POS1147 COSTS AND FACTORS AFFECTING HEALTH SERVICE UTILISATION IN PATIENTS WITH GOUT: A LONGITUDINAL, POPULATION-LEVEL LINKED DATA STUDY IN WESTERN AUSTRALIA

Background:Evidence suggests that gout is associated with high health care costs and that many inpatient admissions are preventable (1). Understanding the driver of health care costs will allow more targeted intervention.Objectives:To examine factors associated with high health service utilisation and cost in patients admitted to hospital with gout, using whole-population linked hospital, WA cancer registration, Emergency Department (ED) and death data (2).Methods:The study included patients (18 to 84 years) who had been admitted to hospital with a primary or co-diagnosis of gout for the first time between 1 Jan 02 and 31 Dec 09 Hospital costs were calculated per patient using DRG codes and ED costs were calculated from URG codes. Costs are presented in Australian dollars. Follow-up was completed at five years post their initial gout hospitalisation, at death, or at the 31th of December 2014. Both univariable and multivariable analysis was conducted for each patient characteristic. Independent variables were assessed for collinearity. Collinearity was assumed present where the correlation co-efficient was greater than 0.7.Results:4,379 individuals were included. In the following five years, there was 22,222 ED attendances (median cost, $1826 per patient (IQR: $433 - $4,414)), and 58,920 hospital admissions, (median cost, $25,009 per patient (IQR: $6,844 - $60,535)). 4,059 (18.3%) ED attendances and 3,834 (6.5%) hospital admissions were potentially preventable. Gout was not a major driver of events, with 341 (1.5%) ED attendances and 620 (1.1%) hospital admissions coded with a primary diagnosis of gout. In the univariable analysis (Table 1), Aboriginality and smoking were associated with an increased number of both ED attendances and hospital admissions. Increased socio-economic status was associated with a reduction in ED attendances, however, this was not reflected in hospital admissions.Conclusion:Patients admitted to hospital with gout are highly likely to be re-admitted or attend ED in the following 5 years. Many of these contacts are preventable, but are usually driven by comorbidities rather than gout.References:[1]Loh K, . Intern Med J. 2020 Mar;50(3):386.[2]https://www.datalinkage-wa.org.au.Acknowledgements:The authors wish to thank the staff at the Western Australian Data Linkage Branch and the Hospital Morbidity Data Collection, and the Death Registrations and the Emergency Department Data Collection.Disclosure of Interests:None declared.

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Healthcare utilisation after discharge in patients admitted with gout in Western Australia

10.21203/rs.3.rs-934183/v1 ◽

2021 ◽

Author(s):

Erin Kelty ◽

Philip Robinson ◽

Catherine Hill ◽

Johannes Nossent ◽

Warren Raymond ◽

...

Keyword(s):

Health Care ◽

Health Service ◽

Health Care Costs ◽

Linear Models ◽

Hospital Admissions ◽

Healthcare Utilisation ◽

Health Service Utilisation ◽

Service Utilisation ◽

Median Cost ◽

Care Costs

Abstract Objectives Evidence suggests that gout is associated with high health care costs and that many inpatient admissions are preventable. Understanding the drivers of health care costs in patients with gout will allow more targeted intervention. The objective was to examine factors associated with high health service utilisation and costs in patients admitted to hospital with gout. Methods Hospital and emergency department data was obtained for patients who had been admitted to hospital with a diagnosis of gout for the first time between 2002 and 2009. The total number, cost and potentially preventable events for the follow-up period was calculated for up to five years post the initial gout hospitalisation. The association between patient characteristics with health service utilisation and health care costs was examined using generalised linear models. Results The cohort included 4,379 individuals, that had 22,222 ED attendances (median cost: $1,826 per patient, IQR: $433 - $4,414), and 58,920 hospital admissions (median cost: $25,009 per patient, IQR: $6,844 - $60,535). Gout was not a primary driver of ED attendances or hospitalisations. A history of smoking and comorbidities including cardiovascular disease, diabetes and mental health disorders were associated with an increase health service utilisation and costs. Conclusion The presence of comorbidities play an important role the risk of health service utilization in people with gout and represents an opportunity to both improve the health-related outcomes for these patients and reduce re-presentations and associated health care costs for the health care system.

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Using Linked Data to Estimate the True Number of Individuals Impacted by Residential Fire

International Journal for Population Data Science ◽

10.23889/ijpds.v5i5.1558 ◽

2020 ◽

Vol 5 (5) ◽

Author(s):

Nargess Ghassempour ◽

Lara A Harvey ◽

W. Kathy Tannous

Keyword(s):

Emergency Department ◽

Health Service ◽

Health Services ◽

Hospital Admissions ◽

Population Based ◽

Health Service Utilisation ◽

Service Utilisation ◽

Residential Fire ◽

True Number ◽

Residential Fires

IntroductionResidential fires remain a significant global public health problem. It is recognised that the reported number of residential fires, fire-related injuries and deaths significantly underestimate the true number. Australian population-based surveys show that around two-thirds of respondents who experience a residential fire are unwilling to call fire services, and studies from the US and New Zealand highlight that many individuals who access medical treatment for fire-related injuries do not have an associated fire incident report. Objectives and ApproachThis population-based study aimed to quantify the total number of residential fires, fire-related injuries and associated health service utilisation. The cohort included all persons residing at a residential address in New South Wales, Australia, which experienced a fire between 1 January 2005 - 31 December 2014. The cohort comprised linked person-level data from eight administrative datasets and includes information about nature of fire, first responder use (Fire and Rescue (FRNSW) and ambulance services), health service utilisation (emergency department, hospital and burns outpatient clinic) and health outcomes. ResultsOver the study period, FRNSW responded to 42,491 residential-fire incidents, involving 42,160 individuals with some individuals reporting multiple times. In total, 3,382 individuals used one or more health service and 154 individuals died. Of individuals who contacted FRNSW, 1,661 (3.9%) used health services;ambulance (n=1,101), emergency department (n=1,114), hospital admissions (n=168). There were 95 deaths. There were 1,721 (51%) additional individuals who used one or more health service as a result of a residential-fire that did not contact FRNSW and 59 additional deaths were identified. Conclusion / ImplicationsThis study found that more than half of individuals who used health services for residential fire-related injuries did not have an associated fire report, highlighting the importance of data linkage for accurate communication to policy makers and the public on the prevalence and impact of residential-fires.

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Factors Affecting Discharges against Medical Advice in an Emergency Department of a Tertiary Care Center

Journal of KIST Medical College ◽

10.3126/jkistmc.v2i2.33576 ◽

2020 ◽

Vol 2 (2) ◽

pp. 31-35

Author(s):

Trishna Shrestha ◽

Sneha Pradhananga ◽

Kabita Hada Batajoo ◽

Manjita Bajracharya

Keyword(s):

Health Care ◽

Emergency Department ◽

Health Care Costs ◽

Medical Advice ◽

Health Concern ◽

Against Medical Advice ◽

Factors Affecting ◽

Tertiary Center ◽

Care Costs ◽

Leaving Against Medical Advice

Introduction: Patients leaving against the advice of the treating team before being certified as fit is a major concern and challenge for the treating professionals as it possesses adverse medical outcomes. This study hence aimed at identifying the prevalence and major factors affecting such discharges so that advocacy can be done to help prevent it. Methods: A descriptive cross-sectional study was conducted at emergency department of a tertiary center in Lalitpur from 15th May 2019 to 15th August 2019. All the patients visiting the emergency department were included in the study and a non-probability purposive sampling method was used excluding the patients who denied giving reasons for them leaving against medical advice. Data was collected using pre-structured questionnaire and analyzed using SPSS-v21 software. Results: A hundred and fifteen patients (4.08%) left against medical advice out of 2812 patients who presented to emergency department. There were 63 male patients (54.8%), 75 patients of the total patients in the age group of 15-44 years (65.2%) and those living within a distance of 1km from the hospital (53%). The most common reason for the patients leaving against medical advice was found to be due to financial constraint (38.3%) followed by preference to other hospitals (16.5%). Conclusion: Patients leaving against medical advice possesses a small percentage of actual hospital admissions but is still a major health concern as it drastically increases the morbidity, re-admission rates and total health-care costs. Hence, understanding the general characteristics and predictors of such discharges is of utmost importance to help improve the patient outcome and reduce the health-care costs.

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Barriers to and facilitators of health services utilisation by refugees in resettlement countries: an overview of systematic reviews

Australian Health Review ◽

10.1071/ah18108 ◽

2020 ◽

Vol 44 (1) ◽

pp. 132 ◽

Cited By ~ 1

Author(s):

Jamuna Parajuli ◽

Dell Horey

Keyword(s):

Health Care ◽

Health Service ◽

Health Services ◽

Systematic Reviews ◽

Health Professionals ◽

Health Service Utilisation ◽

Barriers And Facilitators ◽

Service Utilisation ◽

Knowledge And Skills ◽

Overview Of Systematic Reviews

Objective The aim of this study was to provide an overview of the previously reviewed research literature to identify barriers and facilitators to health service utilisation by refugees in resettlement countries. Methods An overview of systematic reviews was conducted. Seven electronic databases (Medline, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, ProQuest Central, Scopus, EBSCO and Google Scholar) were searched for systematic reviews of barriers and facilitators to health-seeking behaviour and utilisation of health services by refugees following resettlement. The two authors independently undertook data selection, data extraction and quality assessment using a validated tool. Results Nine systematic reviews covered a range of study areas and refugee populations. Barriers to health service utilisation fell into three broad areas: (1) issues related to refugees, including refugee characteristics, sociocultural factors and the effects of previous experiences; (2) issues related to health services, including practice issues and the knowledge and skills of health professionals; and (3) issues related to the resettlement context, including policies and practical issues. Few facilitators were identified or evaluated, but these included approaches to care, health service responses and behaviours of health professionals. Conclusions Barriers to accessing health care include refugee characteristics, practice issues in health services, including the knowledge and skills of health professionals, and the resettlement context. Health services need to identify barriers to culturally sensitive care. Improvements in service delivery are needed that meet the needs of refugees. More research is needed to evaluate facilitators to improving health care accessibility for these vulnerable groups. What is known about the topic? Refugee health after resettlement is poor, yet health service use is low. What does this paper add? Barriers to accessing health services in resettlement countries are related not only to refugees, but also to issues regarding health service practices and health professionals’ knowledge and skill, as well as the context of resettlement. Few facilitators to improving refugee access to health services have been identified. What are the implications for practitioners? The barriers associated with health professionals and health services have been linked to trust building, and these need to be addressed to improve accessibility of care for refugees.

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Do general practice management and/or team care arrangements reduce avoidable hospitalisations in Central and Eastern Sydney, Australia?

BMC Health Services Research ◽

10.1186/s12913-019-4663-3 ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 1

Author(s):

Heidi Welberry ◽

Margo Linn Barr ◽

Elizabeth J. Comino ◽

Ben F. Harris-Roxas ◽

Elizabeth Harris ◽

...

Keyword(s):

General Practice ◽

Data Collection ◽

Health Service ◽

Baseline Period ◽

Health Service Utilisation ◽

Service Utilisation ◽

Complex Care ◽

Care Needs ◽

Team Care ◽

Complex Care Needs

Abstract Background The number of people living with chronic health conditions is increasing in Australia. The Chronic Disease Management program was introduced to Medicare Benefits Schedule (MBS) to provide a more structured approach to managing patients with chronic conditions and complex care needs. The program supports General Practitioners (GP)s claiming for up to one general practice management plan (GPMP) and one team care arrangement (TCA) every year and the patient claiming for up to five private allied health visits. We describe the profile of participants who claimed for GPMPs and/or TCAs in Central and Eastern Sydney (CES) and explore if GPMPs and/or TCAs are associated with fewer emergency hospitalisations (EH)s or potentially preventable hospitalisations (PPH)s over the following 5 years. Methods This research used the CES Primary and Community Health Cohort/Linkage Resource (CES-P&CH) based on the 45 and Up Study to identify a community-dwelling population in the CES region. There were 30,645 participants recruited within the CES area at baseline. The CES-P&CH includes 45 and Up Study questionnaire data linked to MBS data for the period 2006–2014. It also includes data from the Admitted Patient Data Collection, Emergency Department Data Collection and Deaths Registry linked by the NSW Centre for Health Record Linkage. Results Within a two-year health service utilisation baseline period 22% (5771) of CES participants had at least one claim for a GPMP and/or TCA. Having at least one claim for a GPMP and/or TCA was closely related to the socio-demographic and health needs of participants with higher EHs and PPHs in the 5 years that followed. However, after controlling for confounding factors such as socio-demographic need, health risk, health status and health care utilization no significant difference was found between having claimed for a GPMP and/or TCA during the two-year health service utilisation baseline period and EHs or PPHs in the subsequent 5 years. Conclusions The use of GPMPs and/or TCAs in the CES area appears well-targeted towards those with chronic and complex care needs. There was no evidence to suggest that the use of GPMPs and /or TCAs has prevented hospitalisations in the CES region.

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44 Ultrasonography as a First-line Imaging Modality for Appendicitis: Does It Reduce Health Care Costs, Radiation Exposure and Length of Stay in Emergency Department Patients?

Annals of Emergency Medicine ◽

10.1016/j.annemergmed.2012.06.071 ◽

2012 ◽

Vol 60 (4) ◽

pp. S17-S18

Author(s):

J. Pare ◽

S. Saijwani ◽

L. Farooq ◽

C. Douriez ◽

H. Chiu ◽

...

Keyword(s):

Health Care ◽

Emergency Department ◽

Length Of Stay ◽

Radiation Exposure ◽

Health Care Costs ◽

Imaging Modality ◽

First Line ◽

Line Imaging ◽

Emergency Department Patients ◽

Care Costs

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Physician and Nurse Awareness of Health Care Costs in Common Emergency Department Patients

Academic Emergency Medicine ◽

10.1197/j.aem.2006.03.117 ◽

2006 ◽

Vol 13 (5Supplement 1) ◽

pp. S52-S53

Author(s):

A. A. LePage

Keyword(s):

Health Care ◽

Emergency Department ◽

Health Care Costs ◽

Emergency Department Patients ◽

Care Costs

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142 High and Low Frequency Emergency Department Users: A Comparative Analysis of Morbidity, Diagnostic Testing, and Health Care Costs

Annals of Emergency Medicine ◽

10.1016/j.annemergmed.2011.06.169 ◽

2011 ◽

Vol 58 (4) ◽

pp. S225 ◽

Cited By ~ 3

Author(s):

J. Oostema ◽

J. Troost ◽

K. Schurr ◽

R. Waller

Keyword(s):

Health Care ◽

Emergency Department ◽

Comparative Analysis ◽

Health Care Costs ◽

Diagnostic Testing ◽

Low Frequency ◽

Care Costs

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Health Care Costs Associated to Type of Feeding in the First Year of Life

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17134719 ◽

2020 ◽

Vol 17 (13) ◽

pp. 4719

Author(s):

Carolina Lechosa-Muñiz ◽

María Paz-Zulueta ◽

María Sáez de Adana Herrero ◽

Elsa Cornejo del Rio ◽

Sonia Mateo Sota ◽

...

Keyword(s):

Primary Care ◽

Health Care ◽

Infectious Diseases ◽

Emergency Room ◽

Health Care Costs ◽

Medical Records ◽

Hospital Admissions ◽

First Year ◽

First Year Of Life ◽

Care Costs

Background: Breastfeeding is associated with lower risk of infectious diseases, leading to fewer hospital admissions and pediatrician consultations. It is cost saving for the health care system, however, it is not usually estimated from actual cohorts but via simulation studies. Methods: A cohort of 970 children was followed-up for twelve months. Data on mother characteristics, pregnancy, delivery and neonate characteristics were obtained from medical records. The type of neonate feeding at discharge, 2, 4, 6, 9 and 12 months of life was reported by the mothers. Infectious diseases diagnosed in the first year of life, hospital admissions, primary care and emergency room consultations and drug treatments were obtained from neonate medical records. Health care costs were attributed using public prices and All Patients Refined–Diagnosis Related Groups (APR–DRG) classification. Results: Health care costs in the first year of life were higher in children artificially fed than in those breastfed (1339.5€, 95% confidence interval (CI): 903.0–1775.0 for artificially fed vs. 443.5€, 95% CI: 193.7–694.0 for breastfed). The breakdown of costs also shows differences in primary care consultations (295.7€ for formula fed children vs. 197.9€ for breastfed children), emergency room consultations (260.1€ for artificially fed children vs. 196.2€ for breastfed children) and hospital admissions (791.6€ for artificially fed children vs. 86.9€ for breastfed children). Conclusions: Children artificially fed brought about more health care costs related to infectious diseases than those exclusively breastfed or mixed breastfed. Excess costs were caused in hospital admissions, primary care consultations, emergency room consultations and drug consumption.

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