Abstract 186: Rates and Causes of Short Term Rehospitalization Across the Spectrum of Age and Insurance Types in the United States

2017 ◽  
Vol 10 (suppl_3) ◽  
Author(s):  
Jordan B Strom ◽  
Daniel B Kramer ◽  
Yun Wang ◽  
Jason H Wasfy ◽  
Bruce E Landon ◽  
...  
Keyword(s):  
Substance Abuse ◽  
Private Insurance ◽  
Random Effect ◽  
The United States ◽  
Charge Ratio ◽  
Hospital Charges ◽  
Hospital Discharges ◽  
Admission Source ◽  
Substance Abuse Disorders ◽  
Dual Eligible

Background: Few studies have examined rates, characteristics, and costs of 30-day readmissions across the spectrum of age and insurance. In this setting, the relative impact of non-Medicare readmissions is unknown. Methods: Discharges of patients ≥18 hospitalized for any cause 1/1/13 - 11/30/13 at 2,006 hospitals in the Nationwide Readmissions Database (NRD), an 85% sample of hospital discharges from 21 states, were included. Results were stratified by age (18-44, 45-64, ≥65) and insurance (Medicare, Medicaid, private insurance, self-pay, and unknown). Outcomes included rates of 30-day readmission, index hospitalization diagnoses associated with readmission, and total direct costs of readmissions determined using hospital charges and the NRD Cost to Charge ratio. A hierarchical logistic regression model was used to examine the association between insurance and readmission risk, adjusting for age, admission source, and Elixhauser comorbidities, including a random effect for hospital. Dual eligible patients are classified according to primary insurance in the NRD. Results: Among 12,533,551 discharges, 1,818,093 (14.5%) resulted in readmission within 30 days. Medicaid insurance was associated with the highest adjusted odds ratio (AOR) for readmission both in those ≥65 years old (AOR 1.12, 95%CI 1.10-1.14; p <0.001), and 45-64 (AOR 1.67, 95% CI 1.66-1.69; p < 0.001), and Medicare in the 18-44 group (Medicare vs. private insurance: AOR 1.99, 95% CI 1.96-2.01; p <0.001). Discharges for psychiatric or substance abuse disorders, septicemia, and heart failure accounted for the largest numbers of readmissions, 5.0%, 4.7%, and 4.6% of total readmissions, with readmission rates of 24.0%, 17.9%, 22.9% respectively ( Table ). Total costs for readmissions were 50.7 billion USD, highest for Medicare (29.6 billion USD [58%]), with non-Medicare costs exceeding 21 billion USD (42%). Conclusions: Costs of non-Medicare readmissions are large. Medicaid patients have the highest odds of readmission in individuals older than age 44, commonly due to hospitalizations for psychiatric illness and substance abuse disorders. Medicaid patients represent a population at uniquely high risk for readmission.

Incisional Hernia in the United States: Trends in Hospital Encounters and Corresponding Healthcare Charges

2018 ◽  
Vol 84 (1) ◽  
pp. 118-125 ◽  
Author(s):  
Valeriy Shubinets ◽  
Justin P. Fox ◽  
Michael A. Lanni ◽  
Michael G. Tecce ◽  
Eric M. Pauli ◽  
...  
Keyword(s):  
United States ◽  
Adverse Events ◽  
Incisional Hernia ◽  
Private Insurance ◽  
The United States ◽  
Hospital Charges ◽  
Hospital Discharges ◽  
Serious Adverse Events ◽  
Comorbidity Index ◽  
Primary Payer

Incisional hernia (IH) is a challenging, potentially morbid condition. This study evaluates recent trends in hospital encounters associated with IH care in the United States. Using Nationwide Inpatient Sample databases from 2007 to 2011, annual estimates of IH-related hospital discharges, charges, and serious adverse events were identified. Significance in observed trends was tested using regression modeling. From 2007 to 2011, there were 583,054 hospital discharges associated with a diagnosis of IH. 81.1 per cent had a concurrent procedure for IH repair. The average discharge included a female patient (63.2%), 59.8 years of age, with either Medicare (45.3%) or Private insurance (38.3%) as the anticipated primary payer. Comparing 2007 to 2011, significant increases in IH discharges (12%; 2007 = 109,702 vs 2011 = 123,034, P = 0.009) and IH repairs (10%; 2007 = 90,588 vs 2011 = 99,622, P < 0.001) were observed. This was accompanied by a 37 per cent increase in hospital charges (2007 = $44,587 vs 2011 = $60,968, P < 0.001), resulting in a total healthcare bill of $7.3 billion in 2011. Significant trends toward greater patient age (2007 = 59.7 years vs 2011 = 60.2 years, P < 0.001), higher comorbidity index (2007 = 3.0 vs 2011 = 3.5, P < 0.001), and increased frequency of serious adverse events (2007 = 13.5% vs 2011 = 17.7%, P < 0.001) were noted. Further work is needed to identify interventions to mitigate the risk of IH development.

Trends and presentation patterns of acute rheumatic fever hospitalisations in the United States

2019 ◽  
Vol 29 (11) ◽  
pp. 1387-1390
Author(s):  
Tyler Bradley-Hewitt ◽  
Chris T. Longenecker ◽  
Vuyisile Nkomo ◽  
Whitney Osborne ◽  
Craig Sable ◽  
...  
Keyword(s):  
United States ◽  
Length Of Stay ◽  
Rheumatic Fever ◽  
Private Insurance ◽  
Case Fatality ◽  
The United States ◽  
Hospital Charges ◽  
The South ◽  
Asian Pacific Islanders ◽  
Asian Pacific

AbstractObjective:Rheumatic fever, an immune sequela of untreated streptococcal infections, is an important contributor to global cardiovascular disease. The goal of this study was to describe trends, characteristics, and cost burden of children discharged from hospitals with a diagnosis of RF from 2000 to 2012 within the United States.Methods:Using the Kids’ Inpatient Database, we examined characteristics of children discharged from hospitals with the diagnosis of rheumatic fever over time including: overall hospitalisation rates, age, gender, race/ethnicity, regional differences, payer type, length of stay, and charges.Results:The estimated national cumulative incidence of rheumatic fever in the United States between 2000 and 2012 was 0.61 cases per 100,000 children. The median age was 10 years, with hospitalisations significantly more common among children aged 6–11 years. Rheumatic fever hospitalisations among Asian/Pacific Islanders were significantly over-represented. The proportion of rheumatic fever hospitalisations was greater in the Northeast and less in the South, although the highest number of rheumatic fever admissions occurred in the South. Expected payer type was more likely to be private insurance, and the median total hospital charges (adjusted for inflation to 2012 dollars) were $16,000 (interquartile range: $8900–31,200). Median length of stay was 3 days, and the case fatality ratio for RF in the United States was 0.4%.Conclusions:Rheumatic fever persists in the United States with an overall downwards trend between 2003 and 2012. Rheumatic fever admissions varied considerably based on age group, region, and origin.

Socioeconomic and geographic disparities in immediate reconstruction after mastectomy in the United States.

2012 ◽  
Vol 30 (27_suppl) ◽  
pp. 63-63 ◽  
Author(s):  
Barbara A. Wexelman ◽  
Xiangji Ma ◽  
Alison Estabrook ◽  
Ayemoethu Ma
Keyword(s):  
Breast Implant ◽  
Private Insurance ◽  
Tissue Expander ◽  
Breast Cancer Diagnosis ◽  
The United States ◽  
Hospital Charges ◽  
National Study ◽  
Flap Reconstruction ◽  
Immediate Reconstruction ◽  
Geographic Disparities

63 Background: Disparities are found in breast cancer diagnosis, treatment, and outcomes. We seek to determine if socioeconomic and geographic disparities exist nationally in immediate reconstruction type after mastectomy. Methods: This retrospective study compares socioeconomic and geographic features for 14,986 women who underwent mastectomy in 2008 using the Nationwide Inpatient Sample (NIS), an all-payer stratified statistical sample of all US hospital discharges. Statistical analysis was performed to understand variations between three groups: patients without reconstruction (NR), patients who underwent breast implant/ tissue expander reconstruction (TE), and patients with advanced reconstruction techniques such as free or pedicled flaps (FLAP). Results: The majority of women (63%) had no reconstruction (NR), while 25.3% had TE and 12% underwent FLAP. Compared to patients with NR, women with TE or FLAP were younger (64.9 years vs. 51.3 & 51.1 years, p<0.001), had fewer chronic conditions (3.85 NR vs. 2.60 TE & 2.54 FLAP conditions, p<0.001), and higher mean hospital charges ($22,300 NR vs. $42,850 TE and $48.680 FLAP, p<0.001). The length of stay was longest for FLAP patients (3.62 days) compared to the NR group (2.02 days) and the TE group (1.90 days), p<0.001. Caucasians were disproportionately more likely to undergo both TE and FLAP compared to Black and Hispanic women. Patients with FLAP reconstruction were more likely to have private insurance (81.1%), than TE (80.1%) and NR (35.2%) while women without reconstruction were more likely to have Medicare and Medicaid insurance. Compared to NR, those undergoing reconstructions were more likely to live in zip codes with higher average incomes and more likely to live in or near a major city (>1 million people). The states with the highest rates of FLAP reconstruction are New Hampshire (52.9%), Kansas (22.6%), New York (20.9%), and New Jersey (20.0%). Conclusions: This is the first national study analyzing patients of all insurance types and regions of the US to show statistically significant disparities in the type of immediate reconstruction after mastectomy based on age, race, insurance type, and geographic location.

Facility and state-level factors associated with telemental health (TMH) adoption among mental health facilities in the United States

2019 ◽  
pp. 1357633X1986890 ◽  
Author(s):  
Xiaohui Zhao ◽  
Kim E Innes ◽  
Sandipan Bhattacharjee ◽  
Nilanjana Dwibedi ◽  
Traci M LeMasters ◽  
...  
Keyword(s):  
Mental Health ◽  
Substance Abuse ◽  
Mental Healthcare ◽  
Health Resources ◽  
State Level ◽  
The United States ◽  
Cross Sectional Study ◽  
Telemental Health ◽  
Cross Sectional ◽  
Substance Abuse Disorders

Introduction Telemental health (TMH) is a promising approach to increase access to mental healthcare. This study examined the TMH adoption rates and associations with facility- and state-level factors among US mental health (MH) facilities. Methods This retrospective, cross-sectional study used linked data for 2016 from the National Mental Health Services Survey ( N = 11,833), Area Health Resources File, and national reports for broadband access and telehealth policies. The associations of facility and state-level characteristics with TMH adoption were examined with multi-level logistic regressions. Results Overall, 25.9% had used TMH. Having veteran affiliation [Adjusted Odds Ratio (AOR) = 18.53, 95% Confidence Interval (95%CI): 10.66–32.21] and greater Information Technology (IT) capacity [AOR(95%CI): 2.89(2.10–3.98)] were the strongest correlates of TMH adoption. Other facility characteristics associated with higher likelihood of TMH adoption were: public ownership, high patient volumes, having comprehensive MH treatments or Quality Improvement practices, having private or non-Medicaid public payers, and treating elderly patients (AORs: 1.16–2.41). TMH adoption was less likely among facilities treating more African Americans or patients with substance abuse disorders. TMH adoption varied substantially across states, with adoption more likely in states issuing special telehealth licences and those with more rural counties. Discussion One in four MH facilities adopted TMH in 2016. TMH adoption varied by multiple facility- and state-level factors. Our findings suggest that: legal/regulatory burden and lower facility IT capacity may discourage TMH adoption; significant racial disparities exist in TMH adoption; and there is a need to increase TMH use for substance abuse disorders.

scholarly journals Variability in the Method of Gastrostomy Placement in Children

Children ◽  
2020 ◽  
Vol 7 (6) ◽  
pp. 53
Author(s):  
Jose H. Salazar ◽  
Charles Spanbauer ◽  
Manu R. Sood ◽  
John C. Densmore ◽  
Kyle J. Van Arendonk
Keyword(s):  
Private Insurance ◽  
Random Effect ◽  
The United States ◽  
Mixed Effects ◽  
Tube Placement ◽  
Endoscopic Gastrostomy ◽  
Random Intercept ◽  
Gastrostomy Tube Placement ◽  
Surgical Gastrostomy ◽  
Inpatient Database

Although gastrostomy placement is one of the most common procedures performed in children, the optimal technique remains unclear. The purpose of this study was to evaluate variability in the method of gastrostomy tube placement in children in the United States. Patients <18 years old undergoing percutaneous endoscopic gastrostomy (PEG) or surgical gastrostomy (SG) (including open or laparoscopic) from 1997 to 2012 were identified using the Kids’ Inpatient Database. Method of gastrostomy placement was evaluated using a multivariable mixed-effects logistic regression model with a random intercept term and a patient-age random-effect term. A total of 67,811 gastrostomy placements were performed during the study period. PEG was used in 36.6% of entries overall and was generally consistent over time. PEG placement was less commonly performed in infants (adjusted odds ratio [aOR] 0.30, 95%CI 0.26–0.33), children at urban hospitals (aOR: 0.38, 95%CI 0.18–0.82), and children cared for at children’s hospitals (aOR 0.57, 95%CI 0.48–0.69) and was more commonly performed in children with private insurance (aOR 1.17, 95%CI 1.09–1.25). Dramatic variability in PEG use was identified between centers, ranging from 0% to 100%. The random intercept and slope terms significantly improved the model, confirming significant center-level variability and increased variability among patients <1 year old. These findings emphasize the need to further evaluate the safest method of gastrostomy placement in children, in particular among the youngest patients in whom practice varies the most.

Herpes Zoster–Related Hospitalizations and Expenditures Before and After Introduction of the Varicella Vaccine in the United States

2008 ◽  
Vol 29 (12) ◽  
pp. 1157-1163 ◽  
Author(s):  
Mitesh S. Patel ◽  
Achamyeleh Gebremariam ◽  
Matthew M. Davis
Keyword(s):  
United States ◽  
Herpes Zoster ◽  
Nationwide Inpatient Sample ◽  
The United States ◽  
Hospital Charges ◽  
Varicella Vaccination ◽  
Severe Illness ◽  
Zoster Vaccine ◽  
Hospital Discharges ◽  
Total Charges

Objective.With childhood varicella vaccination in the United States have come concerns that the incidence of herpes zoster may increase, because of diminishing natural exposure to varicella and consequent reactivation of latent varicella zoster virus. We wanted to estimate the rate of herpes zoster-related hospitalizations and the associated hospital charges before and during the promotion of varicella vaccination in the United States.Design.A retrospective study of patients from the Nationwide Inpatient Sample for the years 1993–2004 who were hospitalized due to herpes zoster infection.Methods.We searched for diagnoses of herpes zoster (using the International Classification of Diseases, Ninth Revison, Clinical Modification codes starting with 053) in all 15 diagnostic-code fields included for hospital discharges in the Nationwide Inpatient Sample during 1993–2004. We designed our analysis to examine the rates of severe illness due to herpes zoster that resulted in hospitalization, as measured by the rates of herpes zoster-related hospital discharges (HZHDs). The annual population-adjusted rate of HZHDs (per 10,000 US population) and the annual inflation-adjusted total charges for HZHDs were the primary outcomes. Secondary outcomes included mean charges for HZHDs and the distribution of total charges for HZHDs by expected primary payer. Varicella-related hospital discharges (VRHDs) were identified by use of similar diagnosis-based methods, which were described in our previous study.Results.Population-adjusted rates of HZHDs did not change significantiy from the prevaccination years (1993–1995) through the initial 5 years of the varicella vaccination period. Beginning in 2001, however, the rate of HZHDs overall began to increase, and by 2004 the overall rate was 2.5 HZHDs (95% confidence interval, 2.38–2.62) per 10,000 US population, significantly higher than any of the rates calculated during the years prior to 2002. Hospital charges for HZHDs overall increased by more than $700 million annually by 2004; in particular, we found that the herpes zoster vaccine–eligible population (ie, persons aged 60 years or older) accounted for 74% of the total annual hospital charges in 2004. The annual rate of VRHDs and the associated hospital charges decreased significantly from 1993 through 2004, but the decrease in hospitalizations and charges for VRHDs was less than the increase in hospitalizations and charges for HZHDs.Conclusions.AS the rates of VRHDs and the associated charges have decreased, there has been a significant increase in HZHDs and associated charges, disproportionately among older adults. Herpes zoster vaccine may mitigate these trends for HZHDs.

scholarly journals Trends in Substance Abuse Disorders Among Patients Hospitalized for Heart Failure in the United States

2021 ◽  
Author(s):  
Muhammad Shahzeb Khan ◽  
Jayakumar Sreenivasan ◽  
Izza Shahid ◽  
Jasjit Bhinder ◽  
Marat Fudim ◽  
...  
Keyword(s):  
United States ◽  
Heart Failure ◽  
Substance Abuse ◽  
The United States ◽  
Substance Abuse Disorders

scholarly journals Affective and Substance Abuse Disorders Following Abortion by Pregnancy Intention in the United States: A Longitudinal Cohort Study

Medicina ◽  
2019 ◽  
Vol 55 (11) ◽  
pp. 741 ◽  
Author(s):  
Donald Paul Sullins
Keyword(s):  
Mental Health ◽  
United States ◽  
Substance Abuse ◽  
Relative Risk ◽  
The United States ◽  
Pregnancy Intention ◽  
Psychological Outcomes ◽  
Policy Implications ◽  
Unwanted Pregnancies ◽  
Substance Abuse Disorders

Background and Objectives: Psychological outcomes following termination of wanted pregnancies have not previously been studied. Does excluding such abortions affect estimates of psychological distress following abortion? To address this question this study examines long-term psychological outcomes by pregnancy intention (wanted or unwanted) following induced abortion relative to childbirth in the United States. Materials and Methods: Panel data on a nationally-representative cohort of 3935 ever-pregnant women assessed at mean age of 15, 22, and 28 years were examined from the National Longitudinal Survey of Adolescent to Adult Health (Add Health). Relative risk (RR) and incident rate ratios (IRR) for time-dynamic mental health outcomes, conditioned by pregnancy intention and abortion exposure, were estimated from population-averaged longitudinal logistic and Poisson regression models, with extensive adjustment for sociodemographic differences, pregnancy and mental health history, and other confounding factors. Outcomes were assessed using the Diagnostic and Statistical Manual, Version 4, American Psychiatric Association (DSM-IV) diagnostic criteria or another validated index for suicidal ideation, depression, and anxiety (affective problems); drug abuse, opioid abuse, alcohol abuse, and cannabis abuse (substance abuse problems); and summary total disorders. Results: Women who terminated one or more wanted pregnancies experienced a 43% higher risk of affective problems (RR 1.69, 95% CI 1.3–2.2) relative to childbirth, compared to women terminating only unwanted pregnancies (RR 1.18, 95% CI 1.0–1.4). Risks of depression (RR 2.22, 95% CI 1.3–3.8) and suicidality (RR 3.44 95% CI 1.5–7.7) were especially elevated with wanted pregnancy abortion. Relative risk of substance abuse disorders with any abortion was high, at about 2.0, but unaffected by pregnancy intention. Excluding wanted pregnancies artifactually reduced estimates of affective disorders by 72% from unity, substance abuse disorders by 11% from unity, and total disorders by 21% from unity. Conclusions: Excluding wanted pregnancies moderately understates overall risk and strongly understates affective risk of mental health difficulties for women following abortion. Compared to corresponding births, abortions of wanted pregnancies are associated with a greater risk of negative psychological affect, particularly depression and suicide ideation, but not greater risk of substance abuse, than are abortions of unwanted pregnancies. Clinical, research, and policy implications are discussed briefly.

Substance Abuse in Older Psychiatric Inpatients

2017 ◽  
Vol 63 (2) ◽  
pp. 115-121 ◽  
Author(s):  
Tilman Wetterling ◽  
Klaus Junghanns
Keyword(s):  
Substance Abuse ◽  
Substance Abusers ◽  
Psychiatric Inpatient ◽  
Psychiatric Inpatients ◽  
Severe Withdrawal ◽  
Psychiatric Inpatient Treatment ◽  
Clinical Diagnoses ◽  
Multiple Substance ◽  
Icd 10 ◽  
Substance Abuse Disorders

Abstract. Aim: This study investigates the characteristics of older patients with substance abuse disorders admitted to a psychiatric department serving about 250.000 inhabitants. Methods: The clinical diagnoses were made according to ICD-10. The data of the patients with substance abuse were compared to a matched sample of psychiatric inpatients without substance abuse as well as to a group of former substance abusers with long-term abstinence. Results: 19.3 % of the 941 patients aged > 65 years showed current substance abuse, 9.4 % consumed alcohol, 7.9 % took benzodiazepines or z-drugs (zolpidem and zopiclone), and 7.0 % smoked tobacco. Multiple substance abuse was rather common (30.8 %). About 85 % of the substance abusers had psychiatric comorbidity, and about 30 % showed severe withdrawal symptoms. As with the rest of the patients, somatic multimorbidity was present in about 70 % of the substance abusers. Remarkable was the lower rate of dementia in current substance abusers. Conclusion: These results underscore that substance abuse is still a challenge in the psychiatric inpatient treatment of older people.

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