RESUMEN
Acute respiratory infections (ARI) are an important cause of morbidity and mortality worldwide, affecting mainly children and the elderly. They are associated with a high economic burden, increased number of medical visits and hospitalizations. The surveillance of the circulation of respiratory viruses can reduce the health care associated costs, and to optimize the health response. A platform based on R and its package Shiny was designed, to create an interactive and friendly web interface for gathering, analysis and publication of the data. The data from the Chilean metropolitan respiratory viruses surveillance network, available since 2006, was uploaded into the platform. Using this platform, the researcher spends less than 1 minute to upload the data, and the analysis and publication is immediate, available to be seen by any user with a device connected to Internet, who can choose the variables to be displayed. With a very low cost, in a short time, and using the R programming language, it was possible to create a simple, and interactive platform, considerably decreasing the upload and analysis time, and increasing the impact and availability of this surveillance.
Asunto(s)
Costos de la Atención en Salud , Modelos Teóricos , Infecciones del Sistema Respiratorio , Programas Informáticos , Virosis , Anciano , Niño , Chile/epidemiología , Humanos , Internet , Infecciones del Sistema Respiratorio/economía , Infecciones del Sistema Respiratorio/epidemiología , Programas Informáticos/economía , Programas Informáticos/normas , Virosis/epidemiología , VirusRESUMEN
Resumen Las infecciones respiratorias agudas (IRA) causadas por virus son una importante causa de morbilidad y mortalidad en el mundo, afectando principalmente a niños y adultos mayores. Se asocian a un alto número de consultas y hospitalizaciones, a una significativa sobrecarga del sistema de salud y a un alto costo económico. La vigilancia de virus respiratorios tiene el potencial de ayudar a optimizar la respuesta sanitaria, garantizar la disponibilidad de recursos humanos, racionalizar los recursos y disminuir los costos asociados a la atención en salud. Con el objetivo de optimizar la recolección y visualización de los datos de nuestro actual sistema de vigilancia de virus respiratorios, se diseñó una plataforma basada en R y sus paquetes Shiny, que permite la creación de una interfase web interactiva y amigable para la recolección, análisis y publicación de los datos. Se ingresaron a esta plataforma los datos de la red de vigilancia metropolitana de virus respiratorios disponibles desde 2006. En esta plataforma, el investigador demora menos de un minuto en registrar los datos. El análisis y publicación es inmediato, llegando a cualquier usuario con un dispositivo conectado a Internet, quien puede elegir las variables a consultar. Con un costo muy bajo, en poco tiempo y utilizando el lenguaje de programación R, se logró crear un sistema simple e interactivo, disminuyendo el tiempo de carga y análisis de datos de forma considerable, posiblemente aumentando el impacto y la disponibilidad de esta vigilancia.
Abstract Acute respiratory infections (ARI) are an important cause of morbidity and mortality worldwide, affecting mainly children and the elderly. They are associated with a high economic burden, increased number of medical visits and hospitalizations. The surveillance of the circulation of respiratory viruses can reduce the health care associated costs, and to optimize the health response. A platform based on R and its package Shiny was designed, to create an interactive and friendly web interface for gathering, analysis and publication of the data. The data from the Chilean metropolitan respiratory viruses surveillance network, available since 2006, was uploaded into the platform. Using this platform, the researcher spends less than 1 minute to upload the data, and the analysis and publication is immediate, available to be seen by any user with a device connected to Internet, who can choose the variables to be displayed. With a very low cost, in a short time, and using the R programming language, it was possible to create a simple, and interactive platform, considerably decreasing the upload and analysis time, and increasing the impact and availability of this surveillance.
Asunto(s)
Humanos , Niño , Anciano , Infecciones del Sistema Respiratorio/economía , Infecciones del Sistema Respiratorio/epidemiología , Programas Informáticos/economía , Programas Informáticos/normas , Virosis/epidemiología , Costos de la Atención en Salud , Modelos Teóricos , Virus , Chile/epidemiología , InternetRESUMEN
BACKGROUND: The mortality rate in children under 5 years old (U5MR) has decreased considerably in Ecuador in the last decade; however, thousands of children continue to die from causes related to poverty. A social program known as Bono de Desarrollo Humano (BDH) was created to guarantee a minimum level of consumption for families and to reduce chronic malnutrition and preventable childhood diseases. We sought to evaluate the effect of the BDH program on mortality of children younger than 5 years, particularly from malnutrition, diarrheal diseases, and lower respiratory tract infections. METHODS: Mortality rates and BDH coverage from 2009 to 2014 were evaluated from the 144 (of 222) Ecuadorian counties with intermediate and high quality of vital information. A multivariable regression analyses for panel data was conducted by using a negative binomial regression model with fixed effects, adjusted for all relevant demographic and socioeconomic covariates. RESULTS: Our research shows that for each 1% increase in BDH county coverage there would be a decrease in U5MR from malnutrition of 3% (RR 0.971, 95% CI 0.953-0.989). An effect of BDH county coverage on mortality resulting from respiratory infections was also observed (RR 0.992, 95% CI 0.984-0.999). The BDH also reduced hospitalization rates in children younger than 5 years, overall and for diarrhea. CONCLUSIONS: A conditional cash transfer program such as BDH could contribute to the reduction of mortality due to causes related to poverty, such as malnutrition and respiratory infections. The coverage should be maintained -or increased in a period of economic crisis- and its implementation strengthened.
Asunto(s)
Salud Infantil/economía , Mortalidad del Niño/tendencias , Pobreza/economía , Asistencia Pública/economía , Trastornos de la Nutrición del Niño/economía , Trastornos de la Nutrición del Niño/mortalidad , Preescolar , Diarrea/economía , Diarrea/mortalidad , Ecuador/epidemiología , Femenino , Hospitalización/tendencias , Humanos , Lactante , Recién Nacido , Masculino , Análisis de Regresión , Infecciones del Sistema Respiratorio/economía , Infecciones del Sistema Respiratorio/mortalidadRESUMEN
OBJECTIVES: To determine differences in the incidence of respiratory morbidity during the first year of life among infants born 32(0/7)-34(6/7) weeks' gestational age (GA) before and after the administration policy for palivizumab, as written by the American Academy of Pediatrics, was updated in 2009. STUDY DESIGN: Secondary analysis of the dataset collected for the Gastrointestinal Risk Factors for Wheezing in Premature Infants study, which enrolled preterm infants without bronchopulmonary dysplasia and followed them by parental questionnaires at 3, 6, 9, and 12 months adjusted age for prematurity. Participants were included if they were enrolled in Gastrointestinal Risk Factors for Wheezing in Premature Infants, born 32(0/7)-34(6/7) weeks' GA, and completed the 12-month questionnaire. We compared rates of recurrent wheezing, respiratory medication use, and health care use before (Epoch 1) and after (Epoch 2) the 2009 administration policy change. RESULTS: A total of 165 infants met inclusion criteria. There was a significant increase in recurrent wheezing in Epoch 2 (46.2%) vs Epoch 1 (28.8%) (OR 2.22 [95% CI 1.08-4.53], P = .03). There was a nonsignificant increase in visits to the emergency department in Epoch 2 (27.4%) vs Epoch 1 (15.3%) (OR 2.12 [95% CI 0.91-4.96], P = .08). There were no differences in hospital admissions or respiratory medication use. CONCLUSIONS: Infants born 32(0/7)-34(6/7) weeks' GA treated after the American Academy of Pediatrics administration policy change in 2009 had a greater incidence of recurrent wheezing than those treated according to the previous policy. It will be important to track rates of recurrent wheezing after the 2014 administration policy, because it may be an important factor in future cost-effectiveness analyses.
Asunto(s)
Displasia Broncopulmonar/tratamiento farmacológico , Palivizumab/administración & dosificación , Pediatría/normas , Infecciones por Virus Sincitial Respiratorio/tratamiento farmacológico , Infecciones del Sistema Respiratorio/tratamiento farmacológico , Academias e Institutos , Displasia Broncopulmonar/epidemiología , Femenino , Edad Gestacional , Humanos , Lactante , Recién Nacido , Recien Nacido Prematuro , Enfermedades del Prematuro/tratamiento farmacológico , Enfermedades del Prematuro/epidemiología , Masculino , Palivizumab/economía , Admisión del Paciente , Ruidos Respiratorios , Infecciones por Virus Sincitial Respiratorio/epidemiología , Infecciones del Sistema Respiratorio/economía , Infecciones del Sistema Respiratorio/epidemiología , Factores de Riesgo , Encuestas y Cuestionarios , Estados UnidosRESUMEN
Objective To estimate the burden of disease and related direct medical cost of Acute Respiratory Infections (ARI) for the health-care system in a low-income district of Bogota, generated by children under age five and senior population over age sixty. Methods A cross-sectional, retrospective, patient level study was conducted in San Cristobal district from 2008 to 2012 among the subsidized population. All inpatients and outpatients with ARI from three hospitals were reported. The total and average direct medical costs were estimated and are reported in International Dollars (Int$). Results It is estimated that, for children, ambulatory incidence rate for ARI varied between 54.4 % and 66.3 % and hospitalization rate between 9.2 % and 12.3 %. The mortality rate in the district oscillated between 18.1 and 27.7 deaths per 100 000. The main medical costs were attributed to hospitalizations, and the total medical hospitalization cost per year estimated ranged between Int$ 1 334 352 and Int$ 2 139 597. In the case of senior population, the ambulatory incidence rate fluctuated between 7.6 % and 10.0 %, and the hospitalization rates between 0.6 % and 2.1 %; the mortality rate ranged between 8.9 and 47.8 deaths per 100 000. Hospitalization cost per year was estimated to be between Int$ 88 957 and Int$ 373 382. Conclusion Direct medical costs due to ARI have an important disease and direct medical cost burden in this low-income district.
Asunto(s)
Pobreza/estadística & datos numéricos , Infecciones del Sistema Respiratorio/economía , Infecciones del Sistema Respiratorio/epidemiología , Factores de Edad , Anciano , Atención Ambulatoria/economía , Atención Ambulatoria/estadística & datos numéricos , Niño , Colombia/epidemiología , Costos y Análisis de Costo , Estudios Transversales , Costos de la Atención en Salud , Hospitalización/economía , Hospitalización/estadística & datos numéricos , Humanos , Incidencia , Estudios Retrospectivos , Población UrbanaRESUMEN
BACKGROUND: Breastfeeding is vital for child survival, health, and development. Mexico has very low rates of breastfeeding and experienced a severe decrease in the prevalence of exclusive breastfeeding from 21% in 2006 to 14% in 2012. OBJECTIVE: The objective of the article was to estimate the pediatric costs of inadequate breastfeeding in Mexico associated with the following acute health conditions: respiratory infections, otitis media, gastroenteritis, necrotizing enterocolitis (NEC), and sudden infant death syndrome (SIDS). DESIGN: The authors estimated the economic costs of inadequate breastfeeding as follows: the sum of direct health care costs for diseases whose risk increases when infants are non-exclusively breastfed <6 mo or are not breastfed from ages 6 to <11 mo, lost future earnings due to premature infant death, and the costs of purchasing infant formula. Incidence cases were retrieved from national surveillance systems, except for NEC and SIDS, which were estimated from the literature. A sensitivity analysis was carried out to provide a range of costs based on different assumptions of the number of incident cases of all infant health outcomes examined. The model applied to the cohort of 1-y-old children born in 2012. RESULTS: The total annual costs of inadequate breastfeeding in Mexico for the studied cohort ranged from $745.6 million to $2416.5 million, where the costs of infant formula accounted for 11-38% of total costs. A range of 1.1-3.8 million reported cases of disease and from 933 to 5796 infant deaths per year for the diseases under study are attributed to inadequate infant breastfeeding practices; altogether these represent nearly 27% of the absolute number of episodes of such diseases. CONCLUSIONS: This study provides costs of inadequate breastfeeding that had not been quantified in Mexico. The costs presented in this article provide the minimum amount that the country should invest to achieve better breastfeeding practices.
Asunto(s)
Lactancia Materna , Desarrollo Infantil , Promoción de la Salud , Política Nutricional , Cooperación del Paciente , Adulto , Lactancia Materna/economía , Estudios de Cohortes , Costo de Enfermedad , Enterocolitis Necrotizante/economía , Enterocolitis Necrotizante/epidemiología , Enterocolitis Necrotizante/mortalidad , Enterocolitis Necrotizante/terapia , Monitoreo Epidemiológico , Femenino , Gastroenteritis/economía , Gastroenteritis/epidemiología , Gastroenteritis/mortalidad , Gastroenteritis/terapia , Costos de la Atención en Salud , Humanos , Incidencia , Lactante , Fórmulas Infantiles/economía , Mortalidad Infantil , Masculino , México/epidemiología , Encuestas Nutricionales , Otitis Media/economía , Otitis Media/epidemiología , Otitis Media/mortalidad , Otitis Media/terapia , Infecciones del Sistema Respiratorio/economía , Infecciones del Sistema Respiratorio/epidemiología , Infecciones del Sistema Respiratorio/mortalidad , Infecciones del Sistema Respiratorio/terapia , Muerte Súbita del Lactante/epidemiologíaRESUMEN
BACKGROUND: In the past 15 years, Brazil has undergone notable social and public health changes, including a large reduction in child mortality. The Bolsa Familia Programme (BFP) is a widespread conditional cash transfer programme, launched in 2003, which transfers cash to poor households (maximum income US$70 per person a month) when they comply with conditions related to health and education. Transfers range from $18 to $175 per month, depending on the income and composition of the family. We aimed to assess the effect of the BFP on deaths of children younger than 5 years (under-5), overall and resulting from specific causes associated with poverty: malnutrition, diarrhoea, and lower respiratory infections. METHODS: The study had a mixed ecological design. It covered the period from 2004-09 and included 2853 (of 5565) municipalities with death and livebirth statistics of adequate quality. We used government sources to calculate all-cause under-5 mortality rates and under-5 mortality rates for selected causes. BFP coverage was classified as low (0·0-17·1%), intermediate (17·2-32·0%), high (>32·0%), or consolidated (>32·0% and target population coverage ≥100% for at least 4 years). We did multivariable regression analyses of panel data with fixed-effects negative binomial models, adjusted for relevant social and economic covariates, and for the effect of the largest primary health-care scheme in the country (Family Health Programme). FINDINGS: Under-5 mortality rate, overall and resulting from poverty-related causes, decreased as BFP coverage increased. The rate ratios (RR) for the effect of the BFP on overall under-5 mortality rate were 0·94 (95% CI 0·92-0·96) for intermediate coverage, 0·88 (0·85-0·91) for high coverage, and 0·83 (0·79-0·88) for consolidated coverage. The effect of consolidated BFP coverage was highest on under-5 mortality resulting from malnutrition (RR 0·35; 95% CI 0·24-0·50) and diarrhoea (0·47; 0·37-0·61). INTERPRETATION: A conditional cash transfer programme can greatly contribute to a decrease in childhood mortality overall, and in particular for deaths attributable to poverty-related causes such as malnutrition and diarrhoea, in a large middle-income country such as Brazil. FUNDING: National Institutes of Science and Technology Programme, Ministry of Science and Technology, and Council for Scientific and Technological Development Programme (CNPq), Brazil.
Asunto(s)
Trastornos de la Nutrición del Niño/prevención & control , Protección a la Infancia/economía , Diarrea/prevención & control , Infecciones del Sistema Respiratorio/prevención & control , Seguridad Social/economía , Brasil/epidemiología , Mortalidad del Niño/tendencias , Trastornos de la Nutrición del Niño/economía , Trastornos de la Nutrición del Niño/mortalidad , Preescolar , Ciudades , Diarrea/economía , Diarrea/mortalidad , Métodos Epidemiológicos , Financiación Gubernamental , Humanos , Lactante , Pobreza , Evaluación de Programas y Proyectos de Salud , Infecciones del Sistema Respiratorio/economía , Infecciones del Sistema Respiratorio/mortalidadRESUMEN
The clinical profile of respiratory infections in 140 children who attend a day care center was described in a prospective study and direct costs were estimated. The costs estimation included diagnostic procedures, laboratory exams, drugs, kinesitherapy, parents' absenteeism, medical certificates and hospitalization. Two hundred and two respiratory episodes in 90 (64.2%) children, 75 (37.1%) in 30 infants and 127 (62.8%) in 60 toddlers were analyzed. There were 61.3% lower respiratory infections in infants versus 39.4% in toddlers (p < 0.002). Antimicrobials were prescribed in 42.6% of the medical attendance. Infants represent major costs regarding medical consultations, kinesitherapy, laboratory tests and refunds for medical certificates or leave of absence (p < 0.001). The mean global cost of a respiratory infection was US $ 129,3 for infants and US $ 53,0 for toddlers (p < 0.001). This situation needs the development of an intervention program.
Asunto(s)
Antibacterianos/uso terapéutico , Guarderías Infantiles/estadística & datos numéricos , Costo de Enfermedad , Costos de la Atención en Salud/estadística & datos numéricos , Infecciones del Sistema Respiratorio/economía , Preescolar , Chile/epidemiología , Estudios Transversales , Femenino , Humanos , Lactante , Masculino , Infecciones del Sistema Respiratorio/tratamiento farmacológico , Infecciones del Sistema Respiratorio/epidemiología , Estaciones del Año , Factores SocioeconómicosRESUMEN
Se evaluó mediante estudio descriptivo, características y costos directos de infecciones respiratorias en 140 niños que asisten a sala cuna y jardín infantil. Se consignó diagnóstico, exámenes, fármacos, kinesioterapia, ausentismo, licencias médicas y hospitalización. Se analizan 202 eventos respiratorios en 90 niños: 75 (37,1 por ciento) en 30 lactantes y 127 (62,8 por ciento) en 60 pre-escolares. Hubo 61,3 por ciento de infecciones respiratorias bajas en lactantes versus 39,4 por ciento en pre-escolares (p < 0,002). Existió indicación de antimicrobianos en 42,6 por ciento de las consultas. Se encontró mayor costo en lactantes respecto de consulta médica, kinesioterapia, exámenes de laboratorio y pago de licencias médicas o permisos (p < 0,001). El costo promedio total de una infección respiratoria alcanzó a $ 68.577 en lactantes y $ 28.130 en pre-escolares (p < 0,001). Con predominio de infecciones bajas en lactantes, elevado consumo de antimicrobianos y alto impacto económico, esta realidad amerita focalizar programas de intervención.
Asunto(s)
Humanos , Lactante , Preescolar , Costo de Enfermedad , Infecciones del Sistema Respiratorio/economía , Infecciones del Sistema Respiratorio/epidemiología , Casas Cuna , Atención a la Salud/economía , Escuelas de Párvulos , Enfermedad Aguda , Chile , Costos y Análisis de Costo , Epidemiología DescriptivaRESUMEN
OBJECTIVES: To quantify the cost and distribution of health care resources consumed annually in management of Canadian children from birth to 4 years of age with respiratory syncytial virus (RSV) infection. STUDY DESIGN: Estimates of direct medical expenditures (in 1993 U.S. dollars) were collected from a prospective cohort study of hospitalized children with RSV and from national and provincial databases. RESULTS: The annual cost of RSV-associated illness was almost $18 million. The largest component of direct expenditures (62%) was for inpatient care for the estimated 0.7% of all infected children ill enough to require admission. Physician fees comprised only 4% of inpatient expenses. Expenditures for ambulatory patients accounted for 38% of direct costs. CONCLUSIONS: The greatest reductions in the economic cost of RSV infections will be found in interventions that reduce duration of or prevent hospital stay. Costs for management of RSV infection in children in the Canadian health care system are considerably less than charges reported in the United States.
Asunto(s)
Infecciones por Virus Sincitial Respiratorio/economía , Infecciones del Sistema Respiratorio/economía , Absentismo , Adulto , Atención Ambulatoria/economía , Bronquiolitis/economía , Bronquiolitis/terapia , Bronquiolitis/virología , Canadá , Preescolar , Estudios de Cohortes , Control de Costos , Costo de Enfermedad , Costos Directos de Servicios , Estudios de Evaluación como Asunto , Honorarios Médicos , Femenino , Costos de la Atención en Salud , Asignación de Recursos para la Atención de Salud , Gastos en Salud , Hospitalización/economía , Humanos , Lactante , Recién Nacido , Sistemas de Información , Tiempo de Internación/economía , Admisión del Paciente , Estudios Prospectivos , Infecciones por Virus Sincitial Respiratorio/terapia , Infecciones del Sistema Respiratorio/terapia , Sensibilidad y Especificidad , Estados Unidos , Mujeres TrabajadorasAsunto(s)
Terapia por Inhalación de Oxígeno/instrumentación , Infecciones del Sistema Respiratorio/terapia , Cateterismo Periférico/economía , Cateterismo Periférico/instrumentación , Preescolar , Costos y Análisis de Costo , Humanos , Lactante , Recién Nacido , Nasofaringe , Terapia por Inhalación de Oxígeno/economía , Infecciones del Sistema Respiratorio/economíaRESUMEN
OBJECTIVE: Lower respiratory tract illness (LRI) is the most common serious illness in childhood and the most common reason for hospitalization of infants beyond the neonatal period. This study assessed the potential for cost savings from reduction in hospitalization for LRI. SETTING AND SAMPLE: LRI hospitalization rates for children in the first 2 years of life (infants) were studied for the 62 counties of New York State and six socioeconomic areas within Monroe County (Rochester) for the years 1985 through 1991. DESIGN: Analysis of small area variations. RESULTS: LRI accounted for 51.2% of infant hospitalizations in New York State. The overall LRI hospitalization rate for New York's 62 counties was 27.0 per 1000 child-years and ranged, among the 18 most populous counties, from 10.7 for Monroe County to 39.3 for the Bronx. Unemployment rate was the strongest predictor of LRI hospitalization rates for counties, explaining 29% of the variance in multiple regression analysis. Within Monroe County, LRI hospitalization rates followed a geographic gradient from the inner city (22.5) to the rest of the city (12.2), and to the suburbs (7.3). Deaths from LRI were uncommon (0.36% of state LRI hospitalizations) and varied little between inner city (0.42%) and suburbs (0.51%). If LRI hospitalization rates for Monroe County suburban children prevailed for the entire state, 10,439 hospitalizations and $32,916,000 would be saved annually. CONCLUSIONS: A large portion of the increased cost of health care for children living in poverty is attributable to hospitalization for LRI in infants. Physician discretion in decision making and factors associated with socioeconomic status are probably major determinants of variation. Well-coordinated follow-up of acute illness visits, home monitoring by visiting nurses, and empirically based clinical guidelines for management of LRI might yield both substantial cost savings and better service to families.
Asunto(s)
Hospitalización/estadística & datos numéricos , Infecciones del Sistema Respiratorio/epidemiología , Costos y Análisis de Costo , Grupos Diagnósticos Relacionados/economía , Grupos Diagnósticos Relacionados/estadística & datos numéricos , Hospitalización/economía , Humanos , Lactante , Recién Nacido , Modelos Lineales , New York/epidemiología , Distribución de Poisson , Infecciones del Sistema Respiratorio/diagnóstico , Infecciones del Sistema Respiratorio/economía , Infecciones del Sistema Respiratorio/terapia , Factores de Riesgo , Factores Socioeconómicos , Resultado del TratamientoRESUMEN
The single most important respiratory pathogen in infancy and early childhood is respiratory syncytial virus (RSV). Approximately 40% of primary RSV infections in children result in lower respiratory tract disease. Approximately 1% of RSV-infected children require hospitalization. Especially in high-risk children, primary RSV infection results in significant morbidity and, sometimes, death. This high-risk group includes children with bronchopulmonary dysplasia, children with congenital heart disease, premature infants less than 6 months of age, and children with immunodeficiency diseases. It has been estimated that, in the United States, 14,000 infants with chronic lung disease and 16,400 infants with heart disease will be identified by 12 months of age. More than 91,000 children are hospitalized annually with lower respiratory tract disease caused by RSV, and 4500 deaths occur. In 1985 a report from the Institute of Medicine calculated that the annual hospitalization costs attributable to RSV infection were $300 million. Data collected at the New England Medical Center in 1991 show that the average cost of hospitalization of a child with RSV was $808 each day. Because of difficulty in developing a safe and effective RSV vaccine, attention is now focused on passive immunization using an RSV immune globulin. On the basis of a recently completed multiinstitutional trial, RSV immune globulin appears to be a safe and cost-effective option for prevention of severe RSV disease in high-risk children.
Asunto(s)
Infecciones por Virus Sincitial Respiratorio , Virus Sincitial Respiratorio Humano , Infecciones del Sistema Respiratorio , Preescolar , Enfermedad Crónica , Cardiopatías Congénitas/complicaciones , Hospitalización/economía , Humanos , Huésped Inmunocomprometido , Inmunoglobulinas/uso terapéutico , Lactante , Recién Nacido , Recien Nacido Prematuro , Enfermedades Pulmonares/complicaciones , Infecciones por Virus Sincitial Respiratorio/economía , Infecciones por Virus Sincitial Respiratorio/epidemiología , Infecciones por Virus Sincitial Respiratorio/etiología , Infecciones por Virus Sincitial Respiratorio/prevención & control , Infecciones del Sistema Respiratorio/economía , Infecciones del Sistema Respiratorio/epidemiología , Infecciones del Sistema Respiratorio/etiología , Infecciones del Sistema Respiratorio/prevención & control , Factores de RiesgoRESUMEN
Information from the hospital records of 1,660 children under two years of age admitted to the Hospital Roberto del Río (Northern District of Santiago) during 1979, allowed carrying out an analysis of the effect of malnutrition upon the admission rate and length of stay for diarrhea and respiratory infections. The following indexes were calculated and related to nutritional status: a) Admission rate for the total population of children under two years of age from the Northern District of Santiago; b) frequency of associated and intercurrent pathology, and c) length of stay. The three indexes evidenced a clear relationship with nutritional status (P much less than 0.01), showing a progressive deterioration as the relationship weight/age became impaired. The admission rate for diarrhea was nine times higher, and the length of stay 16.9% higher (P less than 0.001) in children with mild malnutrition as compared with normal patients. For respiratory infections the rates were 2.4 and 24.7% higher (P less than 0.001) in malnourished patients than in normals. The excess of admission rate for diarrhea and respiratory pathology, conditioned by malnutrition in the Northern District of Santiago, was estimated as the cost equivalent to 10,609 extra days of stay, with an annual cost above US$300,000. The investment of such an amount of money in health promotion and protection activities would certainly increase its social cost-effectiveness.
Asunto(s)
Diarrea Infantil/complicaciones , Hospitalización/economía , Desnutrición Proteico-Calórica/complicaciones , Infecciones del Sistema Respiratorio/complicaciones , Diarrea Infantil/economía , Humanos , Lactante , Recién Nacido , Tiempo de Internación/economía , Desnutrición Proteico-Calórica/economía , Infecciones del Sistema Respiratorio/economíaRESUMEN
As part of ambulatory-care review, the New Mexico Experimental Medical Care Review Organization (EMCRO) developed medical guidelines for the use of injections and informed physicians about them through written communications and personal visits. After their adoption, the EMCRO denied payment for Medicaid claims not meeting the guidelines. To study the effect of these activities, we compared quality of care in entire episodes of respiratory infections before and after guidelines were promulgated. Quality as judged by minimal criteria for antibiotic use improved. Percentages of episodes with appropriate therapy rose from 36% to 42% for streptococcal sore throat, from 42% to 81% for bronchitis, and from 36% to 51% for acute upper respiratory infection. Quality improved most among physicians with the poorest records initially; "outliers" still gave inadequate care. Assessment of episodes of care derived from claims data thus appears to be a feasible and nonintrusive mechanism for detecting deficiencies in quality and evaluating quality-assurance activities.