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

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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Evaluation of Peer-to-Peer Support and Health Care Utilization Among Community-Dwelling Older Adults

JAMA Network Open ◽

10.1001/jamanetworkopen.2020.30090 ◽

2020 ◽

Vol 3 (12) ◽

pp. e2030090 ◽

Cited By ~ 1

Author(s):

Elizabeth A. Jacobs ◽

Rebecca Schwei ◽

Scott Hetzel ◽

Jane Mahoney ◽

Katherine Sebastian ◽

...

Keyword(s):

Older Adults ◽

Health Care ◽

Health Care Utilization ◽

Peer Support ◽

Peer To Peer ◽

Community Dwelling ◽

Care Utilization ◽

Community Dwelling Older Adults

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Healthcare Utilization Characteristics for Intranasal Midazolam Versus Rectal Diazepam

Journal of Child Neurology ◽

10.1177/0883073817744696 ◽

2017 ◽

Vol 33 (2) ◽

pp. 158-163 ◽

Cited By ~ 6

Author(s):

Sunjay Nunley ◽

Peter Glynn ◽

Steve Rust ◽

Jorge Vidaurre ◽

Dara V. F. Albert ◽

...

Keyword(s):

Health Care ◽

Emergency Department ◽

Confidence Interval ◽

Health Care Utilization ◽

Cost Effective ◽

Emergency Department Visits ◽

Urgent Care ◽

Care Utilization ◽

Unplanned Hospitalizations ◽

Intranasal Midazolam

To investigate connections between patient demographics, health care utilization, prescription use, and refills for patients using intranasal midazolam, per rectum diazepam, or both. A retrospective cohort contained patients with epilepsy prescribed intranasal midazolam, per rectum diazepam, or both. We analyzed number of emergency department visits, ambulance services, urgent care visits, and unplanned hospitalizations. A total of 5458 patients were identified. Patients on intranasal midazolam had on average 1.53 fewer emergency department visits (95% confidence interval 1.16-1.89, P < .0001), 0.29 fewer uses of ambulance services (95% confidence interval 0.17-0.41, P < .0001), and 0.60 fewer urgent care visits (95% confidence interval 0.36-0.83, P < .0001) compared to patients in the per rectum diazepam group. Patients with commercial insurance were more likely to have intranasal midazolam prescription (odds ratio = 1.73, 95% confidence interval 1.42-2.11, P < .0001). The results substantiate the cost-effective benefits of prescribing intranasal midazolam compared to per rectum diazepam because several aspects of health care utilization were decreased in those using intranasal midazolam.

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Relationship Between Intensive Care Unit Delirium Severity and 2-Year Mortality and Health Care Utilization

American Journal of Critical Care ◽

10.4037/ajcc2020498 ◽

2020 ◽

Vol 29 (4) ◽

pp. 311-317

Author(s):

Patricia S. Andrews ◽

Sophia Wang ◽

Anthony J. Perkins ◽

Sujuan Gao ◽

Sikandar Khan ◽

...

Keyword(s):

Health Care ◽

Intensive Care Unit ◽

Emergency Department ◽

Intensive Care ◽

Health Care Utilization ◽

Mortality Risk ◽

Hazard Ratio ◽

Emergency Department Visits ◽

Care Utilization ◽

Increased Risk

Background Critical care patients with delirium are at an increased risk of functional decline and mortality long term. Objective To determine the relationship between delirium severity in the intensive care unit and mortality and acute health care utilization within 2 years after hospital discharge. Methods A secondary data analysis of the Pharmacological Management of Delirium and Deprescribe randomized controlled trials. Patients were assessed twice daily for delirium or coma using the Richmond Agitation-Sedation Scale and the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). Delirium severity was measured using the CAM-ICU-7. Mean delirium severity (from time of randomization to discharge) was categorized as rapidly resolving, mild to moderate, or severe. Cox proportional hazards regression was used to model time to death, first emergency department visit, and rehospitalization. Analyses were adjusted for age, sex, race, Charlson Comorbidity Index, Acute Physiology and Chronic Health Evaluation II score, discharge location, diagnosis, and intensive care unit type. Results Of 434 patients, those with severe delirium had higher mortality risk than those with rapidly resolving delirium (hazard ratio 2.21; 95% CI, 1.35-3.61). Those with 5 or more days of delirium or coma had higher mortality risk than those with less than 5 days (hazard ratio 1.52; 95% CI, 1.07-2.17). Delirium severity and number of days of delirium or coma were not associated with time to emergency department visits and rehospitalizations. Conclusion Increased delirium severity and days of delirium or coma are associated with higher mortality risk 2 years after discharge.

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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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Opioid Prescribing for Proximal Row Carpectomy versus Four-Corner Arthrodesis

Journal of Wrist Surgery ◽

10.1055/s-0041-1731821 ◽

2021 ◽

Author(s):

Thomas E. Moran ◽

Sheriff D. Akinleye ◽

Alex J. Demers ◽

Grace L. Forster ◽

Brent R. DeGeorge

Keyword(s):

Risk Factors ◽

Health Care ◽

Emergency Department ◽

Health Care Utilization ◽

Hospital Readmissions ◽

Emergency Department Visits ◽

Prescribing Patterns ◽

Care Utilization ◽

Proximal Row Carpectomy ◽

Opioid Prescribing

Abstract Background Proximal row carpectomy (PRC) and four-corner arthrodesis (4-CA) represent motion-sparing procedures for addressing degenerative wrist pathologies. While both procedures demonstrate comparable functional outcomes, postoperative pain presents a surgical challenge that often necessitates the use of opioids. Objectives The aim of this study was to (1) compare opioid prescribing patterns surrounding PRC and 4-CA, (2) identify risk factors predisposing patients to increased perioperative and prolonged postoperative opioids, and (3) examine the association between opioids and perioperative health care utilization. Patients and Methods PearlDiver Patients Records Database was used to retrospectively identify patients undergoing primary PRC and 4-CA between 2010 and 2018. Patient demographics, comorbidities, prescription drug usage, and perioperative health care utilization were evaluated. Perioperative opioid prescriptions and post-operative opioid prescriptions were recorded. Logistic regression analysis evaluated the association of patient risk factors. Results There was no significant difference in perioperative (PRC [odds ratio {OR}: 0.84, p = 0.788]; 4-CA [OR: 0.75, p = 0.658]) or prolonged postoperative opioid prescriptions (PRC [OR: 0.95, p = 0.927]; 4-CA [OR: 0.99, p = 0.990]) between PRC and 4-CA. Chronic back pain and use of benzodiazepines or anticonvulsants were associated with increased risks of prolonged postoperative opioids. Prolonged postoperative opioids presented increased risks of emergency department visits (OR: 2.09, p = 0.019) and hospital readmissions (OR: 10.2, p = 0.003). Conclusion No significant differences exist in the prescription of opioids for PRC versus 4-CA. Both procedures have high amounts of prolonged postoperative opioid use, which is associated with increased risks of emergency department visits and hospital readmissions. Level of Evidence This is a level III, retrospective comparative study.

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Utilization of Systemic Therapy in Patients With Cancer Near the End of Life in the Pre- Versus Postimmune Checkpoint Inhibitor Eras

JCO Oncology Practice ◽

10.1200/op.20.01050 ◽

2021 ◽

pp. OP.20.01050

Author(s):

Ali Raza Khaki ◽

Shasank Chennupati ◽

Catherine Fedorenko ◽

Li Li ◽

Qin Sun ◽

...

Keyword(s):

Health Care ◽

Emergency Department ◽

Cell Death ◽

Health Care Utilization ◽

Systemic Therapy ◽

Emergency Department Visits ◽

Cancer Surveillance ◽

Care Utilization ◽

Annual Prevalence ◽

Cell Death Protein

PURPOSE: Systemic therapy use in the last 30 days of life (DOL) for patients with advanced cancer is a low-value medical practice. We hypothesized that systemic therapy use in the last 30 DOL increased after approval of antiprogrammed cell death protein 1 immune checkpoint inhibitors (ICIs) and has contributed to increased health care utilization and spending. METHODS: We investigated the change in prevalence of any systemic therapy use in the last 30 DOL among patients with advanced solid tumors in the 4 years before and after antiprogrammed cell death protein 1 ICI approval in 2014. We used cases from the Western Washington Cancer Surveillance System linked to commercial and Medicare insurance. We calculated the difference in prevalence between the pre- and post-ICI periods. We also calculated the annual prevalence of any systemic therapy and ICI use in the last 30 DOL and measured health care utilization (emergency department visits and hospitalizations) and costs during the last 30 DOL. RESULTS: Eight thousand eight hundred seventy-one patients (median age 73 years) were included; 34% and 66% in the pre-and post-ICI period, respectively. Systemic therapy use in the last 30 DOL was lower in the post-ICI versus pre-ICI period (12.4% v 14.4%; difference −2.0% [95% CI, −3.5 to −0.5]). The annual prevalence of systemic therapy use in the last 30 DOL also declined, although ICI use rose. Patients treated with ICIs in last 30 DOL had more emergency department visits, hospitalizations, and higher costs. CONCLUSION: Systemic therapy use in the last 30 DOL was lower in the period after ICI approval. However, ICI use rose over time and had higher utilization and costs in the last 30 DOL. Systemic therapy use in the last 30 DOL warrants monitoring, especially as more ICI indications are approved.

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

Innovation in Aging ◽

10.1093/geroni/igaa057.2786 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 771-771

Author(s):

Lauren Abbate ◽

Jiejin Li ◽

Peter Veazie ◽

Orna Intrator ◽

Cathy Lee ◽

...

Keyword(s):

Older Adults ◽

Health Care ◽

Emergency Department ◽

Health Care Utilization ◽

Inpatient Care ◽

Nearest Neighbor ◽

Group Differences ◽

Care Utilization ◽

Ed Visits ◽

The Relationship

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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The influence of integrated geriatric outpatient clinics on the health care utility of older people

10.21203/rs.2.21639/v4 ◽

2020 ◽

Author(s):

Yu-Ju Wei ◽

Cheng-Fang Hsieh ◽

Yu-Ting Huang ◽

Ming-Shyan Huang ◽

Tzu-Jung Fang

Keyword(s):

Health Care ◽

Emergency Department ◽

Health Care Utilization ◽

Older People ◽

Outpatient Clinic ◽

Emergency Department Visits ◽

Care Utilization ◽

Second Year ◽

Clinic Visits

Abstract Background: The number of people aged greater than 65 years is growing in many countries. Taiwan will be a superaged society in 2026, and health care utilization will increase considerably. Our study aimed to evaluate the efficacy of the geriatric integrated outpatient clinic model for reducing health care utilization by older people.Methods: This was a retrospective case-control study. Patients aged greater than 65 years seen at the geriatric outpatient clinic (Geri-OPD) and non-geriatric outpatient clinic (non-Geri-OPD) at a single medical centre were age and sex matched. Data on the number of outpatient clinic visits, emergency department visits, hospitalizations and medical expenditures were collected during the first and second years. A subgroup analysis by Charlson comorbidity index (CCI) and older age (age≧80 years) was performed, and the results were compared between the Geri-OPD and non-Geri-OPD groups.Results: A total of 6723 patients were included (3796 women and 2927 men). The mean age was 80.42 ± 6.39 years. There were 1291 (19.2%) patients in the Geri-OPD group and 5432 (80.8%) patients in the non-Geri-OPD group. After one year of regular follow-up, the Geri-OPD patients showed a significant reduction in the types of drugs included in each prescription (5.62±10.85) and the number of clinic visits per year (18.18 ± 48.85) (P<0.01). After a two-year follow-up, the number of clinic visits, emergency department visits, and hospitalizations and the annual medical costs were still decreased in the Geri-OPD patients. The Geri-OPD patients had more comorbidities and a higher rate of health care utilization than the non-Geri-OPD patients. In the subgroup analysis, patients with more comorbidities (CCI≧2) and an older age (≧80 years) in the Geri-OPD group showed a significant reduction in health care utilization. The Geri-OPD patients also showed a significant decrease in medical utilization in the second year compared with the non-Geri-POD patients.Conclusion: The Geri-OPD reduced medical costs, the number of drugs prescribed, and the frequency of outpatient clinic visits, emergency department visits and hospitalizations in older patients with complicated conditions. The effect was even better in the second year.

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Integrated, Accountable Care For Medicaid Expansion Enrollees: A Comparative Evaluation of Hennepin Health

Medical Care Research and Review ◽

10.1177/1077558718769481 ◽

2018 ◽

Vol 77 (1) ◽

pp. 46-59 ◽

Cited By ~ 3

Author(s):

Katherine D. Vickery ◽

Nathan D. Shippee ◽

Jeremiah Menk ◽

Ross Owen ◽

David M. Vock ◽

...

Keyword(s):

Primary Care ◽

Health Care ◽

Emergency Department ◽

Managed Care ◽

Health Care Utilization ◽

Emergency Department Visits ◽

Care Utilization ◽

Care Organization ◽

Medicaid Expansion ◽

Accountable Care

Hennepin Health, a Medicaid accountable care organization, began serving early expansion enrollees (very low-income childless adults) in 2012. It uses an integrated care model to address social and behavioral needs. We compared health care utilization in Hennepin Health with other Medicaid managed care in the same area from 2012 to 2014, controlling for demographics, chronic conditions, and enrollment patterns. Homelessness and substance use were higher in Hennepin Health. Overall adjusted results showed Hennepin Health had 52% more emergency department visits and 11% more primary care visits than comparators. Over time, modeling a 6-month exposure to Hennepin Health, emergency department and primary care visits decreased and dental visits increased; hospitalizations decreased nonsignificantly but increased among comparators. Subgroup analysis of high utilizers showed lower hospitalizations in Hennepin Health. Integrated, accountable care under Medicaid expansion showed some desirable trends and subgroup benefits, but overall did not reduce acute health care utilization versus other managed care.

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The influence of integrated geriatric outpatient clinics on the health care utility of older people

10.21203/rs.2.21639/v3 ◽

2020 ◽

Author(s):

YU-JU WEI ◽

Cheng-Fang Hsieh ◽

Yu-Ting Huang ◽

Ming-Shyan Huang ◽

Tzu-Jung Fang

Keyword(s):

Health Care ◽

Emergency Department ◽

Health Care Utilization ◽

Older People ◽

Outpatient Clinic ◽

Emergency Department Visits ◽

Care Utilization ◽

Second Year ◽

Clinic Visits

Abstract Background: The number of people aged greater than 65 years is growing in many countries. Taiwan will be a superaged society in 2026, and health care utilization will increase considerably. Our study aimed to evaluate the efficacy of the geriatric integrated outpatient clinic model for reducing health care utilization by older people. Methods: This was a retrospective case-control study. Patients aged greater than 65 years seen at the geriatric outpatient clinic (Geri-OPD) and non-geriatric outpatient clinic (non-Geri-OPD) at a single medical centre were age and sex matched. Data on the number of outpatient clinic visits, emergency department visits, hospitalizations and medical expenditures were collected during the first and second years. A subgroup analysis by Charlson comorbidity index (CCI) and older age (age≧80 years) was performed, and the results were compared between the Geri-OPD and non-Geri-OPD groups. Results: A total of 6723 patients were included (3796 women and 2927 men). The mean age was 80.42 ± 6.39 years. There were 1291 (19.2%) patients in the Geri-OPD group and 5432 (80.8%) patients in the non-Geri-OPD group. After one year of regular follow-up, the Geri-OPD patients showed a significant reduction in the types of drugs included in each prescription (5.62±10.85) and the number of clinic visits per year (18.18 ± 48.85) (P<0.01). After a two-year follow-up, the number of clinic visits, emergency department visits, and hospitalizations and the annual medical costs were still decreased in the Geri-OPD patients. The Geri-OPD patients had more comorbidities and a higher rate of health care utilization than the non-Geri-OPD patients. In the subgroup analysis, patients with more comorbidities (CCI≧2) and an older age (≧80 years) in the Geri-OPD group showed a significant reduction in health care utilization. The Geri-OPD patients also showed a significant decrease in medical utilization in the second year compared with the non-Geri-POD patients. Conclusion: The Geri-OPD reduced medical costs, the number of drugs prescribed, and the frequency of outpatient clinic visits, emergency department visits and hospitalizations in older patients with complicated conditions. The effect was even better in the second year.

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