scholarly journals A generalized semiparametric mixed model for analysis of multivariate health care utilization data

2015 ◽  
Vol 26 (6) ◽  
pp. 2909-2918 ◽  
Author(s):  
Zhuokai Li ◽  
Hai Liu ◽  
Wanzhu Tu
Keyword(s):  
Health Care ◽  
Health Care Utilization ◽  
Mixed Model ◽  
Hospital Admissions ◽  
Likelihood Method ◽  
Care Utilization ◽  
Services Research ◽  
Modeling Framework ◽  
Smooth Functions ◽  
Ed Visits

Health care utilization is an outcome of interest in health services research. Two frequently studied forms of utilization are counts of emergency department (ED) visits and hospital admissions. These counts collectively convey a sense of disease exacerbation and cost escalation. Different types of event counts from the same patient form a vector of correlated outcomes. Traditional analysis typically model such outcomes one at a time, ignoring the natural correlations between different events, and thus failing to provide a full picture of patient care utilization. In this research, we propose a multivariate semiparametric modeling framework for the analysis of multiple health care events following the exponential family of distributions in a longitudinal setting. Bivariate nonparametric functions are incorporated to assess the concurrent nonlinear influences of independent variables as well as their interaction effects on the outcomes. The smooth functions are estimated using the thin plate regression splines. A maximum penalized likelihood method is used for parameter estimation. The performance of the proposed method was evaluated through simulation studies. To illustrate the method, we analyzed data from a clinical trial in which ED visits and hospital admissions were considered as bivariate outcomes.

scholarly journals 3247 Implementing an Interdisciplinary, Student-Run Consult Service for Homeless Patients: The Critical Role of Community Partnerships

2019 ◽  
Vol 3 (s1) ◽  
pp. 91-91
Author(s):  
Frances Loretta Gill
Keyword(s):  
Health Care ◽  
Health Care Utilization ◽  
Hospital Admissions ◽  
Community Partnerships ◽  
Care Utilization ◽  
Consult Service ◽  
Utilization Patterns ◽  
Ed Visits ◽  
Hospital Days ◽  
The Impact

OBJECTIVES/SPECIFIC AIMS: Elucidate the unique challenges associated with hospital discharge planning for patients experiencing homelessness. Assess the impact of robust community partnerships and strong referral pathways on participating patients’ health care utilization patterns in an interdisciplinary, student-run hospital consult service for patients experiencing homelessness. Identify factors (both patient-level and intervention-level) that are associated with successful warm hand-offs to outside social agencies at discharge. METHODS/STUDY POPULATION: To assess the impact of participation in HHL on patients’ health care utilization, we conducted a medical records review using the hospital’s electronic medical record system comparing patients’ health care utilization patterns during the nine months pre- and post- HHL intervention. Utilization metrics included number of ED visits and hospital admissions, number of hospital days, 30-day hospital readmissions, total hospital costs, and follow-up appointment attendance rates, as well as percentage of warm hand-offs to community-based organizations upon discharge. Additionally, we collected data regarding patient demographics, duration of homelessness, and characteristics of homelessness (primarily sheltered versus primarily unsheltered, street homeless versus couch surfing, etc) and intervention outcome data (i.e. percentage of warm hand-offs). This study was reviewed and approved by the Tulane University Institutional Review Board and the University Medical Center Research Review Committee. RESULTS/ANTICIPATED RESULTS: For the first 41 patients who have been enrolled in HHL, participation in HHL is associated with a statistically significant decrease in hospital admissions by 49.4% (p < 0.01) and hospital days by 47.7% (p < 0.01). However, the intervention is associated with a slight, although not statistically significant, increase in emergency department visits. Additionally, we have successfully accomplished warm hand-offs at discharge for 71% percent of these patients. Over the next year, many more patients will be enrolled in HHL, which will permit a more finely grained assessment to determine which aspects of the HHL intervention are most successful in facilitating warm hand-offs and decreased health care utilization amongst patients experiencing homelessness. DISCUSSION/SIGNIFICANCE OF IMPACT: Providing care to patients experiencing homelessness involves working within complex social problems that cannot be adequately addressed in a hospital setting. This is best accomplished with an interdisciplinary team that extends the care continuum beyond hospital walls. The HHL program coordinators believe that ED visits amongst HHL patients and percentage of warm hand-offs are closely related outcomes. If we are able to facilitate a higher percentage of warm hand-offs to supportive social service agencies, we may be able to decrease patient reliance on the emergency department as a source of health care, meals, and warmth. Identifying the factors associated with successful warm hand-offs upon discharge from the hospital may assist us in building on the HHL program’s initial successes to further decrease health care utilization while offering increased interdisciplinary educational opportunities for medical students.

Resource Use and Expenditures Among Adult Sickle Cell Patients with and without Depression

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 1534-1534 ◽  
Author(s):  
Shital Kamble ◽  
Shelby D Reed ◽  
Charlene Flahiff ◽  
Soheir Adam ◽  
Laura M DeCastro
Keyword(s):  
Health Care ◽  
Health Care Utilization ◽  
Resource Use ◽  
Hospital Admissions ◽  
Study Entry ◽  
Care Utilization ◽  
Outpatient Visits ◽  
Ed Visits ◽  
Time Periods ◽  
One Year

Abstract Abstract 1534 Objective: Depression is commonly associated with less favorable medical outcomes among patients with sickle cell disease (SCD), yet little is known about its associated impact on medical resource use and expenditures. In this study, we descriptively compared inpatient stays, number of hospital admissions, emergency department (ED) visits, outpatient visits, and expenditures for SCD patients with and without depression. Methods: 150 adult SCD patients were prospectively enrolled in a cross-sectional cohort study in 2009 to evaluate the prevalence of depression and its association with quality of life, disease severity scores measuring end organ damage, and health care utilization. Detailed cost accounting and administrative physician billing records from the Duke University Health System were obtained for all enrolled patients and used to generate estimates of medical care utilization and costs. Indexing on the enrollment date, we included data representing one year prior to and six months following study entry. Based on the Beck Depression Inventory (BDI) scores, we categorized SCD patients into those with depression (BDI score ≥14) and those without depression (BDI score <14). Given the skewed distributions of resource use and expenditures, we used generalized linear regression models (GLM) with negative binomial distributions and log links to compare inpatient stays, number of hospital admissions, ED visits, and outpatient visits and GLMs with gamma distributions and log links to compare costs associated with each resource use category between patients with and without depression. Results: Data from 142 patients analyzed, 81 females and 61 males with a mean age of 34.2 years. We identified 50 patients with depression and 92 patients without depression. At study entry, females represented 72% of SCD patients with depression and 49% of SCD patients without depression (P< 0.01). Median age was 32.5 years among patients with depression and 29.5 years among those without depression (P= 0.22). Hospital admissions, ED visits, and outpatient visits were generally similar between patients with and without depression one year prior to and six months after study entry. Patients with depression spent more days in the hospital during both time periods. Total inpatient expenditures, including physician fees paid, were higher for patients with depression than those without depression for both time periods (Table). Conclusion: SCD patients with depression incur higher expenditures and longer stays than SCD patients without depression. Efforts should be made for early diagnosis and active therapeutic intervention for depression among SCD patients, to decrease health care utilization and cost. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Emergency department revisits and rehospitalizations among infants and toddlers for acute allergic reactions

2021 ◽  
Vol 42 (3) ◽  
pp. 247-256
Author(s):  
Lacey B. Robinson ◽  
Anna Chen Arroyo ◽  
Rebecca E. Cash ◽  
Susan A. Rudders ◽  
Carlos A. Camargo
Keyword(s):  
Health Care ◽  
Emergency Department ◽  
New York ◽  
Health Care Utilization ◽  
Population Based ◽  
Care Utilization ◽  
Allergic Reactions ◽  
Infants And Toddlers ◽  
Ed Visits ◽  
Total Charges

Background and Objective: Allergic reactions, including anaphylaxis, are rising among children. Little is known about health care utilization among infants and toddlers. Our objective was to characterize health care utilization and charges for acute allergic reactions (AAR). Methods: We conducted a retrospective cohort study of trends in emergency department (ED) visits and revisits, hospitalizations and rehospitalizations, and charges among infants and toddlers (ages < 3 years), with an index ED visit or hospitalization for AAR (including anaphylaxis). We used data from population-based multipayer data: State Emergency Department Databases and State Inpatient Databases from New York and Nebraska. Multivariable logistic regression was used to identify factors associated with ED revisits and rehospitalizations. Results: Between 2006 and 2015, infant and toddler ED visits for AAR increased from 27.8 per 10,000 population to 35.2 (Ptrend < 0.001), whereas hospitalizations for AAR remained stable (Ptrend = 0.11). In the one year after an index AAR visit, 5.1% of these patients had at least one AAR ED revisit and 5.9% had at least one AAR rehospitalization. Factors most strongly associated with AAR ED revisits included an index visit hospitalization and receipt of epinephrine. Total charges for AAR ED visits (2009‐2015) and hospitalizations (2011‐2015) were more than $29 million and $11 million, respectively. Total charges increased more than fourfold for both AAR ED revisits for AAR rehospitalizations during the study period. Conclusion: Infants and toddlers who presented with an AAR were at risk for ED revisits and rehospitalizations for AAR within the following year. The charges associated with these revisits were substantial and seemed to be increasing.

Patterns of Health Care Utilization for Noncommunicable Diseases in a Transitional European Country: Results From the National Health Survey

2018 ◽  
Vol 49 (1) ◽  
pp. 37-50
Author(s):  
Janko Janković ◽  
Sladjana Šiljak ◽  
Jelena Marinković ◽  
Bojan Kovač ◽  
Slavenka Janković
Keyword(s):  
Health Care ◽  
Health Care Utilization ◽  
National Health ◽  
Health Survey ◽  
Hospital Admissions ◽  
National Health Survey ◽  
Urgent Care ◽  
Noncommunicable Diseases ◽  
Care Utilization ◽  
The Relationship

This study aimed to assess possible differences in health services utilization among people living with noncommunicable diseases (NCDs) in the Republic of Srpska (RS), Bosnia and Herzegovina, with special reference to NCD multimorbidity. In addition, the relationship between self-perceived health and health care utilization was assessed. Data were retrieved from the 2010 National Health Survey. A cross-sectional study design was used. A total of 4,673 persons aged 18 years and older were identified in the households, of which 4,128 were interviewed. Logistic regression analyses were used to estimate the effects of NCDs on health care utilization in RS. Respondents with NCD multimorbidity more frequently visited family physicians (odds ratio [OR], 2.74; 95% confidence interval [CI], 2.34 − 3.19), dentists (OR, 1.57; CI, 1.28 − 1.92), private doctors (OR, 2.14; CI, 1.74 − 2.64), and urgent care departments (OR, 2.30; CI, 1.75 − 3.03) than their counterparts without NCDs. They also had more hospital admissions (OR, 2.03; CI, 1.56 − 2.64). This is the first study to address the relationship between health care utilization and NCDs in the population of RS. Further research is needed to explore how best to organize health care to meet the needs of people in RS with NCDs, especially with NCD multimorbidity.

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 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.

scholarly journals Fewer hospitalizations and prolonged technique survival with Home Hemodialysis– a matched cohort study from the Swedish Renal Registry

2019 ◽  
Author(s):  
Helena Rydell ◽  
Kerstin Ivarsson ◽  
Martin Almquist ◽  
Naomi Clyne ◽  
Mårten Segelmark
Keyword(s):  
Health Care ◽  
Health Care Utilization ◽  
Hospital Admissions ◽  
Admission Rate ◽  
Care Utilization ◽  
Matched Cohort ◽  
Home Hemodialysis ◽  
Technique Survival ◽  
Start Date ◽  
Dialysis Technique

Abstract Background Patients on home hemodialysis (HHD) exhibit superior survival compared with patients on institutional hemodialysis (IHD) and peritoneal dialysis (PD). However, the effects of treatment modality on morbidity and health care utilization are divergent between studies. The aim of this study is to compare health care utilization between modalities. Methods The Swedish Renal Registry was used to retrieve patients starting on HHD, IHD or PD. Patients were matched according to sex, age, comorbidity and start date. The Swedish Inpatient Registry was used to determine comorbidity before starting renal replacement therapy (RRT) and hospital admissions during RRT. Dialysis technique survival was compared between HHD and PD. Results RRT was initiated with HHD for 152 patients; these were matched with 608 patients with IHD and 456 with PD. Patients with HHD had significantly lower median annual admission rate and number of days in hospital. (1.7 admissions; 12 days) compared with IHD (2.2; 14) and PD (2.8; 20). The annual admission rate was significantly lower for patients with HHD compared with IHD for cardiovascular diagnoses and compared with PD for infectious disease diagnoses. Dialysis technique survival was significantly longer with HHD compared with PD. Conclusions Patients choosing HHD as initial RRT spend less time in hospital compared with patients on IHD and PD and they were more likely than PD patients, to remain on their initial modality. These advantages, in combination with better survival and higher likelihood of renal transplantation, are important incentives for promoting the use of HHD.

scholarly journals Evaluating the Impact of a Risk Assessment System With Tailored Interventions in Germany: Protocol for a Prospective Study With Matched Controls (Preprint)

2019 ◽  
Author(s):  
Marten Pijl ◽  
Jorn op den Buijs ◽  
Andreas Landgraf
Keyword(s):  
Health Care ◽  
Health Care Utilization ◽  
Hospital Admissions ◽  
Intervention Group ◽  
Case Manager ◽  
The Elderly ◽  
Risk Scores ◽  
Care Utilization ◽  
Hospital Transport ◽  
Care Costs

BACKGROUND With a worldwide increase in the elderly population, and an associated increase in health care utilization and costs, preventing avoidable emergency department visits and hospitalizations is becoming a global priority. A personal emergency response system (PERS), consisting of an alarm button and a means to establish a live connection to a response center, can help the elderly live at home longer independently. Individual risk assessment through predictive modeling can help indicate what PERS subscribers are at elevated risk of hospital transport so that early intervention becomes possible. OBJECTIVE The aim is to evaluate whether the combination of risk scores determined through predictive modeling and targeted interventions offered by a case manager can result in a reduction of hospital admissions and health care costs for a population of German PERS subscribers. The primary outcome of the study is the difference between the number of hospitalizations in the intervention and matched control groups. METHODS As part of the Sicher Zuhause program, an intervention group of 500 PERS subscribers will be tracked for 8 months. During this period, risk scores will be determined daily by a predictive model of hospital transport, and at-risk participants may receive phone calls from a case manager who assesses the health status of the participant and recommends interventions. The health care utilization of the intervention group will be compared to a group of matched controls, retrospectively drawn from a population of PERS subscribers who receive no interventions. RESULTS Differences in health care utilization and costs between the intervention group and the matched controls will be determined based on reimbursement records. In addition, qualitative data will be collected on the participants’ satisfaction with the Sicher Zuhause program and utilization of the interventions offered as part of the program. CONCLUSIONS The study evaluation will offer insight into whether a combination of predictive analytics and case manager-driven interventions can help in avoiding hospital admissions and health care costs for PERS subscribers in Germany living at home independently. In the future, this may lead to improved quality of life and reduced medical costs for the population of the study. CLINICALTRIAL Deutsches Register Klinischer Studien (DRKS), DRKS00017328; https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&amp;TRIAL_ID=DRKS00017328 INTERNATIONAL REGISTERED REPORT DERR1-10.2196/17584

scholarly journals Meta-Analysis: Association of Parent and Child Mental Health with Pediatric Health Care Utilization

2019 ◽  
Vol 44 (9) ◽  
pp. 1097-1110 ◽  
Author(s):  
John V Lavigne ◽  
Kathryn Mendelsohn Meyers
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Emergency Department ◽  
Health Care Utilization ◽  
Child Mental Health ◽  
Internalizing Symptoms ◽  
Care Utilization ◽  
Pediatric Health ◽  
Pediatric Health Care ◽  
Ed Visits

Abstract Objective To examine the association of psychological factors and pediatric health care utilization. Method Ovid Medline and PsychInfo were searched and archival and forward searchers were conducted of relevant articles. Studies of the association between psychological risk factors and pediatric health care utilization of outpatient services, emergency department, inpatient length of stay, and costs were identified. Effect sizes were expressed in the form of the standardized mean difference. From 4,546 studies identified in the search, 69 studies met inclusion criteria. Results There were significant low-moderate associations between higher outpatient visits and general child mental health (MH) problems (mean ES [mES] = 0.35), overall psychopathology (mES = 0.44), and internalizing symptoms (mES = 0.16). Results were significant for any parent MH problem (mES = 0.18). For emergency department (ED) visits, there were significant association between more ED visits and any child MH problems (mES = 0.25), internalizing symptoms (mES = 0.24), externalizing symptoms (mES = 0.16), and Attention Deficit/Hyperactivity Disorder (mES= 0.14), as well as parent MH (mES = 0.24) and maternal depression (mES = 0.21). Increased hospitalizations were associated with any child MH problem (mES = 0.3), overall child psychopathology (mES = 0.49), child depression (ES = 0.41), and any parent MH problem (mES = 0.54). For costs, results were significant for any child MH problem (mES = 0.38). Conclusions Child and parent MH problems are significantly associated with increased HCU.

Social Support, Health Literacy, and Health Care Utilization Among Older Adults

2019 ◽  
Vol 31 (4) ◽  
pp. 359-366 ◽  
Author(s):  
Yong-Bing Liu ◽  
Ping Hou ◽  
Hui-Ping Xue ◽  
Xin-E Mao ◽  
Yong-Nan Li
Keyword(s):  
Social Support ◽  
Older Adults ◽  
Health Care ◽  
Health Literacy ◽  
Nursing Homes ◽  
Health Care Utilization ◽  
Hospital Admissions ◽  
Effective Means ◽  
Care Utilization ◽  
Cross Sectional Survey

The purpose of this study was to explore the relationship between social support, health literacy, and health care utilization in older Chinese adults. A cross-sectional survey design was employed. Data were collected from 32 nursing homes from Urumqi in Xinjiang of China. A total of 1486 respondents completed a pack of questionnaires. The average health literacy level of older adults in nursing homes was relatively low, only 73.68 ± 29.42 points; the average social support level was also relatively low, only 31.42 ± 7.12 points (lower than domestic norm of Chinese residents, P < .001). Both values were below the midpoint for the overall population, indicating a sample with below-average levels of healthy literacy and social support. Low social support levels are associated with poor health literacy and greater likelihood of hospital admission ( P < .05). Social support was significantly associated with health literacy. Improving the quantity and quality of social support may be an effective means to obtain better health literacy and lower hospital admissions.

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