Patterns of Health Services Use Before Age 1 in Children Later Diagnosed With ADHD

Background: Children with ADHD have 2 to 3 times increased health care utilization and annual costs once diagnosed, but little is known about utilization patterns early in life, prior to diagnosis. Quantifying early health services use among children later diagnosed with ADHD could help us understand the early life impact of the disorder and uncover health care utilization patterns associated with higher ADHD risk. Methods: Electronic health record (EHR) data from the Duke University Health System (DUHS) was analyzed for patients born October 1, 2006–October 1, 2016. Those with at least two well-child visits before age 1 were grouped as ADHD or not ADHD based on retrospective billing codes. Adjusted odds ratios (AORs) for hospital admissions, procedures, emergency department (ED) visits, and outpatient clinic encounters before age 1 were compared between groups via logistic regression controlling for sex, race, and ethnicity. Results: ADHD diagnoses were identified in 1,315 (4.4%) of 29,929 patients meeting criteria. Before age 1, individuals with ADHD had 60% increased odds of hospital admission, 58% increased odds of visiting the emergency department, and 41% increased odds of procedures ( p < .0001), including 4.7-fold increased odds of blood transfusion ( p < .0001). They also had more outpatient clinic visits (μ = 14.7 vs. μ = 12.5, p < .0001), including 52% increased odds of visiting a medical specialist, 38% increased odds of visiting a surgical specialist, 70% increased odds of visiting a neonatologist, and 71% increased odds of visiting an ophthalmologist ( p < .0001 for all AORs). In addition, individuals with ADHD had 6-fold increased odds of visits related to child abuse and neglect ( p = .0010). Conclusions: Children later diagnosed with ADHD were more likely to be admitted to the hospital, visit the ED, and visit specific medical and surgical services before age 1. Future work will identify patterns of health interactions unique to ADHD to stratify ADHD risk.

Download Full-text

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

Journal of Clinical and Translational Science ◽

10.1017/cts.2019.210 ◽

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.

Download Full-text

The influence of integrated geriatric outpatient clinics on the health care utility of older people

10.21203/rs.2.21639/v4 ◽

2020 ◽

Author(s):

Yu-Ju Wei ◽

Cheng-Fang Hsieh ◽

Yu-Ting Huang ◽

Ming-Shyan Huang ◽

Tzu-Jung Fang

Keyword(s):

Health Care ◽

Emergency Department ◽

Health Care Utilization ◽

Older People ◽

Outpatient Clinic ◽

Emergency Department Visits ◽

Care Utilization ◽

Second Year ◽

Clinic Visits

Abstract Background: The number of people aged greater than 65 years is growing in many countries. Taiwan will be a superaged society in 2026, and health care utilization will increase considerably. Our study aimed to evaluate the efficacy of the geriatric integrated outpatient clinic model for reducing health care utilization by older people.Methods: This was a retrospective case-control study. Patients aged greater than 65 years seen at the geriatric outpatient clinic (Geri-OPD) and non-geriatric outpatient clinic (non-Geri-OPD) at a single medical centre were age and sex matched. Data on the number of outpatient clinic visits, emergency department visits, hospitalizations and medical expenditures were collected during the first and second years. A subgroup analysis by Charlson comorbidity index (CCI) and older age (age≧80 years) was performed, and the results were compared between the Geri-OPD and non-Geri-OPD groups.Results: A total of 6723 patients were included (3796 women and 2927 men). The mean age was 80.42 ± 6.39 years. There were 1291 (19.2%) patients in the Geri-OPD group and 5432 (80.8%) patients in the non-Geri-OPD group. After one year of regular follow-up, the Geri-OPD patients showed a significant reduction in the types of drugs included in each prescription (5.62±10.85) and the number of clinic visits per year (18.18 ± 48.85) (P<0.01). After a two-year follow-up, the number of clinic visits, emergency department visits, and hospitalizations and the annual medical costs were still decreased in the Geri-OPD patients. The Geri-OPD patients had more comorbidities and a higher rate of health care utilization than the non-Geri-OPD patients. In the subgroup analysis, patients with more comorbidities (CCI≧2) and an older age (≧80 years) in the Geri-OPD group showed a significant reduction in health care utilization. The Geri-OPD patients also showed a significant decrease in medical utilization in the second year compared with the non-Geri-POD patients.Conclusion: The Geri-OPD reduced medical costs, the number of drugs prescribed, and the frequency of outpatient clinic visits, emergency department visits and hospitalizations in older patients with complicated conditions. The effect was even better in the second year.

Download Full-text

Health Care Utilization by Preterm Infants with Respiratory Complications in Quebec

Canadian Respiratory Journal ◽

10.1155/2012/606507 ◽

2012 ◽

Vol 19 (4) ◽

pp. 255-260 ◽

Cited By ~ 14

Author(s):

Jennifer S Landry ◽

Dan Croitoru ◽

Yulan Jin ◽

Kevin Schwartzman ◽

Andrea Benedetti ◽

...

Keyword(s):

Health Care ◽

Health Care Utilization ◽

Preterm Infants ◽

Hospital Admissions ◽

Preterm Births ◽

Administrative Databases ◽

Care Utilization ◽

Respiratory Complications ◽

Health Services Use ◽

Psychiatric Complications

INTRODUCTION: Despite notable advances in prenatal and neonatal care, respiratory distress syndrome (RDS) and bronchopulmonary dysplasia (BPD) remain important complications of preterm births, and their long-term sequelae are poorly understood.OBJECTIVE: To describe health care utilization and costs over a 16- to 25-year follow-up period in a cohort of preterm infants with respiratory complications.METHODS: Using provincial health administrative databases from Quebec, a cohort of individuals who were born prematurely with complications of RDS and/or BPD between 1983 and 1992 were identified. From these databases, which cover all Quebec residents, health services use, medication prescriptions, associated diagnoses and costs were tabulated.RESULTS: A total of 3442 subjects with respiratory complications following preterm birth were identified, of whom 773 had been diagnosed with BPD and 2669 had RDS without BPD. Asthma was diagnosed twice as frequently (1.7 to 2.4 times) in the BPD group compared with the RDS group, with more frequent hospital readmission, and outpatient and emergency room visits. Although respiratory causes remained the main reason for consultation in both groups, 3.7% and 3.4% of the outpatient visits were for mental or psychological ailments, such as depression, attention deficit hyperactivity disorder or dysthymia for the BPD and RDS groups, respectively.CONCLUSION: BPD patients experienced more hospital admissions, outpatient and emergency rooms visits, and were more likely to suffer from respiratory illnesses and to use respiratory drugs than RDS patients. Neurological and psychiatric complications occurred at a high frequency in both RDS and BPD subjects, and were associated with significant use of antipsychotic and antidepressant medications.

Download Full-text

The influence of integrated geriatric outpatient clinics on the health care utility of older people

10.21203/rs.2.21639/v3 ◽

2020 ◽

Author(s):

YU-JU WEI ◽

Cheng-Fang Hsieh ◽

Yu-Ting Huang ◽

Ming-Shyan Huang ◽

Tzu-Jung Fang

Keyword(s):

Health Care ◽

Emergency Department ◽

Health Care Utilization ◽

Older People ◽

Outpatient Clinic ◽

Emergency Department Visits ◽

Care Utilization ◽

Second Year ◽

Clinic Visits

Abstract Background: The number of people aged greater than 65 years is growing in many countries. Taiwan will be a superaged society in 2026, and health care utilization will increase considerably. Our study aimed to evaluate the efficacy of the geriatric integrated outpatient clinic model for reducing health care utilization by older people. Methods: This was a retrospective case-control study. Patients aged greater than 65 years seen at the geriatric outpatient clinic (Geri-OPD) and non-geriatric outpatient clinic (non-Geri-OPD) at a single medical centre were age and sex matched. Data on the number of outpatient clinic visits, emergency department visits, hospitalizations and medical expenditures were collected during the first and second years. A subgroup analysis by Charlson comorbidity index (CCI) and older age (age≧80 years) was performed, and the results were compared between the Geri-OPD and non-Geri-OPD groups. Results: A total of 6723 patients were included (3796 women and 2927 men). The mean age was 80.42 ± 6.39 years. There were 1291 (19.2%) patients in the Geri-OPD group and 5432 (80.8%) patients in the non-Geri-OPD group. After one year of regular follow-up, the Geri-OPD patients showed a significant reduction in the types of drugs included in each prescription (5.62±10.85) and the number of clinic visits per year (18.18 ± 48.85) (P<0.01). After a two-year follow-up, the number of clinic visits, emergency department visits, and hospitalizations and the annual medical costs were still decreased in the Geri-OPD patients. The Geri-OPD patients had more comorbidities and a higher rate of health care utilization than the non-Geri-OPD patients. In the subgroup analysis, patients with more comorbidities (CCI≧2) and an older age (≧80 years) in the Geri-OPD group showed a significant reduction in health care utilization. The Geri-OPD patients also showed a significant decrease in medical utilization in the second year compared with the non-Geri-POD patients. Conclusion: The Geri-OPD reduced medical costs, the number of drugs prescribed, and the frequency of outpatient clinic visits, emergency department visits and hospitalizations in older patients with complicated conditions. The effect was even better in the second year.

Download Full-text

The influence of integrated geriatric outpatient clinics on the health care utilization of older people

BMC Geriatrics ◽

10.1186/s12877-020-01782-7 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Yu-Ju Wei ◽

Cheng-Fang Hsieh ◽

Yu-Ting Huang ◽

Ming-Shyan Huang ◽

Tzu-Jung Fang

Keyword(s):

Health Care ◽

Emergency Department ◽

Health Care Utilization ◽

Older People ◽

Outpatient Clinic ◽

Emergency Department Visits ◽

Care Utilization ◽

Second Year ◽

Clinic Visits

Abstract Background The number of people aged greater than 65 years is growing in many countries. Taiwan will be a superaged society in 2026, and health care utilization will increase considerably. Our study aimed to evaluate the efficacy of the geriatric integrated outpatient clinic model for reducing health care utilization by older people. Methods This was a retrospective case-control study. Patients aged greater than 65 years seen at the geriatric outpatient clinic (Geri-OPD) and non-geriatric outpatient clinic (non-Geri-OPD) at a single medical centre were age and sex matched. Data on the number of outpatient clinic visits, emergency department visits, hospitalizations and medical expenditures were collected during the first and second years. A subgroup analysis by Charlson comorbidity index (CCI) and older age (age≧80 years) was performed, and the results were compared between the Geri-OPD and non-Geri-OPD groups. Results A total of 6723 patients were included (3796 women and 2927 men). The mean age was 80.42 ± 6.39 years. There were 1291 (19.2%) patients in the Geri-OPD group and 5432 (80.8%) patients in the non-Geri-OPD group. After one year of regular follow-up, the Geri-OPD patients showed a significant reduction in the types of drugs included in each prescription (5.62 ± 10.85) and the number of clinic visits per year (18.18 ± 48.85) (P < 0.01). After a two-year follow-up, the number of clinic visits, emergency department visits, and hospitalizations and the annual medical costs were still decreased in the Geri-OPD patients. The Geri-OPD patients had more comorbidities and a higher rate of health care utilization than the non-Geri-OPD patients. In the subgroup analysis, patients with more comorbidities (CCI≧2) and an older age (≧80 years) in the Geri-OPD group showed a significant reduction in health care utilization. The Geri-OPD patients also showed a significant decrease in medical utilization in the second year compared with the non-Geri-POD patients. Conclusion The Geri-OPD reduced medical costs, the number of drugs prescribed, and the frequency of outpatient clinic visits, emergency department visits and hospitalizations in older patients with complicated conditions. The effect was even better in the second year.

Download Full-text

End-of-life Health-Care Utilization Patterns Among Chronically Ill Older Adults

American Journal of Hospice and Palliative Medicine® ◽

10.1177/1049909118824962 ◽

2019 ◽

Vol 36 (6) ◽

pp. 507-512 ◽

Cited By ~ 2

Author(s):

Meredith MacKenzie Greenle ◽

Karen B. Hirschman ◽

Ken Coburn ◽

Sherry Marcantonio ◽

Alexandra L. Hanlon ◽

...

Keyword(s):

Older Adults ◽

Health Care ◽

Emergency Department ◽

Health Care Utilization ◽

End Of Life ◽

Emergency Department Visit ◽

Chronically Ill ◽

Care Utilization ◽

Utilization Patterns ◽

Over Time

Patients with chronic illness are associated with high health-care utilization and this is exacerbated in the end of life, when health-care utilization and costs are highest. Complex Care Management (CCM) is a model of care developed to reduce health-care utilization, while improving patient outcomes. We aimed to examine the relationship between health-care utilization patterns and patient characteristics over time in a sample of older adults enrolled in CCM over the last 2 years of life. Generalized estimating equation models were used. The sample (n = 126) was 52% female with an average age of 85 years. Health-care utilization rose sharply in the last 3 months of life with at least one hospitalization for 67% of participants and an emergency department visit for 23% of participants. In the last 6 months of life, there was an average of 2.17 care transitions per participant. The odds of hospitalization increased by 27% with each time interval ( P < .001). Participants demonstrated 11% greater odds of having a hospitalization for each additional comorbidity ( P = .05). A primary diagnosis of heart failure or coronary artery disease was associated with 21% greater odds of hospitalization over time compared to other primary diagnoses ( P = .017). Females had 70% greater odds of an emergency department visit compared to males ( P = .046). For each additional year of life, the odds of an emergency department visit increased by about 7% ( P < .001). Findings suggest the need for further interventions targeting chronically ill older adults nearing end of life within CCM models.

Download Full-text

The influence of integrated geriatric outpatient clinics on the health care utilization of older people

10.21203/rs.2.21639/v2 ◽

2020 ◽

Author(s):

YU-JU WEI ◽

Cheng-Fang Hsieh ◽

Yu-Ting Huang ◽

Ming-Shyan Huang ◽

Tzu-Jung Fang

Keyword(s):

Health Care ◽

Emergency Department ◽

Health Care Utilization ◽

Outpatient Clinic ◽

Emergency Department Visits ◽

Outpatient Clinics ◽

Care Utilization ◽

Second Year ◽

Clinic Visits

Abstract Background: The number of people above the age of 65 years is growing in many countries. Taiwan will be a superaged society in 2026, and health care utilization will increase considerably. Our study aimed to evaluate the efficacy of the geriatric integrated outpatient clinic model for reducing health care utilization by in older people.Methods: This was a retrospective case-control study. Patients aged more than 65 years seen at the geriatric outpatient clinic (Geri-OPD) and non-geriatric outpatient clinics (non-Geri-OPD) at a single medical centre were age- and sex-matched. Data on the number of outpatient clinic visits, emergency department visits, and hospitalizations and medical expenditures were collected in the first and second years. A subgroup analysis by Charlson comorbidity index (CCI) and older age (age≧80 years old) was performed, and the results were compared between the Geri-OPD and non-Geri-OPD groups.Results: A total of 6723 patients were included (3796 women and 2927 men). The mean age was 80.42 ± 6.39 years. There were 1291 (19.2%) patients from the Geri-OPD group and 5432 (80.8%) patients from the non-Geri-OPD group. After one year of regular follow-up, the Geri-OPD patients showed a significant reduction in the types of drugs included in each prescription (5.62±10.85) and the number of clinic visits per year (18.18 ± 48.85) (P<0.01). After a two-year follow-up, the number of clinic visits, emergent department visits, and hospitalizations and the annual medical costs were still decreased in the Geri-OPD patients. The Geri-OPD patients had more comorbidities and a higher rate of health care utilization than the non-Geri-OPD patients. In the subgroup analysis, patients with more comorbidities (CCI≧2) and older age (≧80 years old) in the Geri-OPD group showed a significant reduction in health care utilization. The Geri-OPD patients also showed a significant decrease in medical utilization in the second year compared to the non-Geri-POD patients.Conclusion: The Geri-OPD reduced medical costs, the number of drugs prescribed, and the frequency of outpatient clinic visits, emergency department visits and hospitalizations in complicated elderly patients. The effect was even better in the second year.Trial registration: Not applicable

Download Full-text