scholarly journals 2061

2017 ◽  
Vol 1 (S1) ◽  
pp. 68-68
Author(s):  
Michelle Patch ◽  
Jacquelyn Campbell
Keyword(s):  
Health Care ◽  
Emergency Department ◽  
Health Care System ◽  
Qualitative Data ◽  
Future Research ◽  
Adult Women ◽  
Care Seeking ◽  
Individual Interviews ◽  
Ed Visits ◽  
Care System

OBJECTIVES/SPECIFIC AIMS: Aim 1—estimate prevalence and associated characteristics of nonfatal, non-self-inflicted strangulation among women ages 18 and older who presented to a US emergency department between 2006 and 2013. Aim 2—explore care-seeking behaviors, the context of the care seeking, treatment expectations and perceived diagnosis in a sample of women ages 18 and older who present to a US emergency department and report being strangled by an intimate partner. Aim 3—merge and synthesize findings from both the quantitative and qualitative strands to provide a more complete understanding of post-strangulation emergency care of women. METHODS/STUDY POPULATION: This mixed-methods study will use a convergent parallel design, with a single phase of concurrent and independent data collection. Analysis of quantitative and qualitative data will be performed separately then compared, with main findings integrated during the interpretation phase and presented in a merged data analysis display. IRB review and approval will be obtained before initiating this study. Aim 1 will include a cross-sectional analysis of 2006–2013 Nationwide Emergency Department Sample (NEDS) data, from the Agency for Healthcare Research and Quality’s Healthcare Cost and Utilization Project (HCUP). NEDS is the US’s largest all-payer emergency department (ED) database, providing national estimates of hospital-based ED visits from ~120 to 135 million ED visits/year (weighted). For this study, we will examine data from patients meeting inclusion criteria with an International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM; Medicode, 1996) code of strangulation. For this strand, females aged 18 years or older who presented to a US emergency department between 2006 and 2013 will be included. The outcome variable will be non-fatal, non-self-inflicted strangulation, defined using at least one of the ICD-9-CM codes for strangulation. These codes are: 994.7 (“asphyxiation and strangulation”), E963 (“assault by hanging and strangulation”), E983.8 (“strangulation or suffocation by other specified means undetermined whether accidentally or purposely inflicted”), and E983.9 (“strangulation or suffocation by unspecified means undetermined whether accidentally or purposely inflicted”). Patients with a concurrent ICD-9-CM code for suicide attempt (E953, “Suicide and self-inflicted injury by hanging, strangulation and suffocation”) will be excluded, to minimize self-inflicted assault events. Aim 2 will employ a narrative descriptive approach, with semistructured individual interviews to gather more information about women’s experiences when engaging the health care system after being strangled. Medical records related to the strangulation event will also be reviewed for diagnostic codes and other nursing and/or medical notes that may relate to diagnoses, treatment and referrals. For this strand, women aged 18 years or older who present for care to an urban, academic ED will be recruited, purposely sampling those reporting strangulation as a reason for their visit. We anticipate interviewing ~20–30 women to achieve saturation of information. RESULTS/ANTICIPATED RESULTS: Data from the NEDS from 2006 to 2013 will be analyzed for prevalence and associated characteristics of women seeking care after being strangled. Individual interviews and medical record reviews of a small sample of adult women will be conducted to explore women’s in-depth experiences within the health care system. Results from both the quantitative and qualitative analyses will then be collectively compared and interpreted to better synthesize the evidence from this work. Convergent and divergent findings will be presented in a merged data analysis display (Creswell and Plano Clark, 2011). Qualitative data will be used to fill the knowledge gap remaining from the quantitative analysis, and to explain and contextualize some of the findings. Such integration will help expand the current limited evidence on care of strangled women, and will identify additional research questions that will guide future research in this area. DISCUSSION/SIGNIFICANCE OF IMPACT: To our knowledge, this study will be the first to explore this issue using a nationally representative sample of adult women who sought emergency medical care for strangulation analyzed in conjunction with a detailed qualitative analysis of strangled women’s experiences with the health care system. The resulting knowledge will be critical to informing clinical assessment, intervention and prevention efforts for this vulnerable population, as well as public policy and future research regarding this specific violence tactic.

scholarly journals P1546UK ANNUAL THERAPY COST OF DIALYSIS WITH THE QUANTA SC+ PERSONAL HAEMODIALYSIS SYSTEM

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Thomas Ferguson ◽  
Paul Komenda ◽  
Gerard Harper ◽  
John Milad
Keyword(s):  
Health Care ◽  
Emergency Department ◽  
Health Care System ◽  
Self Care ◽  
Emergency Department Visits ◽  
Weekend Effect ◽  
Care At Home ◽  
The Uk ◽  
Care System ◽  
At Home

Abstract Background and Aims The number of patients receiving dialysis is increasing in the United Kingdom, costing the National Health Service (NHS) over 500 million GBP annually. New personal haemodialysis systems are being developed, such as the Quanta SC+, that are smaller and simpler to use by patients while providing the clearances of conventional systems. Increasing uptake of lower intensity assistance and full self-care dialysis may provide economic benefits to the public health payer. In addition, promotion of every other day dialysis (3.5x weekly) may improve costs to the health system by helping to close the “post-weekend effect” with increased emergency department use and hospitalisations following the long interdialytic gap. As such, we aimed to describe the annual therapy costs of using SC+ in the UK for 3x weekly and 3.5x weekly dialysis regimens, both for self-care haemodialysis provided in-centre and at home in comparison to dialysis provided with conventional machines from the perspective of the health care system. Method Cost minimisation approach. Costs for human resources, equipment, and consumables were sourced from the dialysis machine developer (Quanta Dialysis Technologies). Other costs, such as facility expenses, dialysis-related drugs, avoided emergency department and hospitalisation events, and utilities were taken from a review of the literature. Costs are provided in 2018 GBP. Results Therapy provided as self-care in-centre or full self-care at home were found to have similar costs (£33,721 in-centre versus £33,836 at home for the 3x weekly regimen). Costs increased to £37,238 for self-care in-centre and £35,557 at home for the 3.5x weekly regimen. A comparator cost of £39,416 was established for dialysis provided with conventional machines in-hospital 3x weekly. For each dialysis patient, the health care system is anticipated to save £3,666 in costs associated with excess hospital stays and £2,176 in costs associated with excess emergency department visits. Conclusion In the UK, SC+ offers cost savings when used both for self-care in-centre and full self-care at home in comparison to dialysis provided in the clinic using conventional machines.

scholarly journals Does higher health literacy lead to higher trust in public hospitals?

2021 ◽  
Author(s):  
Maja Bertram ◽  
Urs Steiner Brandt ◽  
Rikke Klitten Hansen ◽  
Gert Tinggaard Svendsen
Keyword(s):  
Game Theory ◽  
Health Care ◽  
Health Literacy ◽  
Health Care System ◽  
Empirical Data ◽  
Health Care Professionals ◽  
Social Groups ◽  
Public Hospitals ◽  
Future Research ◽  
Care System

Abstract Background: Does higher health literacy lead to higher trust in public hospitals? Existing literature suggests that this is the case since a positive association between the level of health literacy and the level of trust in physicians and the health care system has been shown. This study aims to challenge this assumption. Methods: Based on theoretical arguments from game theory and analysis of empirical data, we argue that the association is better described as an inversely u-shaped curve, suggesting that low and high levels of health literacy lead to a lower level of trust than a medium level of health literacy does. The empirical analysis is based on a study of the Danes’ relationship to the overall health care system. More than 6,000 Danes have been asked about their overall expectations of the health service, their concrete experiences and their attitudes to a number of change initiatives. Results: Game theory analysis show that the combined perceived cooperation and benefit effects can explain an inversely u-shaped relationship between social groups and trust in the health care system. Based on quantitative, binary regression analyses of empirical data, the lowest degree of trust is found among patients from the lowest and highest social groups, while the highest degree of trust is found in the middle group. The main driver for this result is that while patients having low health literacy perceive that the health care system is not cooperative, patients with a high level of health literacy have high expectations about the quality, which the health care system might not be able to provide. This reduces the perceived benefit from their encounter with the health care system. Conclusion: It is important that health care professionals understand that some patient groups have a higher chance of cooperation (e.g., agreeing on the choice of treatment) or defection (e.g. passing a complaint) than others. In perspective, future research should undertake further qualitative examinations of possible patient types and their demands in relation to different health care sectors, focusing specifically on the opportunities to improve the handling of different patient types.

scholarly journals Assessing Health Care Equity Through Administrative Data-Derived Qquity Indicators and Socio-Economic Determinants of Health in Emergency Care: A Systematic Review

2020 ◽  
Author(s):  
Kevin Morisod ◽  
Xhyljeta Luta ◽  
Joachim Marti ◽  
Jacques Spycher ◽  
Mary Malebranche ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care System ◽  
Administrative Data ◽  
Emergency Care ◽  
Health Care Systems ◽  
Economic Determinants ◽  
Health Care Equity ◽  
Care Systems ◽  
Ed Visits ◽  
Care System

Abstract Background: Achieving equity in health care remains a challenge for health care systems worldwide and marked inequities in access and quality of care persist. The performance assessment of health care systems is often limited to quality and efficiency indicators. Identifying indicators of health care equity is an important first step in integrating the concept of equity into assessments of health care system performance. Because emergency care serves as the interface between ambulatory and inpatient care, it appears to be a key setting in which to begin this process.Methods: We conducted a systematic review of administrative data-derived health care equity indicators and their association with socio-economic determinants of health (SEDH) in emergency care settings. Ovid MEDLINE, EMBASE, PUBMED and Web of Science were searched for relevant studies using administrative data following PRISMA-equity guidelines. The outcomes of interest were indicators of health care equity and the associated SEDH they examine.Results: Among 29 studies identified, 14 equity indicators were identified and grouped into four categories that reflect the patient emergency care pathway. Total emergency department (ED) visits and ambulatory care sensitive condition-related ED visits were the two most frequently used indicators. The studies analysed equity based on seven SEDH: social deprivation, income, education level, social class, insurance coverage, health literacy and financial and non-financial barriers. Despite some conflicting results, all identified SEDH are associated with inequalities in access to and use of emergency care. Conclusion: The use of administrative data-derived indicators in combination with identified SEDH could improve the measurement of health care equity in emergency care settings across health care systems worldwide. Using a combination of indicators is likely to lead to a more comprehensive, well-rounded analysis of health care equity than using any one indicator in isolation. Though studies analysed focused on emergency care settings, it seems possible to extrapolate these indicators to measure equity in other areas of the health care system. Further studies elucidating root causes of health inequities in and outside the health care system are needed.

From Bodily Sensations to Symptoms: Health Care–Seeking Practices Among People Affected by Acute Coronary Syndrome

2019 ◽  
Vol 29 (11) ◽  
pp. 1651-1660
Author(s):  
Kirsten Beedholm ◽  
Lene Søndergaard Andersen ◽  
Vibeke Lorentzen
Keyword(s):  
Health Care ◽  
Acute Coronary Syndrome ◽  
Health Care System ◽  
Medical Anthropology ◽  
Care Seeking ◽  
Coronary Syndrome ◽  
Starting Point ◽  
Depth Analysis ◽  
Bodily Sensations ◽  
Care System

The reduction of prehospital delay for patients with acute coronary syndrome (ACS) is widely discussed within cardiac research. Medically informed literature generally considers patient hesitancy in seeking treatment a significant barrier to accessing timely treatment. With this starting point, we conducted an interview study with people previously hospitalized for ACS and with the bystanders involved in their decision to contact the health care system. The analysis was conducted in two stages: first, a systematic extraction of key information; second, an in-depth analysis informed by medical anthropology. This led us to understand the prehospital period as an interpretation process where bodily sensations appeared as symptoms. Informants vacillated between sensations, knowledge, interpretations, and emotions as they struggled to preserve everyday ordinariness. They were led to contact the health care system by bodily discomfort rather than a rational decision to reduce risk. The paradigmatic implications from medical anthropology proved an important alternative to the medical paradigm.

scholarly journals From Their Perspective: The Connection between Life Stressors and Health Care Service Use Patterns of Homeless Frequent Users of the Emergency Department

2019 ◽  
Vol 44 (2) ◽  
pp. 113-122 ◽  
Author(s):  
Megan Moore ◽  
Kelsey M Conrick ◽  
Ashok Reddy ◽  
Ann Allen ◽  
Craig Jaffe
Keyword(s):  
Health Care ◽  
Emergency Department ◽  
Service Utilization ◽  
Health Care System ◽  
Service Use ◽  
Care Service ◽  
Health Care Service ◽  
Frequent Users ◽  
Medical Needs ◽  
Care System

Abstract The perspective of homeless adults on their health care service utilization is not well studied. This article describes a study that used in-depth, semistructured interviews with 18 individuals to highlight the viewpoints of homeless people who are frequent users of the emergency department (ED) about the influence of life events on service utilization. Participants reported high levels of pain and comorbid psychiatric, substance use, and medical conditions. They also reported an identifiable pattern of health care utilization, often centered on a crisis event, influenced by high perceived medical needs, inability to cope after crisis, predisposing vulnerability from social determinants of health, and health care system factors. A social work case management intervention often led to a period of stability and use of ED alternatives. Modifiable targets for intervention at the health care system and local levels include improving trust and convenience of ED alternatives, enhancing consistency of care at ED-alternative sites, and educating those at risk of frequent ED use about community alternatives.

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