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Individual psychosocial support for breast cancer patients : quality of life, psychological effects, patient satisfaction, health care utilization and costs /Arving, Cecilia, January 2007 (has links)
Diss. (sammanfattning) Uppsala : Uppsala universitet, 2007. / Härtill 4 uppsatser.
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Disease activity, function and costs in early rheumatoid arthritis : the Swedish TIRA project /Hallert, Eva, January 2006 (has links) (PDF)
Diss. (sammanfattning) Linköping : Linköpings universitet, 2006. / Härtill 4 uppsatser.
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Public participation in the rationing of health care /Obermann, Konrad. January 2000 (has links)
Thesis--Hannover, 1999. / Includes index and bibliographies.
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Assessment of support interventions in dementia : methodological and empirical studies /Alwin, Jenny, January 2010 (has links)
Diss. (sammanfattning) Linköping : Linköpings universitet, 2010. / Härtill 4 uppsatser.
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Clinically relevant and economic outcomes of maintenance pharmacotherapy in chronic obstructive pulmonary disease (COPD)D'Souza, Anna. January 1900 (has links)
Thesis (Ph. D.)--West Virginia University, 2006. / Title from document title page. Document formatted into pages; contains xii, 251 p. : ill. (some col.). Vita. Includes abstract. Includes bibliographical references (p. 203-215).
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Diabete e gravidez: estudo prospectivo do custo benefício da hospilização comparado com atenção ambulatorialCavassini, Ana Claudia Molina [UNESP] 30 November 2009 (has links) (PDF)
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cavassini_acm_dr_botfm.pdf: 397533 bytes, checksum: 34f45e1a9cd93db1d4ae9ec62d1f61ff (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / A avaliação de custos é importante instrumento de trabalho na otimização do gerenciamento hospitalar, indicando ao administrador os resultados que estão dentro dos parâmetros esperados e os que exigem correção. Auxilia também na determinação do preço de venda, nas decisões de investimentos, na expansão de instalações hospitalares e na definição de volumes de estoques de materiais e medicamentos. Os custos podem ser classificados em diretos, indiretos, variáveis e fixos; podem ser calculados por diferentes sistemas de custeio, entre eles, cálculo por absorção, procedimento ou atividade ABC. A partir desses dados, diversas avaliações econômicas são realizadas: custo e comparação do custo da doença, custo-minimização, custo-utilidade, custo-efetividade e custobenefício. Tendo em vista a importância do controle de custos nas instituições de saúde e do ensino do cálculo de custo em saúde, foram apresentados neste estudo os conceitos básicos, os tipos de custos, os sistemas de custeio e os tipos de avaliações econômicas. Finalmente, foram propostas planilhas de custo para uso em atendimento ambulatorial/hospitalar de gestações complicadas por diabete. / Cost evaluation is an important work tool in hospital management optimization as it shows managers the results that are in accordance with expected parameters as well as those that require correction. It also helps the determination of sale prices, investment decisions, the expansion of hospital facilities and the definition of stock volumes of material and medicines. Costs can be classified as direct, indirect, variable and fixed, and they can be estimated by different costing systems, among which are absorption costing and activity-based costing (ABC). From this information, various economic evaluations are performed: disease cost and comparison of disease cost, cost-minimization, cost-usefulness, costeffectiveness and cost-benefit. Considering the importance of cost control in health care institutions and the teaching of cost estimation in health care, basic concepts, cost types, costing systems and economicevaluation types were presented in this study. Finally, cost worksheets were proposed for use in outpatient units and hospitals for the care to pregnancies complicated by diabetes.
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Diabete e gravidez : estudo prospectivo do custo benefício da hospilização comparado com atenção ambulatorial /Cavassini, Ana Claudia Molina. January 2009 (has links)
Resumo: A avaliação de custos é importante instrumento de trabalho na otimização do gerenciamento hospitalar, indicando ao administrador os resultados que estão dentro dos parâmetros esperados e os que exigem correção. Auxilia também na determinação do preço de venda, nas decisões de investimentos, na expansão de instalações hospitalares e na definição de volumes de estoques de materiais e medicamentos. Os custos podem ser classificados em diretos, indiretos, variáveis e fixos; podem ser calculados por diferentes sistemas de custeio, entre eles, cálculo por absorção, procedimento ou atividade ABC. A partir desses dados, diversas avaliações econômicas são realizadas: custo e comparação do custo da doença, custo-minimização, custo-utilidade, custo-efetividade e custobenefício. Tendo em vista a importância do controle de custos nas instituições de saúde e do ensino do cálculo de custo em saúde, foram apresentados neste estudo os conceitos básicos, os tipos de custos, os sistemas de custeio e os tipos de avaliações econômicas. Finalmente, foram propostas planilhas de custo para uso em atendimento ambulatorial/hospitalar de gestações complicadas por diabete. / Abstract: Cost evaluation is an important work tool in hospital management optimization as it shows managers the results that are in accordance with expected parameters as well as those that require correction. It also helps the determination of sale prices, investment decisions, the expansion of hospital facilities and the definition of stock volumes of material and medicines. Costs can be classified as direct, indirect, variable and fixed, and they can be estimated by different costing systems, among which are absorption costing and activity-based costing (ABC). From this information, various economic evaluations are performed: disease cost and comparison of disease cost, cost-minimization, cost-usefulness, costeffectiveness and cost-benefit. Considering the importance of cost control in health care institutions and the teaching of cost estimation in health care, basic concepts, cost types, costing systems and economicevaluation types were presented in this study. Finally, cost worksheets were proposed for use in outpatient units and hospitals for the care to pregnancies complicated by diabetes. / Orientador: Marilza Vieira Cunha Rudge / Coorientador: Iracema de Mattos Paranhos Calderon / Banca: Roberto Antonio de Araújo Costa / Banca: Emílio Carlos Curcelli / Banca: Paulo Carrara de Castro / Banca: Luiz Carlos Zeferino / Doutor
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Strategies for Improving the Process of Lean Implementation in Health CareBoudreau, Nathalie Lise 01 January 2019 (has links)
The Canadian health care system is a complex system under pressure due to an aging population. The annual health care budget has decreased, posing challenges for health care administrators. The purpose of this qualitative study, which was grounded in Deming's total quality management system framework, was to explore strategies 6 health care managers used to implement Lean initiatives to reduce health care costs in the province of Ontario, Canada. Data were collected through semistructured interviews and analyzed in accordance with Yin's approach, which includes compiling data, disassembling, reassembling, and interpreting data, and drawing conclusions. Four themes emerged from data analysis: the review of operational processes can reduce health care costs, specific management skills can reduce health care costs, employee engagement can have a positive impact on health care costs, and alignment can have a positive impact on health care costs. Findings from this study may contribute to positive social change by providing health care managers with successful strategies to improve operational processes and reduce health care costs, increase patient safety, and reduce negative patient outcomes. The results further contribute to positive social change by highlighting the importance of having employees participate in process improvement, which may improve employee and patient satisfaction in the community.
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HEALTH CARE UTILIZATION AND COSTS OF BARIATRIC SURGERY PATIENTS WITH VS. WITHOUT COMORBID OBSTRUCTIVE SLEEP APNEAMartelli, Vanessa January 2023 (has links)
Obstructive sleep apnea (OSA) is underrecognized. Between 10% and 69% of preoperative
patients have undiagnosed OSA. To reduce the risk of peri-operative complications related to undiagnosed OSA, patients planned to undergo bariatric surgery are screened for OSA.
To understand the OSA detection rate with screening practices, the prevalence of OSA
within patients who underwent publicly funded bariatric surgery in Ontario between 2010 and
2016 was measured. Secondly, to understand the effect of OSA screening practices on perioperative and longer-term health care costs, health care utilization and costs were compared between patients with OSA and matched patients without OSA in the 30 days post-bariatric surgery, as well as in the 1 year post-bariatric surgery.
The Ontario Bariatric Registry (OBR) linked to the ICES health administrative databases
were used. A diagnosis of OSA was identified if recorded in the OBR at time of initial
bariatric consultation, or if recorded in ICES databases from the bariatric surgery admission
records. Costs were calculated based on the “Guidelines on Person-Level Costing Using
Administrative Databases in Ontario” using ICES costing algorithms.
The overall prevalence of OSA was 47% (95% CI 46% to 47%). Total health care costs
per patient, in the 30-day post-operative period, were 1% lower (95% CI 1% to 1%, p < 0.001) in patients with OSA compared to matched patients without OSA. Similarly, at 1 year postbariatric surgery, total health care costs per patient, were 1% lower (95% CI 1% to 1%, p < 0.001) in patients with OSA compared to matched patients without OSA. At 30 days and 1 year, this difference was driven by lower hospitalization-related costs.
OSA screening practices at surgical centers in our network led to similar rates of OSA
detection as reported in the literature. However, the literature suggests that screening practices lead to missed OSA diagnoses. Further study is required to understand the reduced post-bariatric surgery costs in patients with OSA compared to matched controls without OSA; and, we postulate that missed OSA diagnoses may be a contributor. / Thesis / Master of Science (MSc) / Obstructive sleep apnea (OSA) is underrecognized and a good proportion of patients with
OSA are undiagnosed. To reduce the risk of peri-operative complications related to undiagnosed OSA, patients planned to undergo bariatric surgery are screened for OSA. To understand the performance of OSA screening practices, using a province-wide registry, the proportion of patients diagnosed with OSA within patients who underwent publicly-funded bariatric surgery in Ontario between 2010 and 2016 was measured at 47%. Furthermore, to understand the effect of OSA screening practices on peri-operative costs and longer-term health care costs, health care utilization and costs were compared between patients with OSA and matched patients without OSA in the 30 days and 1 year post-bariatric surgery. Total health care costs per patient were 1% lower in patients with OSA compared to patients without OSA, and this difference was driven by lower hospitalization-related costs.
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Custos comparativos entre a revascularização miocárdica com e sem circulação extracorpórea / Comparative costs between the surgical of myocardial revascularization with and without cardiopulmonary bypassGirardi, Priscyla Borges Miyamoto de Araújo 26 June 2009 (has links)
INTRODUÇÃO: Técnicas cirúrgicas de revascularização miocárdica sem o uso de circulação extracorpórea (CEC) trouxeram esperanças de resultados operatórios com menor dano sistêmico, menor ocorrência de complicações clínicas e menor tempo de internação hospitalar gerando expectativas de menor custo hospitalar. OBJETIVOS: Avaliar o custo hospitalar em pacientes submetidos à cirurgia de revascularização miocárdica com e sem o uso de CEC, em portadores de doença multiarterial coronária estável com função ventricular preservada. MÉTODOS: Os custos hospitalares foram baseados na remuneração governamental vigente. Foram acrescentados nos custos, o uso de orteses, próteses, complicações e intercorrências clinicas. Foram considerados o tempo e os custos da permanência na UTI e de internação hospitalar. Não foram consideradas remuneração de profissionais médicos e equipe multiprofissional, bem como depreciação de materiais, taxa de administração predial, água luz, telefone, alimentação, exames laboratoriais de admissão e medicamentos. RESULTADOS: Entre janeiro de 2002 a Agosto de 2006 foram randomizados 131 pacientes para cirurgia com CEC e 128 pacientes sem CEC. As características clínicas basais foram semelhantes para os dois grupos. Os custos das intercorrências cirúrgicas foram significantemente menores (p<0,001) para pacientes do grupo SCEC comparados ao grupo CCEC (606,00 ± 525,00 vs 945,90 ± 440,00) bem como, os custos na UTI (432,20 ± 391,70 vs 717,70 ± 257,70) respectivamente. Entretanto, o custo final foi maior no grupo SCEC (6.877,00 ± 525,20 vs 5.305,00 ± 440,11; p<0.001) devido ao preço do estabilizador utilizado. Os tempos de permanência na sala cirúrgica foram (4,9 ± 1,1h vs 3,9 ± 1,0h), (p<0,001), na UTI (48,25 ± 17,2h vs 29,20 ± 26,1h) (p<0,001), com tempo de entubação (9,2 ± 4,5h vs 6,4 ± 5,1h) (p<0,001) para pacientes do grupo com CEC e sem CEC respectivamente. CONCLUSÃO: Esses resultados permitem concluir que a cirurgia de revascularização miocárdica sem circulação extracorpórea, proporcionou diminuição de custos operacionais relacionados com a diminuição de tempo de permanência em cada setor do tratamento cirúrgico. Todavia, o alto custo do estabilizador, determinou o aumento do custo final da cirurgia SCEC. / INTRODUCTION: Techniques of coronary artery bypass grafting without the use of cardiopulmonary bypass (CPB) aim surgical results with less systemic damage, lower incidence of clinical complications and shorter hospitalization, generating expectations of lower hospital costs. OBJECTIVE: To evaluate the hospital cost in patients undergoing coronary artery bypass grafting with and without the use of CPB, in patients with multivessel coronary disease with stable preserved ventricular function. METHODS: Hospital costs were based on the current local government payment for the cardiac surgery. The use of orthoses, prostheses, and the clinical complications events were added in the cost. It was also added the duration of staying at ICU and total hospitalization period in the final cost. Yet, it was not considered remuneration of medical professionals as well as the cost of the depreciation of equipment, administration fee of land, water, electricity, phone, food, laboratory tests for admission and medicines. RESULTS: From January 2002 to August 2006, 131 patients and 128 patients were randomized for surgery with CPB and without CPB, respectively. The baseline characteristics were similar for both groups. The cost of surgical complications of the group without CPB were significantly lower compared to the group with CPB (606.00 ± 525.00 vs 945, 90 ± 440.00, p <0,001); as well as, the costs of ICU (432, 20 ± 391.70 vs 717.70 ± 257.70, p<0,001). Yet, the final cost was higher in the without CPB group (6.877,00 ± 525,20 vs 5.305,00 ± 440,11; p<0.001) due to the price of the Octopus stabilizer. Additionally, the occupation time at the operating room was (4.9 ± 1.1h vs 3, 9 ± 1.0h, p<0,001), at the ICU was (48.25 ± 17.2h vs 29, 20 ± 26.1h, p<0001) with intubations time (9.2 ± 4.5h vs 6, 4 ± 5.1h, p <0001) in the group with CPB and without CPB, respectively. CONCLUSION: These results showed that the coronary artery bypass grafting without cardiopulmonary bypass has decreased operational costs related to reduce length of stay in each sector of the surgical procedure. However, the high cost of the stabilizer lead to increased final cost of SCEC surgery.
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