scholarly journals Developing a Community Engaged Sickle Cell Disease Center: An Initial Data Analysis of Healthcare Utilization Rates and Perspectives of Key Informants.

2021 ◽  
Author(s):  
Hannatu Tunga-Lergo
Keyword(s):  
Access To Care ◽  
Acute Care ◽  
Sickle Cell ◽  
Outpatient Clinic ◽  
Care Utilization ◽  
Adult Care ◽  
Care Services ◽  
Barriers To Access ◽  
Key Informant ◽  
Acute Care Services

Background: The mortality rate of individuals with Sickle cell disease (SCD), the most prevalent genetic disease in the United States, has been has been increasing at 1% per year. It has been declared a global and national public health priority by the World Health Organization (WHO) and Centers for Disease Control and Prevention (CDC). As a complex chronic and acute condition, preventive care and patient management of SCD requires a patient-centered, comprehensive, and multidisciplinary approach; unfortunately, few SCD treatment centers use this approach. Moreover, individuals with SCD are at the intersectionality of race and socioeconomics and thus face additional barriers to access to quality care, which may ultimately result in higher utilization of acute care services, especially during the transitioning period from pediatric to adult care. Greater acute care utilization has been found to be associated with higher mortality rate and severely compromised health related quality of life; thus, it is important to assessing needs of SCD patients as they relate to access to care. Objective: The aim of this study was to conduct a preliminary needs assessment for the development of a community engaged SCD center. This study also aimed to determine if frequency of acute care utilization was associated with age and insurance type, to provide surveillance data, and to identify opportunities to address barriers to access to care from key informant (local and cross-institutional) perspectives. Method: A retrospective cohort study of SCD related emergency department (ED), inpatient hospitalization, and outpatient clinic utilization encounters, which occurred from 09/01/2012-06/01/2019, was queried from UF Health's Integrated Data Repository (IDR). Quantitative analysis, frequencies, proportions, and Pearson Chi-square inference, were conducted on the administrative data received. Further, key informant interviews of stakeholders in Alachua County, FL and Yale New Haven Health's Adult Sickle Cell Program, New Haven, CT were performed. An iterative qualitative thematic analysis of their perspectives was conducted. Result: There were 27,932 total encounters that were stratified by age and payer type. The average length of hospitalization stay was .71 +/- 3.84. The 18-30-year-olds had the highest proportion of ED utilization (34.7%), hospitalizations (32.1%), and outpatient clinic utilization (26.4%). This was followed by the 31-45-year-olds with 20.4% of ED utilizations, 22% of hospitalizations, and 20.5% of outpatient clinic utilizations. Those with public health insurance accounted for 74% of ED encounters, 81% of hospitalizations, and 82% of outpatient encounters. Common themes and subthemes from key informant interviews included: champion, transition of care, pain management, bias, patient and family education, provider knowledge, social worker, multidisciplinary/comprehensive care, mental health, education, and employment. Conclusion: Among adults with SCD in the UF Health system, younger adults (e.g., those who are transitioning into adult care) and those with public insurance utilized acute care services at greater proportions, indicating a need to identify and address possible barriers to access to care.

Factors Associated With Unplanned Acute Care Services for Patients With Newly Diagnosed Hematologic Malignancies

2021 ◽  
pp. 1197-1206
Author(s):  
Kai Zu ◽  
Kristina L. Greenwood ◽  
Joyce C. LaMori ◽  
Besa Smith ◽  
Tyler Smith ◽  
...  
Keyword(s):  
Acute Care ◽  
Predictive Models ◽  
Psychosocial Functioning ◽  
Predictive Accuracy ◽  
Care Utilization ◽  
Medical Complication ◽  
Quality Reporting ◽  
Care Services ◽  
Acute Care Services ◽  
The Impact

PURPOSE This study evaluated risk factors predicting unplanned 30-day acute service utilization among adults subsequent to hospitalization for a new diagnosis of leukemia, lymphoma, or myeloma. This study explored the prevalence of medical complications (aligned with OP-35 measure specifications from the Centers for Medicare & Medicaid Services [CMS] Hospital Outpatient Quality Reporting Program) and the potential impact of psychosocial factors on unplanned acute care utilization. METHODS This study included 933 unique patients admitted to three acute care inpatient facilities within a nonprofit community-based health care system in southern California from 2012 to 2017. Integrated comprehensive data elements from electronic medical records and facility oncology registries were leveraged for univariate statistics, predictive models constructed using multivariable logistic regression, and further exploratory data mining, with predictive accuracy of the models measured with c-statistics. RESULTS The mean age of study participants was 65 years, and 55.1% were male. Specific diagnoses were lymphoma (48.7%), leukemia (35.2%), myeloma (14.0%), and mixed types (2.1%). Approximately one fifth of patients received unplanned acute care services within 30 days postdischarge, and over half of these patients presented with one or more symptoms associated with the CMS medical complication measure. The predictive models, with c-statistics ranging from 0.7 and above for each type of hematologic malignancy, indicated good predictive qualities with the impact of psychosocial functioning on the use of acute care services ( P values < .05), including lack of consult for social work during initial admission (lymphoma or myeloma), history of counseling or use of psychotropic medications (lymphoma), and past substance use (myeloma). CONCLUSION This study provides insights into patient-related factors that may inform a proactive approach to improve health outcomes, such as enhanced care transition, monitoring, and support interventions.

scholarly journals Interruption in Care Continuity during Healthcare Transition from Pediatric to Adult Care Increases Acute Care Utilization

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 2226-2226
Author(s):  
Pradeep S. B. Podila ◽  
Vikki Nolan ◽  
Anjelica Christina Saulsberry ◽  
Sheila Anderson ◽  
Jason R Hodges ◽  
...  
Keyword(s):  
Health Care ◽  
Acute Care ◽  
Sickle Cell ◽  
Pediatric Care ◽  
Care Utilization ◽  
Latency Time ◽  
Adult Care ◽  
Care Continuity ◽  
Centered Care ◽  
Acute Care Utilization

Abstract Background: Among youth with sickle cell disease (SCD), morbidity and mortality substantially increase following departure from pediatric care. Care continuity following transfer from pediatric to adult-centered care is paramount to ensure maintenance of health care delivery and reduce the risk of poor clinical outcomes. The American Academy of Pediatrics recommends matriculation in adult care within 6 months from leaving pediatric care for patients with special health care needs. Failure to transition from pediatric to adult care among youth with SCD may contribute to frequent disease complications and early death. No formal analysis has been conducted to quantify the risk of care interruption as youth transition from pediatric to adult care on the rate of acute health care utilization. We tested the hypothesis that patients who interrupted care for more than 6 months as they moved from the pediatric to the adult-centered care setting would have higher frequency of acute health care utilization. Methods: With IRB approval, we conducted a retrospective review of the rate of acute care utilization among patients with SCD who were transitioned from the pediatric sickle cell program at St. Jude Children's Research Hospital to the adult sickle cell program at Methodist University Hospital, Memphis TN between January 2014 and December 2017. We compared the rates of emergency department (ED) and inpatient utilization among those who established care >6 months from completing pediatric care (interrupted care continuity) and those who established adult care within 6 months from completing pediatric care (uninterrupted care continuity). We used person-time rates to compare the rates of emergency department and inpatient encounters per patient between the two care continuity groups. Results: Between January 2014 and December 2017 there were 172 patients with SCD who completed pediatric care and established adult care: 63 of them had a latency time from pediatric to adult care >6 months and 109 had a latency time from pediatric to adult care ≤6 months. Their follow-up since matriculation in adult care was 2245 and 2197 person-years for interrupted and uninterrupted care continuity groups, respectively The median (range) age upon establishing adult care was 20 (range, 20 to 24) years and 18 (range, 18 to 19) years for the interrupted and uninterrupted care continuity groups, respectively. Patients who interrupted care >6 months after leaving pediatric care had an incidence rate of 0.18 ED visits/person-year compared to 0.09 ED visits/person-year among those who completed the first visit within 6 months from leaving pediatric care (IRR 0.48, 95%CI 0.40-0.57, p<0.0001) (Figure panels A and B). Patients who interrupted care >6 months after leaving pediatric care had an incidence rate of 0.09 inpatient visits/person-year compared to 0.04 inpatient visits/person-year among those who completed the first visit within 6 months from leaving pediatric care (IRR 0.42 (95%CI 0.32-0.54, p<0.0001) (Figure panels C and D). Conclusions: The latency time from pediatric to adult care may impact the frequency of acute care utilization among youth with SCD. Patients who do not establish adult care within 6 months from leaving pediatric care, as recommended by the American Academy of Pediatrics, are at risk of experiencing greater ED and inpatient visits than those who establish care within 6 months from leaving pediatric care. Efforts to avoid care interruptions during the health care transition period are important to ensure optimal health outcomes among youth with SCD. Disclosures Hankins: NCQA: Consultancy; bluebird bio: Consultancy; Novartis: Research Funding; Global Blood Therapeutics: Research Funding.

A new perspective on women’s care burden and employment in Turkey

2021 ◽  
pp. 1-24
Author(s):  
Çisel Ekiz Gökmen
Keyword(s):  
Access To Care ◽  
Empirical Studies ◽  
Women's Employment ◽  
Full Time ◽  
Time Dimension ◽  
Adult Care ◽  
Women’S Employment ◽  
Care Burden ◽  
Care Services ◽  
Household Members

Abstract Women’s intra-household care burden is one of the main reasons behind women’s low employment rates in Turkey. Many empirical studies have tested this relationship by focusing on the existence of dependent household members, if any. They have largely overlooked the use of care services and the time spent on caring for dependent household members to evaluate women’s care burden. The purpose of this study is to examine the relationship between women’s care burden and employment prospects and status in Turkey from the perspective of access to care services and the time dimension of the care burden. This relationship is analyzed through the logit model by using latest available data from the 2014–2015 Time Use Survey. The article shows that the time spent by women caring for dependent household members, and access to care services, are the most important factors influencing women’s employment probability in Turkey. Benefiting from informal childcare services increases the employment probability of women approximately twenty-seven times, while benefiting from formal childcare services increases two times and informal adult-care services 2.6 times. Ensuring the accessibility of institutional care services improves women’s employment status by enabling women’s transition from part-time to full-time jobs, and from unskilled to professional jobs.

Clinical handover practices among healthcare practitioners in acute care services: A qualitative study

2018 ◽  
Vol 28 (1-2) ◽  
pp. 80-88 ◽  
Author(s):  
Gerard Fealy ◽  
Suzanne Donnelly ◽  
Gerardine Doyle ◽  
Maria Brenner ◽  
Mary Hughes ◽  
...  
Keyword(s):  
Qualitative Study ◽  
Acute Care ◽  
Clinical Handover ◽  
Care Services ◽  
Acute Care Services

Perceptions of emergency medicine and acute care among a cohort of non-emergency medicine health providers in Myanmar

2019 ◽  
Author(s):  
Corey B. Bills ◽  
Peter Acker ◽  
Tina McGovern ◽  
Rebecca Walker ◽  
Htoo Ohn ◽  
...  
Keyword(s):  
Emergency Medicine ◽  
Acute Care ◽  
Emergency Care ◽  
Healthcare Providers ◽  
Unmet Need ◽  
Health Providers ◽  
Care Providers ◽  
Convenience Sample ◽  
Care Services ◽  
Acute Care Services

Abstract Background Currently, Myanmar does not have a nationalized emergency care or emergency medical services (EMS) system. The provision of emergency medicine (EM) education to physicians without such training is essential to address this unmet need for high quality emergency care. We queried a group of healthcare providers in Myanmar about their experience, understanding and perceptions regarding the current and future needs for EM training in their country. Methods A 34-question survey was administered to a convenience sample of healthcare workers from two primary metropolitan areas in Myanmar to assess exposure to and understanding of emergency and pre-hospital care in the country. Results 236 of 290 (81% response rate) individuals attending one of two full-day symposia on emergency medicine completed the survey. The majority of respondents were female (n=138, 59%), physicians (n=171, 74%), and working in private practice (n=148, 64%). A majority of respondents (n=133, 57%) spent some to all of their clinical time providing acute and emergency care however 83.5% (n=192) of all surveyed reported little or no past training in emergency care; and those who have received prior emergency medicine training were more likely to care for emergencies (>2 weeks training; p=.052). 81% (n= 184) thought the development of emergency and acute care services should be a public health priority. Conclusions Although this subset of surveyed health practitioners commonly provides acute care, providers in Myanmar may not have adequate training in emergency medicine. Continued efforts to train Myanmar’s existing healthcare workforce in emergency and acute care should be emphasized.

The COAG Reforms and Community Health Services

1995 ◽  
Vol 1 (1) ◽  
pp. 3 ◽  
Author(s):  
Stephen Duckett ◽  
Tracie Hogan ◽  
Jan Southgate
Keyword(s):  
Health Care ◽  
Health Services ◽  
Community Health ◽  
Acute Care ◽  
Community Health Services ◽  
Community Wellbeing ◽  
Care Services ◽  
Acute Care Services ◽  
English Speaking ◽  
The Impact

Ultimately, the reform directions announced by the Council of Australian Governments (COAG) in April 1995 have the potential to touch all aspects of health care and community wellbeing, and the impact will be felt as much by community health services, and for groups with special needs, such as people from non-English speaking backgrounds, as it will for acute care services.

Sign in / Sign up

Export Citation Format

Share Document