The Effect of Multidisciplinary Heart Failure Clinic Characteristics on 1-Year Postdischarge Health Care Costs

Wijeysundera, Harindra C.; Austin, Peter C.; Wang, Xuesong; Bennell, Maria C.; Abrahamyan, Lusine; Ko, Dennis T.; Tu, Jack V.; Krahn, Murray

doi:10.1097/mlr.0000000000000071

Cited by 14 publications

(21 citation statements)

References 28 publications

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“…Recognizing that the formation of PUs often results from the interaction of multiple factors suggests that an ideal prevention strategy would be to address all of the key identified risks. Pragmatically, multifactorial approaches have been demonstrated to be effective in managing other chronic conditions with complex interactions, such as fall prevention [54], diabetes [55], heart failure [56], and Parkinson disease [57]. However, the reviewed technological approaches are limited to a subset of risk factors, as illustrated in the radar diagram.…”

Section: Discussionmentioning

confidence: 99%

Assistive technologies for self-managed pressure ulcer prevention in spinal cord injury: A scoping review

Tung

Stead²,

Mann³

et al. 2015

J Rehabil Res Dev

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Abstract-Pressure ulcers (PUs) in individuals with spinal cord injury (SCI) present a persistent and costly problem. Continuing effort in developing new technologies that support selfmanaged care is an important prevention strategy. Specifically, the aims of this scoping review are to review the key concepts and factors related to self-managed prevention of PUs in individuals with SCI and appraise the technologies available to assist patients in self-management of PU prevention practices. There is broad consensus that sustaining long-term adherence to prevention regimens is a major concern. Recent literature highlights the interactions between behavioral and physiological risk factors. We identify four technology categories that support self-management: computer-based educational technologies demonstrated improved short-term gains in knowledge (2 studies), interface pressure mapping technologies demonstrated improved adherence to pressure-relief schedules up to 3 mo (5 studies), electrical stimulation confirmed improvements in tissue tolerance after 8 wk of training (3 studies), and telemedicine programs demonstrated improvements in independence and reduced hospital visits over 6 mo (2 studies). Overall, self-management technologies demonstrated low-to-moderate effectiveness in addressing a subset of risk factors. However, the effectiveness of technologies in preventing PUs is limited due to a lack of incidence reporting. In light of the key findings, we recommend developing integrated technologies that address multiple risk factors.

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Section: Discussionmentioning

confidence: 99%

Assistive technologies for self-managed pressure ulcer prevention in spinal cord injury: A scoping review

Tung

Stead²,

Mann³

et al. 2015

J Rehabil Res Dev

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“…A study conducted of high-risk elderly patients showed significant reduction in health care utilization and improvement in the quality of life after consultation with a multidisciplinary team of medical professionals [40]. However, although a multidisciplinary approach is effective, it may also result in higher treatment costs [41]. …”

Section: Discussionmentioning

confidence: 99%

Clinical Practice: A Proposed Standardized Ophthalmological Assessment for Patients with Cystinosis

et al. 2017

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Cystinosis is a rare autosomal recessive disease with an incidence of approximately 1 case per 100,000–200,000 live births. Over the years, gaining in-depth knowledge of the disease has led to vast improvement in patient life expectancy. However, debilitating, extra-renal manifestations such as eye disease, in particular corneal crystal deposition and its associated photophobia, still occur frequently, regardless of patient age and notwithstanding the increased implementation of systemic therapy. Ophthalmological assessment has not yet been standardized. The aim of this article was to provide clear recommendations for ophthalmological assessment during follow-up of patients with cystinosis to improve quality and regularity of ophthalmological care and thereby minimize ophthalmological complications. A literature search was performed to assess previous and current recommendations on examinations to conduct during follow-up of patients with cystinosis. Multidisciplinary cystinosis clinics were set up in collaboration with the Department of Ophthalmology and the Department of Pediatric Nephrology to allow patients to be seen by a nephrologist, an ophthalmologist and other specialists on the same day. Based on the results of these multidisciplinary clinics the standardized clinical ophthalmological assessment was drafted. This is a protocol for follow-up, describing the approach taken regarding ophthalmological follow-up of patients with cystinosis, considering the different types of the disease and the time since diagnosis. Standard examination includes history, visual acuity, tonometry and slit-lamp examination, with fundus photography performed at diagnosis and annually thereafter. Confocal microscopy is the imaging modality of choice, while anterior segment optical coherence tomography (OCT) is a good alternative. Finally, posterior segment OCT for imaging of the macular region and optic nerve should be conducted on an annual basis.

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“…28 The resource intensity weights method was used to estimate the cost of hospital admission. 29,30,31,32 This method provides a measure of the resources used during a patient’s encounter with the health care system. The resource intensity weights associated with the case mix group for each hospital admission in the CIHI Discharge Abstract Database were multiplied by the average provincial cost per weighted case for all Ontario acute and chronic care hospitals that year.…”

Section: Methodsmentioning

confidence: 99%

“…The resource intensity weights associated with the case mix group for each hospital admission in the CIHI Discharge Abstract Database were multiplied by the average provincial cost per weighted case for all Ontario acute and chronic care hospitals that year. 29,30,31,32 The resource intensity weights method was also used to determine emergency department visit and same-day surgery costs found in the National Ambulatory Care Reporting System database. Costs were adjusted to 2016 Canadian dollars using the consumer price index.…”

Section: Methodsmentioning

confidence: 99%

Association of Clinical and Economic Outcomes With Permanent Pacemaker Implantation After Transcatheter Aortic Valve Replacement

Aljabbary

Qiu²,

Masih³

et al. 2018

JAMA Netw Open

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Key Points Question What are the clinical and economic outcomes in patients who required permanent pacemaker implantation after transcatheter aortic valve replacement ? Findings In this population-based cohort study of 1263 patients who underwent transcatheter aortic valve replacement, implantation of a new permanent pacemaker was associated with significantly greater all-cause mortality, all-cause readmission, and all-cause emergency department visits. However, this did not translate to a statistically significant difference in cumulative postdischarge health care costs. Meaning The need for permanent pacemaker implantation after transcatheter aortic valve replacement is a complication associated with worse survival as well as increased risk of hospitalization.

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The Effect of Multidisciplinary Heart Failure Clinic Characteristics on 1-Year Postdischarge Health Care Costs

Cited by 14 publications

References 28 publications

Assistive technologies for self-managed pressure ulcer prevention in spinal cord injury: A scoping review

Assistive technologies for self-managed pressure ulcer prevention in spinal cord injury: A scoping review

Clinical Practice: A Proposed Standardized Ophthalmological Assessment for Patients with Cystinosis

Association of Clinical and Economic Outcomes With Permanent Pacemaker Implantation After Transcatheter Aortic Valve Replacement

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