5,652 research outputs found
Funding intensive care - approaches in systems using diagnosis-related groups.
This report reviews approaches to funding intensive care in health systems that use activitybased
payment mechanisms based on diagnosis-related groups (DRGs) to reimburse
hospital care. The report aims to inform the current debate about options for funding
intensive care services for adults, children and newborns in England.
Funding mechanisms reviewed here include those in Australia (Victoria), Denmark,
France, Germany, Italy, Spain, Sweden and the United States (Medicare). Approaches to
organising, providing and funding hospital care vary widely among these countries/states,
largely reflecting structural differences in the organisation of healthcare systems.
Mechanisms of funding intensive care services tend to fall into three broad categories:
⢠those that fund intensive care through DRGs as part of one episode of hospital
care only (US Medicare, Germany, selected regions in Sweden and Italy)
⢠those that use DRGs in combination with co-payments (Victoria, France)
⢠those that exclude intensive care from DRG funding and use an alternative form
of payment, for example global budgets (Spain) or per diems (South Australia).
Approaches to funding paediatric and neonatal intensive care largely reflect the overall
funding mechanism for intensive care. Evidence reviewed here indicates a general concern
of potential underfunding of intensive care. These problems may be particularly pertinent
for those settings that provide neonatal and paediatric care because of the very high costs
and the relatively smaller number of cases in these settings compared with adult intensive
care. Similar issues apply to highly specialised services in adult intensive care, such as
treatment of severe burns.
Given the variety of approaches to funding intensive care services, this review suggests that
there is no obvious example of âbest practiceâ or dominant approach used by a majority of
systems. Each approach has advantages and disadvantages, particularly in relation to the
financial risk involved in providing intensive care. While the risk of underfunding
intensive care may be highest in systems that apply DRGs to the entire episode of hospital
care, including intensive care, concerns about potential underfunding were voiced in all
systems reviewed here. Arrangements for additional funding in the form of co-payments or
surcharges may reduce the risk of underfunding. However, these approaches also face the
difficulty of determining the appropriate level of (additional) payment and balancing the
incentive effect arising from higher payment
What we have learned about policy-research linkage from providing a rapid response facility for international healthcare comparisons to the Department of Health in England
In this paper we reflect on our experience of providing a rapid response facility for international healthcare policy comparisons to the English Department of Health. We examine the challenges of developing sustained relationships with policy officials while providing an 'on-demand' service in an environment with high turnover of policies and staff. It may be easier for policy makers to draw on researchers in such a setting than for researchers to foster 'linkage and exchange' relationships with policy makers. Under the facility, knowledge transfer has mostly been from researchers to policy officials, affording us little insight into the policy process or the impact of our work
Measurement of the proton light response of various LAB based scintillators and its implication for supernova neutrino detection via neutrino-proton scattering
The proton light output function in electron-equivalent energy of various
scintillators based on linear alkylbenzene (LAB) has been measured in the
energy range from 1 MeV to 17.15 MeV for the first time. The measurement was
performed at the Physikalisch-Technische Bundesanstalt (PTB) using a neutron
beam with continuous energy distribution. The proton light output data is
extracted from proton recoil spectra originating from neutron-proton scattering
in the scintillator. The functional behavior of the proton light output is
described succesfully by Birks' law with a Birks constant kB between (0.0094
+/- 0.0002) cm/MeV and (0.0098 +/- 0.0003) cm/MeV for the different LAB
solutions. The constant C, parameterizing the quadratic term in the generalized
Birks law, is consistent with zero for all investigated scintillators with an
upper limit (95% CL) of about 10^{-7} cm^2/MeV^2. The resulting quenching
factors are especially important for future planned supernova neutrino
detection based on the elastic scattering of neutrinos on protons. The impact
of proton quenching on the supernova event yield from neutrino-proton
scattering is discussed.Comment: 12 pages, 17 figures, 4 tables, updated version for publication in
Eur.Phys.J.
3D shape reconstruction of the femur from planar X-ray images using statistical shape and appearance models
Major trauma is a condition that can result in severe bone damage. Customised orthopaedic reconstruction allows for limb salvage surgery and helps to restore joint alignment. For the best possible outcome three dimensional (3D) medical imaging is necessary, but its availability and access, especially in developing countries, can be challenging. In this study, 3D bone shapes of the femur reconstructed from planar radiographs representing bone defects were evaluated for use in orthopaedic surgery. Statistical shape and appearance models generated from 40 cadaveric X-ray computed tomography (CT) images were used to reconstruct 3D bone shapes. The reconstruction simulated bone defects of between 0% and 50% of the whole bone, and the prediction accuracy using anteriorâposterior (AP) and anteriorâposterior/medialâlateral (AP/ML) X-rays were compared. As error metrics for the comparison, measures evaluating the distance between contour lines of the projections as well as a measure comparing similarities in image intensities were used. The results were evaluated using the root-mean-square distance for surface error as well as differences in commonly used anatomical measures, including bow, femoral neck, diaphysealâcondylar and version angles between reconstructed surfaces from the shape model and the intact shape reconstructed from the CT image. The reconstructions had average surface errors between 1.59 and 3.59 mm with reconstructions using the contour error metric from the AP/ML directions being the most accurate. Predictions of bow and femoral neck angles were well below the clinical threshold accuracy of 3°, diaphysealâcondylar angles were around the threshold of 3° and only version angle predictions of between 5.3° and 9.3° were above the clinical threshold, but below the range reported in clinical practice using computer navigation (i.e., 17° internal to 15° external rotation). This study shows that the reconstructions from partly available planar images using statistical shape and appearance models had an accuracy which would support their potential use in orthopaedic reconstruction
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