Association of Rural and Critical Access Hospital Status With Patient Outcomes After Emergency Department Visits Among Medicare Beneficiaries

Objective: Emergency departments (EDs) are critical settings for hepatitis C care in the United States. We assessed trends and characteristics of hepatitis C–associated ED visits during 2006-2014. Methods: We used data from the 2006-2014 Nationwide Emergency Department Sample to estimate numbers, rates, and costs of hepatitis C–associated ED visits, defined by either first-listed diagnosis of hepatitis C or all-listed diagnosis of hepatitis C. We assessed trends by demographic characteristics, liver disease severity, and patients’ disposition by using joinpoint analysis, and we calculated the average annual percentage change (AAPC) from 2006 to 2014. Results: During 2006-2014, the rate per 100 000 visits of first-listed and all-listed hepatitis C–associated ED visits increased significantly from 10.1 to 25.4 (AAPC = 13.0%; P < .001) and from 484.4 to 631.6 (AAPC = 3.4%; P < .001), respectively. Approximately 70% of these visits were made by persons born during 1945-1965 (baby boomers); 30% of visits were made by Medicare beneficiaries and 40% by Medicaid beneficiaries. Significant rate increases were among visits by baby boomers (first-listed: AAPC = 13.8%; all-listed: AAPC = 2.6%), persons born after 1965 (first-listed: AAPC = 14.3%; all-listed: AAPC = 9.2%), Medicare beneficiaries (first-listed: AAPC = 18.0%; all-listed: AAPC = 3.9%), and persons hospitalized after ED visits (first-listed: AAPC = 20.0%; all-listed: AAPC = 2.3%; all P < .001). Increasing proportions of compensated cirrhosis were among visits by baby boomers (first-listed: AAPC = 11.5%; all-listed: AAPC = 6.3%). Annual hepatitis C–associated total ED costs increased by 400.0% (first-listed) and 192.0% (all-listed) during 2006-2014. Conclusion: Public health efforts are needed to address the growing burden of hepatitis C care in the ED.

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The Relationship Between Rural Health Clinic Use and Potentially Preventable Hospitalizations and Emergency Department Visits Among Medicare Beneficiaries

The Journal of Rural Health ◽

10.1111/jrh.12253 ◽

2017 ◽

Vol 34 (4) ◽

pp. 423-430 ◽

Cited By ~ 1

Author(s):

Brad Wright ◽

Andrew J. Potter ◽

Amal N. Trivedi ◽

Keith J. Mueller

Keyword(s):

Emergency Department ◽

Rural Health ◽

Emergency Department Visits ◽

Health Clinic ◽

Medicare Beneficiaries ◽

Preventable Hospitalizations ◽

Potentially Preventable Hospitalizations ◽

The Relationship

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Long-term risk of seizures in adult survivors of sepsis

Neurology ◽

10.1212/wnl.0000000000004538 ◽

2017 ◽

Vol 89 (14) ◽

pp. 1476-1482 ◽

Cited By ~ 15

Author(s):

Michael E. Reznik ◽

Alexander E. Merkler ◽

Ali Mahta ◽

Santosh B. Murthy ◽

Jan Claassen ◽

...

Keyword(s):

Emergency Department ◽

General Population ◽

Claims Data ◽

Demographic Data ◽

Hospitalized Patients ◽

Emergency Department Visits ◽

Administrative Claims ◽

Separate Analysis ◽

Medicare Beneficiaries

Objective:To examine the association between sepsis and the long-term risk of seizures.Methods:We conducted a retrospective population-based cohort study using administrative claims data from all emergency department visits and hospitalizations at nonfederal acute care hospitals in California, Florida, and New York from 2005 to 2013. Using previously validated diagnosis codes, we identified all adult patients hospitalized with sepsis. Our outcome was any emergency department visit or hospitalization for seizure. Poisson regression and demographic data were used to calculate age-, sex-, and race-standardized incidence rate ratios (IRR). To confirm our findings, we used a matched cohort of hospitalized patients without sepsis for comparison and additionally assessed claims data from a nationally representative 5% sample of Medicare beneficiaries.Results:We identified 842,735 patients with sepsis. The annual incidence of seizure was 1.29% (95% confidence interval [CI] 1.27%–1.30%) in patients with sepsis vs 0.16% (95% CI 0.16%–0.16%) in the general population (IRR 4.98; 95% CI 4.92–5.04). A secondary analysis using matched hospitalized patients confirmed these findings (IRR 4.33; 95% CI 4.13–4.55), as did a separate analysis of Medicare beneficiaries, in whom we found a similar strength of association (IRR 2.72; 95% CI 2.60–2.83), as we did in patients ≥65 years of age in our primary statewide data (IRR 2.83; 95% CI 2.78–2.88).Conclusions:We found that survivors of sepsis faced a significantly higher long-term risk of seizures than both the general population and other hospitalized patients. Our findings suggest that sepsis is associated with pathways that lead to permanent neurologic sequelae.

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