scholarly journals Bundle Payment, Health Care Utilization, and Outcomes Following Surgery for Anterior, Middle, and Posterior Cranial Fossa Skull Base Meningioma: A Market Scan Analysis

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Mayur Sharma ◽  
Beatrice Ugiliweneza ◽  
Maxwell Boakye ◽  
Norberto O Andaluz ◽  
Brian J Williams
Keyword(s):  
Health Care ◽  
Health Care Utilization ◽  
Hospital Stay ◽  
Complication Rate ◽  
The United States ◽  
Posterior Cranial Fossa ◽  
Care Utilization ◽  
Outpatient Services ◽  
Significant Difference ◽  
Cranial Fossa

Abstract INTRODUCTION Meningioma is the most common benign intracranial brain tumor accounting for approximately one-third of all primary brain tumors. The aim of our study was to compare the bundle payment, health care utilization, and outcomes following surgery for anterior (AFM), middle (MFM), and posterior cranial fossa meningioma (PFM) across the United States. METHODS We queried the Market Scan database using ICD-9 and CPT-4, from 2000 to 2016. We included adult patients who had at least 24 mo of enrollment following the surgical procedure. The outcome of interest was length of hospital stay, disposition, complications, and reoperation following the procedure. RESULTS A cohort of 1,188 patients was identified from the database. In all 43.86% of tumors were AFM, 32.32% were MFM, and only 23.8% were PFM. Patients who underwent surgery for PFM had significant longer hospital stay (P = .0013), higher complication rate (P = .0009), and less likely to be discharged home (P = .0013) during index hospitalization. Patients with MFM and PFM incurred higher outpatient services with no differences in corresponding payments compared to those with AFM at 12 mo (P < .0001) and 24 mo follow-up (P < .0001). There were no differences in overall payments at 12 mo (AFM: $19,702; MFM: $20,671; PFM: $20,922) and 24 mos (AFM: $37,142; MFM: $44,133; PFM: $36,601) among the cohorts. There was no significant difference in 90-d median bundle payments among the groups, $66,173 (AFM) vs $65,602 (MFM), and $71,837 (PFM), P = .1955. CONCLUSION Ninety-day bundle payment and overall payments (at 12 mo and 24 mo) were not significantly different among the cohorts. Patients with PFM had longer hospital stay, higher complication rate, and less likely to be discharged home with higher utilization of outpatient services at 12 mo and 24 mo.

Health Outcomes and Health Care Utilization Among Obstetric Deliveries With Concurrent CKD in the United States

2020 ◽  
Vol 75 (1) ◽  
pp. 148-150 ◽  
Author(s):  
Andrea L. Oliverio ◽  
Lindsay K. Admon ◽  
Laura H. Mariani ◽  
Tyler N.A. Winkelman ◽  
Vanessa K. Dalton
Keyword(s):  
United States ◽  
Health Care ◽  
Health Care Utilization ◽  
Health Outcomes ◽  
The United States ◽  
Care Utilization

scholarly journals A183 TELEHEALTH USE IN RURAL SASKATCHEWAN AND INFLAMMATORY BOWEL DISEASE OUTCOMES

2021 ◽  
Vol 4 (Supplement_1) ◽  
pp. 197-199
Author(s):  
M Patterson ◽  
M Gozdzik ◽  
J Peña-Sánchez ◽  
S Fowler
Keyword(s):  
Health Care ◽  
Inflammatory Bowel Disease ◽  
Health Care Utilization ◽  
Bowel Disease ◽  
Postal Code ◽  
Care Utilization ◽  
Specialist Care ◽  
Disease Characteristics ◽  
Significant Difference ◽  
Inflammatory Bowel

Abstract Background Appropriate management of inflammatory bowel disease (IBD) often requires multiple specialist appointments per year. Living in rural locations may pose a barrier to regular specialist care. Saskatchewan (SK) has a large rural population. Prior to COVID-19, telehealth (TH) in SK was not routinely used for either patient assessment or follow up. Furthermore, TH was exclusively between hospitals and specific TH sites without direct contact using patient’s personal phones. Aims The objective of this study was to assess the differences in demographics, disease characteristics, outcomes, and health care utilization between patients from rural SK with IBD who used TH and those who did not. Methods A retrospective chart review was completed on all rural patients (postal code S0*) with IBD in SK who were followed at the Multidisciplinary IBD Clinic in Saskatoon between January 2018 and February 2020. Patients were classified as using TH if they had ever used it. Information on demographics, disease characteristics, and access to IBD-related health care in the year prior to their last IBD clinic visit or endoscopy was collected. Data was not collected for clinic visits after March 1, 2020 as all outpatient care became remote secondary to the COVID-19 pandemic. Mean, standard deviations, median and interquartile ranges (IQR) were reported. Mann-Witney U and Chi-Square tests were used to determine differences between the groups. Results In total, 288 rural SK IBD patients were included, 30 (10.4%) used TH and 258 (89.6%) did not. Patient demographics were not significantly different between the two groups; although, there was a statistically significant difference in the proportion of ulcerative colitis patients (17% TH vs. 38% non-TH, p=0.02). The percentage of patients with clinical remission was 87% for TH patients and 74% for non-TH patients (p=0.13). There were no significant differences in health care utilization patterns and biochemical markers of disease, including c-reactive protein (CRP) and fecal calprotectin (FCP) (p&gt;0.05). Conclusions Prior to the pandemic, a small percentage of patients with IBD in rural SK ever used TH. A small proportion of UC patients used TH. No significant differences in disease characteristics, outcomes, or health care utilization were identified. Further study is warranted to identify barriers to use of this technology to tailor care to this patient group and improve access to care, especially now as the COVID-19 pandemic has drastically changed the use of virtual care. Funding Agencies None

scholarly journals Predictors of High Health Care Utilization in Patients With Inflammatory Bowel Disease Within 1 Year of Establishing Specialist Care

2020 ◽  
Author(s):  
Kenechukwu Chudy-Onwugaje ◽  
Alexander P Mamunes ◽  
David A Schwartz ◽  
Sara Horst ◽  
Raymond K Cross
Keyword(s):  
Health Care ◽  
Inflammatory Bowel Disease ◽  
Health Care Utilization ◽  
Bowel Disease ◽  
The United States ◽  
Care Utilization ◽  
Medical Assistance ◽  
High Utilizers ◽  
Inflammatory Bowel ◽  
Hospital Visits

Abstract Background A small proportion of patients with inflammatory bowel disease (IBD) consume a disproportionate amount of health care resources, with most of these spent on unplanned care in emergency room (ER) and hospital visits. Interventions in those at high risk in the outpatient setting could reduce the need for future inpatient care. We sought to describe the characteristics predictive of high health care utilization within 1 year after an initial IBD clinic encounter. Methods This was a retrospective study of new IBD patients seen at the outpatient clinics of 2 tertiary IBD centers in the United States. Baseline sociodemographic and clinical characteristics were collected, and the number of IBD-related ER and hospital visits were recorded over the 1-year period after the initial clinic encounter. Patients with ≥2 visits (high utilizers) were compared with those with no visits. Results Of the 735 patients included in the final analysis, 106 (14.4%) were high utilizers, and they had a mean of 2.9 visits (maximum = 10) in the 1 year after their initial encounter. In multivariate analysis, insurance coverage through medical assistance (odds ratio [OR] 3.57; 95% confidence interval [CI], 1.38–9.20), steroid use (OR 1.83; 95% CI, 1.11–3.04), short inflammatory bowel disease questionnaire score &lt;50 (OR 2.29; 95% CI, 1.23–4.27), and current ostomy (OR 4.82; 95% CI, 1.51–15.37) were independently associated with high utilization. Conclusions Multidisciplinary care and resources should be preferentially channeled towards new clinic patients with severe disease and on medical assistance, as this could reduce future inpatient visits and result in cost savings.

scholarly journals Health Care Utilization and Expenditures Attributable to Cigar Smoking Among US Adults, 2000-2015

2018 ◽  
Vol 133 (3) ◽  
pp. 329-337 ◽  
Author(s):  
Yingning Wang ◽  
Hai-Yen Sung ◽  
Tingting Yao ◽  
James Lightwood ◽  
Wendy Max
Keyword(s):  
Health Care ◽  
Health Care Utilization ◽  
Home Care ◽  
Smokeless Tobacco ◽  
Health Care Expenditures ◽  
The United States ◽  
Health Concern ◽  
Care Utilization ◽  
Ed Visits ◽  
Cigar Smoking

Objectives: Cigar use in the United States is a growing public health concern because of its increasing popularity. We estimated health care utilization and expenditures attributable to cigar smoking among US adults aged ≥35. Methods: We analyzed data on 84 178 adults using the 2000, 2005, 2010, and 2015 National Health Interview Surveys. We estimated zero-inflated Poisson (ZIP) regression models on hospital nights, emergency department (ED) visits, physician visits, and home-care visits as a function of tobacco use status—current sole cigar smokers (ie, smoke cigars only), current poly cigar smokers (smoke cigars and smoke cigarettes or use smokeless tobacco), former sole cigar smokers (used to smoke cigars only), former poly cigar smokers (used to smoke cigars and smoke cigarettes or use smokeless tobacco), other tobacco users (ever smoked cigarettes and used smokeless tobacco but not cigars), and never tobacco users (never smoked cigars, smoked cigarettes, or used smokeless tobacco)—and other covariates. We calculated health care utilization attributable to current and former sole cigar smoking based on the estimated ZIP models, and then we calculated total health care expenditures attributable to cigar smoking. Results: Current and former sole cigar smoking was associated with excess annual utilization of 72 137 hospital nights, 32 748 ED visits, and 420 118 home-care visits. Annual health care expenditures attributable to sole cigar smoking were $284 million ($625 per sole cigar smoker), and total annual health care expenditures attributable to sole and poly cigar smoking were $1.75 billion. Conclusions: Comprehensive tobacco control policies and interventions are needed to reduce cigar smoking and the associated health care burden.

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