Financial impact of reducing door-to-balloon time in ST-elevation myocardial infarction: a single hospital experience

<p>Abstract</p> <p>Background</p> <p>The impact of reducing door-to-balloon time on hospital revenues, costs, and net income is unknown.</p> <p>Methods</p> <p>We prospectively determined the impact on hospital finances of (1) emergency department physician activation of the catheterization lab and (2) immediate transfer of the patient to an immediately available catheterization lab by an in-house transfer team consisting of an emergency department nurse, a critical care unit nurse, and a chest pain unit nurse. We collected financial data for 52 consecutive ST-elevation myocardial infarction patients undergoing emergency percutaneous intervention from October 1, 2004–August 31, 2005 and compared this group to 80 consecutive ST-elevation myocardial infarction patients from September 1, 2005–June 26, 2006 after protocol implementation.</p> <p>Results</p> <p>Per hospital admission, insurance payments (hospital revenue) decreased ($35,043 ±$36,670 vs. $25,329 ±$16,185, P = 0.039) along with total hospital costs ($28,082 ±$31,453 vs. $18,195 ±$9,242, P = 0.009). Hospital net income per admission was unchanged ($6962 vs.$7134, P = 0.95) as the drop in hospital revenue equaled the drop in costs. For every $1000 reduction in total hospital costs, insurance payments (hospital revenue) dropped$1077 for private payers and $1199 for Medicare/Medicaid. A decrease in hospital charges ($70,430 ± $74,033 vs.$53,514 ± $23,378, P = 0.059), diagnosis related group relative weight (3.7479 ± 2.6731 vs. 2.9729 ± 0.8545, P = 0.017) and outlier payments with hospital revenue>$100,000 (7.7% vs. 0%, P = 0.022) all contributed to decreasing ST-elevation myocardial infarction hospitalization revenue. One-year post-discharge financial follow-up revealed similar results: Insurance payments: $49,959 ±$53,741 vs. $35,937 ±$23,125, P = 0.044; Total hospital costs: $39,974 ±$37,434 vs. $26,778 ±$15,561, P = 0.007; Net Income: $9984 vs.$9159, P = 0.855.</p> <p>Conclusion</p> <p>All of the financial benefits of reducing door-to-balloon time in ST-elevation myocardial infarction go to payers both during initial hospitalization and after one-year follow-up.</p> <p>Trial Registration</p> <p><b>ClinicalTrials.gov ID</b>: NCT00800163</p

Unbiased estimators of mean, variance and sensitivity level for quantitative characteristics in finite population sampling

Percent relative efficiency, Randomized response, Sample size allocation, Simple random sampling with replacement,

Estimation of nitrogen and phosphorus in effluent from the striped catfish farming sector in the Mekong Delta, Vietnam

In this study an attempt is made to estimate nitrogen and phosphorus discharged to the environment from the striped catfish (Pangasianodon hypophthalmus) farming sector in the Mekong Delta (8&deg;33̕&ndash;10&deg;55̕ N, 104&deg;30̕&ndash;106&deg;50̕ E), South Vietnam. The sector accounted for 687,000 t production in 2007 and 1,094,879 t in 2008, with over 95% of the produce destined for export to over 100 countries. Commercial and farm-made feeds are used in catfish farming, currently the former being more predominant. Nitrogen discharge levels were similar for commercial feeds (median 46.0 kg/t fish) and farm-made feeds (median 46.8 kg/t fish); whilst, phosphorus discharge levels for commercial feeds (median 14.4 kg/t fish) were considerably lower than for farm-made feeds (median 18.4 kg/t fish). Based on the median nutrient discharge levels for commercial feeds, striped catfish production in the Mekong Delta discharged 31,602 t N and 9,893 t P, and 50,364 t N and 15,766 t P in 2007 and 2008, respectively. However, the amount of nutrients returned directly to the Mekong River may be substantially less than this as a significant proportion of the water used for catfish farming as well as the sludge is diverted to other agricultural farming systems. Striped catfish farming in the Mekong Delta compared favourably with other cultured species, irrespective of the type of feed used, when the total amounts of N and P discharged in the production of a tonne of production was estimated.<br /

Deconstructing the differences: a comparison of GBD 2010 and CHERG’s approach to estimating the mortality burden of diarrhea, pneumonia, and their etiologies - Additional files

Data supporting a publication that compares the HME Global Burden of Disease (GBD) 2010 study and UNICEF/Child Health Epidemiology Reference Group (CHERG) approach to estimating mortality burden of diarrhea, pneumonia, and their etiologies. These include a classification of total U5 mortality estimates due to all causes, pneumonia/LRI, and diarrhea by WHO region in 2010, description of data sources for pneumonia etiology mortality models, sources for the diarrhea etiology models, and analytical models for estimating cause-specific mortality