3247 Implementing an Interdisciplinary, Student-Run Consult Service for Homeless Patients: The Critical Role of Community Partnerships

OBJECTIVES/SPECIFIC AIMS: Elucidate the unique challenges associated with hospital discharge planning for patients experiencing homelessness. Assess the impact of robust community partnerships and strong referral pathways on participating patients’ health care utilization patterns in an interdisciplinary, student-run hospital consult service for patients experiencing homelessness. Identify factors (both patient-level and intervention-level) that are associated with successful warm hand-offs to outside social agencies at discharge. METHODS/STUDY POPULATION: To assess the impact of participation in HHL on patients’ health care utilization, we conducted a medical records review using the hospital’s electronic medical record system comparing patients’ health care utilization patterns during the nine months pre- and post- HHL intervention. Utilization metrics included number of ED visits and hospital admissions, number of hospital days, 30-day hospital readmissions, total hospital costs, and follow-up appointment attendance rates, as well as percentage of warm hand-offs to community-based organizations upon discharge. Additionally, we collected data regarding patient demographics, duration of homelessness, and characteristics of homelessness (primarily sheltered versus primarily unsheltered, street homeless versus couch surfing, etc) and intervention outcome data (i.e. percentage of warm hand-offs). This study was reviewed and approved by the Tulane University Institutional Review Board and the University Medical Center Research Review Committee. RESULTS/ANTICIPATED RESULTS: For the first 41 patients who have been enrolled in HHL, participation in HHL is associated with a statistically significant decrease in hospital admissions by 49.4% (p < 0.01) and hospital days by 47.7% (p < 0.01). However, the intervention is associated with a slight, although not statistically significant, increase in emergency department visits. Additionally, we have successfully accomplished warm hand-offs at discharge for 71% percent of these patients. Over the next year, many more patients will be enrolled in HHL, which will permit a more finely grained assessment to determine which aspects of the HHL intervention are most successful in facilitating warm hand-offs and decreased health care utilization amongst patients experiencing homelessness. DISCUSSION/SIGNIFICANCE OF IMPACT: Providing care to patients experiencing homelessness involves working within complex social problems that cannot be adequately addressed in a hospital setting. This is best accomplished with an interdisciplinary team that extends the care continuum beyond hospital walls. The HHL program coordinators believe that ED visits amongst HHL patients and percentage of warm hand-offs are closely related outcomes. If we are able to facilitate a higher percentage of warm hand-offs to supportive social service agencies, we may be able to decrease patient reliance on the emergency department as a source of health care, meals, and warmth. Identifying the factors associated with successful warm hand-offs upon discharge from the hospital may assist us in building on the HHL program’s initial successes to further decrease health care utilization while offering increased interdisciplinary educational opportunities for medical students.

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A generalized semiparametric mixed model for analysis of multivariate health care utilization data

Statistical Methods in Medical Research ◽

10.1177/0962280215615159 ◽

2015 ◽

Vol 26 (6) ◽

pp. 2909-2918 ◽

Cited By ~ 1

Author(s):

Zhuokai Li ◽

Hai Liu ◽

Wanzhu Tu

Keyword(s):

Health Care ◽

Health Care Utilization ◽

Mixed Model ◽

Hospital Admissions ◽

Likelihood Method ◽

Care Utilization ◽

Services Research ◽

Modeling Framework ◽

Smooth Functions ◽

Ed Visits

Health care utilization is an outcome of interest in health services research. Two frequently studied forms of utilization are counts of emergency department (ED) visits and hospital admissions. These counts collectively convey a sense of disease exacerbation and cost escalation. Different types of event counts from the same patient form a vector of correlated outcomes. Traditional analysis typically model such outcomes one at a time, ignoring the natural correlations between different events, and thus failing to provide a full picture of patient care utilization. In this research, we propose a multivariate semiparametric modeling framework for the analysis of multiple health care events following the exponential family of distributions in a longitudinal setting. Bivariate nonparametric functions are incorporated to assess the concurrent nonlinear influences of independent variables as well as their interaction effects on the outcomes. The smooth functions are estimated using the thin plate regression splines. A maximum penalized likelihood method is used for parameter estimation. The performance of the proposed method was evaluated through simulation studies. To illustrate the method, we analyzed data from a clinical trial in which ED visits and hospital admissions were considered as bivariate outcomes.

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Who Gets Irritable Bowel Syndrome and Does Seeing a Gastroenterologist Affect Its Course?

Canadian Journal of Gastroenterology ◽

10.1155/2001/284659 ◽

2001 ◽

Vol 15 (suppl b) ◽

pp. 5B-7B

Author(s):

Charles N Bernstein

Keyword(s):

Health Care ◽

Irritable Bowel Syndrome ◽

Health Care Utilization ◽

Well Being ◽

Care Utilization ◽

Office Visits ◽

Utilization Patterns ◽

Irritable Bowel ◽

The Impact

A review of studies involving patients with irritable bowel syndrome is presented. This review looks at the impact of gastroenterology consultation on health care utilization patterns and the well-being of the patient when followed up over a two-year period. A structured gastroenterological consultation between the physician and patient may decrease the number of office visits for gastrointestinal- related problems.

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The Impact of Psychiatric Comorbidity on Health Care Utilization in Inflammatory Bowel Disease: A Population-based Study

Inflammatory Bowel Diseases ◽

10.1093/ibd/izaa310 ◽

2020 ◽

Author(s):

Charles N Bernstein ◽

Carol A Hitchon ◽

Randy Walld ◽

James M Bolton ◽

Lisa M Lix ◽

...

Keyword(s):

Health Care ◽

Inflammatory Bowel Disease ◽

Health Care Utilization ◽

Bowel Disease ◽

Psychiatric Comorbidity ◽

Care Utilization ◽

Physician Visits ◽

Inflammatory Bowel ◽

Hospital Days ◽

The Impact

Abstract Background Inflammatory bowel disease (IBD) is associated with an increase in psychiatric comorbidity (PC) compared with the general population. We aimed to determine the impact of PC on health care utilization in persons with IBD. Methods We applied a validated administrative definition of IBD to identify all Manitobans with IBD from April 1, 2006, to March 31, 2016, and a matched cohort without IBD. A validated definition for PC in IBD population was applied to both cohorts; active PC status meant ≥2 visits for psychiatric diagnoses within a given year. We examined the association of active PC with physician visits, inpatient hospital days, proportion with inpatient hospitalization, and use of prescription IBD medications in the following year. We tested for the presence of a 2-way interaction between cohort and PC status. Results Our study matched 8459 persons with IBD to 40,375 controls. On crude analysis, IBD subjects had ≥3.7 additional physician visits, had >1.5 extra hospital days, and used 2.1 more drug types annually than controls. Subjects with active PC had >10 more physician visits, had 3.1 more hospital days, and used >6.3 more drugs. There was a synergistic effect of IBD (vs no IBD) and PC (vs no PC) across psychiatric disorders of around 4%. This synergistic effect was greatest for anxiety (6% [2%, 9%]). After excluding psychiatry-related visits and psychiatry-related hospital stays, there remained an excess health care utilization in persons with IBD and PC. Conclusion Inflammatory bowel disease with PC increases health care utilization compared with matched controls and compared with persons with IBD without PC. Active PC further increases health care utilization.

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Patient loneliness in an urban, underserved family medicine residency clinic: prevalence and relationship to health care utilization

Family Practice ◽

10.1093/fampra/cmaa065 ◽

2020 ◽

Vol 37 (6) ◽

pp. 751-758

Author(s):

Stephanie A Hooker ◽

Paul Stadem ◽

Michelle D Sherman ◽

Jason Ricco

Keyword(s):

Primary Care ◽

Health Care ◽

African American ◽

Family Medicine ◽

Health Care Utilization ◽

Care Utilization ◽

Care Clinic ◽

Family Medicine Residency ◽

Ed Visits ◽

The Impact

Abstract Background Mounting evidence suggests that loneliness increases the risk of poor health outcomes, including cardiovascular disease and premature mortality.Objective: This study examined the prevalence of loneliness in an urban, underserved family medicine residency clinic and the association of loneliness with health care utilization. Methods Adult patients (N = 330; M age = 42.1 years, SD = 14.9; 63% female; 58% African American) completed the 3-item UCLA Loneliness screener at their primary care visits between November 2018 and January 2019. A retrospective case–control study design was used to compare health care utilization [hospitalizations, emergency department (ED) visits, primary care visits, no-shows and referrals] in the prior 2 years between patients who identified as lonely versus those who did not. Covariates included demographics and clinical characteristics. Results Nearly half (44%) of patients exceeded the cut-off for loneliness. Patients who were lonely were more likely to identify as African American, have depression and have a substance use disorder. Patients in the lonely group had significantly longer hospital stays and more primary care visits, no-shows and referrals than patients in the non-lonely group; there were no differences in number of hospitalizations or ED visits. Conclusions The prevalence of loneliness in an urban, underserved primary care clinic was much higher than prior prevalence estimates in primary care. Patients who are lonely may use more health care resources than patients who are not lonely. Primary care may be an ideal setting in which to identify patients who are lonely to further understand the impact of loneliness on health care outcomes.

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Health Care Utilization in Transplanted Versus Non-Transplanted Sickle Cell Disease Patients

Blood ◽

10.1182/blood-2018-99-113666 ◽

2018 ◽

Vol 132 (Supplement 1) ◽

pp. 313-313 ◽

Cited By ~ 1

Author(s):

Santosh L. Saraf ◽

Krishna Ghimire ◽

Pritesh Patel ◽

Karen Sweiss ◽

John G. Quigley ◽

...

Keyword(s):

Health Care ◽

Health Care Utilization ◽

Emergency Room ◽

Care Utilization ◽

Emergency Room Visits ◽

Eligibility Criteria ◽

Utilization Patterns ◽

Related Donor ◽

Second Year ◽

Hospital Days

Abstract Sickle cell disease (SCD) is an inherited red blood cell disorder that leads to substantial morbidity and a heavy burden on the health care system. Nonmyeloablative allogeneic hematopoietic stem cell transplantation (HSCT) regimens using HLA-matched related donors have recently demonstrated high rates of engraftment and a favorable safety profile in adults with SCD. The long term effects of these HSCT regimens on health care utilization, particularly in SCD adults who have had a high burden of SCD-related acute and chronic complications, has not been previously reported. Between 8/2011 and 4/2016, 86 SCD patients who received their routine care at our institution were referred to the Blood & Marrow Transplant Clinic. Sixteen patients received a HSCT from an HLA-match related donor during this time period. Reasons for not proceeding to transplantation in the 70 patients included lack of an HLA-matched related donor in 36 (51%), patient/family declining in 21 (30%), insurance denial in 11 (16%), and the presence of RBC antibodies to potential donors in 2 (3%) patients. We compared health care utilization patterns between 1) 1-year pre-HSCT vs. 1- and 2-years post-HSCT in 16 transplanted SCD adults and 2) 16 transplanted vs. 70 non-transplanted SCD patients at 1- and 2-years from the time of HSCT or referral. Comparisons of linear variables and categorical variables were performed using the Kruskal-Wallis and Chi-square test, respectively. In the 16 SCD patients who met standard transplant eligibility criteria and underwent HSCT, the median age at the time of HSCT was 33 years (interquartile range [IQR], 24 - 34 years), 56% were male, and 94% were HbSS genotype. Treatment prior to HSCT was hydroxyurea in 10 (63%), chronic red blood cell (RBC) transfusion therapy in 5 (31%), and no disease modifying therapy in 1 (6%) patient. Thirteen of 16 (81%) transplanted SCD patients maintained a stable graft. Emergency room (ER) visits were lower 1-year and 2-year post-HSCT compared to 1-year pre-HSCT (P=0.03) (Table 1). In the 2nd year post-HSCT, ER visits, hospital length of stay, RBC transfusion requirements, and rates of documented infections were all lower compared to 1-year pre-HSCT (P<0.03). We then compared health care utilization patterns between the 16 SCD patients that underwent HSCT vs. the 70 SCD patients that were not transplanted. The HSCT and non-HSCT patients were similar with respect to median age (33 vs. 31 years old; P=0.2), gender (35% vs. 56% male, P=0.1), number of eligibility criteria met for HSCT (PMID: 24319206) (2 for each group; P=0.4) and SCD genotype (80% vs. 94% HbSS genotype, P=0.4), respectively. During the first year after transplant or of observation, we observed lower rates of emergency room visits but a greater number of inpatient hospital days in the HSCT vs. no HSCT groups (Figure 1). During the second year, both the number of emergency room visits and the number of inpatient hospital days were lower in the HSCT vs. the no HSCT patients (Figure 1). In conclusion, we demonstrate that allogeneic HSCT leads to lower health care utilization by the second year post-HSCT in adults with SCD. These results support the role for HSCT to lower the morbidity, health care burden and costs associated with SCD and should encourage universal insurance coverage for HSCT in adults with SCD. Disclosures Patel: Celgene: Consultancy, Honoraria; Amgen: Consultancy, Honoraria; Janssen: Honoraria. Khan:Teva: Speakers Bureau.

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Impact of diabetes and hyperglycemia on health care utilization, infection risk, and survival in patients with cancer receiving glucocorticoids with chemotherapy.

Journal of Clinical Oncology ◽

10.1200/jco.2018.36.30_suppl.19 ◽

2018 ◽

Vol 36 (30_suppl) ◽

pp. 19-19

Author(s):

Dylan M. Zylla ◽

Grace Gilmore ◽

Justin Eklund ◽

Sara Richter ◽

Anders Carlson

Keyword(s):

Health Care ◽

Health Care Utilization ◽

Hospital Admissions ◽

Urgent Care ◽

Care Utilization ◽

Intravenous Chemotherapy ◽

Logistic Regression Models ◽

Patients With Cancer ◽

One Year ◽

The Impact

19 Background: Glucocorticoid (GC) use is commonly used in chemotherapy regimens and may lead to hyperglycemia and increased infection rates. We assessed the impact of diabetes (DM) and hyperglycemia on rates of health-care utilization, infections and survival among patients with cancer receiving chemotherapy. Methods: We performed a retrospective analysis on 1,781 patients who received intravenous chemotherapy with GC between 2010 and 2015. Demographic, clinical, and health-care utilization (HCU) data was obtained using electronic medical record, billing modules, and the tumor registry; HCU included tallies of emergency room, urgent care, and inpatient visits. Logistic regression models were used to compare survival and new infections between patients with and without DM, after adjusting for demographic and cancer-related variables. Results: In the first 12 months following chemotherapy, patients with DM (n = 330) had higher rates of hospital admissions (70.9% vs 57.4%, p< 0.001), more infection-related admissions (37.0% vs 29.2%, p = 0.007), and increased rates of new infections (61.2% vs 49.2%, p < 0.001) when compared to patients without DM (n = 1,451). One-year survival rate was worse among patients with DM (67.3% vs 78.3%, p < 0.001), as well as patients with at least one glucose reading above 300 mg/dL following chemotherapy (60.8% vs 78.5, p < 0.001). After adjusting for cancer stage, age, and gender, we found DM history increased the odds of dying within one year after diagnosis by 86% (OR 1.86, 95% CI (1.37 2.52), p < 0.001) and of new infections by 68% (OR 1.68, 95% CI (1.26 2.24), p < 0.001). Conclusions: Among patients with cancer receiving intravenous chemotherapy with GC we demonstrate patients with DM have more hospital admissions, increased rates of infections, and worse survival. Prospective studies are urgently needed to elucidate what level of glycemic control is needed to potentially improve outcomes for patients with DM receiving chemotherapy with GC.

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Patterns of Health Services Use Before Age 1 in Children Later Diagnosed With ADHD

Journal of Attention Disorders ◽

10.1177/1087054720914352 ◽

2021 ◽

Vol 25 (12) ◽

pp. 1639-1639

Author(s):

Matthew Engelhard ◽

Samuel Berchuck ◽

Jyotsna Garg ◽

Shelley Rusincovitch ◽

Geraldine Dawson ◽

...

Keyword(s):

Health Care ◽

Emergency Department ◽

Health Services ◽

Health Care Utilization ◽

Outpatient Clinic ◽

Hospital Admissions ◽

Care Utilization ◽

Health Services Use ◽

Utilization Patterns ◽

Services Use

Background: Children with ADHD have 2 to 3 times increased health care utilization and annual costs once diagnosed, but little is known about utilization patterns early in life, prior to diagnosis. Quantifying early health services use among children later diagnosed with ADHD could help us understand the early life impact of the disorder and uncover health care utilization patterns associated with higher ADHD risk. Methods: Electronic health record (EHR) data from the Duke University Health System (DUHS) was analyzed for patients born October 1, 2006–October 1, 2016. Those with at least two well-child visits before age 1 were grouped as ADHD or not ADHD based on retrospective billing codes. Adjusted odds ratios (AORs) for hospital admissions, procedures, emergency department (ED) visits, and outpatient clinic encounters before age 1 were compared between groups via logistic regression controlling for sex, race, and ethnicity. Results: ADHD diagnoses were identified in 1,315 (4.4%) of 29,929 patients meeting criteria. Before age 1, individuals with ADHD had 60% increased odds of hospital admission, 58% increased odds of visiting the emergency department, and 41% increased odds of procedures ( p < .0001), including 4.7-fold increased odds of blood transfusion ( p < .0001). They also had more outpatient clinic visits (μ = 14.7 vs. μ = 12.5, p < .0001), including 52% increased odds of visiting a medical specialist, 38% increased odds of visiting a surgical specialist, 70% increased odds of visiting a neonatologist, and 71% increased odds of visiting an ophthalmologist ( p < .0001 for all AORs). In addition, individuals with ADHD had 6-fold increased odds of visits related to child abuse and neglect ( p = .0010). Conclusions: Children later diagnosed with ADHD were more likely to be admitted to the hospital, visit the ED, and visit specific medical and surgical services before age 1. Future work will identify patterns of health interactions unique to ADHD to stratify ADHD risk.

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Resource Use and Expenditures Among Adult Sickle Cell Patients with and without Depression

Blood ◽

10.1182/blood.v116.21.1534.1534 ◽

2010 ◽

Vol 116 (21) ◽

pp. 1534-1534 ◽

Cited By ~ 1

Author(s):

Shital Kamble ◽

Shelby D Reed ◽

Charlene Flahiff ◽

Soheir Adam ◽

Laura M DeCastro

Keyword(s):

Health Care ◽

Health Care Utilization ◽

Resource Use ◽

Hospital Admissions ◽

Study Entry ◽

Care Utilization ◽

Outpatient Visits ◽

Ed Visits ◽

Time Periods ◽

One Year

Abstract Abstract 1534 Objective: Depression is commonly associated with less favorable medical outcomes among patients with sickle cell disease (SCD), yet little is known about its associated impact on medical resource use and expenditures. In this study, we descriptively compared inpatient stays, number of hospital admissions, emergency department (ED) visits, outpatient visits, and expenditures for SCD patients with and without depression. Methods: 150 adult SCD patients were prospectively enrolled in a cross-sectional cohort study in 2009 to evaluate the prevalence of depression and its association with quality of life, disease severity scores measuring end organ damage, and health care utilization. Detailed cost accounting and administrative physician billing records from the Duke University Health System were obtained for all enrolled patients and used to generate estimates of medical care utilization and costs. Indexing on the enrollment date, we included data representing one year prior to and six months following study entry. Based on the Beck Depression Inventory (BDI) scores, we categorized SCD patients into those with depression (BDI score ≥14) and those without depression (BDI score <14). Given the skewed distributions of resource use and expenditures, we used generalized linear regression models (GLM) with negative binomial distributions and log links to compare inpatient stays, number of hospital admissions, ED visits, and outpatient visits and GLMs with gamma distributions and log links to compare costs associated with each resource use category between patients with and without depression. Results: Data from 142 patients analyzed, 81 females and 61 males with a mean age of 34.2 years. We identified 50 patients with depression and 92 patients without depression. At study entry, females represented 72% of SCD patients with depression and 49% of SCD patients without depression (P< 0.01). Median age was 32.5 years among patients with depression and 29.5 years among those without depression (P= 0.22). Hospital admissions, ED visits, and outpatient visits were generally similar between patients with and without depression one year prior to and six months after study entry. Patients with depression spent more days in the hospital during both time periods. Total inpatient expenditures, including physician fees paid, were higher for patients with depression than those without depression for both time periods (Table). Conclusion: SCD patients with depression incur higher expenditures and longer stays than SCD patients without depression. Efforts should be made for early diagnosis and active therapeutic intervention for depression among SCD patients, to decrease health care utilization and cost. Disclosures: No relevant conflicts of interest to declare.

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The impact of lockdown on pediatric ED visits and hospital admissions during the COVID19 pandemic: a multicenter analysis and review of the literature

European Journal of Pediatrics ◽

10.1007/s00431-021-04015-0 ◽

2021 ◽

Cited By ~ 1

Author(s):

Matthijs D. Kruizinga ◽

Daphne Peeters ◽

Mirjam van Veen ◽

Marlies van Houten ◽

Jantien Wieringa ◽

...

Keyword(s):

The Netherlands ◽

Hospital Admissions ◽

Clinical Care ◽

Pediatric Emergency ◽

Pediatric Care ◽

Care Utilization ◽

Admission Data ◽

Multicenter Analysis ◽

Ed Visits ◽

The Impact

AbstractThe coronavirus disease 2019 pandemic has enormous impact on society and healthcare. Countries imposed lockdowns, which were followed by a reduction in care utilization. The aims of this study were to quantify the effects of lockdown on pediatric care in the Netherlands, to elucidate the cause of the observed reduction in pediatric emergency department (ED) visits and hospital admissions, and to summarize the literature regarding the effects of lockdown on pediatric care worldwide. ED visits and hospital admission data of 8 general hospitals in the Netherlands between January 2016 and June 2020 were summarized per diagnosis group (communicable infections, noncommunicable infections, (probable) infection-related, and noninfectious). The effects of lockdown were quantified with a linear mixed effects model. A literature review regarding the effect of lockdowns on pediatric clinical care was performed. In total, 126,198 ED visits and 47,648 admissions were registered in the study period. The estimated reduction in general pediatric care was 59% and 56% for ED visits and admissions, respectively. The largest reduction was observed for communicable infections (ED visits: 76%; admissions: 77%), whereas the reduction in noninfectious diagnoses was smaller (ED visits 36%; admissions: 37%). Similar reductions were reported worldwide, with decreases of 30–89% for ED visits and 19–73% for admissions.Conclusion: Pediatric ED utilization and hospitalization during lockdown were decreased in the Netherlands and other countries, which can largely be attributed to a decrease in communicable infectious diseases. Care utilization for other conditions was decreased as well, which may indicate that care avoidance during a pandemic is significant. What is Known:• The COVID-19 pandemic had enormous impact on society.• Countries imposed lockdowns to curb transmission rates, which were followed by a reduction in care utilization worldwide. What is New:• The Dutch lockdown caused a significant decrease in pediatric ED utilization and hospitalization, especially in ED visits and hospital admissions because of infections that were not caused by SARS-CoV-2.• Care utilization for noninfectious diagnoses was decreased as well, which may indicate that pediatric care avoidance during a pandemic is significant.

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