scholarly journals P113: Presentations for hypoglycemia associated with diabetes mellitus to emergency departments in a Canadian province: a database and cost analysis

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S116-S116
Author(s):  
C. Alexiu ◽  
S. Jelinski ◽  
A. Chuck ◽  
B.H. Rowe
Keyword(s):  
Diabetes Mellitus ◽  
Administrative Data ◽  
Resource Use ◽  
Emergency Departments ◽  
Data Extraction ◽  
Descriptive Analysis ◽  
Administrative Database ◽  
Public Healthcare ◽  
Average Case ◽  
Common Chronic Disease

Introduction: Diabetes mellitus (DM) is a common chronic disease. The Canadian Diabetes Association (CDA) estimated that the national direct cost of DM accounts for approximately 3.5% of public healthcare spending. The economic burden has been estimated to be $12.2 billion in 2010 and projected to increase by $4.7 billion (38%) by 2020. For the province of Alberta, the estimated cost was $1.3 billion in 2015 and $1.7 billion for 2025. The cost of lesser complications of DM like hypoglycemia is not as well understood. The objective of this study was to estimate the health system cost of presentations by adults to Alberta emergency departments (ED) for hypoglycemia associated with type 1 (T1DM) or type 2 (T2DM) diabetes. Methods: A retrospective cohort study was conducted using administrative data for Alberta for a five-year period (fiscal years 2010/11-2014/15). Data were sourced from an administrative database: National Ambulatory Care Reporting System (NACRS). Records of interest were those for ED patients with an ICD-10-CA diagnosis of DM-associated hypoglycemia. A top-down approach was used to estimate costs, excluding physician and ambulance fees. This involved resource intensity weight (RIW), cost of a standard hospital stay (CSHS), and adjustment for inflation (to average value of Canadian dollar for Alberta for January-September 2015). A descriptive analysis was conducted. Results: Data extraction yielded 7,835 presentations by 5,884 patients. The median RIW was 0.0547. RIWs are centered at 1, thus the resource-use/cost of these presentations is well below that of the “average” case. Estimated costs per episode ranged from $108.63 to $4,136.59 with median of $431.11 (IQR: 369.40-639.50). Median episodic subgrouped costs were as follows: sex: $427.72 for males, $439.20 for females; DM type: $411.61 for T1DM, $511.63 for T2DM; date period: $835,862.09/year, $69,655.17/month, $16,030.23/week, and $2,288.78/day. Conclusion: Using population-based administrative data, we identified median costs for DM-associated hypoglycemia of approximately $430/case. Given the frequency, this condition incurs significant healthcare resource use and costs; continued efforts to reduce these ED visits seem worthwhile.

scholarly journals P111: Presentations for hypoglycemia associated with diabetes mellitus to emergency departments in a Canadian province: a database and epidemiological analysis

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S115-S115
Author(s):  
C. Alexiu ◽  
S. Jelinski ◽  
A. Chuck ◽  
B.H. Rowe
Keyword(s):  
Diabetes Mellitus ◽  
Rural Areas ◽  
Emergency Departments ◽  
Urban Areas ◽  
Average Length ◽  
Data Extraction ◽  
Descriptive Analysis ◽  
Administrative Database ◽  
Average Length Of Stay ◽  
Using Data

Introduction: Diabetes mellitus (DM) is a major chronic disease. Prevalence of diabetes was 9% globally in 2014 and 9.3% in Canada and 7.2% in Alberta in 2015. Complications of the disease are numerous and frequent. Hypoglycemia is one complication of diabetes treatment. The objective of this study was to quantify and characterize presentations by adults to Alberta emergency departments (EDs) for hypoglycemia associated with type 1 (T1DM) or type 2 (T2DM) diabetes. Methods: A retrospective cohort study was conducted using data for Alberta for a five-year period (fiscal years 2010/11-2014/15). Data were sourced from an administrative database: National Ambulatory Care Reporting System (NACRS). Records of interest were those with an ICD-10-CA diagnosis of DM-associated hypoglycemia (i.e., E10.63, E11.63, E13.63, or E14.63). A descriptive analysis was conducted. Results: Data extraction yielded 7,835 presentations by 5,884 patients. The majority of presentations were by males (56.2%) and median patient age was 62. These episodes constituted 0.08% of presentations to Alberta EDs and they occurred at an event rate of 0.67 episodes per 100 patient-years (95% CI: 0.66-0.69). The annual rate of presentations decreased by 11.8% during the five-year period. Most presentations (63.4%) involved transportation to the ED via ambulance. Relative to LOS for ED presentations for all reasons, average length-of-stay (LOS) was 3.2x longer and 1.4x longer for discharged and admitted patients, respectively. For 27.5% of presentations, an X-ray was obtained. Most hypoglycemic episodes (65.2%) were considered to be of moderate severity while 34.3% were considered to be severe. None were mild because all involved access to an ED. The condition mainly (absolute terms) afflicted people with T2DM and urban areas; however, it disproportionately afflicted people with T1DM and rural areas. Conclusion: For a condition that is largely preventable with effective blood glucose management, DM-associated hypoglycemia incurs significant healthcare resource use. People with DM would be better served with more effective and safer euglycemic agents.

scholarly journals Knowledge and attitudes towards dementia in a sample of medical residents from a university-hospital in São Paulo, Brazil

2016 ◽  
Vol 10 (1) ◽  
pp. 37-41 ◽  
Author(s):  
Alessandro Ferrari Jacinto ◽  
Paulo José Fortes Villas Boas ◽  
Vânia Ferreira de Sá Mayoral ◽  
Vanessa de Albuquerque Citero
Keyword(s):  
Descriptive Analysis ◽  
Sao Paulo ◽  
University Hospital ◽  
Medical Residents ◽  
Good Knowledge ◽  
Public Healthcare ◽  
São Paulo ◽  
Medical Specialties ◽  
Dementia Prevalence ◽  
Knowledge And Attitudes

An estimated 61% of the 24.3 million people diagnosed with dementia worldwide live in underdeveloped countries, including Brazil, where a public healthcare system covers the majority of the population. This care is usually provided by General Practitioners (GP) and in Brazil many doctors recently graduated from medical school and residents of different medical specialties practice as GPs. Objective : The aim of this study was to describe the knowledge and attitudes about dementia in a sample of Brazilian medical residents from a university-hospital in São Paulo, Brazil. Methods : A total of 152 Brazilian medical residents participated in the study. Participants answered a "Knowledge Quiz" (KQ) and "Attitude Quiz" (AQ) about dementia issues, transculturally adapted for use in Brazilian physicians. A descriptive analysis of the correct answers on knowledge and of the attitude aspects was performed. Results : The medical residents showed poor knowledge (<50%) about dementia prevalence and incidence and a good knowledge on disease management and diagnosis. Participants tended to be optimistic about caring for demented patients. Conclusion : In this study, it is likely that the physicians' good knowledge about dementia issues is the reason for their optimism dealing with demented patients.

scholarly journals Our Economy is Evolving: Shouldn't the Way We Measure It Evolve Too?

2018 ◽  
Vol 3 (5) ◽  
Author(s):  
Marvin Ward ◽  
Bryan Kim ◽  
Lindsay Relihan ◽  
James Duguid
Keyword(s):  
Public Good ◽  
Administrative Data ◽  
Credit Card ◽  
Administrative Database ◽  
Data Series ◽  
Local Economies ◽  
The Public ◽  
The Us ◽  
Spending Growth ◽  
Economic Vitality

The Local Consumer Commerce Index is a measure of local economic activity parsed by a variety of consumer and merchant characteristics. By leveraging an administrative database of over 24 billion debit and credit card transactions made by over 64 million de-identified customers, this index from the JPMorgan Chase Institute addresses the lack of data series with sufficient spatiotemporal and demo/firmographic resolution to support tactical decision making in local economies. Each transaction carries the age and income of the consumer, the merchant size and type of product it sells, as well as the zip code of both.  Using these characteristics we construct a measure of year-over-year spending growth by consumers at merchants located in 14 major metropolitan areas in the US. The index data are screened and weighted to represent population-wide spending levels. This unique lens on local economies is freely provided to the public in accordance with the Institute’s mission of advancing the public good. We have also extended this data asset beyond its use for reporting and economic monitoring. One extension has been our research that measures intra-city demand.  By measuring the distance between where consumers live and the merchants at which they shop, we have lent nuance and granularity to policy discussions surrounding intra-city inequities in economic vitality. We hope to socialize the power of leveraging administrative data for the public good, in hopes that other administrative data-owners are encouraged to also furnish analyses based on their administrative data to help inform the public policy process.

scholarly journals Trends in the incidence of diabetes mellitus: results from the Global Burden of Disease Study 2017 and implications for diabetes mellitus prevention

2020 ◽  
Author(s):  
Jinli Liu ◽  
Zhen-Hu Ren ◽  
Hua Qiang ◽  
Jine Wu ◽  
Mingwang Shen ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Burden Of Disease ◽  
Temporal Trends ◽  
Global Burden Of Disease ◽  
Public Health Issue ◽  
Global Burden ◽  
Common Chronic Disease ◽  
Incidence Trends ◽  
Disease Study ◽  
Incident Cases

Abstract Backgroud: Diabetes mellitus is a common chronic disease and a severe public health issue. The incidence trends for type 1 diabetes (TIDM) and type 2 diabetes (T2DM) have rarely been studied on a global scale. We aimed to determine the temporal and geographical trends of diabetes globally.Methods: Data on diabetes mellitus, including incidence, prevalence from 1990 to 2017 were obtained from the 2017 Global Burden of Disease study. We calculated the estimated annual percentage changes (EAPCs) in age-standardized incidence rate (ASR) of diabetes mellitus according to sex, region, and disease type.Results: The worldwide incident cases of diabetes mellitus has increased by 102.9% from 11,303,084 cases in 1990 to 22,935,630 cases in 2017 worldwide, while the ASR increased from 233.58/100,000 persons (95% UI, 218.95–249.37) to 284.56/100,000 persons (95% UI, 262.17–309.71) in this period [EAPC=0.87, 95% confidence interval (CI):0.79–0.96]. The global ASRs of T1DM and T2DM both demonstrated significant increase during 1990-2017, with EAPCs of 0.34 (95% CI:0.30–0.39) and 0.89 (95% CI:0.80–0.97), respectively. The ASR trends also varied considerably by regions and countries. The increase in ASR was greatest in high sociodemographic index regions (EAPC=1.05, 95% CI:0.92–1.17) and lowest in low-SDI regions (EAPC=0.79, 95% CI:0.71–0.88).Conclusions: Both the number of incident cases and ASR of diabetes mellitus increased significantly during 1990-2017 worldwide, but the temporal trends varied markedly across regions and countries.

scholarly journals Healthcare resource use and costs for people with type 2 diabetes mellitus with and without severe mental illness in England: longitudinal matched-cohort study using the Clinical Practice Research Datalink

2021 ◽  
pp. 1-8
Author(s):  
Han-I. Wang ◽  
Lu Han ◽  
Rowena Jacobs ◽  
Tim Doran ◽  
Richard I. G. Holt ◽  
...  
Keyword(s):  
Mental Health ◽  
Diabetes Mellitus ◽  
Resource Use ◽  
Healthcare Resource ◽  
Practice Research ◽  
Clinical Practice Research Datalink ◽  
Matched Cohort ◽  
Healthcare Resource Use ◽  
Lifetime Costs

Background Approximately 60 000 people in England have coexisting type 2 diabetes mellitus (T2DM) and severe mental illness (SMI). They are more likely to have poorer health outcomes and require more complex care pathways compared with those with T2DM alone. Despite increasing prevalence, little is known about the healthcare resource use and costs for people with both conditions. Aims To assess the impact of SMI on healthcare resource use and service costs for adults with T2DM, and explore the predictors of healthcare costs and lifetime costs for people with both conditions. Method This was a matched-cohort study using data from the Clinical Practice Research Datalink linked to Hospital Episode Statistics for 1620 people with comorbid SMI and T2DM and 4763 people with T2DM alone. Generalised linear models and the Bang and Tsiatis method were used to explore cost predictors and mean lifetime costs respectively. Results There were higher average annual costs for people with T2DM and SMI (£1930 higher) than people with T2DM alone, driven primarily by mental health and non-mental health-related hospital admissions. Key predictors of higher total costs were older age, comorbid hypertension, use of antidepressants, use of first-generation antipsychotics, and increased duration of living with both conditions. Expected lifetime costs were approximately £35 000 per person with both SMI and T2DM. Extrapolating nationally, this would generate total annual costs to the National Health Service of around £250 m per year. Conclusions Our estimates of resource use and costs for people with both T2DM and SMI will aid policymakers and commissioners in service planning and resource allocation.

scholarly journals Investigating the relationship between how a chief complaint is expressed and the patient workflow

2020 ◽  
Vol 6 (2) ◽  
pp. 63-67
Author(s):  
Sajjad Ahmadi ◽  
Niloufar Pouresmaeil ◽  
Farima Najjarian ◽  
Samad Shams Vahdati ◽  
Maryam Rahimpour Asenjan ◽  
...  
Keyword(s):  
Emergency Department ◽  
Emergency Room ◽  
Emergency Departments ◽  
Descriptive Analysis ◽  
Critical Role ◽  
Kidney Injury ◽  
Chief Complaint ◽  
Final Decision ◽  
Bloody Stool ◽  
The Relationship

Objective: Emergency departments and hospital emergency departments are important due to their critical role in providing urgent medical care to patients in dire need of medical interventions. Checking bottlenecks in new conditions and planning to reduce bed occupancy and hospitalization is needed. The purpose of this study is to investigate the relationship between the patient’s chief complaint and their departure to the emergency room. Methods: From non-traumatic patients referred to the emergency department of Imam Reza Hospital during 2018, about 57000 patients were selected and enrolled in the study. Then, age, sex, initial diagnosis, time of the final decision, and time of departure from the emergency department as well as hospitalization ward were included in the checklist. Patients whose documentation was incomplete were excluded. Data were entered into SPSS software version 15.0 and descriptive statistics (normal distribution, average of time, minimum time and maximum time, confidence interval, mode, and median, etc) were used for descriptive analysis and linear regression was used to analyze the correlation among findings. Results: There was a significant relationship between chief complaint and the length of stay in the emergency department (P = 0.046) and patients with dyspnea due to heart disease, bloody vomit, bloody stool, constipation, jaundice, anemia, decreased level of consciousness, diabetes, complications of diabetes, shortness of breath and kidney injury stayed longer in the emergency room compared to other complaints. Conclusion: The patient’s manner of expressing and chief complaint has an impact on the length of time they wait to leave the emergency room. Also, most patients with problems related to internal medicine have the longest time in the emergency room; in particular gastrointestinal patients have the longest stay in the emergency room.

Frequency, management, and resource use of adverse events (AEs) in nonmetastatic castrate-resistant prostate cancer (nmCRPC) patients receiving apalutamide or enzalutamide: A real-world study.

2021 ◽  
Vol 39 (6_suppl) ◽  
pp. 217-217
Author(s):  
Shan Jiang ◽  
Della Varghese ◽  
Sreevalsa Appukkuttan ◽  
Shelby Corman ◽  
Nehemiah Kebede ◽  
...  
Keyword(s):  
Resource Use ◽  
Real World ◽  
Descriptive Analysis ◽  
Specific Antigen ◽  
Retrospective Chart Review ◽  
The United States ◽  
Patient Decision Making ◽  
Hot Flush ◽  
Initial Cohort ◽  
Frequency Management

217 Background: Second generation androgen receptor inhibitors (SGARIs), apalutamide (APA) and enzalutamide (ENZ) and darolutamide, are approved in the United States (US) for the treatment of nmCRPC. The objectives of this study were to describe the frequency of AEs and actions taken to manage AEs among nmCRPC patients treated with APA or ENZ and their downstream resource implications. Methods: This is a further descriptive analysis of a retrospective chart review study conducted in 43 US nmCRPC-treating sites. In our sample, the 43 physicians identified 699 nmCRPC patients initiating treatment with APA (N = 368) or ENZ (N = 333) with 2 patients receiving both, between February 1, 2018 and December 31, 2018 and AEs were collected as reported in regular clinical practice. A representative subset of patients, experiencing at least 1 AE for either APA (N = 125) or ENZ (N = 125), were selected randomly from the initial cohort, and their detailed chart data were extracted to understand the actions taken to manage AEs. Results: Of the initial cohort of nmCRPC patients, 72.0% and 78.7% of men receiving APA (N = 368) and ENZ (N = 333) experienced ≥1 AE, respectively. The three most common AEs reported were fatigue/asthenia (APA, 30.2%; ENZ, 38.7%), hot flush (APA, 14.1%; ENZ, 13.5%), and arthralgia (APA, 14.4%; ENZ, 12.9%). Cognitive and mental changes were observed in 5.4% (APA) and 7.8% (ENZA) men. The subset analysis of randomly selected patients experiencing ≥1 AE (APA, 125; ENZ, 125) were mostly Caucasian (APA, 72.8%; ENZ, 71.2%), ECOG score 0-1 (APA, 84%; ENZ, 88%), median prostate specific antigen (PSA) value 13 ng/ml and 11 ng/ml (APA, ENZ; respectively). Actions to address AEs included treatment of AE, SGARI discontinuation, dose reduction and hospitalization (Table). Specifically, treatment discontinuation due to AE was observed in 8.0% (APA) and 12.8 (%) of men. AEs were often not resolved (APA, 43.6%; ENZ, 39.4%), and the median duration of days to resolve AEs were 60.0 for APA and 56.0 for ENZ. Conclusions: This real-world study highlights the clinical and resource use burden of AEs among nmCRPC patients treated with APA and ENZ. The results demonstrate the importance of safety and tolerability as key considerations in shared clinician-patient decision-making regarding SGARI therapy in nmCRPC. [Table: see text]

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