Purpose: Renown Health (Reno, Nevada), a large, locally owned, not-for-profit integrated health care network, has developed an institution-wide policy to shift the treatment of deep vein thrombosis (DVT) from a short-acting anticoagulant and vitamin K antagonist to the direct oral anticoagulant rivaroxaban combined with pharmacy-directed follow-up at an outpatient anticoagulation clinic. We examined data on hospitalizations and costs pre-/post-policy change.
Methods: Data were obtained from the electronic health records of adults with newly diagnosed DVT treated at Renown Health. A quasi-experimental design was used to evaluate patients who received a DVT diagnosis before versus after the policy change. Primary outcomes were number of all-cause inpatient nights at 30 and 60 days post-DVT index date. Secondary outcomes were costs of all-cause overnight stays at 30 and 60 days post-DVT index. Outcomes were evaluated in propensity-weighted logistic regression and generalized linear models.
Findings: There were 343 patients pre-policy change and 266 post-policy change. In the first 30 days postindex, the mean (95% CI) numbers of propensity-weighted all-cause inpatient nights were 1.27 (0.83-1.95) prechange and 0.66 (0.42-1.02) postchange (P = 0.038). Mean propensity-weighted estimated all-cause hospital costs in patients diagnosed as outpatients were $7848 ($4990-$12,344) prechange and $2466 ($1553-$3915) postchange (P <0.001). Mean costs of all-cause overnight stays in inpatient-diagnosed DVT patients were $8907 prechange and $7449 postchange (P = 0.600). In the first 60 days postindex, the mean number of all-cause inpatient nights (P = 0.219) and mean costs of all-cause overnight stays (P = 0.275) were not significantly different before and after the policy change.
Implications: Changing institutional policy to increase the utilization of a direct oral anticoagulant and pharmacist-led outpatient anticoagulation clinics may reduce length of hospital stay and decrease health care expenditures in the treatment of DVT.
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http://dx.doi.org/10.1016/j.clinthera.2018.12.006 | DOI Listing |
J Environ Manage
January 2025
Graduate School of Media and Governance, Keio University, 5322 Endo, Fujisawa City, Kanagawa Prefecture, 252-0882, Japan. Electronic address:
The adoption of residential renewable energy is pivotal for achieving the 'Net Zero' goal, yet financial assessments of household investments in this area remain complex due to dynamic market conditions. This study introduces a novel closed-form financial valuation framework for residential solar photovoltaic (PV) systems, explicitly addressing the uncertainties of electricity market price fluctuations (market risk) and energy policy changes (policy risk) using Geometric Brownian Motion (GBM). A case study in France demonstrates the framework's application, revealing that the discount rate is the most influential factor in solar PV valuation, followed by system lifespan and policy-driven Feed-in Tariff (FiT) rates.
View Article and Find Full Text PDFAm J Obstet Gynecol MFM
January 2025
Division of Maternal Fetal Medicine, Brigham and Women's Hospital.
Background: As induction of labor increases in the United States, safe, effective outpatient cervical ripening has been explored as a method to decrease the inpatient time burden. The most effective method of outpatient mechanical cervical ripening remains unclear.
Objective: To evaluate if Dilapan-S is non-inferior to cervical balloon for outpatient cervical ripening (CR) based on change in Bishop score.
Sci Total Environ
January 2025
State Key Laboratory of Environmental Geochemistry, Institute of Geochemistry, Chinese Academy of Sciences, Guiyang 550081, China.
Since the Industrial Revolution, significant changes in global land-use patterns have occurred, which have disrupted terrestrial carbon emissions. However, the disturbance processes, change trends, and distribution patterns are not clear. Therefore, the changes in terrestrial carbon emissions (E) caused by land-use change (LUC) since 1850 were analyzed in this study.
View Article and Find Full Text PDFJ Adv Nurs
January 2025
Independant Scholar.
Aim: To explore psychiatric and mental health nurses' perceptions of patients with co-occurring psychiatric and substance use disorders in psychiatric settings.
Design: An exploratory qualitative study design based on grounded theory, employing Straussian analytic procedures.
Method: Semi-structured interviews were conducted with 11 psychiatric and mental health nurses.
Arthritis Rheumatol
January 2025
Department of Immunology and inflammation, Imperial College London, UK.
Background: Takayasu arteritis (TAK) and giant cell arteritis (GCA), the most common forms of large-vessel vasculitis (LVV), can result in serious morbidity. Understanding the molecular basis of LVV should aid in developing better biomarkers and treatments.
Methods: Plasma proteomic profiling of 184 proteins was performed in two cohorts.
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