scholarly journals Impact of COVID-19 Lockdowns on Sexual Health Care Utilization and STD Reporting, Maricopa County

2021 ◽  
Vol 58 ◽  
pp. 004695802110555
Author(s):  
Jonathan Bell ◽  
Stefano Canepa ◽  
Stephanie Kreis ◽  
Melanie M. Taylor
Keyword(s):  
Health Care ◽  
Sexual Health ◽  
Health Care Utilization ◽  
Care Utilization ◽  
Clinic Attendance ◽  
Maricopa County ◽  
Sexual Health Care ◽  
Significant Difference ◽  
Parametric Testing ◽  
At Home

The Maricopa County Department of Public Health (MCDPH) Sexually Transmitted Disease (STD) Clinic remained operational during a 6-week statewide Coronavirus Disease 2019 (COVID-19) Stay-at-Home Order. The present study sought to evaluate the effect of the Stay-at-Home Order on countywide STD reporting and uptake of sexual health services. We compared countywide daily median STD reporting and MCDPH STD clinic attendance across 3 timeframes; (1) Pre-Lockdown (01/01/2020–03/30/2020); (2) Lockdown (03/31/2020–05/15/2020); and (3) Post-Lockdown (05/16/2020–12/31/2020). STD reporting was characterized as incident chlamydia, gonorrhea, and primary and secondary syphilis. Clinic attendance was characterized as clients visiting through express testing or provider visits. Differences in STD reporting and clinic attendance were evaluated using non-parametric testing. Comparing Pre-Lockdown to Lockdown, we observed significant declines in the daily median chlamydia case reporting (−22%) and clinic express testing attendance (−29%). Comparing Lockdown to Post-Lockdown, we observed significant increases in daily median chlamydia and gonorrhea case reporting (+20%, +15%; respectively) and clinic express testing and provider visits (+42%, +20%; respectively). No significant difference was observed in countywide syphilis reporting across the 3 timeframes. Declines in STD reporting were observed countywide during the lockdown and were concurrent with declines in attendance observed at the MCDPH STD Clinic. Maintenance of clinic operations during the lockdown allowed for continued uptake of STD testing, diagnosis, treatment, and partner services. This study of sexual health care utilization at the public STD clinic in Maricopa County, Arizona, found reduced testing and provider visits contributed to lower countywide STD reporting during the Arizona COVID-19 Stay-at-Home Order.

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>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

Real Men Do…Real Men Don’t: Young Latino and African American Men’s Discourses Regarding Sexual Health Care Utilization

2009 ◽  
Vol 4 (3) ◽  
pp. 218-230 ◽  
Author(s):  
Debra Kalmuss ◽  
Karen Austrian
Keyword(s):  
Health Care ◽  
African American ◽  
Sexual Health ◽  
African American Men ◽  
The United States ◽  
Care Utilization ◽  
Care Seeking ◽  
Sexual Health Care ◽  
New Directions ◽  
The Relationship

There is growing recognition that men as well as women need sexual health care (SHC) services. Despite this, male friendly sexual health services are not readily available in the United States, and men are underutilizing the services that are available. This situation needs to be rectified to improve sexual health outcomes for men and women. In this study we conducted 10 focus groups with young adult Latino and African American men to examine their perceptions of the factors influencing SHC utilization among the men they know, with an emphasis on how notions of what it means to be a man affects health care seeking. The findings both amplify and complicate the relationship between masculinity and SHC seeking. They suggest new directions for public health efforts to enhance men’s SHC utilization.

98 Parental perspective on changes in health care following integration to a complex care program

2021 ◽  
Vol 26 (Supplement_1) ◽  
pp. e71-e71
Author(s):  
Louis-Philippe Thibault ◽  
Maria Marano ◽  
Lydia Saad ◽  
Nathalie Gaucher ◽  
Karine Couture ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Utilization ◽  
Driving Forces ◽  
Care Program ◽  
Care Utilization ◽  
Complex Care ◽  
Healthcare Resources ◽  
Care Experience ◽  
Ed Visits ◽  
At Home

Abstract Primary Subject area Complex Care Background Quantitative studies have found that integration into a complex care program (CCP) leads to decreased number of visits to the emergency department (ED) and hospitalization days for children with medical complexity (CMC). However, little is known about CMC families’ experiences regarding their healthcare resource utilization patterns following their child’s integration in the CCP. Objectives To analyze parental perspectives regarding changes in healthcare resources utilization following CCP admission. Design/Methods This study was conducted in our tertiary care pediatric university hospital, between December 2019 and January 2021 using individual semi-structured interviews. To assess the effect of CCP admission on healthcare resources utilization, only patients with at least 6 months of chronic disease before inclusion were eligible (32 families). The interview guide was co-constructed by our CCP team of nurses, doctors, social worker and parents of CMC. Participation rate was over one third (12/32) throughout, for which a satisfactory level of data saturation was obtained, as core themes specific to the research question were repeatedly identified. Verbatims were analyzed with NVivo. Descriptive thematic analysis was performed by coding themes emerging from the data. Results Sixteen parents from twelve families were interviewed (11 mothers, 5 fathers, including 4 couples). Most parents had experienced a decrease in ED visits with improvement in their perceived satisfaction regarding the provided healthcare services following CCP admission. Visits to the CCP pediatrician led to appreciated, continuous and tailored care. In comparison, the constant change of pediatricians in the ED and during hospitalization on the ward seemed to complicate their care experience. Also, the support from pivot nurses and social workers for daily health issues, drug prescription and paperwork was perceived as a relief. This directly favorably influenced care experience. Profound knowledge of patients’ health conditions and families’ personal challenges and strengths, led to personalized care and trust that greatly improved parents’ confidence in care and empowered families. Individualized advice by the CCP team leading to prompt treatment and preventive measures started early at home were identified by parents as the main driving forces leading to the observed decrease in ED visits. When hospitalized, confidence in the quality of care provided by parents at home with close follow-up by CCP were identified as the main driving forces leading to the quicker discharge. Conclusion Changes in health care utilization following admission to CCP was associated with an improved care experience. Parents identified individualized care and close follow-ups as key factors leading to decreased health care utilization.

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.

Evaluation of Oncology Hospital at Home: Unplanned Health Care Utilization and Costs in the Huntsman at Home Real-World Trial

2021 ◽  
pp. JCO.20.03609
Author(s):  
Kathi Mooney ◽  
Karen Titchener ◽  
Benjamin Haaland ◽  
Lorinda A. Coombs ◽  
Brock O'Neil ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Utilization ◽  
Health Care Costs ◽  
Care Utilization ◽  
Patients With Cancer ◽  
Hospital Stays ◽  
Hospital At Home ◽  
Unplanned Hospitalizations ◽  
Care Costs ◽  
At Home

PURPOSE Patients with cancer experience high rates of morbidity and unplanned health care utilization and may benefit from new models of care. We evaluated an adult oncology hospital at home program's rate of unplanned hospitalizations and health care costs and secondarily, emergency department (ED) use, length of hospital stays, and intensive care unit (ICU) admissions during the 30 days after enrollment. METHODS We conducted a prospective, nonrandomized, real-world cohort comparison of 367 hospitalized patients with cancer—169 patients consecutively admitted after hospital discharge to Huntsman at Home (HH), a hospital-at-home program, compared with 198 usual care patients concurrently identified at hospital discharge. All patients met clinical criteria for HH admission, but those in usual care lived outside the HH service area. Primary outcomes were the number of unplanned hospitalizations and costs during the 30 days after enrollment. Secondary outcomes included length of hospital stays, ICU admissions, and ED visits during the 30 days after enrollment. RESULTS Groups were comparable except that more women received HH care. In propensity-weighted analyses, the odds of unplanned hospitalizations was reduced in the HH group by 55% (odds ratio, 0.45, 95% CI, 0.29 to 0.70; P < .001) and health care costs were 47% lower (mean cost ratio, 0.53; 95% CI, 0.39 to 0.72; P < .001) over the 30-day period. Secondary outcomes also favored HH. Total hospital stay days were reduced by 1.1 days ( P = .004) and ED visits were reduced by 45% (odds ratio, 0.55; 95% CI, 0.33 to 0.92; P = .022). There was no evidence of a difference in ICU admissions ( P = .972). CONCLUSION This oncology hospital at home program shows initial promise as a model for oncology care that may lower unplanned health care utilization and health care costs.

scholarly journals Evaluation of Longitudinal Pain Study in Sickle Cell Disease (ELIPSIS) by Electronic Patient-Reported Outcomes, Actigraphy, and Biomarkers

Blood ◽  
2020 ◽  
Author(s):  
Debra Pittman ◽  
Patrick C Hines ◽  
David Roger Beidler ◽  
Denis Rybin ◽  
Andrew L Frelinger ◽  
...  
Keyword(s):  
Health Care ◽  
Clinical Trials ◽  
Sickle Cell Disease ◽  
Health Care Utilization ◽  
Sickle Cell ◽  
Patient Reported Outcomes ◽  
Care Utilization ◽  
Cell Disease ◽  
Patient Reported ◽  
At Home

Clinical trials in sickle cell disease (SCD) often focus on health care utilization for painful vaso-occlusive crises (VOC). However, no objective, quantifiable pain biomarkers exist, pain is not specific to VOCs, health care utilization varies between patients, unreported at-home VOCs likely contribute to long-term outcomes, and patient-reported outcomes are seldom considered. This non-interventional, longitudinal, 6-month study aimed to develop tools to identify VOCs in SCD patients with or without health care utilization. Participants wore an actigraph device, tracking sleep and activity. SCD patients used an electronic patient-reported outcome (ePRO) tool collecting pain, medication, fatigue, and daily function. Patients self-reported when they experienced VOC pain (VOC day). Biomarkers were collected every 3 weeks (non-VOC). Self-reported VOCs triggered at-home or in-hospital blood collection. The study enrolled 37 participants with SCD; 35 completed the study. Participants reported 114 VOC events and 346 VOC days, of which 62.3% and 78.3%, respectively, were self-treated at home. The ePRO and actigraphy captured endpoints of pain, functionality, fatigue, activity, and sleep; each was significantly altered on VOC days compared with non-VOC days. Biomarkers collected at home or in hospital on VOC days were significantly altered compared with non-VOC baseline values, including leukocyte-platelet aggregates, microfluidic-based blood cell adhesion, interleukin-6, C-reactive protein, interleukin-10, tumor necrosis factor-alpha, and thrombin-antithrombin. ELIPSIS: demonstrates the feasibility of accurately monitoring out-of-hospital pain, using patient-reported VOC days as potential endpoints for clinical trials in SCD; showed changes in biomarkers and activity measured by actigraphy that may enable improved identification and assessment of VOCs.

scholarly journals Comparative Study of Early Health Care Use after Forearm Corrective Osteotomy

2019 ◽  
Vol 08 (02) ◽  
pp. 139-142
Author(s):  
Jason Shrouder-Henry ◽  
Christine Novak ◽  
Timothy Jackson ◽  
Heather Baltzer
Keyword(s):  
Health Care ◽  
Length Of Stay ◽  
Health Care Utilization ◽  
Corrective Osteotomy ◽  
Hospital Length Of Stay ◽  
Care Utilization ◽  
Long Bones ◽  
Improvement Program ◽  
Significant Difference ◽  
The Impact

Background Bone reconstruction is frequently required for corrective osteotomy of the forearm long bones. Studies have evaluated long term outcomes but not the impact of these procedures on early postoperative complications and health care utilization. Questions/Purposes This study evaluated the early postoperative health care utilization following corrective osteotomy of the radius and/or ulna. Patients and Methods The American College of Surgeons' National Surgical Quality Improvement Program (NSQIP) was the primary data source to perform a comparative statistical analysis of the bone autograft and nonautograft (allograft, graft substitute, or no graft) procedures. We performed a review of the NSQIP database (2005–2013) to evaluate patients who underwent a corrective osteotomy of the radius and/or ulna. Results There were 362 cases; autograft (n = 117) and nonautograft (n = 245). There were no significant differences with demographics or comorbidities. The majority of cases were outpatient surgeries and there were no significant differences in anesthesia time, operative time, or hospital length of stay. Overall, the average length of stay was 0.6 days, readmission rate was 2%, and the total complication rate was 1% and there was no statistically significant difference between reconstruction groups. Harvesting of autograft was not associated with the overall 30-day complications and specific markers of health care utilization. Conclusions Our results are derived from the heterogeneous hospital setting of NSQIP contributing centers. The health care utilization and 30-day complications are low following corrective osteotomy of forearm long bones and autograft harvest did not influence the health care utilization. Level of Evidence Therapeutic Level II.

Improving patient outcomes with oncology hospital at home: A program model.

2020 ◽  
Vol 38 (29_suppl) ◽  
pp. 5-5
Author(s):  
Karen Alexandra Titchener ◽  
Lorinda A Coombs ◽  
Shannon Shepherd ◽  
John Harris Ward ◽  
Karen Ameloot ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Utilization ◽  
Nurse Practitioners ◽  
The United States ◽  
Home Health ◽  
Electrolyte Imbalance ◽  
Care Utilization ◽  
Patient Profile ◽  
Hospital At Home ◽  
At Home

5 Background: Hospital at Home provides acute hospital level care to patients in their homes, diminishing the need for inpatient care or emergency department (ED) use. It has been evaluated for a variety of acute and chronic conditions but not in adult oncology. Results from program evaluations have demonstrated equivalent or improved outcomes with lower health care utilization and costs and high patient satisfaction when compared to usual care. The first evaluation of an oncology Hospital at Home program in the United States, Huntsman at Home (HH) was launched in 2018 to provide acute level care after hospitalization and address emergent symptoms that arise in the home between clinic visits. We describe the structure and patient profile of HH over the first 15 months of service. Methods: We compiled data for the 169 cancer patients admitted to HH between 8/2018 and 10/2019. We examined patient characteristics, the reason for referral, team structure, services provided and provider visit pattern. Results: The 169 patients referred to HH were predominately female (62%), white (83%), with metastatic disease (79%) and an average age 62 years. The most common diagnoses were GI, lung, GU and GYN cancer. All required acute level medical care and were referred by their oncology or inpatient provider after hospitalization. The HH multidisciplinary team was led by 9 nurse practitioners (NP) partnering with palliative care hospitalists, and the patient’s oncology team. Registered nurses (RN) and other home health personnel were provided by a community-based home health agency. The most common reasons for referral were acute pain, dehydration and electrolyte imbalance, infection, unstable symptoms, failure to thrive and post-surgical needs. The most common interventions provided by HH were: assessment and management of symptoms, medication monitoring and titration, monitoring lab chemistries, intravenous management and administration of medications and fluids, and wound, drain and line assessment and care. Home visits varied based on need; generally, there were 3 NP visits with 5 RN visits in the first week. Health care utilization and cost outcomes were recently reported at the ASCO Virtual Scientific meeting and demonstrated HH patients had fewer hospitalizations, shorter length of stay, decreased ED use and lower costs than the comparison group. Conclusions: HH has proven to be an effective and efficient way to successfully manage a variety of oncology acute care needs in patients’ homes averting further hospitalization or ED use. Hospital at home shows promise as an oncology care delivery model.

scholarly journals Health Care Utilization Behaviors Predict Disengagement From HIV Care: A Latent Class Analysis

2018 ◽  
Vol 5 (5) ◽  
Author(s):  
Nwora Lance Okeke ◽  
Meredith E Clement ◽  
Mehri S McKellar ◽  
Jason E Stout
Keyword(s):  
Health Care ◽  
Health Care Utilization ◽  
Viral Suppression ◽  
Latent Class ◽  
Hiv Care ◽  
Care Utilization ◽  
Clinic Attendance ◽  
Persons Living With Hiv ◽  
Definition Of ◽  
Health Care Engagement

Abstract Background The traditional definition of engagement in HIV care in terms of only clinic attendance and viral suppression provides a limited understanding of how persons living with HIV (PLWH) interact with the health care system. Methods We conducted a retrospective analysis of patients with ≥1 HIV clinic visits at the Duke Adult Infectious Diseases Clinic between 2008 and 2013. Health care utilization was characterized by 4 indicators: clinic attendance in each half of the year (yes/no), number of emergency department (ED) visits/year (0, 1, or 2+), inpatient admissions/year (0, 1, 2+), and viral suppression (never, intermittent, always). Health care engagement patterns were modeled using latent class/latent transition analysis. Results.  A total of 2288 patients (median age, 46.4 years; 59% black, 71% male) were included in the analysis. Three care engagement classes were derived from the latent class model: “adherent” “nonadherent,” and “sick.” Patients age ≤40 years were more likely to be in the nonadherent class (odds ratio, 2.64; 95% confidence interval, 1.38–5.04) than other cohort members. Whites and males were more likely to transition from nonadherent to adherent the following year. Nonadherent patients were significantly more likely to disengage from care the subsequent year than adherent patients (23.6 vs 0.2%, P &lt; .001). Conclusions A broader definition of health care engagement revealed distinct and dynamic patterns among PLWH that would have been hidden had only previous HIV clinic attendance had been considered. These patterns may be useful for designing engagement-targeted interventions.

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