CONSTRAINED OPTIMIZATION MODEL TO ESTIMATE BEST BOOSTER ALLOCATION STRATEGY TO MINIMIZE HOSPITAL BED-DAYS UNDER A FIXED HEALTHCARE BUDGET

Abstract

patients with ACS in Kazakhstan. Methods: A cross-sectional study was perfomed. The total number of patients was 2656. As a control group, patients treated in the period 2015-2017 in the amount of 1584 patients were taken. Results: During the indicated period, 2656 patients diagnosed with ACS were hospitalized, PCI was performed in 844 patients (31.8%), PCI with stenting-in 1089 patients (41%), CABG-428 (16.1%). The comparison group consisted of 1584 patients diagnosed with ACS, of which 595 patients (37.6%) underwent diagnostic PCI, 512 patients (32.3%) underwent PCI with following stenting, and 199 (12.6%) underwent CABG. The detection of ACS increased by 67%, a decrease in cases of unreasonable hospitalization by 5.8%, a decrease in hospital's day of reasonable coronary stenting by 8.7%, in the context of myocardial revascularization by CABG by 3.5%. Conclusions: Due to the work of CPU department, the total number of reasonably hospitalized patients has increased by 67%, which in the long term leads to a decrease in the number of unnecessary hospitalizations, and therefore boost up the efficiency of cardiological care for the population. Objectives: Occupational burnout is a common phenomenon among healthcare providers. However, information about burnout in pediatric neurologists managing spinal muscular atrophy (SMA) is limited. Our aim was to assess the presence of burnout and its influence on treatment decisions in SMA care. Methods: We conducted a multicenter, non-interventional, cross-sectional, web-based study. Pediatric neurologists involved in SMA care from across Spain answered a survey with demographic and professional characteristics, questions about their standard clinical practice using 11 simulated case-scenarios of SMA type 1 and 2, and a behavioral battery including the Maslach Burnout Inventory-Human Services Survey (MBI-HSS). The primary outcome was therapeutic inertia (TI), defined as the number of simulated scenarios with lack of treatment initiation or escalation when warranted over the total presented cases. A multivariable logistic regression analysis was conducted to determine the association between participants' characteristics and treatment preferences. Results: A total of 35 pediatric neurologists completed the study. Mean age (6SD) was 40.6 (9.6) years, 62.9% were women, with a mean experience of 11.5 (9.1) years. Eleven (31.4%) participants had burnout. The mean (SD) TI score was 4.2 (1.7), and 3.29 (1.5) for treatment initiation. Of a total 385 individual responses, TI was observed in 147 (38.2%) of treatment choices. TI scores (mean, [SD]) were higher among participants with burnout compared to their counterpart (4.0 [0.36] vs. 2.96 [0.32], respectively; p=0.05). The multivariable analysis showed that burnout was associated with higher TI scores (b coefficient 1.24, 95%CI 0.12-2.4; p=0.03) after adjustment for age and years of professional experience. Conclusions: Occupational burnout is associated with increased risk of therapeutic inertia among pediatric neurologists managing patients with SMA. Identifying burnout may be critical for implementing specific intervention strategies to maintain an optimal disease control.