Seizure-related hospital admissions, readmissions and costs: Comparisons with asthma and diabetes in South Australia.

Seizures are listed as an Ambulatory Care Sensitive Condition (ACSC), where, in some cases, hospitalisation may be avoided with appropriate preventative and early management in primary care. We examined the frequencies, trends and financial costs of first and subsequent seizure-related hospital admissions in the adult and paediatric populations, with comparisons to bronchitis/asthma and diabetes admissions in South Australia between 2012 and 2014. De-identified hospital separation data from five major public hospitals in metropolitan South Australia were analysed to determine the number of children and adults admitted for the following Australian Refined Diagnosis Related Groups: seizure related conditions; bronchitis/asthma; and diabetes. Additional data included length of hospital stay and type of admission. Demographic data were analysed to identify whether social determinants influence admission, and a macro costing approach was then applied to calculate the financial costs to the Health Care System. The rate of total seizure hospitalizations was 649 per 100,000; lower than bronchitis/asthma (751/100,000), yet higher than diabetes (500/100,000). The highest proportions of subsequent separations were recorded by children with seizures regardless of complexity (47% +CSCC; 17% -CSCC) compared with asthma (11% +CSCC; 14% -CSCC) or diabetes (14% +CSCC; 13% -CSCC), and by adults with seizures with catastrophic or severe complications/comorbidity (25%), compared with diabetes (22%) or asthma (14%). The mean cost per separation in both children and adults was highest for diabetes (AU$4438/$7656), followed by seizures (AU$2408/$5691) and asthma (AU$2084/$3295). Following the lead of well-developed and resourced health promotion initiatives in asthma and diabetes, appropriate primary care, community education and seizure management services (including seizure clinics) should be targeted in an effort to reduce seizure related hospitalisations which may be avoidable, minimise costs to the health budget, and maximise health care quality.

Bellon ML ，Barton C ，McCaffrey N ，Parker D ，Hutchinson C ... -  《-》

Hospital care direct costs due to ambulatory care sensitive conditions related to diabetes mellitus in the Mexican public healthcare system.

Hospitalizations for ambulatory care sensitive conditions (ACSC) incur substantial costs on the health system that could be partially avoided with adequate outpatient care. Complications of chronic diseases, such as diabetes mellitus (DM), are considered ACSC. Previous studies have shown that hospitalizations due to diabetes have a significant financial burden. In Mexico, DM is a major health concern and a leading cause of death, but there is limited evidence available. This study aimed to estimate the direct costs of hospitalizations by DM-related ACSC in the Mexican public health system. We selected three hospitals from each of Mexico's main public institutions: the Mexican Social Security Institute (IMSS), the Ministry of Health (MoH), and the Institute of Social Security and Services for State Workers (ISSSTE). We employed a bottom-up microcosting approach from the healthcare provider perspective to estimate the total direct costs of hospitalizations for DM-related ACSC. Input data regarding length of stay (LoS), consultations, medications, colloid/crystalloid solutions, procedures, and laboratory/medical imaging studies were obtained from clinical records of a random sample of 532 hospitalizations out of a total of 1,803 DM-related ACSC (ICD-10 codes) discharges during 2016. The average cost per DM-related ACSC hospitalization varies among institutions, ranging from $1,427 in the MoH to $1,677 in the IMSS and $1,754 in the ISSSTE. The three institutions' largest expenses are LoS and procedures. Peripheral circulatory and renal complications were the major drivers of hospitalization costs for patients with DM-related ACSC. Direct costs due to hospitalizations for DM-related ACSC in these three institutions represent 1% of the gross domestic product (GDP) dedicated to health and social services and 2% of total hospital care expenses. The direct costs of hospitalizations for DM-related ACSC vary considerably across institutions. Disparities in such costs for the same ACSC among different institutions suggest potential disparities in care quality across primary and hospital settings (processes and resource utilization), which should be further investigated to ensure optimal supply utilization. Prioritizing preventive measures for peripheral circulatory and renal complications in DM patients could be highly beneficial.

Saturno-Hernández P ，Moreno-Zegbe E ，Poblano-Verastegui O ，Torres-Arreola LDP ，Bautista-Morales AC ，Maya-Hernández C ，Uscanga-Castillo JD ，Flores-Hernández S ，Gómez-Cortez PM ，Vieyra-Romero WI ... -  《-》

Hospitalisations, admission costs and re-fracture risk related to osteoporosis in Western Australia are substantial: a 10-year review.

To quantify hospitalisation costs to Western Australia (WA) for osteoporosis-related fractures and estimate risk of readmission after incident fracture. All hospitalisation records for WA residents aged ≥50 years admitted to a WA hospital between 2002 and 2011 due to osteoporotic fractures were extracted from the WA Hospital Morbidity Data System. Data linkage enabled identification of the first (index) fracture admission, determination of subsequent osteoporotic fracture-related readmissions, and quantification of total admission costs and bed days. Cox proportional hazard models assessed factors influencing first readmission. A total of 5,326 patients were admitted to WA hospitals for an index fracture. Of the 2,037 (38.2%) patients who sustained a re-fracture requiring readmission, 1,223 (23.0%) had one re-fracture episode, 453 (8.5%) has two, and 361 (6.8%) has three or more re-fracture episodes requiring readmission. Cost of index admissions was $57,007,262 while $48,948,623 was associated with readmissions (CPI-adjusted to 2011/12). Cumulative probability of readmission within six months of the index admission was 20% (males) and 17% (females). Osteoporotic fracture-related hospitalisations impose a substantial financial impact on WA, exceeding $100 million in a decade. Considering the large system costs, policy and programs to improve identification of index fractures and initiation of osteoporosis treatments and primary prevention initiatives are justified.

Briggs AM ，Sun W ，Miller LJ ，Geelhoed E ，Huska A ，Inderjeeth CA ... -  《-》

Asthma hospitalisation trends from 2010 to 2015: variation among rural and metropolitan Australians.

Terry D ，Robins S ，Gardiner S ，Wyett R ，Islam MR ... -  《-》

Clinical redesign using all patient refined diagnosis related groups.

Sedman AB ，Bahl V ，Bunting E ，Bandy K ，Jones S ，Nasr SZ ，Schulz K ，Campbell DA ... -  《-》