Identifying Low-value Inpatient Hospitalizations Following Emergency Department Requests for Surgical Consultations

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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Innovative Population Health Model Associated With Reduced Emergency Department Use And Inpatient Hospitalizations

Health Affairs ◽

10.1377/hlthaff.2017.1099 ◽

2018 ◽

Vol 37 (4) ◽

pp. 543-550 ◽

Cited By ~ 3

Author(s):

Donald Wesson ◽

Heather Kitzman ◽

Kenneth H. Halloran ◽

Kristen Tecson

Keyword(s):

Emergency Department ◽

Population Health ◽

Emergency Department Use ◽

Inpatient Hospitalizations ◽

Health Model

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

American Journal of Industrial Medicine ◽

10.1002/ajim.22504 ◽

2015 ◽

Vol 58 (10) ◽

pp. 1114-1125 ◽

Cited By ~ 16

Author(s):

L. Harduar Morano ◽

T.L. Bunn ◽

M. Lackovic ◽

A. Lavender ◽

G.T.T. Dang ◽

...

Keyword(s):

Emergency Department ◽

Emergency Department Visits ◽

Southeast Region ◽

Inpatient Hospitalizations

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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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Emergency Department and Inpatient Hospitalizations for Young People With Fragile X Syndrome

American Journal on Intellectual and Developmental Disabilities ◽

10.1352/1944-7558-120.3.230 ◽

2015 ◽

Vol 120 (3) ◽

pp. 230-243 ◽

Cited By ~ 11

Author(s):

Suzanne McDermott ◽

James W Hardin ◽

Julie A Royer ◽

Joshua R Mann ◽

Xin Tong ◽

...

Keyword(s):

Autism Spectrum Disorder ◽

Emergency Department ◽

Fragile X Syndrome ◽

Comparison Group ◽

Fragile X ◽

Insurance Coverage ◽

Age Groups ◽

Autism Spectrum ◽

Ambulatory Care Sensitive Condition ◽

Inpatient Hospitalizations

Abstract We compared hospital encounters between adolescents and young adults with fragile X syndrome (FXS) to peers with intellectual disability (ID) from other causes, autism spectrum disorder (ASD), and a comparison group without these conditions matched by gender, age, and insurance coverage. Those with FXS, ASD, or ID were more likely to have had hospital encounters. In terms of age groups, we found mental illness hospitalizations decreased during adulthood as compared to adolescence for those with FXS, and we found that for conditions unrelated to FXS (e.g., respiratory, genitourinary, gastroenteritis, and pneumonia) adolescents had higher rates of hospitalization compared to their peers with FXS, ID, or ASD. We analyzed epilepsy, common among people with FXS and designated as an ambulatory care sensitive condition that can be treated outside the hospital, and found that people with FXS, ID, and ASD had higher odds of hospitalization due to epilepsy in both age groups than did the comparison group.

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