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Dormont B, Dottin A. Does the opening of an emergency department influence hospital admissions? Evidence from French private hospitals. Soc Sci Med 2024; 340:116380. [PMID: 38007967 DOI: 10.1016/j.socscimed.2023.116380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 10/26/2023] [Accepted: 10/27/2023] [Indexed: 11/28/2023]
Abstract
Although operating an emergency department (ED) can influence general admission activity of hospitals, most articles that analyze hospital care ignore the potential spillover of emergency activity. In this paper, we examine the consequences of a French reform that encouraged the creation of EDs within private-for-profit (PFP) hospitals in order to decrease congestion in EDs. We use administrative panel data on 365 French PFP hospitals observed between 2002 and 2012. Specifications including hospital fixed-effects are estimated to examine the impact of an ED opening on private hospitals' admission activity, namely inpatient and day-care admissions (ED visits are excluded, but patients admitted following an ED visit are included). We control for shocks that can impact demand for care in hospitals, and we estimate yearly changes before and after the opening. We find that an ED opening is followed by an increase in the number and proportion of inpatient admissions, and by an increase in the length of inpatient stays. A transitory increase in the bed occupancy rate is also observed. In many countries, public and private hospitals compete to some extent. The former provide a public service, while the latter are profit-maximizers that are allowed to specialize in profitable activities. They generally focus on day-care admissions. We provide empirical evidence that private hospitals experience a significant change in the composition of their admissions when they start providing emergency care. Opening an ED creates a new non-selective entryway to private hospitals, resulting in admissions of inpatients with health problems that are more severe. Hence, involving PFP hospitals in the provision of emergency care is likely to make the structure of admissions of private hospitals closer to that of public hospitals.
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Affiliation(s)
- Brigitte Dormont
- Université Paris Dauphine, PSL Research University, LEDa, 75016, Paris, France.
| | - Alexis Dottin
- Université Paris Panthéon Assas, 75006, Paris, France.
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Diaz MJ, Margulies S, Tran JT, Taneja K, Patel K, Forouzandeh M, Montanez-Wiscovich M. Factors influencing inpatient hospitalization for hidradenitis suppurativa: a retrospective cohort study of 59,100 ED visits (2015-2019). Arch Dermatol Res 2023; 315:2999-3001. [PMID: 37796340 DOI: 10.1007/s00403-023-02728-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 08/13/2023] [Accepted: 09/06/2023] [Indexed: 10/06/2023]
Affiliation(s)
- Michael J Diaz
- College of Medicine, University of Florida, Gainesville, FL, USA.
| | - Shae Margulies
- Department of Medicine, University of Florida College of Medicine, Gainesville, FL, USA
| | - Jasmine T Tran
- School of Medicine, Indiana University, Indianapolis, IN, USA
| | - Kamil Taneja
- Renaissance School of Medicine, Stony Brook University, Stony Brook, NY, USA
| | - Karan Patel
- Cooper Medical School, Rowan University, Camden, NJ, USA
| | - Mahtab Forouzandeh
- Department of Dermatology, University of Florida College of Medicine, Gainesville, FL, USA
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Dyason KM, Ozkul B, Knight K, Sara G, Brakoulias V, Farrell LJ, Grisham JR, Perkes IE. Hospital admission characteristics for children and adolescents with OCD in Sydney, Australia. Gen Hosp Psychiatry 2023; 85:236-238. [PMID: 37775419 DOI: 10.1016/j.genhosppsych.2023.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 09/14/2023] [Accepted: 09/22/2023] [Indexed: 10/01/2023]
Affiliation(s)
- Katelyn M Dyason
- Department of Psychological Medicine, Sydney Children's Hospitals Network, New South Wales, Australia; Discipline of Psychiatry & Mental Health, School of Clinical Medicine, Faculty of Medicine & Health, University of New South Wales, New South Wales, Australia.
| | - Burcu Ozkul
- Department of Psychological Medicine, Sydney Children's Hospitals Network, New South Wales, Australia; Discipline of Psychiatry & Mental Health, School of Clinical Medicine, Faculty of Medicine & Health, University of New South Wales, New South Wales, Australia
| | - Katherine Knight
- Department of Psychological Medicine, Sydney Children's Hospitals Network, New South Wales, Australia
| | - Grant Sara
- Discipline of Psychiatry & Mental Health, School of Clinical Medicine, Faculty of Medicine & Health, University of New South Wales, New South Wales, Australia; InforMH, Ministry of Health, NSW Health, New South Wales, Australia
| | - Vlasios Brakoulias
- Mental Health, Western Sydney Local Health District, New South Wales, Australia; School of Medicine and Translational Health Research Institute, Western Sydney University, New South Wales, Australia; Specialty of Psychiatry, Faculty of Medicine and Health, The University of Sydney, New South Wales, Australia
| | - Lara J Farrell
- Griffith University, Centre for Mental Health and School of Applied Psychology, Griffith University, Queensland, Australia
| | - Jessica R Grisham
- School of Psychology, University of New South Wales, New South Wales, Australia
| | - Iain E Perkes
- Department of Psychological Medicine, Sydney Children's Hospitals Network, New South Wales, Australia; Discipline of Psychiatry & Mental Health, School of Clinical Medicine, Faculty of Medicine & Health, University of New South Wales, New South Wales, Australia; Discipline of Paediatrics & Child Health, School of Clinical Medicine, Faculty of Medicine & Health, University of New South Wales, New South Wales, Australia; School of Psychology, University of New South Wales, New South Wales, Australia
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Rampersaud YR, Sundararajan K, Docter S, Perruccio AV, Gandhi R, Adams D, Briggs N, Davey JR, Fehlings M, Lewis SJ, Magtoto R, Massicotte E, Sarro A, Syed K, Mahomed NN, Veillette C. Hospital spending and length of stay attributable to perioperative adverse events for inpatient hip, knee, and spine surgery: a retrospective cohort study. BMC Health Serv Res 2023; 23:1150. [PMID: 37880706 PMCID: PMC10598977 DOI: 10.1186/s12913-023-10055-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 09/23/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND The incremental hospital cost and length of stay (LOS) associated with adverse events (AEs) has not been well characterized for planned and unplanned inpatient spine, hip, and knee surgeries. METHODS Retrospective cohort study of hip, knee, and spine surgeries at an academic hospital in 2011-2012. Adverse events were prospectively collected for 3,063 inpatient cases using the Orthopaedic Surgical AdVerse Event Severity (OrthoSAVES) reporting tool. Case costs were retrospectively obtained and inflated to equivalent 2021 CAD values. Propensity score methodology was used to assess the cost and LOS attributable to AEs, controlling for a variety of patient and procedure factors. RESULTS The sample was 55% female and average age was 64; 79% of admissions were planned. 30% of cases had one or more AEs (82% had low-severity AEs at worst). The incremental cost and LOS attributable to AEs were $8,500 (95% confidence interval [CI]: 5100-11,800) and 4.7 days (95% CI: 3.4-5.9) per admission. This corresponded to a cumulative $7.8 M (14% of total cohort cost) and 4,290 bed-days (19% of cohort bed-days) attributable to AEs. Incremental estimates varied substantially by (1) admission type (planned: $4,700/2.4 days; unplanned: $20,700/11.5 days), (2) AE severity (low: $4,000/3.1 days; high: $29,500/11.9 days), and (3) anatomical region (spine: $19,800/9 days; hip: $4,900/3.8 days; knee: $1,900/1.5 days). Despite only 21% of admissions being unplanned, adverse events in these admissions cumulatively accounted for 59% of costs and 62% of bed-days attributable to AEs. CONCLUSIONS This study comprehensively demonstrates the considerable cost and LOS attributable to AEs in orthopaedic and spine admissions. In particular, the incremental cost and LOS attributable to AEs per admission were almost five times as high among unplanned admissions compared to planned admissions. Mitigation strategies focused on unplanned surgeries may result in significant quality improvement and cost savings in the healthcare system.
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Affiliation(s)
- Y Raja Rampersaud
- Division of Orthopaedic Surgery, Schroeder Arthritis Institute, University Health Network, Toronto, ON, Canada.
- Krembil Research Institute, University Health Network, Toronto, ON, Canada.
- Department of Surgery, University of Toronto, Toronto, ON, Canada.
- Division of Neurosurgery, Krembil Neuroscience Centre, University Health Network, Toronto, ON, Canada.
| | - Kala Sundararajan
- Division of Orthopaedic Surgery, Schroeder Arthritis Institute, University Health Network, Toronto, ON, Canada
- Krembil Research Institute, University Health Network, Toronto, ON, Canada
| | - Shgufta Docter
- Division of Orthopaedic Surgery, Schroeder Arthritis Institute, University Health Network, Toronto, ON, Canada
| | - Anthony V Perruccio
- Division of Orthopaedic Surgery, Schroeder Arthritis Institute, University Health Network, Toronto, ON, Canada
- Krembil Research Institute, University Health Network, Toronto, ON, Canada
- Department of Surgery, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management & Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Rajiv Gandhi
- Division of Orthopaedic Surgery, Schroeder Arthritis Institute, University Health Network, Toronto, ON, Canada
- Krembil Research Institute, University Health Network, Toronto, ON, Canada
- Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Diana Adams
- Division of Orthopaedic Surgery, Schroeder Arthritis Institute, University Health Network, Toronto, ON, Canada
| | - Natasha Briggs
- Division of Orthopaedic Surgery, Schroeder Arthritis Institute, University Health Network, Toronto, ON, Canada
| | - J Rod Davey
- Division of Orthopaedic Surgery, Schroeder Arthritis Institute, University Health Network, Toronto, ON, Canada
- Krembil Research Institute, University Health Network, Toronto, ON, Canada
- Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Michael Fehlings
- Krembil Research Institute, University Health Network, Toronto, ON, Canada
- Department of Surgery, University of Toronto, Toronto, ON, Canada
- Division of Neurosurgery, Krembil Neuroscience Centre, University Health Network, Toronto, ON, Canada
| | - Stephen J Lewis
- Division of Orthopaedic Surgery, Schroeder Arthritis Institute, University Health Network, Toronto, ON, Canada
- Krembil Research Institute, University Health Network, Toronto, ON, Canada
- Department of Surgery, University of Toronto, Toronto, ON, Canada
- Division of Neurosurgery, Krembil Neuroscience Centre, University Health Network, Toronto, ON, Canada
| | - Rosalie Magtoto
- Division of Neurosurgery, Krembil Neuroscience Centre, University Health Network, Toronto, ON, Canada
| | - Eric Massicotte
- Krembil Research Institute, University Health Network, Toronto, ON, Canada
- Department of Surgery, University of Toronto, Toronto, ON, Canada
- Division of Neurosurgery, Krembil Neuroscience Centre, University Health Network, Toronto, ON, Canada
| | - Angela Sarro
- Division of Orthopaedic Surgery, Schroeder Arthritis Institute, University Health Network, Toronto, ON, Canada
- Department of Surgery, University of Toronto, Toronto, ON, Canada
- Division of Neurosurgery, Krembil Neuroscience Centre, University Health Network, Toronto, ON, Canada
| | - Khalid Syed
- Division of Orthopaedic Surgery, Schroeder Arthritis Institute, University Health Network, Toronto, ON, Canada
- Krembil Research Institute, University Health Network, Toronto, ON, Canada
- Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Nizar N Mahomed
- Division of Orthopaedic Surgery, Schroeder Arthritis Institute, University Health Network, Toronto, ON, Canada
- Krembil Research Institute, University Health Network, Toronto, ON, Canada
- Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Christian Veillette
- Division of Orthopaedic Surgery, Schroeder Arthritis Institute, University Health Network, Toronto, ON, Canada
- Krembil Research Institute, University Health Network, Toronto, ON, Canada
- Department of Surgery, University of Toronto, Toronto, ON, Canada
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Maconick L, Ikhtabi S, Broeckelmann E, Pitman A, Barnicot K, Billings J, Osborn D, Johnson S. Crisis and acute mental health care for people who have been given a diagnosis of a 'personality disorder': a systematic review. BMC Psychiatry 2023; 23:720. [PMID: 37798701 PMCID: PMC10552436 DOI: 10.1186/s12888-023-05119-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 08/18/2023] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND People who have been given a diagnosis of a 'personality disorder' need access to good quality mental healthcare when in crisis, but the evidence underpinning crisis services for this group is limited. We synthesised quantitative studies reporting outcomes for people with a 'personality disorder' diagnosis using crisis and acute mental health services. METHODS We searched OVID Medline, PsycInfo, PsycExtra, Web of Science, HMIC, CINAHL Plus, Clinical Trials and Cochrane CENTRAL for randomised controlled trials (RCTs) and observational studies that reported at least one clinical or social outcome following use of crisis and acute care for people given a 'personality disorder' diagnosis. We performed a narrative synthesis of evidence for each model of care found. RESULTS We screened 16,953 records resulting in 35 studies included in the review. Studies were published between 1987-2022 and conducted in 13 countries. Six studies were RCTs, the remainder were non randomised controlled studies or cohort studies reporting change over time. Studies were found reporting outcomes for crisis teams, acute hospital admission, acute day units, brief admission, crisis-focused psychotherapies in a number of settings, Mother and Baby units, an early intervention service and joint crisis planning. The evidence for all models of care except brief admission and outpatient-based psychotherapies was assessed as low or very low certainty. CONCLUSION The literature found was sparse and of low quality. There were no high-quality studies that investigated outcomes following use of crisis team or hospital admission for this group. Studies investigating crisis-focused psychological interventions showed potentially promising results.
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Affiliation(s)
- Lucy Maconick
- Division of Psychiatry, University College London, Maple House, 149 Tottenham Court Road, London, W1T 7BN, UK.
- Camden and Islington NHS Foundation Trust, St Pancras Hospital, 4 St Pancras Way, London, NW1 0PE, UK.
| | - Sarah Ikhtabi
- Division of Psychiatry, University College London, Maple House, 149 Tottenham Court Road, London, W1T 7BN, UK
| | - Eva Broeckelmann
- Division of Psychiatry, University College London, Maple House, 149 Tottenham Court Road, London, W1T 7BN, UK
| | - Alexandra Pitman
- Division of Psychiatry, University College London, Maple House, 149 Tottenham Court Road, London, W1T 7BN, UK
- Camden and Islington NHS Foundation Trust, St Pancras Hospital, 4 St Pancras Way, London, NW1 0PE, UK
| | - Kirsten Barnicot
- Department of Health Services Research & Management, City, University of London, Northampton Square, London, EC1V 0HB, UK
| | - Jo Billings
- Division of Psychiatry, University College London, Maple House, 149 Tottenham Court Road, London, W1T 7BN, UK
| | - David Osborn
- Division of Psychiatry, University College London, Maple House, 149 Tottenham Court Road, London, W1T 7BN, UK
- Camden and Islington NHS Foundation Trust, St Pancras Hospital, 4 St Pancras Way, London, NW1 0PE, UK
| | - Sonia Johnson
- Division of Psychiatry, University College London, Maple House, 149 Tottenham Court Road, London, W1T 7BN, UK
- Camden and Islington NHS Foundation Trust, St Pancras Hospital, 4 St Pancras Way, London, NW1 0PE, UK
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Patel K, Diaz MJ, Taneja K, Batchu S, Zhang A, Mohamed A, Wolfe J, Patel UK. Predictors of inpatient admission likelihood and prolonged length of stay among cerebrovascular disease patients: A nationwide emergency department sample analysis. J Stroke Cerebrovasc Dis 2023; 32:106983. [PMID: 36641949 DOI: 10.1016/j.jstrokecerebrovasdis.2023.106983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 12/20/2022] [Accepted: 01/09/2023] [Indexed: 01/15/2023] Open
Abstract
PURPOSE To examine the hospital- and patient-related factors associated with increased likelihood of inpatient admission and extended hospitalization. METHODS We applied multivariate logistic regression to a subset of ED hospital and patient characteristics linearly extrapolated from the 2019 National Emergency Department Sample database (n=626,508). Patient characteristics with 10 or fewer ED visits after national extrapolation were not reported in the current study to maintain patient confidentiality, in accordance with the HCUP Data Use Agreement. All selected ED visits represented a primary diagnosis of CVD (ICD-10 codes 160-168). All reported hospital and patient characteristics were subject to adjustment for covariates. P-values < 0.05 were considered statistically significant. MAIN FINDINGS Medicare beneficiaries report higher inpatient admission rates than uninsured OR 0.81 (0.73-0.91) and privately insured OR 0.86 (0.79-0.94) individuals. Black and Native-American patients were 37% and 55% more likely to be hospitalized long (>75th percentile) (OR 1.37 [1.25-1.50], OR 1.55 [1.14-2.10]). Northeast emergency departments reported an increased odds of admission compared to the Midwest OR (0.40-0.62), South OR 0.79 (0.63-0.98) and West OR 0.52 (0.39-0.69). Patients with multiple comorbidities (mCCI = 3+) were 226% more likely to have a longer stay OR 3.26 (3.09-3.45) than patients presenting with zero or few comorbidities. Level I, II, and III trauma centers report distinctly high odds of inpatient admission (OR 3.54 [2.84-4.42], OR 2.68 [2.14-3.35], OR 1.51 [1.25-1.84]). PRINCIPAL CONCLUSIONS Likelihoods of inpatient admission and long hospital stays were observably stratified through multiple, independently acting hospital and patient characteristics. Significant associations were stratified by race/ethnicity, location, and clinical presentation, among others. Attention to the factors reported here may serve well to mitigate emergency department crowding and its sobering impact on United States healthcare systems and patients.
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Affiliation(s)
- Karan Patel
- Cooper Medical School of Rowan University, 401 South Broadway, Camden, NJ, 08103, United States.
| | | | - Kamil Taneja
- Renaissance School of Medicine at Stony Brook University, 100 Nicolls Rd, Stony Brook, NY, 11794, United States
| | | | - Alex Zhang
- Cooper Medical School of Rowan University, 401 South Broadway, Camden, NJ, 08103, United States
| | - Aleem Mohamed
- Cooper Medical School of Rowan University, 401 South Broadway, Camden, NJ, 08103, United States
| | - Jared Wolfe
- Cooper Medical School of Rowan University, 401 South Broadway, Camden, NJ, 08103, United States
| | - Urvish K Patel
- Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Pl, New York, NY, 10029, United States
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Sung YS, Zhang D, Eswaran H, Lowery CL. Evaluation of a telemedicine program managing high-risk pregnant women with pre-existing diabetes in Arkansas's Medicaid program. Semin Perinatol 2021; 45:151421. [PMID: 34274150 DOI: 10.1016/j.semperi.2021.151421] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE We aim to evaluate the effects of the telemedicine program, High-Risk Pregnancy Program at University of Arkansas for Medical Sciences (UAMS), on health services utilization and medical expenditures among pregnant women with pre-existing diabetes and their newborns. RESEARCH DESIGN AND METHODS The study sample was selected from the Arkansas Medicaid claims linked to infant birth/death certificates and UAMS telemedicine records from 2013 through 2016. We used propensity score matching based on participants' characteristics to create three groups - UAMS telemedicine care, UAMS in-person care, and non-UAMS prenatal care. We compared inpatient and outpatient care services, medication use and caesarean section rates, severe maternal morbidity, infant mortality and preterm birth rates and medical expenditures. RESULTS The UAMS telemedicine group had fewer inpatient admissions (1.18 vs 1.31; 95% CI: -0.27, 0.00), lower insulin use rates (41.86% vs 59.88%; 95% CI: -29.00%, -7.05%) and lower maternal care expenditures ($7,846 vs $10,644; 95% CI: -$4,089, -$1,507) compared with the UAMS in-person care group. Women receiving UAMS telemedicine had more prenatal care visits (10.45 vs 8.57; 95% CI: -2.96, -0.81), higher insulin use rates (41.86% vs 26.74%: 95% CI: 4.63%, 25.60%) and similar maternal care expenditures ($7,846 vs $7,051), compared with those receiving non-UAMS in-person care. Caesarean section, severe maternal morbidity, and infant mortality rates were similar across the three groups. CONCLUSION UAMS telemedicine was associated with improved utilization of prenatal care among pregnant women with pre-existing diabetes. Telemedicine services did not differ from usual in-person services in clinical outcomes and medical expenditures.
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Affiliation(s)
- Yi-Shan Sung
- Institute for Digital Health & Innovation, University of Arkansas for Medical Sciences
| | - Donglan Zhang
- Department of Health Policy and Management, College of Public Health, University of Georgia, 100 Foster Road, Wright Hall 205D, Athens, GA 30677, United States.
| | - Hari Eswaran
- Institute for Digital Health & Innovation, University of Arkansas for Medical Sciences; Department of Health Policy and Management, College of Public Health, University of Georgia, 100 Foster Road, Wright Hall 205D, Athens, GA 30677, United States
| | - Curtis L Lowery
- Institute for Digital Health & Innovation, University of Arkansas for Medical Sciences; Department of Health Policy and Management, College of Public Health, University of Georgia, 100 Foster Road, Wright Hall 205D, Athens, GA 30677, United States
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Slade D, Ray R, Moretz C, Germain G, Laliberté F, Shen Q, Duh MS, MacKnight SD, Hahn B. Hospital Admission and Readmission Among US Patients Receiving Umeclidinium/Vilanterol or Tiotropium as Initial Maintenance Therapy for Chronic Obstructive Pulmonary Disease. Pulm Ther 2021; 7:203-19. [PMID: 33728597 DOI: 10.1007/s41030-021-00151-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 02/15/2021] [Indexed: 11/15/2022] Open
Abstract
Introduction Patients hospitalized for chronic obstructive pulmonary disease (COPD) exacerbations are at risk of further readmissions, increased treatment costs, and excess mortality. This study evaluated inpatient admissions and readmissions in patients receiving initial maintenance therapy with umeclidinium/vilanterol (UMEC/VI) versus tiotropium (TIO). Methods This retrospective, matched cohort study identified patients with COPD who initiated maintenance therapy with UMEC/VI or TIO from Optum’s de-identified Clinformatics Data Mart database between January 1, 2013, and December 31, 2018 (index date defined as earliest dispensing). Eligibility criteria included: ≥ 1 medical claim for COPD pre-index or on the index date; ≥ 12 months of continuous eligibility pre-index; age ≥ 40 years at index; no pre- or post-index asthma diagnosis; and no pre-index claims for medications containing inhaled corticosteroids, long-acting β2-agonists, or long-acting muscarinic antagonists. Outcomes included time to first on-treatment COPD-related inpatient admission, rate of on-treatment COPD-related admissions, and rate of all-cause and COPD-related readmissions within 30 and 90 days. Propensity score matching was used to adjust for potential confounders. Results Matched UMEC/VI and TIO cohorts each included 7997 patients and were balanced on baseline characteristics (mean age 70.9 years; female 47.1–47.6%). Over 12 months, patients initiating UMEC/VI had significantly reduced risk (hazard ratio [95% CI]: 0.87 [0.79, 0.96]; p = 0.006) and rates (rate ratio [95% CI]: 0.80 [0.72, 0.92]; p = 0.008) of COPD-related inpatient admissions compared with TIO. While all-cause readmission rates were similar between treatment cohorts, readmission rates among patients with an initial admission length of stay of 1–3 days were numerically lower for UMEC/VI versus TIO (30-day readmissions: 10.5% vs. 12.4%; 90-day readmissions: 15.5% vs. 19.8%). Similar patterns were observed for COPD-related readmissions. Conclusions These findings highlight the real-world benefits of dual therapy with UMEC/VI versus TIO in reducing inpatient admissions and readmissions in patients with COPD, which may translate to lower healthcare costs. Supplementary Information The online version contains supplementary material available at 10.1007/s41030-021-00151-y. Patients with chronic obstructive pulmonary disease (COPD) who are admitted to the hospital are more likely to be readmitted in the future, have higher healthcare costs, and are more likely to die from their illness. Patients who are readmitted to hospital have even higher treatment costs. Identifying which treatments are best at reducing the number of patients with COPD who are admitted to the hospital may help to improve outcomes and reduce the cost of COPD treatment. We used US healthcare claims data to compare two daily treatments for COPD, umeclidinium/vilanterol and tiotropium. We aimed to find out which treatment was more effective at reducing hospital admissions due to COPD. We also compared how many patients on each treatment were readmitted within 30 or 90 days of their original hospital admission for COPD. We found that patients who started treatment with umeclidinium/vilanterol were less likely to be admitted to the hospital for COPD than patients who started treatment with tiotropium. Similar numbers of patients on each treatment were readmitted to the hospital within 30 or 90 days after they were discharged. However, among patients whose initial hospital stay was short (1–3 days), readmissions within 30 or 90 days were less common with umeclidinium/vilanterol than tiotropium. These findings suggest that umeclidinium/vilanterol may be more effective than tiotropium at reducing the number of patients with COPD who need to be admitted or readmitted to hospital. Starting COPD treatment with umeclidinium/vilanterol may lead to better health outcomes and lower costs than tiotropium.
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Ucyigit MA. Outpatient management of hyperemesis gravidarum and the impact on inpatient admissions; A retrospective observational study. Eur J Obstet Gynecol Reprod Biol 2020; 254:298-301. [PMID: 33039838 DOI: 10.1016/j.ejogrb.2020.09.048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 09/23/2020] [Accepted: 09/28/2020] [Indexed: 12/27/2022]
Abstract
OBJECTIVES The objectives of this study were to investigate the impact of the Ambulatory Hyperemesis Unit at an inner-city teaching hospital since its establishment in 2012, on both the inpatient admission rate and length of stay for hyperemesis gravidarum, and to provide an estimate of the financial impact this service has on the hospital trust. STUDY DESIGN A retrospective observational analysis was undertaken at King's College Hospital, London, spanning a 12 year period. Data were collected from the admissions database, both before and after the unit opened. The number of inpatient spells per year, inpatient nights per year and length of stay were analysed (unpaired t-test). The estimated cost of inpatient care for hyperemesis gravidarum prior and subsequent to the unit opening was also compared. RESULTS The average number of inpatient spells per year before and after the unit opened was 243.25 and 254.13 spells respectively (p = 0.6128). The average number of inpatient nights per year was 424.5 vs. 227.38 nights respectively (p < 0.0001). The average length of inpatient stay per spell was 1.74 vs. 0.89 nights respectively (p < 0.0001). The estimated average cost of inpatient stays per year was £199,535 versus £106,866 respectively (p < 0.0001). CONCLUSIONS Although the total number of inpatient admissions did not appear to alter after outpatient services were established, the length of stay per patient admission and total number of inpatient nights per year were significantly reduced. This benefit is sustained over many years, and is likely due to the focused and accessible aftercare the ambulatory hyperemesis unit provides. As a consequence, there was a substantial estimated cost-saving to the hospital trust, of almost £100,000 per year.
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Affiliation(s)
- Miss Asli Ucyigit
- Early Pregnancy and Acute Gynaecology Unit, King's College Hospital, Denmark Hill, London, SE5 9RS, United Kingdom.
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Barua P, Narattharaksa K. The impact of the stateless health insurance scheme on inpatient service utilization of stateless children at the four selected district hospitals in Tak Province, Thailand. Int J Health Plann Manage 2019; 35:e12-e27. [PMID: 31710147 DOI: 10.1002/hpm.2913] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 09/13/2019] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE The objective of this study was to assess the impact of the stateless insurance scheme on inpatient service utilization of stateless patients in comparison to the universal coverage scheme (UCS) insurees and the uninsured. DESIGN The retrospective study used the routinely collected health data (eg, 43-file database) from January 1,2013, to December 31,2017. The study took a sample of 9528 child patients aged 0to 18years who had an inpatient (IP)admission at the four selected district hospitals in Tak Province. The outcome variable was IP utilization rate (admissions/person/year), while the exposure was the three-insurance status: uninsured, stateless, and UCS. With the counted outcome data, the researchers applied the Poisson regression, taking confounders into account, to measure the effect of exposure on outcome. RESULTS The overall median IP utilization rate was one admissions/person/year. Compared with the uninsured group, the stateless and the UCS insurees had 98% (incidence rate ratio [IRR]=1.980, 95% confidence interval [CI] = 1.250, 2.710) and 67% (IRR=1.670, 95% CI = 0.949, 2.390) higher IP admissions, respectively. The younger stateless insurees (2-3 years) had 16% (IRR=0.837, 95% CI=-0.036, 1.710) fewer admissions while oldest stateless insurees had 6% (IRR = 1.060, 95% CI = 0.235, 1.880) more admissions compared withtheir youngest uninsured counterpart (0-1 year). Stateless females had 21% (IRR=0.789, 95% CI = 0.344, 1.230) fewer IP admissions compared with their uninsured males counterparts. Overall IP utilization rate increased from 4% (IRR=1.040, 95% CI = 0.981,1.090) in 2014 to 14% (IRR=1.140, 95% CI = 1.070, 1.210) in 2017 compared with IP utilization in 2013. CONCLUSIONS The study suggests that inpatient utilization rate differs by insurance status with statistical significance. Further experimental studies are needed to understand the causal effect of the stateless insurance on adverse health outcomes in stateless children in the country.
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Affiliation(s)
- Proloy Barua
- Health Systems Management, Graduate School, Naresuan University, Phitsanulok, Thailand.,Independent Evaluation and Research Cell (IERC), BRAC International, Dhaka, Bangladesh
| | - Kanida Narattharaksa
- Health Systems Management, Graduate School, Naresuan University, Phitsanulok, Thailand.,Faculty of Medical Science, Naresuan University, Phitsanulok, Thailand
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Padwal JA, Burton BN, Fiallo AA, Swisher MW, Gabriel RA. The association of neuraxial versus general anesthesia with inpatient admission following arthroscopic knee surgery. J Clin Anesth 2019; 56:145-150. [PMID: 30807886 DOI: 10.1016/j.jclinane.2019.01.045] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 01/24/2019] [Accepted: 01/29/2019] [Indexed: 12/28/2022]
Abstract
STUDY OBJECTIVE Arthroscopic knee procedures are increasingly being performed in an outpatient setting. Appropriate intraoperative anesthesia is vital to prevent complications such as unanticipated hospital admission. We examined differences in complications between general (GA) vs neuraxial anesthesia (NA) as the primary anesthetic for patients undergoing arthroscopic knee procedures. DESIGN This was a retrospective cohort study. We queried the National Surgical Quality Improvement Program for arthroscopic knee procedures performed between 2007 and 2016. We compared postoperative complication rates between propensity-matched cohorts (NA vs GA). The anesthesia groups were matched based on age, race, BMI, gender, diabetes, smoking history, COPD, CHF, functional status, HTN, ASA class, steroid use, bleeding disorder history, and readmission status. Univariable and multivariable logistic regression were used to compare factors associated with inpatient admission - defined as hospital length of stay >1 day. PATIENTS A total of 57,494 patients were included - 55,257 GA and 2237 NA patients. MAIN RESULTS Among the matched cohorts, NA patients were significantly more likely to be admitted to the hospital postoperatively (p < 0.001). Neuraxial anesthesia (OR 5.93, 95% CI 4.90-7.21) use was also significant in the final multivariable regression model for inpatient admission. Additional significant predictors for inpatient admission included history of bleeding disorder (OR 5.44, 95% CI 2.14-12.76), Asian race (OR 6.47, 95% CI 4.90-8.56), COPD (OR 3.10, 95% CI 1.94-4.82), diabetes (OR 1.90, 95% CI 1.43-2.49), and increased operation time (OR 3.01, 95% CI 2.69-3.37). CONCLUSIONS NA was significantly associated with inpatient admission following knee arthroscopy. Further research should focus on examining the reason for this association and methods to reduce inpatient admission for patients undergoing arthroscopic knee procedures using neuraxial anesthesia.
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Affiliation(s)
- Jennifer A Padwal
- School of Medicine, University of California, San Diego-9500 Gilman Drive, San Diego, CA 92093, United States of America.
| | - Brittany N Burton
- School of Medicine, University of California, San Diego-9500 Gilman Drive, San Diego, CA 92093, United States of America.
| | - Alfredo A Fiallo
- Department of Anesthesiology, Division of Regional Anesthesia and Acute Pain, University of California, San Diego, UCSD Medical Cent Hillcrest, 200 W. Arbor Drive, San Diego, CA 92103-8770, United States of America.
| | - Matthew W Swisher
- Department of Anesthesiology, Division of Regional Anesthesia and Acute Pain, University of California, San Diego, UCSD Medical Cent Hillcrest, 200 W. Arbor Drive, San Diego, CA 92103-8770, United States of America.
| | - Rodney A Gabriel
- Department of Anesthesiology, Division of Regional Anesthesia and Acute Pain, University of California, San Diego, UCSD Medical Cent Hillcrest, 200 W. Arbor Drive, San Diego, CA 92103-8770, United States of America; Department of Medicine, Division of Biomedical Informatics, University of California, San Diego, San Diego - 9500 Gilman Dr. MC 0728, La Jolla, CA 92093-0728, United States of America.
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Ajnakina O, Trotta A, Forti MD, Stilo SA, Kolliakou A, Gardner-Sood P, Lopez-Morinigo J, Gaughran F, David AS, Dazzan P, Pariante C, Mondelli V, Murray RM, Fisher HL. Different types of childhood adversity and 5-year outcomes in a longitudinal cohort of first-episode psychosis patients. Psychiatry Res 2018; 269:199-206. [PMID: 30153597 DOI: 10.1016/j.psychres.2018.08.054] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Revised: 08/15/2018] [Accepted: 08/16/2018] [Indexed: 01/01/2023]
Abstract
Little is known about the impact of different forms of childhood adversity on outcomes in first-episode psychosis (FEP) patients beyond the first year of treatment. We investigated associations between different types of childhood adversity and outcomes of FEP patients over the 5 years following their first contact with mental health services for psychosis. 237 FEP cases aged 18-65 years were followed on average for 5 years after first presentation to psychiatric services in South London, UK. Childhood adversity prior to 17 years of age was assessed at baseline using the Childhood Experience of Care and Abuse Questionnaire (CECA.Q). The results showed that exposure to at least one type of childhood adversity was significantly associated with a lower likelihood of achieving symptomatic remission, longer inpatient stays, and compulsory admission over the 5-year follow-up. There was no evidence though of a dose-response effect. Some specificity was evident. Childhood parental separation was associated with significantly greater likelihood of non-compliance with antipsychotic medications, compulsory admission, and substance dependence. Institutional care was significantly associated with longer total length of inpatient stays; and parental death was significantly associated with compulsory admissions. Clinicians should screen FEP patients for childhood adversity and tailor interventions accordingly to improve outcomes.
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Affiliation(s)
- Olesya Ajnakina
- King's College London, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Antonella Trotta
- King's College London, Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Marta Di Forti
- King's College London, Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, London, UK; National Institute for Health Research (NIHR) Maudsley Biomedical Research Centre, South London, Maudsley NHS Foundation Trust, King's College London, London, UK
| | - Simona A Stilo
- King's College London, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Anna Kolliakou
- King's College London, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Poonam Gardner-Sood
- Imaging Trials Unit, University College London and University College London Hospitals NIHR Biomedical Research Centre, London UK; Centre for Medical Imaging, University College London, Charles Bell House, London, UK
| | - Javier Lopez-Morinigo
- King's College London, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Fiona Gaughran
- King's College London, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, London, UK; National Institute for Health Research (NIHR) Maudsley Biomedical Research Centre, South London, Maudsley NHS Foundation Trust, King's College London, London, UK; National Psychosis Unit, South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, London, UK
| | - Anthony S David
- King's College London, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, London, UK; National Institute for Health Research (NIHR) Maudsley Biomedical Research Centre, South London, Maudsley NHS Foundation Trust, King's College London, London, UK
| | - Paola Dazzan
- King's College London, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, London, UK; National Institute for Health Research (NIHR) Maudsley Biomedical Research Centre, South London, Maudsley NHS Foundation Trust, King's College London, London, UK
| | - Carmine Pariante
- National Institute for Health Research (NIHR) Maudsley Biomedical Research Centre, South London, Maudsley NHS Foundation Trust, King's College London, London, UK; King's College London, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Valeria Mondelli
- National Institute for Health Research (NIHR) Maudsley Biomedical Research Centre, South London, Maudsley NHS Foundation Trust, King's College London, London, UK; King's College London, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Robin M Murray
- King's College London, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, London, UK; National Institute for Health Research (NIHR) Maudsley Biomedical Research Centre, South London, Maudsley NHS Foundation Trust, King's College London, London, UK
| | - Helen L Fisher
- King's College London, Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, London, UK.
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Rieke K, McGeary C, Schmid KK, Watanabe-Galloway S. Risk Factors for Inpatient Psychiatric Readmission: Are There Gender Differences? Community Ment Health J 2016; 52:675-82. [PMID: 26303903 DOI: 10.1007/s10597-015-9921-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Accepted: 08/10/2015] [Indexed: 12/13/2022]
Abstract
The objectives of the study were to compare characteristics of women and men discharged from an inpatient psychiatric facility and to identify gender-specific risk factors associated with 30-day and 1-year readmission using administrative data. The sample included adults discharged from an inpatient psychiatric facility in a Midwestern city (N = 1853). The analysis showed that the 30-day readmission rate was significantly lower among women, but there was no difference in the 1-year readmission rate. Risk factors for readmission differed by gender. For example, for 30-day readmission, being on Medicare versus commercial insurance increased the odds for women (OR 3.08; 95 % CI 1.35-7.04) and taking first-generation antipsychotics versus no antipsychotics increased the odds for men (OR 2.09; 95 % CI 1.26-3.48). These findings suggest there are important differences between women and men readmitted to an inpatient psychiatric facility. Future strategies need to take into account gender-specific risk factors in order to improve long-term patient outcomes.
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Affiliation(s)
- Katherine Rieke
- Department of Epidemiology, University of Nebraska Medical Center, 984395 Nebraska Medical Center, Omaha, NE, 68198-4395, USA.
| | | | - Kendra K Schmid
- Department of Biostatistics, University of Nebraska Medical Center, Omaha, NE, USA
| | - Shinobu Watanabe-Galloway
- Department of Epidemiology, University of Nebraska Medical Center, 984395 Nebraska Medical Center, Omaha, NE, 68198-4395, USA
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Andreoli SM, Kofmehl E, Sobol SE. Is inpatient admission necessary following removal of airway foreign bodies? Int J Pediatr Otorhinolaryngol 2015; 79:1436-8. [PMID: 26194048 DOI: 10.1016/j.ijporl.2015.06.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Revised: 06/15/2015] [Accepted: 06/16/2015] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To determine the need for postoperative admission following airway foreign body retrieval by examining the preoperative presentation, operative details, and postoperative recovery. INTRODUCTION Inpatient admission following foreign body removal is common, however little evidence supports this practice. In the era of cost containment and prudent utilization of hospital resources, careful examination of the postoperative course following airway foreign body removal is required. METHODS A retrospective review of cases over a four year period from a pediatric tertiary care pediatric hospital was performed. All children presenting with concerns for airway foreign bodies were included. Children without identification of an airway foreign body during bronchoscopy were excluded. Microlaryngoscopy and bronchoscopy with airway foreign body extraction was performed. Details concerning demographics, operative findings, and pre and postoperative course including pulse oximetry were collected. All respiratory events, intubations, and persistent oxygen requirements were investigated. RESULTS Thirty five children underwent successful airway foreign body removal. The mean age was 3.2±2.6 years with a preponderance of males (68.6%). The retrieved items included: nuts (31.4%), popcorn (14.3%), seeds (8.6%), and inorganic materials (34.3%). Mean operative time was 29.7±25.6min. The mean length of stay following surgery was 1.3±1.9 days. Most patients (31/35) (88.6%) were extubated prior to transfer to recovery. 30/35 (85.7%) patients required no supplemental oxygen without desaturations following post anesthesia care unit (PACU) recovery. One patient developed laryngospasm requiring reintubation within 15min of surgery. Two patients were intubated prior to transfer for respiratory distress and remained intubated following surgery. Two patients breathing spontaneously prior to surgery were left intubated following surgery secondary to prolonged pneumonia treatment or multifocal foreign bodies with airway edema. All patients subsequently extubated without complication. In total, 30/31 (96.7%) of patients extubated in the operating room returned to room air oxygenation within 2h of surgery. CONCLUSIONS PACU observation and discharge is feasible in select children following airway foreign body extraction. Patients carefully monitored in the recovery unit without oxygen requirement are candidates for discharge. Inpatient monitoring is advised in 'children with preoperative respiratory distress or a complicated operative course.
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Affiliation(s)
- Steven M Andreoli
- Nemours Children's Specialty Care of Jacksonville Division of Pediatric Otolaryngology, Jacksonville, FL 32207 USA.
| | - Emma Kofmehl
- Children's Hospital of Philadelphia University of Pennsylvania, Perelman School of Medicine Department of Pediatric Otolaryngology Philadelphia, PA 19104 USA
| | - Steven E Sobol
- Children's Hospital of Philadelphia University of Pennsylvania, Perelman School of Medicine Department of Pediatric Otolaryngology Philadelphia, PA 19104 USA
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