill will decline as a result of the EHR alone.

  8. 42 CFR 412.105 - Special treatment: Hospitals that incur indirect costs for graduate medical education programs.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... costs for graduate medical education programs. 412.105 Section 412.105 Public Health CENTERS FOR... costs for graduate medical education programs. CMS makes an additional payment to hospitals for indirect medical education costs using the following procedures: (a) Basic data. CMS determines the following...

  9. 38 CFR 17.121 - Limitations on payment or reimbursement of the costs of emergency hospital care and medical...

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... reimbursement of the costs of emergency hospital care and medical services not previously authorized. 17.121... reimbursement of the costs of emergency hospital care and medical services not previously authorized. Claims for payment or reimbursement of the costs of emergency hospital care or medical services not...

  10. 38 CFR 17.121 - Limitations on payment or reimbursement of the costs of emergency hospital care and medical...

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... reimbursement of the costs of emergency hospital care and medical services not previously authorized. 17.121... reimbursement of the costs of emergency hospital care and medical services not previously authorized. Claims for payment or reimbursement of the costs of emergency hospital care or medical services not...

  11. Lean Six Sigma to Reduce Intensive Care Unit Length of Stay and Costs in Prolonged Mechanical Ventilation.

    PubMed

    Trzeciak, Stephen; Mercincavage, Michael; Angelini, Cory; Cogliano, William; Damuth, Emily; Roberts, Brian W; Zanotti, Sergio; Mazzarelli, Anthony J

    2016-11-29

    Patients with prolonged mechanical ventilation (PMV) represent important "outliers" of hospital length of stay (LOS) and costs (∼$26 billion annually in the United States). We tested the hypothesis that a Lean Six Sigma (LSS) approach for process improvement could reduce hospital LOS and the associated costs of care for patients with PMV. Before-and-after cohort study. Multidisciplinary intensive care unit (ICU) in an academic medical center. Adult patients admitted to the ICU and treated with PMV, as defined by diagnosis-related group (DRG). We implemented a clinical redesign intervention based on LSS principles. We identified eight distinct processes in preparing patients with PMV for post-acute care. Our clinical redesign included reengineering daily patient care rounds ("Lean ICU rounds") to reduce variation and waste in these processes. We compared hospital LOS and direct cost per case in patients with PMV before (2013) and after (2014) our LSS intervention. Among 259 patients with PMV (131 preintervention; 128 postintervention), median hospital LOS decreased by 24% during the intervention period (29 vs. 22 days, p < .001). Accordingly, median hospital direct cost per case decreased by 27% ($66,335 vs. $48,370, p < .001). We found that a LSS-based clinical redesign reduced hospital LOS and the costs of care for patients with PMV.

  12. Rewards, costs and challenges: the general practitioner's experience of teaching medical students.

    PubMed

    Sturman, Nancy; Régo, Patricia; Dick, Marie-Louise

    2011-07-01

    Medical student attachments in general practices play an important role in undergraduate medical education internationally. The recruitment by universities of new teaching practices or an increase in the teaching commitment of existing practices will be necessary to address rising medical student numbers. General practitioners (GPs) are likely to weigh the perceived rewards of practice-based teaching against the perceived costs and challenges in deciding whether to accept a student placement and how to teach. These aspects of the 'lived experience' of the GP-teacher have not been adequately investigated. This study aims to enhance understanding of the GP clinical teacher experience in order to inform strategies for the recruitment, retention, training and support of teaching general practices. Sixty GP clinical teachers in Brisbane-based urban teaching general practices were interviewed individually face-to-face by the principal investigator, using a semi-structured interview plan. Representativeness was ensured through quota sampling. The interview data were analysed thematically by two of the investigators independently, following member checking of interview transcripts. The results demonstrate a number of key inter-related perceived rewards, costs and challenges of teaching, including intellectual stimulation, cognitive fatigue and student characteristics. The findings extend reports in the previous literature by offering a richer description of current GP-teacher experience. Participants identified teaching rewards in a manner largely consistent with previous research, with the exception of enhanced practice morale and teamwork. Findings confirm that reduced productivity and increased time pressures remain key perceived negative impacts of teaching, but also reveal a number of other important costs and challenges. They emphasise the diversity of GP experience and practice cultures, and the need for teaching to enhance both GP and patient perceptions of

  13. Price elasticity and medication use: cost sharing across multiple clinical conditions.

    PubMed

    Gatwood, Justin; Gibson, Teresa B; Chernew, Michael E; Farr, Amanda M; Vogtmann, Emily; Fendrick, A Mark

    2014-11-01

    To address the impact that out-of-pocket prices may have on medication use, it is vital to understand how the demand for medications may be affected when patients are faced with changes in the price to acquire treatment and how price responsiveness differs across medication classes.  To examine the impact of cost-sharing changes on the demand for 8 classes of prescription medications. This was a retrospective database analysis of 11,550,363 commercially insured enrollees within the 2005-2009 MarketScan Database. Patient cost sharing, expressed as a price index for each medication class, was the main explanatory variable to examine the price elasticity of demand. Negative binomial fixed effect models were estimated to examine medication fills. The elasticity estimates reflect how use changes over time as a function of changes in copayments. Model estimates revealed that price elasticity of demand ranged from -0.015 to -0.157 within the 8 categories of medications (P  less than  0.01 for 7 of 8 categories). The price elasticity of demand for smoking deterrents was largest (-0.157, P  less than  0.0001), while demand for antiplatelet agents was not responsive to price (P  greater than 0.05). The price elasticity of demand varied considerably by medication class, suggesting that the influence of cost sharing on medication use may be related to characteristics inherent to each medication class or underlying condition.

  14. Using Cost as an Independent Variable (CAIV) to Reduce Total Ownership Cost

    DTIC Science & Technology

    2006-01-31

    CAIV pilot programs in each of the DoD Components that might yield valuable lessons- learned for the acquisition community. Without designated CAIV...Costs,” that comprises a collection of the lessons- learned and best practices garnered from the R-TOC Pilot programs.7 Expert Interviews Published...each of the DoD Components that might yield valuable lessons- learned for the acquisition community. However, for unknown reasons, none has been

  15. Cost and Efficacy Assessment of an Alternative Medication Compliance Urine Drug Testing Strategy.

    PubMed

    Doyle, Kelly; Strathmann, Frederick G

    2017-02-01

    This study investigates the frequency at which quantitative results provide additional clinical benefit compared to qualitative results alone. A comparison between alternative urine drug screens and conventional screens including the assessment of cost-to-payer differences, accuracy of prescription compliance or polypharmacy/substance abuse was also included. In a reference laboratory evaluation of urine specimens from across the United States, 213 urine specimens with provided prescription medication information (302 prescriptions) were analyzed by two testing algorithms: 1) conventional immunoassay screen with subsequent reflexive testing of positive results by quantitative mass spectrometry; and 2) a combined immunoassay/qualitative mass-spectrometry screen that substantially reduced the need for subsequent testing. The qualitative screen was superior to immunoassay with reflex to mass spectrometry in confirming compliance per prescription (226/302 vs 205/302), and identifying non-prescription abuse (97 vs 71). Pharmaceutical impurities and inconsistent drug metabolite patterns were detected in only 3.8% of specimens, suggesting that quantitative results have limited benefit. The percentage difference between the conventional testing algorithm and the alternative screen was projected to be 55%, and a 2-year evaluation of test utilization as a measure of test order volume follows an exponential trend for alternative screen test orders over conventional immunoassay screens that require subsequent confirmation testing. Alternative, qualitative urine drug screens provide a less expensive, faster, and more comprehensive evaluation of patient medication compliance and drug abuse. The vast majority of results were interpretable with qualitative results alone indicating a reduced need to automatically reflex to quantitation or provide quantitation for the majority of patients. This strategy highlights a successful approach using an alternative strategy for both the

  16. Excess Medical Care Costs Associated with Physical Inactivity among Korean Adults: Retrospective Cohort Study.

    PubMed

    Min, Jin-Young; Min, Kyoung-Bok

    2016-01-18

    Physical inactivity is a major risk factor for chronic diseases and premature death. The increased health risks associated with physical inactivity may also generate a heavier economic burden to society. We estimated the direct medical costs attributable to physical inactivity among adults using data from the 2002-2010 Korean National Health Insurance Service-National Sample Cohort. A total of 68,556 adults whose reported physical activity status did not change during the study period was included for this study. Propensity scores for inactive adults were used to match 23,645 inactive groups with 23,645 active groups who had similar propensity scores. We compared medical expenditures between the two groups using generalized linear models with a gamma distribution and a log link. Direct medical costs were based on the reimbursement records of all medical facilities from 2005 to 2010. The average total medical costs for inactive individuals were $1110.5, which was estimated to be 11.7% higher than the costs for physically active individuals. With respect to specific diseases, the medical costs of inactive people were significantly higher than those of active people, accounting for approximately 8.7% to 25.3% of the excess burden. Physical inactivity is associated with considerable medical care expenditures per capita among Korean adults.

  17. The cost of bariatric medical tourism on the Canadian healthcare system.

    PubMed

    Sheppard, Caroline E; Lester, Erica L W; Karmali, Shahzeer; de Gara, Christopher J; Birch, Daniel W

    2014-05-01

    Medical tourists are defined as individuals who intentionally travel from their home province/country to receive medical care. Minimal literature exists on the cost of postoperative care and complications for medical tourists. The costs associated with these patients were reviewed. Between February 2009 and June 2013, 62 patients were determined to be medical tourists. Patients were included if their initial surgery was performed between January 2003 and June 2013. A chart review was performed to identify intervention costs sustained upon their return. Conservatively, the costs of length of stay (n = 657, $1,433,673.00), operative procedures (n = 110, $148,924.30), investigations (n = 700, $214,499.06), blood work (n = 357, $19,656.90), and health professionals' time (n = 76, $17,414.87) were summated to the total cost of $1.8 million CAD. The absolute denominator of patients who go abroad for bariatric surgery is unknown. Despite this, a substantial cost is incurred because of medical tourism. Future investigations will analyze the cost effectiveness of bariatric surgery conducted abroad compared with local treatment. Copyright © 2014 Elsevier Inc. All rights reserved.

  18. Cost-Effectiveness of an Intervention to Reduce Emergency Re-Admissions to Hospital among Older Patients

    PubMed Central

    Graves, Nicholas; Courtney, Mary; Edwards, Helen; Chang, Anne; Parker, Anthony; Finlayson, Kathleen

    2009-01-01

    Background The objective is to estimate the cost-effectiveness of an intervention that reduces hospital re-admission among older people at high risk. A cost-effectiveness model to estimate the costs and health benefits of the intervention was implemented. Methodology/Principal Findings The model used data from a randomised controlled trial conducted in an Australian tertiary metropolitan hospital. Participants were acute medical admissions aged >65 years with at least one risk factor for re-admission: multiple comorbidities, impaired functionality, aged >75 years, recent multiple admissions, poor social support, history of depression. The intervention was a comprehensive nursing and physiotherapy assessment and an individually tailored program of exercise strategies and nurse home visits with telephone follow-up; commencing in hospital and continuing following discharge for 24 weeks. The change to cost outcomes, including the costs of implementing the intervention and all subsequent use of health care services, and, the change to health benefits, represented by quality adjusted life years, were estimated for the intervention as compared to existing practice. The mean change to total costs and quality adjusted life years for an average individual over 24 weeks participating in the intervention were: cost savings of $333 (95% Bayesian credible interval $ -1,932∶1,282) and 0.118 extra quality adjusted life years (95% Bayesian credible interval 0.1∶0.136). The mean net-monetary-benefit per individual for the intervention group compared to the usual care condition was $7,907 (95% Bayesian credible interval $5,959∶$9,995) for the 24 week period. Conclusions/Significance The estimation model that describes this intervention predicts cost savings and improved health outcomes. A decision to remain with existing practices causes unnecessary costs and reduced health. Decision makers should consider adopting this program for elderly hospitalised patients. PMID:19829702

  19. Effects of reduced cost-sharing on children's health: Evidence from Japan.

    PubMed

    Takaku, Reo

    2016-02-01

    Although childhood health status is widely recognized as an important determinant for future achievement and health, there are few studies on the impact of patient cost-sharing on children's health. This paper investigates whether reduced cost-sharing leads to an improvement of health status among preschool and school-age children in Japan, exploiting regional disparities in expansions of municipality-level subsidy programs for out-of-pocket expenditure. With the eligibility for this subsidy program, known as the Medical Subsidy for Children and Infants (MSCI), the coinsurance rate generally decreases from 30% or 20% to zero for outpatient health care services and drug prescriptions. In order to uncover the impact of this program, I conducted an original survey of all municipalities in Japan to understand the time-series evolution of the eligible age for the MSCI in October 2013 (weighted response rate = 75%), and the probability of being eligible for the MSCI was then calculated by the age, prefecture of residence, and year. These probabilities were matched to children's health data from the Comprehensive Survey of Living Conditions from 1995 to 2010. The results show that eligibility for the MSCI improves subjective measures of health status among preschool children (n = 115,019). However, I find no such improvement among school-age children (n = 133,855). In addition, MSCI eligibility does not reduce hospitalization among either preschool or school-age children. Taken together, this study finds no discernible effects on health among school-age children, suggesting recent rapid expansions of the MSCI for this age group have not been associated with the improvement of health status. Copyright © 2016 Elsevier Ltd. All rights reserved.

  20. The Future Train Wreck: Paying for Medical Costs for Higher Education's Retirees

    ERIC Educational Resources Information Center

    Biggs, John H.

    2006-01-01

    Trustees and administrators today confront one of two problems with post-retirement medical care. First, if institutions provide no support for their retirees' medical care, they implicitly offer a powerful incentive for senior faculty to stay on. The compensation and opportunity costs of this effect are obviously very high. But, second, if they…

  1. Development of a fixed abrasive slicing technique (FAST) for reducing the cost of photovoltaic wafers

    SciTech Connect

    Schmid, F. )

    1991-12-01

    This report examines a wafer slicing technique developed by Crystal Systems, Inc. that reduces the cost of photovoltaic wafers. This fixed, abrasive slicing technique (FAST) uses a multiwire bladepack and a diamond-plated wirepack; water is the coolant. FAST is in the prototype production stage and reduces expendable material costs while retaining the advantages of a multiwire slurry technique. The cost analysis revealed that costs can be decreased by making more cuts per bladepack and slicing more wafers per linear inch. Researchers studied the degradation of bladepacks and increased wirepack life. 21 refs.

  2. Continuing medical education costs and benefits: lessons for competing in a changing health care economy.

    PubMed

    Mazmanian, Paul E

    2009-01-01

    Current approaches to evaluation in continuing medical education (CME) feature results defined as changes in participation, satisfaction, knowledge, behavior, and patient outcomes. Few studies link costs and effectiveness of CME to improved quality of care. As continuing education programs compete for scarce resources, cost-inclusive evaluation offers strategies to measure change and to determine value for resources spent.

  3. Estimated Lifetime Medical and Work-Loss Costs of Fatal Injuries--United States, 2013.

    PubMed

    Florence, Curtis; Simon, Thomas; Haegerich, Tamara; Luo, Feijun; Zhou, Chao

    2015-10-02

    Injury-associated deaths have substantial economic consequences. In 2013, unintentional injury was the fourth leading cause of death, suicide was the tenth, and homicide was the sixteenth; these three causes accounted for approximately 187,000 deaths in the United States. To assess the economic impact of fatal injuries, CDC analyzed death data from the National Vital Statistics System for 2013, along with cost of injury data using the Web-Based Injury Statistics Query and Reporting System. This report updates a previous study that analyzed death data from the year 2000, and employs recently revised methodology for determining the costs of injury outcomes, which uses the most current economic data and incorporates improvements for estimating medical costs associated with injury. Number of deaths, crude and age-specific death rates, and total lifetime work-loss costs and medical costs were calculated for fatal injuries by sex, age group, intent (intentional versus unintentional), and mechanism of injury. During 2013, the rate of fatal injury was 61.0 per 100,000 population, with combined medical and work-loss costs exceeding $214 billion. Costs from fatal injuries represent approximately one third of the total $671 billion medical and work-loss costs associated with all injuries in 2013. The magnitude of the economic burden associated with injury-associated deaths underscores the need for effective prevention.

  4. Costs of inguinal hernia repair associated with using different medical devices in the Czech Republic.

    PubMed

    Marešová, Petra; Peteja, Matus; Lerch, Milan; Zonca, Pavel; Kuca, Kamil

    2016-01-01

    Inguinal hernia repair is one of the most frequently carried out operations worldwide. The purpose of this article is to analyze the costs of hernia repair and to specify the loss or profit made under the conditions in the Czech Republic with respect to the currently used