scholarly journals A78 THE IMPACT OFGASTROINTESTINAL FOLLOW UP CARE ON HEALTHCARE UTILIZATION IN PATIENTS WITH ESINOPHILICESOPHAGITID (EOE).

2021 ◽  
Vol 4 (Supplement_1) ◽  
pp. 45-46
Author(s):  
K Alazemi ◽  
M Alkhattabi ◽  
J C Gregor
Keyword(s):  
Emergency Room ◽  
Healthcare Utilization ◽  
Attrition Rate ◽  
Quality Improvement Initiative ◽  
Food Impaction ◽  
Emergency Room Visits ◽  
True Rate ◽  
Funding Agencies ◽  
The Impact

Abstract Background EOE is an increasingly recognized gastrointestinal condition that causes significant morbidity ranging from dietary limitations to food impactions requiring emergency room visits. There are a variety of dietary, pharmacologic and endoscopic treatments available but most are more practically guided by a subspecialist familiar and experienced with the condition. There is a perception among some physicians that follow up is sporadic and may be related at least in part to patient compliance. Aims To assess the true rate of EOE patients follow up rate at Lodon Health Scince Center Methods We used a retrospective cohort of patients diagnosed with EoE between July 2011 and June 2014 who met the traditional diagnostic criteria. As part of a quality improvement initiative, local follow up over the ensuing 5–7 years was tracked. The impact of follow up on subsequent healthcare utilization was analyzed. Results 123 patients with biopsy confirmed EoE were analyzed. Follow up appointments were made for 114/123 (92%) patients. 55/123 (45%) had repeat elective endoscopy booked. Only 10/114 (8.7%) of initial appointments went unattended but 15/55 (27.2%) of the patients offered ongoing follow up failed to attend. There were no complications (ie. perforation or bleeding) attributable to any of the procedures. 5/123 (4%) patients required repeat emergency room endoscopy for food impaction. Two patients required this on multiple occasions. 4/5 patients requiring repeat emergency room endoscopy for food impaction had received some sort of follow up, although 4/5 of these had at least one missed appointment. 2/5 patients having emergency room endoscopy required overnight admission. There were no perforations in the cohort. Conclusions Patients with a confirmed diagnosis of EOE do have a risk of requiring subsequent emergency endoscopy for food impaction although it is not clear that scheduled follow up significantly reduces that risk. Contrary to the perception of some physicians, patients with EoE are very likely to attend their first follow up visit although the attrition rate for subsequent scheduled visits is not insignificant. Funding Agencies None

scholarly journals A84 THE IMPACT OF GASTROINTESTINAL FOLLOW UP CARE ON HEALTHCARE UTILIZATION IN PATIENTS WITH EOSINOPHILIC ESOPHAGITIS (EOE).

2021 ◽  
Vol 4 (Supplement_1) ◽  
pp. 53-54
Author(s):  
K Alazemi ◽  
M Alkhattabi ◽  
J C Gregor
Keyword(s):  
Emergency Room ◽  
Healthcare Utilization ◽  
Attrition Rate ◽  
Quality Improvement Initiative ◽  
Food Impaction ◽  
Emergency Room Visits ◽  
Funding Agencies ◽  
Follow Up Care ◽  
The Impact

Abstract Background EoE is an increasingly recognized gastrointestinal condition that causes significant morbidity ranging from dietary limitations to food impactions requiring emergency room visits. There are a variety of dietary, pharmacologic and endoscopic treatments available but most are more practically guided by a subspecialist familiar and experienced with the condition. There is a perception among some physicians that follow up is sporadic and may be related at least in part to patient compliance Aims To assess patients with EoE utilization of health care in LHSC Methods We used a retrospective cohort of patients diagnosed with EoE between July 2011 and June 2014 who met the traditional diagnostic criteria. As part of a quality improvement initiative, local follow up over the ensuing 5–7 years was tracked. The impact of follow up on subsequent healthcare utilization was analyzed. Results 123 patients with biopsy confirmed EoE were analyzed. Follow up appointments were made for 114/123 (92%) patients. 55/123 (45%) had repeat elective endoscopy booked. Only 10/114 (8.7%) of initial appointments went unattended but 15/55 (27.2%) of the patients offered ongoing follow up failed to attend. There were no complications (ie. perforation or bleeding) attributable to any of the procedures. 5/123 (4%) patients required repeat emergency room endoscopy for food impaction. Two patients required this on multiple occasions. 4/5 patients requiring repeat emergency room endoscopy for food impaction had received some sort of follow up, although 4/5 of these had at least one missed appointment. 2/5 patients having emergency room endoscopy required overnight admission. There were no perforations in the cohort. Conclusions Patients with a confirmed diagnosis of EoE do have a risk of requiring subsequent emergency endoscopy for food impaction although it is not clear that scheduled follow up significantly reduces that risk. Contrary to the perception of some physicians, patients with EoE are very likely to attend their first follow up visit although the attrition rate for subsequent scheduled visits is not insignificant. Funding Agencies None

scholarly journals Involuntary out-patient commitment: 2-year follow-up

2013 ◽  
Vol 37 (2) ◽  
pp. 60-64 ◽  
Author(s):  
Laura Castells-Aulet ◽  
Miguel Hernández-Viadel ◽  
Pedro Asensio-Pascual ◽  
Carlos Cañete-Nicolás ◽  
Carmen Bellido-Rodríguez ◽  
...  
Keyword(s):  
Mental Disorder ◽  
Emergency Room ◽  
Average Length ◽  
Length Of Hospital Stay ◽  
Delusional Disorder ◽  
Emergency Room Visits ◽  
Court Order ◽  
Severe Mental Disorder ◽  
The Impact

Aims and methodTo evaluate the impact of involuntary out-patient commitment (OPC) in patients with severe mental disorder who use hospital services. This is a retrospective–observational study in a population of 91 patients under OPC. The psychiatric diagnosis, sociodemographic variables, who requested the court order and for what motive were studied. The study also looked at the use of the available health services (emergency room visits, admissions, average length of hospital stay) for the period beginning 2 years before and ending 2 years after the initiation of the OPC.ResultsThe number of emergency room visits, admissions and the length of hospitalisation diminished in the 2 years following the initiation of the OPC. In terms of diagnosis, the OPC has the most impact on individuals with schizophrenia and delusional disorder.Clinical implicationsThe OPC can be useful for certain patients with severe mental disorder, particularly individuals with schizophrenia and delusional disorder.

The impact of pharmacist telephone calls after discharge on satisfaction of oncology patients: A randomized controlled study

2017 ◽  
Vol 24 (5) ◽  
pp. 359-364 ◽  
Author(s):  
Sewar S Salmany ◽  
Lujeen Ratrout ◽  
Abdallah Amireh ◽  
Randa Agha ◽  
Noor Nassar ◽  
...  
Keyword(s):  
Emergency Room ◽  
Hospital Readmissions ◽  
Randomized Controlled Study ◽  
Controlled Study ◽  
Emergency Room Visits ◽  
Oncology Patients ◽  
Randomized Controlled ◽  
Significant Difference ◽  
The Impact

Purpose The aim of the study was to determine the impact of telephone follow-up calls on satisfaction in oncology patients after hospital discharge. Method A randomized controlled study, in which patients were randomized into two groups: The experimental group with the telephone follow-up (TFU) calls (intervention) and the control group (no intervention). The telephone follow-up call was conducted within 72 h after discharge. During the call, patients were asked about their medications, namely, whether they received them, understood how to take them, and whether they developed any medication-related adverse effect. Both groups were contacted by phone two weeks later to assess their satisfaction with the discharge medication instructions and the provided pharmaceutical services, using the 5-point Likert scale. In addition, hospital records were reviewed for emergency room visits and hospital readmissions within 30 days after discharge. Results There was no difference in the percentage of patients who reported being very satisfied between both the intervention and the control groups (45% intervention vs. 48% control, P = 0.68). The mean time of the intervention phone call was 3 ± 1.7 (SD) min. During the telephone follow-up call, medication-related problems were identified in 20% of the patients. There was no significant difference in emergency room visits and hospital readmissions in the intervention group vs. control (44% vs. 53%, P = 0.123) and (37% vs. 43%, P = 0.317), respectively. Conclusion Telephone follow-up calls conducted by a pharmacist to discharged oncology patients did not improve patients' satisfaction, emergency room visits or hospital readmissions; however, they helped to identify medication-related adverse effects in the oncology patients.

Coexistent Osteoarthritis and Parkinson’s Disease: Data from the Parkinson’s Foundation Outcomes Project

2020 ◽  
Vol 10 (4) ◽  
pp. 1601-1610
Author(s):  
Jaimie A. Roper ◽  
Abigail C. Schmitt ◽  
Hanzhi Gao ◽  
Ying He ◽  
Samuel Wu ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Study Data ◽  
Functional Mobility ◽  
Quality Improvement Initiative ◽  
Timed Up And Go ◽  
Mobility Performance ◽  
Risk Of Mortality ◽  
The Impact

Background: The impact of concurrent osteoarthritis on mobility and mortality in individuals with Parkinson’s disease is unknown. Objective: We sought to understand to what extent osteoarthritis severity influenced mobility across time and how osteoarthritis severity could affect mortality in individuals with Parkinson’s disease. Methods: In a retrospective observational longitudinal study, data from the Parkinson’s Foundation Quality Improvement Initiative was analyzed. We included 2,274 persons with Parkinson’s disease. The main outcomes were the effects of osteoarthritis severity on functional mobility and mortality. The Timed Up and Go test measured functional mobility performance. Mortality was measured as the osteoarthritis group effect on survival time in years. Results: More individuals with symptomatic osteoarthritis reported at least monthly falls compared to the other groups (14.5% vs. 7.2% without reported osteoarthritis and 8.4% asymptomatic/minimal osteoarthritis, p = 0.0004). The symptomatic group contained significantly more individuals with low functional mobility (TUG≥12 seconds) at baseline (51.5% vs. 29.0% and 36.1%, p < 0.0001). The odds of having low functional mobility for individuals with symptomatic osteoarthritis was 1.63 times compared to those without reported osteoarthritis (p < 0.0004); and was 1.57 times compared to those with asymptomatic/minimal osteoarthritis (p = 0.0026) after controlling pre-specified covariates. Similar results hold at the time of follow-up while changes in functional mobility were not significant across groups, suggesting that osteoarthritis likely does not accelerate the changes in functional mobility across time. Coexisting symptomatic osteoarthritis and Parkinson’s disease seem to additively increase the risk of mortality (p = 0.007). Conclusion: Our results highlight the impact and potential additive effects of symptomatic osteoarthritis in persons with Parkinson’s disease.

scholarly journals Examining the impact of mental disease on type 2 diabetes outcomes: results from the EpiChron Cohort

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
I Guerrero Fernández de Alba ◽  
A Gimeno-Miguel ◽  
B Poblador Plou ◽  
K Bliek Bueno ◽  
J Carmona Pirez ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Substance Abuse ◽  
Early Detection ◽  
Health Outcomes ◽  
Emergency Room ◽  
Mental Disease ◽  
Emergency Room Visits ◽  
Mental Diseases ◽  
The Impact

Abstract Background Type 2 diabetes mellitus (T2D) is often accompanied by other chronic diseases, including mental diseases (MD). This work aimed at studying MD prevalence in T2D patients and analyse its impact on T2D health outcomes. Methods Retrospective, observational study of individuals of the EpiChron Cohort aged 18 and over with prevalent T2D at baseline (2011) in Aragón, Spain (n = 63,365). Participants were categorized by the existence or absence of MD, defined as the presence of depression, anxiety, schizophrenia or substance abuse. MD prevalence was calculated, and a logistic regression model was performed to analyse the likelihood of the four studied health outcomes (4-year all-cause mortality, all-cause hospitalization, T2D-hospitalization, and emergency room visits) based on the presence of each type of MD, after adjusting by age, sex and number of comorbidities. Results Mental diseases were observed in 19% of T2D patients, with depression being the most frequent condition, especially in women (20.7% vs. 7.57%). Mortality risk was significantly higher in patients with MD (odds ratio -OR- 1.24; 95% confidence interval -CI- 1.16-1.31), especially in those with substance abuse (OR 2.18; 95% CI 1.84-2.57) and schizophrenia (OR 1.82; 95% CI 1.50-2.21). The presence of MD also increased the risk of T2D-hospitalization (OR 1.51; 95% CI 1.18-1.93), emergency room visits (OR 1.26; 95% CI 1.21-1.32) and all-cause hospitalization (OR 1.16; 95% CI 1.10-1.23). Conclusions The high prevalence of MD among T2D patients, and its association with health outcomes, underscores the importance of providing integrated, person-centred care and early detection of comorbid mental diseases in T2D patients to improve disease management and health outcomes. Key messages Comprehensive care of T2D should include specific strategies for prevention, early detection, and management of comorbidities, especially mental disorders, in order to reduce their impact on health. Substance abuse was the mental disease with the highest risk of T2D-hospitalization, emergency room visits and all-cause hospitalization.

Empiric proton pump inhibitor therapy after esophageal food impaction may mask eosinophilic esophagitis diagnosis at follow-up

2021 ◽  
Author(s):  
Luke Hillman ◽  
Sarah Donohue ◽  
Aimee Teo Broman ◽  
Patrick Hoversten ◽  
Eric Gaumnitz ◽  
...  
Keyword(s):  
Proton Pump Inhibitor ◽  
Proton Pump ◽  
Eosinophilic Esophagitis ◽  
Empiric Therapy ◽  
Proton Pump Inhibitor Therapy ◽  
Significant Heterogeneity ◽  
Food Impaction ◽  
Esophageal Food Impaction ◽  
The Impact

Summary Esophageal food impaction (EFI) is often the first presentation for patients with eosinophilic esophagitis (EoE); however, there is significant heterogeneity in the management of EFI. We aimed to study the impact of EFI management, particularly post-EFI medication prescriptions on EoE diagnosis, follow-up, and recurrence in patients with endoscopic features of EoE. In our retrospective study, adults presenting between 2007 and 2017 with EFI requiring endoscopic dis-impaction with endoscopic features of EoE (furrows, rings, and/or exudates) were included. We examined the impact of demographics and EFI management on EoE diagnosis, follow-up (esophagogastroduodenoscopy [EGD] or clinic visit within 6 months), and recurrence. We identified 164 cases of EFI due to suspected EoE. Biopsy was performed in 68 patients (41.5%), and 144 patients (87.8%) were placed on proton pump inhibitor (PPI) and/or swallow corticosteroids after EFI, including 88.5% of those not biopsied. PPI use at time of biopsy was negatively associated with EoE diagnosis (odds ratio: 0.39, confidence interval: 0.17–0.85). Sixty-one (37.4%) patients were lost to follow-up at 6 months. Recurrent EFI at 1 year occurred in 3.7% of patients. Medications, most commonly PPI, are frequently prescribed after EFI when the endoscopic features of EoE are present, which may mask the diagnosis of EoE on follow-up EGD. We estimated that for every five patients biopsied on PPI, one case of EoE is masked. As recurrent EFI within 1 year is uncommon, empiric therapy should be avoided until diagnostic biopsies are obtained. Further efforts to reduce loss to follow-up after EFI are also needed.

Abstract 18655: Efficacy of Cardiac Computerized Tomographic Angiography in the Evaluation of Patients with Cocaine-Induced Chest Pain: A Pilot Randomized Trial

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Richard Peralta ◽  
Andrew Yoon ◽  
Moustapha Atoui ◽  
Karomibal Mejia ◽  
Maryam Afshar ◽  
...  
Keyword(s):  
Chest Pain ◽  
Length Of Stay ◽  
Emergency Room ◽  
Randomized Trial ◽  
Cardiovascular Events ◽  
Hospital Admissions ◽  
Major Adverse Cardiovascular Events ◽  
Emergency Room Visits ◽  
Tomographic Angiography

Background: Cocaine-induced chest pain (CICP) is reported in 40% of patients using cocaine and is associated with frequent emergency room visits and hospital admissions. Hypothesis: Coronary computed tomographic angiography (CCTA) has better outcomes than standard-of-care (SOC) for the evaluation of patients with CICP. Method: CICP patients were randomized to CCTA protocol or SOC. The primary outcome of the study was a composite of recurrent emergency room visits and hospital admissions. Secondary outcomes included length of stay, major adverse cardiovascular events and all-cause mortality. Results: The study population consisted of 202 patients with CICP (CCTA=23 and SOC=179). As compared to SOC, the number of emergency room visits in the CCTA group were lower at 30 days (1.04±0.1 vs. 1.24±0.5, p=0.012) and 1 year (2.43±0.9 vs. 2.61±2.1, p=0.008), but not at 3 years (5.04±3.3 vs. 4.87±1, p=0.112) findings that were independent of CCTA results. Mean admission rates for the CCTA group were slightly but not significantly lower than the SOC group at 30 days (0.91±0.1 vs.1.10±0.2 p=0.438) and 1 year (1.52±0.3 vs. 1.82±0.3 p=0.187), but not at 3 years (3.22±0.6 vs. 2.95±0.5, p=0.111). Hospital length of stay was also lower in CCTA patients than in SOC patients (2.61±0.5 vs. 3.34 ± 0.5 p<0.001). After 3 year follow-up, there was 1 major adverse cardiovascular event in the CCTA group compared to 22 in the SOC group (p=0.024). No patient died in the CCTA while 3 patients died from any cause in the SOC group (p=0.776) after 3 years of follow-up. Conclusion: In this prospective randomized trial, CCTA reduced near and intermediate-term but not long-term rates of emergency room visits and hospitalizations. When compared to SOC, the use of CCTA was associated with a reduction of major adverse cardiovascular events. Larger randomized controlled trials to further assess the efficacy of a CCTA-based strategy for CICP appear warranted.

scholarly journals 112 Healthcare Utilization and Costs for Patients With Tardive Dyskinesia

CNS Spectrums ◽  
2018 ◽  
Vol 23 (1) ◽  
pp. 72-72
Author(s):  
Benjamin Carroll ◽  
Paul Juneau ◽  
Debra Irwin
Keyword(s):  
Mental Health ◽  
Tardive Dyskinesia ◽  
Emergency Room ◽  
Healthcare Utilization ◽  
Resource Utilization ◽  
Cohort Analysis ◽  
Emergency Room Visits ◽  
Retrospective Cohort Analysis ◽  
Health Related ◽  
Pharmaceutical Industries

AbstractIntroductionTardive dyskinesia (TD) is an often-irreversible movement disorder that usually results from prolonged use of antipsychotics. Although the burden of TD on patients’ quality of life has been reported, there is limited evidence of its impact on the healthcare system.ObjectiveTo assess healthcare utilization and costs between TD and non-TD patients in a sample of patients from the commercially insured and Medicare Supplemental US populations.MethodsA retrospective cohort analysis was conducted using Truven MarketScan Commercial/Medicare claims data. For each patient included in the analysis, the index date was set as the first TD diagnosis between 1/1/2008 and 9/30/2014. Patients with TD were then matched to similar patients without TD to compare resource utilization andcosts. Descriptive statistics on the incidence of resource utilization and costs of healthcare were reported.ResultsA total of 1020 patients were included in this analysis. TD patients had significantly greater annual all-cause (TD: $54,656; non-TD: $28,777) and mental health-related (TD: $10,199; non-TD: $2,605) healthcare costs compared with non-TD patients (P<0.01). This was primarily because a higher proportion of the TD patientsexperienced hospitalizations (all-cause 56%; mental health 17%) and emergency room visits (all-cause 62%; mental health 27%) compared with non-TD patients(hospitalizations: all-cause 26%, mental health 5%; emergency room visits: all-cause 41%; mental health 13%) (all P<0.001).ConclusionsPatients identified as being diagnosed with TD demonstrate significantly higher healthcare utilization and costs in the 12 months after diagnosis than do similar patients without TD.Presented at: Psych Congress; September 16–19, 2017; New Orleans, Louisiana, USA.Funding AcknowledgementsThis study was funded by Teva Pharmaceutical Industries, Petach Tikva, Israel.

The Effectiveness of Medical and Surgical Treatment for Children With Refractory Epilepsy

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Melissa LoPresti ◽  
Iwen Pan ◽  
Dave Clarke ◽  
Sandi Lam
Keyword(s):  
Surgical Treatment ◽  
Healthcare Utilization ◽  
Epilepsy Surgery ◽  
Refractory Epilepsy ◽  
Survival Rates ◽  
Treated Group ◽  
Pediatric Epilepsy ◽  
Ed Visits ◽  
The Impact

Abstract INTRODUCTION Pediatric refractory epilepsy affects quality of life, clinical disability, and healthcare costs for patients and families. We aimed to show the impact of surgical treatment for pediatric epilepsy on healthcare utilization compared to medically treated pediatric epilepsy over 5 yr. METHODS The Pediatric Health Information System database was used to study hospitalized children with epilepsy using five published algorithms. Refractory epilepsy (RE) patients treated with either antiepileptic medications (AEDs) only or AEDs plus epilepsy surgery (ES) between 1/1/2008 and 12/31/2014 were included. Patients with a history of ES before 1/1/2008 or a vagus nerve stimulation implantation surgery were excluded. ICD-9-CM codes were used to identify ES. Healthcare utilization following the index date at 2- and 5-yr including inpatient, emergency department (ED), and all epilepsy-related visits were evaluated. The propensity scores (PS) method was used to match surgically and medically treated patients. Covariates associated with the probability of receiving surgical treatment were chosen in the logistic regression model for calculating PS. SAS 9.4 and Stata 14.0 were used for data management and statistical analysis. RESULTS A total of 2106 (17.1%) and 10186 (82.9%) were surgically and medically treated, respectively. A total of 4050 matched cases, 2025 per each treated group, were included. Overall survival rates of matched cases were 98.07% and 99.58% at 2-yr and 96.66% and 98.99% at 5-yr for medically and surgically treated patients, respectively. Within 5-yr follow-up, seizure-associated healthcare utilization was lower for the surgically treated group: number of inpatient visits were 3.9 vs 2.5 and ED visits were 3.2 vs 1.7 for medically and surgically treated patients, respectively. The number of AEDs at 1-yr follow-up was significantly lower for the surgically treated group (3.22 decreased to 2.59: surgical group, 3.24 decreased to 3.06: medical group). CONCLUSION We found a significant decrease in inpatient and ED visits and number of antiepileptic drug prescriptions, as well as higher survival rates, at 2- and 5-yr follow-up in the surgically treated group compared to the medically treated group for pediatric patients with refractory epilepsy. Pediatric epilepsy surgery can provide beneficial outcomes, favorable long-term effectiveness, and reduced healthcare utilization compared to medical management.

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