Category Archives: Asthma

Variations in Pediatric Asthma Hospitalization Rates and Costs Between and Within Nordic Countries: ICD

Several limitations are present in this study. For many reasons, administrative databases routinely include incomplete and biased data that can significantly influence the numerators and denominators used in the analyses. In order to ensure homogeneity of the data sources, our study used the nationwide inpatient registries, which are established in each country included in this article by the ministry of health (government institutes). Due to the nature of the health systems in these countries as well as in Europe in general (“universal” health-care systems), uniform systems of delivery, financing, and tracking of health care within the countries are in place. Therefore, the nature of the data collection within each country is homogeneous, though there may well be differences between the countries

Variations in Pediatric Asthma Hospitalization Rates and Costs Between and Within Nordic Countries: Asthma management plans

Variations in Pediatric Asthma Hospitalization Rates and Costs Between and Within Nordic Countries: Asthma management plansLarge regional variations in hospitalization patterns found in this study are surprising in view of the sociodemographic, health status, and health-care system similarities among the four Nordic countries. Indicators like gross domestic product, percentage of gross domestic product spent on health care, public spending for health care per inhabitant, proportion of urban population, infant mortality rate, life expectancy at birth, and the number of physicians per 100,000 inhabitants, are very similar for the Nordic countries., In addition, asthma-specific mortality rates and access to specialist care as approximated by the presence of pediatric departments do not vary substantially. The prevalence of asthma in children also has been shown to be similar between countries, as well as between regions within Nor-way and Sweden.

Variations in Pediatric Asthma Hospitalization Rates and Costs Between and Within Nordic Countries: Asthmatic children

Hospitalization rates may reflect reliance on hospitalization for asthma management and/or a lower level of asthma control in the primary care setting. Lack of disease control at the primary care level often results in higher hospital utilization. We previously introduced readmission rate as a measure of the efficiency of asthma management in the secondary care setting. Once the child has been hospitalized, it is largely a failure of the secondary care if readmission for asthma is needed. Hospital LOS also may reflect the efficiency of hospital-based asthma management. In this study, LOS showed geographic variations in concordance with the differences in hospital admission rates and RHR, which supports the validity of these measures.

Variations in Pediatric Asthma Hospitalization Rates and Costs Between and Within Nordic Countries: Discussion

Variations in Pediatric Asthma Hospitalization Rates and Costs Between and Within Nordic Countries: DiscussionThe incidence of first hospital admissions, LOS, hospitalization cost, and RHR are given by geographic location in Table 1. Large variations in these measures of hospitalization patterns were observed between and within the countries. x2 tests showed no consistent pattern in LOS regarding rural vs urban areas nor gender. Denmark presented with the highest figures regardless of the measure, apart from the nonsignificantly higher RHR in Sweden. (Table 1).

Variations in Pediatric Asthma Hospitalization Rates and Costs Between and Within Nordic Countries: Results

The longitudinal, patient-specific data from Sweden, Denmark, and Norway were used to assess the RHR, defined as a separate admission to the hospital > 1 week after the first asthma discharge during the study period. At least 7 days between the hospitalizations were required in order to ensure that the second hospitalization was a consequence of a new exacerbation and not administrative transfer/shifting between departments (eg, emergency department to pediatrics) during the same episode. Ex ante sensitivity analysis revealed no significant differences in rate of rehospitalization when required gap was varied between 1 day and 7 days. The Cox proportional hazards model was used to estimate the RHR between age groups, regions and countries, controlling for asthma type (based on ICD, 10th Revision) and gender. The response variable was the length of time between subsequent hospitalizations during a 2-year period. Cox modeling is a semiparametric method, which uses the data on patients whose event of interest has occurred (eg, second hospitalization in a given time period), and also on patients who did not experience the event of interest (censored patients). It accounts for the timing of the outcome variable, such as second hospitalization in our example, vs regular nonlinear multivariate models, which only account for whether the event of interest occurred or not.

Variations in Pediatric Asthma Hospitalization Rates and Costs Between and Within Nordic Countries: Hospitalization

Variations in Pediatric Asthma Hospitalization Rates and Costs Between and Within Nordic Countries: HospitalizationData sources on cost per asthma episode were obtained from the Ministries of Health in respective countries, which routinely collect data for prospective budgeting purposes. The total number of children living in each county and country was obtained from the national statistical institutes for 1999, where centralized population census serves as a data collection tool. Counties were first classified into either urban or rural, according to the population density and presence of major urban centers, and later grouped into geographic regions.

Variations in Pediatric Asthma Hospitalization Rates and Costs Between and Within Nordic Countries: Materials and Methods

The study was designed as a 12-month retrospective database analysis on a regional, national, and overall Nordic level assessing inpatient resource use in Denmark, Sweden, Norway, and Finland in 1999. Two types of data on asthma-related hospitalizations were obtained from publicly available national inpatient registries (Danish National Board of Health and Welfare, Norwegian Patient Register, Finnish National Research and Development Centre for Health and Welfare, and Swedish National Board of Health and Welfare) for children < 15 years old. The first source included data on county-level aggregate inpatient services use according to gender and three age groups (< 2 years [infants], 2 to 5 years [young children], and 6 to 14 years [schoolchildren]) from Denmark, Sweden, Norway, and Finland.

Variations in Pediatric Asthma Hospitalization Rates and Costs Between and Within Nordic Countries

Variations in Pediatric Asthma Hospitalization Rates and Costs Between and Within Nordic CountriesOne of the main goals of long-term asthma management is to avoid asthma-related hospital admissions, which remain the second most common cause of hospitalizations in children. In addition, hospitalization costs account for 46 to 74% of the total direct cost of asthma management in the United States and Europe. Significant reductions in hospitalization and readmission rates have been reported during the recent decade from Denmark, and also from local regions within other Nordic countries.” However, a large proportion of children is still hospitalized each year despite extensive educational programs and use of preventive drugs, and the rate of variation within and between national health-care systems remains unknown. Denmark, Sweden, Norway, and Finland are relatively homogeneous in terms of culture, sociodemographic characteristics, and access to publicly funded care. Validated nationwide inpatient registries, based on the International Classification of Diseases (ICD), 10th Revision, and used for prospective hospital financing and policy development, also are available throughout the region, creating a favorable setting for clinical and health-services research.

Reports of the Working Groups: C. Implementation Strategies for Primary Care Providers (6)

1.4    Incorporation of Essential Knowledge into Asthma Protocols
Many medical institutions participate in clinical asthma projects. Essential information to be included in protocols for such projects should be developed and disseminated to funding groups, including federal and state agencies, foundations, professional societies, and teaching institutions, to ensure implementation of state-of-the-art medical practice in regard to cases of occupational and environmental asthma — asthma inhalers. Wide circulation of such information or guidelines would constitute an important avenue of primary care provider education.

Reports of the Working Groups: C. Implementation Strategies for Primary Care Providers (5)

Reports of the Working Groups: C. Implementation Strategies for Primary Care Providers (5)•    In assessing the patient with occupational and environmental asthma, a complete occupational history is required of all patients with reversible air flow limitation since current employment may not be the cause of asthma arising from previous occupational exposures. Buy Asthma Inhalers Online
•    Since asthma is a variable condition, a single measurement of lung function is not sufficient for the initial assessment of severity.
•    Since workers with occupational asthma are often young and cannot continue work in the environment which cause their asthma, vocational rehabilitation is to be initiated as soon as possible.

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