Evidence of Pent-Up Demand for Care After Medicaid Expansion

2017 ◽  
Vol 75 (4) ◽  
pp. 516-524 ◽  
Author(s):  
Angela R. Fertig ◽  
Caroline S. Carlin ◽  
Scott Ode ◽  
Sharon K. Long
Keyword(s):  
Primary Care ◽  
Emergency Department ◽  
Disease Management ◽  
Emergency Department Visit ◽  
Claims Data ◽  
Office Visit ◽  
Medicaid Expansion ◽  
Management Plans ◽  
Over Time

We compared new Medicaid enrollees with similar ongoing enrollees for evidence of pent-up demand using claims data following Minnesota’s 2014 Medicaid expansion. We hypothesized that if new enrollees had pent-up demand, utilization would decline over time as testing and disease management plans are put in place. Consistent with pent-up demand among new enrollees, the probability of an office visit, a new patient office visit, and an emergency department visit declines over time for new enrollees relative to ongoing Medicaid enrollees. The pattern of utilization suggests that the newly insured are connecting with primary care after the 2014 Medicaid expansion and, unlike ongoing Medicaid enrollees; the newly insured have a declining reliance on the emergency department over time.

scholarly journals Exploring characteristics of COPD patients with clinical improvement after integrated disease management or usual care: post-hoc analysis of the RECODE study

2019 ◽  
Author(s):  
Eline Meijer ◽  
Annelies E. van Eeden ◽  
Annemarije L. Kruis ◽  
Melinde R.S. Boland ◽  
W. J.J. (Pim) Assendelft ◽  
...  
Keyword(s):  
Primary Care ◽  
Disease Management ◽  
Usual Care ◽  
Clinical Improvement ◽  
Chronic Obstructive ◽  
Integrated Disease Management ◽  
Copd Patients ◽  
Treatment Type ◽  
Post Hoc ◽  
Over Time

Abstract Background: The cluster randomized controlled trial on (cost-)effectiveness of integrated chronic obstructive pulmonary disease (COPD) management in primary care (RECODE) showed that integrated disease management (IDM) in primary care had no effect on quality of life (QOL) in COPD patients compared with usual care. It is possible that only a subset of COPD patients in primary care benefit from IDM. We therefore examined which patients benefit from IDM, and whether patient characteristics predict clinical improvement over time. Method: Post-hoc analyses of the RECODE trial among 1086 COPD patients. Logistic regression analyses were performed with baseline characteristics as predictors to examine determinants of improvement in QOL, defined as a minimal decline in Clinical COPD Questionnaire (CCQ) of 0.4 points after 12 and 24 months of IDM. We also performed moderation analyses to examine whether predictors of clinical improvement differed between IDM and usual care. Results: Regardless of treatment type, more severe dyspnea (MRC) was the most important predictor of clinically improved QOL at 12 and 24 months, suggesting that these patients have most room for improvement. Although the interaction effect between gender and treatment condition was nonsignificant, it appeared that male patients were worse off with IDM than usual care. Conclusions: More severe dyspnea is a key predictor of improved QOL in COPD patients over time. Future IDM programs, provided that they are effective, may benefit from tailoring to gender such that the programs meet the individual needs of both female and male COPD patients. Trial registration: Netherlands Trial Register, NTR2268. Registered 31 March 2010, https://www.trialregister.nl/trial/2144 .

Using Google Trends to track walk-in clinic and emergency department searches over time and across provinces in Canada (Preprint)

2019 ◽  
Author(s):  
Joseph Ssendikaddiwa ◽  
Ruth Lavergne
Keyword(s):  
Primary Care ◽  
Emergency Department ◽  
British Columbia ◽  
Emergency Departments ◽  
Google Trends ◽  
Care Seeking ◽  
Primary Care Access ◽  
Care Access ◽  
After Hours ◽  
Over Time

BACKGROUND Access to primary care is a challenge for many Canadians. Models of primary care vary widely across provinces, including arrangements for same day and after-hours access. Use of walk-in clinics and emergency departments may also vary, but data sources that allow comparison are limited. OBJECTIVE We use Google Trends to examine searches for walk-in clinics and emergency departments across provinces and over time in Canada, and compare results to other information about primary care access. METHODS We developed search strategies to capture the range of terms used for walk-in clinics (e.g. urgent care clinic, after-hours clinic) and emergency departments (e.g. ER, emergency room) across Canadian provinces. We used Google Trends to determine the frequencies of these terms relative to total search volume, and standardized search frequencies to allow comparisons across provinces and over time (2011-2018). We explored how care seeking captured by Google Trends correlates with other sources of data on primary care access by province. RESULTS Manitoba, British Columbia, and Nova Scotia had highest search frequency for emergency departments, and Saskatchewan, Alberta, and Ontario had the lowest. Searches for walk-in clinics were most common in the western provinces of British Columbia, Alberta, and Saskatchewan. Relative search frequency for walk-in clinics increased steadily, doubling in most provinces between 2011 and 2018. Higher search frequency for walk-in clinics was correlated with ability to get a same or next-day appointment and inversely correlated with both ED use for conditions treatable in patients’ regular place of care and having a regular medical provider. Emergency department searches were not correlated with survey data. CONCLUSIONS Search frequencies may reflect patient care seeking but may also be impacted by news coverage and other events, especially in the case of emergency department searches. We observe substantial interprovincial variation, and marked growth in the frequency of searches for walk-in clinics. Google Searches for walk-in clinics correlate with other measures of access, and appear to correspond to differences in policies related to walk-in clinics, advanced access, and after-hours care between provinces.

scholarly journals Exploring characteristics of COPD patients with clinical improvement after integrated disease management or usual care: post-hoc analysis of the RECODE study

2020 ◽  
Author(s):  
Eline Meijer ◽  
Annelies E. van Eeden ◽  
Annemarije L. Kruis ◽  
Melinde R.S. Boland ◽  
W. J.J. (Pim) Assendelft ◽  
...  
Keyword(s):  
Primary Care ◽  
Disease Management ◽  
Usual Care ◽  
Clinical Improvement ◽  
Patient Characteristics ◽  
Integrated Disease Management ◽  
Copd Patients ◽  
Treatment Type ◽  
Post Hoc ◽  
Over Time

Abstract Background: The cluster randomized controlled trial on (cost-)effectiveness of integrated chronic obstructive pulmonary disease (COPD) management in primary care (RECODE) showed that integrated disease management (IDM) in primary care had no effect on quality of life (QOL) in COPD patients compared with usual care (guideline-supported non-programmatic care). It is possible that only a subset of COPD patients in primary care benefit from IDM. We therefore examined which patients benefit from IDM, and whether patient characteristics predict clinical improvement over time.Method: Post-hoc analyses of the RECODE trial among 1086 COPD patients. Logistic regression analyses were performed with baseline characteristics as predictors to examine determinants of improvement in QOL, defined as a minimal decline in Clinical COPD Questionnaire (CCQ) of 0.4 points after 12 and 24 months of IDM. We also performed moderation analyses to examine whether predictors of clinical improvement differed between IDM and usual care.Results: Regardless of treatment type, more severe dyspnea (MRC) was the most important predictor of clinically improved QOL at 12 and 24 months, suggesting that these patients have most room for improvement. Clinical improvement with IDM was associated with female gender (12-months) and being younger (24-months), and improvement with usual care was associated with having a depression (24-months).Conclusions: More severe dyspnea is a key predictor of improved QOL in COPD patients over time. More research is needed to replicate patient characteristics associated with clinical improvement with IDM, such that IDM programs can be offered to patients that benefit the most, and can potentially be adjusted to meet the needs of other patient groups as well.Trial registration: Netherlands Trial Register, NTR2268. Registered 31 March 2010, https://www.trialregister.nl/trial/2144.

scholarly journals Development and Validation of an Inflammatory Bowel Disease Severity Index Using US Administrative Claims Data: A Retrospective Cohort Study

2020 ◽  
Author(s):  
Grace Chen ◽  
Trevor Lissoos ◽  
Christopher Dieyi ◽  
Kyle D Null
Keyword(s):  
Inflammatory Bowel Disease ◽  
Emergency Department ◽  
Disease Severity ◽  
Emergency Department Visit ◽  
Bowel Disease ◽  
Claims Data ◽  
Administrative Claims ◽  
Total Cost ◽  
Administrative Claims Data ◽  
Inflammatory Bowel

Abstract Background Clinical indices to characterize the severity of inflammatory bowel disease (IBD) are widely used in clinical trials and real-world practice. However, there are few validated instruments for assessing IBD severity in administrative claims-based studies. Methods Patients (18–89 years) diagnosed with ulcerative colitis (UC) or Crohn’s disease (CD) and receiving ≥1 prescription claim for IBD therapy were identified using administrative claims data from the Optum Clinformatics, IMS PharMetrics, and Truven MarketScan databases (January 1, 2013–September 30, 2017). Regression modeling identified independent predictors of IBD-related hospitalization (inpatient stay or emergency department visit resulting in hospitalization), which were used to develop IBD severity indices. The index was validated against all-cause hospitalization and total cost and IBD-related hospitalization and total cost. Results There were 51,767 patients diagnosed with UC (n = 30,993) or CD (n = 20,774) who were initiated treatment with IBD therapy. Independent predictors of IBD-related hospitalization were Charlson Comorbidity Index score >1, anemia, weight loss, intravenous corticosteroid use, prior gastrointestinal-related emergency department visit and hospitalization, and unspecified disease location or more extensive disease. Female sex, renal comorbidities, intestinal fistula, and stricture were additional risk factors for patients with CD, whereas age <40 years was a UC-specific risk factor. Median IBD severity scores were 8 and 13 for UC and CD, respectively, from possible total scores of 51 and 37. Inflammatory bowel disease severity score correlated with significantly higher all-cause hospitalization and cost, all-cause total cost, IBD-related hospitalization cost, and total cost. Conclusions These validated UC and CD severity indices can be used to predict IBD-related outcomes using administrative claims databases.

Sign in / Sign up

Export Citation Format

Share Document