The cost of radiology procedures using Activity Based Costing (ABC) for development of cost weights in implementation of casemix system in Malaysia

Presently there is a gross lack of information on cost and cost weights in many developing countries that implement casemix system. Furthermore, studies that employed Activity Based Costing method (ABC) to estimate the costs of radiology procedures were rarely done in developing countries, including Malaysia. The main objective of this study is to determine the costs of radiology procedures for each group in casemix system, in order to develop cost weights to be used in the implementation of the casemix system. An economic evaluation study was conducted in all units in the Department of Radiology in the first teaching hospital using the casemix system in Malaysia. From the 25,754 cases, 16,173 (62.8%) of them were from medical discipline. Low One Third and High One Third (L3H3) method was employed to trim the outlier cases. Output from the trimming, 15,387 cases were included in the study. The results revealed that the total inpatients’ charges of all the radiology procedures was RM1,820,533.00 while the cost imputed using ABC method was RM2,970,505.54. The biggest cost component were human resources in Radiology Unit (Mobile) (57.5%), consumables (78.5%) of Endovascular Interventional Radiology (EIR) Unit, equipment (81.4%) of Magnetic Resonance Imaging (MRI) Unit, reagents (68.1%) of Medical Nuclear Unit. The one highest radiology cost weight, was for Malaysia Diagnosis Related Group (MY-DRG®) B-4-11-II (Hepatobiliary and Pancreas Neoplasms with severity level II, 2.8301). The method of calculation of the cost of procedures need to be revised by the hospital as findings from this study showed that the cost imposed to patient is lower than the actual cost

Sustainable Ecosystem Services Framework for Tropical Catchment Management: A Review

The monsoon season is a natural phenomenon that occurs over the Asian continent, bringing extra precipitation which causes significant impact on most tropical watersheds. The tropical region’s countries are rich with natural rainforests and the economies of the countries situated within the region are mainly driven by the agricultural industry. In order to fulfill the agricultural demand, land clearing has worsened the situation by degrading the land surface areas. Rampant land use activities have led to land degradation and soil erosion, resulting in implications on water quality and sedimentation of the river networks. This affects the ecosystem services, especially the hydrological cycles. Intensification of the sedimentation process has resulted in shallower river systems, thus increasing their vulnerability to natural hazards (i.e., climate change, floods). Tropical forests which are essential in servicing their benefits have been depleted due to the increase in human exploitation. This paper provides an overview of the impact of land erosion caused by land use activities within tropical rainforest catchments, which lead to massive sedimentation in tropical rivers, as well as the effects of monsoon on fragile watersheds which can result in catastrophic floods. Forest ecosystems are very important in giving services to regional biogeochemical processes. Balanced ecosystems therefore, play a significant role in servicing humanity and ultimately, may create a new way of environmental management in a cost-effective manner. Essentially, such an understanding will help stakeholders to come up with better strategies in restoring the ecosystem services of tropical watersheds

Study on the blood glucose management with controlled goal feed in Malaysian critically ill patients

Stress-induced hyperglycaemia is commonly occurred in the intensive care unit (ICU). It is known that the intensive insulin therapy (IIT) has successfully managed the blood glucose level within the targeted band. However, modifications on the current practice need to be considered to minimize the risk of hypoglycaemia and mortality. Thus, the aim of this study is to assess the performance of a new practice known as Stochastic Targeted (STAR) Protocol in managing blood glucose levels in Malaysia ICU setting. STAR is a tablet-computer based protocols that provides patient-specific glucose control framework accounting for patient variability with a stochastically derived maximum 5% risk of hypoglycaemia events. A retrospective 92 non-diabetes patient's data who underwent IIT were identified. Patient's blood glucose levels, exogenous insulin and nutrition inputs including patient demographics were extracted from the ICU charts to create virtual patients by using physiologically mathematical model. Three trials were simulated with controlled goal feed (GF) and without GF. Only one type of nutrition is considered in this study which is Glucerna. The outcomes will be compared in terms of %BG within the targeted band of 4.4 to 10.0 mmol/L, the total number of BG measurements, and the % of severe hypoglycaemia. The results indicate that STAR virtual trial with controlled GF reduced the risk of hypoglycaemia to 3% and the clinical burden up to 1630 hours while maintaining BG within the targeted band. The total number of BG measurements also decreased to 5384 from 7038. Thus, the implementation of STAR protocol in the Malaysia ICU is beneficial and it is proven safe while aiding nurses and physicians in reducing the clinical burden and medical cost in treating stress-induce hyperglycaemia in the demanding ICU setting

Potential loss of revenue due to errors in clinical coding during the implementation of the Malaysia diagnosis related group (MY-DRG®) Casemix system in a teaching hospital in Malaysia

Abstract Background The accuracy of clinical coding is crucial in the assignment of Diagnosis Related Groups (DRGs) codes, especially if the hospital is using Casemix System as a tool for resource allocations and efficiency monitoring. The aim of this study was to estimate the potential loss of income due to an error in clinical coding during the implementation of the Malaysia Diagnosis Related Group (MY-DRG®) Casemix System in a teaching hospital in Malaysia. Methods Four hundred and sixty-four (464) coded medical records were selected, re-examined and re-coded by an independent senior coder (ISC). This ISC re-examined and re-coded the error code that was originally entered by the hospital coders. The pre- and post-coding results were compared, and if there was any disagreement, the codes by the ISC were considered the accurate codes. The cases were then re-grouped using a MY-DRG® grouper to assess and compare the changes in the DRG assignment and the hospital tariff assignment. The outcomes were then verified by a casemix expert. Results Coding errors were found in 89.4% (415/424) of the selected patient medical records. Coding errors in secondary diagnoses were the highest, at 81.3% (377/464), followed by secondary procedures at 58.2% (270/464), principal procedures of 50.9% (236/464) and primary diagnoses at 49.8% (231/464), respectively. The coding errors resulted in the assignment of different MY-DRG® codes in 74.0% (307/415) of the cases. From this result, 52.1% (160/307) of the cases had a lower assigned hospital tariff. In total, the potential loss of income due to changes in the assignment of the MY-DRG® code was RM654,303.91. Conclusions The quality of coding is a crucial aspect in implementing casemix systems. Intensive re-training and the close monitoring of coder performance in the hospital should be performed to prevent the potential loss of hospital income

Sustainable Ecosystem Services Framework for Tropical Catchment Management: A Review

The monsoon season is a natural phenomenon that occurs over the Asian continent, bringing extra precipitation which causes significant impact on most tropical watersheds. The tropical region’s countries are rich with natural rainforests and the economies of the countries situated within the region are mainly driven by the agricultural industry. In order to fulfill the agricultural demand, land clearing has worsened the situation by degrading the land surface areas. Rampant land use activities have led to land degradation and soil erosion, resulting in implications on water quality and sedimentation of the river networks. This affects the ecosystem services, especially the hydrological cycles. Intensification of the sedimentation process has resulted in shallower river systems, thus increasing their vulnerability to natural hazards (i.e., climate change, floods). Tropical forests which are essential in servicing their benefits have been depleted due to the increase in human exploitation. This paper provides an overview of the impact of land erosion caused by land use activities within tropical rainforest catchments, which lead to massive sedimentation in tropical rivers, as well as the effects of monsoon on fragile watersheds which can result in catastrophic floods. Forest ecosystems are very important in giving services to regional biogeochemical processes. Balanced ecosystems therefore, play a significant role in servicing humanity and ultimately, may create a new way of environmental management in a cost-effective manner. Essentially, such an understanding will help stakeholders to come up with better strategies in restoring the ecosystem services of tropical watersheds

Cost effectiveness of quadrivalent influenza vaccines in the elderly population of Malaysia

Abstract The economic burden of influenza is a significant issue within healthcare system, related to higher medical costs particularly among the elderly. Yet, influenza vaccination rates in the elderly in Malaysia were considerably low as it is not part of Malaysia’s national immunization program, with substantial mortality and morbidity consequences. Therefore, we conducted a cost-effectiveness analysis of quadrivalent influenza vaccine (QIV) for the elderly in Malaysia compared with the current no-vaccination policy. A static cost-utility model, with a lifetime horizon based on age, was used for the analysis to assess the cost-effectiveness and health outcomes associated with QIV. Univariate and probabilistic sensitivity analyses were performed to test the effects of variations in the parameters. The use of QIV in Malaysia’s elderly population would prevent 66,326 potential influenza cases and 888 potential deaths among the elderly, leading to 10,048 potential quality-adjusted life years (QALYs) gained. The QIV would also save over USD 4.4 million currently spent on influenza-related hospitalizations and reduce productivity losses by approximately USD 21.6 million. The ICER per QALY gained from a third-party payer’s perspective would be USD 2216, which is lower than the country’s gross domestic product per capita. A QIV-based vaccination program in the elderly was found to be highly cost-effective, therefore would reduce the financial burden of managing influenza and reduce pre-mature death related to this disease

Defining Reprogramming Checkpoints from Single-Cell Analyses of Induced Pluripotency

Summary: Elucidating the mechanism of reprogramming is confounded by heterogeneity due to the low efficiency and differential kinetics of obtaining induced pluripotent stem cells (iPSCs) from somatic cells. Therefore, we increased the efficiency with a combination of epigenomic modifiers and signaling molecules and profiled the transcriptomes of individual reprogramming cells. Contrary to the established temporal order, somatic gene inactivation and upregulation of cell cycle, epithelial, and early pluripotency genes can be triggered independently such that any combination of these events can occur in single cells. Sustained co-expression of Epcam, Nanog, and Sox2 with other genes is required to progress toward iPSCs. Ehf, Phlda2, and translation initiation factor Eif4a1 play functional roles in robust iPSC generation. Using regulatory network analysis, we identify a critical role for signaling inhibition by 2i in repressing somatic expression and synergy between the epigenomic modifiers ascorbic acid and a Dot1L inhibitor for pluripotency gene activation. : Tran et al. combine ascorbic acid, 2i, and Dot1l inhibition to robustly generate induced pluripotent stem cells. With single-cell transcriptomes, they define the transcriptional signature and key regulators of reprogramming cells. Using network analysis, they find 2i suppresses somatic while ascorbic acid and Dot1l inhibitor collaboratively upregulate pluripotency genes