High Cost and Resource Utilization of Frostbite Readmissions in the United States

2021 ◽  
Author(s):  
Frederick W Endorf ◽  
Rachel M Nygaard
Keyword(s):  
Alcohol Abuse ◽  
Urban Areas ◽  
National Level ◽  
The United States ◽  
Population Based ◽  
Unplanned Readmission ◽  
High Morbidity ◽  
Injury Index ◽  
Comorbidity Index ◽  
Injured Patients

Abstract Background Frostbite is a high morbidity, high-cost injury that can lead to digit or limb necrosis requiring amputation. Our primary aim is to describe the rate of readmission following frostbite injury. Our secondary aims are to describe the overall burden of care, cost, and characteristics of repeat hospitalizations of frostbite-injured people. Methods Hospitalizations following frostbite injury (index and readmissions) were identified in the 2016 and 2017 Nationwide Readmission Database. Multivariable logistic regression was clustered by hospital and additionally adjusted for severe frostbite injury, gender, year, payor group, severity, and comorbidity index. Population estimates were calculated and adjusted for by using survey weight, sampling clusters, and stratum. Results In the two-year cohort, 1,065 index hospitalizations resulted in 1,907 total hospitalizations following frostbite injury. Most patients were male (80.3%), lived in metropolitan/urban areas (82.3%), and nearly half were insured with Medicaid (46.4%). Of the 842 readmissions, 53.7% were associated with complications typically associated with frostbite injury. Overall, 29% of frostbite injuries resulted in at least one amputation. The average total cost and total LOS of readmissions was $236,872 and 34.7 days. Drug or alcohol abuse, homelessness, Medicaid insurance, and discharge AMA were independent predictors of unplanned readmission. Factors associated with multiple readmissions include discharge AMA and Medicare Insurance, but not drug or alcohol abuse or homelessness. The population-based estimated unplanned readmission rate following frostbite injury was 35.4% (95% CI 32.2 – 38.6%). Conclusions This is the first study examining readmissions following frostbite injury on a national level. Drug or alcohol abuse, homelessness, Medicaid insurance, and discharge AMA were independent predictors of unplanned readmission, while only AMA discharge and Medicare insurance were associated with multiple readmissions. Supportive resources (community and hospital-based) may reduce unplanned readmissions of frostbite injured patients with those additional risk factors.

73 High Cost and Resource Utilization of Frostbite Readmissions

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S50-S51
Author(s):  
Frederick W Endorf ◽  
Rachel M Nygaard
Keyword(s):  
Alcohol Abuse ◽  
Urban Areas ◽  
National Level ◽  
Unplanned Readmission ◽  
High Morbidity ◽  
Burden Of Care ◽  
Total Cost ◽  
Factors Associated ◽  
Comorbidity Index ◽  
Nationwide Readmission Database

Abstract Introduction Frostbite is a high morbidity, high-cost injury that can lead to digit or limb necrosis requiring amputation. Our primary aim is to describe the rate of readmission following frostbite injury. Our secondary aims are to describe the overall burden of care, cost, and characteristics of repeat hospitalizations of frostbite-injured people. Methods Index hospitalizations and readmissions were identified in the 2016 and 2017 Nationwide Readmission Database. Weighted incidence and characteristics of readmissions associated with frostbite injury were calculated and adjusted for by using survey weight, sampling clusters, and stratum. Multivariable logistic regression was clustered by hospital and additionally adjusted for severe frostbite injury, gender, year, payor group, severity, and comorbidity index. Results The unplanned readmission rate following frostbite injury was 35.4% (95% CI 32.2 – 38.6%). In the two-year cohort, 1,065 index hospitalizations resulted in 1,907 total hospitalizations following frostbite injury. Most patients were male (80.3%), lived in metropolitan/urban areas (82.3%), and nearly half were insured with Medicaid (46.4%). Of the 842 readmissions, 53.7% were associated with complications typically associated with frostbite injury. Overall, 29% of frostbite injuries resulted in at least one amputation. The average total cost and total LOS of readmissions was $236,872 and 34.7 days. Drug or alcohol abuse, homelessness, Medicaid insurance, and discharge AMA were independent predictors of unplanned readmission. Factors associated with multiple readmissions include discharge AMA and Medicare Insurance, but not drug or alcohol abuse or homelessness. Conclusions This is the first study examining readmissions following frostbite injury on a national level. Drug or alcohol abuse, homelessness, Medicaid insurance, and discharge AMA were independent predictors of unplanned readmission, while only AMA discharge and Medicare insurance were associated with multiple readmissions.

scholarly journals Presentation, Management, and Outcomes across the Rural-Urban Continuum for Hepatocellular Carcinoma

2020 ◽  
Author(s):  
Kali Zhou ◽  
Trevor A Pickering ◽  
Christina S Gainey ◽  
Myles Cockburn ◽  
Mariana C Stern ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Rural Communities ◽  
Urban Areas ◽  
Tumor Stage ◽  
The United States ◽  
Population Based ◽  
Urban Residents ◽  
Place Of Residence ◽  
Incidence And Mortality ◽  
Receive Treatment

Abstract Background Hepatocellular carcinoma is one of few cancers with rising incidence and mortality in the United States. Little is known about disease presentation and outcomes across the rural-urban continuum. Methods Using the population-based SEER registry, we identified adults with incident hepatocellular carcinoma between 2000–2016. Urban, suburban and rural residence at time of cancer diagnosis were categorized by the Census Bureau’s percent of the population living in non-urban areas. We examined association between place of residence and overall survival. Secondary outcomes were late tumor stage and receipt of therapy. Results Of 83,368 cases, 75.8%, 20.4%, and 3.8% lived in urban, suburban, and rural communities, respectively. Median survival was 7 months (IQR 2–24). All stage and stage-specific survival differed by place of residence, except for distant stage. In adjusted models, rural and suburban residents had a respective 1.09-fold (95% CI = 1.04–1.14, p < .001) and 1.08-fold (95% CI = 1.05–1.10, p < .001) increased hazard of overall mortality as compared to urban residents. Furthermore, rural and suburban residents had 18% (OR = 1.18, 95% CI 1.10–1.27, p < .001) and 5% (OR = 1.05, 95% CI = 1.02–1.09, p = .003) higher odds of diagnosis at late stage and were 12% (OR = 0.88, 95% CI = 0.80–0.94, p < .001) and 8% (OR = 0.92, 95% CI = 0.88–0.95, p < .001) less likely to receive treatment, respectively, compared to urban residents. Conclusions Residence in a suburban and rural community at time of diagnosis was independently associated with worse indicators across the cancer continuum for liver cancer. Further research is needed to elucidate the primary drivers of these rural-urban disparities.

Breast Cancer in Latin America: A Map of the Disease in the Region

2018 ◽  
pp. 451-456 ◽  
Author(s):  
Eduardo Cazap
Keyword(s):  
Breast Cancer ◽  
Health Care ◽  
Latin America ◽  
Urban Areas ◽  
Access To Health Care ◽  
Cancer Control ◽  
Public Health Problem ◽  
The United States ◽  
High Morbidity ◽  
Patient Organizations

In the next few decades, breast cancer will become a leading global public health problem as it increases disproportionately in low- and middle-income countries. Disparities are clear when comparisons are made with rates in Europe and the United States, but they also exist between the countries of the region or even within the same country in Latin America. Large cities or urban areas have better access and resource availability than small towns or remote zones. This article presents the status of the disease across 12 years with data obtained through three studies performed in 2006, 2010, and 2013 and based on surveys, reviews of literature, patient organizations, and public databases. The first study provided a general picture of breast cancer control in the region (Latin America); the second compared expert perceptions with medical care standards; and the third was a review of literature and public databases together with surveys of breast cancer experts and patient organizations. We conclude that breast cancer is the most frequent cancer and kills more women than any other cancer; we also suggest that aging is the principal risk factor, which will drive the incidence to epidemic levels as a result of demographic transition in Latin America. The economic burden also is large and can be clearly observed: in countries that today allocate insufficient resources, women go undiagnosed or uncared for or receive treatment with suboptimal therapies, all of which results in high morbidity and the associated societal costs. The vast inequities in access to health care in countries translates into unequal results in outcomes. National cancer control plans are the fundamental building block to an organized governance, financing, and delivery of health care for breast cancer.

scholarly journals Couple Age Discrepancy and Risk of Intimate Partner Homicide

2004 ◽  
Vol 19 (3) ◽  
pp. 321-342 ◽  
Author(s):  
Noelia Breitman ◽  
Todd K. Shackelford ◽  
Carolyn Rebecca Block
Keyword(s):  
Common Law ◽  
National Level ◽  
The United States ◽  
Population Based ◽  
Intimate Partner ◽  
Heterosexual Couples ◽  
Intimate Partner Homicide ◽  
Arrest Record ◽  
Increased Risk ◽  
Age Discrepancy

Although national level studies in the United States and Canada find that extreme partner age discrepancy is a risk factor for intimate partner homicide in opposite-sex couples, these studies carry two caveats: They are limited to cohabiting marital or common-law couples and they are not detailed enough to explore alternative explanations for the age discrepancy-homicide risk association. Using the Chicago Homicide Dataset, which includes all homicides that occurred in Chicago from 1965 to 1996, we analyze the 2,577 homicides in which the victim was killed by a current or former legal spouse, common-law spouse, or heterosexual boyfriend or girlfriend, and in which the woman was at least 18 years of age. Within each of 14 categories of couple age discrepancy, we estimate the population of intimate heterosexual couples and calculate the population-based risk of homicide. The results replicate national level findings showing that the risk of intimate partner homicide is considerably elevated for couples with a large discrepancy between their ages—where the man is at least 16 years older than the woman or the woman is at least 10 years older than the man. This risk pattern occurs regardless of whether the man or the woman was the homicide offender. We then investigate whether the link between partner age discrepancy and homicide risk is explained by the offender’s arrest record. Results show that the higher risk of intimate partner homicide for age discrepant couples is robust, and does not depend on the previous arrest record of the offender. Discussion addresses other possible explanations for the increased risk of partner homicide for age discrepant couples, and the practical implications of these findings.

Abstract 15368: Index Admission and Thirty-day Readmission Outcomes of Cancer Patients Presenting With Stemi

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Mohammed Osman ◽  
Mina M Benjamin ◽  
Sudarshan Balla ◽  
Babikir Kheiri ◽  
Christopher Bianco ◽  
...  
Keyword(s):  
Propensity Score ◽  
Cancer Patients ◽  
National Level ◽  
The United States ◽  
Index Admission ◽  
Bleeding Complications ◽  
Unplanned Readmission ◽  
St Segment Elevation ◽  
Propensity Score Model ◽  
Infectious Cancer

Introduction: National-level data of cancer patients’ readmissions after a ST-segment elevation myocardial infarction (STEMI) are lacking. Objectives: The primary aim of this study was to describe rates and causes of 30-day readmissions in this population. Methods: Among patients who were admitted with STEMI in the United States National Readmission Database (NRD) from October 2015-December 2017, we identified patients with the diagnosis of active breast, colorectal, lung or prostate cancer. The primary endpoint was 30-day unplanned readmission rate. Secondary endpoints included in-hospital outcomes during the index admission and causes of readmissions. A propensity score model was used to compare the outcomes of cancer and no cancer patients. Results: A total of 385,522 patients were included in the current analysis (Cancer= 5,956, No Cancer=379,566). After propensity score matching, 23,880 patients were compared (Cancer=5,949, No Cancer=17,931). Cancer patients had higher 30-day readmission (19% vs 14%, p<0.01). The most common causes for readmission among cancer patients were cardiac (31%), followed by infectious (21%), hematological and oncological (17%), respiratory (4%), stroke (4%) and renal (3%). During the first readmission, cancer patients had higher in-hospital mortality (15% vs 7%; p<0.01) and bleeding complications (31% vs 21%; p<0.01). In multivariate logistic regression, cancer status (OR 1.5, 95% CI 1.2-1.6, p<0.01) was an independent predictor for 30-day readmission. Conclusions: About one in five cancer patients presenting with STEMI will be readmitted within 30 days. Cancer patients’ 30-day readmissions are still predominantly cardiac-related but with a higher proportion of admissions for infectious, cancer-related and bleeding and than those without cancer.

scholarly journals Prevalence of childhood hearing impairment of different severities in urban and rural areas: a nationwide population-based study in Taiwan

BMJ Open ◽  
2018 ◽  
Vol 8 (3) ◽  
pp. e020955 ◽  
Author(s):  
Cheng-Yu Lin ◽  
Yen-Cheng Tseng ◽  
How-Ran Guo ◽  
Der-Chung Lai
Keyword(s):  
Hearing Impairment ◽  
Rural Areas ◽  
Urban Areas ◽  
Pure Tone ◽  
National Level ◽  
Population Based ◽  
Hearing Level ◽  
Prevalence Rates ◽  
Factors Affecting ◽  
Urban And Rural Areas

ObjectiveChildhood hearing impairment (CHI) is a major developmental disability, but data at the national level are limited, especially those on different severities. We conducted a study to fill this data gap.DesignA nationwide study on the basis of a reporting system.SettingTo provide services to disabled citizens, the Taiwanese government maintains a registry of certified cases. Using data from this registry, we estimated prevalence rates of CHI of different severities from 2004 to 2010 and made comparisons between urban and rural areas.ParticipantsTaiwanese citizens ≤17 years old.Primary outcome measuresTo qualify for CHI disability benefits, a child must have an unaided pure-tone better ear hearing level at 0.5, 1 and 2 kHz with an average ≥55 decibels (dB), confirmed by an otolaryngologist. The severity was classified by pure-tone better ear hearing level as mild (55–69 dB), moderate (70–89 dB) and severe (≥90 dB).ResultsThe registered cases under 17 years old decreased annually from 4075 in 2004 to 3533 in 2010, but changes in the prevalence rate were small, ranging from 7.62/10 000 in 2004 to 7.91/10 000 in 2006. The prevalence rates of mild CHI increased in all areas over time, but not those of moderate or severe CHI. Rural areas had higher overall prevalence rates than urban areas in all years, with rate ratios (RRs) between 1.01 and 1.09. By severity, rural areas had higher prevalence rates of mild (RRs between 1.08 and 1.25) and moderate (RRs between 1.06 and 1.21) CHI but had lower prevalence rates of severe CHI (RRs between 0.92 and 0.99).ConclusionWhile rural areas had higher overall prevalence rates of CHI than urban areas, the RRs decreased with CHI severity. Further studies that identify factors affecting the rural–urban difference might help the prevention of CHI.

scholarly journals Growing Income Inequality and Socioeconomic Segregation in the Chicago Region

2021 ◽  
pp. 349-369
Author(s):  
Janet L. Smith ◽  
Zafer Sonmez ◽  
Nicholas Zettel
Keyword(s):  
United States ◽  
New York ◽  
Los Angeles ◽  
Income Inequality ◽  
Urban Areas ◽  
Census Data ◽  
National Level ◽  
The United States ◽  
Ethnic Segregation ◽  
Us Census

AbstractIncome inequality in the United States has been growing since the 1980s and is particularly noticeable in large urban areas like the Chicago metro region. While not as high as New York or Los Angeles, the Gini Coefficient for the Chicago metro area (.48) was the same as the United States in 2015 but rising at a faster rate, suggesting it will surpass the US national level in 2020. This chapter examines the Chicago region’s growing income inequality since 1980 using US Census data collected in 1990, 2000, 2010, and 2015, focusing on where people live based on occupation as well as income. When mapped out, the data shows a city and region that is becoming more segregated by occupation and income as it becomes both richer and poorer. A result is a shrinking number of middle-class and mixed neighbourhoods. The resulting patterns of socioeconomic spatial segregation also align with patterns of racial/ethnic segregation attributed to historical housing development and market segmentation, as well as recent efforts to advance Chicago as a global city through tourism and real estate development.

scholarly journals Cohort profile: the ChicagO Multiethnic Prevention and Surveillance Study (COMPASS)

BMJ Open ◽  
2020 ◽  
Vol 10 (9) ◽  
pp. e038481
Author(s):  
Briseis Aschebrook-Kilfoy ◽  
Muhammad G Kibriya ◽  
Farzana Jasmine ◽  
Liz Stepniak ◽  
Rajan Gopalakrishnan ◽  
...  
Keyword(s):  
Data Collection ◽  
Biological Samples ◽  
Medical Records ◽  
Urban Areas ◽  
National Level ◽  
Measurement Data ◽  
Population Based ◽  
Surveillance Study ◽  
Health Lifestyle ◽  
Reported Data

PurposeThe ChicagO Multiethnic Prevention and Surveillance Study or ‘COMPASS’ is a population-based cohort study with a goal to examine the risk and determinants of cancer and chronic disease. COMPASS aims to address factors causing and/or exacerbating health disparities using a precision health approach by recruiting diverse participants in Chicago, with an emphasis on those historically underrepresented in biomedical research.ParticipantsNearly 8000 participants have been recruited from 72 of the 77 Chicago community areas. Enrolment entails the completion of a 1-hour long survey, consenting for past and future medical records from all sources, the collection of clinical and physical measurement data and the on-site collection of biological samples including blood, urine and saliva. Indoor air monitoring data and stool samples are being collected from a subset of participants. On collection, all biological samples are processed and aliquoted within 24 hours before long-term storage and subsequent analysis.Findings to dateThe cohort reported an average age of 53.7 years, while 80.5% identified as African-American, 5.7% as Hispanic and 47.8% as men. Over 50% reported earning less than US$15 000 yearly, 35% were obese and 47.8% were current smokers. Moreover, 38% self-reported having had a diagnosis of hypertension, while 66.4% were measured as hypertensive at enrolment.Future plansWe plan to expand recruitment up to 100 000 participants from the Chicago metropolitan area in the next decade using a hybrid community and clinic-based recruitment framework that incorporates data collection through mobile medical units. Follow-up data collection from current cohort members will include serial samples, as well as longitudinal health, lifestyle and behavioural assessment. We will supplement self-reported data with electronic medical records, expand the collection of biometrics and biosamples to facilitate increasing digital epidemiological study designs and link to state and/or national level databases to ascertain outcomes. The results and findings will inform potential opportunities for precision disease prevention and mitigation in Chicago and other urban areas with a diverse population.RegistrationNA.

scholarly journals Fractures in the prodromal period of Parkinson disease

Neurology ◽  
2020 ◽  
Vol 94 (23) ◽  
pp. e2448-e2456
Author(s):  
Alejandra Camacho-Soto ◽  
Anat Gross ◽  
Susan Searles Nielsen ◽  
Anna N. Miller ◽  
Mark N. Warden ◽  
...  
Keyword(s):  
Parkinson Disease ◽  
Time Windows ◽  
The United States ◽  
Population Based ◽  
Medicare Beneficiaries ◽  
Prodromal Phase ◽  
Logistic Regression Models ◽  
Time Interaction ◽  
Case Status ◽  
Comorbidity Index

ObjectiveTo examine the association between fractures and Parkinson disease (PD) during the 5-year prodromal phase as compared to controls.MethodsWe performed a population-based case–control study of Medicare beneficiaries in the United States from 2004 to 2009. We identified 89,632 incident PD cases and 117,760 comparable controls 66–90 years of age in 2009. PD case status was the outcome, and noncranial fracture the independent variable. We used logistic regression models to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for association between fracture and PD in yearly time intervals prior to PD diagnosis/control reference date, after adjusting for covariates.ResultsThere were 39,606 total fractures (25.4% cases, 14.3% controls) over the 5 years prior to the PD diagnosis/control reference date. PD was positively associated with fractures even after adjusting for age, sex, race/ethnicity, Charlson comorbidity index, alcohol use, tobacco use, and osteoporosis. The association between PD and fracture was evident at yearly time windows prior to PD diagnosis/control reference date. The association between PD and each type of fracture strengthened as the PD diagnosis/control reference date approached (all time interaction p values ≤0.02). Among beneficiaries with a mechanism of injury, the majority were attributed to falls (74.6% cases, 72.8% controls).ConclusionFractures occur more commonly during the prodromal period of PD compared to controls, especially as diagnosis date approached, suggesting that patients with PD may experience unrecognized motor and nonmotor symptoms.

scholarly journals Rural EMR adoption rates overtake those in urban areas

2015 ◽  
Vol 22 (2) ◽  
pp. 399-408 ◽  
Author(s):  
Brian E. Whitacre
Keyword(s):  
United States ◽  
Rural Areas ◽  
Urban Areas ◽  
National Level ◽  
State Level ◽  
The United States ◽  
Physician Practices ◽  
Rural And Urban Areas ◽  
Rural And Urban ◽  
Emr Adoption

Abstract Objective To assess rural-urban differences in electronic medical record (EMR) adoption among office-based physician practices in the United States. Methods Survey data on over 270 000 office-based physician sites (representing over 1 280 000 physicians) in the United States from 2012 was used to assess differences in EMR adoption rates among practices in rural and urban areas. Logistic regression tests for differences in the determinants of EMR adoption by geography, and a nonlinear decomposition is used to quantify how much of the rural-urban gap is due to differences in measureable characteristics (such as type of practice or affiliation with a health system). Results Overall EMR adoption rates were significantly higher for practices in rural areas (56%) vs those in urban areas (49%) in 2012 (P &lt; 0.001). Twenty-nine states had statistically significantly different adoption rates between rural and urban areas, with only two states demonstrating higher rates in urban areas. EMR adoption continues to be higher for primary care practices when compared to specialists (51% vs 49%, P &lt; 0.001), and state-level rural-urban differences in adoption are more pronounced for specialists. The decomposition technique finds that only 14% of the rural-urban gap can be explained by differences in measurable characteristics between practices. Conclusions At the national level, rates of EMR adoption are higher for rural practices than for their urban counterparts, reversing earlier trends. This suggests that outreach efforts, namely the Regional Extension Centers created by the Office of the National Coordinator, have been particularly effective in increasing EMR adoption in rural areas.

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