Hospital Care Cost and Resource Use of Early Discharge of Healthy Late Preterm and Term Singletons: A Population-based Cohort Study and Cost Analysis

ObjectivesA current diagnosis of asthma cannot be objectively confirmed in many patients with physician-diagnosed asthma. Estimates of resource use in overdiagnosed cases of asthma are necessary to measure the burden of overdiagnosis and to evaluate strategies to reduce this burden. We assessed differences in asthma-related healthcare resource use between patients with a confirmed asthma diagnosis and those with asthma ruled out.DesignPopulation-based, prospective cohort study.SettingParticipants were recruited through random-digit dialling of both landlines and mobile phones in the province of British Columbia, Canada.ParticipantsWe included 345 individuals ≥12 years of age with a self-reported physician diagnosis of asthma. The diagnosis of asthma was reassessed at the end of 12 months of follow-up using a structured algorithm, which included a bronchodilator reversibility test, methacholine challenge test, and if necessary medication tapering and a second methacholine challenge test.Primary and secondary outcome measuresSelf-reported annual asthma-related direct healthcare costs (2017 Canadian dollars), outpatient physician visits and medication use from the perspective of the Canadian healthcare system.ResultsAsthma was ruled out in 86 (24.9%) participants. The average annual asthma-related direct healthcare costs for participants with confirmed asthma were $C497.9 (SD $C677.9) and for participants with asthma ruled out, $C307.7 (SD $C424.1). In the adjusted analyses, a confirmed diagnosis was associated with higher direct healthcare costs (relative ratio (RR)=1.60, 95% CI 1.14 to 2.22), increased rate of specialist visits (RR=2.41, 95% CI 1.05 to 5.40) and reliever medication use (RR=1.62, 95% CI 1.09 to 2.35), but not primary care physician visits (p=0.10) or controller medication use (p=0.11).ConclusionsA quarter of individuals with a physician diagnosis of asthma did not have asthma after objective re-evaluation. These participants still consumed a significant amount of asthma-related healthcare resources. The population-level economic burden of asthma overdiagnosis could be substantial.

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Admissions and Emergency Visits by Late Preterm Singletons and Twins in the First 5 Years: A Population-Based Cohort Study

American Journal of Perinatology ◽

10.1055/s-0039-3402718 ◽

2019 ◽

Cited By ~ 1

Author(s):

Tetsuya Isayama ◽

Daria O'Reilly ◽

Joseph Beyene ◽

Shoo K. Lee ◽

Prakesh S. Shah ◽

...

Keyword(s):

Cohort Study ◽

Preterm Infants ◽

Population Based ◽

Late Preterm ◽

Administrative Database ◽

Term Infants ◽

Emergency Visits ◽

Late Preterm Infants ◽

Adjusted Incidence Rate ◽

The Difference

Abstract Objective To compare admission and emergency visits of late preterm (340/7–366/7 weeks) versus term infants (370/7–416/7 weeks) in the first 5 years. Study Design This population-based cohort study included all singletons and twins born alive at 340/7 to 416/7 weeks' gestation registered in a health administrative database in Ontario, Canada, between April 1, 2002 and December 31, 2012. Admissions and emergency visits from initial postnatal discharge to 5 years were compared between late preterm and term infants adjusting for maternal and infant characteristics. Results A total of 1,316,931 infants (75,364 late preterm infants) were included. Late preterm infants had more frequent admissions than term infants in the first 5 years in both singletons (adjusted incidence rate ratio [95% confidence interval] = 1.46 [1.42–1.49]) and twins (1.21 [1.11–1.31]). The difference in admissions between late preterm and term infants were smaller in twins than singletons and decreased with children's ages. Twins had less frequent admissions than singletons for late preterm infants, but not for term infants. The emergency visits were more frequent in late preterm than term infants in all the periods. Conclusion Admissions and emergency visits were more frequent in late preterm than term infants through the first 5 years. Admissions were less frequent in late preterm twins than singletons.

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Respiratory distress syndrome in moderately late and late preterm infants and risk of cerebral palsy: a population-based cohort study

BMJ Open ◽

10.1136/bmjopen-2016-011643 ◽

2016 ◽

Vol 6 (10) ◽

pp. e011643 ◽

Cited By ~ 10

Author(s):

Sandra Kruchov Thygesen ◽

Morten Olsen ◽

John R Østergaard ◽

Henrik Toft Sørensen

Keyword(s):

Cerebral Palsy ◽

Cohort Study ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Preterm Infants ◽

Distress Syndrome ◽

Population Based ◽

Late Preterm ◽

Late Preterm Infants

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Hospitalization Resource Use and Costs Before and After TIA and Stroke: Results from a Population-Based Cohort Study (OXVASC)

Value in Health ◽

10.1016/j.jval.2012.10.013 ◽

2013 ◽

Vol 16 (2) ◽

pp. 280-287 ◽

Cited By ~ 10

Author(s):

Ramon Luengo-Fernandez ◽

Louise E. Silver ◽

Sergei A. Gutnikov ◽

Alastair M. Gray ◽

Peter M. Rothwell

Keyword(s):

Cohort Study ◽

Resource Use ◽

Population Based ◽

Before And After

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Hospital revisits after paediatric tonsillectomy: a cohort study

Journal of Otolaryngology - Head and Neck Surgery ◽

10.1186/s40463-021-00552-8 ◽

2022 ◽

Vol 51 (1) ◽

Author(s):

Aimy H. L. Tran ◽

Ken L. Chin ◽

Rosemary S. C. Horne ◽

Danny Liew ◽

Joanne Rimmer ◽

...

Keyword(s):

Emergency Department ◽

Cohort Study ◽

Hospital Readmission ◽

Improve Patient Safety ◽

Early Discharge ◽

Population Based ◽

Common Reason ◽

Older Children ◽

Post Surgery ◽

Operative Complications

Abstract Background Tonsillectomy, with or without adenoidectomy, is the leading reason for paediatric unplanned hospital readmission, some of which are potentially avoidable. Reducing unplanned hospital revisits would improve patient safety and decrease use of healthcare resources. This study aimed to describe the incidence, timing and risk factors for any surgery-related hospital revisits (both emergency presentation and readmission) following paediatric tonsillectomy and adenotonsillectomy in a large state-wide cohort. Methods We conducted a population-based cohort study using linked administrative datasets capturing all paediatric tonsillectomy and adenotonsillectomy surgeries performed between 2010 and 2015 in the state of Victoria, Australia. The primary outcome was presentation to the emergency department or hospital readmission within 30-day post-surgery. Results Between 2010 and 2015, 46,583 patients underwent 47,054 surgeries. There was a total of 4758 emergency department presentations (10.11% total surgeries) and 2750 readmissions (5.84% total surgeries). Haemorrhage was the most common reason for both revisit types, associated with 33.02% of ED presentations (3.34% total surgeries) and 67.93% of readmissions (3.97% total surgeries). Day 5 post-surgery was the median revisit time for both ED presentations (IQR 3–7) and readmission (IQR 3–8). Predictors of revisit included older age, public and metropolitan hospitals and peri-operative complications during surgery. Conclusions Haemorrhage was the most common reason for both emergency department presentation and hospital readmission. The higher risk of revisits associated with older children, surgeries performed in public and metropolitan hospitals, and in patients experiencing peri-operative complications, suggest the need for improved education of postoperative care for caregivers, and avoidance of inappropriate early discharge. Graphical Abstract

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Patient characteristics, resource use and outcomes associated with general internal medicine hospital care: the General Medicine Inpatient Initiative (GEMINI) retrospective cohort study

CMAJ Open ◽

10.9778/cmajo.20170097 ◽

2017 ◽

Vol 5 (4) ◽

pp. E842-E849 ◽

Cited By ~ 15

Author(s):

Amol A. Verma ◽

Yishan Guo ◽

Janice L. Kwan ◽

Lauren Lapointe-Shaw ◽

Shail Rawal ◽

...

Keyword(s):

Internal Medicine ◽

Cohort Study ◽

General Internal Medicine ◽

Resource Use ◽

Retrospective Cohort Study ◽

Hospital Care ◽

Retrospective Cohort ◽

General Medicine ◽

Patient Characteristics ◽

General Internal

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A cost analysis of early discharge and domiciliary visits versus standard hospital care for low-risk obstetric clients

Australian Journal of Public Health ◽

10.1111/j.1753-6405.1994.tb00203.x ◽

2010 ◽

Vol 18 (1) ◽

pp. 96-100 ◽

Cited By ~ 15

Author(s):

Anthony Scott

Keyword(s):

Cost Analysis ◽

Hospital Care ◽

Early Discharge ◽

Low Risk

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Coronavirus and birth in Italy: results of a national population-based cohort study

10.1101/2020.06.11.20128652 ◽

2020 ◽

Author(s):

Alice Maraschini ◽

Edoardo Corsi ◽

Michele Antonio Salvatore ◽

Serena Donati ◽

Keyword(s):

Cohort Study ◽

Caesarean Section ◽

General Population ◽

Hospital Care ◽

Caesarean Section Rate ◽

National Level ◽

Population Based ◽

Decision Makers ◽

Lombardy Region ◽

National Population

AbstractIntroductionThe study was implemented to provide guidance to decision-makers and clinicians by describing hospital care offered to women who gave birth with confirmed COVID-19 infection.Materials and methodsNational population-based prospective cohort study involving all women with confirmed COVID-19 who gave birth between February 25 and April 22, 2020 in any Italian hospital.ResultsThe incidence rate of confirmed SARS-CoV-2 infection in women who gave birth was 2.1 per 1000 maternities at a national level and 6.9/1000 in the Lombardy Region. Overall one third of the women developed a pneumonia and 49.7% assumed at least one drug. Caesarean section rate was 32.9%, no mothers nor newborns died. Six percent of the infants tested positive for SARS – CoV-2 at birth.ConclusionsClinical features and outcomes of COVID-19 in women who gave birth are similar to those described for the general population, most women developing mild to moderate illness.

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