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Gordon AM, Magruder ML, Schwartz J, Ng MK, Erez O, Mont MA. Preoperative Depression Screening for Primary Total Knee Arthroplasty: An Evaluation of Its Modifiability on Outcomes in Patients Who Have Depression. J Arthroplasty 2024:S0883-5403(24)00133-5. [PMID: 38382629 DOI: 10.1016/j.arth.2024.02.035] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 01/24/2024] [Accepted: 02/13/2024] [Indexed: 02/23/2024] Open
Abstract
BACKGROUND Few studies have evaluated preoperative depression screenings in patients who have depression. We studied whether depression screenings before total knee arthroplasty (TKA) were associated with lower: 1) medical complications; 2) emergency department (ED) utilizations and readmissions; 3) implant complications; and 4) costs. METHODS A nationwide sample from January 1, 2010, to April 30, 2021, was collected using an insurance database. Depression patients were 1:1 propensity-score matched based on those who had (n = 29,009) and did not have (n = 29,009) preoperative depression screenings or psychotherapy visits within 3 months of TKA. A case-matched population who did not have depression was compared (n = 144,994). A 90-day period was used to compare complications and health-care utilization and 2-year follow-up for periprosthetic joint infections (PJIs) and implant survivorship. Costs were 90-day reimbursements. Logistic regression models computed odds ratios (ORs) of depression screening on dependent variables. P values less than .001 were significant. RESULTS Patients who did not receive preoperative screening were associated with higher medical complications (18.7 versus 5.2%, OR: 4.15, P < .0001) and ED utilizations (11.5 versus 3.2%, OR: 3.93, P < .0001) than depressed patients who received screening. Patients who had screening had lower medical complications (5.2 versus 5.9%, OR: 0.88, P < .0001) and ED utilizations compared to patients who did not have depression (3.2 versus 3.8%, OR: 0.87, P = .0001). Two-year PJI incidences (3.0 versus 1.3%, OR: 2.63, P < .0001) and TKA revisions (4.3 versus 2.1%, OR: 2.46, P < .0001) were greater in depression patients who were not screened preoperatively versus screened patients. Depression patients who had screening had lower PJIs (1.3 versus 1.8%, OR: 0.74, P < .0001) compared to nondepressed patients. Reimbursements ($13,949 versus $11,982; P < .0001) were higher in depression patients who did not have screening. CONCLUSIONS Preoperative screening was associated with improved outcomes in depression patients. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Adam M Gordon
- Department of Orthopaedic Surgery and Rehabilitation, Maimonides Medical Center, Brooklyn, New York; Questrom School of Business, Boston University, Boston, Massachusetts
| | - Matthew L Magruder
- Department of Orthopaedic Surgery and Rehabilitation, Maimonides Medical Center, Brooklyn, New York
| | - Jake Schwartz
- Department of Orthopaedic Surgery and Rehabilitation, Maimonides Medical Center, Brooklyn, New York
| | - Mitchell K Ng
- Department of Orthopaedic Surgery and Rehabilitation, Maimonides Medical Center, Brooklyn, New York
| | - Orry Erez
- Department of Orthopaedic Surgery and Rehabilitation, Maimonides Medical Center, Brooklyn, New York
| | - Michael A Mont
- Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, Maryland
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Rabiee R, Sjöqvist H, Agardh E, Lundin A, Danielsson AK. Risk of readmission among individuals with cannabis use disorder during a 15-year cohort study: the impact of socio-economic factors and psychiatric comorbidity. Addiction 2023. [PMID: 36746781 DOI: 10.1111/add.16158] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 01/17/2023] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIM Cannabis use disorder (CUD) is one of the main reasons for seeking substance treatment in the Nordic countries, but there are few studies on readmission to care. We aimed to characterize CUD readmission and estimate the magnitude of how socio-economic factors and psychiatric comorbidity influence the risk of CUD readmission. DESIGN, SETTING AND PARTICIPANTS This was a nation-wide cohort study carried out between 2001 and 2016 in Sweden. The participants were individuals with CUD, aged 17 years and above (n = 12 143). MEASUREMENTS Information on predictors was obtained from registers and included education, income and psychiatric comorbidity assessed by six disease groups. The outcome measure was readmission, defined as a CUD visit to health-care at least 6 months after initial CUD diagnosis. Hazard ratios (HR) were estimated using Cox survival analyses and flexible parametric survival analyses to assess risk of readmission and how the risk varied with age. FINDINGS The vast majority of CUD visits took place in outpatient care (~80%). Approximately 23% of the included individuals were readmitted to care during follow-up. The fully adjusted model showed an increased risk of readmission among those with schizophrenia and other psychotic disorders [HR = 1.54, 95% confidence interval (CI) = 1.29-1.84], low education (HR = 1.40, 95% CI = 1.24-1.57), personality disorders (HR = 1.27, 95% CI = 1.05-1.54) or mood disorders (HR = 1.27, 95% CI = 1.12-1.45). Flexible parametric modeling revealed increased risk of readmission mainly in individuals aged 18-35 years. CONCLUSIONS The risk of readmission was highest among those with low education, schizophrenia and other psychotic disorders, mood-related disorders or personality disorders. Individuals aged 18-35 years showed the highest risk of readmission. Our findings highlight individuals with complex health-care needs.
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Affiliation(s)
- Rynaz Rabiee
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Hugo Sjöqvist
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Emilie Agardh
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Andreas Lundin
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.,Center for Epidemiology and Community Medicine, Region Stockholm, Stockholm, Sweden
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Liu CC, Liu CH, Wang JY, Chang KC. Health-care utilization among dementia patients with or without comorbid depression in Taiwan: A nationwide population-based longitudinal study. Int J Geriatr Psychiatry 2023; 38:e5889. [PMID: 36773286 DOI: 10.1002/gps.5889] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 01/26/2023] [Indexed: 02/01/2023]
Abstract
BACKGROUND Few studies have examined the association of comorbid depression with health-care utilization among dementia patients. This study compared health-care utilization between dementia patients with and without comorbid depression. METHODS Using Taiwan's National Health Insurance Research Database, we identified 10,710 patients with newly diagnosed dementia between 2005 and 2014: 1785 had comorbid depression (group 1) and 8925 did not (group 2). Patients were tracked for 1 year to evaluate outpatient, emergency, and inpatient service utilization and length of hospital stay (LOS). Multivariable regression was applied to examine the association between comorbid depression and health-care utilization and analyze factors associated with inpatient visits and LOS. RESULTS Group 1 had significantly fewer outpatient visits (β = -0.115; p < 0.001), more inpatient visits (β = 0.157; p = 0.005), and a longer LOS (β = 0.191; p < 0.001) than did group 2. The groups did not differ significantly in emergency visits (β = 0.030; p = 0.537). In group 1, age, gender, and specific comorbidities were predictors of inpatient visits; those factors and salary-based insurance premiums were predictors of LOS. CONCLUSION Group 1 utilized less outpatient care but more inpatient care, suggesting health-care service for these patients may be needed to improvement.
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Affiliation(s)
- Chih-Ching Liu
- Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung, Taiwan
| | - Chien-Hui Liu
- Institute of Biomedical Informatics, National Yang Ming Chiao Tung University, Hsinchu, Taiwan.,New Taipei City Fire Department, Division of Emergency Medical Service, New Taipei, Taiwan
| | - Jiun-Yi Wang
- Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung, Taiwan.,Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Kun-Chia Chang
- Jianan Psychiatric Center, Ministry of Health and Welfare, Tainan, Taiwan.,Department of Psychiatry, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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Quiñones AR, McAvay GJ, Peak KD, Vander Wyk B, Allore HG. The Contribution of Chronic Conditions to Hospitalization, Skilled Nursing Facility Admission, and Death: Variation by Race. Am J Epidemiol 2022; 191:2014-2025. [PMID: 35932162 PMCID: PMC10144669 DOI: 10.1093/aje/kwac143] [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: 04/19/2021] [Revised: 06/24/2022] [Accepted: 08/01/2022] [Indexed: 02/01/2023] Open
Abstract
Multimorbidity (≥2 chronic conditions) is a common and important marker of aging. To better understand racial differences in multimorbidity burden and associations with important health-related outcomes, we assessed differences in the contribution of chronic conditions to hospitalization, skilled nursing facility admission, and mortality among non-Hispanic Black and non-Hispanic White older adults in the United States. We used data from a nationally representative study, the National Health and Aging Trends Study, linked to Medicare claims from 2011-2015 (n = 4,871 respondents). This analysis improved upon prior research by identifying the absolute contributions of chronic conditions using a longitudinal extension of the average attributable fraction for Black and White Medicare beneficiaries. We found that cardiovascular conditions were the greatest contributors to outcomes among White respondents, while the greatest contributor to outcomes for Black respondents was renal morbidity. This study provides important insights into racial differences in the contributions of chronic conditions to costly health-care utilization and mortality, and it prompts policy-makers to champion delivery reforms that will expand access to preventive and ongoing care for diverse Medicare beneficiaries.
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Affiliation(s)
- Ana R Quiñones
- Correspondence to Dr. Ana R. Quiñones, Department of Family Medicine, School of Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239 (e-mail: )
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5
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Bothe T, Walker J, Kröger C. Gender-related differences in health-care and economic costs for eating disorders: A comparative cost-development analysis for anorexia and bulimia nervosa based on anonymized claims data. Int J Eat Disord 2022; 55:61-75. [PMID: 34599621 DOI: 10.1002/eat.23610] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [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: 04/26/2020] [Revised: 09/09/2021] [Accepted: 09/09/2021] [Indexed: 01/12/2023]
Abstract
OBJECTIVE Anorexia nervosa (AN) and bulimia nervosa (BN) impose a significant financial burden and immense sufferings on affected individuals. Yet little is known about the differences between how each disorder affects males and females, respectively. METHOD We performed a retrospective cost-development analysis of anonymized claims data from the German statutory health-insurance system. Insured persons who suffered from an onset of AN (F50.0; N = 1,242 females and 71 males) or BN (F50.2; N = 1,104 females and 64 males) were analyzed for cost-of-illness over a 5-year period, beginning 2 years before the index diagnosis. RESULTS In total, all groups incurred similar distributions of total costs over the 5-year observation period, with roughly 14,000-20,000 EUR median costs. About two-thirds of the total costs for females and males with AN are associated with mental illness, whereas for females and males with BN, this applies to approximately half the total costs. Analyses revealed differences between disorders and genders for single outcomes. AN is associated with a stronger increase in costs within a short period following onset and higher inpatient treatment costs, whereas BN entails more instances of incapacity to work before and after onset. Compared to females, males incurred lower costs in outpatient treatments. DISCUSSION Our study adds evidence as to the disparities in health-care utilizations and costs over the course of illness, in outcome ratios, and between genders, for both AN and BN.
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Affiliation(s)
- Tim Bothe
- InGef-Institute for Applied Health Research Berlin, Berlin, Germany.,Department of Psychology, University of Hildesheim, Hildesheim, Germany
| | - Jochen Walker
- InGef-Institute for Applied Health Research Berlin, Berlin, Germany
| | - Christoph Kröger
- Department of Psychology, University of Hildesheim, Hildesheim, Germany
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6
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Sakai-Bizmark R, Kumamaru H, Estevez D, Marr EH, Haghnazarian E, Bedel LEM, Mena LA, Kaplan MS. Health-Care Utilization Due to Suicide Attempts Among Homeless Youth in New York State. Am J Epidemiol 2021; 190:1582-1591. [PMID: 33576370 PMCID: PMC8484771 DOI: 10.1093/aje/kwab037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 05/05/2020] [Accepted: 02/10/2021] [Indexed: 11/14/2022] Open
Abstract
Suicide remains the leading cause of death among homeless youth. We assessed differences in health-care utilization between homeless and nonhomeless youth presenting to the emergency department or hospital after a suicide attempt. New York Statewide Inpatient and Emergency Department Databases (2009-2014) were used to identify homeless and nonhomeless youth aged 10-17 who utilized health-care services following a suicide attempt. To evaluate associations with homelessness, we used logistic regression models for use of violent means, intensive care unit utilization, log-transformed linear regression models for hospitalization cost, and negative binomial regression models for length of stay. All models adjusted for individual characteristics with a hospital random effect and year fixed effect. We identified 18,026 suicide attempts with health-care utilization rates of 347.2 (95% confidence interval (CI): 317.5, 377.0) and 67.3 (95% CI: 66.3, 68.3) per 100,000 person-years for homeless and nonhomeless youth, respectively. Length of stay for homeless youth was statistically longer than that for nonhomeless youth (incidence rate ratio = 1.53, 95% CI: 1.32, 1.77). All homeless youth who visited the emergency department after a suicide attempt were subsequently hospitalized. This could suggest a higher acuity upon presentation among homeless youth compared with nonhomeless youth. Interventions tailored to homeless youth should be developed.
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Affiliation(s)
- Rie Sakai-Bizmark
- Correspondence to Dr. Rie Sakai-Bizmark, Department of Pediatrics, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, 1124 W. Torrance Street, Torrance, CA 90502 (e-mail: )
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7
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DuBrock HM, Burger CD, Bartolome SD, Feldman JP, Ivy DD, Rosenzweig EB, Sager JS, Presberg KW, Mathai SC, Lammi MR, Klinger JR, Eggert M, De Marco T, Elwing JM, Badesch D, Bull TM, Cadaret LM, Ramani G, Thenappan T, Ford HJ, Al-Naamani N, Simon MA, Mazimba S, Runo JR, Chakinala M, Horn EM, Ryan JJ, Frantz RP, Krowka MJ. Health disparities and treatment approaches in portopulmonary hypertension and idiopathic pulmonary arterial hypertension: an analysis of the Pulmonary Hypertension Association Registry. Pulm Circ 2021; 11:20458940211020913. [PMID: 34158918 PMCID: PMC8186121 DOI: 10.1177/20458940211020913] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Compared to idiopathic pulmonary arterial hypertension (IPAH), patients with portopulmonary hypertension (POPH) have worse survival. Health disparities may contribute to these differences but have not been studied. We sought to compare socioeconomic factors in patients with POPH and IPAH and to determine whether socioeconomic status and/or POPH diagnosis were associated with treatment and health-care utilization. We performed a cross-sectional study of adults enrolled in the Pulmonary Hypertension Association Registry. Patients with IPAH (n = 344) and POPH (n = 57) were compared. Compared with IPAH, patients with POPH were less likely to be college graduates (19.6% vs. 34.9%, p = 0.02) and more likely to be unemployed (54.7% vs. 30.5%, p < 0.001) and have an annual household income below poverty level (45.7% vs. 19.0%, p < 0.001). Patients with POPH had similar functional class, quality of life, 6-min walk distance, and mean pulmonary arterial pressure with a higher cardiac index. Compared with IPAH, patients with POPH were less likely to receive combination therapy (46.4% vs. 62.2%, p = 0.03) and endothelin receptor antagonists (28.6% vs. 55.1%, p < 0.001) at enrollment with similar treatment at follow-up. Patients with POPH had more emergency department visits (1.7 ± 2.1 vs. 0.9 ± 1.2, p = 0.009) and hospitalizations in the six months preceding enrollment (1.5 ± 2.1 vs. 0.8 ± 1.1, p = 0.02). Both POPH diagnosis and lower education level were independently associated with a higher number of emergency department visits. Compared to IPAH, patients with POPH have lower socioeconomic status, are less likely to receive initial combination therapy and endothelin receptor antagonists but have similar treatment at follow-up, and have increased health-care utilization.
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Affiliation(s)
- Hilary M DuBrock
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Charles D Burger
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - Sonja D Bartolome
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Jeremy P Feldman
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Arizona Pulmonary Specialists, Ltd, Scottsdale, AZ, USA
| | - D Dunbar Ivy
- Division of Cardiology, Department of Pediatrics, Children's Hospital Colorado, Aurora, CO, USA
| | - Erika B Rosenzweig
- Division of Cardiology, Department of Pediatrics, Columbia University Medical Center, New York, NY, USA
| | - Jeffrey S Sager
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Cottage Pulmonary Hypertension Center, Santa Barbara, CA, USA
| | - Kenneth W Presberg
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Stephen C Mathai
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Matthew R Lammi
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Comprehensive Pulmonary Hypertension Center, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - James R Klinger
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Brown University, Providence, RI, USA
| | - Michael Eggert
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Sentara Cardiovascular Research Institute, Norfolk, VA, USA
| | - Teresa De Marco
- Division of Cardiology, Department of Internal Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Jean M Elwing
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - David Badesch
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Colorado, Denver, CO, USA
| | - Todd M Bull
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Colorado, Denver, CO, USA
| | - Linda M Cadaret
- Division of Cardiology, Department of Internal Medicine, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Gautam Ramani
- Division of Cardiology, Department of Internal Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Thenappan Thenappan
- Division of Cardiology, Department of Internal Medicine, University of Minnesota, Minneapolis, MN, USA
| | - H James Ford
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Nadine Al-Naamani
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Marc A Simon
- Division of Cardiology, Department of Internal Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.,Division of Cardiology, Department of Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Sula Mazimba
- Division of Cardiology, Department of Internal Medicine, University of Virginia Health System, Charlottesville, VA, USA
| | - James R Runo
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Wisconsin-Madison, Madison, WI, USA
| | - Murali Chakinala
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Washington University at Barnes-Jewish, St. Louis, MO, USA
| | - Evelyn M Horn
- Division of Cardiology, Department of Internal Medicine, Weill Cornell Medical School, New York, NY, USA
| | - John J Ryan
- Division of Cardiology, Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA
| | - Robert P Frantz
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - Michael J Krowka
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
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8
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Ensrud KE, Kats AM, Schousboe JT, Langsetmo L, Vo TN, Blackwell TL, Buysse DJ, Ancoli-Israel S, Stone KL. Multidimensional sleep health and subsequent health-care costs and utilization in older women. Sleep 2021; 43:5637931. [PMID: 31755954 DOI: 10.1093/sleep/zsz230] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 04/02/2019] [Revised: 07/31/2019] [Indexed: 11/13/2022] Open
Abstract
STUDY OBJECTIVES Determine the association of poor multidimensional sleep health with health-care costs and utilization. METHODS We linked 1,459 community-dwelling women (mean age 83.6 years) participating in the Study of Osteoporotic Fractures Year 16 visit (2002-2004) with their Medicare claims. Five dimensions of sleep health (satisfaction, daytime sleepiness, timing, latency, and duration) were assessed by self-report. The number of impaired dimensions was expressed as a score (range 0-5). Total direct health-care costs and utilization were ascertained during the subsequent 36 months. RESULTS Mean (SD) total health-care costs/year (2017 dollars) increased in a graded manner across the sleep health score ranging from $10,745 ($15,795) among women with no impairment to up to $15,332 ($22,810) in women with impairment in three to five dimensions (p = 0.01). After adjustment for age, race, and enrollment site, women with impairment in three to five dimensions vs. no impairment had greater mean total costs (cost ratio [CR] 1.34 [95% CI = 1.13 to 1.60]) and appeared to be at higher risk of hospitalization (odds ratio (OR) 1.31 [95% CI = 0.96 to 1.81]). After further accounting for number of medical conditions, functional limitations, and depressive symptoms, impairment in three to five sleep health dimensions was not associated with total costs (CR 1.02 [95% CI = 0.86 to 1.22]) or hospitalization (OR 0.91 [95% CI = 0.65 to 1.28]). Poor multidimensional sleep health was not related to outpatient costs or risk of skilled nursing facility stay. CONCLUSIONS Older women with poor sleep health have higher subsequent total health-care costs largely attributable to their greater burden of medical conditions, functional limitations, and depressive symptoms.
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Affiliation(s)
- Kristine E Ensrud
- Department of Medicine, University of Minnesota, Minneapolis.,Division of Epidemiology and Community Health, University of Minnesota, Minneapolis.,Center for Care Delivery and Outcomes Research, VA Health Care System, Minneapolis, MN
| | - Allyson M Kats
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis
| | - John T Schousboe
- HealthPartners Institute, Bloomington, MN.,Division of Health Policy and Management, University of Minnesota, Minneapolis
| | - Lisa Langsetmo
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis
| | - Tien N Vo
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis
| | | | | | | | - Katie L Stone
- California Pacific Medical Center Research Institute, San Francisco
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9
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Müskens WD, Rongen-van Dartel SAA, Vogel C, Huis A, Adang EMM, van Riel PLCM. Telemedicine in the management of rheumatoid arthritis: maintaining disease control with less health-care utilization. Rheumatol Adv Pract 2021; 5:rkaa079. [PMID: 33688619 PMCID: PMC7928564 DOI: 10.1093/rap/rkaa079] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 12/02/2020] [Indexed: 12/15/2022] Open
Abstract
Objectives We aimed to evaluate the use of an eHealth platform and a self-management outpatient clinic in patients with RA in a real-world setting. The effects on health-care utilization and disease activity were studied. Methods Using hospital data of patients with RA between 2014 and 2019, the use of an eHealth platform and participation in a self-management outpatient clinic were studied. An interrupted time series analysis compared the period before and after the introduction of the eHealth platform. The change in trend (relative to the pre-interruption trend) for the number of outpatient clinic visits and the DAS for 28 joints (DAS28) were determined for several scenarios. Results After implementation of the platform in April 2017, the percentage of patients using it was stable at ∼37%. On average, the users of the platform were younger, more highly educated and had better health outcomes than the total RA population. After implementation of the platform, the mean number of quarterly outpatient clinic visits per patient decreased by 0.027 per quarter (95% CI: -0.045, -0.08, P = 0.007). This was accompanied by a significant decrease in DAS28 of 0.056 per quarter (95% CI: -0.086, -0025, P = 0.001). On average, this resulted in 0.955 fewer visits per patient per year and a reduction of 0.503 in the DAS28. Conclusion The implementation of remote patient monitoring has a positive effect on health-care utilization, while maintaining low disease activity. This should encourage the use of this type of telemedicine in the management of RA, especially while many routine outpatient clinic visits are cancelled owing to COVID-19.
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Affiliation(s)
- Wieland D Müskens
- Radboud Institute for Health Sciences, Radboud University Medical Center, Scientific Institute for Quality of Healthcare, Nijmegen
| | - Sanne A A Rongen-van Dartel
- Radboud Institute for Health Sciences, Radboud University Medical Center, Scientific Institute for Quality of Healthcare, Nijmegen.,Department of Rheumatology, Bernhoven, Uden
| | | | - Anita Huis
- Radboud Institute for Health Sciences, Radboud University Medical Center, Scientific Institute for Quality of Healthcare, Nijmegen
| | - Eddy M M Adang
- Radboud Institute for Health Sciences, Radboud University Medical Center, Scientific Department of Health Evidence, Nijmegen, The Netherlands
| | - Piet L C M van Riel
- Radboud Institute for Health Sciences, Radboud University Medical Center, Scientific Institute for Quality of Healthcare, Nijmegen.,Department of Rheumatology, Bernhoven, Uden
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10
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Grigonis AM, Mathews KS, Benka-Coker WO, Dawson AM, Hammerman SI. Long-Term Acute Care Hospitals Extend ICU Capacity for COVID-19 Response and Recovery. Chest 2021; 159:1894-901. [PMID: 33309523 DOI: 10.1016/j.chest.2020.12.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 10/23/2020] [Accepted: 12/03/2020] [Indexed: 11/21/2022] Open
Abstract
The COVID-19 pandemic has presented novel challenges for the entire health-care continuum, requiring transformative changes to hospital and post-acute care, including clinical, administrative, and physical modifications to current standards of operations. Innovative use and adaptation of long-term acute care hospitals (LTACHs) can safely and effectively care for patients during the ongoing COVID-19 pandemic. A framework for the rapid changes, including increasing collaboration with external health-care organizations, creating new methods for enhanced communication, and modifying processes focused on patient safety and clinical outcomes, is described for a network of 94 LTACHs. When managed and modified correctly, LTACHs can play a vital role in managing the national health-care pandemic crisis.
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Liu Q, Liu J, Sui S. Public Medical Insurance and Healthcare Utilization and Expenditures of Older with Chronic Diseases in Rural China: Evidence from NRCMS. Int J Environ Res Public Health 2020; 17:E7683. [PMID: 33096761 DOI: 10.3390/ijerph17207683] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Revised: 10/16/2020] [Accepted: 10/18/2020] [Indexed: 01/02/2023]
Abstract
China's rural older are the threat from chronic diseases, making it important to evaluate the effect of public health insurance on the health care utilization and expenditures with chronic diseases. In 2003, China initiated a public health insurance, which was called the New Rural Cooperative Medical System (NRCMS). NRCMS is a voluntary program, targeting rural residents with government subsidies and individual contribution. Using the two-stage residual inclusion approach (2SRI), we analyzed the impact of NRCMS on health-care service utilization and expenditure of rural older with chronic diseases by using the 2011 and 2013 China Health and Retirement Survey (CHARLS) data. The results showed NRCMS did not play an effective role on improving the medical services utilization of rural older with chronic diseases. Although NRCMS immediate reimbursement significantly reduced the outpatient service fee, the actual outpatient reimbursement is the opposite. In addition, NRCMS did not significantly decrease their hospitalization expense. Policy makers should pay attention to health management about chronic diseases in rural China, and some measures should be taken to deepen the medical security system reform and improve the public health service system.
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12
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Gershon AS, McGihon RE, Thiruchelvam D, To T, Wu R, Bell CM, Aaron SD. Medication Discontinuation in Adults With COPD Discharged From the Hospital: A Population-Based Cohort Study. Chest 2020; 159:975-984. [PMID: 33011204 DOI: 10.1016/j.chest.2020.09.254] [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: 01/13/2020] [Revised: 09/21/2020] [Accepted: 09/25/2020] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Patients admitted to the hospital with COPD are commonly managed with inhaled short-acting bronchodilators, sometimes in lieu of the long-acting bronchodilators they take as outpatients. If held on admission, these long-acting inhalers should be re-initiated upon discharge; however, health-care transitions sometimes result in unintentional discontinuation. RESEARCH QUESTION What is the risk of unintentional discontinuation of long-acting muscarinic antagonist (LAMA) and long-acting beta-agonist and inhaled corticosteroid (LABA-ICS) combination medications following hospital discharge in older adults with COPD? STUDY DESIGN AND METHODS A retrospective cohort study was conducted by using health administrative data from 2004 to 2016 from Ontario, Canada. Adults with COPD aged ≥ 66 years who had filled prescriptions for a LAMA or LABA-ICS continuously for ≥ 1 year were included. Log-binomial regression models were used to determine risk of medication discontinuation following hospitalization in each medication cohort. RESULTS Of the 27,613 hospitalization discharges included in this study, medications were discontinued 1,466 times. Among 78,953 patients with COPD continuously taking a LAMA or LABA-ICS, those hospitalized had a higher risk of having medications being discontinued than those who remained in the community (adjusted risk ratios of 1.50 [95% CI, 1.34-1.67; P < .001] and 1.62 [95% CI, 1.39, 1.90; P < .001] for LAMA and LABA-ICS, respectively). Crude rates of discontinuation for people taking LAMAs were 5.2% in the hospitalization group and 3.3% in the community group; for people taking LABA-ICS, these rates were 5.5% in the hospitalization group and 3.1% in the community group. INTERPRETATION In an observational study of highly compliant patients with COPD, hospitalization was associated with an increased risk of long-acting inhaler discontinuation. These Results suggest a likely larger discontinuation problem among less adherent patients and should be confirmed and quantified in a prospective cohort of patients with COPD and average compliance. Quality improvement efforts should focus on safe transitions and patient medication reconciliation following discharge.
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Affiliation(s)
- Andrea S Gershon
- Department of Medicine and Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; ICES, Toronto, ON, Canada; Department of Medicine, University of Toronto, Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
| | - Rachel E McGihon
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada
| | | | - Teresa To
- ICES, Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada; Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada; Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada
| | - Robert Wu
- Department of Medicine, University of Toronto, Toronto, ON, Canada; Division of General Internal Medicine, University Health Network, Toronto, ON, Canada
| | - Chaim M Bell
- ICES, Toronto, ON, Canada; Department of Medicine, University of Toronto, Toronto, ON, Canada; Sinai Health System, Toronto, ON, Canada
| | - Shawn D Aaron
- The Ottawa Hospital Research Institute, Ottawa, ON, Canada; Department of Medicine, University of Ottawa, ON, Canada
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Ramnath VR, McSharry DG, Malhotra A. Do No Harm: Reaffirming the Value of Evidence and Equipoise While Minimizing Cognitive Bias in the Coronavirus Disease 2019 Era. Chest 2020; 158:873-876. [PMID: 32473949 PMCID: PMC7833575 DOI: 10.1016/j.chest.2020.05.548] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 05/06/2020] [Accepted: 05/11/2020] [Indexed: 01/22/2023] Open
Affiliation(s)
- Venktesh R Ramnath
- Division of Pulmonary, Critical Care, and Sleep Medicine, UC San Diego Health, La Jolla, CA.
| | - David G McSharry
- Mater Misericordiae University Hospital and University College Dublin, Dublin, Ireland
| | - Atul Malhotra
- Division of Pulmonary, Critical Care, and Sleep Medicine, UC San Diego Health, La Jolla, CA
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Abstract
The purpose of this study was to use focus groups to explore married men’s avoidance of health-care utilization. Five focus groups of 8 to 10 married, heterosexual, male participants (N = 44) were conducted and analyzed using grounded theory methods. Several important themes emerged connected to how masculine norms were associated with health-care utilization at several domains including at the organizational level (perceptions of doctors), interpersonal level (past family context and current family context), and individual level (illness severity, money concerns). These themes were all connected with the societal theme of masculine norms, where men’s reasons for health-care utilization (or underutilization) seemed in large part to emerge because of their perceptions of male gender roles. Implications for married men’s health-care utilization and health prevention education will be discussed.
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Affiliation(s)
- Josh R Novak
- 1 Department of Human Development and Family Studies, Auburn University, AL, USA
| | - Terry Peak
- 2 Sociology, Social Work, and Anthropology Department, Utah State University, Logan, UT, USA
| | - Julie Gast
- 3 Department of Kinesiology and Health Sciences, Utah State University, Logan, UT, USA
| | - Melinda Arnell
- 3 Department of Kinesiology and Health Sciences, Utah State University, Logan, UT, USA
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15
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Tanner JA, Hensel J, Davies PE, Brown LC, Dechairo BM, Mulsant BH. Economic Burden of Depression and Associated Resource Use in Manitoba, Canada. Can J Psychiatry 2020; 65:338-346. [PMID: 31835904 PMCID: PMC7265616 DOI: 10.1177/0706743719895342] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVES To characterize the health-care utilization and economic burden associated with depression in Manitoba, Canada. METHODS Patient-level data were retrieved from the Manitoba Centre for Health Policy administrative, clinical, and laboratory databases for the study period of January 1, 1996, through December 31, 2016. Patients were assigned to the depression cohort based on diagnoses recorded in hospitalizations and outpatient physician claims, as well as antidepressant prescription drug claims. A comparison cohort of nondepressed subjects, matched with replacement for age, gender, place of residence (urban vs. rural), and index date, was created. Demographics, comorbidities, intentional self-harm, mortality, health-care utilization, prescription drug utilization, and costs of health-care utilization and social services were compared between depressed patients and matched nondepressed patients, and incidence rate ratios and hazard ratios were reported. RESULTS There were 190,065 patients in the depression cohort and 378,177 patients in the nondepression cohort. Comorbidities were 43% more prevalent among depressed patients. Intentional self-harm, all-cause mortality, and suicide mortality were higher among patients with depression than the nondepression cohort. Health-care utilization-including hospitalizations, physician visits, physician-provided psychotherapy, and prescription drugs-was higher in the depression than the nondepression cohort. Mean health-care utilization costs were 3.5 times higher among depressed patients than nondepressed patients ($10,064 and $2,832, respectively). Similarly, mean social services costs were 3 times higher ($1,522 and $510, respectively). Overall, depression adds a total average cost of $8,244 (SD = $40,542) per person per year. CONCLUSIONS Depression contributes significantly to health burden and per patient costs in Manitoba, Canada. Extrapolation of the results to the entire Canadian health-care system projects an excess of $12 billion annually in health system spending.
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Affiliation(s)
- Julie-Anne Tanner
- Tanenbaum Pharmacogenetics Centre, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada
- Department of Psychiatry, University of Toronto, Ontario, Canada
- Assurex Health Ltd., Toronto, Ontario, Canada
| | - Jennifer Hensel
- Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | | | | | - Benoit H. Mulsant
- Department of Psychiatry, University of Toronto, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
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Abstract
PURPOSE To estimate the relationship between employees' health risks and health-care costs to inform health promotion program design. DESIGN An observational study of person-level health-care claims and health risk assessment (HRA) data that used regression models to estimate the relationship between 10 modifiable risk factors and subsequent year 1 health-care costs. SETTING United States. PARTICIPANTS The sample included active, full-time, adult employees continuously enrolled in employer-sponsored health insurance plans contributing to IBM MarketScan Research Databases who completed an HRA. Study criteria were met by 135 219 employees from 11 employers. MEASURES Ten modifiable risk factors and individual sociodemographic and health characteristics were included in the models as independent variables. Five settings of health-care costs were outcomes in addition to total expenditures. ANALYSIS After building the analytic file, we estimated generalized linear models and conducted postestimation bootstrapping. RESULTS Health-care costs were significantly higher for employees at higher risk for blood glucose, obesity, stress, depression, and physical inactivity (all at P < .0001) than for those at lower risk. Similar cost differentials were found when specific health-care services were examined. CONCLUSION Employers may achieve cost savings in the short run by implementing comprehensive health promotion programs that focus on decreasing multiple health risks.
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Affiliation(s)
- Ron Z Goetzel
- Institute for Health and Productivity Studies, Johns Hopkins Bloomberg School of Public Health, Bethesda, MD, USA.,IBM Watson Health, Bethesda, MD, USA
| | | | | | | | - Kyu Rhee
- IBM Watson Health, Cambridge, MA, USA
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17
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Debnath S, Jain T. Social connections and tertiary health-care utilization. Health Econ 2020; 29:464-474. [PMID: 31981292 DOI: 10.1002/hec.3996] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 12/14/2019] [Accepted: 12/17/2019] [Indexed: 06/10/2023]
Abstract
The use of tertiary health care by socially proximate peers helps individuals learn about program and treatment procedures, signals that using such care is socially appropriate, and could support the use of formal health care, all of which could increase program utilization. Using complete administrative claims data from a publicly financed tertiary care program in India, we estimate that the elasticity of first-time claims with respect to claims by members of caste groups within the village is 0.046, with smaller effects of more socially distant individuals. The point elasticity of inpatient care expenditure with respect to claims filed by the same group in village peers in the previous quarter is - 0.035. We find support for an information channel as peers increase awareness of the program and its features. Our findings have implications for the development of network-based models to determine health-care demand, as well as in use of network-based targeting to boost tertiary health-care utilization.
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Affiliation(s)
- Sisir Debnath
- Department of Humanities and Social Sciences, Indian Institute of Technology Delhi, New Delhi, India
| | - Tarun Jain
- Economics Area, Indian Institute of Management Ahmedabad, Ahmedabad, India
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18
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Nishi SPE, Zhou J, Okereke I, Kuo YF, Goodwin J. Use of Imaging and Diagnostic Procedures After Low-Dose CT Screening for Lung Cancer. Chest 2020; 157:427-434. [PMID: 31521671 PMCID: PMC7005377 DOI: 10.1016/j.chest.2019.08.2187] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [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: 05/09/2019] [Revised: 07/06/2019] [Accepted: 08/10/2019] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Clinical trials have demonstrated a mortality benefit from lung cancer screening by low-dose CT (LDCT) in current or past tobacco smokers who meet criteria. Potential harms of screening mostly relate to downstream evaluation of abnormal screens. Few data exist on the rates outside of clinical trials of imaging and diagnostic procedures following screening LDCT. We describe rates in the community setting of follow-up imaging and diagnostic procedures after screening LDCT. METHODS We used Clinformatics Data Mart national database to identify enrollees age 55 to 80 year who underwent screening LDCT from January 1, 2016, to December 31, 2016. We assessed rates of follow-up imaging (diagnostic chest CT scan, MRI, and PET) and follow-up procedures (bronchoscopy, percutaneous biopsy, thoracotomy, mediastinoscopy, and thoracoscopy) in the 12 months following LDCT for lung cancer screening. We also assessed these rates in an age-, sex-, and number of comorbidities-matched population that did not undergo LDCT to estimate rates unrelated to the screening LDCT. We then reported the adjusted rate of follow-up testing as the observed rate in the screening LDCT population minus the rate in the non-LDCT population. RESULTS Among 11,520 enrollees aged 55 to 80 years who underwent LDCT in 2016, the adjusted rates of follow up 12 months after LDCT examinations were low (17.7% for imaging and 3.1% for procedures). Among procedures, the adjusted rates were 2.0% for bronchoscopy, 1.3% for percutaneous biopsy, 0.9% for thoracoscopy, 0.2% for mediastinoscopy, and 0.4% for thoracotomy. Adjusted rates of follow-up procedures were higher in enrollees undergoing an initial screening LDCT (3.3%) than in those after a second screening examination (2.2%). CONCLUSIONS In general, imaging and rates of procedures after screening LDCT was low in this commercially insured population.
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Affiliation(s)
- Shawn P E Nishi
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, Galveston, TX; Sealy Center on Aging, University of Texas Medical Branch, Galveston, Galveston, TX.
| | - Jie Zhou
- Sealy Center on Aging, University of Texas Medical Branch, Galveston, Galveston, TX
| | - Ikenna Okereke
- Department of Surgery, University of Texas Medical Branch, Galveston, Galveston, TX
| | - Yong-Fang Kuo
- Department of Preventive Medicine, University of Texas Medical Branch, Galveston, Galveston, TX; Sealy Center on Aging, University of Texas Medical Branch, Galveston, Galveston, TX
| | - James Goodwin
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, Galveston, TX; Department of Preventive Medicine, University of Texas Medical Branch, Galveston, Galveston, TX; Sealy Center on Aging, University of Texas Medical Branch, Galveston, Galveston, TX
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19
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Sineshaw HM, Sahar L, Osarogiagbon RU, Flanders WD, Yabroff KR, Jemal A. County-Level Variations in Receipt of Surgery for Early-Stage Non-small Cell Lung Cancer in the United States. Chest 2020; 157:212-222. [PMID: 31813533 PMCID: PMC6965692 DOI: 10.1016/j.chest.2019.09.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [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: 05/30/2019] [Revised: 09/09/2019] [Accepted: 09/12/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Although counties are the smallest geographic level for comprehensive health-care delivery analysis, little is known about county-level variations in receipt of curative-intent surgery for early-stage non-small cell lung cancer (NSCLC) and factors contributing to such variations in the United States. METHODS A total of 179,189 patients aged ≥ 35 years who were diagnosed with stage I to II NSCLC between 2007 and 2014 in 2,263 counties were identified from 39 states, the District of Columbia, and Detroit population-based cancer registries; the data were compiled by the North American Association of Central Cancer Registries. The percentage of patients who underwent surgery was calculated for each county with ≥ 20 cases. Adjusted risk ratios were generated by using generalized estimating equation models with modified Poisson regression. RESULTS Receipt of surgery for early-stage NSCLC during 2007 to 2014 according to county ranged from 12.8% to 48.6% in the lowest decile of counties, to 74.3% to 91.7% in the highest decile of counties. There were pockets of low surgery receipt rate counties within each state. For example, there was a 25% absolute difference between the lowest and highest surgery receipt rate counties in Massachusetts. Counties in the lowest quartile for receipt of surgery were those with a high proportion of non-Hispanic black subjects, high poverty and uninsured rates, low surgeon-to-population ratio, and nonmetropolitan status. CONCLUSIONS Receipt of curative-intent surgery for early-stage NSCLC varied substantially across counties in the United States, with pockets of low receipt counties in each state. Low surgery receipt counties were characterized by unfavorable area-level socioeconomic and health-care delivery factors.
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Affiliation(s)
| | | | | | - W Dana Flanders
- American Cancer Society, Atlanta, GA; Rollins School of Public Health, Emory University, Atlanta, GA
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20
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Soares LGL, Gomes RV, Palma A, Japiassu AM. Quality Indicators of End-of-Life Care Among Privately Insured People With Cancer in Brazil. Am J Hosp Palliat Care 2019; 37:594-599. [PMID: 31726853 DOI: 10.1177/1049909119888180] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
PURPOSE To examine quality indicators of end-of-life (EOL) care among privately insured people with cancer in Brazil. METHODS We evaluated medical records linked to health insurance databank to study consecutive patients who died of cancer. We collected information about demographics, cancer type, and quality indicators of EOL care including emergency department (ED) visits, intensive care unit (ICU) admissions, chemotherapy use, medical imaging utilization, blood transfusions, home care support, days of inpatient care, and hospital deaths. RESULTS We included 865 patients in the study. In the last 30 days of life, 62% visited the ED, 33% were admitted to the ICU, 24% received blood transfusions, and 51% underwent medical imaging. Only 1% had home care support in the last 60 days of life, and 29% used chemotherapy in the last 14 days of life. Patients had an average of 8 days of inpatient care and 52% died in the hospital. Patients with advanced cancer who used chemotherapy were more likely to visit the ED (78% vs 59%; P < .001), undergo medical imaging (67% vs 51%; P < .001), and die in the hospital (73% vs 50%; P = .03) than patients who did not use chemotherapy. In the multivariate analysis, chemotherapy use near death and advanced cancer were associated with ED visits and ICU admissions, respectively (odds ratio >1). CONCLUSION Our study suggests that privately insured people with cancer receive poor quality EOL care in Brazil. Further research is needed to assess the impact of improvements in palliative care provision in this population.
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Affiliation(s)
- Luiz Guilherme L Soares
- End of Life Care Study Group, Department of Health Services and Costs, Unimed Federação, Rio de Janeiro, Brazil.,Palliative Care Program, Hospital de Câncer/Rede Casa, Rio de Janeiro, Brazil
| | - Renato V Gomes
- End of Life Care Study Group, Department of Health Services and Costs, Unimed Federação, Rio de Janeiro, Brazil
| | - Alberto Palma
- End of Life Care Study Group, Department of Health Services and Costs, Unimed Federação, Rio de Janeiro, Brazil
| | - André M Japiassu
- Fundação Oswaldo Cruz, Research Laboratory of Intensive Care Medicine, Rio de Janeiro, Brazil
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21
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Moosan H, Stanley A, Vijayakumar K, Jayasree AK, Lawrence T, Veena A. Impediments to Optimal Health-care Utilization of a Particularly Vulnerable Tribal Group in Wayanad: A Qualitative Study. Indian J Community Med 2019; 44:S62-S65. [PMID: 31728094 PMCID: PMC6824166 DOI: 10.4103/ijcm.ijcm_48_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Introduction The pathways and mechanisms through which constraints that impede optimal utilization of the government health-care service provisions translate into health inequities among Particularly Vulnerable Tribal Groups seem to be an area that warrants research. Objective The objective is to explore and understand the mechanisms/pathways through which various factors result in health care inequity among the Kattunayakan tribe in Wayanad. Materials and Methods Designed as a qualitative case study, using observations and interviews with mothers, community members, and frontline health-care personnel, the study was conducted in a Kattunayakan hamlet in Wayanad. The data, in the form of digital audio recordings and field notes, were transcribed, coded, and analyzed using a thematic approach. Results and Discussion Axes of inquiry like access to health-care institutions, acceptability of the services provided, hurdles faced by the tribes, the health-care personnel, and how the system responded to these issues were explored. Disregard for the identity and culture of the tribes, geographical barriers for utilization and providing health services, proactive efforts from government systems, collaborations with private and professional bodies are important factors that possibly influence health inequities among tribes. Conclusion Acknowledgment of the sociocultural identity of the tribes, gaining their trust, proactive efforts from the government machinery, innovative context-specific programs, strategic partnerships and a departure from the "blame the victim" philosophy are key in the effort to provide services that meet the health-care needs of the tribes.
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Affiliation(s)
- Hisham Moosan
- Health Action by People, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India.,Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Antony Stanley
- Health Action by People, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India.,Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Krishnapillai Vijayakumar
- Health Action by People, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India.,Amrita Insititute of Medical Sciences, Kochi, Kerala, India
| | - A K Jayasree
- Health Action by People, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India.,Academy of Medical Sciences, Kannur, Kerala, India
| | - Tony Lawrence
- Health Action by People, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India.,Department of Community Medicine, Government Medical College, Thiruvananthapuram, Kerala, India
| | - A Veena
- Health Action by People, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
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22
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Shinall MC, Karlekar M, Martin S, Gatto CL, Misra S, Chung CY, Porayko MK, Scanga AE, Schneider NJ, Ely EW, Pulley JM, Jerome RN, Dear ML, Conway D, Buie R, Liu D, Lindsell CJ, Bernard GR. COMPASS: A Pilot Trial of an Early Palliative Care Intervention for Patients With End-Stage Liver Disease. J Pain Symptom Manage 2019; 58:614-622.e3. [PMID: 31276810 PMCID: PMC6754773 DOI: 10.1016/j.jpainsymman.2019.06.023] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [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: 05/16/2019] [Revised: 06/24/2019] [Accepted: 06/25/2019] [Indexed: 12/25/2022]
Abstract
CONTEXT Palliative care interventions have shown promise in improving quality of life and reducing health-care utilization among patients with chronic organ failure. OBJECTIVES To evaluate the effect of a palliative care intervention for adults with end-stage liver disease. METHODS A randomized controlled trial of patients with end-stage liver disease admitted to the hepatology service at a tertiary referral center whose attending hepatologist indicated they would not be surprised if the patient died in the following year on a standardized questionnaire was performed. Control group patients received usual care. Intervention group patients received inpatient specialist palliative care consultations and outpatient phone follow-up by a palliative care nurse. The primary outcome was time until first readmission. Secondary outcomes included days alive outside the hospital, referral to hospice care, death, readmissions, patient quality of life, depression, anxiety, and quality of end-of-life care over 6 months. RESULTS The trial stopped early because of difficulties in accruing patients. Of 293 eligible patients, only 63 patients were enrolled, 31 in the intervention group and 32 in the control group. This pace of enrollment was only 25% of what the study had planned, and so it was deemed infeasible to complete. Despite stopping early, intervention group patients had a lower hazard of readmission (hazard ratio: 0.36, 95% confidence interval: 0.16-0.83, P = 0.017) and greater odds of having more days alive outside the hospital than control group patients (odds ratio: 3.97, 95% confidence interval: 1.14-13.84, P = 0.030). No other statistically significant differences were observed. CONCLUSION Logistical obstacles hindered completion of the trial as originally designed. Nevertheless, a preemptive palliative care intervention resulted in increased time to first readmission and more days alive outside the hospital in the first six months after study entry.
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Affiliation(s)
- Myrick C Shinall
- Section of Palliative Care, Division of General Internal Medicine and Public Health, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Critical Illness, Brain Dysfunction, and Survivorship Center, Nashville, Tennessee, USA; Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
| | - Mohana Karlekar
- Section of Palliative Care, Division of General Internal Medicine and Public Health, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Sara Martin
- Section of Palliative Care, Division of General Internal Medicine and Public Health, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Cheryl L Gatto
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Sumi Misra
- Section of Palliative Care, Division of General Internal Medicine and Public Health, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Tennessee Valley Geriatrics Research Education and Clinical Center, Veterans Affairs Tennessee Valley Healthcare System, Nashville, Tennessee, USA
| | - Chan Y Chung
- Vanderbilt Hepatology and Liver Transplant Center, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Michael K Porayko
- Vanderbilt Hepatology and Liver Transplant Center, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Andrew E Scanga
- Vanderbilt Hepatology and Liver Transplant Center, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Natasha J Schneider
- Vanderbilt Hepatology and Liver Transplant Center, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - E Wesley Ely
- Critical Illness, Brain Dysfunction, and Survivorship Center, Nashville, Tennessee, USA; Tennessee Valley Geriatrics Research Education and Clinical Center, Veterans Affairs Tennessee Valley Healthcare System, Nashville, Tennessee, USA; Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jill M Pulley
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Rebecca N Jerome
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Mary Lynn Dear
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Douglas Conway
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Reagan Buie
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Dandan Liu
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Christopher J Lindsell
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Gordon R Bernard
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Khajeh A, Vardanjani HM, Salehi A, Rahmani N, Delavari S. Healthcare-seeking behavior and its relating factors in South of Iran. J Educ Health Promot 2019; 8:183. [PMID: 31867368 PMCID: PMC6796318 DOI: 10.4103/jehp.jehp_93_19] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 04/22/2019] [Indexed: 06/10/2023]
Abstract
INTRODUCTION Health systems aimed to increase health utilization. Habits and behavior about using health facilities, which is called health-seeking behavior, are different among different cultures and influenced by different factors. The present study is aimed at investigating Iranian Southern population health-seeking behavior and its influencing factors. MATERIALS AND METHODS A sample of 397 people was selected using proportional stratified random sampling for this cross-sectional study. They were asked to fill a questionnaire about their health-seeking behaviors (seeking treatment, inattention to treatment, and self-medication) and socioeconomic factors. Data were analyzed using regression models including linear, ordinal, and logistic regressions. RESULTS Near 80% of participants reported self-medication and most of them prefer public hospitals as their first point of contact with health system compared to others such as family physician. Using linear regression revealed seeking treatment has significant relationship with age (P = 0.037), living place (P = 0.018), and having complementary insurance (P = 0.013). Self-medication behavior has relation with age (P = 0.015), gender (P = 0.039), education years (P = 0.031), living place (P = 0.005), having complementary insurance (P = 0.001), and satisfaction with health-care providers (P = 0.003) in logistic regression. Using ordinal regression, it was found that inattention to treatment has a relation with education years (P = 0.044), living place (P = 0.042), having complementary insurance (P = 0.049), and severity of illness (P = 0.031). CONCLUSION Southern population does not accept family physician as the first point of interaction with the health system, and they prefer to go to public hospitals directly. Moreover, self-medication is a prevalent behavior among the population and thus their acceptance of health care is low. Based on the findings, it can be suggested providing more satisfying health care, increasing insurance coverage, and informing population could lead to better utilization of health-care services.
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Affiliation(s)
- Atefeh Khajeh
- Department of MPH, Shiraz Medical School, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Alireza Salehi
- Research Center for Traditional Medicine and History of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Negin Rahmani
- Department of MPH, Shiraz Medical School, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sajad Delavari
- Health Human Resources Research Center, School of Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
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Chamberlain AM, Rutten LJF, Jacobson DJ, Fan C, Wilson PM, Rocca WA, Roger VL, St Sauver JL. Multimorbidity, functional limitations, and outcomes: Interactions in a population-based cohort of older adults. J Comorb 2019; 9:2235042X19873486. [PMID: 31523633 PMCID: PMC6734596 DOI: 10.1177/2235042x19873486] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 08/07/2019] [Accepted: 08/08/2019] [Indexed: 12/20/2022]
Abstract
Objective: To understand the interaction of multimorbidity and functional limitations in
determining health-care utilization and survival in older adults. Methods: Olmsted County, Minnesota, residents aged 60–89 years in 2005 were categorized into
four cohorts based on the presence or absence of multimorbidity (≥3 chronic conditions
from a list of 18) and functional limitations (≥1 limitation in an activity of daily
living from a list of 9), and were followed through December 31, 2016. Andersen–Gill and
Cox regression estimated hazard ratios (HRs) for emergency department (ED) visits,
hospitalizations, and death using persons with neither multimorbidity nor functional
limitations as the reference (interaction analyses). Results: Among 13,145 persons, 34% had neither multimorbidity nor functional limitations, 44%
had multimorbidity only, 4% had functional limitations only, and 18% had both. Over a
median follow-up of 11 years, 5906 ED visits, 2654 hospitalizations, and 4559 deaths
occurred. Synergistic interactions on an additive scale of multimorbidity and functional
limitations were observed for all outcomes; however, the magnitude of the interactions
decreased with advancing age. The HR (95% confidence interval) for death among persons
with both multimorbidity and functional limitations was 5.34 (4.40–6.47) at age 60–69,
4.16 (3.59–4.83) at age 70–79, and 2.86 (2.45–3.35) at age 80–89 years. Conclusion: The risk of ED visits, hospitalizations, and death among persons with both
multimorbidity and functional limitations is greater than additive. The magnitude of the
interaction was strongest for the youngest age group, highlighting the importance of
interventions to prevent and effectively manage multimorbidity and functional
limitations early in life.
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Affiliation(s)
- Alanna M Chamberlain
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA.,Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Lila J Finney Rutten
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA.,Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Debra J Jacobson
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA.,Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Chun Fan
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Patrick M Wilson
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA.,Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Walter A Rocca
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA.,Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Véronique L Roger
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA.,Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - Jennifer L St Sauver
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA.,Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
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Starr LT, Ulrich CM, Corey KL, Meghani SH. Associations Among End-of-Life Discussions, Health-Care Utilization, and Costs in Persons With Advanced Cancer: A Systematic Review. Am J Hosp Palliat Care 2019; 36:913-926. [PMID: 31072109 DOI: 10.1177/1049909119848148] [Citation(s) in RCA: 73] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Aggressive end-of-life (EOL) care is associated with lower quality of life and greater regret about treatment decisions. Higher EOL costs are also associated with lower quality EOL care. Advance care planning and goals-of-care conversations ("EOL discussions") may influence EOL health-care utilization and costs among persons with cancer. OBJECTIVE To describe associations among EOL discussions, health-care utilization and place of death, and costs in persons with advanced cancer and explore variation in study measures. METHODS A systematic review was conducted using PubMed, Embase, and CINAHL. Twenty quantitative studies published between January 2012 and January 2019 were included. RESULTS End-of-life discussions are associated with lower health-care costs in the last 30 days of life (median US$1048 vs US$23482; P < .001); lower likelihood of acute care at EOL (odds ratio [(OR] ranging 0.43-0.69); lower likelihood of intensive care at EOL (ORs ranging 0.26-0.68); lower odds of chemotherapy near death (ORs 0.41, 0.57); lower odds of emergency department use and shorter length of hospital stay; greater use of hospice (ORs ranging 1.79 to 6.88); and greater likelihood of death outside the hospital. Earlier EOL discussions (30+ days before death) are more strongly associated with less aggressive care outcomes than conversations occurring near death. CONCLUSIONS End-of-life discussions are associated with less aggressive, less costly EOL care. Clinicians should initiate these discussions with patients having cancer earlier to better align care with preferences.
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Affiliation(s)
- Lauren T Starr
- 1 NewCourtland Center for Transitions and Health, University of Pennsylvania School of Nursing, Philadelphia, PA, USA.,2 Penn Center for Bioethics, University of Pennsylvania, Philadelphia, PA, USA.,3 Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA.,4 University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | - Connie M Ulrich
- 1 NewCourtland Center for Transitions and Health, University of Pennsylvania School of Nursing, Philadelphia, PA, USA.,4 University of Pennsylvania School of Nursing, Philadelphia, PA, USA.,5 Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Kristin L Corey
- 1 NewCourtland Center for Transitions and Health, University of Pennsylvania School of Nursing, Philadelphia, PA, USA.,4 University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | - Salimah H Meghani
- 1 NewCourtland Center for Transitions and Health, University of Pennsylvania School of Nursing, Philadelphia, PA, USA.,3 Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA.,4 University of Pennsylvania School of Nursing, Philadelphia, PA, USA
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26
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Jang DW, Abraham C, Cyr DD, Schulz K, Abi Hachem R, Witsell DL. Preoperative Management of Chronic Rhinosinusitis Prior to Office Balloon Sinus Dilation: A 2011-2014 MarketScan® Analysis. Am J Rhinol Allergy 2019; 33:347-353. [PMID: 30732455 DOI: 10.1177/1945892419829335] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background In-office balloon sinus dilation (BSD) has recently gained popularity as a surgical treatment option for chronic rhinosinusitis (CRS). However, utilization, indications, and practice patterns surrounding in-office BSD remain unclear. Objective The purpose of this study was to use a large national administrative database to assess preoperative management of CRS prior to in-office BSD. Methods Patients undergoing standalone in-office BSD from 2011 to 2014 were identified on MarketScan and compared to a control group undergoing functional endoscopic sinus surgery (FESS). Visits to the otolaryngologist, number of computed tomography (CT) scans, number of antibiotic and steroid prescriptions, and duration of time from first visit to procedure were compared. Results When compared to the FESS group, the in-office BSD group overall had fewer office visits (2.0 vs 2.2), CT scans (1.0 vs 1.1), prescriptions for antibiotics (2.0 vs 2.2), prescriptions for systemic steroids (1.5 vs 1.8), and topical steroids (1.4 vs 1.5) in the preoperative period. They also had a shorter mean duration of time between first visit and CT scan (17.5 vs 21.4 days) as well as between first visit and procedure (55.0 vs 67.8 days). All of these findings were statistically significant. Conclusion In-office BSD for CRS was overall associated with less intense management in the preoperative period when compared to FESS. Such differences may reflect ongoing shifts in practice patterns and need to be further investigated.
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Affiliation(s)
- David W Jang
- 1 Division of Head and Neck Surgery & Communication Sciences, Department of Surgery, Duke University, Durham, North Carolina
| | - Cecily Abraham
- 2 Duke Clinical Research Institute, Duke University, Durham, North Carolina
| | - Derek D Cyr
- 2 Duke Clinical Research Institute, Duke University, Durham, North Carolina
| | - Kristine Schulz
- 1 Division of Head and Neck Surgery & Communication Sciences, Department of Surgery, Duke University, Durham, North Carolina
| | - Ralph Abi Hachem
- 1 Division of Head and Neck Surgery & Communication Sciences, Department of Surgery, Duke University, Durham, North Carolina
| | - David L Witsell
- 1 Division of Head and Neck Surgery & Communication Sciences, Department of Surgery, Duke University, Durham, North Carolina
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Greenle MM, Hirschman KB, Coburn K, Marcantonio S, Hanlon AL, Naylor M, Mauer E, Ulrich C. End-of-life Health-Care Utilization Patterns Among Chronically Ill Older Adults. Am J Hosp Palliat Care 2019; 36:507-512. [PMID: 30696252 DOI: 10.1177/1049909118824962] [Citation(s) in RCA: 5] [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] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Patients with chronic illness are associated with high health-care utilization and this is exacerbated in the end of life, when health-care utilization and costs are highest. Complex Care Management (CCM) is a model of care developed to reduce health-care utilization, while improving patient outcomes. We aimed to examine the relationship between health-care utilization patterns and patient characteristics over time in a sample of older adults enrolled in CCM over the last 2 years of life. Generalized estimating equation models were used. The sample (n = 126) was 52% female with an average age of 85 years. Health-care utilization rose sharply in the last 3 months of life with at least one hospitalization for 67% of participants and an emergency department visit for 23% of participants. In the last 6 months of life, there was an average of 2.17 care transitions per participant. The odds of hospitalization increased by 27% with each time interval ( P < .001). Participants demonstrated 11% greater odds of having a hospitalization for each additional comorbidity ( P = .05). A primary diagnosis of heart failure or coronary artery disease was associated with 21% greater odds of hospitalization over time compared to other primary diagnoses ( P = .017). Females had 70% greater odds of an emergency department visit compared to males ( P = .046). For each additional year of life, the odds of an emergency department visit increased by about 7% ( P < .001). Findings suggest the need for further interventions targeting chronically ill older adults nearing end of life within CCM models.
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Affiliation(s)
| | - Karen B Hirschman
- 2 University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | - Ken Coburn
- 3 Health Quality Partners, Doylestown, PA, USA
| | | | | | - Mary Naylor
- 2 University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | | | - Connie Ulrich
- 2 University of Pennsylvania School of Nursing, Philadelphia, PA, USA
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Farahbakhsh M, Sadeghi Bazargani H, Saadati M, Tabrizi JS, Golestani M, Zakery A. Health services utilisation and responsiveness profiles in Iran: a provincial household study. Fam Med Community Health 2019; 7:e000007. [PMID: 32148689 PMCID: PMC6910723 DOI: 10.1136/fmch-2018-000007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 01/02/2019] [Accepted: 01/06/2019] [Indexed: 11/06/2022] Open
Abstract
Objective The aim of this study was to describe health services utilisation and responsiveness in East Azerbaijan province, Iran. Design A cross-sectional household study as part of a larger research on primary healthcare system. Setting We carried out the study in East Azerbaijan Province, northwest Iran from July to September 2015. Participants A total of 1318 households were included. Results Most of the participating households had social security health insurance. Heart failure or hypertension care, general outpatient care and arthritis care were the most used services. High services cost and inadequate medicine and medical equipment were introduced to be the main barriers to health services utilisation in Tabriz and province representative sample (PRS), respectively. Health system responsiveness mean score (the maximum is 100) was 33.71±16.15 (95% CI 32.45 to 34.97) in Tabriz and 32.02±14.3 (95% CI 30.9 to 33.13) in PRS, which showed significant difference (p≤0.02). Conclusions Differences in the utilisation and responsiveness of health services and distribution of health resources were observed between Tabriz and PRS. Evidently, health system responsiveness in both Tabriz and PRS was at low level. The results demonstrate the need for changing resource distribution policies and employing reactive health policies to response the public health.
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Affiliation(s)
- Mostafa Farahbakhsh
- Psychiatrics Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.,Road Traffic Injury Research Center, Statistics and Epidemiology Department, School of Health, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Homayoun Sadeghi Bazargani
- Road Traffic Injury Research Center, Statistics and Epidemiology Department, School of Health, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mohammad Saadati
- Road Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Jafar Sadegh Tabrizi
- Tabriz Health Services Management Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mina Golestani
- Road Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Akram Zakery
- Tabriz Health Services Management Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
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Abstract
Despite an aging population and an increase in the prevalence of chronic severe illness, many patients will not have end-of-life care discussions with their outpatient physicians. This very likely contributes to considerable hospital utilization toward the end of life, without any clear benefit. At our medical center, we noticed a very high rate of floor-to-intensive care unit (ICU) transfers for patients with life-limiting illness and poor prognosis. We initiated a quality assessment and improvement project aimed at increasing goals-of-care conversations for high-risk patients early in their hospital stays. Patients were identified using a risk assessment score combined with presence of life-limiting illness and alerting the inpatient attending physician to the patient's severity of illness. Inpatient attending physicians were encouraged to expeditiously initiate and document goals-of-care discussions with their patients and families or to consult palliative care. Patient data were extracted retrospectively from high-risk patients prior to and during the intervention period. Analysis showed a significant increase in overall goals-of-care discussions and a significant reduction in floor-to-ICU transfers during initial admission. There was no change in mortality at 1 year, but there was a trend toward more in-home deaths for those patients who died within the year. Early inpatient goals-of-care conversations may reduce ICU utilization at index hospitalization and may reduce overall health-care utilization near the end of life.
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Affiliation(s)
- Amber Zimmer Deptola
- 1 Medicine Service, John Cochran VA Medical Center, St Louis, MO, USA.,2 Division of Medical Education, Department of Internal Medicine, Washington University in St. Louis, St Louis, MO, USA
| | - Jessica Riggs
- 3 Department of Pulmonary, Critical Care and Sleep Medicine, New York University School of Medicine, New York, NY, USA
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Weissman GE. Hierarchical Condition Categories for Pulmonary Diseases: Population Health Management and Policy Opportunities. Chest 2019; 155:868-873. [PMID: 30659819 DOI: 10.1016/j.chest.2018.12.013] [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: 08/31/2018] [Revised: 12/11/2018] [Accepted: 12/21/2018] [Indexed: 10/27/2022] Open
Abstract
Hierarchical condition categories (HCCs) are groups of diagnostic codes that are used to adjust federal payments to insurers and health systems based on differences in expected spending. Risk models built on HCCs improve on previous adjustment strategies that used demographic characteristics but did not include clinical diagnoses. Thus, accurate coding by clinicians of inpatient and outpatient encounters ensures capitated payments and reimbursements that are commensurate with predicted expenditures. Pulmonary diseases and various forms of critical illness play a significant role in this risk adjustment process both through their associated HCC codes and through interactions with other risk categories representing cardiac and psychiatric diseases. Ongoing uncertainty in federal health policy ensures a changing role for HCCs and risk-adjusted reimbursements across a variety of payment models and federal programs.
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Affiliation(s)
- Gary E Weissman
- Pulmonary, Allergy, and Critical Care Division, Perelman School of Medicine, Palliative and Advanced Illness Research Center, Department of Medicine, Perelman School of Medicine, and the Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA.
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Gonzaludo N, Belmont JW, Gainullin VG, Taft RJ. Estimating the burden and economic impact of pediatric genetic disease. Genet Med 2018; 21:1781-1789. [PMID: 30568310 PMCID: PMC6752475 DOI: 10.1038/s41436-018-0398-5] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Accepted: 11/29/2018] [Indexed: 12/13/2022] Open
Abstract
PURPOSE To identify the economic impact of pediatric patients with clinical indications of genetic disease (GD) on the US health-care system. METHODS Using the 2012 Kids' Inpatient Database, we identified pediatric inpatient discharges with International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes linked to genetic disease, including well-established genetic disorders, neurological diseases, birth defects, and other physiological or functional abnormalities with a genetic basis. Cohort characteristics and health-care utilization measures were analyzed. Discharges with a GD-associated primary diagnosis were used to estimate the minimum burden; discharges with GD-associated primary or secondary codes established the maximum burden. RESULTS Of 5.85 million weighted discharges, 2.6-14% included GD-associated ICD-9-CM codes. For these discharges, mean total costs were $16,000-77,000 higher (P < 0.0001) in neonates and $12,000-17,000 higher (P < 0.0001) in pediatric patients compared with background, corresponding to significantly higher total charges and lengths of stay. Aggregate total charges for suspected GD accounted for $14 to $57 billion (11-46%) of the "national bill" for pediatric patients in 2012. CONCLUSION Pediatric inpatients with diagnostic codes linked to genetic disease have a significant and disproportionate impact on resources and costs in the US health-care system.
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Affiliation(s)
- Nina Gonzaludo
- Illumina, Inc., 5200 Illumina Way, San Diego, 92122, CA, USA
| | - John W Belmont
- Illumina, Inc., 5200 Illumina Way, San Diego, 92122, CA, USA
| | | | - Ryan J Taft
- Illumina, Inc., 5200 Illumina Way, San Diego, 92122, CA, USA.
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Abstract
Introduction: Regular exercise and physical activity participation are recommended in guideline-based care for individuals with cystic fibrosis (CF) across the spectrum of age and disease severity. However, the best training methods to improve physical function and encourage ongoing exercise and activity participation are not clear, which is an ongoing challenge for clinicians. Areas covered: This perspective provides an overview of current evidence for exercise and physical activity relative to clinical outcomes and health-care utilization in people with CF, and highlights areas of future research need. Expert commentary: What kind, how much, how often, and how best to support people with CF to be physically active is uncertain. Whether new methods of training, the use of technology, or pharmaceutical developments could best deliver increased activity and physiological benefit without increased therapeutic burden is unclear. At present, if people with CF are going to be physically active, seemingly they should aim to perform this activity in the way most likely to confer some health benefit i.e. concerted exercise bouts of at least 10 min in addition to any incidental (habitual) activity performed during the course of daily life.
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Affiliation(s)
- Narelle S Cox
- a Discipline of Physiotherapy , La Trobe University , Melbourne , Victoria , Australia.,b Institute for Breathing and Sleep , Melbourne , Australia.,c Youth Activity Unlimited , Strategic Research Centre of the UK Cystic Fibrosis Trust
| | - Anne E Holland
- a Discipline of Physiotherapy , La Trobe University , Melbourne , Victoria , Australia.,b Institute for Breathing and Sleep , Melbourne , Australia.,c Youth Activity Unlimited , Strategic Research Centre of the UK Cystic Fibrosis Trust.,d Department of Physiotherapy , Alfred Hospital , Melbourne , Australia
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Poder TG, Carrier N, Bélanger M, Couillard S, Courteau J, Larivée P, Vanasse A. Eosinophil counts in first COPD hospitalizations: a 1-year cost analysis in Quebec, Canada. Int J Chron Obstruct Pulmon Dis 2018; 13:3065-3076. [PMID: 30349220 PMCID: PMC6183549 DOI: 10.2147/copd.s170747] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Exacerbations explain much of the cost of COPD. Higher blood eosinophil cell counts at admission for acute exacerbation of COPD increase the risk of subsequent exacerbations and hospitalizations. However, there is no literature on the economic burden of patients with this inflammatory profile. The objective of this study is to assess the cost of health-care service utilization according to different counts of blood eosinophils. METHODS The observational retrospective cohort included all first hospitalizations for COPD exacerbation between April 2006 and March 2013. The eosinophilic group was defined by blood eosinophil counts on admission ≥200 cells/µL and/or ≥2% of the total white blood cell count. Study outcomes were: total costs (2016 Canadian dollars) (index hospitalization and 1-year follow-up), total index hospitalization costs, total 1-year costs (all-cause readmissions, ambulatory and emergency service use), and 1-year COPD-related costs (only cost for COPD after initial discharge). Sensitivity analyses were conducted to evaluate the impact of different eosinophil cut-offs on outcomes. RESULTS In total, 479 patients were included, 173 in the eosinophilic group (92 in the higher cut-off). The average total cost was $18,263 ($6,706 for the index hospitalization), without significant difference between groups (P=0.3). The average 1-year COPD-related cost was higher in the eosinophilic group ($3,667 vs $2,472, P=0.006), with an adjusted mean difference of $1,416. Analysis of data using the higher cut-off of ≥400 cells or ≥3% was associated with a slightly larger difference in 1-year COPD-related costs between groups ($4,060 vs $2,629, P=0.003), with an adjusted mean difference of $1,640. CONCLUSION A higher blood eosinophil cell count at admission for a first hospitalization is associated with an increase in total 1-year COPD-related costs.
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Affiliation(s)
- Thomas G Poder
- Research Center, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC, Canada,
- Health Technology Assessment Unit, UETMIS, CIUSSS de l'Estrie -CHUS, Sherbrooke, QC, Canada
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada,
| | - Nathalie Carrier
- Research Center, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC, Canada,
| | - Maryse Bélanger
- Research Center, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC, Canada,
- Respirology Service Department of Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Simon Couillard
- Research Center, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC, Canada,
- Respirology Service Department of Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Josiane Courteau
- Research Center, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC, Canada,
| | - Pierre Larivée
- Research Center, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC, Canada,
- Respirology Service Department of Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Alain Vanasse
- Research Center, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC, Canada,
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada,
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Lautner SC, Garney WR, Harney IS. Addressing the Needs of African American Male Smokers Through Community Outreach and Tailored Smoking Cessation Strategies. Am J Mens Health 2018; 12:2055-2063. [PMID: 30058417 PMCID: PMC6199448 DOI: 10.1177/1557988318790895] [Citation(s) in RCA: 2] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
The prevalence of adult smokers within the state of Texas population is 19.2% with 25% of those smokers being African American. Although the smoking rate of African Americans in Texas is very high, they only represent about 18% of the calls to the Texas Tobacco Quitline. To investigate this phenomenon, researchers from Texas A&M University completed a qualitative study to investigate the social norms and awareness of the Quitline among African American males. Focus groups were conducted in a rural community to determine perceptions and attitudes towards smoking among the African American population, as this was an exploratory study. The focus group participants were 71% smokers and 90% identified as African American. Data collected during the focus groups revealed information three major themes which were derived from the research question. These themes were social norms of smoking, smoking cessation, and services needed for smoking cessation. Information learned was insightful because little information exists about successful smoking cessation strategies specifically for African American male subpopulations. With this information, data can be further synthesized and outreach strategies can be further developed to help decrease the gap in health equity as it related to African American males and smoking and increase calls to the Quitline.
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Jo YS, Kim YH, Lee JY, Kim K, Jung KS, Yoo KH, Rhee CK. Impact of BMI on exacerbation and medical care expenses in subjects with mild to moderate airflow obstruction. Int J Chron Obstruct Pulmon Dis 2018; 13:2261-2269. [PMID: 30100716 PMCID: PMC6067770 DOI: 10.2147/copd.s163000] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background and objective The rate of obesity is increasing in Asia, but the clinical impact of body mass index (BMI) on the outcome of chronic obstructive pulmonary disease (COPD) remains unknown. We aimed to assess this impact while focusing on the risk of exacerbation, health-care utilization, and medical costs. Methods We examined 43,864 subjects registered in the Korean National Health and Nutrition Examination Survey (KNHANES) database from 2007 to 2012, and linked the data of COPD patients who had mild to moderate airflow obstruction (n = 1,320) to National Health Insurance (NHI) data. COPD was confirmed by spirometry. BMI was used to stratify patients into four categories: underweight (BMI <18.5 kg/m2), normal range (18.5–22.9 kg/m2), overweight (23–24.9 kg/m2), and obese (≥25 kg/m2). Results Of the 1,320 patients with COPD with mild to moderate airflow obstruction, 27.8% had a BMI ≥25 kg/m2. Compared with normal-weight patients, obese patients tended to experience fewer exacerbations (incidence rate ratio [IRR] 0.88; 95% CI 0.77–0.99; P = 0.04), although this association was not significant in a multivariable analysis. COPD-related health-care utilization and medical expenses were higher among underweight patients than the other groups. After adjustment, the risk of COPD-related hospitalization was highest among underweight and higher among overweight patients vs normal-weight patients (adjusted IRRs: 7.12, 1.00, 1.26, and 1.02 for underweight, normal, overweight, and obese groups, respectively; P = 0.01). Conclusion Decreased weight tends to negatively influence prognosis of COPD with mild to moderate airflow obstruction, whereas higher BMI was not significantly related to worse outcomes.
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Affiliation(s)
- Yong Suk Jo
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kyung Hee University Hospital, Seoul, Republic of Korea
| | - Yee Hyung Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea
| | - Jung Yeon Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Konkuk University Chungju Hospital, Chungju, Republic of Korea
| | - Kyungjoo Kim
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, College of Medicine, Seoul St Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea,
| | - Ki-Suck Jung
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Republic of Korea
| | - Kwang Ha Yoo
- Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Chin Kook Rhee
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, College of Medicine, Seoul St Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea,
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Adame Perez SI, Senior PA, Field CJ, Jindal K, Mager DR. Frailty, Health-Related Quality of Life, Cognition, Depression, Vitamin D and Health-Care Utilization in an Ambulatory Adult Population With Type 1 or Type 2 Diabetes Mellitus and Chronic Kidney Disease: A Cross-Sectional Analysis. Can J Diabetes 2018; 43:90-97. [PMID: 30139571 DOI: 10.1016/j.jcjd.2018.06.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [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] [Received: 01/04/2018] [Revised: 05/31/2018] [Accepted: 06/06/2018] [Indexed: 12/25/2022]
Abstract
OBJECTIVES Frailty can cause increased vulnerability to adverse health outcomes, such as falls, fractures, depression and reduced health-related quality of life (HRQoL). This cross-sectional study compared the differences in body composition, HRQoL, mental health and cognitive and vitamin D (vitD) status with health-care utilization by frail and nonfrail adults with diabetes mellitus (type 1 and type 2) and with chronic kidney disease (stages 1 through 5). METHODS We studied adults with type 1 and type 2 diabetes and chronic kidney disease stages 1 through 5 who were participating in a longitudinal follow-up study (41 to 83 years of age; n=41). Body composition (dual-energy x-ray absorptiometry); vitD status (serum 25[OH]D3); frailty (Edmonton Frail Scale); depression (Major Depression Inventory); HRQoL (Short Form Health Survey-36); and cognitive status (Mini Mental State exam) were measured using validated tools. Participants who were on dialysis and had body weights >136 kg, and coinciding comorbidities known to influence vitD metabolism were excluded. RESULTS Frailty occurred in 17% of participants (n=7). Frail participants had lower lean body mass, lower HRQoL scores (individual and composite scores), more depression (p=<0.05) and higher numbers of health visits (total, inpatient and emergency) compared with nonfrail participants (p<0.05). No differences in health-care visit types or vitD status were noted between frail and nonfrail participants (p>0.05). CONCLUSIONS Frailty in an ambulatory population of adults with chronic kidney disease and diabetes is associated with low lean body mass, low HRQoL, greater depression and higher numbers of health-care visits.
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Affiliation(s)
- Stephany I Adame Perez
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, Alberta, Canada
| | - Peter A Senior
- Department of Endocrinology, University of Alberta, Edmonton, Alberta, Canada
| | - Catherine J Field
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, Alberta, Canada
| | - Kailash Jindal
- Northern Alberta Renal Program, Alberta Health Services and Department of Nephrology, University of Alberta, Edmonton, Alberta, Canada
| | - Diana R Mager
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, Alberta, Canada.
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Ortiz-Rivera MC. Asthma-related health services and asthma control among women in Puerto Rico. SAGE Open Med 2018; 6:2050312117745903. [PMID: 29780586 PMCID: PMC5952275 DOI: 10.1177/2050312117745903] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Accepted: 11/09/2017] [Indexed: 12/22/2022] Open
Abstract
Objectives: This study evaluates social, behavioral, and environmental determinants to differentiate between active and inactive asthma and how predisposing, enabling, and need factors elucidate asthma-related health services and asthma control among women in Puerto Rico. Methods: This study analyzed secondary cross-sectional data from a subsample of 625 adult females who participated in the Asthma Call Back Survey in Puerto Rico. Logistic and multinomial regression analyses were conducted to examine associations between explanatory variables and asthma outcomes. Results: In total, 63% of women reported active asthma, from which 37.9% have not well controlled or very poorly controlled asthma. Women with active asthma were significantly more likely to be out of work, have middle income (US$25,000–<US$35,000), and be obese (≥30 kg/m2). Perceived need of health status is a good predictor to know the odds ratio of women to use emergency room. Women with poorly controlled asthma were significantly associated with increased units of physician urgent visits and emergency room visits. Conclusion: The findings confirmed significant determinants for active asthma and adds information on odds ratio for sensitive subgroups that utilize asthma-related health services in higher proportion than their counterparts. These associations suggest a development of asthma management plan targeting women to control the condition and reduce health-care utilization.
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Romo RD, Cenzer IS, Williams BA, Smith AK. Relationship Between Expectation of Death and Location of Death Varies by Race/Ethnicity. Am J Hosp Palliat Care 2018; 35:1323-1329. [PMID: 29724110 DOI: 10.1177/1049909118773989] [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] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Older black and Latino Americans are more likely than white Americans to die in the hospital. Whether ethnic differences in expectation of death account for this disparity is unknown. OBJECTIVES To determine whether surviving family members' expectation of death has a differential association with site of death according to race or ethnicity. METHODS We conducted an analysis of decedents from the Health and Retirement Study, a nationally representative study of US older adults. Telephone surveys were conducted with family members for 5979 decedents (decedents were 55% were women, 85% white, 9% black, and 6% Latino). The outcome of interest was death in the hospital; the predictor variable was race/ethnicity, and the intervening variable was expectation of death. Covariates included sociodemographics (gender, age, household net worth, educational attainment level, religion) and health factors (chronic conditions, symptoms, health-care utilization). RESULTS Decedents' race/ethnicity was statistically related to the expectation of death and death in the hospital. When death was not expected, whites and Latinos were more likely to die in the hospital than when death was expected (49% vs 29% for whites and 55% vs 37% for Latinos; P < .001). There was no difference in site of death according to family's expectation of death among blacks. CONCLUSION Expectation of death did not fully account for site of death and played a greater role among whites and Latinos than among black Americans. Discussing prognosis by itself is unlikely to address ethnic disparities. Other factors appear to play an important role as well.
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Affiliation(s)
- Rafael D Romo
- 1 University of Virginia School of Nursing, Charlottesville, VA, USA.,2 Geriatrics, Extended and Palliative Care, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Irena S Cenzer
- 2 Geriatrics, Extended and Palliative Care, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA.,3 Division of Geriatrics, University of California, San Francisco, CA, USA
| | - Brie A Williams
- 3 Division of Geriatrics, University of California, San Francisco, CA, USA
| | - Alexander K Smith
- 2 Geriatrics, Extended and Palliative Care, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA.,3 Division of Geriatrics, University of California, San Francisco, CA, USA
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Christensen KD, Bernhardt BA, Jarvik GP, Hindorff LA, Ou J, Biswas S, Powell BC, Grundmeier RW, Machini K, Karavite DJ, Pennington JW, Krantz ID, Berg JS, Goddard KAB. Anticipated responses of early adopter genetic specialists and nongenetic specialists to unsolicited genomic secondary findings. Genet Med 2018; 20:1186-95. [PMID: 29388940 DOI: 10.1038/gim.2017.243] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Accepted: 12/01/2017] [Indexed: 12/15/2022] Open
Abstract
PURPOSE Secondary findings from genomic sequencing are becoming more common. We compared how health-care providers with and without specialized genetics training anticipated responding to different types of secondary findings. METHODS Providers with genomic sequencing experience reviewed five secondary-findings reports and reported attitudes and potential clinical follow-up. Analyses compared genetic specialists and physicians without specialized genetics training, and examined how responses varied by secondary finding. RESULTS Genetic specialists scored higher than other providers on four-point scales assessing understandings of reports (3.89 vs. 3.42, p = 0.0002), and lower on scales assessing reporting obligations (2.60 vs. 3.51, p < 0.0001) and burdens of responding (1.73 vs. 2.70, p < 0.0001). Nearly all attitudes differed between findings, although genetic specialists were more likely to assert that laboratories had no obligations when findings had less-established actionability (p < 0.0001 in interaction tests). The importance of reviewing personal and family histories, documenting findings, learning more about the variant, and recommending familial discussions also varied according to finding (all p < 0.0001). CONCLUSION Genetic specialists felt better prepared to respond to secondary findings than providers without specialized genetics training, but perceived fewer obligations for laboratories to report them, and the two groups anticipated similar clinical responses. Findings may inform development of targeted education and support.
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Farrokhi F, Beanlands H, Logan A, Kurdyak P, Jassal SV. Patient-perceived barriers to a screening program for depression: a patient opinion survey of hemodialysis patients. Clin Kidney J 2017; 10:830-837. [PMID: 29225813 PMCID: PMC5716221 DOI: 10.1093/ckj/sfx047] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Accepted: 04/19/2017] [Indexed: 01/22/2023] Open
Abstract
Background Depression is a prevalent, yet underdiagnosed, psychiatric disorder among patients with end-stage renal disease. Active case identification through routine screening is suggested; however, patient-related barriers may reduce the effectiveness of screening for, and treating, depression. This study aimed to explore the perceived barriers that limit patients from participating in screening and treatment programs for depression. Methods In a cross-sectional study of chronic maintenance hemodialysis patients, the Perceived Barriers to Psychological Treatment questionnaire, adapted to include screening, was used to measure perceived barriers. The two-item Patient Health Questionnaire was used to identify patients with depressive symptoms. Results Of 160 participants, 73.1% reported at least one barrier preventing them from participation [95% confidence interval (95% CI) 66.2–80.0%]. Patients with depressive symptoms were more likely to perceive at least one barrier to a screening program for depression compared with those without depressive symptoms (96% versus 68.9%, respectively; odds ratio = 10.8; 95% CI 1.4–82.8; P = 0.005). The association of the barrier scores with depressive symptoms remained significant after adjustment for patient’s characteristics. The most common barriers that patients expressed were concerns about the side effects of any antidepressant medications that may be prescribed (40%), concerns about having more medications (32%), feeling that the problem is not severe enough (23%) and perceiving no risk of depression (23%). Conclusions Negative perceptions about depression and its treatment among hemodialysis patients constitute an important barrier to identifying this condition and first need to be addressed before implementing a screening program in this population.
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Affiliation(s)
- Farhat Farrokhi
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Heather Beanlands
- Daphne Cockwell School of Nursing, Ryerson University, Toronto, Ontario, Canada
| | - Alexander Logan
- Division of Nephrology, Department of Medicine, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Paul Kurdyak
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Institute for Clinical Evaluative Sciences, University of Toronto, Toronto, Ontario, Canada.,Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Sarbjit Vanita Jassal
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Division of Nephrology, Department of Medicine, University Health Network, University of Toronto, Toronto, Ontario, Canada
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Abstract
BACKGROUND Safety plans are recommended as tools to mitigate suicide risk; however, their effectiveness remains unclear. AIM To evaluate the impact of safety plans on patient care at an outpatient mental health clinic. METHOD In this retrospective chart review, patients' treatment engagement, health-care utilization, and risk behaviors were measured. Patients served as their own historical controls, and we compared outcomes in the 6 months before and 6 months after creation of safety plans. RESULTS In all, 48 patient charts were identified. Hospitalizations were significantly reduced and use of crisis calls significantly increased after implementation of safety plans. There were five suicide attempts before safety plan completion and one after, representing a trend toward statistical significance. Outpatient encounters increased by 18%, missed appointments increased by 34%, psychiatric emergency room visits decreased by 47%, and a 69% reduction in inpatient hospital days was observed, all trending toward statistical significance. No differences were seen in episodes of violence or self-injurious behavior. LIMITATIONS The study sample was small and there was a lack of randomization. CONCLUSION Results suggest that safety plans can lead to improvements in utilization of care and patient engagement. Further research is needed to better understand the clinical impact of safety plans on high-risk patients.
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Affiliation(s)
- Jess Zonana
- 1 Weill Cornell Medical College, New York, NY, USA.,2 New York Presbyterian Hospital, New York, NY, USA
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Phongtankuel V, Johnson P, Reid MC, Adelman RD, Grinspan Z, Unruh MA, Abramson E. Risk Factors for Hospitalization of Home Hospice Enrollees Development and Validation of a Predictive Tool. Am J Hosp Palliat Care 2017; 34:806-813. [PMID: 27448668 PMCID: PMC5684698 DOI: 10.1177/1049909116659439] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [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] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Over 10% of hospice patients experience at least 1 care transition 6 months prior to death. Transitions at the end of life, particularly from hospice to hospital, result in burdensome and fragmented care for patients and families. Little is known about factors that predict hospitalization in this population. OBJECTIVES To develop and validate a model predictive of hospitalization after enrollment into home hospice using prehospice admission risk factors. DESIGN Retrospective cohort study using Medicare fee-for-service claims. PARTICIPANTS Patients enrolled into the Medicare hospice benefit were ≥18 years old in 2012. OUTCOME MEASURED Hospitalization within 2 days from a hospice discharge. RESULTS We developed a predictive model using 61 947 hospice enrollments, of which 3347 (5.4%) underwent a hospitalization. Seven variables were associated with hospitalization: age 18 to 55 years old (adjusted odds ratio [95% confidence interval]: 2.94 [2.41-3.59]), black race (2.13 [1.93-2.34]), east region (1.97 [1.73-2.24]), a noncancer diagnosis (1.32 [1.21-1.45]), 4 or more chronic conditions (8.11 [7.19-9.14]), 2 or more prior hospice enrollments (1.75 [1.35-2.26]), and enrollment in a not-for-profit hospice (2.01 [1.86-2.18]). A risk scoring tool ranging from 0 to 29 was developed, and a cutoff score of 18 identified hospitalized patients with a positive predictive value of 22%. CONCLUSIONS Reasons for hospitalization among home hospice patients are complex. Patients who are younger, belong to a minority group, and have a greater number of chronic conditions are at increased odds of hospitalization. Our newly developed predictive tool identifies patients at risk for hospitalization and can serve as a benchmark for future model development.
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Affiliation(s)
- Veerawat Phongtankuel
- 1 Department of Medicine, Division of Geriatrics and Palliative Medicine, Joan and Sanford I Weill Medical College of Cornell University, New York, NY, USA
| | - P Johnson
- 2 Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, NY, USA
| | - M C Reid
- 1 Department of Medicine, Division of Geriatrics and Palliative Medicine, Joan and Sanford I Weill Medical College of Cornell University, New York, NY, USA
| | - R D Adelman
- 1 Department of Medicine, Division of Geriatrics and Palliative Medicine, Joan and Sanford I Weill Medical College of Cornell University, New York, NY, USA
| | - Z Grinspan
- 2 Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, NY, USA
- 3 Department of Pediatrics, Weill Cornell Medical College, New York, NY, USA
| | - M A Unruh
- 2 Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, NY, USA
| | - E Abramson
- 2 Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, NY, USA
- 3 Department of Pediatrics, Weill Cornell Medical College, New York, NY, USA
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Hatipoğlu U, Wells BJ, Chagin K, Joshi D, Milinovich A, Rothberg MB. Predicting 30-Day All-Cause Readmission Risk for Subjects Admitted With Pneumonia at the Point of Care. Respir Care 2017; 63:43-49. [PMID: 29066584 DOI: 10.4187/respcare.05719] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND The pneumonia 30-d readmission rate has been endorsed by the National Quality Forum as a quality metric. Hospital readmissions can potentially be lowered by improving in-hospital care, transitions of care, and post-discharge disease management programs. The purpose of this study was to create an accurate prediction model for determining the risk of 30-d readmission at the point of discharge. METHODS The model was created using a data set of 1,295 hospitalizations at the Cleveland Clinic Main Campus with pneumonia over 3 y. Candidate variables were limited to structured variables available in the electronic health record. The final model was compared with the Centers for Medicare and Medicaid Services (CMS) model among subjects 65 y of age and older (n = 628) and was externally validated. RESULTS Three hundred thirty subjects (25%) were readmitted within 30 d. The final model contained 13 variables and had a bias-corrected C statistic of 0.74 (95% CI 0.71-0.77). Number of admissions in the prior 6 months, opioid prescription, serum albumin during the first 24 h, international normalized ratio and blood urea nitrogen during the last 24 h were the predictor variables with the greatest weight in the model. In terms of discriminative performance, the Cleveland Clinic model outperformed the CMS model on the validation cohort (C statistic 0.69 vs 0.60, P = .042). CONCLUSIONS The proposed risk prediction model performed better than the CMS model. Accurate readmission risk prediction at the point of discharge is feasible and can potentially be used to focus post-acute care interventions in a high-risk group of patients.
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Affiliation(s)
| | - Brian J Wells
- Clinical and Translational Science Institute, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | | | | | | | - Michael B Rothberg
- Center for Value-Based Care Research, Medicine Institute, Cleveland Clinic, Cleveland, Ohio
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Pinto P, Brown T, Khilkin M, Chuang E. Patient Outcomes After Palliative Care Consultation Among Patients Undergoing Therapeutic Hypothermia. Am J Hosp Palliat Care 2017; 35:570-573. [PMID: 28789562 DOI: 10.1177/1049909117724779] [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] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To compare the clinical outcomes of patients who did and did not receive palliative care consultation among those who experienced out-of-hospital cardiac arrest and underwent therapeutic hypothermia. METHODS We identified patients at a single academic medical center who had undergone therapeutic hypothermia after out-of-hospital cardiac arrest between 2009 and 2013. We performed a retrospective chart review for demographic data, hospital and critical care length of stay, and clinical outcomes of care. RESULTS We reviewed the charts of 62 patients, of which 35 (56%) received a palliative care consultation and 27 (44%) did not. Palliative care consultation occurred an average of 8.3 days after admission. Patients receiving palliative care consultation were more likely to have a do-not-resuscitate (DNR) order placed (odds ratio: 2.3, P < .001). The mean length of stay in the hospital was similar for patients seen by palliative care or not (16.7 vs 17.1 days, P = .90). Intensive care length of stay was also similar (11.3 vs 12.6 days, P = .55). CONCLUSIONS Palliative care consultation was underutilized and utilized late in this cohort. Palliative consultation was associated with DNR orders but did not affect measures of utilization such as hospital and intensive care length of stay.
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Affiliation(s)
- Priya Pinto
- 1 Division of Palliative Medicine and Bioethics, Winthrop University Hospital, Mineola, NY, USA
| | - Tartania Brown
- 2 Wyckoff Hospital, MJHS Hospice and Palliative Care, Brooklyn, NY, USA
| | - Michael Khilkin
- 3 Department of Critical Care Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Elizabeth Chuang
- 4 Hospice and Palliative Medicine, Department of Family and Social Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
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Merianos AL, Odar Stough C, Nabors LA, Mahabee-Gittens EM. Tobacco Smoke Exposure and Health-Care Utilization Among Children in the United States. Am J Health Promot 2017; 32:123-130. [PMID: 29214835 DOI: 10.1177/0890117116686885] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE The purpose of this study was to assess patterns of health-care utilization among children who potentially had tobacco smoke exposure (TSE) compared to those who were not exposed. DESIGN A secondary data analysis of the 2011 to 2012 National Survey on Children's Health was performed. SETTING Households nationwide were selected. PARTICIPANTS A total of 95 677 children aged 0 to 17 years. MEASURES Sociodemographic characteristics, TSE status, and health-care visits were measured. ANALYSIS Multivariable logistic regression models were performed. RESULTS A total of 24.1% of children lived with smokers. Approximately 5% had home TSE. Participants who lived with a smoker were significantly more likely to have had a medical care visit (odds ratio [OR] = 1.22, confidence interval [CI] = 1.21-1.22) and were more likely to seek sick care or health advice at an emergency department (OR = 1.23, CI = 1.23-1.24) but were less likely to have had a dental care visit (OR = 0.82, CI = 0.82-0.83) than those who did not live with a smoker. Similar findings were found among participants who had home TSE. CONCLUSION TSE is a risk factor for increased use of pediatric medical care. Based on the high number of children who potentially had TSE and received sick care or health advice at an emergency emergency department, this setting may be a venue to deliver health messages to caregivers.
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Affiliation(s)
- Ashley L Merianos
- 1 Health Promotion and Education Program, School of Human Services, University of Cincinnati, Cincinnati, OH, USA
| | - Cathy Odar Stough
- 2 Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Laura A Nabors
- 1 Health Promotion and Education Program, School of Human Services, University of Cincinnati, Cincinnati, OH, USA
| | - E Melinda Mahabee-Gittens
- 3 Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, College of Medicine, University of Cincinnati, Cincinnati, OH, USA
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Ward L, Powell RE, Scharf ML, Chapman A, Kavuru M. Patient-Centered Specialty Practice: Defining the Role of Specialists in Value-Based Health Care. Chest 2017; 151:930-935. [PMID: 28089817 DOI: 10.1016/j.chest.2017.01.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [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: 09/30/2016] [Revised: 12/27/2016] [Accepted: 01/04/2017] [Indexed: 01/17/2023] Open
Abstract
Health care is at a crossroads and under pressure to add value by improving patient experience and health outcomes and reducing costs to the system. Efforts to improve the care model in primary care, such as the patient-centered medical home, have enjoyed some success. However, primary care accounts for only a small portion of total health-care spending, and there is a need for policies and frameworks to support high-quality, cost-efficient care in specialty practices of the medical neighborhood. The Patient-Centered Specialty Practice (PCSP) model offers ambulatory-based specialty practices one such framework, supported by a formal recognition program through the National Committee for Quality Assurance. The key elements of the PCSP model include processes to support timely access to referral requests, improved communication and coordination with patients and referring clinicians, reduced unnecessary and duplicative testing, and an emphasis on continuous measurement of quality, safety, and performance improvement for a population of patients. Evidence to support the model remains limited, and estimates of net costs and value to practices are not fully understood. The PCSP model holds promise for promoting value-based health care in specialty practices. The continued development of appropriate incentives is required to ensure widespread adoption.
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Affiliation(s)
- Lawrence Ward
- Department of Medicine, Division of Internal Medicine, Thomas Jefferson University, Philadelphia, PA.
| | - Rhea E Powell
- Department of Medicine, Division of Internal Medicine, Thomas Jefferson University, Philadelphia, PA
| | - Michael L Scharf
- Department of Medicine, Division of Pulmonary and Critical Care, Thomas Jefferson University, Philadelphia, PA
| | - Andrew Chapman
- Department of Medical Oncology, Thomas Jefferson University, Philadelphia, PA
| | - Mani Kavuru
- Department of Medicine, Division of Pulmonary and Critical Care, Thomas Jefferson University, Philadelphia, PA
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Abera Abaerei A, Ncayiyana J, Levin J. Health-care utilization and associated factors in Gauteng province, South Africa. Glob Health Action 2017; 10:1305765. [PMID: 28574794 PMCID: PMC5496078 DOI: 10.1080/16549716.2017.1305765] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Accepted: 02/23/2017] [Indexed: 10/30/2022] Open
Abstract
BACKGROUND More than a billion people, mainly in low- and middle-income countries, are unable to access needed health-care services for a variety of reasons. Possible factors influencing health-care utilization include socio-demographic and economic factors such as age, sex, education, employment and income. However, different studies have showed mixed results. Moreover, there are limited studies on health-care utilization. OBJECTIVE This study aimed to determine health-care utilization and associated factors among all residents aged 18 or over in Gauteng province, South Africa. METHODS A cross-sectional study was conducted from data collected for a Quality of Life survey which was carried out by Gauteng City-Region Observatory in 2013. Simple random sampling was used to select participants. A total of 27,490 participants have been interviewed. Data were collected via a digital data collection instrument using an open source system called Formhub. Coarsened Exact Matching (CEM) was used to improve estimation of causal effects. Stepwise multiple logistic regression was employed to identify factors associated with health-care utilization. RESULTS Around 95.7% reported usually utilizing health-care services while the other 4.3% reported not having sought health-care services of any type. Around 75% of participants reported reduced quality of public health services as a major reason not to visit them. Higher odds of reported health-care utilization were associated with being female (OR = 2.18, 95% CI: 1.88-2.53; p < 0.001), being White compared to being African (OR = 2.28, 95% CI: 1.84-2.74; p < 0.001), and having medical insurance (OR = 5.41, 95% CI: 4.06-7.23; p < 0.001). Lower odds of seeking health-care were associated with being an immigrant (OR = 0.61, 95% CI: 0.53-0.70; p < 0.001). CONCLUSIONS The results indicated that there is a need to improve the quality of public health-care services and perception towards them as improved health-care quality increases the choice of health-care providers.
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Affiliation(s)
- Admas Abera Abaerei
- Faculty of Health Sciences, School of Public Health, Division of Epidemiology and Biostatistics, University of the Witwatersrand, Johannesburg, South Africa
- College of Health and Medical Sciences, School of Public Health, Haramaya University, Harar, Ethiopia
| | - Jabulani Ncayiyana
- Faculty of Health Sciences, School of Public Health, Division of Epidemiology and Biostatistics, University of the Witwatersrand, Johannesburg, South Africa
| | - Jonathan Levin
- Faculty of Health Sciences, School of Public Health, Division of Epidemiology and Biostatistics, University of the Witwatersrand, Johannesburg, South Africa
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Abstract
It is unclear whether concurrent pneumonia and chronic obstructive pulmonary disease (COPD) have a higher mortality than either condition alone. Further, it is unknown how this interaction changes over time. We explored the effect of pneumonia and COPD on inpatient, 30-day and overall mortality. We used a Veterans Health Affairs database to compare patients who were hospitalized for a COPD exacerbation without pneumonia (AECOPD), patients hospitalized for pneumonia without COPD (PNA) and patients hospitalized for pneumonia who had a concurrent diagnosis of COPD (PCOPD). We studied records of 15,065 patients with the following primary discharge diagnoses: (a) AECOPD cohort (7,154 individuals); (b) PNA cohort (4,433 individuals); and (c) PCOPD (3,478 individuals), comparing inpatient, 30-day and overall mortality in the three study cohorts. We observed a stepwise increase in inpatient mortality for AECOPD, PNA and PCOPD (4.8%, 9.5% and 13.2%, respectively). These differences persisted at 30 days post-discharge (AECOPD = 6.7%, PNA = 12.4% and PCOPD = 14.6%; p < 0.0001), but not throughout the study period (median follow-up: 37 months). With time, the death rate rose disproportionally in patients who had been admitted for AECOPD (AECOPD = 64.5%; PNA = 57.4% and PCOPD 66.2%; p < 0.001). In multivariate analysis, PCOPD predicted the greatest inpatient mortality (p < 0.001). The data showed a progression in inpatient and 30-day mortality from AECOPD to PNA to PCOPD. Pneumonia and COPD differentially affected inpatient, 30-day and overall mortality with pneumonia affecting predominantly inpatient and 30-day mortality while COPD affecting the overall mortality.
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Affiliation(s)
- Amir Sharafkhaneh
- a Medical Care Line, Michael E. DeBakey VA Medical Center , Houston , TX , USA.,b Department of Medicine , Section of Pulmonary, Critical Care and Sleep Medicine, Baylor College of Medicine , Houston , TX , USA
| | | | - Kevin Main
- d Allied Health Sciences, Baylor College of Medicine , Houston , TX , USA
| | - Shahriar Tavakoli-Tabasi
- a Medical Care Line, Michael E. DeBakey VA Medical Center , Houston , TX , USA.,c Department of Medicine , Section of Infectious Diseases, Baylor College of Medicine , Houston , TX , USA
| | - Charlie Lan
- a Medical Care Line, Michael E. DeBakey VA Medical Center , Houston , TX , USA.,b Department of Medicine , Section of Pulmonary, Critical Care and Sleep Medicine, Baylor College of Medicine , Houston , TX , USA
| | - Daniel Musher
- a Medical Care Line, Michael E. DeBakey VA Medical Center , Houston , TX , USA.,c Department of Medicine , Section of Infectious Diseases, Baylor College of Medicine , Houston , TX , USA
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Maragh-Bass AC, Powell C, Park J, Flynn C, German D. Sociodemographic and access-related correlates of health-care utilization among African American injection drug users: The BESURE study. J Ethn Subst Abuse 2016; 16:344-362. [PMID: 27404977 DOI: 10.1080/15332640.2016.1196629] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Persons who inject drugs (PWID) may have less access to, and utilization of, health-care services, and African American PWID may be less likely than other racial groups to utilize health care in the United States. The present study evaluated the prevalence of health-care utilization (HCU) among a cohort of African American PWID in Baltimore. Data were from the 2012 Baltimore National HIV Behavioral Surveillance study. Participants were adult PWID and recruited using respondent-driven sampling (RDS). They completed a comprehensive sociobehavioral survey and voluntary HIV test with trained study interviewers. Analyses included descriptive and bivariate statistics to examine the prevalence of HCU, defined as seeing a health-care provider in the past year. Poisson regression assessed correlates of HCU. Participants were 61% male; 23% self-reported HIV seropositivity. Nearly 90% reported unemployment and/or disability; HCU prevalence was 85%. Significant negative correlates of HCU included age and higher injection frequency; positive correlates included previous incarceration and moderate financial stability. Interaction analyses showed unemployed publicly insured individuals had 30% higher HCU than unemployed and uninsured individuals (χ2 = 2.52; p < .05). There is a need to improve health-care utilization among PWID. High prevalence of disability was still found, despite insurance coverage and access to care in this population. While the recent Affordable Care Act has increased health-care coverage and access, our results suggest that is only a first step to improving health outcomes among PWID; targeted intervention to integrate these individuals is still needed.
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Affiliation(s)
| | | | - Ju Park
- b Johns Hopkins University , Baltimore , Maryland
| | - Colin Flynn
- c Maryland Department of Health and Mental Hygiene , Baltimore , Maryland
| | - Danielle German
- d Johns Hopkins Bloomberg School of Public Health , Baltimore , Maryland
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Valley TS, Sjoding MW, Goldberger ZD, Cooke CR. ICU Use and Quality of Care for Patients With Myocardial Infarction and Heart Failure. Chest 2016; 150:524-32. [PMID: 27318172 DOI: 10.1016/j.chest.2016.05.034] [Citation(s) in RCA: 8] [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] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Revised: 05/26/2016] [Accepted: 05/31/2016] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Quality of care for acute myocardial infarction (AMI) and heart failure (HF) varies across hospitals, but the factors driving variation are incompletely understood. We evaluated the relationship between a hospital's ICU or coronary care unit (CCU) admission rate and quality of care provided to patients with AMI or HF. METHODS A retrospective cohort study of Medicare beneficiaries hospitalized in 2010 with AMI or HF was performed. Hospitals were grouped into quintiles according to their risk- and reliability-adjusted ICU admission rates for AMI or HF. We examined the rates that hospitals failed to deliver standard AMI or HF processes of care (process measure failure rates), 30-day mortality, 30-day readmissions, and Medicare spending after adjusting for patient and hospital characteristics. RESULTS Hospitals in the lowest quintile had ICU admission rates < 29% for AMI or < 8% for HF. Hospitals in the top quintile had rates > 61% for AMI or > 24% for HF. Hospitals in the highest quintile had higher process measure failure rates for some but not all process measures. Hospitals in the top quintile had greater 30-day mortality (14.8% vs 14.0% [P = .002] for AMI; 11.4% vs 10.6% [P < .001] for HF), but no differences in 30-day readmissions or Medicare spending were seen compared with hospitals in the lowest quintile. CONCLUSIONS Hospitals with the highest rates of ICU admission for patients with AMI or HF delivered lower quality of care and had higher 30-day mortality for these conditions. Hospitals with high ICU use may be targets to improve care delivery.
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Affiliation(s)
- Thomas S Valley
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI; Michigan Center for Integrative Research in Critical Care, University of Michigan, Ann Arbor, MI.
| | - Michael W Sjoding
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI; Michigan Center for Integrative Research in Critical Care, University of Michigan, Ann Arbor, MI
| | - Zachary D Goldberger
- Division of Cardiology, Department of Internal Medicine, University of Washington, Seattle, WA
| | - Colin R Cooke
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI; Michigan Center for Integrative Research in Critical Care, University of Michigan, Ann Arbor, MI; Center for Health Outcomes and Policy, and the Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI
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