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INTRODUCTION: Safety-net hospitals (SNHs) have higher postoperative complications and costs versus low-burden hospitals. Do low socioeconomic status/vulnerable patients receive care at lower-quality hospitals or are there factors beyond providers' control? We studied the association of private, Medicare, and vulnerable insurance type with complications/costs in a high-burden SNH. METHODS: Retrospective inpatient cohort study using National Surgical Quality Improvement Program (NSQIP) data (2013-2019) with cost data risk-adjusted by frailty, preoperative serious acute conditions (PASC), case status, and expanded operative stress score (OSS) to evaluate 30-day unplanned reoperations, any complication, Clavien-Dindo IV (CDIV) complications, and hospitalization variable costs. RESULTS: Cases (Private 1517; Medicare 1224; Vulnerable 3648) with patient mean age 52.3 y [standard deviation = 14.7] and 47.3% male. Adjusting for frailty and OSS, vulnerable patients had higher odds of PASC (aOR = 1.71, CI = 1.39-2.10, P < 0.001) versus private. Adjusting for frailty, PASC and OSS, Medicare (aOR = 1.27, CI = 1.06-1.53, P = 0.009), and vulnerable (aOR = 2.44, CI = 2.13-2.79, P < 0.001) patients were more likely to undergo urgent/emergent surgeries. Vulnerable patients had increased odds of reoperation and any complications versus private. Variable cost percentage change was similar between private and vulnerable after adjusting for case status. Urgent/emergent case status increased percentage change costs by 32.31%. We simulated "switching" numbers of private (3648) versus vulnerable (1517) cases resulting in an estimated variable cost of $49.275 million, a 25.2% decrease from the original $65.859 million. CONCLUSIONS: Increased presentation acuity (PASC and urgent/emergent surgeries) in vulnerable patients drive increased odds of complications and costs versus private, suggesting factors beyond providers' control. The greatest impact on outcomes may be from decreasing the incidence of urgent/emergent surgeries by improving access to care.
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Fragilidad , Pacientes Internos , Anciano , Humanos , Masculino , Estados Unidos/epidemiología , Persona de Mediana Edad , Femenino , Estudios Retrospectivos , Medicare , Estudios de Cohortes , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiologíaRESUMEN
We analyzed differences (charges, total, and variable costs) in estimating cost savings of quality improvement projects using reduction of serious/life-threatening complications (Clavien-Dindo Level IV) and insurance type (Private, Medicare, and Medicaid/Uninsured) to evaluate the cost measures. Multiple measures are used to analyze hospital costs and compare cost outcomes across health systems with differing patient compositions. We used National Surgical Quality Improvement Program inpatient (2013-2019) with charge and cost data in a hospital serving diverse socioeconomic status patients. Simulation was used to estimate variable costs and total costs at 3 proportions of fixed costs (FC). Cases (Private 1517; Medicare 1224; Medicaid/Uninsured 3648) with patient mean age 52.3 years (Standard Deviationâ =â 14.7) and 47.3% male. Medicare (adjusted odds ratioâ =â 1.55, 95% confidence intervalâ =â 1.16-2.09, Pâ =â .003) and Medicaid/Uninsured (adjusted odds ratioâ =â 1.41, 95% confidence intervalâ =â 1.10-1.82, Pâ =â .008) had higher odds of complications versus Private. Medicaid/Uninsured had higher relative charges versus Private, while Medicaid/Uninsured and Medicare had higher relative variable and total costs versus Private. Targeting a 15% reduction in serious complications for robust patients undergoing moderate-stress procedures estimated variable cost savings of $286,392. Total cost saving estimates progressively increased with increasing proportions of FC; $443,943 (35% FC), $577,495 (50% FC), and $1184,403 (75% FC). In conclusion, charges did not identify increased costs for Medicare versus Private patients. Complications were associated withâ >â 200% change in costs. Surgical hospitalizations for Medicare and Medicaid/Uninsured patients cost more than Private patients. Variable costs should be used to avoid overestimating potential cost savings of quality improvement interventions, as total costs include fixed costs that are difficult to change in the short term.
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Seguro de Salud , Medicare , Humanos , Masculino , Anciano , Estados Unidos , Persona de Mediana Edad , Femenino , Costos de Hospital , Ahorro de Costo , Estudios Retrospectivos , Pacientes Internos , Hospitales , Precios de HospitalRESUMEN
Adverse symptoms of prolonged masking were reported by personnel. A drop of essential oil was added to the mask to mitigate these effects and significantly lessened symptoms. Symptoms declined by almost half, including anxiety, nausea, and indigestion. This simple intervention can mitigate adverse effects of prolonged masking in the hospital setting.
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Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos , Aceites Volátiles , Humanos , Aceites Volátiles/efectos adversos , Ansiedad , Náusea , HospitalesRESUMEN
PURPOSE: To examine and quantify the burden of opioid-related mortality utilizing a serial cross-sectional design of individuals 15 to 64 years of age whose death was related to opioid use from January 1, 1999, to January 31, 2019. METHODS: Data was obtained from the CDC WONDER Multiple Cause of Death Online Database, which captures mortality and population estimates across the United States stratified by geography, age, sex, race, and ethnicity. The burden of opioid-related deaths in Texas was evaluated as the proportion of all deaths attributable to this underlying cause of death over the study period and years of potential life lost (YPLL). RESULTS: Results revealed that between 1999 and 2019, 19,039 opioid-related deaths occurred among persons age 15 to 64, resulting in an increase of 402% over the study period (from 3.8 per 100,000 in 1999 to 8.2 per 100,000 in 2019). In 2019, the number of opioid-related deaths was highest among males (67.1%), non-Hispanic whites (76.0%), and adults aged 25-54 (74.1%). Overall, in Texas in 2019, opioid-related deaths resulted in 51,743 years of potential life lost (3.2 YPLL per 1000) most of which were among males (36,318 YPLL). Additionally, premature mortality due to opioids was highest among adults aged 25 to 34 years (5.1 YPLL per 1000) , and those aged 35 to 44 years (3.8 YPLL per 1000). CONCLUSIONS: We identified a steady yet significant rise in opioid-related mortality in Texas since 1999 and in particular among demographic groups considered at relatively high risk for midlife mortality. This study is also considered the first of its kind to quantify the burden of premature mortality related to opioid overdoses in Texas.
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Analgésicos Opioides , Trastornos Relacionados con Opioides , Adolescente , Adulto , Analgésicos Opioides/efectos adversos , Estudios Transversales , Humanos , Masculino , Persona de Mediana Edad , Mortalidad , Mortalidad Prematura , Texas/epidemiología , Estados Unidos , Adulto JovenRESUMEN
The American Diabetes Association (ADA) recommends healthful food choices; however, some geographic areas are limited in the types of foods they offer. Little is known about the role of convenience stores as viable channels to provide healthier foods in our "grab and go" society. The purposes of this study were to (1) identify foods offered within convenience stores located in two Bexar County, Texas, ZIP Codes and (2) compare the availability and cost of ADA-recommended foods including beverages, produce, grains, and oils/fats. Data were analyzed from 28 convenience store audits performed in two sociodemographically diverse ZIP Codes in Bexar County, Texas. Chi-squared tests were used to compare food availability, and t-tests were used to compare food cost in convenience stores between ZIP Codes. A significantly larger proportion of convenience stores in more affluent areas offered bananas (χ (2) = 4.17, P = 0.003), whole grain bread (χ (2) = 8.33, P = 0.004), and baked potato chips (χ (2) = 13.68, P < 0.001). On average, the price of diet cola (t = -2.12, P = 0.044) and certain produce items (e.g., bananas, oranges, tomatoes, broccoli, and cucumber) was significantly higher within convenience stores in more affluent areas. Convenience stores can play an important role to positively shape a community's food environment by stocking healthier foods at affordable prices.
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Comida Rápida/economía , Comida Rápida/provisión & distribución , Abastecimiento de Alimentos , Alimentos/economía , Bebidas/economía , Bebidas/provisión & distribución , Alimentos Orgánicos/economía , Alimentos Orgánicos/provisión & distribución , Factores Socioeconómicos , TexasRESUMEN
OBJECTIVE: To assess changes in self-reported quality of life indicators among Chronic Disease Self-Management Program (CDSMP) participants from baseline to 6-month followup and compare observed changes by racial and ethnic group. DESIGN: A pre-post evaluation design was employed for this evidence-based chronic disease self-management intervention. Data were collected at baseline and again six months post intervention. SETTING: Using the aging services network and public health system, workshops were hosted in a variety of community settings including senior centers, churches, libraries, and health care settings. PARTICIPANTS: One-hundred thirty-six adults aged > or =50 years residing in Bexar County, Texas. INTERVENTIONS: CDSMP is an evidence-based program created at Stanford University. The program was held one time per week for six consecutive weeks. Each session lasted approximately 150 minutes. MAIN OUTCOME MEASURES: Health-related quality of life indicators developed by the Centers for Disease Control and Prevention (ie, total number of unhealthy physical days, unhealthy mental days). RESULTS: From baseline to 6-month follow-up, significant differences by racial/ethnic group were observed for changes in unhealthy physical days and changes in combined unhealthy days. Hispanic participants showed greatest improvement, followed by African American participants, followed by non-Hispanic White participants. CONCLUSIONS: Findings indicate health-related quality of life improvements can be sustained months after the conclusion of CDSMP. Given gains seen among minority participants and forthcoming demographic shifts in this Texas region, community-driven interventions should be expanded as part of broader efforts to reduce racial and ethnic disparities in health.