Does Gerofit Exercise Reduce Veterans’ Use of Emergency Department and Inpatient Care?

Abstract Little is known about the relationship between exercise and health care utilization in older adults. This study examined hospitalizations/emergency Department (ED) visits in the 12 months prior to and during 12 months of active Gerofit participation (across 5 sites). Data were compared for each outcome to a propensity matched nearest neighbor sample from the same site [Mean, 95% CI]. Of the 226 Veterans who were active in the program for ≥12 months and enrolled in VA and Traditional Medicare for 12 months prior to Gerofit participation, hospitalizations/ED visits were greater prior to (15.3%/42.0%) than during (6.8%/37.1%) Gerofit participation. Gerofit participants were 8% less likely to have a hospitalization in the 12 months following enrollment than controls [-0.08 (-0.14, -0.02)] but no between-group differences in ED use [-0.00 (-0.11, 0.10)] were observed. Participation in Gerofit may reduce hospitalizations, but its impact on ED use is inconclusive.

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Emergency department revisits and rehospitalizations among infants and toddlers for acute allergic reactions

Allergy and Asthma Proceedings ◽

10.2500/aap.2021.42.210031 ◽

2021 ◽

Vol 42 (3) ◽

pp. 247-256

Author(s):

Lacey B. Robinson ◽

Anna Chen Arroyo ◽

Rebecca E. Cash ◽

Susan A. Rudders ◽

Carlos A. Camargo

Keyword(s):

Health Care ◽

Emergency Department ◽

New York ◽

Health Care Utilization ◽

Population Based ◽

Care Utilization ◽

Allergic Reactions ◽

Infants And Toddlers ◽

Ed Visits ◽

Total Charges

Background and Objective: Allergic reactions, including anaphylaxis, are rising among children. Little is known about health care utilization among infants and toddlers. Our objective was to characterize health care utilization and charges for acute allergic reactions (AAR). Methods: We conducted a retrospective cohort study of trends in emergency department (ED) visits and revisits, hospitalizations and rehospitalizations, and charges among infants and toddlers (ages < 3 years), with an index ED visit or hospitalization for AAR (including anaphylaxis). We used data from population-based multipayer data: State Emergency Department Databases and State Inpatient Databases from New York and Nebraska. Multivariable logistic regression was used to identify factors associated with ED revisits and rehospitalizations. Results: Between 2006 and 2015, infant and toddler ED visits for AAR increased from 27.8 per 10,000 population to 35.2 (Ptrend < 0.001), whereas hospitalizations for AAR remained stable (Ptrend = 0.11). In the one year after an index AAR visit, 5.1% of these patients had at least one AAR ED revisit and 5.9% had at least one AAR rehospitalization. Factors most strongly associated with AAR ED revisits included an index visit hospitalization and receipt of epinephrine. Total charges for AAR ED visits (2009‐2015) and hospitalizations (2011‐2015) were more than $29 million and $11 million, respectively. Total charges increased more than fourfold for both AAR ED revisits for AAR rehospitalizations during the study period. Conclusion: Infants and toddlers who presented with an AAR were at risk for ED revisits and rehospitalizations for AAR within the following year. The charges associated with these revisits were substantial and seemed to be increasing.

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PEER TO PEER SUPPORT AND HEALTH CARE UTILIZATION AMONG COMMUNITY-DWELLING OLDER ADULTS

Innovation in Aging ◽

10.1093/geroni/igz038.3151 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S857-S857

Author(s):

Elizabeth A Jacobs ◽

Rebecca Schwei ◽

Scott Hetzel ◽

Jane Mahoney ◽

KyungMann Kim

Keyword(s):

Older Adults ◽

Health Care ◽

Emergency Department ◽

Health Care Utilization ◽

Peer Support ◽

Peer Group ◽

Peer To Peer ◽

Emergency Department Visits ◽

Urgent Care ◽

Care Utilization

Abstract The majority of older adults want to live and age in their communities. Some community-based organizations (CBOs) have initiated peer-to-peer support services to promote aging in place but the effectiveness of these programs is not clear. Our objective was to compare the effectiveness of a community-designed and implemented peer-to-peer support program vs. access to standard community services, in promoting health and wellness in vulnerable older adult populations. We partnered with three CBOs, one each in California, Florida, and New York, to enroll adults 65 > years of age who received peer support and matched control participants (on age, gender, and race/ethnicity) in an observational study. We followed participants over 12 months, collecting data on self-reported urgent care and emergency department visits and hospitalizations. In order to account for the lack of randomization, we used a propensity score method to compare outcomes between the two groups. We enrolled 222 older adults in the peer-to-peer group and 234 in the control group. After adjustment, we found no differences between the groups in the incidence of hospitalization, urgent and emergency department visits, and composite outcome of any health care utilization. The incidence of urgent care visits was statistically significantly greater in the standard community service group than in the peer-to-peer group. Given that the majority of older adults and their families want them to age in place, the question of how to do this is highly relevant. Peer-to-peer services may provide some benefit to older adults in regard to their health care utilization.

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Meta-Analysis: Association of Parent and Child Mental Health with Pediatric Health Care Utilization

Journal of Pediatric Psychology ◽

10.1093/jpepsy/jsz049 ◽

2019 ◽

Vol 44 (9) ◽

pp. 1097-1110 ◽

Cited By ~ 2

Author(s):

John V Lavigne ◽

Kathryn Mendelsohn Meyers

Keyword(s):

Mental Health ◽

Health Care ◽

Emergency Department ◽

Health Care Utilization ◽

Child Mental Health ◽

Internalizing Symptoms ◽

Care Utilization ◽

Pediatric Health ◽

Pediatric Health Care ◽

Ed Visits

Abstract Objective To examine the association of psychological factors and pediatric health care utilization. Method Ovid Medline and PsychInfo were searched and archival and forward searchers were conducted of relevant articles. Studies of the association between psychological risk factors and pediatric health care utilization of outpatient services, emergency department, inpatient length of stay, and costs were identified. Effect sizes were expressed in the form of the standardized mean difference. From 4,546 studies identified in the search, 69 studies met inclusion criteria. Results There were significant low-moderate associations between higher outpatient visits and general child mental health (MH) problems (mean ES [mES] = 0.35), overall psychopathology (mES = 0.44), and internalizing symptoms (mES = 0.16). Results were significant for any parent MH problem (mES = 0.18). For emergency department (ED) visits, there were significant association between more ED visits and any child MH problems (mES = 0.25), internalizing symptoms (mES = 0.24), externalizing symptoms (mES = 0.16), and Attention Deficit/Hyperactivity Disorder (mES= 0.14), as well as parent MH (mES = 0.24) and maternal depression (mES = 0.21). Increased hospitalizations were associated with any child MH problem (mES = 0.3), overall child psychopathology (mES = 0.49), child depression (ES = 0.41), and any parent MH problem (mES = 0.54). For costs, results were significant for any child MH problem (mES = 0.38). Conclusions Child and parent MH problems are significantly associated with increased HCU.

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Self-Reported Hearing Loss in Older Adults Is Associated With Higher Emergency Department Visits and Medical Costs

INQUIRY The Journal of Health Care Organization Provision and Financing ◽

10.1177/0046958019896907 ◽

2019 ◽

Vol 56 ◽

pp. 004695801989690

Author(s):

Timothy S. Wells ◽

Lizi Wu ◽

Gandhi R. Bhattarai ◽

Lorraine D. Nickels ◽

Steven R. Rush ◽

...

Keyword(s):

Older Adults ◽

Health Care ◽

Emergency Department ◽

Hearing Loss ◽

Health Care Utilization ◽

Hearing Aid ◽

Medical Costs ◽

Care Utilization ◽

Severe Hearing Loss ◽

Hearing Aid Use

Hearing loss is common among older adults. Thus, it was of interest to explore differences in health care utilization and costs associated with hearing loss and hearing aid use. Hearing loss and hearing aid use were assessed through self-reports and included 5 categories: no hearing loss, aided mild, unaided mild, aided severe, and unaided severe hearing loss. Health care utilization and costs were obtained from medical claims. Those with aided mild or severe hearing loss were significantly more likely to have an emergency department visit. Conversely, those with aided severe hearing loss were about 15% less likely to be hospitalized. Individuals with unaided severe hearing loss had the highest annual medical costs ($14349) compared with those with no hearing loss ($12118, P < .001). In this study, those with unaided severe hearing loss had the highest medical costs. Further studies should attempt to better understand the relationship between hearing loss, hearing aid use, and medical costs.

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Associations Between Health and Driving in an Older Adult Cohort in Rancho Bernardo

Journal of Aging and Health ◽

10.1177/0898264316661828 ◽

2016 ◽

Vol 29 (8) ◽

pp. 1367-1387

Author(s):

Linda L. Hill ◽

Gail A. Laughlin ◽

Richele Bettencourt ◽

Elizabeth Barrett-Connor

Keyword(s):

Health Care ◽

Emergency Department ◽

Health Care Utilization ◽

Older Adult ◽

Neurological Disease ◽

Care Utilization ◽

Self Assessment ◽

Driving Pattern ◽

Temporal Relationships ◽

Ed Visits

Objective: The purpose of this study was to identify the associations between health and health care utilization with driving patterns in a cohort of older adults. Method: In 2012, a total of 1,826 surviving participants in the Rancho Bernardo cohort were sent a health and driving pattern survey; 1,277 were returned. Results: The majority of the respondents (1,151, 91%) were still driving. Older age, female sex, hospitalizations, emergency department (ED) visits and physical therapy visits, neurological disease, depression, limited vision, and limited hearing were associated with non-driving status. A total of 809 (71%) of drivers reported no citations or crashes in the last 5 years. Discussion: The vast majority of older drivers in this cohort continued to drive, and did so safely. Health care utilization, medications, medical conditions, and self-assessment of health were associated with non-driving status. Prospective studies are needed to clarify the temporal relationships between these factors.

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Hospitalizations and emergency department use in cancer clinical trial patients.

Journal of Clinical Oncology ◽

10.1200/jco.2015.33.29_suppl.160 ◽

2015 ◽

Vol 33 (29_suppl) ◽

pp. 160-160

Author(s):

Ryan David Nipp ◽

Elizabeth Powell ◽

Beverly Moy

Keyword(s):

Health Care ◽

Emergency Department ◽

Health Care Utilization ◽

Metastatic Disease ◽

Massachusetts General Hospital ◽

Patient Characteristics ◽

Care Utilization ◽

Care Needs ◽

Hematologic Cancer ◽

Ed Visits

160 Background: Cancer clinical trials (CTs) often represent the best available treatment for many patients, but little is known about the health care utilization of these patients. We examined correlates of hospitalizations and emergency department (ED) use in cancer CT patients to determine those at greatest risk for these outcomes. Methods: We prospectively collected data on patient characteristics, hospitalizations and ED use among all patients enrolled in cancer CTs at Massachusetts General Hospital in 2014. We calculated the number of hospitalizations and ED visits in the 6-month interval following patients’ CT enrollment. We used linear regression with purposeful selection of covariates to identify factors associated with hospitalizations and ED use. Results: Of 1,218 CT patients (mean age = 58 years; 575 (47%) male), 781 (64%) were married and 851 (70%) had metastatic disease. All cancer types were represented, but hematologic cancers (21%) were most common. Within 6 months following CT enrollment, 519 (43%) and 327 (27%) had at least one hospitalization and ED visit, respectively. At any time during their cancer course, 177 (15%) received a palliative care (PC) consult. Controlling for presence of metastatic disease, PC consults correlated with both hospitalizations and ED visits. Having a hematologic cancer and being unmarried correlated with more hospitalizations and ED visits, respectively. Conclusions: Hospitalizations and ED visits occur in a substantial proportion of cancer CT patients. We need to better understand reasons for these high rates of health care utilization, but the correlations with PC consults suggest that CT patients have unique supportive care needs and that PC services are being targeted to a population particularly in need. [Table: see text]

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End-of-life Health-Care Utilization Patterns Among Chronically Ill Older Adults

American Journal of Hospice and Palliative Medicine® ◽

10.1177/1049909118824962 ◽

2019 ◽

Vol 36 (6) ◽

pp. 507-512 ◽

Cited By ~ 2

Author(s):

Meredith MacKenzie Greenle ◽

Karen B. Hirschman ◽

Ken Coburn ◽

Sherry Marcantonio ◽

Alexandra L. Hanlon ◽

...

Keyword(s):

Older Adults ◽

Health Care ◽

Emergency Department ◽

Health Care Utilization ◽

End Of Life ◽

Emergency Department Visit ◽

Chronically Ill ◽

Care Utilization ◽

Utilization Patterns ◽

Over Time

Patients with chronic illness are associated with high health-care utilization and this is exacerbated in the end of life, when health-care utilization and costs are highest. Complex Care Management (CCM) is a model of care developed to reduce health-care utilization, while improving patient outcomes. We aimed to examine the relationship between health-care utilization patterns and patient characteristics over time in a sample of older adults enrolled in CCM over the last 2 years of life. Generalized estimating equation models were used. The sample (n = 126) was 52% female with an average age of 85 years. Health-care utilization rose sharply in the last 3 months of life with at least one hospitalization for 67% of participants and an emergency department visit for 23% of participants. In the last 6 months of life, there was an average of 2.17 care transitions per participant. The odds of hospitalization increased by 27% with each time interval ( P < .001). Participants demonstrated 11% greater odds of having a hospitalization for each additional comorbidity ( P = .05). A primary diagnosis of heart failure or coronary artery disease was associated with 21% greater odds of hospitalization over time compared to other primary diagnoses ( P = .017). Females had 70% greater odds of an emergency department visit compared to males ( P = .046). For each additional year of life, the odds of an emergency department visit increased by about 7% ( P < .001). Findings suggest the need for further interventions targeting chronically ill older adults nearing end of life within CCM models.

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