Economic analysis and management of decision making in healthcare: application in patient safety

The economic crisis in Greece uncovered chronic deficiencies and omissions in the health care sector and made it necessary to look into problems concerning the fiscal consolidation and cost containment in the Greek Health System. Based on our research in 680 cases of medical negligence, it was found that in Greece, as in many foreign countries, medical errors exist and can provoke discussion and debate about quality and patient safety issues of health care provision, with multiple and complex social and economic implications.The mean age of the patients who had a bad experience whilst in the healthcare system, was 31 years, while the average prolonged hospitalization reached 83 inpatient days. Medical errors resulting in death were in 38.8% of patients and permanent disability in 32.2%. It was found that the severity of a medical error was significantly influenced by the type of healthcare provider, the error phase of care, if it is surgical or medical incident, specialty involved, the ICD-10, etc.Medical errors, apart from the fact that they can seriously threaten patient safety, are associated with a significant financial burden on the healthcare system, mainly due to the use of additional health services, prolonged inpatient stay in specialist hospital and non-hospital units, extra visits to hospital outpatient departments and medical professionals in the private sector as well as extra drug prescriptions. It is also true that this cost (obvious and hidden) is passed down the whole of society. At the same time, the research showed that the claimed compensation for half of our sample, were € 600,000 and the mean compensation awarded by civil courts amounted to € 300,692. The amount of compensation awarded was found to be significantly influenced by the severity of medical error, the type of healthcare provider, etc.Realizing the need to acquire knowledge about the preventable errors or adverse incidents which can seriously threaten the patient safety in the Greek healthcare system and the need for health care cost containment, we developed and implemented a pilot program called MERIS, an integrated incident reporting system which detects, records and analyzes medical errors and adverse events. MERIS has a mandatory module for measuring adverse events and medical errors in Intensive Care Unit environment and a voluntary one which is accessible by anybody who wants to report an adverse event or a “near miss” about her/his experience in the Greek health system.Σε μια εποχή που η χώρα μας, λόγω της οικονομικής ύφεσης που βιώνει, καλείται σε προσπάθεια δημοσιονομικού εξορθολογισμού και συγκράτησης των δαπανών υγείας, έχουν αναδειχθεί με μεγαλύτερη ένταση, οι ανεπάρκειες και παραλείψεις του ελληνικού συστήματος υγείας, που ήδη χρόνιζαν. Από τη διενεργηθείσα έρευνα σε 680 υποθέσεις ιατρικής αμέλειας, διαπιστώθηκε ότι και στην Ελλάδα, τα ιατρικά σφάλματα όπως δείχνει και η εμπειρία από πολλές χώρες του εξωτερικού, είναι υπαρκτά και αποτελούν πράγματι ένα σοβαρό ζήτημα για την ποιότητα των παρεχομένων υπηρεσιών υγείας και την ασφάλεια των ασθενών, με σημαντικές κοινωνικές και οικονομικές διαστάσεις. Ο μέσος όρος ηλικίας των ασθενών που βίωσαν κάποια αρνητική εμπειρία κατά την επαφή τους με το ελληνικό σύστημα υγείας, ήταν τα 31 έτη ενώ η μέση παρατεταμένη διάρκεια νοσηλείας τους έφτανε τις 83 ημέρες. Το 38,8% των ασθενών που υπέστησαν ιατρικό σφάλμα κατέληξε και στο 32,2% προκλήθηκε μόνιμη αναπηρία. Διαπιστώθηκε επίσης ότι το μέγεθος της βαρύτητας ενός ιατρικού σφάλματος, επηρεάζεται σημαντικά από τον τύπο της μονάδας υγείας που εμφανίζεται, το στάδιο που προκαλείται το ιατρικό σφάλμα, το εάν επρόκειτο για χειρουργικό ή παθολογικό περιστατικό, την ειδικότητα που εμπλέκεται, το ICD-10, κ.ά. Τα ιατρικά σφάλματα πέρα του ότι μπορούν να απειλήσουν σοβαρά την ασφάλεια του ασθενούς, επιφέρουν και σημαντική οικονομική επιβάρυνση στο σύστημα υγείας, λόγω κυρίως της χρήσης επιπρόσθετων υπηρεσιών υγείας, της παρατεταμένης νοσηλείας σε εξειδικευμένα ή μη τμήματα του νοσοκομείου, των συνεχών επισκέψεων σε ιδιώτες ιατρούς και σε εξωτερικά ιατρεία του νοσοκομείου και της επιπρόσθετης συνταγογράφησης φαρμάκων, ενώ είναι επίσης γεγονός ότι το κόστος αυτό (εμφανές και αφανές) μετακυλίεται στο σύνολο της κοινωνίας. Παράλληλα, η έρευνα έδειξε ότι στις μισές υποθέσεις, οι ασθενείς/συγγενείς αιτούνταν χρηματικές αποζημιώσεις ύψους €600.000 και οι χρηματικές ικανοποιήσεις που επιδίκασαν τελικά τα ελληνικά διοικητικά και πολιτικά δικαστήρια, ήταν κατά μέσο όρο €300.692. Το ύψος της επιδικασθείσας αποζημίωσης βρέθηκε ότι επηρεάζεται σημαντικά από το μέγεθος της βαρύτητας του ιατρικού σφάλματος, από τον τύπο της μονάδας υγείας που εμφανίστηκε το ιατρικό σφάλμα, κ.ά. Αντιλαμβανόμενοι την ανάγκη για απόκτηση της γνώσης, γύρω από τα περιστατικά σωματικής βλάβης που είναι ικανά να απειλήσουν σοβαρά την ασφάλεια του ασθενούς και μπορούν όμως να προληφθούν και την προσπάθεια των ιθυνόντων για συγκράτηση των δαπανών υγείας, αναπτύξαμε και εφαρμόσαμε πιλοτικά το MERIS, ένα ολοκληρωμένο σύστημα ανίχνευσης, καταγραφής και ανάλυσης των ιατρικών σφαλμάτων και ανεπιθύμητων περιστατικών. Το MERIS «φιλοξενεί» το υποχρεωτικό υποσύστημα αναφοράς (Mandatory Reporting Module) που προσβλέπει στη συνεχή επιτήρηση των περιστατικών σωματικής βλάβης που συμβαίνουν σε περιβάλλον ΜΕΘ και το υποσύστημα αυτόβουλης (οικειοθελούς) αναφοράς (Voluntary Reporting Module) που απευθύνεται στους ίδιους τους πολίτες, με σκοπό την καταγραφή ιατρικών σφαλμάτων και ανεπιθύμητων περιστατικών που έχουν υποστεί οι ίδιοι ή ο κοινωνικός τους περίγυρος

Ostatochnye smeshcheniya pri zakrytom lechenii perelomov tela nizhnej chelyusti

Available from Latvian Academic Library / LAL - Latvian Academic LibrarySIGLELVLatvi

Investigation of Medication Dosage Influences from Biological Weather

Part 20: Informatics and Intelligent Systems Applications for Quality of Life information Services (ISQLIS) WorkshopInternational audienceAirborne pollen has been associated with allergic symptoms in sensitized individuals, whereas atmospheric pollution indisputably aggravates the impact on the overall quality of life. Therefore, it is of major importance to correlate, forecast and disseminate information concerning high concentration levels of allergic pollen types and air pollutants to the public, in order to safeguard the quality of life of the population. In this study, we investigate the relationship between the Defined Daily Dose (DDD) given to patients in a triggered allergy reaction and the different levels of air pollutants and pollen types. By profiling specific atmospheric conditions, specialists may define the need for medication to individuals suffering from pollen allergy, not only according to their personal medical record but also to the existing air quality observations. Paper results indicate some interesting interrelationships between the use of medication and atmospheric quality conditions and shows that the forecasting of daily medication is possible with the aid of proper algorithms

Littera scripta.. Trudy molodykh filologov-slavistov

Abstracts in EnglishAvailable from Latvian Academic Library / LAL - Latvian Academic LibrarySIGLELVLatvi

An ontology design pattern for digital video

The paper proposes an Ontology Design Pattern (ODP) for modelling digital video resources, which was developed in the context of the PERICLES domain ontologies for Art & Media. The ODP can be found at this address: http://ontologydesignpatterns.org/wiki/Submissions:DigitalVide

The Use of the Hypotension Prediction Index Integrated in an Algorithm of Goal Directed Hemodynamic Treatment during Moderate and High-Risk Surgery

(1) Background: The Hypotension Prediction Index (HPI) is an algorithm that predicts hypotension, defined as mean arterial pressure (MAP) less than 65 mmHg for at least 1 min, based on arterial waveform features. We tested the hypothesis that the use of this index reduces the duration and severity of hypotension during noncardiac surgery. (2) Methods: We enrolled adults having moderate- or high-risk noncardiac surgery with invasive arterial pressure monitoring. Participating patients were randomized 1:1 to standard of care or hemodynamic management with HPI guidance with a goal directed hemodynamic treatment protocol. The trigger to initiate treatment (with fluids, vasopressors, or inotropes) was a value of HPI of 85 (range, 0–100) or higher in the intervention group. Primary outcome was the amount of hypotension, defined as time-weighted average (TWA) MAP less than 65 mmHg. Secondary outcomes were time spent in hypertension defined as MAP more than 100 mmHg for at least 1 min; medication and fluids administered and postoperative complications. (3) Results: We obtained data from 99 patients. The median (IQR) TWA of hypotension was 0.16 mmHg (IQR, 0.01–0.32 mmHg) in the intervention group versus 0.50 mmHg (IQR, 0.11–0.97 mmHg) in the control group, for a median difference of −0.28 (95% CI, −0.48 to −0.09 mmHg; p = 0.0003). We also observed an increase in hypertension in the intervention group as well as a higher weight-adjusted administration of phenylephrine in the intervention group. (4) Conclusions: In this single-center prospective study of patients undergoing elective noncardiac surgery, the use of this prediction model resulted in less intraoperative hypotension compared with standard care. An increase in the time spent in hypertension in the treatment group was also observed, probably as a result of overtreatment. This should provide an insight for refining the use of this prediction index in future studies to avoid excessive correction of blood pressure

Designing for inconsistency – the dependency-based PERICLES approach

The rise of the Semantic Web has provided cultural heritage researchers and practitioners with several tools for ensuring semantic-rich representations and interoperability of cultural heritage collections. Although indeed offering a lot of advantages, these tools, which come mostly in the form of ontologies and related vocabularies, do not provide a conceptual model for capturing contextual and environmental dependencies contributing to long-term digital preservation. This paper presents one of the key outcomes of the PERICLES FP7 project, the Linked Resource Model, for modelling dependencies as a set of evolving linked resources. The proposed model is evaluated via a domain-specific representation involving digital video art

Dependency modelling for inconsistency management in digital preservation: the PERICLES approach

The rise of the Semantic Web has provided cultural heritage researchers and practitioners with several tools for providing semantically rich representations and interoperability of cultural heritage collections. Although indeed offering a lot of advantages, these tools, which come mostly in the form of ontologies and related vocabularies, do not provide a conceptual model for capturing contextual and environmental dependencies, contributing to long-term digital preservation. This paper presents one of the key outcomes of the PERICLES FP7 project, the Linked Resource Model, for modelling dependencies as a set of evolving linked resources. The adoption of the proposed model and the consistency of its representation are evaluated via a specific instantiation involving the domain of digital video art