Esta dissertação buscou avaliar os custos hospitalares parciais decorrentes de internações por traumas causados por ocorrências motociclísticas bem como o perfil epidemiológico destas vítimas. Foi feito um estudo retrospectivo de usuários do Sistema Único de Saúde, de 460 vítimas do trauma com motocicletas, internados na Unidade de Emergência do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, divididos de acordo com o mecanismo do trauma e gravidade dos casos. Para efeito de análise, os usuários foram categorizados por faixa etária, estado civil, escolaridade, sexo, local de ocorrência do trauma e dia da semana em que houve este evento. Para consecução deste trabalho foram utilizados o banco de dados do Núcleo Epidemiológico Hospitalar, o sistema de informação interna e dados da seção de custos do mesmo hospital. Como resultado foi identificado que as maiores vítimas de eventos motociclísticos são jovens, solteiros, com baixa escolaridade e do sexo masculino. Também foi identificado que os eventos ocorrem com mais frequência nos finais de semana, além da quarta feira, e que ocorrem próximo do horário da saída do expediente de trabalho e no período da noite. As principais lesões ocorrem nos membros (lesões moderadas e graves) e na cabeça (lesões graves e críticas), sendo múltiplas lesões característica deste tipo de paciente. O custo hospitalar foi principalmente relacionado ao tempo de internação em enfermarias e no CTI e a gravidade do trauma. O valor final do custo avaliado no estudo foi de R$ 5.315.357,15, com média geral de R$11.555,12 por paciente. Para os casos mais graves (ISS > 15) a média de custo foi de R$ 33.259,50 por paciente / This dissertation evaluates the partial hospital costs of hospitalizations for injuries caused by motorcycle accidents and the epidemiological profile of these victims. A retrospective study based on Unified Health System patients was done. 460 motorcycles trauma victims admitted to the Emergency Unit of the Hospital of Ribeirão Preto Medical School Clinical, University of Sao Paulo, were included in the study. Data were collected based on Epidemiological Nucleus database of the Hospital, the internal information system and data from the same hospital costs section, including: mechanism and severity of trauma, epidemiological and socioeconomic data such as age, sex, marital status, education, local, date, and time of occurrences. tThe majority of motorcycle accidents victims were young, single, with low level of education, and male. Accidents occurred more frequently on weekends and Wednesday. Usually from 12 pm to midnight. . The major injuries occurred in the limbs (moderate and severe lesions) and head (severe and critical injuries), being typical of this type of accident several injuries. The hospital costs were mainly related to the wards and ICU length of stay, and the trauma severity. The final value of costs was R$ 5,315,357.15, and in average R$ 11.555,12 per patient. To severe cases (ISS>15) the average cost was R$33,259.50 per patient

Abstract Hip fracture causes substantial burden for individual and society, with increased mortality and loss of function. The purpose of this study was to (1) examine the effects of specialized (physical and geriatric) rehabilitation on home-dwelling hip fracture patients 50 years or older on recovery one year after the fracture, (2) to evaluate the costs and cost-effectiveness of specialized rehabilitation modalities, (3) to study the recovery after hip fracture between home-dwelling male and female patients and (4) to determine recommendations for hip fracture rehabilitation concerning the general rehabilitation practices in Finland. A total of 538 consecutively, independently living patients with non-pathological hip fracture treated in Oulu University hospital, were randomized to one of the three rehabilitation modalities: privately-based rehabilitation unit (physical rehabilitation), geriatric department (geriatric rehabilitation) and healthcare centre hospital (control group). Patients were evaluated on admission, at 4 and 12 months for social status, residential status, walking ability, use of walking aids, pain in the hip, activities of daily living and mortality. Costs were evaluated by recording the use of healthcare service and the prices were obtained from Diagnosis Related Group (DRG) price list for the hospital and from a publication of the National Research and Development Centre for Welfare and Health. Mortality was lower in the physical rehabilitation group 4 and 12 months after the fracture compared to geriatric and the control rehabilitation group. Physical and geriatric rehabilitation improved the ability of independent living after 4 months, but this effect could not be seen after 12 months. The rehabilitation costs were higher in the physical rehabilitation than in the control group, but the total healthcare-related costs one year after the fracture were lower in the physical rehabilitation group than in the control. Male and female patients recovered similarly after hip fracture. Age, poor functional status before the fracture and high ASA-score increased the mortality risk. This thesis suggests that intensive mobilization and rehabilitation is a recommended practice after the hip fracture, resulting in better functional recovery, survival and lower economic costs compared to routine treatment. Poor recovery was predicted not by sex, but by prefracture function and morbidity. / Tiivistelmä Lonkkamurtuma on yksi merkittävimmistä toimintakyvyn laskua ja kuolleisuutta aiheuttavista vammoista. Tämän väitöskirjatutkimuksen tarkoituksena oli (1) tutkia tehostetun (fysikaalisen ja geriatrisen) kuntoutuksen vaikutusta itsenäisesti asuvien, vähintään 50-vuotiaiden lonkkamurtumapotilaiden kuntoutumiseen murtumaa seuraavan vuoden aikana, (2) arvioida lonkkamurtuman hoidon kustannuksia ja kustannusvaikuttavuutta tehostetussa kuntoutusyksikössä, (3) tutkia lonkkamurtuman kuntoutumisen eroja mies- ja naispotilaiden välillä sekä (4) tarkentaa lonkkamurtuman hoitoketjun yleisiä suosituksia Suomessa. Tutkimuksessa seurattiin 538 lonkkamurtumapotilasta, jotka hoidettiin kirurgisesti Oulun yliopistollisessa sairaalassa. Valintakriteereihin kuului vähintään 50 vuoden ikä sekä kyky itsenäiseen asumiseen joko omassa kodissa tai kodinomaisessa ympäristössä ennen murtumaa. Lonkkaleikkauksen jälkeen potilaat satunnaistettiin yhteen kolmesta kuntoutusryhmästä: fysikaaliseen kuntoutusryhmään (Oulun Diakonissalaitos), geriatriseen kuntoutusryhmään (Oulun kaupunginsairaalan kuntoutusosasto) sekä kontrolliryhmään (terveyskeskussairaalassa tapahtuva kuntoutus). Seuranta-aika oli yksi vuosi. Potilaat haastateltiin ennen kuntoutusta, sekä neljän ja 12 kuukauden kuluttua murtumasta, joiden yhteydessä aineisto kerättiin koskien yleistä terveydentilaa, toiminta- ja kävelykykyä, asumismuotoa ja kuolleisuutta. Kustannukset arvioitiin terveyspalveluiden käytöstä ja näiden hintoina käytettiin sairaalan yksikköhintoja (DRG) ja sosiaali- ja terveysalan tutkimus- ja kehittämiskeskuksen (STAKES) yksikköhintoja. Fysikaalinen kuntoutus vähensi merkittävästi potilaiden kuolleisuutta neljän ja 12 kuukauden seurannoissa verrattuna geriatriseen kuntoutukseen sekä kontrolliryhmään. Lisäksi fysikaalinen ja geriatrinen kuntoutus lisäsivät lyhytaikaisesti potilaiden kykyä itsenäiseen asumiseen verrattuna kontrolliryhmään. Taloudellisten vaikutusten osalta fysikaalinen kuntoutusjakso oli huomattavasti tavanomaista kuntoutusta kalliimpi, mutta fysikaalisen kuntoutusryhmän kokonaiskustannukset vuoden aikana olivat pienemmät kuin kontrolliryhmän potilailla. Sukupuolella ei ollut vaikutusta potilaiden toimintakykyyn, laitostumiseen tai kuolleisuusriskiin murtuman jälkeen. Merkittäviksi kuolleisuutta ennustaviksi tekijöiksi osoittautuivat ikä, toimintakyky ennen murtumaa sekä leikkauskelpoisuusluokitus. Tulokset puoltavat tehostetun, erikoistuneessa kuntoutusyksikössä suoritetun hoidon käyttöä lonkkamurtumapotilailla sekä terveydellisten että taloudellisten syiden osalta.

As a growing body of research has focused on the individual, social, and environmental factors that facilitate life after spinal cord injury (SCI), particular emphasis has been placed on health conditions that are modifiable and preventable. Subsequent injuries are a serious health problem for individuals with SCI. They are a direct threat to further morbidity and mortality, and are both a cause and consequence other secondary health conditions. As a first step toward understanding this public health problem, the purpose of this dissertation research was to describe the patterns, burdens, and prevention of subsequent injury among individuals with SCI. In three distinct, but related studies, this dissertation examined the characteristics of hospitalizations due to an injury among individuals with paraplegia, and compared the differences in length of stay (LOS) and hospital costs of injury hospitalizations between individuals with quadriplegia versus paraplegia. In addition, it explored the experience of subsequent injury among individuals with SCI who return to work and examined perceptions of threat and efficacy in preventing subsequent injury using the Extended Parallel Process Model. Using discharge level weighting available in the Nationwide Inpatient Sample, Study 1 calculated national estimates of injury hospitalizations for individuals with paraplegia by patient, hospital, and injury characteristics. Most injury hospitalizations occurred among males, to individuals 35-49 years, and were due to falls, poisonings, or motor vehicle traffic. With the same dataset, Study 2 used logistic regression to estimate the effect of patient characteristics on odds of hospitalized patients with quadriplegia versus paraplegia, and linear regression to estimate predicted differences in hospital costs for individuals with quadriplegia compared to paraplegia. Fewer injury hospitalizations but longer hospital stays, and higher hospital costs per discharge were found for individuals with quadriplegia compared to individuals with paraplegia. Males, younger age, and the uninsured were significant predictors of higher hospital costs. Finally, Study 3 used in-depth interviews to qualitatively explore the perceptions on subsequent injury among individuals with SCI who return to work, and found individuals with SCI who return to work recognized the importance of preventing subsequent injury, and were taking actions to prevent subsequent injury in their daily life and in the workplace. The significance of this research is that it is the first description of injury hospitalizations for all causes of injury by specific type of SCI, and the associated medical outcomes of LOS and direct medical costs. Prevention of subsequent injury should be a priority. The perceptions of individuals with SCI about the severity of and their susceptibility to injury and the efficacy of individual and environmental actions to prevent subsequent injury described in this research should be used to inform the development of interventions that prevent subsequent injury.

Objetivo: elaborar um matriz de decisão, utilizando custos e fatores relacionados à qualidade em serviços públicos de saúde, como auxiliar na análise de incorporação de uma ressonância magnética. Métodos: os cálculos foram realizados pela Análise de Custos pelo Ciclo de Vida , e pelos custos hospitalares correntes, para dois cenários: aquisição do equipamento ou terceirização do serviço.Estipulou-se o ciclo de vida do equipamento em dez anos, a taxa anual de depreciação em 10%, o fator de desconto em 10% ao ano e um incremento anual de exames de 10% até o final do ciclo. Resultados: para o gestor estadual, praticando serviço terceirizado, o custo anual de 1440 exames foi estimado em R$1.211.040,00 e o custo unitário médio do exame em R$841,00. Considerando a aquisição e implantação de serviço próprio, e os cálculos realizados pelo ciclo de vida, o custo anual total foi estimado em R$1.169.280,00 e o custo unitário médio do exame em R$812,00. Para o primeiro cenário (serviço próprio) o Valor Presente Líquido foi estimado em R$- 7.586.892 e para o segundo cenário (serviço terceirizado) em R$ -8.675.617,00. A diferença entre os dois cenários foi de R$ -1.088.725,00. Os demais critérios a serem considerados na análise, contemplando as dimensões técnica, interpessoal e ambiental, foram contemplados em um questionário a ser aplicado com servidores e acompanhantes, cujos resultados deverão compor a Matriz de Decisão. Conclusões: no momento o serviço próprio é o mais viável do ponto de vista econômico-financeiro, com o Ponto de Equilíbrio Financeiro atingido a partir do quinto ano do ciclo. Para completar a Matriz de Decisão, um questionário contemplando fatores de qualidade em serviços (domínios percepção e satisfação) será aplicado com os clientes internos (servidores) e externos (acompanhantes), cujos resultados deverão ser analisados quando da tomada de decisão. / Objective: To develop a decision matrix, using costs and factors related to quality on public health services as an aid in the analysis of incorporation of an MRI. Methods: The calculations were carried out by the Life Cycle Cost Analysis and the current hospital costs for two scenarios: acquisition of equipment or outsourcing serviçe. The life cycle of the equipment was stipulated in ten years, the annual depreciation at 10%, the discount factor at 10% per year and an annual increase of 10% of examinations by the end of the cycle. Results: For the state manager, practicing outsourced service, the annual cost of 1440 examinations was estimated at R $ 1,211,040.00 and the average unit cost of the test in R$ 841.00. Considering the acquisition and deployment of service itself, and the calculations made by the Life Cycle Cost Analysis, the total annual cost was estimated at R $ 1,169,280.00 and the average unit cost of the test in R$ 812.00. For the first scenario the Net Present Value was estimated at R$ -7.586.892 and the second scenario at R$ -8,675,617.00. The difference between the two scenarios was R$ 1,088,725.00. Other criteria to be considered in the analysis, contemplating the technical, interpersonal and environmental factors, were included in a questionnaire to be applied to servers and companions whose results will compose the Decision Matrix. Conclusions: At the time the own service is the most feasible from the economic and financial standpoint, with the Financial Breakeven Point reached at the fifth year of the cycle. To complete the Decision Matrix, a questionnaire on Service Quality (perceptions and satisfactions domains) will be applied to internal (servers) and external (companions) clients, whose results should be considered when making any decision.

Objetivo: elaborar um matriz de decisão, utilizando custos e fatores relacionados à qualidade em serviços públicos de saúde, como auxiliar na análise de incorporação de uma ressonância magnética. Métodos: os cálculos foram realizados pela Análise de Custos pelo Ciclo de Vida , e pelos custos hospitalares correntes, para dois cenários: aquisição do equipamento ou terceirização do serviço.Estipulou-se o ciclo de vida do equipamento em dez anos, a taxa anual de depreciação em 10%, o fator de desconto em 10% ao ano e um incremento anual de exames de 10% até o final do ciclo. Resultados: para o gestor estadual, praticando serviço terceirizado, o custo anual de 1440 exames foi estimado em R$1.211.040,00 e o custo unitário médio do exame em R$841,00. Considerando a aquisição e implantação de serviço próprio, e os cálculos realizados pelo ciclo de vida, o custo anual total foi estimado em R$1.169.280,00 e o custo unitário médio do exame em R$812,00. Para o primeiro cenário (serviço próprio) o Valor Presente Líquido foi estimado em R$- 7.586.892 e para o segundo cenário (serviço terceirizado) em R$ -8.675.617,00. A diferença entre os dois cenários foi de R$ -1.088.725,00. Os demais critérios a serem considerados na análise, contemplando as dimensões técnica, interpessoal e ambiental, foram contemplados em um questionário a ser aplicado com servidores e acompanhantes, cujos resultados deverão compor a Matriz de Decisão. Conclusões: no momento o serviço próprio é o mais viável do ponto de vista econômico-financeiro, com o Ponto de Equilíbrio Financeiro atingido a partir do quinto ano do ciclo. Para completar a Matriz de Decisão, um questionário contemplando fatores de qualidade em serviços (domínios percepção e satisfação) será aplicado com os clientes internos (servidores) e externos (acompanhantes), cujos resultados deverão ser analisados quando da tomada de decisão. / Objective: To develop a decision matrix, using costs and factors related to quality on public health services as an aid in the analysis of incorporation of an MRI. Methods: The calculations were carried out by the Life Cycle Cost Analysis and the current hospital costs for two scenarios: acquisition of equipment or outsourcing serviçe. The life cycle of the equipment was stipulated in ten years, the annual depreciation at 10%, the discount factor at 10% per year and an annual increase of 10% of examinations by the end of the cycle. Results: For the state manager, practicing outsourced service, the annual cost of 1440 examinations was estimated at R $ 1,211,040.00 and the average unit cost of the test in R$ 841.00. Considering the acquisition and deployment of service itself, and the calculations made by the Life Cycle Cost Analysis, the total annual cost was estimated at R $ 1,169,280.00 and the average unit cost of the test in R$ 812.00. For the first scenario the Net Present Value was estimated at R$ -7.586.892 and the second scenario at R$ -8,675,617.00. The difference between the two scenarios was R$ 1,088,725.00. Other criteria to be considered in the analysis, contemplating the technical, interpersonal and environmental factors, were included in a questionnaire to be applied to servers and companions whose results will compose the Decision Matrix. Conclusions: At the time the own service is the most feasible from the economic and financial standpoint, with the Financial Breakeven Point reached at the fifth year of the cycle. To complete the Decision Matrix, a questionnaire on Service Quality (perceptions and satisfactions domains) will be applied to internal (servers) and external (companions) clients, whose results should be considered when making any decision.

Objetivo: elaborar um matriz de decisão, utilizando custos e fatores relacionados à qualidade em serviços públicos de saúde, como auxiliar na análise de incorporação de uma ressonância magnética. Métodos: os cálculos foram realizados pela Análise de Custos pelo Ciclo de Vida , e pelos custos hospitalares correntes, para dois cenários: aquisição do equipamento ou terceirização do serviço.Estipulou-se o ciclo de vida do equipamento em dez anos, a taxa anual de depreciação em 10%, o fator de desconto em 10% ao ano e um incremento anual de exames de 10% até o final do ciclo. Resultados: para o gestor estadual, praticando serviço terceirizado, o custo anual de 1440 exames foi estimado em R$1.211.040,00 e o custo unitário médio do exame em R$841,00. Considerando a aquisição e implantação de serviço próprio, e os cálculos realizados pelo ciclo de vida, o custo anual total foi estimado em R$1.169.280,00 e o custo unitário médio do exame em R$812,00. Para o primeiro cenário (serviço próprio) o Valor Presente Líquido foi estimado em R$- 7.586.892 e para o segundo cenário (serviço terceirizado) em R$ -8.675.617,00. A diferença entre os dois cenários foi de R$ -1.088.725,00. Os demais critérios a serem considerados na análise, contemplando as dimensões técnica, interpessoal e ambiental, foram contemplados em um questionário a ser aplicado com servidores e acompanhantes, cujos resultados deverão compor a Matriz de Decisão. Conclusões: no momento o serviço próprio é o mais viável do ponto de vista econômico-financeiro, com o Ponto de Equilíbrio Financeiro atingido a partir do quinto ano do ciclo. Para completar a Matriz de Decisão, um questionário contemplando fatores de qualidade em serviços (domínios percepção e satisfação) será aplicado com os clientes internos (servidores) e externos (acompanhantes), cujos resultados deverão ser analisados quando da tomada de decisão. / Objective: To develop a decision matrix, using costs and factors related to quality on public health services as an aid in the analysis of incorporation of an MRI. Methods: The calculations were carried out by the Life Cycle Cost Analysis and the current hospital costs for two scenarios: acquisition of equipment or outsourcing serviçe. The life cycle of the equipment was stipulated in ten years, the annual depreciation at 10%, the discount factor at 10% per year and an annual increase of 10% of examinations by the end of the cycle. Results: For the state manager, practicing outsourced service, the annual cost of 1440 examinations was estimated at R $ 1,211,040.00 and the average unit cost of the test in R$ 841.00. Considering the acquisition and deployment of service itself, and the calculations made by the Life Cycle Cost Analysis, the total annual cost was estimated at R $ 1,169,280.00 and the average unit cost of the test in R$ 812.00. For the first scenario the Net Present Value was estimated at R$ -7.586.892 and the second scenario at R$ -8,675,617.00. The difference between the two scenarios was R$ 1,088,725.00. Other criteria to be considered in the analysis, contemplating the technical, interpersonal and environmental factors, were included in a questionnaire to be applied to servers and companions whose results will compose the Decision Matrix. Conclusions: At the time the own service is the most feasible from the economic and financial standpoint, with the Financial Breakeven Point reached at the fifth year of the cycle. To complete the Decision Matrix, a questionnaire on Service Quality (perceptions and satisfactions domains) will be applied to internal (servers) and external (companions) clients, whose results should be considered when making any decision.

Introdução: A unidade de terapia intensiva (UTI) é conhecida por ser um setor de alta complexidade dos pacientes e por seu alto custo ao sistema hospitalar. A gravidade da doença, o tempo de internação na UTI e a necessidade de ventilação mecânica invasiva (VMI) são fatores conhecidos como influenciadores no custo destas unidades, sendo que aproximadamente 30% dos pacientes internados em UTI necessitam de VMI. Os objetivos deste estudo foram avaliar os custos de internação em UTI comparando unidades com assistência de fisioterapia 24 horas e unidades com assistência de fisioterapia 12 horas e analisar o impacto da fisioterapia nos referidos custos. Método: Este é um estudo observacional, prospectivo, realizado em um hospital geral, público e de grande porte, localizado na cidade de São Paulo. Foram incluídos pacientes clínicos e cirúrgicos com 18 anos de idade ou mais, que estiveram em VMI por um período >= 24 horas e que receberam alta da UTI para a enfermaria. A coleta de dados incluiu diagnóstico de internação hospitalar, diagnóstico de admissão na UTI, gravidade do paciente no momento da admissão na UTI através do Acute Physiology and Chronic Health Disease Classification (APACHE II), tempo de VMI e tempo de internação na UTI; para a análise de custos utilizamos a ferramenta Omega French Score. Um modelo de regressão linear múltipla foi construído para verificar a associação entre o custo de internação em UTI com o turno diário de assistência fisioterapêutica. Resultados: Foram incluídos na amostra 815 pacientes, distribuídos em dois grupos conforme o turno de fisioterapia existente na UTI: 332 pacientes em UTI\'s com 24 horas de assistência fisioterapêutica (PT-24) e 483 pacientes em UTI\'s com 12 horas de assistência fisioterapêutica (PT-12). Os grupos não apresentaram diferença quanto ao APACHE II (p=0,65); comparado ao grupo PT-12 o grupo PT-24 era mais velho (p < 0,001), apresentou menor tempo de VMI (p < 0,001) e de internação na UTI (p=0,013). Quanto a análise de custos o grupo PT-24 apresentou custos menores indicados pela menor pontuação no Omega 3 (p=0,005) e Omega Total (p=0,010), menor custo direto, custo com equipe médica e enfermagem (p=0,010). A análise de regressão linear múltipla indicou associação do custo da internação em UTI com as variáveis APACHE II (p < 0,001), tempo de internação da UTI (p < 0,001) e assistência fisioterapêutica em turnos de 24 horas (p=0,05). Conclusão: O grupo com assistência de fisioterapia em turnos de 24 horas apresentou custos menores sendo que a severidade da doença, o tempo de internação na UTI e a assistência de fisioterapia foram variáveis preditoras para redução de custo de internação na UTI / Background: Intensive care unit (ICU) is considered a complex and expensive hospital department. The severity of illness, the length of ICU stay and the need for invasive mechanical ventilation (IMV) are known as influencing factors of costs to these units and approximately 30% of patients admitted at ICU will need IMV. Our aim is to address the costs related to ICU stay by comparing units with the provision of a daily 24-hour physiotherapy shift to a regular 12-hour PT shift and to analyze the impact of physical therapy in ICU costs. Method: This is a prospective, observational study, carried out in a general, public and large hospital, located in the city of São Paulo. Were included in the sample clinical and surgical patients, aged >=18 years old, invasive mechanically ventilated (IMV) >= 24 hours and discharged to ward were included. Data collection included reason of hospital admission and reason of ICU admission; Acute Physiology and Chronic Health Disease Classification System II (APACHE II); IMV duration; ICU-LOS; for cost analysis we use the Omega French Score. A multiple linear regression model was constructed to verify the association between costs of ICU stay and daily shift of physiotherapy. Results: 815 patients were included, distributed into two groups: 332 patients at ICUs with 24-hour physiotherapy shift (PT-24) and 483 patients in ICUs with 12-hour physiotherapy shift (PT-12). There was no statistical difference between the groups regarding the APACHE II (p=0,65); the PT-24 group was older (p < 0,001), and featured better clinical outcome when compared to the PT-12 group with shorter IMV (p < 0,001) and duration of stay in the ICU (p=0,013). About cost analysis the PT-24 group showed lower scores on Omega 3 (p=0,005) and Omega (p=0,010), lower direct cost, cost of medical and nursing staff (p=0,010). Multiple linear regression reveal that costs of ICU hospitalization to be associated to APACHE II (p < 0,001), length of ICU stay (p < 0,001) and 24-hour physiotherapy assistance (p=0,05). Conclusion: Patients in the group with the assistance of physiotherapy in 24-hour shifts presented decreased total and staff costs, physiotherapy assistance were considered predictor for cost reduction.

Esta dissertação buscou avaliar os custos hospitalares parciais decorrentes de internações por traumas causados por ocorrências motociclísticas bem como o perfil epidemiológico destas vítimas. Foi feito um estudo retrospectivo de usuários do Sistema Único de Saúde, de 460 vítimas do trauma com motocicletas, internados na Unidade de Emergência do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, divididos de acordo com o mecanismo do trauma e gravidade dos casos. Para efeito de análise, os usuários foram categorizados por faixa etária, estado civil, escolaridade, sexo, local de ocorrência do trauma e dia da semana em que houve este evento. Para consecução deste trabalho foram utilizados o banco de dados do Núcleo Epidemiológico Hospitalar, o sistema de informação interna e dados da seção de custos do mesmo hospital. Como resultado foi identificado que as maiores vítimas de eventos motociclísticos são jovens, solteiros, com baixa escolaridade e do sexo masculino. Também foi identificado que os eventos ocorrem com mais frequência nos finais de semana, além da quarta feira, e que ocorrem próximo do horário da saída do expediente de trabalho e no período da noite. As principais lesões ocorrem nos membros (lesões moderadas e graves) e na cabeça (lesões graves e críticas), sendo múltiplas lesões característica deste tipo de paciente. O custo hospitalar foi principalmente relacionado ao tempo de internação em enfermarias e no CTI e a gravidade do trauma. O valor final do custo avaliado no estudo foi de R$ 5.315.357,15, com média geral de R$11.555,12 por paciente. Para os casos mais graves (ISS > 15) a média de custo foi de R$ 33.259,50 por paciente / This dissertation evaluates the partial hospital costs of hospitalizations for injuries caused by motorcycle accidents and the epidemiological profile of these victims. A retrospective study based on Unified Health System patients was done. 460 motorcycles trauma victims admitted to the Emergency Unit of the Hospital of Ribeirão Preto Medical School Clinical, University of Sao Paulo, were included in the study. Data were collected based on Epidemiological Nucleus database of the Hospital, the internal information system and data from the same hospital costs section, including: mechanism and severity of trauma, epidemiological and socioeconomic data such as age, sex, marital status, education, local, date, and time of occurrences. tThe majority of motorcycle accidents victims were young, single, with low level of education, and male. Accidents occurred more frequently on weekends and Wednesday. Usually from 12 pm to midnight. . The major injuries occurred in the limbs (moderate and severe lesions) and head (severe and critical injuries), being typical of this type of accident several injuries. The hospital costs were mainly related to the wards and ICU length of stay, and the trauma severity. The final value of costs was R$ 5,315,357.15, and in average R$ 11.555,12 per patient. To severe cases (ISS>15) the average cost was R$33,259.50 per patient

<p>Hronična opstruktivna bolest pluća (HOBP) je rastući zdravstveni problem radno sposobne populacije. Akutne egzacerbacije hronične opstruktivne bolesti pluća (AEHOBP) značajno doprinose pogor&scaron;anju bolesti i sa aspekta kvaliteta života bolesnika i sa aspekta tro&scaron;kova. Cilj istraživanja je bila identifikacija faktora visokih tro&scaron;kova lečenja AEHOBP koja može pomoći u definisanju strategija smanjenja HOBP egzacerbacija ove bolesti i analiza podataka o prehospitalnom lečenju obolelih od HOBP. Materijal i metode: Istraživanjem je obuhvaćeno 130 pacijenata koji su ispunjavali uključujuće kriterijume studije. Rezultati: Ukupni godi&scaron;nji direktni tro&scaron;kovi hospitalizacija usled AEHOBP čine17,3% od tro&scaron;kova svih hospitalizovanih pacijenata. Prosečna dužina hospitalizacije je bila duža kod pacijenata sa te&scaron;kom AEHOBP u odnosu na srednje te&scaron;ku, razlika je statistički značajna (p = 0,044). Prema rezultatima istraživanja o potro&scaron;nji lekova godinu dana pre hospitalizacije, adekvatnu terapiju je koristilo 41,7% pacijenata, a neadekvatnu 58,3% pacijenata i postojala je negativna korelacija između adekvatnosti lečenja i stepena težine akutne egzacerbacije. Multivarijantnom logističkom regresijom dobijena je formula za predikciju ukupnih tro&scaron;kova. Zaključak: Nezavisni prediktori direktnih tro&scaron;kova lečenja su: mu&scaron;ki pol, pu&scaron;ačka navika, te&scaron;ka AEHOBP, postojanje acidoze, primena neadekvatne ili adekvatne terapije trajanja kraćeg od devet meseci tokom godine koja je prethodila hospitalnom lečenju egzacerbacije.</p> / <p>Chronic obstructive pulmonary disease (COPD) is a rising health issue of working population. Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are significantly contributing to worsening of the disease prognosis, consequently leading to decline of patient&rsquo;s quality of life and increasing costs of treatment. Objective of the study was identification of factors for high AECOPD treatment costs, which can help in defining strategy for decreasing COPD exacerbations and data analysis of prehospital treatment of COPD patients. Material and Methods: The study included 130 patients who fulfilled including criteria of the study. Results: Total direct costs of AECOPD hospitalizations demonstrated 17.3% of all hospitalized patients costs. Average length of hospitalization was longer in patients with severe AECOPD compared to patients with moderate AEHOBP, there was statistically significant difference (p= 0,044). According to research results of medication usage one year before the hospitalization, adequate treatment used 41.7% of patients, and inadequate 58.3%; there was negative correlation between adequate treatment and level of severance of acute exacerbations. Multivariate logistic regression was used for obtaining total costs predictions formula. Conclusion: Independent predictors of direct treatment costs were: male patients, smokers, prehospital treatment, inadequate or adequate, not longer than nine months per year.</p>

This research examines the safety and cost effectiveness of an institutional policy on discharge of preterm infants with Apnea of Prematurity (AOP) from the Virginia Commonwealth University Medical Center Newborn Intensive Care Unit (VCUNC NICU) with caffeine therapy and a cardiorespiratory monitor. This practice policy was developed over a decade ago as a cost containment measure in neonatal care and continues to be implemented today despite the lack of a formal evaluation. The secondary objective was to examine through a review of the literature the psychosocial impact of premature birth on the family and the potential effect on the infant's hospital discharge. The evaluation of this policy is based on the conceptual framework of effectiveness, efficiency, and equity in health care. Results were used to generate policy recommendations.This is a retrospective case study of 933 infants admitted to the VCU Medical Center and the community hospital NICU between 1993 and 2002 diagnosed with Apnea of Prematurity. Data was obtained from the Neonatal Information System database at Virginia Commonwealth University Health System (VCUHS), the Virginia Department of Health, and the VCUHS hospital information system. In this mixed methods study, the infants were divided into two groups: 1) those discharged from the hospital on caffeine citrate therapy, and a cardiorespiratory monitor for continued management of apnea; and 2) those that were hospitalized until resolution of apnea. Data was analyzed for differences in mortality and morbidity, hospital readmissions and cost of hospital care from birth to 1 year of age. Interviews were conducted with NICU clinicians to obtain a qualitative perspective on this policy. No significant differences were found in the mortality rate between the two groups (p=.65), and the causes of the four deaths were unrelated to Apnea of Prematurity. Mean hospital costs were approximately $58,000 in both groups. Bronchiolitis was the leading cause for hospital readmission and there was no difference in the rate of hospital readmissions. Based on interviews with NICU clinicians, the policy works well and early discharge is advantageous to the infant and family. Therefore, we find no reason to not continue this policy. Study results support the importance and direction for further research on early discharge of infants with AOP and enhanced epidemiologic surveillance of this population.