The Experts below are selected from a list of 2058 Experts worldwide ranked by ideXlab platform

Andreas Laupacis - One of the best experts on this subject based on the ideXlab platform.

Leora T. Yarboro - One of the best experts on this subject based on the ideXlab platform.

  • Same Game New Rules: What is the Impact of the 2018 UNOS Heart Allocation Change?
    The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation, 2020
    Co-Authors: L.b. Whalen, J. Dahl, E Krebs, Leora T. Yarboro
    Abstract:

    The 2018 UNOS heart allocation policy shifted priority from patients supported with durable devices to those with temporary mechanical support. We sought to quantify the implications of this change including impact on wait times, Hospital Bed Utilization and use of mechanical circulatory support devices. This study was a retrospective review of 32 consecutive patients who underwent heart transplantation at a single center between October 2017 and May 2019. Patient charts were reviewed for information regarding preoperative characteristics, operative data, and perioperative characteristics. Univariate analysis compared demographics and outcomes before and after the October 2018 policy change. There were 16 patients each in the pre and post policy-change groups. Patients did not differ significantly in their demographic profiles. Significant differences were noted, however, in the time on transplant list with median days of 166 before vs. 18.5 after policy change (p= .017), and in the presence of preoperative temporary support (12.5% vs. 68.75%, p= .011). Prior to the allocation change most heart transplant patients were admitted from home on the day of transplant (9/16 vs. 6/16), while afterwards the average preoperative length of stay was 14.7 days with the majority of these days as ICU status (11.06). Operative times were shorter (593 vs. 685 median minute, p= .0026) in the post allocation change group. There was no difference in operating room blood transfusions, postoperative outcomes, or postoperative length of stay between the groups. This study suggests that following the 2018 policy change, patients who received heart transplants experienced shorter waitlist times, longer preoperative Hospital stays, and had an increased use of temporary mechanical assist devices. This shift to a resource intensive inpatient management strategy has implications that will require further evaluation. Copyright © 2020. Published by Elsevier Inc.

  • Same Game New Rules: What is the Impact of the 2018 UNOS Heart Allocation Change?
    The Journal of Heart and Lung Transplantation, 2020
    Co-Authors: L.b. Whalen, J. Dahl, Elizabeth D. Krebs, Leora T. Yarboro
    Abstract:

    Purpose The 2018 UNOS heart allocation policy shifted priority from patients supported with durable devices to those with temporary mechanical support. We sought to quantify the implications of this change including impact on wait times, Hospital Bed Utilization and use of mechanical circulatory support devices. Methods This study was a retrospective review of 32 consecutive patients who underwent heart transplantation at a single center between October 2017 and May 2019. Patient charts were reviewed for information regarding preoperative characteristics, operative data, and perioperative characteristics. Univariate analysis compared demographics and outcomes before and after the October 2018 policy change. Results There were 16 patients each in the pre and post policy-change groups. Patients did not differ significantly in their demographic profiles. Significant differences were noted, however, in the time on transplant list with median days of 166 before vs. 18.5 after policy change (p= .017), and in the presence of preoperative temporary support (12.5% vs. 68.75%, p= .011). Prior to the allocation change most heart transplant patients were admitted from home on the day of transplant (9/16 vs. 6/16), while afterwards the average preoperative length of stay was 14.7 days with the majority of these days as ICU status (11.06). Operative times were shorter (593 vs. 685 median minute, p= .0026) in the post allocation change group. There was no difference in operating room blood transfusions, postoperative outcomes, or postoperative length of stay between the groups. Conclusion This study suggests that following the 2018 policy change, patients who received heart transplants experienced shorter waitlist times, longer preoperative Hospital stays, and had an increased use of temporary mechanical assist devices. This shift to a resource intensive inpatient management strategy has implications that will require further evaluation.

Andrew F Shorr - One of the best experts on this subject based on the ideXlab platform.

  • prolonged acute mechanical ventilation and Hospital Bed Utilization in 2020 in the united states implications for budgets plant and personnel planning
    BMC Health Services Research, 2008
    Co-Authors: Marya D Zilberberg, Andrew F Shorr
    Abstract:

    Background Adult patients on prolonged acute mechanical ventilation (PAMV) comprise 1/3 of all adult MV patients, consume 2/3 of Hospital resources allocated to MV population, and are nearly twice as likely to require a discharge to a skilled nursing facility (SNF). Their numbers are projected to double by year 2020. To aid in planning for this growth, we projected their annualized days and costs of Hospital use and SNF discharges in year 2020 in the US.

  • Prolonged acute mechanical ventilation and Hospital Bed Utilization in 2020 in the United States: implications for budgets, plant and personnel planning
    BMC Health Services Research, 2008
    Co-Authors: Marya D Zilberberg, Andrew F Shorr
    Abstract:

    Background Adult patients on prolonged acute mechanical ventilation (PAMV) comprise 1/3 of all adult MV patients, consume 2/3 of Hospital resources allocated to MV population, and are nearly twice as likely to require a discharge to a skilled nursing facility (SNF). Their numbers are projected to double by year 2020. To aid in planning for this growth, we projected their annualized days and costs of Hospital use and SNF discharges in year 2020 in the US. Methods We constructed a model estimating the relevant components of Hospital Utilization. We computed the total days and costs for each component; we also applied the risk for SNF discharge to the total 2020 PAMV population. The underlying assumption was that process of care does not change over the time horizon. We performed Monte Carlo simulations to establish 95% confidence intervals (CI) for the point estimates. Results Given 2020 projected PAMV volume of 605,898 cases, they will require 3.6 (95% CI 2.7–4.8) million MV, 5.5 (95% CI 4.3–7.0) million ICU and 10.3 (95% CI 8.1–13.0) million Hospital days, representing an absolute increase of 2.1 million MV, 3.2 million ICU and 6.5 million Hospital days over year 2000, at a total inflation-adjusted cost of over $64 billion. Expected discharges to SNF are 218,123 (95% CI 177,268–266,739), compared to 90,928 in 2000. Conclusion Our model suggest that the projected growth in the US in PAMV population by 2020 will result in annualized increases of more than 2, 3, and 6 million MV, ICU and Hospital days, respectively, over year 2000. Such growth requires careful planning efforts and attention to efficiency of healthcare delivery.

  • Prolonged acute mechanical ventilation and Hospital Bed Utilization in 2020 in the United States: implications for budgets, plant and personnel planning.
    BMC health services research, 2008
    Co-Authors: Marya D Zilberberg, Andrew F Shorr
    Abstract:

    Adult patients on prolonged acute mechanical ventilation (PAMV) comprise 1/3 of all adult MV patients, consume 2/3 of Hospital resources allocated to MV population, and are nearly twice as likely to require a discharge to a skilled nursing facility (SNF). Their numbers are projected to double by year 2020. To aid in planning for this growth, we projected their annualized days and costs of Hospital use and SNF discharges in year 2020 in the US. We constructed a model estimating the relevant components of Hospital Utilization. We computed the total days and costs for each component; we also applied the risk for SNF discharge to the total 2020 PAMV population. The underlying assumption was that process of care does not change over the time horizon. We performed Monte Carlo simulations to establish 95% confidence intervals (CI) for the point estimates. Given 2020 projected PAMV volume of 605,898 cases, they will require 3.6 (95% CI 2.7–4.8) million MV, 5.5 (95% CI 4.3–7.0) million ICU and 10.3 (95% CI 8.1–13.0) million Hospital days, representing an absolute increase of 2.1 million MV, 3.2 million ICU and 6.5 million Hospital days over year 2000, at a total inflation-adjusted cost of over $64 billion. Expected discharges to SNF are 218,123 (95% CI 177,268–266,739), compared to 90,928 in 2000. Our model suggest that the projected growth in the US in PAMV population by 2020 will result in annualized increases of more than 2, 3, and 6 million MV, ICU and Hospital days, respectively, over year 2000. Such growth requires careful planning efforts and attention to efficiency of healthcare delivery.

Dale M. Needham - One of the best experts on this subject based on the ideXlab platform.

L.b. Whalen - One of the best experts on this subject based on the ideXlab platform.

  • Same Game New Rules: What is the Impact of the 2018 UNOS Heart Allocation Change?
    The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation, 2020
    Co-Authors: L.b. Whalen, J. Dahl, E Krebs, Leora T. Yarboro
    Abstract:

    The 2018 UNOS heart allocation policy shifted priority from patients supported with durable devices to those with temporary mechanical support. We sought to quantify the implications of this change including impact on wait times, Hospital Bed Utilization and use of mechanical circulatory support devices. This study was a retrospective review of 32 consecutive patients who underwent heart transplantation at a single center between October 2017 and May 2019. Patient charts were reviewed for information regarding preoperative characteristics, operative data, and perioperative characteristics. Univariate analysis compared demographics and outcomes before and after the October 2018 policy change. There were 16 patients each in the pre and post policy-change groups. Patients did not differ significantly in their demographic profiles. Significant differences were noted, however, in the time on transplant list with median days of 166 before vs. 18.5 after policy change (p= .017), and in the presence of preoperative temporary support (12.5% vs. 68.75%, p= .011). Prior to the allocation change most heart transplant patients were admitted from home on the day of transplant (9/16 vs. 6/16), while afterwards the average preoperative length of stay was 14.7 days with the majority of these days as ICU status (11.06). Operative times were shorter (593 vs. 685 median minute, p= .0026) in the post allocation change group. There was no difference in operating room blood transfusions, postoperative outcomes, or postoperative length of stay between the groups. This study suggests that following the 2018 policy change, patients who received heart transplants experienced shorter waitlist times, longer preoperative Hospital stays, and had an increased use of temporary mechanical assist devices. This shift to a resource intensive inpatient management strategy has implications that will require further evaluation. Copyright © 2020. Published by Elsevier Inc.

  • Same Game New Rules: What is the Impact of the 2018 UNOS Heart Allocation Change?
    The Journal of Heart and Lung Transplantation, 2020
    Co-Authors: L.b. Whalen, J. Dahl, Elizabeth D. Krebs, Leora T. Yarboro
    Abstract:

    Purpose The 2018 UNOS heart allocation policy shifted priority from patients supported with durable devices to those with temporary mechanical support. We sought to quantify the implications of this change including impact on wait times, Hospital Bed Utilization and use of mechanical circulatory support devices. Methods This study was a retrospective review of 32 consecutive patients who underwent heart transplantation at a single center between October 2017 and May 2019. Patient charts were reviewed for information regarding preoperative characteristics, operative data, and perioperative characteristics. Univariate analysis compared demographics and outcomes before and after the October 2018 policy change. Results There were 16 patients each in the pre and post policy-change groups. Patients did not differ significantly in their demographic profiles. Significant differences were noted, however, in the time on transplant list with median days of 166 before vs. 18.5 after policy change (p= .017), and in the presence of preoperative temporary support (12.5% vs. 68.75%, p= .011). Prior to the allocation change most heart transplant patients were admitted from home on the day of transplant (9/16 vs. 6/16), while afterwards the average preoperative length of stay was 14.7 days with the majority of these days as ICU status (11.06). Operative times were shorter (593 vs. 685 median minute, p= .0026) in the post allocation change group. There was no difference in operating room blood transfusions, postoperative outcomes, or postoperative length of stay between the groups. Conclusion This study suggests that following the 2018 policy change, patients who received heart transplants experienced shorter waitlist times, longer preoperative Hospital stays, and had an increased use of temporary mechanical assist devices. This shift to a resource intensive inpatient management strategy has implications that will require further evaluation.