Occupational heat-related illness emergency department visits and inpatient hospitalizations in the southeast region, 2007-2011

Abstract Background Older patients with brain metastases (BrM) commonly experience symptoms that prompt acute medical evaluation. We characterized emergency department (ED) visits and inpatient hospitalizations in this population. Methods We identified 17,789 and 361 Medicare enrollees diagnosed with BrM using the Surveillance, Epidemiology, and End Results-Medicare database (2010-2016) and an institutional database (2007-2016), respectively. Predictors of ED visits and hospitalizations were assessed using Poisson regression. Results The institutional cohort averaged 3.3 ED visits/1.9 hospitalizations per person-year, with intracranial disease being the most common reason for presentation/admission. SEER-Medicare patients averaged 2.8 ED visits/2.0 hospitalizations per person-year. For patients with synchronous BrM (N=7,834), adjusted risk factors for ED utilization and hospitalization, respectively, included: male sex (rate ratio [RR]=1.15 [95% CI=1.09-1.22], p<0.001; RR=1.21 [95% CI=1.13-1.29], p<0.001); African American vs. white race (RR=1.30 [95% CI=1.18-1.42], p<0.001; RR=1.25 [95% CI=1.13-1.39], p<0.001); unmarried status (RR=1.07 [95% CI=1.01-1.14], p=0.02; RR=1.09 [95% CI=1.02-1.17], p=0.01); Charlson co-morbidity score >2 (RR=1.27 [95% CI=1.17-1.37], p<0.001; RR=1.36 [95% CI=1.24-1.49], p<0.001); and receipt of non-stereotactic vs. stereotactic radiation (RR=1.44 [95% CI=1.34-1.55, p<0.001; RR=1.49 [95% CI=1.37-1.62, p<0.001). For patients with metachronous BrM (N=9,955), ED visits and hospitalizations were more common after vs. before BrM diagnosis (2.6 vs. 1.2 ED visits per person-year; 1.8 vs. 0.9 hospitalizations per person-year, respectively; RR=2.24 [95% CI=2.15-2.33], p<0.001; RR=2.06 [95% CI=1.98-2.15], p<0.001, respectively). Conclusions Older patients with BrM commonly receive hospital-level care secondary to intracranial disease, especially in select subpopulations. Enhanced care coordination, closer outpatient follow-up, and patient navigator programs seem warranted for this population.

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Associations of Telemedicine vs. In-Person Ambulatory Care Visits on Cancellation Rates and 30-Day Follow-Up Hospitalizations and Emergency Department Visits

10.1101/2021.08.13.21262018 ◽

2021 ◽

Author(s):

Julianne N Kubes ◽

Ilana Graetz ◽

Zanthia Wiley ◽

Nicole Franks ◽

Ambar Kulshreshtha

Keyword(s):

Emergency Department ◽

Clinical Outcomes ◽

Emergency Department Visit ◽

Emergency Department Visits ◽

Ambulatory Clinic ◽

Hospitalization Rates ◽

Clinic Appointment ◽

Rural Settings ◽

Inpatient Hospitalizations ◽

Race Ethnicity

Importance: Studies have shown that telemedicine use in specific conditions can promote continuity of care, decreases healthcare costs, and can potentially improve clinical outcomes. The COVID-19 pandemic forced many healthcare systems to expand access for patients using telemedicine, but little is known about cancellation frequencies in telemedicine vs. in-person appointments and its impact on clinical outcomes. Objective: Compare ambulatory clinic cancellation rates, 30-day inpatient hospitalizations rates, and 30-day emergency department visit rates between in-person and video telemedicine appointments, and examine differences in cancellation rates by age, race/ethnicity, gender, and insurance. Design: A retrospective cohort study. Setting: The largest academic healthcare system in the state of Georgia with ambulatory clinics in urban, suburban and rural settings. Participants: Adults scheduled for an ambulatory clinic appointment from June 2020 to December 2020 were included. Each appointment was identified as either a video telemedicine or in-person clinic appointment. Demographics including age, race, ethnicity, gender, primary insurance, and comorbidities were extracted from the electronic medical record. Main Outcomes and Measures: The primary process outcome was ambulatory clinic cancellation rates. The primary clinical outcomes were 30-day hospitalization rates and 30-day emergency department visit rates. Multivariable logistic regression was used to assess differences in the clinical outcomes between appointment types.

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