scholarly journals Impact of frailty on periprocedural health care utilization in patients undergoing transcatheter edge-to-edge mitral valve repair

2020 ◽  
Author(s):  
Christos Iliadis ◽  
Leandra Schwabe ◽  
Dirk Müller ◽  
Stephanie Stock ◽  
Stephan Baldus ◽  
...  
Keyword(s):  
Health Care ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Mitral Valve ◽  
Health Care Utilization ◽  
Mitral Valve Repair ◽  
Care Utilization ◽  
Valve Repair ◽  
Frail Patients ◽  
Intermediate Intensive Care Unit

Abstract Background Frailty is a common characteristic of patients undergoing transcatheter mitral valve repair (TMVR). It is unclear whether the physical vulnerability of frail patients translates into increased procedural health care utilization. Methods and results Frailty was assessed using the Fried criteria in 229 patients undergoing TMVR using the MitraClip system at our institution and associations with total costs and costs by cost centers within the hospital incurred during periprocedural hospitalization were examined. Frail patients (n = 107, 47%) compared to non-frail patients showed significantly higher total costs [median/interquartile range, excluding implant costs: 7,337 € (5,911–9,814) vs 6,238 € (5,584–7,499), p = 0.001], with a difference in means of 2,317 €. Frailty was the only clinical baseline characteristic with significant association with total costs. Higher total costs in frail patients were attributable primarily to longer stay on intermediate/intensive care unit (3.8 ± 5.7 days in frail vs 2.1 ± 1.7 days in non-frail, p = 0.003), but also to costs of clinical chemistry and physiotherapy. The prolonged stay on intermediate/intensive care unit in frail patients was attributable to postprocedural complications such as bleeding, kidney injury, infections and cardiovascular instability. Conclusion Frailty is associated with a mean 32% increase of hospital costs in patients undergoing TMVR, which is primarily the result of a prolonged recovery and increased vulnerability to complications. These findings are valuable for a hospital’s total cost calculation and resource allocation planning. Since frailty is regarded a potentially reversible health state, preventive interventions may help reduce costs in frail patients. Graphic abstract

Palliative care and end-of-life health utilization in elder patients with pancreatic cancer.

2018 ◽  
Vol 36 (4_suppl) ◽  
pp. 488-488
Author(s):  
Nizar Bhulani ◽  
Ang Gao ◽  
Arjun Gupta ◽  
Jenny Jing Li ◽  
Chad Guenther ◽  
...  
Keyword(s):  
Health Care ◽  
Pancreatic Cancer ◽  
Intensive Care Unit ◽  
Palliative Care ◽  
Intensive Care ◽  
Health Care Utilization ◽  
End Of Life ◽  
Cancer Patients ◽  
Cost Of Care ◽  
Care Utilization

488 Background: Prospective trials have shown that palliative care is associated with improved survival and quality of life, with lower rate of end-of-life health care utilization and cost. We examined trends in palliative care utilization in older pancreatic cancer patients. Methods: Pancreatic cancer patients with and without palliative care consults were identified using the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database between 2000 and 2009. Trend of palliative care use was studied. Emergency room and Intensive Care utilization and costs in the last 30 days of life were assessed. Statistical analyses were performed with SAS version 9.4 (SAS Institute, Inc., Cary, NC). Results: Of the 72205 patients with pancreatic cancer, 3383 (4.1%) received palliative care. The proportion of patients receiving palliative care increased from 1.8% in 2000 to 7.8% in 2009 (p for trend < 0.001). Patients with palliative care were more likely to be Asian and women. Of those who received palliative care, 73% received it in the last 30 days of life, and only 11% at least 12 weeks before death. The average number of visits to the ED in the last 30 days of life were significantly higher for patients who received palliative care (0.93±0.62) versus those who did not (0.79±0.61), p < 0.001, and had a significantly higher cost of care ($1317 vs $842, p < 0.001). Intensive care unit length of stay in the last 30 days of life did not differ between patients who did and did not receive palliative care (1.14 days vs 1.04 days, p 0.08). Intensive care unit cost of care was significantly higher for patients with palliative care compared to their counterparts ($5202.641 vs $3896.750, p < 0.001). Conclusions: Palliative care use for pancreatic cancer patients has increased between 2000 and 2009 in this study of Medicare patients. However, it was largely offered close to the end of life and was not associated with reduced health care utilization or cost. Early palliative care referral may be more beneficial.

scholarly journals Relationship Between Intensive Care Unit Delirium Severity and 2-Year Mortality and Health Care Utilization

2020 ◽  
Vol 29 (4) ◽  
pp. 311-317
Author(s):  
Patricia S. Andrews ◽  
Sophia Wang ◽  
Anthony J. Perkins ◽  
Sujuan Gao ◽  
Sikandar Khan ◽  
...  
Keyword(s):  
Health Care ◽  
Intensive Care Unit ◽  
Emergency Department ◽  
Intensive Care ◽  
Health Care Utilization ◽  
Mortality Risk ◽  
Hazard Ratio ◽  
Emergency Department Visits ◽  
Care Utilization ◽  
Increased Risk

Background Critical care patients with delirium are at an increased risk of functional decline and mortality long term. Objective To determine the relationship between delirium severity in the intensive care unit and mortality and acute health care utilization within 2 years after hospital discharge. Methods A secondary data analysis of the Pharmacological Management of Delirium and Deprescribe randomized controlled trials. Patients were assessed twice daily for delirium or coma using the Richmond Agitation-Sedation Scale and the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). Delirium severity was measured using the CAM-ICU-7. Mean delirium severity (from time of randomization to discharge) was categorized as rapidly resolving, mild to moderate, or severe. Cox proportional hazards regression was used to model time to death, first emergency department visit, and rehospitalization. Analyses were adjusted for age, sex, race, Charlson Comorbidity Index, Acute Physiology and Chronic Health Evaluation II score, discharge location, diagnosis, and intensive care unit type. Results Of 434 patients, those with severe delirium had higher mortality risk than those with rapidly resolving delirium (hazard ratio 2.21; 95% CI, 1.35-3.61). Those with 5 or more days of delirium or coma had higher mortality risk than those with less than 5 days (hazard ratio 1.52; 95% CI, 1.07-2.17). Delirium severity and number of days of delirium or coma were not associated with time to emergency department visits and rehospitalizations. Conclusion Increased delirium severity and days of delirium or coma are associated with higher mortality risk 2 years after discharge.

Ringless Alfieri Mitral Valve Repair for Significant Ischemic Mitral Regurgitation with Coronary Artery Bypass Grafting

2013 ◽  
Vol 16 (4) ◽  
pp. 184
Author(s):  
Alper Sami Kunt
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Mitral Valve Repair ◽  
Artery Bypass ◽  
Bypass Grafting ◽  
Valve Repair

<p><b>Background:</b> Ischemic mitral regurgitation (IMR) is associated with diminished survival prospects. Ringless edge-to-edge mitral valve repair is usually performed in association with coronary artery bypass grafting (CABG). In this report, we present our early results for ringless edge-to-edge repair and concomitant CABG.</p><p><b>Methods:</b> Between January 2011 and June 2012, 17 patients underwent ringless edge-to-edge mitral valve repair. The cause was ischemic in all patients. A double-orifice repair was done in all patients. Complete coronary revascularization was routinely added in all cases.</p><p><b>Results:</b> There were no hospital and late deaths. Low cardiac output developed in 5 patients (29.41%) and was treated with inotropic agents. Two of these patients required intraaortic balloon pump support. Atrial fibrillation and ventricular arrhythmia developed in 5 (29.41%) of the patients, and all of them converted to sinus rhythm with antiarrhythmic agents. The mean (SD) stays in the intensive care unit and the hospital were 2.83 � 1.29 days and 7.74 � 2.14 days, respectively. As of the latest follow-up, all patients were in New York Heart Association class I or II. There was no recurrent mitral valve regurgitation or valve-related complications.</p><p><b>Conclusions:</b> Alfieri mitral valve repair is associated with lower risks of mortality, postoperative stroke, and prolonged intensive care unit and hospital stays. Alfieri mitral valve repair and concomitant CABG surgery can be performed in patients with IMR.</p>

Inpatient Health Care Utilization By Medically Complex Children Admitted to the Pediatric Intensive Care Unit

PEDIATRICS ◽  
2016 ◽  
Vol 137 (Supplement 3) ◽  
pp. 267A-267A
Author(s):  
Titus Chan ◽  
Jonathan Rodean ◽  
Troy Richardson ◽  
Reid W.D. Farris ◽  
Jane L. Di Gennaro ◽  
...  
Keyword(s):  
Health Care ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Health Care Utilization ◽  
Pediatric Intensive Care Unit ◽  
Pediatric Intensive Care ◽  
Care Utilization

scholarly journals Transient systolic anterior motion with junctional rhythm after mitral valve repair in the intensive care unit

2018 ◽  
Vol 10 (1) ◽  
Author(s):  
Yusuke Seino ◽  
Nobuo Sato ◽  
Kimiya Fukui ◽  
Junya Ishikawa ◽  
Masahi Nakagawa ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Mitral Valve ◽  
Mitral Valve Repair ◽  
Systolic Anterior Motion ◽  
Valve Repair ◽  
Junctional Rhythm

scholarly journals Health care utilization before and after intensive care unit admission in multiple sclerosis

2015 ◽  
Vol 4 (4) ◽  
pp. 296-303 ◽  
Author(s):  
Ruth Ann Marrie ◽  
Charles N. Bernstein ◽  
Christine A. Peschken ◽  
Carol A. Hitchon ◽  
Hui Chen ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Health Care ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Intensive Care Unit Admission ◽  
Health Care Utilization ◽  
Care Utilization ◽  
Before And After

scholarly journals No Exit: Identifying Avoidable Terminal Oncology Intensive Care Unit Hospitalizations

2016 ◽  
Vol 12 (10) ◽  
pp. e901-e911 ◽  
Author(s):  
Bobby Daly ◽  
Andrew Hantel ◽  
Kristen Wroblewski ◽  
Jay S. Balachandran ◽  
Selina Chow ◽  
...  
Keyword(s):  
Health Care ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Performance Status ◽  
Case Series ◽  
Care Utilization ◽  
Poor Performance Status ◽  
Retrospective Case ◽  
Avoidable Hospitalizations ◽  
Ambulatory Oncology

Purpose: Terminal oncology intensive care unit (ICU) hospitalizations are associated with high costs and inferior quality of care. This study identifies and characterizes potentially avoidable terminal admissions of oncology patients to ICUs. Methods: This was a retrospective case series of patients cared for in an academic medical center’s ambulatory oncology practice who died in an ICU during July 1, 2012 to June 30, 2013. An oncologist, intensivist, and hospitalist reviewed each patient’s electronic health record from 3 months preceding terminal hospitalization until death. The primary outcome was the proportion of terminal ICU hospitalizations identified as potentially avoidable by two or more reviewers. Univariate and multivariate analysis were performed to identify characteristics associated with avoidable terminal ICU hospitalizations. Results: Seventy-two patients met inclusion criteria. The majority had solid tumor malignancies (71%), poor performance status (51%), and multiple encounters with the health care system. Despite high-intensity health care utilization, only 25% had documented advance directives. During a 4-day median ICU length of stay, 81% were intubated and 39% had cardiopulmonary resuscitation. Forty-seven percent of these hospitalizations were identified as potentially avoidable. Avoidable hospitalizations were associated with factors including: worse performance status before admission (median 2 v 1; P = .01), worse Charlson comorbidity score (median 8.5 v 7.0, P = .04), reason for hospitalization (P = .006), and number of prior hospitalizations (median 2 v 1; P = .05). Conclusion: Given the high frequency of avoidable terminal ICU hospitalizations, health care leaders should develop strategies to prospectively identify patients at high risk and formulate interventions to improve end-of-life care.

Parent Activation in the Neonatal Intensive Care Unit

2021 ◽  
Author(s):  
Ryan Skeens ◽  
Kerri L. Cavanaugh ◽  
Robert Cronin ◽  
QinGxia Chen ◽  
Yuhan Liu ◽  
...  
Keyword(s):  
Health Care ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Health Literacy ◽  
Neonatal Intensive Care Unit ◽  
Neonatal Intensive Care ◽  
Patient Activation ◽  
Care Utilization ◽  
Sociodemographic Characteristics ◽  
Parent Activation

Objective Patient activation is the knowledge, skills, and confidence to manage one's health; parent activation is a comparable concept related to a parent's ability to manage a child's health. Activation in adults is a modifiable risk factor and associated with clinical outcomes and health care utilization. We examined activation in parents of hospitalized newborns observing temporal trends and associations with sociodemographic characteristics, neonate characteristics, and outcomes. Study Design Participants included adult parents of neonates admitted to a level-IV neonatal intensive care unit in an academic medical center. Activation was measured with the 10-item Parent version of the Patient Activation Measure (P-PAM) at admission, discharge, and 30 days after discharge. Associations with sociodemographic variables, health literacy, clinical variables, and health care utilization were evaluated. Results A total of 96 adults of 64 neonates were enrolled. The overall mean P-PAM score on admission was 81.8 (standard deviation [SD] = 18), 88.8 (SD = 13) at discharge, and 86.8 (SD = 16) at 30-day follow-up. Using linear mixed regression model, P-PAM score was significantly associated with timing of measurement. Higher P-PAM scores were associated with higher health literacy (p = 0.002) and higher in mothers compared to fathers (p = 0.040). There were no significant associations of admission P-PAM scores with sociodemographic characteristics. Parents of neonates who had a surgical diagnosis had a statistically significant (p = 0.003) lower score than those who did not. There were no associations between discharge P-PAM scores and neonates' lengths of stay or other indicators of illness severity. Conclusion Parental activation in the NICU setting was higher than reported in the adult and limited pediatric literature; scores increased from admission to discharge and 30-day postdischarge. Activation was higher in mothers and parents with higher health literacy. Additional larger scale studies are needed to determine whether parental activation is associated with long-term health care outcomes as seen in adults. Key Points

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