Early recognition and treatment of OSA in hospitalized patients and its impact on health care utilization in rural population: a real-world study

STUDY OBJECTIVES

Obstructive sleep apnea (OSA) is a highly prevalent, yet under-diagnosed condition. Due to its adverse impact on risk for cardiopulmonary disorders, there is interest in pro-active screening of OSA in hospitalized patients. We studied the long-term outcome of such screened patients who were initiated on positive airway pressure (PAP) therapy.

METHODS

Hospitalized patients who screened positive for OSA and were confirmed with post-discharge polysomnography (PSG) were dichotomized by PAP adherence and followed for a period of 12 months to evaluate for the composite endpoint of hospital readmissions and emergency room (ED) visits for cardiopulmonary reasons. Cost analysis between the two groups was also conducted.

RESULTS

2042 hospitalized patients were assessed for OSA as part of a hospital sleep medicine program from August 2019 to June 2023. Of these, 293 patients were diagnosed with OSA and prescribed PAP therapy. Of these 293 patients, 108 were adherent to therapy and 185 were non-adherent. The overall characteristics of the groups included a mean (SD) age: 58 years (12.82), mean BMI (kg/m2): 39.72 (10.71), male sex: 57%, and apnea-hypopnea index (AHI): 25.49 (26). 78%, 41% and 43% had hypertension, congestive heart failure, and diabetes mellitus, respectively.

The composite endpoint of hospital readmissions and ED visits for cardiovascular and pulmonary reasons was significantly higher in the non-adherent group as compared to the adherent group (HR: 1.24, 95% CI: 1-1.54) (p=0.03). The cost of care for both hospital billing (HB) as well as professional billing(PB) was higher for the non-adherent group ($1455.6 vs $1723.5, p = 0.004) in HB cost and $130.9 vs $144.7, p<0.001) in PB. Length of stay was higher for non-adherent patients (2.7 ± 5.1 days vs. 2.3 ± 5.9 days).

CONCLUSIONS

Hospitalized patients diagnosed with OSA and adherent to therapy have reduced readmissions and ED visits for cardiopulmonary reasons 12 months after discharge. Adherent patients have reduced cost of health care and length of stay during hospitalizations.

On the short-term impact of pollution: The effect of PM 2.5 on emergency room visits

In this paper, we study the short-term effect of fine particulate matter (PM 2.5) exposure on respiratory emergency room (ER) visits in Chile, a middle-income country with high levels of air pollution. To instrument for PM 2.5, we use wind speed at different altitudes (pressure levels). Unlike previous papers, our data allow us to study the impact of high pollution levels across all age groups. We find that a 1 μg per cubic meter (μg/m3 ) increase in PM 2.5 exposure for 1 day increases ER visits for respiratory illness by 0.36%. The effect is positive and significant for all age groups. Furthermore, the coefficients on government environmental alerts suggest that avoidance behavior becomes increasingly significant across all age groups as restrictions become more severe.

Partly unequal receipt of healthcare in last month of life in amyotrophic lateral sclerosis: a retrospective cohort study of the Stockholm region

Context

In amyotrophic lateral sclerosis (ALS), equal care is important, given that the disease often has complex symptoms at the end of life.

Objectives

The aim was to study the possible associations between demographic and clinical factors, including age, sex, and frailty, with acute healthcare utilization in the last month of life, measured by emergency room (ER) visits, admissions to acute hospitals and, acute hospitals as place of death, among patients with ALS. A second aim was to study whether receipt of specialized palliative care (SPC) affects above-mentioned healthcare utilization.

Methods

Observational, retrospective study based on Region Stockholm's administrative data warehouse (VAL) in Sweden. Data were retrieved for 2015-2021 and analyzed with descriptive statistics and logistic regression models.

Results

All deceased patients (n = 448) ≥18 years with ALS were included. The mean age was 70.5 years, 46% were women and 58% had risk of frailty according to Hospital Frailty Risk Score (HFRS). Ninety-nine (22%) were nursing home residents and 49% received SPC. The receipt of SPC in patients with ALS was equal in relation to gender, socio-economic standing, frailty, and age <75 years. Patients ≥75 years, those with dementia and/or residing in nursing homes (NH) were less likely to receive SPC (P = 0.01, P = 0.03 and P = 0.002, respectively). Receipt of SPC reduced ER visits (29% vs. 48%, P < 0.001) and deaths at hospital (12% vs. 48%, P <0.001). Patients who were frail, had a higher risk of ER visits and were more likely to die at an acute hospital setting (P < 0.001 and P = 0.004). NH residents were less likely to have ER visits and to die in hospital (P = 0.002 and P = 0.005).

Conclusions

The results indicate partly unequal distribution of palliative care, however the actual, individual preferences cannot be deducted from registry studies. All patients with ALS should be offered SPC when needed.

Key message

This register study shows that receipt of SPC in patients with ALS is equal in relation to gender, socioeconomic standing, frailty, and age <75 years, while those ≥75 years, with dementia, or residing in NH were somewhat less likely to receive SPC. Receipt of SPC reduces ER visits and acute hospital admissions.

Identifying the process and agency characteristics associated with poor utilization outcomes in home healthcare

This study identified the process and agency characteristics associated with poor utilization outcomes - higher percentages of patients (i) admitted to an acute care organization and (ii) visited an emergency room (ER) unplanned without hospitalization - for home health agencies (HHAs) in the United States. We conducted a secondary analysis of data about HHAs' various characteristics, process adherence levels, and utilization outcomes collected from disparate public repositories for 2010-2022. We developed descriptive tree-based models using HHAs' hospital admission or ER visit percentages as response variables. Across the board, hospital admission percentages have steadily improved while ER percentages deteriorated for an extended period. Recently, checking for fall risks and depression was associated with improved outcomes for urban agencies. In general, rural HHAs had worse utilization outcomes than urban HHAs. Targeted investments and improvement initiatives can help rural HHAs close the urban-rural gap in the future.

Healthcare Costs and Healthcare Utilization Outcomes of Vitamin D3 Supplementation at 5000 IU Daily during a 10.9 Month Observation Period within a Pragmatic Randomized Clinical Trial

Vitamin D insufficiency has been linked to multiple conditions including bone disease, respiratory disease, cardiovascular disease, diabetes, and cancer. Observational studies indicate lower healthcare costs and healthcare utilization with sufficient vitamin D levels. The secondary aims of our previously published pragmatic clinical trial of vitamin D3 supplementation were comparisons of healthcare costs and healthcare utilization. Comparisons were made between the vitamin D3 at 5000 IU supplementation group and a non-supplemented control group. Costs of care between the groups differed but were not statistically significant. Vitamin D3 supplementation reduced healthcare utilization in four major categories: hospitalizations for any reason (rate difference: -0.19 per 1000 person-days, 95%-CI: -0.21 to -0.17 per 1000 person-days, p < 0.0001); ICU admissions for any reason (rate difference: -0.06 per 1000 person-days, 95%-CI: -0.08 to -0.04 per 1000 person-days, p < 0.0001); emergency room visits for any reason (rate difference: -0.26 per 1000 person-days, 95%-CI: -0.46 to -0.05 per 1000 person-days, p = 0.0131; and hospitalizations due to COVID-19 (rate difference: -8.47 × 10-3 per 1000 person-days, 95%-CI: -0.02 to -1.05 × 10-3 per 1000 person-days, p = 0.0253). Appropriately powered studies of longer duration are recommended for replication of these utilization findings and analysis of cost differences.

Predictors and Outcomes of Falls in Older Adults Presenting to the Emergency Room in Saudi Arabia: A Cross-Sectional Analysis

INTRODUCTION

Saudi Arabia is witnessing a demographic shift characterized by a rising elderly population. Cases of fall in this demographic have emerged as a significant health concern, especially in emergency room (ER) settings. Despite this, there is limited research on the causes and outcomes of such incidents. This study intends to bridge the gap in understanding the factors leading to falls in elderly patients presenting to ERs and the subsequent outcomes. Such understanding is pivotal for the formulation of effective prevention strategies and enhanced healthcare services for the elderly.

METHODS

To achieve the study's objectives, we employed SPSS software for Windows, version 28.0 (IBM Corp., Armonk, NY) for data analysis. We collected demographic information, including age, gender, education, employment status, and location, to measure patient satisfaction with the quality and responsiveness of emergency care, using Likert scale responses via electronic survey conducted as a cross-sectional study from January 2023 to August 2023, summarizing it using descriptive statistics. We analyzed categorical variables by frequencies and percentages. Chi-square tests were utilized to examine differences in distribution across categories for fall factors, and a p-value below 0.05 was deemed significant. Through logistic regression, we pinpointed the predictors of falls among older adults, showcasing the strength and direction of these relationships. Adjusted odds ratios with 95% confidence intervals were documented. A perception survey was also conducted to evaluate ER patient satisfaction.

RESULTS

Our results shed light on various aspects of fall prevention and emergency care. There was a pronounced representation in age groups of 18-24 and 25-34 years, indicating the need for interventions tailored to different age groups. Patterns were identified where subjects engaged in limited physical activity and consumed alcohol infrequently. Mobility and balance problems were commonly found, stressing the need to address these issues. Chronic conditions such as hypertension and diabetes correlated with fall incidents. Additionally, sociodemographic factors like gender, education, and employment status played a role in influencing the risk of falls. Although age and location seemed to have a less pronounced effect, there exists an opportunity to enhance communication and patient participation in emergency care for improved experiences.

CONCLUSION

The findings from our study provide crucial insights into the prevention of falls and enhancement of emergency care for Saudi Arabia's elderly population. By revealing the intricate relationships between sociodemographic attributes, health indicators, chronic ailments, and incidents of falls, we emphasize the need for well-rounded interventions. There is a pressing requirement for comprehensive fall prevention initiatives tailored to specific risk groups. Additionally, improving ER services is integral to ensuring the safety and well-being of older adults. This research can serve as a foundational resource for healthcare professionals and policymakers to devise robust strategies to reduce fall-related injuries and elevate the quality of emergency care outcomes.

Are restrictions in sales hours of alcohol associated with fewer emergency room visits in Lithuania? An interrupted time-series analysis

INTRODUCTION

On 1 January 2018, an amendment to the alcohol control law was introduced in Lithuania which, among other changes, reduced trading hours for alcoholic beverages by 4 h for weekdays and Saturdays, and by 9 h for Sundays. The objective of the current study was to quantify the potential association of this law with the numbers and types of emergency room (ER) visits in Lithuania, in general and specifically for Sundays, for all ER visits, for injury-related ER visits and specifically for alcohol poisoning as a 100% alcohol-attributable cause.

METHODS

Sex-stratified time-series analysis-based models for the period 2016-2019 were used to test for associations and for potential alternative explanations (e.g., the increase in minimum legal drinking age, which occurred at the same time).

RESULTS

Overall, while the reduction in sales hours for both sexes was associated with slight increases in all types and in injury-related ER visits on a weekly basis, the association with ER visits for alcohol poisoning was in the opposite direction for men in all models. Specifically, among men, it was associated with an approximate decrease of 20% of alcohol poisoning-related ER visits on Sundays and an approximate decrease of 12% of alcohol poisoning-related ER visits for all seven weekdays.

DISCUSSION AND CONCLUSIONS

As predicted, restrictions on availability were associated with marked reductions in ER visits for alcohol poisoning in men. However, contrary to expectations, there were no overall reductions in overall ER visits, nor reductions in injury-related ER visits.

Geographic information system-based mapping of air pollution & emergency room visits of patients for acute respiratory symptoms in Delhi, India (March 2018-February 2019)

Background & objectives

Studies assessing the spatial and temporal association of ambient air pollution with emergency room visits of patients having acute respiratory symptoms in Delhi are lacking. Therefore, the present study explored the relationship between spatio-temporal variation of particulate matter (PM)_2.5 concentrations and air quality index (AQI) with emergency room (ER) visits of patients having acute respiratory symptoms in Delhi using the geographic information system (GIS) approach.

Methods

The daily number of ER visits of patients having acute respiratory symptoms (less than or equal to two weeks) was recorded from the ER of four hospitals of Delhi from March 2018 to February 2019. Daily outdoor PM_2.5 concentrations and air quality index (AQI) were obtained from the Delhi Pollution Control Committee. Spatial distribution of patients with acute respiratory symptoms visiting ER, PM_2.5 concentrations and AQI were mapped for three seasons of Delhi using ArcGIS software.

Results

Of the 70,594 patients screened from ER, 18,063 eligible patients were enrolled in the study. Winter days had poor AQI compared to moderate and satisfactory AQI during summer and monsoon days, respectively. None of the days reported good AQI (<50). During winters, an increase in acute respiratory ER visits of patients was associated with higher PM_2.5 concentrations in the highly polluted northwest region of Delhi. In contrast, a lower number of acute respiratory ER visits of patients were seen from the 'moderately polluted' south-west region of Delhi with relatively lower PM_2.5 concentrations.

Interpretation & conclusions

Acute respiratory ER visits of patients were related to regional PM_2.5 concentrations and AQI that differed during the three seasons of Delhi. The present study provides support for identifying the hotspots and implementation of focused, intensive decentralized strategies to control ambient air pollution in worst-affected areas, in addition to the general city-wise strategies.

[Effect of Air Pollution on Emergency Room Visits for Respiratory Diseases in Lanzhou]

Objective To explore the effect of air pollution on the number of emergency room visits for respiratory diseases in residents at different ages and its seasonal changes in Lanzhou,so as to provide a scientific basis for the early prevention of respiratory diseases in Lanzhou. Methods The daily number of emergency room visits for respiratory diseases in three class A hospitals in Lanzhou from January 1,2013 to December 31,2017,as well as the air pollutants and meteorological data of Lanzhou in the same period,was collected.After controlling the confounding factors including long-term trend of time,meteorological factors and day-of-week effect using a generalized additive model,we analyzed the relationships between air pollutants and the daily number of emergency room visits for respiratory diseases,and explored whether there was a lag effect of air pollutants.Results From 2013 to 2017,the emergency room visits for respiratory diseases in Lanzhou had a total number of 124 871,with an average of 69(1-367)visits per day.The single pollutant model showed that among the six conventional air pollutants monitored in Lanzhou,PM _2.5,PM₁₀,NO₂,SO₂ and O₃8h had a lag effect on the number of emergency room visits for respiratory diseases.For every 10 μg/m ³ increase in the concentration of PM_2.5 (lag02:t=4.792, P=0.001), PM₁₀ (lag2:t=3.421, P<0.001), NO₂ (lag6:t=3.654, P=0.003), SO₂(lag06:t=4.712, P<0.001)and O₃8h (lag07:t=3.021, P=0.012), the number of emergency room visits for respiratory diseases increased by 0.900%(95% CI:0.573%-1.249%), 0.083%(95% CI:0.012%-0.153%), 1.293%(95% CI:0.867%-1.720%), 3.851%(95% CI:2.675%-5.041%)and 0.737%(95% CI:0.129%-1.348%), respectively.For every 1 mg/m³ increase in the concentration of CO(lag0:t=3.564,P<0.001),the number of emergency room visits for respiratory diseases increased by 2.556% (95%CI: 1.493%-3.629%). In gender stratification, PM_2.5(male:t=3.124, P=0.019;female:t=3.418, P=0.007), PM₁₀(male:t=2.980, P=0.160;female:t=2.997, P=0.013)and CO(male:t=4.117, P=0.001;female:t=4.629, P<0.001)in winter had stronger effects on the emergency room visits for respiratory diseases in females than that in males, while the effects of NO₂(male:t=3.020, P=0.107;female:t=3.006, P=0.128), SO₂(male:t=4.101, P<0.001;female:t=3.820, P<0.001)and O₃8h(male:t=3.660, P=0.022;female:t=3.517, P=0.018)in winter showed an opposite trend.In age stratification, the increase in the daily average concentration of PM_2.5(0-14 years old:t=3.520, P=0.008), PM₁₀(0-14 years old:t=3.840, P<0.001), SO₂(0-14 years old:t=4.570, P<0.001), CO(0-14 years old:t=4.102, P=0.002)in winter would increase the emergency visits for respiratory diseases in the 0-14-year-old population.The daily average concentration of O₃8h(0-14 years old:t=4.210, P<0.001;15-64 years old:t=3.807, P=0.001)in summer only affected the visits of the 0-14-year-old and the 15-64-year-old populations, and the air pollutants had no significant effect on the visits of those≥65 years old.The double pollutant model analysis revealed that after introducing 5 other pollutants respectively, PM_2.5, PM₁₀, NO₂, SO₂ and O₃8h significantly increased the emergency room visits for respiratory diseases, and CO had a more obvious effect than that predicted with the single pollutant model. Conclusion The rises in the concentrations of six air pollutants in Lanzhou will increase the emergency room visits for respiratory diseases, and the patterns vary with different genders, ages and seasons.

Short-Term Exposure to Ambient Air Pollution and Increased Emergency Room Visits for Skin Diseases in Beijing, China

Skin diseases have become a global concern. This study aims to evaluate the associations between ambient air pollution and emergency room visits for skin diseases under the background of improving air quality in China. Based on 45,094 cases from a general hospital and fixed-site monitoring environmental data from 2014–2019 in Beijing, China, this study used generalized additive models with quasi-Poisson regression to estimate the exposure–health associations at lag 0–1 to lag 0–7. PM_2.5 and NO₂ exposure were associated with increased emergency room visits for total skin diseases (ICD10: L00-L99). Positive associations of PM_2.5, PM₁₀, O₃ and NO₂ with dermatitis/eczema (ICD-10: L20–30), as well as SO₂ and NO₂ with urticaria (ICD-10: L50) visits were also found. For instance, a 10 μg/m³ increase in PM_2.5 was associated with increases of 0.7% (95%CI: 0.2%, 1.2%) in total skin diseases visits at lag 0–5 and 1.1% (95%CI: 0.6%, 1.7%) in dermatitis/eczema visits at lag 0–1, respectively. For PM_2.5, PM₁₀ and CO, stronger annual associations were typically observed in the high-pollution (2014) and low-pollution (2018/2019) years. For instance, a 10 μg/m³ increase in PM_2.5 at lag 0–5 was associated with increases of 1.8% (95%CI: 1.0%, 2.6%) and 2.3% (95%CI: 0.4%, 4.3%) in total skin disease visits in 2014 and 2018, respectively. Our study emphasizes the necessity of controlling the potential health hazard of air pollutants on skin, although significant achievements in air quality control have been made in China.

Time-series analysis of ambient PM2.5 and cardiorespiratory emergency room visits in Lima, Peru during 2010-2016

INTRODUCTION

There have been no time-series studies of air pollution in Peru. Here we evaluate the effect of ambient PM_2.5 on emergency room (ER) visits in Lima.

METHODS

We estimated daily PM_2.5 levels at a 1 km² resolution during 2010-2016 using ground measurements, satellite data, and chemical transport model simulations. Population-weighted average daily PM_2.5 levels were calculated for each district in Lima (n = 40), and assigned to patients based on residence. ER visits for respiratory and circulatory diseases were gathered from nine large public hospitals. Poisson regression was used to estimate the rate ratio for daily ER visits with change in daily PM_2.5, controlling for meteorology, time trends, and district.

RESULTS

For each interquartile range (IQR) increase in PM_2.5, respiratory disease ER visits increased 4% (95% CI: 0-5%), stroke visits 10% (3-18%), and ischemic heart disease visits (adults, 18-64 years) 11% (-1, 24%). Districts with higher poverty showed significantly stronger associations of PM_2.5 and respiratory disease ER visits than districts with lower poverty. Effects were diminished 24-42% using Lima-wide instead of district-specific PM_2.5 levels.

CONCLUSIONS

Short-term exposure to ambient PM_2.5 is associated with increases in ER visits in Lima for respiratory diseases and stroke, and among middle-aged adults, ischemic heart disease.

Reducing potentially preventable health events among patients with asthma through multi-state, multi-center quality improvement program

INTRODUCTION

Enhancing Care for Patients with Asthma is a multi-state, multi-center quality improvement program developed to augment guideline-based practice among health care providers through Plan-Do-Study-Act cycle. This study examined the association between the implementation of the guideline-based quality improvement program and subsequent changes in asthma-related emergency room visits and hospitalizations.

METHODS

This retrospective, interrupted time-series study used administrative claims data from a private insurer that provided coverage to patients receiving care from participating health centers (15 centers in New Mexico, Oklahoma, Texas, and Illinois). The 12-month implementation period started in January 2013 for centers in Cohort 1 and October 2013 for centers in Cohort 2. The claims of 1,828 patients with asthma from January 2012 to May 2015 were analyzed. The data included 12-month pre-program implementation, 12-month program implementation, and 5-month post-program completion periods.

RESULTS

The average number of asthma-related emergency room visits and hospitalizations decreased from 2.22 to 1.38 and 1.97 to 1.04 per 100 patients per month, respectively, in the 12-month pre-implementation period as compared to 12-month implementation period. The results of three-level generalized linear mixed models found that during the 12-month implementation period, patients had 37.7% and 47.1% lower rates of emergency room visits and hospitalizations, respectively, compared to the 12-month pre-implementation period (p < 0.001 in both comparisons).

CONCLUSIONS

Enhancing Care for Patients with Asthma is an effective quality improvement program that was successfully executed in diverse geographical states and associated with reductions in potentially preventable health events. The findings support the widespread use of the program in other settings.

Disparities in Health Care Utilization Between Asian Immigrant Women and Non-Hispanic White Women in the United States

Background: Asians accounted for 30% of all U.S. immigrants in 2014, of which 53% were women. Foreign-born Asian immigrant (FBAI) women experience difficulties in obtaining timely and needed health care due to multifaceted barriers. This study examined factors influencing health service utilization among FBAI women compared with native-born (non-Hispanic) White American (NBWA) women. Materials and Methods: A secondary data analysis was conducted using the 2014-2015 California Health Interview Survey. Guided by a modified version of Andersen's behavioral model of health service utilization, FBAI women aged 18 to 64 (n = 1,021) were compared with NBWA women of the same ages (n = 7,086). Outcome variables included having at least one doctor's visit in the past year and having an emergency room (ER) visit in the past year. Analyses included descriptive statistics, t-tests, chi-square tests, and multivariate logistic regressions. Results: FBAI women were significantly less likely to have at least one doctor's visit in the past year and were less likely to have a usual source of care than NBWA women. Significant predictors of having at least one doctor's visit for FBAI women were having high school education, having a usual source of care, having medical insurance, and having a chronic disease. The only significant predictor of having an ER visit for FBAI women was having a chronic disease. Conclusions: Health care providers must be aware of lower levels of health service utilization among FBAI women than NBWA women regardless of whether or not the FBAI women have chronic conditions. It is important to educate these women on the importance of regular health care visits.

Housing Instability Results in Increased Acute Care Utilization in an Urban HIV Clinic Cohort

Background

People living with HIV (PLWH) who experience homelessness and unstable housing (HUH) often have fragmented health care. Research that incorporates granular assessments of housing status and primary care visit adherence to understand patterns of acute care utilization can help pinpoint areas for intervention.

Methods

We collected self-reported living situation, categorized as stable (rent/own, hotel/single room occupancy), unstable (treatment/transitional program, staying with friends), or homeless (homeless shelter, outdoors/in vehicle) at an urban safety-net HIV clinic between February and August 2017 and abstracted demographic and clinical information from the medical record. Regression models evaluated the association of housing status on the frequency of acute care visits—urgent care (UC) visits, emergency department (ED) visits, and hospitalizations—and whether suboptimal primary care visit adherence (<75%) interacted with housing status on acute care visits.

Results

Among 1198 patients, 25% experienced HUH. In adjusted models, unstable housing resulted in a statistically significant increase in the incidence rate ratio for UC visits (incidence rate ratio [IRR], 1.35; 95% confidence interval [CI], 1.10 to 1.66; P < .001), ED visits (IRR, 2.12; 95% CI, 1.44 to 3.13; P < .001), and hospitalizations (IRR, 1.75; 95% CI, 1.10 to 2.77; P = 0.018). Homelessness led to even greater increases in UC visits (IRR, 1.75; 95% CI, 1.29 to 2.39; P < .001), ED visits (IRR, 4.18; 95% CI, 2.77 to 6.30; P < .001), and hospitalizations (IRR, 3.18; 95% CI, 2.03 to 4.97; P < .001). Suboptimal visit adherence differentially impacted UC and ED visits by housing status, suggesting interaction.

Conclusions

Increased acute care visit frequency among HUH-PLWH suggests that interventions at these visits may create opportunities to improve care.

Insight Into Health Care Services: A Characterization of Emergency Room Visits and Economic Hazards in the United States

OBJECTIVE

This study explores the impact of economic hazard areas on hospital-based emergency departments to determine whether economically hazardous environments, characterized by the change of population, income per capita, and unemployment rate, experience a higher number of emergency room visits than areas of lower rated economic hazard risk in the United States.

METHOD

A cross-sectional design was used of a nationally constructed data set of hospital-based emergency departments of over 6,000 hospitals in the United States. We identified our quality outcome measure as the emergency room visits rate within a hospital service area. We created the variable by dividing the number of emergency room visits by the population of the hospital services area in which the emergency room was located.

RESULTS

Results indicate that there is a difference in the incident rate ratio of emergency room visits between environments considered to be experiencing greater amounts of hazard, compared to lower amounts of hazard.

CONCLUSION

Hospital administrators and health policy-makers need to work in conjunction to focus efforts on public safety as a key objective in the delivery of emergency medical care. One crucial effort that hospital administrators need to focus on is improving emergency room capacity and efficiency as part of the disaster preparedness plan (Disaster Med Public Health Prep. 2019;13:470-475).

Coordinated Asthma Program Improves Asthma Outcomes in High-Risk Children

Innovative approaches within primary care are needed to reduce fragmented care, increase continuity of care, and improve asthma outcomes in children with asthma. Our objective was to assess the impact of coordinated team-based asthma care on unplanned asthma-related health care utilization. A multidisciplinary asthma team was developed to provide coordinated care to high-risk asthma patients. Patients received an in-depth diagnostic and family needs assessment, asthma education, and coordinated referral to social and community services. Over a 2-year period, 141 patients were followed. At both 1 and 2 years postintervention, there was a significant decrease from preintervention rates in urgent care visits (40%, P = .002; 50%, P < .0001), emergency department visits (63%, P < .0001; 70%, P < .0001), and inpatient hospitalization (69%, P = .002; 54%, P = .04). Our coordinated asthma care program was associated with a reduction in urgent care visits, emergency department visits, and inpatient hospitalizations among high-risk children with asthma.

Associations of PM2.5 and Black Carbon with Hospital Emergency Room Visits during Heavy Haze Events: A Case Study in Beijing, China

In January 2013, severe haze events over northeastern China sparked substantial health concerns. This study explores the associations of fine particulate matter less than 2.5 μm (PM_2.5) and black carbon (BC) with hospital emergency room visits (ERVs) during a haze season in Beijing. During that period, daily counts of ERVs for respiratory, cardiovascular and ocular diseases were obtained from a Level-3A hospital in Beijing from 1 December 2012 to 28 February 2013, and associations of which with PM_2.5 and BC were estimated by time-stratified case-crossover analysis in single- and two-pollutant models. We found a 27.5% (95% confidence interval (CI): 13.0, 43.9%) increase in respiratory ERV (lag02), a 19.4% (95% CI: 2.5, 39.0%) increase in cardiovascular ERV (lag0), and a 12.6% (95% CI: 0.0, 26.7%) increase in ocular ERV (lag0) along with an interquartile range (IQR) increase in the PM_2.5. An IQR increase of BC was associated with 27.6% (95% CI: 9.6, 48.6%) (lag02), 18.8% (95% CI: 1.4, 39.2%) (lag0) and 11.8% (95% CI: −1.4, 26.8%) (lag0) increases for changes in these same health outcomes respectively. Estimated associations were consistent after adjusting SO₂ or NO₂ in two-pollutant models. This study provides evidence that improving air quality and reducing haze days would greatly benefit the population health.

Association between parental access to paid sick leave and children's access to and use of healthcare services

BACKGROUND

We examined the association between parental access to paid sick leave (PPSL) and children's use of preventive care and reduced likelihood of delayed medical care and emergency room (ER) visits.

METHODS

We used the child sample of the National Health Interview Survey data (linked to the adult and family samples) from 2011 through 2015 and logistic and negative binomial regression models.

RESULTS

Controlling for covariates, the odds of children with PPSL receiving flu vaccination were 12.5% [95%CI: 1.06-1.19] higher and receiving annual medical checkups were 13.2% [95%CI: 1.04-1.23] higher than those of children without PPSL. With PPSL, the odds of children receiving delayed medical care because of time mismatch were 13.3% [95%CI: 0.76-0.98] lower, and being taken to ER were 53.6% [95%CI: 0.27-0.81] lower than those of children without PPSL. PPSL was associated with 11% [95%CI: 0.82-0.97] fewer ER visits per year.

CONCLUSION

PPSL may improve children's access and use of healthcare services and reduce the number of ER visits. Am. J. Ind. Med. 60:276-284, 2017. © 2017 Wiley Periodicals, Inc.

The Impacts of Air Temperature on Accidental Casualties in Beijing, China

Emergency room (ER) visits for accidental casualties, according to the International Classification of Deceases 10th Revision Chapters 19 and 20, include injury, poisoning, and external causes (IPEC). Annual distribution of 187,008 ER visits that took place between 2009 and 2011 in Beijing, China displayed regularity rather than random characteristics. The annual cycle from the Fourier series fitting of the number of ER visits was found to explain 63.2% of its total variance. In this study, the possible effect and regulation of meteorological conditions on these ER visits are investigated through the use of correlation analysis, as well as statistical modeling by using the Distributed Lag Non-linear Model and Generalized Additive Model. Correlation analysis indicated that meteorological variables that positively correlated with temperature have a positive relationship with the number of ER visits, and vice versa. The temperature metrics of maximum, minimum, and mean temperatures were found to have similar overall impacts, including both the direct impact on human mental/physical conditions and indirect impact on human behavior. The lag analysis indicated that the overall impacts of temperatures higher than the 50th percentile on ER visits occur immediately, whereas low temperatures show protective effects in the first few days. Accidental casualties happen more frequently on warm days when the mean temperature is higher than 14 °C than on cold days. Mean temperatures of around 26 °C result in the greatest possibility of ER visits for accidental casualties. In addition, males were found to face a higher risk of accidental casualties than females at high temperatures. Therefore, the IPEC-classified ER visits are not pure accidents; instead, they are associated closely with meteorological conditions, especially temperature.

Association between Ambient Air Pollution and Emergency Room Visits for Respiratory Diseases in Spring Dust Storm Season in Lanzhou, China

Background: Air pollution has become a major global public health problem. A number of studies have confirmed the association between air pollutants and emergency room (ER) visits for respiratory diseases in developed countries and some Asian countries, but little evidence has been seen in Western China. This study aims to concentrate on this region. Methods: A time-series analysis was used to examine the specific effects of major air pollutants (PM₁₀, SO₂ and NO₂) on ER visits for respiratory diseases from 2007 to 2011 in the severely polluted city of Lanzhou. We examined the effects of air pollutants for stratified groups by age and gender, accounting for the modifying effect of dust storms in spring to test the possible interaction. Results: Significant associations were found between outdoor air pollution concentrations and respiratory diseases, as expressed by daily ER visits in Lanzhou in the spring dust season. The association between air pollution and ER visits appeared to be more evident on dust days than non-dust days. Relative risks (RRs) and 95% CIs per 10 µg/m³ increase in 3-day PM₁₀ (L3), 5-day SO₂ (L5), and the average of current and previous 2-day NO₂ (L01) were 1.140 (1.071–1.214), 1.080 (0.967–1.205), and 1.298 (1.158–1.454), respectively, on dust days. More significant associations between PM₁₀, SO₂ and NO₂ and ER visits were found on dust days for elderly females, elderly males and adult males, respectively. Conclusions: This study strengthens the evidence of dust-exacerbated ER visits for respiratory diseases in Lanzhou.

Effects of Air Pollution on Hospital Emergency Room Visits for Respiratory Diseases: Urban-Suburban Differences in Eastern China

A study on the relationships between ambient air pollutants (PM_2.5, SO₂ and NO₂) and hospital emergency room visits (ERVs) for respiratory diseases from 2013 to 2014 was performed in both urban and suburban areas of Jinan, a heavily air-polluted city in Eastern China. This research was analyzed using generalized additive models (GAM) with Poisson regression, which controls for long-time trends, the “day of the week” effect and meteorological parameters. An increase of 10 μg/m³ in PM_2.5, SO₂ and NO₂ corresponded to a 1.4% (95% confidence interval (CI): 0.7%, 2.1%), 1.2% (95% CI: 0.5%, 1.9%), and 2.5% (95%: 0.8%, 4.2%) growth in ERVs for the urban population, respectively, and a 1.5% (95%: 0.4%, 2.6%), 0.8% (95%: −0.7%, 2.3%), and 3.1% (95%: 0.5%, 5.7%) rise in ERVs for the suburban population, respectively. It was found that females were more susceptible than males to air pollution in the urban area when the analysis was stratified by gender, and the reverse result was seen in the suburban area. Our results suggest that the increase in ERVs for respiratory illnesses is linked to the levels of air pollutants in Jinan, and there may be some urban-suburban discrepancies in health outcomes from air pollutant exposure.

Ozone is associated with cardiopulmonary and stroke emergency hospital visits in Reykjavík, Iceland 2003-2009

BACKGROUND

Air pollution exposure is associated with hospital admissions and emergency room visits for cardiopulmonary disease and stroke. Iceland's capital area, Reykjavik, has generally low air pollution levels, but traffic and natural sources contribute to pollution levels. The objective of this study was to investigate temporal associations between emergency hospital visits and air pollutants ozone (O3), nitrogen dioxide (NO2), and particulate matter (PM10) in the Icelandic capital area.

METHODS

We constructed a time series of the daily number of adults who visited the emergency room, or were acutely admitted for stroke or cardiorespiratory causes to Landspitali University Hospital 1 January 2003 - 31 December 2009 from the hospital in-patient register. We used generalized additive models assuming Poisson distribution, to analyze the daily emergency hospital visits as a function of the pollutant levels, and adjusted for meteorological variables, day of week, and time trend with splines.

RESULTS

Daily emergency hospital visits increased 3.9% (95% confidence interval (CI) 1.7-6.1%) per interquartile (IQR) change in average O3 the same and two previous days. For females, the increase was 7.8% (95% CI 3.6-12.1) for elderly (70+), the increase was 3.9% (95% CI 0.6-7.3%) per IQR increase of NO2. There were no associations with PM10.

CONCLUSIONS

We found an increase in daily emergency hospital visits associated with O3, indicating that low-level exposure may trigger cardiopulmonary events or stroke.

Size-segregated particle number concentrations and respiratory emergency room visits in Beijing, China

BACKGROUND

The link between concentrations of particulate matter (PM) and respiratory morbidity has been investigated in numerous studies.

OBJECTIVES

The aim of this study was to analyze the role of different particle size fractions with respect to respiratory health in Beijing, China.

METHODS

Data on particle size distributions from 3 nm to 1 µm; PM10 (PM ≤ 10 µm), nitrogen dioxide (NO(2)), and sulfur dioxide concentrations; and meteorologic variables were collected daily from March 2004 to December 2006. Concurrently, daily counts of emergency room visits (ERV) for respiratory diseases were obtained from the Peking University Third Hospital. We estimated pollutant effects in single- and two-pollutant generalized additive models, controlling for meteorologic and other time-varying covariates. Time-delayed associations were estimated using polynomial distributed lag, cumulative effects, and single lag models.

RESULTS

Associations of respiratory ERV with NO(2) concentrations and 100-1,000 nm particle number or surface area concentrations were of similar magnitude-that is, approximately 5% increase in respiratory ERV with an interquartile range increase in air pollution concentration. In general, particles < 50 nm were not positively associated with ERV, whereas particles 50-100 nm were adversely associated with respiratory ERV, both being fractions of ultrafine particles. Effect estimates from two-pollutant models were most consistent for NO(2).

CONCLUSIONS

Present levels of air pollution in Beijing were adversely associated with respiratory ERV. NO(2) concentrations seemed to be a better surrogate for evaluating overall respiratory health effects of ambient air pollution than PM(10) or particle number concentrations in Beijing.