Telepsychiatry Halved ED Visits, Helped Behavior

2012 ◽  
Vol 46 (8) ◽  
pp. 8
Author(s):  
HEIDI SPLETE
Keyword(s):  
Ed Visits

Suicidal Behavior and Non-Suicidal Self-Injury in Emergency Departments Underestimated by Administrative Claims Data

Crisis ◽  
2018 ◽  
Vol 39 (5) ◽  
pp. 318-325 ◽  
Author(s):  
Barbara Stanley ◽  
Glenn W. Currier ◽  
Megan Chesin ◽  
Sadia Chaudhury ◽  
Shari Jager-Hyman ◽  
...  
Keyword(s):  
Emergency Departments ◽  
Suicide Attempts ◽  
The United States ◽  
Administrative Claims ◽  
Suicide Attempters ◽  
Self Injury ◽  
Axis I ◽  
Ed Visits ◽  
External Causes ◽  
Severe Psychopathology

Abstract. Background: External causes of injury codes (E-codes) are used in administrative and claims databases for billing and often employed to estimate the number of self-injury visits to emergency departments (EDs). Aims: This study assessed the accuracy of E-codes using standardized, independently administered research assessments at the time of ED visits. Method: We recruited 254 patients at three psychiatric emergency departments in the United States between 2007 and 2011, who completed research assessments after presenting for suicide-related concerns and were classified as suicide attempters (50.4%, n = 128), nonsuicidal self-injurers (11.8%, n = 30), psychiatric controls (29.9%, n = 76), or interrupted suicide attempters (7.8%, n = 20). These classifications were compared with their E-code classifications. Results: Of the participants, 21.7% (55/254) received an E-code. In all, 36.7% of research-classified suicide attempters and 26.7% of research-classified nonsuicidal self-injurers received self-inflicted injury E-codes. Those who did not receive an E-code but should have based on the research assessments had more severe psychopathology, more Axis I diagnoses, more suicide attempts, and greater suicidal ideation. Limitations: The sample came from three large academic medical centers and these findings may not be generalizable to all EDs. Conclusion: The frequency of ED visits for self-inflicted injury is much greater than current figures indicate and should be increased threefold.

Divergence in the epidemiological estimates of traumatic brain injury in the United States: comparison of two national databases

2020 ◽  
pp. 1-10
Author(s):  
Brittany M. Stopa ◽  
Maya Harary ◽  
Ray Jhun ◽  
Arun Job ◽  
Saef Izzy ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Emergency Department ◽  
Brain Injury ◽  
Data Bank ◽  
The United States ◽  
National Sample ◽  
Population Based ◽  
Weighted Estimates ◽  
True Incidence ◽  
Ed Visits

OBJECTIVETraumatic brain injury (TBI) is a leading cause of morbidity and mortality in the US, but the true incidence of TBI is unknown.METHODSThe National Trauma Data Bank National Sample Program (NTDB NSP) was queried for 2007 and 2013, and population-based weighted estimates of TBI-related emergency department (ED) visits, hospitalizations, and deaths were calculated. These data were compared to the 2017 Centers for Disease Control and Prevention (CDC) report on TBI, which used the Healthcare Cost and Utilization Project’s National (“Nationwide” before 2012) Inpatient Sample and National Emergency Department Sample.RESULTSIn the NTDB NSP the incidence of TBI-related ED visits was 59/100,000 in 2007 and 62/100,000 in 2013. However, in the CDC report there were 534/100,000 in 2007 and 787/100,000 in 2013. The CDC estimate for ED visits was 805% higher in 2007 and 1169% higher in 2013. In the NTDB NSP, the incidence of TBI-related deaths was 5/100,000 in 2007 and 4/100,000 in 2013. In the CDC report, the incidence was 18/100,000 in both years. The CDC estimate for deaths was 260% higher in 2007 and 325% higher in 2013.CONCLUSIONSThe databases disagreed widely in their weighted estimates of TBI incidence: CDC estimates were consistently higher than NTDB NSP estimates, by an average of 448%. Although such a discrepancy may be intuitive, this is the first study to quantify the magnitude of disagreement between these databases. Given that research, funding, and policy decisions are made based on these estimates, there is a need for a more accurate estimate of the true national incidence of TBI.

scholarly journals Handling coarsened age information in the analysis of emergency department presentations

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Rhonda J. Rosychuk ◽  
Jeff W.N. Bachman ◽  
Anqi Chen ◽  
X. Joan Hu
Keyword(s):  
Emergency Department ◽  
Sample Size ◽  
Uniform Distribution ◽  
Empirical Distribution ◽  
Data Access ◽  
Recurrent Event ◽  
Fiscal Year ◽  
Recurrent Event Data ◽  
Higher Ed ◽  
Ed Visits

Abstract Background Administrative databases offer vast amounts of data that provide opportunities for cost-effective insights. They simultaneously pose significant challenges to statistical analysis such as the redaction of data because of privacy policies and the provision of data that may not be at the level of detail required. For example, ages in years rather than birthdates available at event dates can pose challenges to the analysis of recurrent event data. Methods Hu and Rosychuk provided a strategy for estimating age-varying effects in a marginal regression analysis of recurrent event times when birthdates are all missing. They analyzed emergency department (ED) visits made by children and youth and privacy rules prevented all birthdates to be released, and justified their approach via a simulation and asymptotic study. With recent changes in data access rules, we requested a new extract of data for April 2010 to March 2017 that includes patient birthdates. This allows us to compare the estimates using the Hu and Rosychuk (HR) approach for coarsened ages with estimates under the true, known ages to further examine their approach numerically. The performance of the HR approach under five scenarios is considered: uniform distribution for missing birthdates, uniform distribution for missing birthdates with supplementary data on age, empirical distribution for missing birthdates, smaller sample size, and an additional year of data. Results Data from 33,299 subjects provided 58,166 ED visits. About 67% of subjects had one ED visit and less than 9% of subjects made over three visits during the study period. Most visits (84.0%) were made by teenagers between 13 and 17 years old. The uniform distribution and the HR modeling approach capture the main trends over age of the estimates when compared to the known birthdates. Boys had higher ED visit frequencies than girls in the younger ages whereas girls had higher ED visit frequencies than boys for the older ages. Including additional age data based on age at end of fiscal year did not sufficiently narrow the widths of potential birthdate intervals to influence estimates. The empirical distribution of the known birthdates was close to a uniform distribution and therefore, use of the empirical distribution did not change the estimates provided by assuming a uniform distribution for the missing birthdates. The HR approach performed well for a smaller sample size, although estimates were less smooth when there were very few ED visits at some younger ages. When an additional year of data is added, the estimates become better at these younger ages. Conclusions Overall the Hu and Rosychuk approach for coarsened ages performed well and captured the key features of the relationships between ED visit frequency and covariates.

P053 VARIATIONS IN HEALTHCARE UTILIZATION PATTERNS AMONG HIGH RISK INFLAMMATORY BOWEL DISEASE PATIENTS ENROLLED IN HIGH DEDUCTIBLE HEALTH PLANS

2020 ◽  
Vol 26 (Supplement_1) ◽  
pp. S67-S68
Author(s):  
Jeffrey Berinstein ◽  
Shirley Cohen-Mekelburg ◽  
Calen Steiner ◽  
Megan Mcleod ◽  
Mohamed Noureldin ◽  
...  
Keyword(s):  
At Risk ◽  
Resource Utilization ◽  
Time Trends ◽  
Healthcare Costs ◽  
Insurance Plan ◽  
High Resource ◽  
Patients At Risk ◽  
Inflammatory Bowel ◽  
Ed Visits ◽  
Out Of Pocket Costs

Abstract Background High-deductible health plan (HDHP) enrollment has increased rapidly over the last decade. Patients with HDHPs are incentivized to delay or avoid necessary medical care. We aimed to quantify the out-of-pocket costs of Inflammatory Bowel Disease (IBD) patients at risk for high healthcare resource utilization and to evaluate for differences in medical service utilization according to time in insurance period between HDHP and traditional health plan (THP) enrollees. Variations in healthcare utilization according to time may suggest that these patients are delaying or foregoing necessary medical care due to healthcare costs. Methods IBD patients at risk for high resource utilization (defined as recent corticosteroid and narcotic use) continuously enrolled in an HDHP or THP from 2009–2016 were identified using the Truven Health MarketScan database. Median annual financial information was calculated. Time trends in office visits, colonoscopies, emergency department (ED) visits, and hospitalizations were evaluated using additive decomposition time series analysis. Financial information and time trends were compared between the two insurance plan groups. Results Of 605,862 with a diagnosis of IBD, we identified 13,052 patients at risk for high resource utilization with continuous insurance plan enrollment. The median annual out-of-pocket costs were higher in the HDHP group (n=524) than in the THP group (n=12,458) ($1,920 vs. $1,205, p<0.001), as was the median deductible amount ($1,015 vs $289, p<0.001), without any difference in the median annual total healthcare expenses (Figure 1). Time in insurance period had a greater influence on utilization of colonoscopies, ED visits, and hospitalization in IBD patients enrolled in HDHPs compared to THPs (Figure 2). Colonoscopies peaked in the 4th quarter, ED visits peaked in the 1st quarter, and hospitalizations peaked in the 3rd and 4th quarter. Conclusion Among IBD patients at high risk for IBD-related utilization, HDHP enrollment does not change the cost of care, but shifts healthcare costs onto patients. This may be a result of HDHPs incentivizing delays with a potential for both worse disease outcomes and financial toxicity and needs to be further examined using prospective studies.

scholarly journals Emergency Department Visits During Outpatient Parenteral Antimicrobial Therapy: A Cohort Study

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S333-S334
Author(s):  
So Lim Kim ◽  
Angela Everett ◽  
Susan J Rehm ◽  
Steven Gordon ◽  
Nabin Shrestha
Keyword(s):  
Risk Factors ◽  
Emergency Department ◽  
Hospital Admission ◽  
Vascular Access ◽  
Antimicrobial Therapy ◽  
Cleveland Clinic ◽  
Emergency Department Visits ◽  
Outpatient Parenteral Antimicrobial Therapy ◽  
Ed Visits ◽  
Access Complications

Abstract Background Outpatient parenteral antimicrobial therapy (OPAT) carries risk of vascular access complications, antimicrobial adverse effects, and worsening of infection. Both OPAT-related and unrelated events may lead to emergency department (ED) visits. The purpose of this study was to describe adverse events that result in ED visits and risk factors associated with ED visits during OPAT. Methods OPAT courses between January 1, 2013 and December 31, 2016 at Cleveland Clinic were identified from the institution’s OPAT registry. ED visits within 30 days of OPAT initiation were reviewed. Reasons and potential risk factors for ED visits were sought in the medical record. Results Among 11,440 OPAT courses during the study period, 603 (5%) were associated with 1 or more ED visits within 30 days of OPAT initiation. Mean patient age was 58 years and 57% were males. 379 ED visits (49%) were OPAT-related; the most common visit reason was vascular access complication, which occurred in 211 (56%) of OPAT-related ED visits. The most common vascular access complications were occlusion and dislodgement, which occurred in 99 and 34 patients (47% and 16% of vascular access complications, respectively). In a multivariable logistic regression model, at least one prior ED visit in the preceding year (prior ED visit) was most strongly associated with one or more ED visits during an OPAT course (OR 2.96, 95% CI 2.38 – 3.71, p-value < 0.001). Other significant factors were younger age (p 0.01), female sex (p 0.01), home county residence (P < 0.001), and having a PICC (p 0.05). 549 ED visits (71%) resulted in discharge from the ED within 24 hours, 18 (2%) left against medical advice, 46 (6%) were observed up to 24 hours, and 150 ED visits (20%) led to hospital admission. Prior ED visit was not associated with hospital admission among patients who visited the ED during OPAT. Conclusion OPAT-related ED visits are most often due to vascular access complications, especially line occlusions. Patients with a prior ED visit in the preceding year have a 3-fold higher odds of at least one ED visit during OPAT compared with patients without a prior ED visit. A strategy of managing occlusions at home and a focus on patients with prior ED visits could potentially prevent a substantial proportion of OPAT-related ED visits. Disclosures All authors: No reported disclosures.

scholarly journals National Trends in Emergency Department Care Processes for Acute Myocardial Infarction in the United States, 2005 to 2015

2020 ◽  
Vol 9 (20) ◽  
Author(s):  
Akshay Pendyal ◽  
Craig Rothenberg ◽  
Jean E. Scofi ◽  
Harlan M. Krumholz ◽  
Basmah Safdar ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Emergency Department ◽  
Length Of Stay ◽  
Real World ◽  
The United States ◽  
Emergency Department Care ◽  
Care Processes ◽  
Ed Visits

Background Despite investments to improve quality of emergency care for patients with acute myocardial infarction (AMI), few studies have described national, real‐world trends in AMI care in the emergency department (ED). We aimed to describe trends in the epidemiology and quality of AMI care in US EDs over a recent 11‐year period, from 2005 to 2015. Methods and Results We conducted an observational study of ED visits for AMI using the National Hospital Ambulatory Medical Care Survey, a nationally representative probability sample of US EDs. AMI visits were classified as ST‐segment–elevation myocardial infarction (STEMI) and non‐STEMI. Outcomes included annual incidence of AMI, median ED length of stay, ED disposition type, and ED administration of evidence‐based medications. Annual ED visits for AMI decreased from 1 493 145 in 2005 to 581 924 in 2015. Estimated yearly incidence of ED visits for STEMI decreased from 1 402 768 to 315 813. The proportion of STEMI sent for immediate, same‐hospital catheterization increased from 12% to 37%. Among patients with STEMI sent directly for catheterization, median ED length of stay decreased from 62 to 37 minutes. ED administration of antithrombotic and nonaspirin antiplatelet agents rose for STEMI (23%–31% and 10%–27%, respectively). Conclusions National, real‐world trends in the epidemiology of AMI in the ED parallel those of clinical registries, with decreases in AMI incidence and STEMI proportion. ED care processes for STEMI mirror evolving guidelines that favor high‐intensity antiplatelet therapy, early invasive strategies, and regionalization of care.

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