Acute care hospitals costs

It is also notable that the numbers of hospitals in urban and rural settings are shrinking. In 1993, there were 3012 urban hospitals and 2249 rural, whereas in 1998, there were 2816 urban and 2199 rural hospitals (13). The numbers of public acute care hospitals decreased from 1390 in 1993 to 1260 in 1997 (8). Closure of hospitals and simultaneous reductions in hospital beds has occurred in inner city areas where care is provided for large numbers of indigent patients. Such closures are related to the high costs of care, which are not concomitantly reimbursed by state and federal sources... 

Sattar et al. discussed the impact of changing social trends on infectious diseases in industrial nations [1]. These investigators observed that in the last 20 years, as healthcare costs have risen, acute-care hospital admissions have decreased dramatically. During this time period, the number of days per hospital stay decreased from 12 to 5 days. Consequently, the number of patients in home care and thus the potential for infectious disease spread in the home have increased. 

In Europe, treatment is reimbursed through a diagnosis-related group (DRG)-based system including beds for chronically ill patients, if they are located in rehabilitation wards of acute care hospitals. If they are independently structured in rehabilitation hospitals, reimbursement is on a per diem basis, with adjustments based on the DRG classification. Most studies estimate care costs in a WF as less than in an ICU (17,40,41) mainly due to staff salaries, NIV, and fewer diagnostic tests. Seneff et al. evaluated mortality and costs over six months... 

LTAC hospitals have higher patient-to-nurse ratios, standardized services, and standard protocols for weaning. Nevertheless, a study of 7440 patients transferred from 155 acute care hospitals to LTAC units reported that costs remain high for PMV patients (usually reimbursed under DRG 483), even in an LTAC hospital, and concluded that this subgroup of patients is still a source of uncompensated care (27). 

In another report, 12-month mortality for LTMV patients in a single LTAC was 50%, with few returning to a fully functional status (26). Predictors of mortality included age, reduced preadmission functional status, renal failure, and diabetes. In one study, it was suggested that LTMV patients treated in an LTAC were noted to have comparable mortality rates to an acute care hospital, but were treated at a lower cost (27,28). 

Managed care was initially embraced to counter the escalating costs and distorted incentives in the fee-for-service system. Under the fee-for-service health care, a physician, hospital, or other health practitioner charges separately for each patient encounter or service rendered. Expenditures increase if the fee itself increases, if more units of service are provided, or if more expensive services are substituted for less expensive ones. In the U.S., the fee-for-service system has historically favored institutional care over community-based care, acute care over preventive care, and medical intervention over patient education and self-care. 

The cost involving treatment of falls is stagger-including costs for hospitalization and acute care, rehabilitation, and institutionalization, if necessary. It has been estimated that falls cost 12.6 billion in lifetime expenses for persons older than 65 years of age. There is also a tremendous emotional impact on... 

Fig. 12.3 Relative hospital costs of stroke patients classified by BASIS as major or minor stroke. Each bar represents the relative total costs for hospital care accrued by a single patient during the hospitalization due to acute ischemic stroke. Red bars represent major stroke patients and the blue bars represent the minor stroke patients. Adapted from Cipriano et al. [29]...

The National Pressure Ulcer Advisory Panel (NPUAP) defines pressure ulcers as localized areas of tissue necrosis that develop when soft tissue is compressed between a bony prominence and an external surface for a prolonged period of time. They are also known as decubitus or decubital ulcers, bed sores, or pressure sores and dermal pressure lesions. The NPUAP has also stated conservatively that well over a million persons in hospitals and nursing homes suffer from pressure ulcers and that estimates of average per case financial cost of pressure ulcer treatment in acute care settings range widely from 2,000 to 30,000. Based on these numbers, medical care costs could well exceed 1,0(X),000,000.00 (1 bilhon dollars) per year. 

Nosocomial pneumonia is the second most common nosocomial infection (1) and the most common nosocomial infection in intensive care units (ICUs). It affects more than 250,000 acute care patients annually in the United States (2). The Centers for Disease Control and Prevention (CDC) recently estimated that nosocomial pneumonia is a primary or contributing cause for more than 30,000 deaths annually in the United States (3). To decrease the incidence of nosocomial pneumonia, hospitals must focus their considerable prevention efforts. However, these efforts begin by appropriate monitoring of this costly complication of hospital care. This task is even more involved because nosocomial pneumonia is probably more than one syndrome with multiple pathogeneses. 

Although ECT is a relatively costly form of treatment, one study in elderly depressed patients who responded to an acute course demonstrated that maintenance ECT reduced the overall cost of medical care and the relapse rate as compared with patients on maintenance medication after ECT ( 87). The reduced costs were evident at the 12-month follow-up, primarily through decreased hospital use. In addition, this strategy was also associated with improvements in functional status and cognition. 

The earlyidentification ofthe clinical andMR patterns of acute territorial infarcts can help the managing physician concerning prediction of outcome, risk of early death and dependency, risk of recurrence, stroke mechanism and etiology, selection of ancillary procedures, selection of best (effective and safe) anti-thrombotic treatment, risk of complications, length of stay and cost of hospital care. 

Acute coronary syndromes (ACS) encompass a wide spectrum of coronary artery disease from unstable angina (UA) to myocardial infarction (MI). According to the 2007 report from the American Heart Associations and Stroke Statistics Committee, about 700,000 Americans are expected to suffer from their first MI yearly, with almost 500,000 recurrent Mis occurring annually (1). Coronary heart disease (CHD) is responsible for about one out of every five deaths in the United States ACS is the cause of over 1.5 million hospitalizations yearly and therefore plays a significant role in the cost of our health care. 

Access to healthcare services is a marker of primary care quality, because acute episodes of asthma are avoidable if they are managed and appropriately treated in the community. Gaps in access to medical services between urban and rural areas exist, and include such things as convenience of transportation, range of services provided locally, as well as the cost for medical treatment. The previous literature indicates that a lack of medical services and specialists are more common in rural than in urban areas (Rural Healthy People 2010), and there is a low utilization efficiency of hospice services in rural areas (Gessert et al. 2006) in addition, disparities exist in the threshold for admission to hospital or clinic care, between urban and rural physicians (Russo et al. 1999). 

Nutritional supplements are not yet used systematically as part of comprehensive care (53). Oral supplementation during hospitalization for an acute exacerbation of chronic pulmonary disease (AECOPD) should supplement rather than replace normal dietary intake. The cost-effectiveness of nutritional supplementation among various patient groups remains to be established (54,55). 

If the onset of respiratory failure is foreseeable, such as in progressive NMD, end-of-life issues should be discussed early on. One survey found that if patients had previously decided to have a tracheostomy, 88% would do so again compared with only 38% of patients who had not decided before an acute deterioration (38). This emphasizes the importance of discussing the issue of tracheostomy early with patients who have degenerative neurological conditions, so that they can be prepared for the respiratory crises and not undergo an unwanted tracheostomy or hospitalization if they would prefer to be cared for at a hospice or at home. Families should be involved in these decisions, if possible, as they bear much of the burden of care, often at the cost of their own personal lives (16). 

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