Health Care Utilization and Cost among Adults with Chronic Rhinosinusitis Enrolled in a Health Maintenance Organization

2002 ◽  
Vol 127 (5) ◽  
pp. 367-376 ◽  
Author(s):  
Michael p. Murphy ◽  
Paul Fishman ◽  
Steven O. Short ◽  
Sean D. Sullivan ◽  
Bevan Yueh ◽  
...  
Keyword(s):  
Health Care ◽  
Chronic Rhinosinusitis ◽  
Health Maintenance Organization ◽  
The United States ◽  
Care Utilization ◽  
Health Maintenance ◽  
Outpatient Visits ◽  
Marginal Total ◽  
Hospital Days ◽  
The Impact

OBJECTIVE: Our goal was to measure the impact of chronic rhinosinusitis (CRS) on the use and cost of health care by adults in a health maintenance organization (HMO). SETTING AND SUBJECTS: In the setting of the Group Health Cooperative, an HMO in Washington State, we conducted a study of all 218,587 adults (≥18 years) who used services during 1994. Using automated data, 20,175 adults were identified with one or more CRS diagnoses during 1994. OUTCOME MEASURES: We identified nonurgent outpatient visits, pharmacy fills, urgent visits, hospital days, and their associated costs (per adult per year). RESULTS: The marginal utilization associated with a diagnosis of CRS was 2.0 nonurgent outpatient visits, 5.1 pharmacy fills, 0.01 urgent visit, and −0.07 hospital day. The marginal total cost of CRS was $206. CONCLUSIONS: Adults with CRS had higher costs primarily because of increased nonurgent outpatient visit and pharmacy fill utilization. The overall direct cost of CRS in the United States in 1994 is estimated to have been $4.3 billion.

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

2019 ◽  
Vol 3 (s1) ◽  
pp. 91-91
Author(s):  
Frances Loretta Gill
Keyword(s):  
Health Care ◽  
Health Care Utilization ◽  
Hospital Admissions ◽  
Community Partnerships ◽  
Care Utilization ◽  
Consult Service ◽  
Utilization Patterns ◽  
Ed Visits ◽  
Hospital Days ◽  
The Impact

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.

Interventions to Decrease Use in Prehospital and Emergency Care Settings Among Super-Utilizers in the United States: A Systematic Review

2019 ◽  
Vol 77 (2) ◽  
pp. 99-111 ◽  
Author(s):  
Samantha Iovan ◽  
Paula M. Lantz ◽  
Katie Allan ◽  
Mahshid Abir
Keyword(s):  
Systematic Review ◽  
Health Care ◽  
Acute Care ◽  
Emergency Care ◽  
Grey Literature ◽  
The United States ◽  
Care Utilization ◽  
Regression To The Mean ◽  
High Quality ◽  
The Impact

Interest in high users of acute care continues to grow as health care organizations look to deliver cost-effective and high-quality care to patients. Since “super-utilizers” of acute care are responsible for disproportionately high health care spending, many programs and interventions have been implemented to reduce medical care use and costs in this population. This article presents a systematic review of the peer-reviewed and grey literature on evaluations of interventions to decrease prehospital and emergency care use among U.S. super-utilizers. Forty-six distinct evaluations were included in the review. The most commonly evaluated intervention was case management. Although a number of interventions reported reductions in prehospital and emergency care utilization and costs, methodological and study design weaknesses—especially regression to the mean—were widespread and call into question reported positive findings. More high-quality research is needed to accurately assess the impact of interventions to reduce prehospital and emergency care use in the super-utilizer population.

Health Care Cost Growth

2011 ◽  
pp. 307-328 ◽  
Author(s):  
Michael E. Chernew ◽  
Dustin May
Keyword(s):  
Health Care ◽  
Health Care Cost ◽  
Population Aging ◽  
Health Care Systems ◽  
Developed Countries ◽  
The United States ◽  
Care Utilization ◽  
Care Plans ◽  
Cost Growth ◽  
The Impact

Health care cost growth is among the most important issues facing the United States and other developed countries. This article describes the rapid growth in expenditure in most developed countries, and discusses the factors that have driven this growth, such as population aging, general economic growth, and the adoption and use of new medical technologies. The public financing aspect of health care spending adds an additional dimension to assessing the impact of rapid health care cost growth. The article considers a range of strategies for slowing cost growth, including economic evaluation of technologies. Most health care systems employ some method of cost sharing as a means to reduce health care utilization. This article also discusses managed care plans that integrate the financing and delivery of care. However, as costs grow, pressures to control spending will grow and distributional issues will become even more salient.

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

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 &gt;1.5 extra hospital days, and used 2.1 more drug types annually than controls. Subjects with active PC had &gt;10 more physician visits, had 3.1 more hospital days, and used &gt;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.

The Impact of Binational Barriers to Medical Care on the Care-Seeking Practices of Mexican Immigrants

2021 ◽  
pp. 104973232199204
Author(s):  
Rebecca M. Crocker
Keyword(s):  
United States ◽  
Health Care ◽  
Medical Care ◽  
Health Care Access ◽  
Mexican Immigrants ◽  
The United States ◽  
Care Utilization ◽  
Care Seeking ◽  
Care Access ◽  
The Impact

Barriers to health care access faced by Mexican immigrants in the United States have been well-documented, including lack of insurance, fear of deportation, and language barriers. However, little is known about this population’s care-seeking experiences before migration. In this article, I use a life-course approach to explore binational isolation from health care and the ways in which early-life experiences pattern Mexicans’ care-seeking practices in the United States. This ethnographic research project took place in Tucson, Arizona, between 2013 and 2014 and used semistructured interviews with service providers and first-generation Mexican immigrants. The majority of participants faced significant barriers to medical care in Mexico, which resulted in low rates of care utilization and heavy reliance on lay modalities. Immigrants faced an even broader array of barriers to care in the United States, and their lack of prior health care access further discouraged care utilization and compromised their medical care experiences after migration.

scholarly journals Geriatric syndromes and subsequent health-care utilization among older community dwellers in Stockholm

2021 ◽  
Author(s):  
Jette Möller ◽  
Christian Rausch ◽  
Lucie Laflamme ◽  
Yajun Liang
Keyword(s):  
Health Care ◽  
Health Care Utilization ◽  
Cox Regression ◽  
Baseline Survey ◽  
Care Utilization ◽  
Geriatric Syndromes ◽  
Outpatient Visits ◽  
The Impact ◽  
Community Dwellers

AbstractLittle is known about the long-term effect of geriatric syndromes on health-care utilization. This study aims to determine the association between geriatric syndromes and health-care utilization during a four-year period among older community dwellers. Based on the Stockholm Public Health Cohort study, a total number of 6700 community dwellers aged ≥65 years were included. From a baseline survey in 2006, geriatric syndromes were defined as having at least one of the following: insomnia, functional decline, urinary incontinence, depressive symptoms and vision impairment. Health-care utilization was identified by linkages at individual level with register data with a four-year follow-up. Cox regression was performed to estimate the associations. Compared to those without geriatric syndromes, participants with any geriatric syndromes had a higher prevalence of frequent hospitalizations, long hospital stays, frequent outpatient visits and polypharmacy in each of the follow-up years. After controlling for covariates, having any geriatric syndromes was associated with higher levels of utilization of inpatient and outpatient care as well as polypharmacy. The association was stable over time, and the fully adjusted hazard ratio (95% confidence interval) remained stable in frequent hospitalizations (from 1.89 [1.31, 2.73] in year 1 to 1.70 [1.23, 2.35] in year 4), long hospital stay (from 1.75 [1.41, 2.16] to 1.49 [1.24, 1.78]), frequent outpatient visits (from 1.40 [1.26, 1.54] to 1.33 [1.22, 1.46]) and polypharmacy (from 1.63 [1.46, 1.83] to 1.53 [1.37, 1.71]). Having any geriatric syndromes is associated with higher levels of health-care utilization among older community dwellers, and the impact of geriatric syndromes is stable over a four-year period.

Sign in / Sign up

Export Citation Format

Share Document