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At least 163 records · Page 9Linked to original sources
PubMed1996

Cost-utility analysis of home parenteral nutrition.

An economic evaluation of home parenteral nutrition (HPN) for intestinal failure is presented. The cost-utility of HPN and factors affecting the cost-utility ratio were examined to determine whether current practice is the most efficient way of treating intestinal failure. Quality-adjusted life-years (QALYs) gained were measured using a validated health status questionnaire. The cost of treating a patient with intestinal failure was calculated, and marginal cost per QALY gained ratios were obtained. The cost per QALY for an average patient was approximately 68,975 pounds, but the value for patients over 55 years of age of about 126,865 pounds compared with approximately 58,233 pounds for those under 44 years. Treating a patient in hospital rather than at home increased the estimated cost per QALY to approximately 190,000 pounds. The current practice of home care is about 65 per cent more cost-effective than hospital care.

Adolescent↗
PubMed1995

[Medical economy of home care in private hospital].

In order to analyze the economics of home care, we calculated the revenue and expenditures of both hospitalization and home care in a private hospital. The home care expenses were about 44.7% of the institutional care expenses. It became clear that home care saved medical expenses. The expenses of patients were about 33.7% less with home care. In conclusion, home care may be favorable medical care if some problems are solved. The home care expenses of a cancer patient on the institutional side were about 3.4 times more that those of a patient with other diseases. If we support home care of cancer patients alone, it would be an excessive burden on them, because patients are too few at present to organize and keep a team. As a private hospital, we support home care regardless of disease. However, medical economic expenses as a total turned out to be about 17% short of the necessary expenses.

Aged↗
PubMed1995

The home health agency as a cost center.

Decisions involving the economics of home health care agencies require accurate and useful data on agency finances and cost-efficiency relationships, One step in the direction of improving economic management can be taken by defining the agency as a cost center, that is as an economic entity, with which specific resources, revenues and costs which can be expressly identified. This paper describes the economics and accounting frameworks within which resources and costs are classified and allocated into direct and indirect, and fixed and variable categories.

Accounting↗
PubMed1991

Women's physical activity and pregnancy outcome: a longitudinal analysis from the Philippines.

We assessed the effects of physical activity on pregnancy outcome in 2741 Filipino women identified during pregnancy as part of a two-year longitudinal study. Specific elements of physical activity hypothesized to be relevant to pregnancy outcome were posture, energy expenditure, and physical stress. Variables were developed for nine household and 48 formal and informal economic activities. Analyses were stratified by whether the woman performed formal waged work outside of the home, income-related activity at home, or was economically inactive. Results show that traditional definitions of physical activity and work based on participation in the formal labour force ignore a sizeable amount of home economic production, as well as the physical demands of housework. We saw no difference in risk of low birthweight or preterm delivery in economically active compared to economically inactive women. However, we found that increased amounts of standing activity affected pregnancy outcome in certain groups of women. Accurate assessment of the effects of physical activity during pregnancy must examine specific components of the activity, rather than relying on formal employment as a proxy for exposure.

Adult↗
PubMed1995

[Total and prolonged parenteral nutrition at the hospital and at the patient's home: its socio-economic importance].

Total parenteral nutrition with "All in one" nutritive mixtures is used in France from 1970. These advances ensure a more simple treatment for intensive care units. Nutritive mixtures provide the caloric and nitrogen daily requirements added with micronutrients (electrolytes, trace elements and vitamins) and this technique allows home parenteral nutrition. "All in one" nutritive mixtures have reduced the infectious complications and the industrial quality control during parenteral solutes admixing has decreased again this infectious risk. So, nutritive mixtures result in sparing of nurse time, material for preparation and antibiotic costs. Moreover, although the costs of home parenteral nutrition are considerable, this technique still reduces annual costs by 50% to 70%, avoids prolonged hospitalization and allows the patients to resume a more normal existence at home. Development of new technologies and nutritive mixtures for specific malnutrition are now required to improve treatment of these patients with insufficiency digestive tract.

Ambulatory Care↗
PubMed2001

Psychological distress and work and home roles: a focus on socio-economic differences in distress.

BACKGROUND: Home and work factors have been linked to psychological status, but less is known about their contribution to social inequalities in psychological status. We examine whether social inequalities in psychological distress can be explained by work-home factors and whether the impact of these potential explanatory factors is similar for men and women. METHODS: Data are from the 1958 British birth cohort study. We sought to explain social class differences in psychological distress at age 33. Explanatory factors were classified as work-home roles: i.e. employment, marital status, domestic responsibility, children and elderly care; and work-home characteristics: i.e. job-strain, insecurity, unsocial working hours, youngest child's age, number of children and level of involvement in childcare. RESULTS: A social gradient in psychological distress was found: odds ratios for classes IV and V v. I and II were 2.65 (men) and 3.02 (women). Work factors had consistently stronger associations with psychological distress and with social class among men than women. Work factors had a greater impact on class differences in psychological distress in men. Associations for home roles and characteristics were less consistent and their combined effect on class differences in distress was negligible for both sexes. CONCLUSION: Explanations for the social gradient differ for men and women. Work may be more important for men than women, but the impact of home factors was not strong during the early adulthood of this cohort.

Activities of Daily Living↗
PubMedDate not supplied

Intermittent subcutaneous infusion of opioids in hospice home care: an effective, economical, manageable option.

Administration of oral opioids is not always possible for terminally-ill patients. Obstruction, emesis, or inability to swallow frequently force us to seek alternative routes of administration. When the rectal route is contraindicated, impractical, or otherwise rejected by the patient or caregivers, we must resort to the parenteral route. The purpose of this study has been to validate the effectiveness, manageability, and side effects of bolus infusions of opioids utilizing an indwelling subcutaneous butterfly needle. The retrospective chart review included a convenience sample of 50 patients enrolled in our home-based hospice program who required subcutaneous infusion of opioids at some point during their enrollment. The total number of patients served during this time was 112. In the majority of cases (88 percent), the indication was inability to swallow or difficulty swallowing, which was related to impending death. Morphine sulfate was the opiate used in 955 of the cases reviewed. The mean four-hourly dose was 14.3 mg, with a range of 5 to 60 mg. Pain ratings were recorded using a 0-10 scale, both prior to initiation of and during the use of subcutaneous injections. Of the 42 percent of patients able to indicate a pain rating (0-10 scale) all rated their pain at 2 or below while using the subcutaneous route. No objective signs of pain were noted by caregivers or hospice nurses in the 58 percent of patients who were unable to rate their pain. The mean duration of time the needle remained in place was 4.62 days, with a range of 1-26 days.(ABSTRACT TRUNCATED AT 250 WORDS)

Analgesics, Opioid↗
PubMed2006

[Economic evaluation of at home subcutaneous and intravenous immunoglobulin substitution].

BACKGROUND: Intravenous (IV) and subcutaneous (SC) immunoglobulin (Ig) administration is a safe and an efficacious treatment in patients with IgG deficiency. Home administration of IV Ig and SC Ig has recently been approved in France. Most of the patients treated in hospital ask for home treatment. Some patients prefer monthly IV administration, others weekly SC administration. MATERIAL AND METHODS: We evaluated in details the cost of both of these practices. We currently use electric pumps for both IV and SC administration which are fixed to the patient giving complete freedom and mobility. RESULTS: For 20 g administrated per 4 week, the total cost of home treatment is 1,518 euro with SC Ig and 1,033 euro with IV Ig. For 40 g administrated per 4 week, the total cost of home treatment is 2,507 euro to 2,729 euro with SC Ig and 2,034 euro with IV Ig. The difference is mainly explained by the cost of renting the electric pumps and by the cost of furniture for SC administration. The choice of home Ig substitution must be given to all patient receiving treatment in hospital. CONCLUSIONS: Home IV and home SC perfusions are two possible options each different with there own advantages and disadvantages. The cost of each procedure must be known by the medical staff.

Cost-Benefit Analysis↗
PubMedDate not supplied

Economic comparison of home-care-based versus hospital-based treatment of chemotherapy-induced febrile neutropenia in children.

OBJECTIVE: The purpose of this study was to compare health-care resource utilization and outcomes among children treated for low-risk febrile neutropenia (FN) in a hospital-based setting with those treated in a home-care-based setting. METHODS: The perspective of this retrospective, cohort study was the health payer. We collected health-care utilization and treatment outcome data from medical records of 63 children (26 boys and 37 girls) with low-risk, chemotherapy-induced FN who were treated at the University of Arizona (27 children, the hospital-based group) and University of New Mexico (36 children, the home-care-based group). We identified 144 FN episodes (72 episodes in each group). Health-care utilization included physician visits, home-care visits, laboratory visits, outpatient visits, hospital days, intensive care unit days, medical tests and studies, and medications used to manage FN (e.g., filgrastim, antimicrobials, and ancilliary drugs and supplies). We applied uniform charges, based on those used at the University of New Mexico in 1998. We collected outcomes of the FN treatment (success vs. failure and time to resolution, defined as number of days of antibiotic therapy). Rates of positive blood cultures during treatment were also compared. Data were analyzed using nonparametric Mann-Whitney U tests for continuous data and chi-square analysis for categorical data. Sensitivity analyses were conducted by varying the amount of total resource utilization, as well as utilization of specific health-care resources. RESULTS: There was no difference in outcome; all episodes of treatment in both groups resulted in successful recovery from FN. Time to resolution of FN was 8.3 +/- 2.7 days for home-care FN episodes versus 7.3 +/- 3.6 days for hospital FN episodes (P =.064). Median charge per FN episode was significantly (P<.001) greater when managed in the hospital compared to home care (9392 US dollars vs. 5893 US dollars). There was greater use of laboratory and radiographic studies in the hospital-based patients (P <.01). However, children in the home-care-based group were more often treated with granulocyte colony-stimulating factor (filgrastim, median charge 1085 US dollars vs. 451 US dollars, P <.001), and median antibiotic charges were higher (2523 US dollars vs. 1526 US dollars, P <.001). Positive blood cultures were more common among the hospital-based FN treatments (30.6 vs. 11.1%, P=.012). CONCLUSIONS: We found that management of low-risk FN in a home-care-based setting was associated with significantly lower median total charges with no differences in outcome.

Adolescent↗