Health Care Utilization after NICU Discharge and Neurodevelopmental Outcome in the First 2 Years of Life in Preterm Infants

2017 ◽  
Vol 35 (05) ◽  
pp. 441-447 ◽  
Author(s):  
Michelle Greene ◽  
Kousiki Patra
Keyword(s):  
Health Care ◽  
Health Care Utilization ◽  
Preterm Infants ◽  
Neonatal Intensive Care ◽  
Neurodevelopmental Outcome ◽  
Health Care Use ◽  
High Rate ◽  
Care Utilization ◽  
Abnormal Head

Objective The objective of this study was to determine predictors of health care utilization and its association with neurodevelopmental outcome in a recent cohort of preterm infants. Study Design A total of 405 infants (born 2008–2011) seen in neonatal intensive care unit (NICU) follow-up were compared for use of hospitalizations (hosps), emergency room (ER), subspecialties (SS), and results of the Bayley-III. High rate of use was defined as having >1 hosp, ER, or SS. Multiple regression adjusted for the effect of risk factors on high health care use. Results High hosp rate was associated with public health insurance (PHI; p = 0.021), severely abnormal head ultrasound (SAHUS; p = 0.04) at 1 year, and PHI (p = 0.011), younger gestational age (GA) (p = 0.029) at 2 years. High ER use was associated with PHI, younger GA at 1 year (p = 0.007 and 0.012) and 2 years (p = 0.010 and 0.005). High SS was associated with NICU morbidities including small for GA (p = 0.005), retinopathy of prematurity (p = 0.001), necrotizing enterocolitis (p = 0.03), and SAHUS (p = 0.045). At 20 months, infants with high hosp and SS had higher rates of cerebral palsy and significantly lower mean cognitive, language, and motor scores. Conclusion Health care utilization is high among preterm infants in recent years and significantly associated with worse neurodevelopmental outcome. Further research is needed to determine if health care utilization after NICU discharge is an independent predictor of poor outcome.

Telemedicine, the effect of nurse-initiated telephone follow up, on health status and health-care utilization in COPD patients: A randomized trial

Respirology ◽  
2014 ◽  
Vol 20 (2) ◽  
pp. 279-285 ◽  
Author(s):  
Farida F. Berkhof ◽  
Jan W.K. van den Berg ◽  
Steven M. Uil ◽  
Huib A.M. Kerstjens
Keyword(s):  
Health Care ◽  
Health Status ◽  
Health Care Utilization ◽  
Randomized Trial ◽  
Care Utilization ◽  
Copd Patients

scholarly journals Understanding Patients’ Decisions to Obtain Unplanned, High-Resource Health Care After Colorectal Surgery

2021 ◽  
pp. 104973232110024
Author(s):  
Stephanie T. Lumpkin ◽  
Eileen Harvey ◽  
Paul Mihas ◽  
Timothy Carey ◽  
Alessandro Fichera ◽  
...  
Keyword(s):  
Health Care ◽  
Colorectal Surgery ◽  
Health Care Utilization ◽  
Care Coordination ◽  
Health Care Use ◽  
Care Utilization ◽  
Discharge Instructions ◽  
Care Needs ◽  
High Resource ◽  
Optimal Health

Readmissions and emergency department (ED) visits after colorectal surgery (CRS) are common, burdensome, and costly. Effective strategies to reduce these unplanned postdischarge health care visits require a nuanced understanding of how and why patients make the decision to seek care. We used a purposefully stratified sample of 18 interview participants from a prospective cohort of adult CRS patients. Thirteen (72%) participants had an unplanned postdischarge health care visit. Participant decision-making was classified by methodology (algorithmic, guided, or impulsive), preexisting rationale, and emotional response to perceived health care needs. Participants voiced clear mental algorithms about when to visit an ED. In addition, participants identified facilitators and barriers to optimal health care use. They also identified tangible targets for health care utilization reduction efforts, such as improved care coordination with streamlined discharge instructions and improved communication with the surgical team. Efforts should be directed at improving postdischarge communication and care coordination to reduce CRS patients’ high-resource health care utilization.

scholarly journals Characterization Of Health Care Utilization And Cost Of Hemophilia A And B In Real-Life: A 4-Year Follow-UP Study In Finland

2017 ◽  
Vol 20 (9) ◽  
pp. A500
Author(s):  
H Ventola ◽  
J Jokelainen ◽  
M Linna ◽  
A Lepäntalo ◽  
T Ylisaukko-oja ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Utilization ◽  
Hemophilia A ◽  
Real Life ◽  
Care Utilization ◽  
Follow Up Study

scholarly journals Follow-UP Autoantibody Testing and Health Care Utilization Among Patients with (Sustained) Celiac Disease Activity in the Netherlands

2014 ◽  
Vol 17 (7) ◽  
pp. A328
Author(s):  
J.G. Kuiper ◽  
F.J.A. Penning-van Beest ◽  
D. Naessens ◽  
F. Leon ◽  
R.M.C. Herings
Keyword(s):  
Health Care ◽  
Celiac Disease ◽  
The Netherlands ◽  
Health Care Utilization ◽  
Disease Activity ◽  
Care Utilization

An Evaluation of Health Care Utilization, Risk of Infection and Bleeding Among MDS Patients During Periods of Transfusion Dependence or Independence with or without Lenalidomide Therapy

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 3151-3151
Author(s):  
B. Douglas Smith ◽  
Dalia Mahmoud ◽  
Henry J Henk ◽  
Zeba M. Khan
Keyword(s):  
Health Care ◽  
Health Care Utilization ◽  
Research Funding ◽  
Index Date ◽  
Care Utilization ◽  
Watch And Wait ◽  
Active Therapy ◽  
Erythroid Response ◽  
Clinically Significant

Abstract Abstract 3151 Introduction A goal of therapy with lenalidomide (LEN) for MDS pts is hematologic improvement, commonly an erythroid response, which results in transfusion independence (TI). However, it is possible that LEN impacts other non-anemia manifestations of MDS, such as significant bleeding (defined as GI, intracranial, hospitalized bleeds, and bleeding deaths), infections. This retrospective claims analysis examined the occurrence of these events as well as health care utilization (ER visits and hospitalizations), for pts with MDS during periods of transfusion dependence (TD) without active therapy compared to periods of TI with or without LEN. Methods: Claims data from a US national commercial health plan were retrospectively reviewed to assess the impact of TD and therapy with LEN on common medical events. Pts ≥ 18 yrs with ≥ 1 claim for MDS (ICD-9-CM diagnosis codes 238.72–238.75) between 01 Jan 07 and 31 Dec 09 were assessed using the 1st MDS diagnosis date as the index date. Continuous enrollment in a commercial or Medicare Advantage plan with a medical and pharmacy benefit for 6 mos before the index date (baseline period) and for a variable period after the index date (follow-up period) was required. Four unique cohorts of pt follow up were identified to analyze pt outcomes. Three groups of TI periods were examined: periods not on any active therapy ‘watch and wait’ (A) periods on any length of LEN therapy (B) and long periods on LEN therapy (> 3 refills) (C) as 90% of responding pts do so after 3 cycles. In addition, TD periods on no active therapy (D) were assessed. The dose of LEN administered varied across pts and time periods analyzed. Common medical events of infection, bleeding, ER visits and hospitalizations were evaluated within each period type. TD was defined as ≥ 2 RBC transfusions in 8 wks and TI as pts on <2 transfusions in 8 weeks. Because length of each time period varied, results are presented as incidence rate per person-year to allow comparison across cohorts adjusting for variable exposure time. Results: A total of 3, 574 pts with MDS were categorized on the basis of transfusions and LEN use resulting in 3, 608 observation periods analyzed. Each pt could account for multiple periods. Average age was 66 yrs and 51% were male. TD periods were associated with the highest incidence of infection and bleeding events compared to any of the TI periods (A, B, or C). In addition hospitalizations and ER visits were highest for TD periods compared to any of the TI periods. Interestingly, the incidence of events during TI periods on longer courses of LEN (≥ 3 LEN cycles) (C) approached that of periods of TI without active therapy (watch and wait) (A). Conclusions: This retrospective database analysis highlights the possible impact of LEN on 2 important clinical manifestations of MDS. As expected, the incidence of infection and clinically significant bleeding was greatest during TD periods. However, the incidence of these events in TI on LEN for > 3 cycles approached that of TI pts not requiring medical therapy (watch and wait) and highlights a potential broader impact of LEN therapy. The effect of LEN in inducing erythroid response in pts with MDS, especially with the 5q- karyotype, is well established; however, these results indicate LEN may also impact the underlying biology of MDS as seen by a lower incidence of infection and clinically significant bleeds during TI periods on LEN (B, C). Furthermore, these data support the concept that effective therapy periods on LEN are not associated with higher rates of medical events and LEN therapy should be considered for eligible TD pts. Disclosures: Smith: Celgene: Consultancy; Genzyme: Consultancy; Incyte: Consultancy; Infinity: Consultancy; Merck-Serono: Research Funding; Synta: Research Funding; Celator: Research Funding; Calistoga: Research Funding; BMS: Research Funding; Novartis: Research Funding. Mahmoud:Celgene: Employment. Khan:Celgene: Employment.

scholarly journals Health Care Utilization Following Newly-Diagnosed Type-2 Diabetes in Sweden: A Follow-Up of 38,956 Patients in a Real Clinical Setting

2013 ◽  
Vol 16 (7) ◽  
pp. A451
Author(s):  
U. Sabale ◽  
J. Bodegård ◽  
J. Sundström ◽  
B. Svennblad ◽  
C.J. Östgren ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Health Care ◽  
Health Care Utilization ◽  
Clinical Setting ◽  
Care Utilization ◽  
Newly Diagnosed

Attachment and Health Care Utilization Among Middle-Aged and Older African-Descent Men

2013 ◽  
Vol 7 (5) ◽  
pp. 382-393 ◽  
Author(s):  
Nathan S. Consedine ◽  
Natalie L. Tuck ◽  
Katherine L. Fiori
Keyword(s):  
Health Care ◽  
Health Care Utilization ◽  
Prostate Specific Antigen ◽  
African Descent ◽  
Small Body ◽  
Specific Antigen ◽  
Health Care Use ◽  
Care Utilization ◽  
Prostate Specific Antigen Testing ◽  
Antigen Testing

Although health care utilization occurs in interpersonal contexts, little is known regarding how interpersonal preferences or styles among patients may be relevant. A small body of work has identified links between attachment—a dispositional style of relating to others—and patterns of health care use. The current report examined how attachment characteristics predicted the frequency of digital rectal exam and prostate-specific antigen testing in a sample of African-descent men. Four hundred and fourteen African-descent men aged 45 to 70 years completed measures of prostate screening and attachment, together with measures of traditional predictors of screening (demographics, insurance, family history, physician variables, knowledge, perceived risk, and accessibility). Consistent with predictions, dismissiveness—the most common relational style among older men—predicted less frequent prostate-specific antigen testing and digital rectal examination. However, attachment security—a comfort with intimate relationships—also predicted lower screening frequency. Identifying the interpersonal characteristics predicting screening may help identify men at risk of suboptimal health care use and guide the development of interventions suited to the normative relational preferences of current cohorts of older, African-descent men.

scholarly journals Associations Between Engagement With an Online Health Community and Changes in Patient Activation and Health Care Utilization: Longitudinal Web-Based Survey

10.2196/13477 ◽  
2019 ◽  
Vol 21 (8) ◽  
pp. e13477 ◽  
Author(s):  
Ruth E Costello ◽  
Amrutha Anand ◽  
Matt Jameson Evans ◽  
William G Dixon
Keyword(s):  
Health Care ◽  
Health Status ◽  
Health Care Utilization ◽  
Patient Activation ◽  
Care Utilization ◽  
Chi Square ◽  
Web Based ◽  
Health Communities ◽  
Very High

Background Participation in online health communities (OHCs) is a popular trend in the United Kingdom. However, so far, no evidence exists to indicate an association between participation in OHCs and improved health outcomes. Objective This study aimed to (1) determine changes in patient activation over 3 months in new users of an OHC, (2) describe patterns of engagement with an OHC, (3) examine whether patients’ characteristics at baseline were associated with subsequent patterns of engagement, and (4) determine if patterns of engagement during the 3 months were associated with changes in patient activation, health care utilization, and health status. Methods Active new OHC users on HealthUnlocked (HU) were surveyed to measure demographics, levels of patient activation (describing a person’s confidence in managing their own health; scale 0-100 with 4 categories), health care utilization, and health status using a Web-based survey at baseline and 3 months. Patient activation at baseline and 3 months was compared (aim 1). Alongside, for a sample of HU users and survey responders, daily OHC website usage data were automatically captured. This was used to identify clusters of engagement with HU (aim 2). For survey responders, baseline characteristics, patient activation, health care utilization, and health status were compared at baseline and 3 months, overall, and between engagement clusters using t tests and chi-square tests (aims 3 and 4). Results In 329 people who completed both surveys, baseline activation was most frequently level 3, described as taking action but still lacking confidence. At follow-up, a change of 2.6 points was seen, with the greatest change seen in those at lowest baseline activation levels. In addition, 4 clusters of engagement were identified: low, medium, high, and very high, who were active on HU for a mean of 4, 12, 29, and 59 days, respectively. Survey responders were more commonly high or very high engagers. Baseline activation was highest in low and very high engagers. Overall activation increased over time in all engagement groups. Very high engagers had the greatest improvement in activation (5 points), although the average change was not above what is considered clinically meaningful for any group. Fewer accident and emergency visits were seen at follow-up in those with higher engagement, although this trend was not seen for other health care utilization measures. There was no change in health status at 3 months. Conclusions This observational study provides some insight into how patterns of engagement with OHCs are associated with changes in patient activation, health care utilization, and health status. Over 3 months, overall, the change in activation was not clinically significant, and there were some indications that OHCs may be of benefit to particular groups. However, the study limitations prevent firm conclusions about causal relationships.

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