DRG prospective payment system: refine or not refine?

We present a model of contracting between a purchaser of health services and a provider (a hospital). We assume that hospitals provide two alternative treatments for a given diagnosis: a less intensive one (for example a medical treatment) and a more intensive one (surgical treatment). We assume that prices are set equal to the average cost reported by the providers, as observed in many OECD countries (yardstick competition). The purchaser has two options: 1) to set one tariff based on the diagnosis only; 2) to differentiate the tariff between the surgical and the medical treatment (i.e.to refine the tariff). We show that when tariffs are refined, the provider has always an incentive to overprovide the surgical treatment. If the tariff is not refined, the hospital underprovides the surgical treatment (and overprovides the medical treatment) if the degree of altruism is sufficiently low compared the opportunity cost of public funds. Our main result is that price refinement might not be optimal.Hospitals; Refinement; Diagnosis-Related-Groups.

The effect of hospital ownership on quality of care : evidence from England

We investigate whether quality of care differs between public and private hospitals in England using data on 3.8 million publicly-funded patients receiving 133 planned (non-emergency) treatments in 393 public and 190 private hospital sites. Private hospitals treat patients with fewer comorbidities and past hospitalisations. Controlling for observed patient characteristics and treatment type, private hospitals have fewer emergency readmissions. But patients’ choice of hospital may influenced by their unobserved morbidity. After instrumenting the choice of hospital type by the difference in distances from the patient to the nearest public and the nearest private hospital, the effect of private ownership changes sign and is statistically insignificant. Similar results are obtained with coarsened exact matching. We also find no quality differences between hospitals specialising in planned treatments and other hospitals, nor between for-profit and not-for-profit private hospitals. Our results show the importance of controlling for unobserved patient heterogeneity when comparing quality of public and private hospitals

Class II treatment by palatal miniscrew-system appliance: A case report

This case shows that using a rapid palatal expander (RPE) and then a pendulum appliance anchored to palatal miniscrews is an option for improving treatment management in a noncompliant patient requiring maxillary expansion and molar distalization in the late mixed dentition. First, an RPE was used to expand the maxillary arch. Then, a modified pendulum appliance was used to distalize the maxillary first permanent molars. Optimal positioning of two palatal miniscrews enabled both appliances to be supported by skeletal anchorage. Treatment was finished using multibracket fixed appliances, and after 2 years, skeletal Class I as well as dental Class I canine and molar relationships were achieved

Description of the relationship between NOHL classification in drug-induced sleep endoscopy and initial AHI in patients with moderate to severe OSAS, and evaluation of the results obtained with oral appliance therapy

Descrizione della relazione tra Classificazione NOHL definita durante la Drug-Induced Sleep Endoscopy e AHI iniziale in pazienti con OSAS da moderato a grave, e valutazione dei risultati ottenuti con dispositivi orali

Extracting relations from Italian wikipedia using self-training

In this paper, we describe a supervised approach for extracting relations from Wikipedia. In particular, we exploit a self-training strategy for enriching a small number of manually labeled triples with new self-labeled examples. We integrate the supervised stage in WikiOIE, an existing framework for unsupervised extraction of relations from Wikipedia. We rely on WikiOIE and its unsupervised pipeline for extracting the initial set of unlabelled triples. An evaluation involving different algorithms and parameters proves that self-training helps to improve performance. Finally, we provide a dataset of about three million triples extracted from the Italian version of Wikipedia and perform a preliminary evaluation conducted on a sample dataset, obtaining promising results

The effect of co-payments on the take-up of prenatal tests

Noninvasive prenatal screening tests help identify genetic disorders in a fetus, but their take-up remains low in several countries. Using a regression discontinuity design, we test the causal effect of a policy that eliminated co-payments for noninvasive screening tests in Italy. We identify the treatment effects by a discontinuity in women's eligibility for a free test based on their conception date. We find that the policy increases the probability of women's undergoing noninvasive screening tests by 5.5 percentage points, and the effect varies by socioeconomic status. We do not find evidence of substitution effects with more expensive and riskier invasive diagnostic tests. In addition, the increase in take-up does not affect pregnancy termination or newborn health. We find some evidence of positive effects on mothers’ health behaviors during pregnancy as measured by reductions in mothers’ weight gain and hospital admissions during pregnancy, but these are statistically significant only at the 10 percent level

Effects of Ti6Al4V mechanical and thermal surface modification on the adhesion of a chitosan-bioactive glass coating

Biomedical implants interact with human tissues introducing significant perturbation into the body. Implant surfaces can be then functionalized enabling better biocompatibility. At the same time, the additional use of a coating provides further functions such as corrosion protection, osteointegration, and drug delivery. In this context, a composite made of chitosan and bioactive glass nanoparticles has been used for coating Ti6Al4V alloy samples processed beforehand using different processes, i.e., polishing, milling, grit blasting, and electrical discharge machining. Experiments have been carried out to correlate substrate surface conditions and coating effectiveness in terms of scratch resistance with the final aim to obtain suitable guidelines to improve substrate-coating performances

Obturator prosthesis rehabilitation after maxillectomy: Functional and aesthetical analysis in 25 patients

The number of patients undergoing a surgical resection of the maxilla for oncological reasons is constantly increasing, the most common complication of which remains the communication between oral and nasal cavities. On the basis of data arising from the literature regarding the treatment options of maxillary oncological post-surgical defects, obturator prosthesis remains the most used worldwide. We studied 25 patients (with at least 1-year follow up) rehabilitated by obturator prosthesis after maxillary resection leading to oro-nasal communication, providing data on the objective/subjective evaluation of such rehabilitation and mastication performance measured by a two-color chewing gum test. The type of defect was classified according to the classification system proposed by Aramany. Among the patients in our study, 72% rated a higher score for either stability and retention than for aesthetic appearance, as confirmed by the Kapur score rated by clinicians. The two-color chewing gum test shows similar results as only one patient had insufficient chewing function. Interestingly, we found no correlation between the masticatory function and residual denture, confirming that the maxillary obturator remains a predictable solution in such patients regardless of the anatomical alterations following surgery

Surgical treatment in patient with non-small-cell lung cancer with fissure involvement: Anatomical versus nonanatomical resection

OBJECTIVE: Despite the intense debate concerning the prognostic impact of fissure involvement (FI) in patients with non-small-cell lung cancer, no specific surgical strategies have been yet recommended when this condition occurs. In this setting, we report our monocentric 10-years experience to investigate this issue. METHODS: From January 2000 to January 2010, the clinical data of 40 non-small-cell lung cancer patients with FI undergoing curative resection were retrospectively reviewed. The sample was stratified according to the type of resection: group A (28 patients): anatomical resection (bilobectomy [21 patients], pneumonectomy [7 patients]); group B (12 patients): nonanatomical resection (lobectomy plus wedge resection [LWR]). The end-points were (1) impact of different surgical approach on the pulmonary function (measured before surgery and 1 month after discharge); (2) disease-specific survival; and (3) tumor recurrence.The t test, χ, and log-rank tests, Kaplan-Meier method, and Cox and logistic regression analyses were used for the statistical analysis. RESULTS: No differences between the two groups were found when comparing the clinical characteristics, histology, pN or pT status, p-stage, residual (R1) disease, tumor grading, or tumor size. Similarly, the baseline preoperative function (tested as forced expiratory volume in 1 second-%-predicted, FEV1%) was likewise comparable (92.5% ± 21.0% in group A versus 85.2% ± 20.0% in group B; p = not significant). The decline of FEV1% after surgery was slightly higher in group A (-24.9% ± 13.5%) when compared with that in group B (-19.5% ± 13.3%), but this difference was not statistically significant (p = ns). Nevertheless, the 5-year disease-specific survival was 56% for group A and 47% for group B (p = ns). The recurrence rate did not differ between the patients undergoing a LWR (3 of 12 patients) and those undergoing a bilobectomy or pneumonectomy (9 of 28 patients) (p = ns). The presence of FI extended for more than 3 cm was found to be the most significant prognostic factor when analyzing survival (p = 0.002) and recurrence rate (p< 0.001). CONCLUSIONS: Our results suggest that nonanatomical resection (LWR) could be considered as a feasible surgical option (especially in "frail" patients with an extent of FI less than 3 cm) in the light of the similar oncological and functional outcome compared with anatomical resection. Further studies based on larger series are needed to confirm these preliminary data and also to investigate the impact on the postoperative quality of life