scholarly journals GERIATRICS PREVENTABLE ADMISSIONS CARE TEAM (GERIPACT): A HIGH-RISK INTENSIVE AMBULATORY GERIATRICS PROGRAM

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S147-S147
Author(s):  
Stephanie W Chow ◽  
Lizette Munoz ◽  
Susana Lavayen ◽  
Shamsi Fani ◽  
Blair MacKenzie ◽  
...  
Keyword(s):  
Health Care ◽  
Social Work ◽  
High Risk ◽  
Emergency Room ◽  
Older Patients ◽  
Care Team ◽  
Emergency Room Visits ◽  
Telephone Hotline ◽  
Ed Visits ◽  
Preventable Admissions

Abstract The Geriatrics Preventable Admissions Care Team (GERIPACT) is an inter-professional team of 2 clinicians, 1 social worker, and 1 care coordinator, dedicated to offering temporary intensive ambulatory care services to complex older patients at high-risk for incurring expensive health care (ie. frequent emergency room visits or hospitalizations). GERIPACT services include frequent office visits for medical and social work needs, frequent telephone contact, home visits, specialty visit accompaniment, and a 24/7 telephone hotline. Use of this innovative model aims to serve communities lacking in geriatrician and geriatric social work providers, with a main goal of serving the highest risk older population. We reviewed the healthcare utilization of GERIPACT enrollees 6 months prior-to-enrollment and compared with 6 months following graduation from GERIPACT from 2016 to 2018. 78 patients were evaluated, with 49 total ED visits prior to enrollment and 35 post-graduation, saving 14 ED visits for a ratio of 18 saved ED visits per 100 GERIPACT patients. There were 45 hospitalizations prior to enrollment with 29 hospitalizations post-graduation, saving 16 hospitalizations, or 20 hospitalizations per 100 GERIPACT patients. Hospital days were reduced by 237 days post-graduation. An intensive ambulatory program for high risk geriatrics patients may be shown to be an efficient model of care for targeting those older patients who potentially incur greater expenses to the health care system. This focused team may be deployed to primary care communities with complex elderly patients in need of geriatricians and geriatric social workers, and may reduce unnecessary emergency room visits and inpatient stays.

scholarly journals Identification of emergency department patients for referral to rapid-access addiction services

CJEM ◽  
2020 ◽  
Vol 22 (2) ◽  
pp. 170-177 ◽  
Author(s):  
Jessica Hann ◽  
Howie Wu ◽  
Aliyah Gauri ◽  
Kathryn Dong ◽  
Ni Lam ◽  
...  
Keyword(s):  
Health Care ◽  
Emergency Department ◽  
High Risk ◽  
Tertiary Care ◽  
Health Care Team ◽  
Care Team ◽  
Rapid Access ◽  
Addiction Services ◽  
Ed Visits ◽  
Emergency Department Patients

ABSTRACTObjectivesSubstance-related emergency department (ED) visits are rapidly increasing. Despite this finding, many EDs do not have access to on-site addiction services. This study characterized substance-related ED presentations and assessed the ED health care team's perceived need for an on-site rapid-access addiction clinic for direct patient referral from the ED.MethodsThis prospectively enrolled cohort study was conducted at an urban tertiary care ED from June to August 2018. Adult ED patients with problematic or high-risk substance use were enrolled by ED staff using a one-page form. The electronic and paper records from the index ED visit were reviewed. The primary outcome evaluated whether the ED health care team would have referred the patient to an on-site rapid-access addiction clinic, if one were available.ResultsWe received 557 enrolment forms and 458 were included in the analysis. Median age was 35 years, and 64% of included patients were male. Alcohol was the most commonly reported substance of problematic or high-risk use (60%). Previous ED visits within 7 days of the index visit were made by 28% of patients. The ED health care team indicated “Yes” for rapid-access addiction clinic referral from the ED for 66% of patients, with a mean of 4.3 patients referred per day during the study period.ConclusionsAt least four patients per day would have been referred to an on-site rapid-access addiction clinic from the ED, had one been available. This indicates a gap in care and collaborating with other sites that have successfully implemented this clinic model is an important next step.

scholarly journals Decreasing Emergency Room Utilization in High Risk Geriatric Patients

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 135-135
Author(s):  
Shamsi Fani ◽  
Lizette Munoz ◽  
Susana Lavayen ◽  
Blair McKenzie ◽  
Audrey Chun ◽  
...  
Keyword(s):  
New York ◽  
High Risk ◽  
Emergency Room ◽  
Geriatric Patients ◽  
Social Issues ◽  
The Elderly ◽  
Mount Sinai Hospital ◽  
Status Change ◽  
Community Paramedicine ◽  
Ed Visits

Abstract Background: The Acute Life Interventions Goals & Needs Program (ALIGN) at the Mount Sinai Hospital in New York City aims to work closely with high risk geriatric patients for short term intensive management of acute medical and social issues. Quantitative measures for determining success of the program is comparing emergency room visits and hospitalizations prior to and after enrollment with ALIGN. The Community Paramedicine service allows a paramedic, the ALIGN provider, and an emergency room physician to assess and triage patients in their home via video conference thereby avoiding ED visits for non-urgent services. Method: We reviewed the utilization of the Community Paramedicine service (from July 2017-February 2020) and its impact on ALIGN’s efforts to reduce unnecessary ED visits and hospitalizations. Results: 36 patients were evaluated with the Community Paramedicine service (from July 2017-February 2020). 19 or 52.8% avoided an ED visit and 17 or 47.2% were transported to the ED. 12 or 70.6% were admitted to the hospital of those that were transported to the ED initially. Top reasons for transport to ED included generalized weakness, acute mental status change (AMS), and shortness of breath (SOB). Conclusions: A Community Paramedicine program utilized by a high risk geriatrics team like ALIGN is effective in reducing ED visits and hospitalizations for the elderly population who incur greater expenses to the health care system and traditionally have poorer health outcomes.

Encouraging Self—Care within a Primary Health Care Framework

2007 ◽  
Vol 20 (2) ◽  
pp. 28-33 ◽  
Author(s):  
Mary Lou O'Neill ◽  
Evelyn Kennedy ◽  
Cyndee MacPhee
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Emergency Room ◽  
Self Care ◽  
Health Problems ◽  
Perceived Usefulness ◽  
Emergency Room Visits ◽  
Primary Health ◽  
Study Results

This study was undertaken primarily to evaluate Do I Need to See the Doctor?, a book designed to assist young families to self-manage common health problems. In addition, the study sought to determine whether providing an introductory explanation to the book had an impact on the respondents' perceived usefulness of it. Comparisons of emergency room visits were made for the timeframe of the study and for the previous year. Study results support the book's usefulness in increasing respondents' confidence to make knowledgeable, informed self-care decisions. Providing explanations did not affect the book's usefulness. A link between emergency room visits and the book requires further study.

Early use of home health care on health care utilization for patients with advanced lung cancer.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e19015-e19015
Author(s):  
Steven Rousey ◽  
Kiran Krishan Lassi ◽  
Jodi Wieczorek ◽  
James Essler ◽  
Marie Brown ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Health Care ◽  
Home Care ◽  
Emergency Room ◽  
Home Health Care ◽  
Home Health ◽  
Advanced Lung Cancer ◽  
Control Group ◽  
Emergency Room Visits ◽  
Early Use

e19015 Background: Patients with advanced lung cancer historically have required significant use of health care resources including hospitalizations, ICU admissions and emergency room visits which are often related to inadequately controlled symptoms. Most patients with advanced lung cancer prefer to remain in their own home as much as possible and are willing to work with home nursing resources, if available. The purpose of this pilot study was to determine the effect of early use of home health care on health care utilization for patients with advanced lung cancer. Methods: Betweem May 2011 and May 2012, 18 patients were enrolled in a pilot program to explore early use of home care for individuals with advanced lung cancer. Inclusion criteria consisted of a diagnosis of stage III/IV lung cancer (any histology) and home care eligibility using Medicare criteria. The endpoints were hospitalization rate, number of ICU admissions and emergency room visits. The results were compared to an historical control group (562 patients with advanced lung cancer diagnosed between 2006 and 2011). Binomial confidence interval (CI) was used to estimate the 95% CIs and Fisher's exact test was used to assess the p-values. Results: Results at one year showed the hospitalization rates for the pilot group and the control group were 44% (95% CI, 22-69) and 78% (95% CI, 74-81), respectively (p<0.01) and the ER visit rate was 17% (95% CI, 4-41) and 41% (95% CI, 37-45), respectively (p=0.049). The ICU admission rates were 0% and 11% in the two groups, respectively, and this difference was not statistically significant. Home care visits ranged from 1-77 with an average of 12 visits per patient. The estimated cost of the home care program for the duration of enrollment was $2,330 per patient. Conclusions: Early use of home health care for patients with advanced lung cancer appears to reduce the rates of hospitalization and emergency room visits when compared with historical controls, and though the results were not statistically significant, none of the 18 patients in the pilot group were admitted to the ICU. A larger multi-institutional study will examine the potential of this simple intervention for cost saving, enhanced care quality and improved patient satisfaction.

scholarly journals Increased Health Care Cost Associated with Venous Thromboembolism in Patients with Malignant Glioma

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 3524-3524
Author(s):  
Heather Wright ◽  
Chris E. Holmes ◽  
Alissa Thomas
Keyword(s):  
Health Care ◽  
Venous Thromboembolism ◽  
Emergency Room ◽  
Malignant Glioma ◽  
Emergency Room Visits ◽  
Total Cost ◽  
Therapeutic Anticoagulation ◽  
Increased Risk ◽  
Inpatient Hospitalizations ◽  
Cancer Types

Abstract Background: The cumulative incidence of symptomatic venous thromboembolism (VTE) among patients with malignant glioma (MG) is high, with estimates ranging from 20-35% during the course of therapy. VTE is the second leading cause of death among ambulatory patients receiving cancer chemotherapy, with a 2-fold or greater increase in mortality compared to those without VTE, even after adjusting for stage. In patients with MG and VTE the chance of two-year survival is significantly reduced. The development of VTE is also associated with increased morbidity, including increased risk of hospitalization, delays in cancer treatment, and an increased risk of complications including pain, bleeding, and bruising from high dose therapeutic anticoagulation. The economic burden of VTE in cancer patients is estimated at a 2-fold increase in cost. Data regarding VTE burden encompasses all cancer types and additional data is needed to characterize VTE burden in specific cancer types, particularly rarer cancers. The aim of this study was to assess the healthcare burden associated with the development of VTE in patients with MG. Methods: A retrospective chart review of patients with MG at an academic medical center was conducted from 2009-2017. Sixty-seven patients, age 18 years and older, with a histologic diagnosis of MG (WHO grade III-IV) were assessed. The number of office visits, emergency room visits, and inpatient hospitalizations with the associated costs of VTE management and its complications were collected. Using SPSS, linear regression models and descriptive statistics were used to determine the relationship between the development of VTE and healthcare consumption. Results: Of the 67 patients in the study, 18 developed VTE (27%). All patients who developed a VTE were placed on therapeutic anticoagulation. Fifty percent of patients developed complications related to anticoagulation, including gastrointestinal, retroperitoneal and intracranial bleeding events. Two patients required placement of an IVC filter after experiencing a bleeding complication. Patients that developed VTE had an increase in inpatient days (16.6 inpatient days) as compared to their non-VTE counterparts (8.8 inpatient days), (p=0.012). There was increased utilization of the emergency room with an average of 3.94 visits in those patients with VTE as compared to those without (1.84), (p=0.003). A full cost analysis found that the average primary total cost for ED visits and inpatient hospitalizations in patients with VTE was $48,863 while those without VTE averaged $35,948. This represented a 26% increase in the average primary total cost in those patients with VTE. Discussion: The development of VTE in patients with MG increases inpatient admissions days and incurs additional pharmaceutical costs related to anticoagulation. This study represents the first assessment of VTE-associated health care burden specific to primary brain cancer. We confirm that VTE affects a large number of patients with MG (27%) and limits the time spent at home due to increased hospitalizations and emergency room visits. VTE may be a preventable complication and further studies are needed to investigate safe prevention strategies for patients with MG. Disclosures No relevant conflicts of interest to declare.

Physician Reimbursement

PEDIATRICS ◽  
1988 ◽  
Vol 82 (2) ◽  
pp. 282-282
Author(s):  
GEORGE J. COHEN
Keyword(s):  
Health Care ◽  
American Academy ◽  
Emergency Room ◽  
Cost Control ◽  
Emergency Room Visits ◽  
Physician Reimbursement ◽  
American Academy Of Pediatrics

To the Editor.— In the excellent study of physician reimbursement by Hickson et al (Pediatrics 1987;80:344-350), there seems to be an implication that more health care visits than stated in the American Academy of Pediatrics' guidelines constitute excessive cost and perhaps unnecessary patient-doctor interaction. The suggestion that limiting compensation to just the visits in the guidelines might be a technique of cost control is really self-defeating. The authors have already demonstrated that more well-child visits decrease the number of emergency room visits, which are far more expensive.

Between Inclusion and Participation: Young Carers Who Are Absent From School

2015 ◽  
Vol 14 (3) ◽  
pp. 314-328 ◽  
Author(s):  
Steffen Kaiser ◽  
Gisela C. Schulze
Keyword(s):  
Health Care ◽  
Social Work ◽  
High Risk ◽  
Family Members ◽  
Interdisciplinary Cooperation ◽  
Young Carers ◽  
The Public ◽  
Interdisciplinary Approaches ◽  
Work And Health

In discussions of inclusion and exclusion, one often-neglected group at high risk of exclusion is that of school absentees. Researchers and the public normally focus on truants and school refusers, whereas students absent from school to take care of family members, or young carers, have received little attention so far. Because of the multicausal factors and extensive impacts of the phenomenon, research on both school absentees and young carers suggests a need for interdisciplinary approaches. Yet, these approaches for support do not always succeed. This study investigated the interdisciplinary cooperation of those professionals in education, social work, and health care who work with young carers absent from school. It identified both barriers to and facilitators of this important cooperation. The aim is to create better support for the inclusion of this unnoticed group and to increase awareness of their situation among the professionals working with them.

Additional Disease Burden from Hay Fever and Sinusitis Accompanying Asthma

2009 ◽  
Vol 118 (9) ◽  
pp. 651-655 ◽  
Author(s):  
Neil Bhattacharyya ◽  
Lynn J. Kepnes
Keyword(s):  
Health Care ◽  
Allergic Rhinitis ◽  
Emergency Room ◽  
National Health Interview Survey ◽  
Disease Burden ◽  
Health Care Expenditures ◽  
Hay Fever ◽  
Health Care Spending ◽  
Emergency Room Visits ◽  
Interview Survey

Objectives: We sought to determine the additional disease burden imparted by sinusitis and hay fever (allergic rhinitis) to patients with asthma. Methods: Patients with a diagnosis of asthma, hay fever, or sinusitis were extracted from the National Health Interview Survey for the 1997 to 2006 adult sample. Disease groups consisting of patients with asthma alone, asthma + hay fever, asthma + sinusitis, and asthma + hay fever + sinusitis were assembled. Disease groups were then compared according to total health-care visits per year, emergency room visits per year, health-care spending per year, and number of workdays lost per year to determine the disease burden. Results: We identified 11,813 patients (mean age, 45.5 years) who reported active asthma with or without hay fever or sinusitis comorbidity. Of these, 5,931 patients (50%) were identified with asthma alone, 1,134 (10%) with combined asthma + hay fever, 2,461 (21%) with asthma + sinusitis, and 2,287 (19%) with combined asthma + hay fever + sinusitis. Patients with asthma + sinusitis and those with asthma + sinusitis + hay fever had more total health-care visits and emergency room visits than did those with asthma alone (p < 0.001). All three groups with comorbidities had higher health-care expenditures than did the group with asthma alone (p ≤ 0.002). Patients with asthma + sinusitis and those with asthma + hay fever + sinusitis missed more workdays than did patients in the group with asthma alone (10.0 and 13.1 versus 7.2, respectively; p < 0.001). Comorbid hay fever alone did not increase workdays lost (6.6 days; p = 0.983). Conclusions: The additional disease burden of sinusitis on asthma is greater than that of hay fever. These data highlight the importance of identifying comorbid diagnoses with asthma.

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