The impact of lockdown on pediatric ED visits and hospital admissions during the COVID19 pandemic: a multicenter analysis and review of the literature

AbstractThe coronavirus disease 2019 pandemic has enormous impact on society and healthcare. Countries imposed lockdowns, which were followed by a reduction in care utilization. The aims of this study were to quantify the effects of lockdown on pediatric care in the Netherlands, to elucidate the cause of the observed reduction in pediatric emergency department (ED) visits and hospital admissions, and to summarize the literature regarding the effects of lockdown on pediatric care worldwide. ED visits and hospital admission data of 8 general hospitals in the Netherlands between January 2016 and June 2020 were summarized per diagnosis group (communicable infections, noncommunicable infections, (probable) infection-related, and noninfectious). The effects of lockdown were quantified with a linear mixed effects model. A literature review regarding the effect of lockdowns on pediatric clinical care was performed. In total, 126,198 ED visits and 47,648 admissions were registered in the study period. The estimated reduction in general pediatric care was 59% and 56% for ED visits and admissions, respectively. The largest reduction was observed for communicable infections (ED visits: 76%; admissions: 77%), whereas the reduction in noninfectious diagnoses was smaller (ED visits 36%; admissions: 37%). Similar reductions were reported worldwide, with decreases of 30–89% for ED visits and 19–73% for admissions.Conclusion: Pediatric ED utilization and hospitalization during lockdown were decreased in the Netherlands and other countries, which can largely be attributed to a decrease in communicable infectious diseases. Care utilization for other conditions was decreased as well, which may indicate that care avoidance during a pandemic is significant. What is Known:• The COVID-19 pandemic had enormous impact on society.• Countries imposed lockdowns to curb transmission rates, which were followed by a reduction in care utilization worldwide. What is New:• The Dutch lockdown caused a significant decrease in pediatric ED utilization and hospitalization, especially in ED visits and hospital admissions because of infections that were not caused by SARS-CoV-2.• Care utilization for noninfectious diagnoses was decreased as well, which may indicate that pediatric care avoidance during a pandemic is significant.

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Can interactive parental education impact health care utilization in pediatric asthma: A study in rural Texas

Journal of International Medical Research ◽

10.1177/0300060518773621 ◽

2018 ◽

Vol 46 (8) ◽

pp. 3172-3182 ◽

Cited By ~ 3

Author(s):

Vijay Agusala ◽

Priyanka Vij ◽

Veena Agusala ◽

Vivekanand Dasari ◽

Bhargavi Kola

Keyword(s):

Rural Areas ◽

Urban Areas ◽

Parental Education ◽

Pediatric Patients ◽

Hospital Admissions ◽

Care Utilization ◽

Asthma Education ◽

Before And After ◽

Ed Visits ◽

The Impact

Objective It is well known that parent/patient education helps to reduce the burden of asthma in urban areas, but data are scarce for rural areas. This study explored the impact of asthma education in Ector County, a rural part of Health Services Region 9 in Texas, which has one of the highest prevalence rates of asthma in the state. Methods This prospective study investigated an interactive asthma education intervention in pediatric patients aged 2–18 years and their caregivers. Change in parental/caregiver knowledge about their child’s asthma along with frequency of missed school days, emergency department (ED) visits and hospital admissions was obtained via telephone surveys before and after the educational intervention was delivered. Results The study enrolled 102 pediatric patients and their parents/caregivers. Asthma education was associated with significantly fewer school absences, ED visits and hospitalizations. Parents/caregivers reported feeling better educated, knowing what triggers an asthma exacerbation, identifying the signs of a severe asthma attack in their child, feeling confident about managing asthma and feeling that the asthma was under control. Conclusion Asthma education of caregivers and children was associated with better symptom management and fewer acute exacerbations, pointing to the relevance and importance of asthma education among pediatric patients in rural areas.

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3247 Implementing an Interdisciplinary, Student-Run Consult Service for Homeless Patients: The Critical Role of Community Partnerships

Journal of Clinical and Translational Science ◽

10.1017/cts.2019.210 ◽

2019 ◽

Vol 3 (s1) ◽

pp. 91-91

Author(s):

Frances Loretta Gill

Keyword(s):

Health Care ◽

Health Care Utilization ◽

Hospital Admissions ◽

Community Partnerships ◽

Care Utilization ◽

Consult Service ◽

Utilization Patterns ◽

Ed Visits ◽

Hospital Days ◽

The Impact

OBJECTIVES/SPECIFIC AIMS: Elucidate the unique challenges associated with hospital discharge planning for patients experiencing homelessness. Assess the impact of robust community partnerships and strong referral pathways on participating patients’ health care utilization patterns in an interdisciplinary, student-run hospital consult service for patients experiencing homelessness. Identify factors (both patient-level and intervention-level) that are associated with successful warm hand-offs to outside social agencies at discharge. METHODS/STUDY POPULATION: To assess the impact of participation in HHL on patients’ health care utilization, we conducted a medical records review using the hospital’s electronic medical record system comparing patients’ health care utilization patterns during the nine months pre- and post- HHL intervention. Utilization metrics included number of ED visits and hospital admissions, number of hospital days, 30-day hospital readmissions, total hospital costs, and follow-up appointment attendance rates, as well as percentage of warm hand-offs to community-based organizations upon discharge. Additionally, we collected data regarding patient demographics, duration of homelessness, and characteristics of homelessness (primarily sheltered versus primarily unsheltered, street homeless versus couch surfing, etc) and intervention outcome data (i.e. percentage of warm hand-offs). This study was reviewed and approved by the Tulane University Institutional Review Board and the University Medical Center Research Review Committee. RESULTS/ANTICIPATED RESULTS: For the first 41 patients who have been enrolled in HHL, participation in HHL is associated with a statistically significant decrease in hospital admissions by 49.4% (p < 0.01) and hospital days by 47.7% (p < 0.01). However, the intervention is associated with a slight, although not statistically significant, increase in emergency department visits. Additionally, we have successfully accomplished warm hand-offs at discharge for 71% percent of these patients. Over the next year, many more patients will be enrolled in HHL, which will permit a more finely grained assessment to determine which aspects of the HHL intervention are most successful in facilitating warm hand-offs and decreased health care utilization amongst patients experiencing homelessness. DISCUSSION/SIGNIFICANCE OF IMPACT: Providing care to patients experiencing homelessness involves working within complex social problems that cannot be adequately addressed in a hospital setting. This is best accomplished with an interdisciplinary team that extends the care continuum beyond hospital walls. The HHL program coordinators believe that ED visits amongst HHL patients and percentage of warm hand-offs are closely related outcomes. If we are able to facilitate a higher percentage of warm hand-offs to supportive social service agencies, we may be able to decrease patient reliance on the emergency department as a source of health care, meals, and warmth. Identifying the factors associated with successful warm hand-offs upon discharge from the hospital may assist us in building on the HHL program’s initial successes to further decrease health care utilization while offering increased interdisciplinary educational opportunities for medical students.

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The Impact of COVID-19 on a Tertiary Care Pediatric Emergency Department

10.21203/rs.3.rs-54932/v1 ◽

2020 ◽

Author(s):

Ilaria Liguoro ◽

Chiara Pilotto ◽

Michela Vergine ◽

Anna Pusiol ◽

Enrico Vidal ◽

...

Keyword(s):

Emergency Department ◽

Tertiary Care ◽

Pediatric Emergency ◽

Relative Increase ◽

Pediatric Care ◽

Pediatric Emergency Department ◽

Care Access ◽

Ed Visits ◽

Novel Coronavirus ◽

The Impact

Abstract Restricting measures required to face the recent outbreak of a novel Coronavirus (CoV-2) may also impact on patterns of healthcare utilization. Our aim was to provide an insight into the changing use of a pediatric Emergency Department (ED) during the CoV-2 pandemic.Medical records of children seen in our Pediatric ED during March and April 2020 were retrospectively reviewed. Comparisons with the same time intervals in 2018 and 2019 and with other seasonal control periods (January-February 2019 and 2020, and July-August 2018-2019) were performed. The total number of ED visits declined of 73% from 2019 to 2020 (3051 vs 818). Significant variations were observed in the distribution of children among triage categories: the proportion of cases scored as green-code showed a 0.59-fold decrease in comparison to 2019 (95%CI 0.5-0.69), while a relative increase in the proportion of yellow codes was observed (OR 1.46, 95%CI 1.2-1.78). Conclusion: Quarantine measures significantly impacted on the total number and reasons for visits in our Pediatric ED. This substantial decrease in pediatric care access may be either due to lower rates of acute infections because of social distancing, and to reticence on the part of parents and caregivers to risk exposure to SARS-CoV-2 in a health-care setting.

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Biomarkers-based personalized follow-up in chronic heart failure improves patient’s outcomes and reduces care associate cost

Health and Quality of Life Outcomes ◽

10.1186/s12955-021-01779-9 ◽

2021 ◽

Vol 19 (1) ◽

Author(s):

Antonio Leon-Justel ◽

Jose I. Morgado Garcia-Polavieja ◽

Ana Isabel Alvarez-Rios ◽

Francisco Jose Caro Fernandez ◽

Pedro Agustin Pajaro Merino ◽

...

Keyword(s):

Heart Failure ◽

Hospital Admissions ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Secondary Outcome ◽

Ventricular Ejection Fraction ◽

Number Of Patients ◽

Ed Visits ◽

The Impact

Abstract Background Heart failure (HF) is a major and growing medical and economic problem, with high prevalence and incidence rates worldwide. Cardiac Biomarker is emerging as a novel tool for improving management of patients with HF with a reduced left ventricular ejection fraction (HFrEF). Methods This is a before and after interventional study, that assesses the impact of a personalized follow-up procedure for HF on patient’s outcomes and care associated cost, based on a clinical model of risk stratification and personalized management according to that risk. A total of 192 patients were enrolled and studied before the intervention and again after the intervention. The primary objective was the rate of readmissions, due to a HF. Secondary outcome compared the rate of ED visits and quality of life improvement assessed by the number of patients who had reduced NYHA score. A cost-analysis was also performed on these data. Results Admission rates significantly decreased by 19.8% after the intervention (from 30.2 to 10.4), the total hospital admissions were reduced by 32 (from 78 to 46) and the total length of stay was reduced by 7 days (from 15 to 9 days). The rate of ED visits was reduced by 44% (from 64 to 20). Thirty-one percent of patients had an improved functional class score after the intervention, whereas only 7.8% got worse. The overall cost saving associated with the intervention was € 72,769 per patient (from € 201,189 to € 128,420) and €139,717.65 for the whole group over 1 year. Conclusions A personalized follow-up of HF patients led to important outcome benefits and resulted in cost savings, mainly due to the reduction of patient hospitalization readmissions and a significant reduction of care-associated costs, suggesting that greater attention should be given to this high-risk cohort to minimize the risk of hospitalization readmissions.

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COPD, Depression and COVID-19 Pandemic: A Harrowing, Demoralizing and Deleterious Triad

Clinical Medical Reviews and Reports ◽

10.31579/2690-8794/095 ◽

2021 ◽

Vol 3 (8) ◽

pp. 01-06

Author(s):

Iqbal Akhtar Khan ◽

Hamza Iltaf Malik

Keyword(s):

Hospital Admissions ◽

Hospital Readmissions ◽

Public Health Problem ◽

Well Being ◽

Care Utilization ◽

Global Public Health ◽

Increased Risk ◽

Co Morbidity ◽

Pulmonary Manifestations ◽

The Impact

COPD is a highly incapacitating global public health problem, with pulmonary and extra-pulmonary manifestations and usually associated with significant concomitant chronic diseases. With enhanced understanding, it has extensively been reported as a complex, heterogeneous and dynamic disease affecting patients’ health beyond pulmones. Depression, with prevalence of 322 million people, is a major contributor to the overall global burden of disease. In various epidemiological and clinical studies, its prevalence among patients with COPD varies from 18% to 80%. This deadly duo leads to excessive health care utilization rates and costs including increased rates of exacerbation, sub-optimal adherence to prescribed medications, increased hospital admissions, longer hospital stays and increased hospital readmissions. Moreover, there is increased risk of suicidal ideation, suicidal attempts, and suicidal drug overdose. It is a pity that, in significant cases, the co-morbidity remains under-recognized and under-treated. The impact of prevailing COVID 19 pandemic, on the dual burden of COPD and depression, and possible remedial measures including “The 6 ways to boost one’s well-being-by Mental Heath UK, “The Living with the Times” toolkit--by WHO” and innovative add-ons like Dance Movement Therapy and Musical Engagement Therapy have been discussed.

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Impact of the COVID-19 Outbreak on Emergency Resources – An Observational Multicenter Study Including All Hospitals in a Major Urban Center of the Rhein Ruhr Metropolitan Region

10.21203/rs.3.rs-97392/v1 ◽

2020 ◽

Author(s):

Sebastian Bergrath ◽

Tobias Strapatsas ◽

Michael Tuemen ◽

Thorsten Reith ◽

Marc Deussen ◽

...

Keyword(s):

Data Analysis ◽

Multicenter Study ◽

Social Life ◽

Hospital Admissions ◽

Statistical Significance ◽

Urban Center ◽

Medical Specialties ◽

Work Related ◽

Ed Visits ◽

The Impact

Abstract Background: The outbreak of the coronavirus disease 2019 (COVID-19) caused by the severe respiratory distress syndrome coronavirus 2 (SARS-CoV-2) led to severe disruption in social life and economics. The present study should analyze the impact of the local COVID-19 epidemic on emergency resources for all hospitals in a major urban center (Moenchengladbach, Germany). Methods: An observational multicenter study was performed involving all four acute care hospitals. Systemic parameters department (ED) parameters from week 4 to 24 in 2020 were compared to the corresponding period in 2019 for each hospital and in a summative data analysis using a logistic regression model. Outcomes: ED visits, ED to hospital admission, ED to Intensive Care Unit (ICU) admission, medical specialties of admitted patients, work related accidents. Results: In week 9/2020 the first SARS-CoV-2 positive patients were detected in our region. All hospitals decided to minimize elective admissions to ensure operational capability for COVID-19 patients. The summative number of ED visits dropped from 34,659 to 28,008. Numbers decreased from week 8 on between 38% and 48% per week per hospital at the maximum and began to rise again from week 16 on. The pooled data analysis showed statistically significant decreases in outpatient ED visits (20,152 vs. 16,477, p=<0.001), hospital admissions of ED patients (14,507 vs. 11,531, p=<0.001), and work-related accidents (2,290 vs. 1,468, p=<0.001). The decrease in admissions from ED to ICU did not reach statistical significance (2,093 vs. 1,566, p=0.255). The decline in ED cases was mainly caused by a decrease in non-trauma and non-surgical patients. Conclusion: The regional COVID-19 outbreak led to significantly reduced ED contacts after the first COVID-19 cases appeared. Even the admissions to the hospitals and the number of ED to ICU-admissions decreased, which is potentially dangerous, because the ratio of emergency outpatients vs. inpatients remained stable. Therefore, one can assume that patients with severe medical problems did not seek ED care in many cases. The decline of patients was earlier than in other German hospitals and in contrast to the findings in the U.S. and Italy where ED visits and hospital admissions in medical disciplines increased.

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Differences in hospital admissions practices following self-harm and their influence on population-level comparisons of self-harm rates in South London: an observational study

BMJ Open ◽

10.1136/bmjopen-2019-032906 ◽

2019 ◽

Vol 9 (10) ◽

pp. e032906

Author(s):

C Polling ◽

Ioannis Bakolis ◽

Matthew Hotopf ◽

Stephani L. Hatch

Keyword(s):

Hospital Admissions ◽

Population Level ◽

City Centre ◽

Spatial Patterning ◽

Patient Demographics ◽

Admission Data ◽

Self Harm ◽

Hospital Practices ◽

The Impact ◽

The City

ObjectivesTo compare the proportions of emergency department (ED) attendances following self-harm that result in admission between hospitals, examine whether differences are explained by severity of harm and examine the impact on spatial variation in self-harm rates of using ED attendance data versus admissions data.SettingA dataset of ED attendances and admissions with self-harm to four hospitals in South East London, 2009–2016 was created using linked electronic patient record data and administrative Hospital Episode Statistics.DesignProportions admitted following ED attendance and length of stay were compared. Variation and spatial patterning of age and sex standardised, spatially smoothed, self-harm rates by small area using attendance and admission data were compared and the association with distance travelled to hospital tested.ResultsThere were 20 750 ED attendances with self-harm, 7614 (37%) resulted in admission. Proportion admitted varied substantially between hospitals with a risk ratio of 2.45 (95% CI 2.30 to 2.61) comparing most and least likely to admit. This was not altered by adjustment for patient demographics, deprivation and type of self-harm. Hospitals which admitted more had a higher proportion of admissions lasting less than 24 hours (54% of all admissions at highest admitting hospital vs 35% at lowest). A previously demonstrated pattern of lower rates of self-harm admission closer to the city centre was reduced when ED attendance rates were used to represent self-harm. This was not altered when distance travelled to hospital was adjusted for.ConclusionsHospitals vary substantially in likelihood of admission after ED presentation with self-harm and this is likely due to the differences in hospital practices rather than in the patient population or severity of self-harm seen. Public health policy that directs resources based on self-harm admissions data could exacerbate existing health inequalities in inner-city areas where these data may underestimate rates relative to other areas.

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MP03: Clearing the air: A retrospective cohort study of cannabis-related harms in urban Alberta emergency departments following legalization

CJEM ◽

10.1017/cem.2020.151 ◽

2020 ◽

Vol 22 (S1) ◽

pp. S43-S43

Author(s):

M. Yeung ◽

C. Weaver ◽

E. Lang ◽

R. Saah-Haines ◽

K. Janz

Keyword(s):

Emergency Departments ◽

Hospital Admissions ◽

Population Increase ◽

Relative Risk Ratio ◽

Poison Control ◽

Absolute Level ◽

Study Objective ◽

Level Change ◽

Ed Visits ◽

The Impact

Introduction: Non-medical cannabis recently became legal on October 18th, 2018 to Canadian adults. The impact of legalization on Emergency Departments (EDs) has been identified as a major concern. The study objective was to identify changes in cannabis-related ED visits and changes in co-existing diagnoses associated with cannabis-related ED visits pre- and post-legalization for the entire urban population of Alberta. Urban Alberta was defined as Calgary and Edmonton, inclusive of Sherwood Park and St. Albert given the proximity of some Edmontonians to their EDs) encompassing 12 adult EDs and 2 pediatric EDs. Methods: Retrospective data was collected from the National Ambulatory Care Reporting System, and from the HealthLink and the Alberta Poison and Drug Information Service (PADIS) public telehealth call databases. An interrupted time-series analysis was completed via segmented regression calculation in addition to incident rate and relative risk ratio calculation for the pre- and post-legalization periods to identify both differences among the entire urban Alberta population and differences among individuals presenting to the ED. Data was collected from October 1st, 2013 up to July 31st, 2019 for ED visits and was adjusted for natural population increase using quarterly reports from the Government of Alberta. Results: The sample included 11 770 pre-legalization cannabis-related visits, and 2962 post-legalization visits. Volumes of ED visits for cannabis-related harms were found to increase post-legalization within urban EDs (IRR 1.45, 95% CI 1.39, 1.51; absolute level change: 43.48 visits per month in urban Alberta, 95% CI 26.52, 60.43), and for PADIS calls (IRR 1.87, 95% CI 1.55, 2.37; absolute level change: 4.02 calls per month in Alberta, 95% CI 0.11, 7.94). The increase in visits to EDs equates to an increase of 2.72 visits per month, per ED. Lastly, increases were observed for cannabinoid hyperemesis (RR 1.23, 95% CI 1.10, 1.36), unintentional ingestion (RR 1.48, 95% CI 1.34, 1.62), and in individuals leaving the ED pre-treatment (RR 1.28, 95% CI 1.08, 1.49). Decreases were observed for coingestant use (RR 0.77, 95% CI 0.73, 0.81) and hospital admissions (RR 0.88, 95% CI 0.80, 0.96). Conclusion: Overall, national legalization of cannabis appears to be correlated with a small increase in cannabis-related ED visits and poison control calls. Post-legalization, fewer patients are being admitted, though cannabinoid hyperemesis appears to be on the rise.

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Targeted therapy at the end of life and the impact on health care utilization.

Journal of Clinical Oncology ◽

10.1200/jco.2014.32.31_suppl.116 ◽

2014 ◽

Vol 32 (31_suppl) ◽

pp. 116-116

Author(s):

Heidi Yeung ◽

Parsa Salehi ◽

James Don Murphy

Keyword(s):

Targeted Therapy ◽

End Of Life ◽

Odds Ratio ◽

Adjusted Odds Ratio ◽

Large Population ◽

Metastatic Breast ◽

Care Utilization ◽

Study Cohort ◽

Ed Visits ◽

The Impact

116 Background: The use of targeted therapy has steadily increased over the past decade, though the impact of targeted agents on patterns of care at the end-of-life life remains unknown. The purpose of this study was to explore the influence of targeted therapy on end-of-life care in a large population-based database. Methods: We identified 14,398 patients from the SEER-Medicare linked database with metastatic breast, lung, or colorectal cancer diagnosed between 2000 and 2009 who received conventional cytotoxic chemotherapy or targeted therapy in the last 3 months of life. Multivariate logistic and linear regression models were used to determine the impact of targeted therapy on the following endpoints in the last 3 months of life: emergency department (ED) visits, hospitalizations, and hospice utilization. Analyses were adjusted for differences in patient age, gender, race, comorbidity, socioeconomic status, and geography. Results: Among the whole study cohort 83% of patients received chemotherapy alone, 12% received chemotherapy with targeted therapy, and 5% received targeted therapy alone. The delivery of any targeted therapy in the last 3 months increased across the study period, from 1.5% in 2000 to 28% in 2009. Compared to patients treated with chemotherapy alone, those treated with targeted therapy alone had lower rates of ED visits (adjusted odds ratio [aOR]=0.81, p=0.01), lower rates of hospitalization (adjusted odds ratio [aOR]=0.69, p<0.0001), no difference in overall hospice utilization rates, though had longer stays on hospice (5.1 days longer, p<0.0001). Compared to patients treated with chemotherapy alone, those treated with both chemotherapy and targeted therapy had no difference in ED visits or hospitalization admission rates, though had decreased rates of hospice utilization (aOR = 0.79, p<0.0001), and shorter stays on hospice (2.7 days longer, p<0.0001). Conclusions: This study found that targeted therapy was associated with varying patterns of healthcare utilization at the end-of-life, though these differences could be influenced by unknown confounding variables. Future research should focus on defining the specific impact of targeted therapy on quality of life at the end-of-life.

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A generalized semiparametric mixed model for analysis of multivariate health care utilization data

Statistical Methods in Medical Research ◽

10.1177/0962280215615159 ◽

2015 ◽

Vol 26 (6) ◽

pp. 2909-2918 ◽

Cited By ~ 1

Author(s):

Zhuokai Li ◽

Hai Liu ◽

Wanzhu Tu

Keyword(s):

Health Care ◽

Health Care Utilization ◽

Mixed Model ◽

Hospital Admissions ◽

Likelihood Method ◽

Care Utilization ◽

Services Research ◽

Modeling Framework ◽

Smooth Functions ◽

Ed Visits

Health care utilization is an outcome of interest in health services research. Two frequently studied forms of utilization are counts of emergency department (ED) visits and hospital admissions. These counts collectively convey a sense of disease exacerbation and cost escalation. Different types of event counts from the same patient form a vector of correlated outcomes. Traditional analysis typically model such outcomes one at a time, ignoring the natural correlations between different events, and thus failing to provide a full picture of patient care utilization. In this research, we propose a multivariate semiparametric modeling framework for the analysis of multiple health care events following the exponential family of distributions in a longitudinal setting. Bivariate nonparametric functions are incorporated to assess the concurrent nonlinear influences of independent variables as well as their interaction effects on the outcomes. The smooth functions are estimated using the thin plate regression splines. A maximum penalized likelihood method is used for parameter estimation. The performance of the proposed method was evaluated through simulation studies. To illustrate the method, we analyzed data from a clinical trial in which ED visits and hospital admissions were considered as bivariate outcomes.

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