Three scenarios of clinical claim reimbursement for nosocomial infection: the good, the bad, and the ugly.

We studied the extent to which hospitals can expect to receive reimbursement for costs relating to nosocomial infections (NI) under the diagnosis-related groups (DRG) system of clinical claims and calculated the loss of reimbursement due to missed or incorrect registration of infective complications on hospital discharge records (HDR). We calculated clinical claim reimbursement in three scenarios: the good, in which all NI are recorded on HDR; the bad, in which a proportion of NI recorded on HDR observed at the 41 participating hospitals; the ugly, in which none of the NI are recorded on HDR. We analysed in which patients the recording of infective complications changed the DRG clinical claim and the economic consequences on reimbursements. Compared with the ugly scenario, the bad scenario, which is closest to what actually occurs, with only 55.9% of NI (180/322) properly recorded, produced an increased DRG clinical claim in 30 cases, of on average 403 for every NI. Compared with the ugly scenario, the good scenario, produced an increased DRG clinical claim in 45 cases with an average reimbursement of 618. The difference between the bad and the good scenarios shows an average loss of 215 for every case. Our calculated good scenario could cover only 3.8% of direct costs per case attributable to NI. Real, tangible benefits in health, both social and economic, will only accrue from the monitoring and control of NI in hospitals

[Antiasthmatic drug consumption as an indicator of the prevalence of respiratory pathology in a pediatric population].

The study of disease prevalence requires specific and sensitive indicators, which are hardly gathered at population level. The use of anti-asthma drugs, which are relatively specific for diseases characterised by bronchospasms, has been already experimented in the USA with algorithms describing patients affected by asthmatic disease by their use of drugs. We retrospectively analyse spatial variations of drug use as dispensed by the SSN (National Health Service) to Lombardy children less than 15 years old, between 1st January 1995 and 31st December 1997, estimating prevalence of use as a proxy of disease prevalence. Two algorithms already experimented and a new one have been employed to select children treated with antiasthmatic therapy (R03 of ATC classification) dispensed. Local communities' data were used for basic demography. Number of daily defined doses (DDD) dispensed has been used as indicator of drug quantity. Euro/year per person has been used as indicator of costs. Small area distribution analysis has been performed with a Geographic Information System at local Communities level. Frequency of patients (of a total of 1,252,958 children): with at least one dispensed drug in the three years was 26.6% (SD 10.5), DDD per person per month were 1.21 (SD 0.78), Euro/Year per person 6.84 (SD 3.61); with the association of a anti-inflammatory and a b2-agonist was 8.2% (SD 5.6), DDD per person per month were 3.01 (SD 3.07), Euro/Year per person 15.87 (SD 15.07); with at least 90 days of DDD in the three years was 2.6% (SD 1.3) DDD per person per month were 7.79 (SD 4.48), Euro/Year per person 37.66 (SD 21.83). It must be taken into account that, in the best of cases, these approximation refers to the prevalence of all diseases, characterised by bronchospasm, treated with the selected drugs. Estimated data of prevalence are comparable with those of other authors. Prevalence of drug use appears to have relevant geographical differences. Taking into consideration these comments, prevalence of drug use and consequently the estimated disease prevalence appears to be worryingly high, having as well wide geographical differences

Three scenarios of clinical claim reimbursment for nosocomial infection: the good, the bad, and the ugly

Summary We studied the extent to which hospitals can expect to receive reimbursement for costs relating to nosocomial infections (NI) under the diagnosis-related groups (DRG) system of clinical claims and calculated the loss of reimbursement due to missed or incorrect registration of infective complications on hospital discharge records (HDR). We calculated clinical claim reimbursement in three scenarios: the good, in which all NI are recorded on HDR; the bad, in which a proportion of NI recorded on HDR observed at the 41 participating hospitals; the ugly, in which none of the NI are recorded on HDR.We analysed in which patients the recording of infective complications changed the DRG clinical claim and the economic consequences on reimbursements. Compared with the ugly scenario, the bad scenario, which is closest to what actually occurs, with only 55.9% of NI (180/322) properly recorded, produced an increased DRG clinical claim in 30 cases, of on average e403 for every NI. Compared with the ugly scenario, the good scenario, produced an increased DRG clinical claim in 45 cases with an average reimbursement of e618. The difference between the bad and the good scenarios shows an average loss of e215 for every case. Our calculated good scenario could cover only 3.8% of direct costs per case attributable to NI. Real, tangible benefits in health, both social and economic, will only accrue from the monitoring and control of NI in hospitals

Aetiology and prognosis of bacteraemia in Italy

A prospective multi-centre study was conducted to assess the microbiological pattern and prognostic factors of bacteraemia and their impact on clinical outcome. All patients admitted to 41 Italian hospitals over 2 months, from whom one or more clinically significant organisms were isolated from blood culture, were studied according to a standardized protocol and case definition. A total of 156 episodes of bacteraemia were identified in 20 601 patients. There were 3.9 episodes of nosocomially acquired bacteraemia and 3.7 episodes of community-acquired bacteraemia per 1000 admissions. The most frequent pathogens isolated were Gram-negative bacteria (44.9%) but Gram-positive species accounted for 40.4% of episodes. Fungal infections due to Candida spp. were found in 3.8% of episodes, and multiple pathogens were recovered from 9.6% of episodes. The clinical response to bacteraemia was classified as sepsis in 90 episodes (57.7%), severe sepsis in 21 (13.5%) and septic shock in 26 (16.7%) ; 19 episodes (12.2%) showed no clinical response. The total in-hospital mortality was 25.0%. By multivariate logistic regression, the variables which independently predicted mortality were increasing age, the presence of septic shock, infection with Gram-positive bacteria or fungi and nosocomial acquisition

Prevalence of nosocomial infections in Italy: result from the Lombardy survey in 2000

A one-day survey was carried out in 88 out of 113 public hospitals in Lombardy to obtain prevalence rates of hospital-acquired infections (HAIs) by hospital departments and to identify the pathogens more frequently involved. In total 18 667 patients were surveyed, representing 72% of the average daily total of occupied beds in public hospitals in Lombardy. The overall prevalence of HAI was 4.9%. The highest prevalence was observed in intensive care units and in spinal units. The prevalence of bloodstream infections was 0.6%; pneumonia 1.1%; urinary tract infections 1.6% and gastrointestinal infections 0.4%. In surgical patients the prevalence of surgical site infections was 2.7%. The most frequently isolated pathogen from all sites of infections was Escherichia coli (16.8%), followed by Staphylococcus aureus (15.0%), Pseudomonos aeruginosa (13.2%) and Candida spp. (8.7%). Methicillin-resistant S. aureus accounted for 23% of all isolated S. aureus. The results provide baseline data for rational priorities in allocation of resources, for further studies and for infection control activities. (C) 2003 The Hospital Infection Society. Published by Elsevier Science Ltd. All rights reserved