scholarly journals Effect of mood and anxiety disorders on health care utilization in multiple sclerosis

2020 ◽  
pp. 135245852096388
Author(s):  
Ruth Ann Marrie ◽  
Randy Walld ◽  
James M Bolton ◽  
Jitender Sareen ◽  
Scott B Patten ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Health Care ◽  
Anxiety Disorders ◽  
Health Care Utilization ◽  
Care Utilization ◽  
Health Services Use ◽  
Physician Visits ◽  
Mood And Anxiety Disorders ◽  
Drug Classes ◽  
Hospital Days

Background: Little is known about the effects of changes in the presence or absence of psychiatric disorders on health care utilization in multiple sclerosis (MS). Objective: To evaluate the association between “active” mood and anxiety disorders (MAD) and health care utilization in MS. Methods: Using administrative data from Manitoba, Canada, we identified 4748 persons with MS and 24,154 persons without MS matched on sex, birth year, and region. Using multivariable general linear models, we evaluated the within-person and between-person effects of any “active” MAD on annual physician visits, hospital days, and number of drug classes dispensed in the following year. Results: Annually, the MS cohort had an additional two physician visits, two drug classes, and nearly two more hospital days versus the matched cohort. Individuals with any MAD had more physician visits, had hospital days, and used more drug classes than individuals without a MAD. Within individuals, having an “active” MAD was associated with more utilization for all outcomes than not having an “active” MAD, but the magnitude of this effect was much smaller for visits and drugs than the between-person effect. Conclusion: Within individuals with MS, changes in MAD activity are associated with changes in health services use.

scholarly journals The Impact of Psychiatric Comorbidity on Health Care Utilization in Inflammatory Bowel Disease: A Population-based Study

2020 ◽  
Author(s):  
Charles N Bernstein ◽  
Carol A Hitchon ◽  
Randy Walld ◽  
James M Bolton ◽  
Lisa M Lix ◽  
...  
Keyword(s):  
Health Care ◽  
Inflammatory Bowel Disease ◽  
Health Care Utilization ◽  
Bowel Disease ◽  
Psychiatric Comorbidity ◽  
Care Utilization ◽  
Physician Visits ◽  
Inflammatory Bowel ◽  
Hospital Days ◽  
The Impact

Abstract Background Inflammatory bowel disease (IBD) is associated with an increase in psychiatric comorbidity (PC) compared with the general population. We aimed to determine the impact of PC on health care utilization in persons with IBD. Methods We applied a validated administrative definition of IBD to identify all Manitobans with IBD from April 1, 2006, to March 31, 2016, and a matched cohort without IBD. A validated definition for PC in IBD population was applied to both cohorts; active PC status meant ≥2 visits for psychiatric diagnoses within a given year. We examined the association of active PC with physician visits, inpatient hospital days, proportion with inpatient hospitalization, and use of prescription IBD medications in the following year. We tested for the presence of a 2-way interaction between cohort and PC status. Results Our study matched 8459 persons with IBD to 40,375 controls. On crude analysis, IBD subjects had ≥3.7 additional physician visits, had >1.5 extra hospital days, and used 2.1 more drug types annually than controls. Subjects with active PC had >10 more physician visits, had 3.1 more hospital days, and used >6.3 more drugs. There was a synergistic effect of IBD (vs no IBD) and PC (vs no PC) across psychiatric disorders of around 4%. This synergistic effect was greatest for anxiety (6% [2%, 9%]). After excluding psychiatry-related visits and psychiatry-related hospital stays, there remained an excess health care utilization in persons with IBD and PC. Conclusion Inflammatory bowel disease with PC increases health care utilization compared with matched controls and compared with persons with IBD without PC. Active PC further increases health care utilization.

scholarly journals Ten-year trajectories of health care utilization by Manitobans with MS predict nursing home entry

2018 ◽  
Vol 9 (1) ◽  
pp. 16-23
Author(s):  
Marcia Finlayson ◽  
Okechukwu Ekuma ◽  
Greg Finlayson ◽  
Depeng Jiang ◽  
Ruth Ann Marrie
Keyword(s):  
Health Care ◽  
Nursing Home ◽  
Health Care Utilization ◽  
Home Care ◽  
Group Membership ◽  
Medication Use ◽  
Care Utilization ◽  
Physician Visits ◽  
Trajectory Group ◽  
Hospital Days

BackgroundNursing home (NH) care is expensive and restrictive. Understanding trajectories to NH entry among people with multiple sclerosis (MS) could facilitate monitoring and early risk identification. We investigated 10-year trajectories of health care use in matched cohorts of people with MS who did and did not enter NH, the characteristics associated with trajectory group membership, and whether group membership predicted NH entry.MethodsWe used population-based administrative (health claims) data from Manitoba, Canada, to identify 226 NH entrants with MS between January 2005 and December 2012 and 896 age-, sex- and geographically matched non-NH entrants with MS. Using semiparametric group-based trajectory approaches, we described trajectories for 5 measures of health care utilization: physician visits, medications, hospital days and their intensity, and home care days. Using multivariable logistic models, we determined whether membership in a trajectory group predicted NH entry.ResultsMean (SD) age at MS diagnosis was 48.35 (13.25) years for NH entrants and 44.91 (11.58) for nonentrants. Most patients were female (NH entrant, 64%; nonentrant, 61%). Over the study period, trajectories for physician visits and medication use were relatively stable, while trajectories for hospital days and home care increased. High use trajectories for hospital days and medication use were associated with NH entry, while higher use of ambulatory physician visits was associated with a 40%–60% lower risk of NH entry.ConclusionComplex patterns of service use and underlying need contribute to NH entry among people with MS. An increasing number of hospital days is strongly associated with NH entry.

Infection-related health care utilization among people with and without multiple sclerosis

2016 ◽  
Vol 23 (11) ◽  
pp. 1506-1516 ◽  
Author(s):  
José MA Wijnands ◽  
Elaine Kingwell ◽  
Feng Zhu ◽  
Yinshan Zhao ◽  
John D Fisk ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Health Care ◽  
Health Care Utilization ◽  
Age Groups ◽  
Population Based ◽  
Care Utilization ◽  
Prescription Data ◽  
Physician Visits ◽  
Intestinal Infections ◽  
Adjusted Rate

Background: Little is known about infection risk in multiple sclerosis (MS). Objective: We examined infection-related health care utilization in people with and without MS. Methods: Using population-based health administrative data from British Columbia, Canada, people with MS were followed from their first demyelinating claim (1996–2013) until death, emigration, or study end (2013). Infection-related hospital, physician, and prescription data of MS cases were compared with sex-, age-, and geographically matched controls using adjusted regression models. Sex and age differences (18–39, 40–49, 50–59, 60+ years) were explored. Results: Relative to 35,837 controls, 7179 MS cases were over twice as likely to be hospitalized for infection (adjusted odds ratio: 2.39; 95% confidence interval (CI): 2.16–2.65), had 41% more physician visits (adjusted rate ratio (aRR): 1.41; 95% CI: 1.36–1.47), and filled 57% more infection-related prescriptions (aRR: 1.57; 95% CI: 1.49–1.65). Utilization was disproportionately higher in MS men than women and was elevated across all ages. MS cases had nearly twice as many physician visits and two to three times more hospitalizations for pneumonia, urinary system infections, and skin infections (aRRs ranged from 1.6 to 3.3) and over twice as many hospitalizations for intestinal infections (aRR = 2.6) and sepsis (aRR = 2.2). Conclusion: Infection-related health care utilization was increased in people with MS across all age groups, with a higher burden for men.

Half-Managed Care

2015 ◽  
Vol 47 (3) ◽  
pp. 519-531
Author(s):  
Shou-Hsia Cheng ◽  
Chih-Ming Chang ◽  
Chi-Chen Chen ◽  
Chih-Yuan Shih ◽  
Shu-Ling Tsai
Keyword(s):  
Health Care ◽  
Health Care Utilization ◽  
Estimating Equation ◽  
Emergency Department Visits ◽  
Care Utilization ◽  
The Novel ◽  
Minimal Impact ◽  
Physician Visits ◽  
Comparison Groups ◽  
Patient Model

In 2011, a novel capitation program was launched in Taiwan under its universal health insurance plan. This study aimed to assess the short-term impact of the program. Two hospitals in the greater Taipei area, one participating in the “loyal patient” model (13,319 enrollees) and one in the “regional resident” model (13,768 enrollees), were analyzed. Two comparison groups were selected by propensity score matching. Generalized estimating equation models with differences-in-differences analysis were used to examine the net effects of the capitation program on health care utilization, expenses, and outcomes. Enrollees in the loyal patient model had fewer physician visits in the host hospital, but more physician visits outside that hospital during the program year than they had the year before. Compared with non-enrollees, the loyal patient model enrollees incurred fewer physician visits (β = −0.042, p < .001), fewer emergency department visits, (β = −0.140, p < .001), and similar total expenses and outcome. For the regional resident model, no differences were found in the number of physician visits, expenses, or outcomes between enrollees and non-enrollees. The novel capitation models in Taiwan had minimal impact on health care utilization after 1 year of implementation and the health care outcome was not compromised.

Factors associated with health care utilization in pediatric multiple sclerosis

2020 ◽  
Vol 38 ◽  
pp. 101511
Author(s):  
Ruth Ann Marrie ◽  
Julia O'Mahony ◽  
Colleen Maxwell ◽  
Vicki Ling ◽  
Christine Till ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Health Care ◽  
Health Care Utilization ◽  
Care Utilization ◽  
Factors Associated ◽  
Pediatric Multiple Sclerosis

Leisure-Time Physical Activity and Health-Care Utilization in Older Adults

2006 ◽  
Vol 14 (4) ◽  
pp. 392-410 ◽  
Author(s):  
Michelle Y. Martin ◽  
M. Paige Powell ◽  
Claire Peel ◽  
Sha Zhu ◽  
Richard Allman
Keyword(s):  
Physical Activity ◽  
Older Adults ◽  
Health Care ◽  
Health Care Utilization ◽  
Leisure Time ◽  
Leisure Time Physical Activity ◽  
Community Dwelling ◽  
Care Utilization ◽  
Physically Active ◽  
Physician Visits

This study examined whether leisure-time physical activity (LTPA) was associated with health-care utilization in a racially diverse sample of rural and urban older adults. Community-dwelling adults (N= 1,000, 75.32 ± 6.72 years old) self-reported participating in LTPA and their use of the health-care system (physician visits, number and length of hospitalizations, and emergency-room visits). After controlling for variables associated with health and health-care utilization, older adults who reported lower levels of LTPA also reported a greater number of nights in the hospital in the preceding year. There was no support, however, for a relationship between LTPA and the other indicators of health-care utilization. Our findings suggest that being physically active might translate to a quicker recovery for older adults who are hospitalized. Being physically active might not only have health benefits for older persons but also lead to lower health-care costs.

scholarly journals High rates of health care utilization in pediatric multiple sclerosis: A Canadian population-based study

PLoS ONE ◽  
2019 ◽  
Vol 14 (6) ◽  
pp. e0218215 ◽  
Author(s):  
Ruth Ann Marrie ◽  
Julia O’Mahony ◽  
Colleen J. Maxwell ◽  
Vicki Ling ◽  
E. Ann Yeh ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Health Care ◽  
Health Care Utilization ◽  
Population Based ◽  
Care Utilization ◽  
Population Based Study ◽  
Pediatric Multiple Sclerosis ◽  
Canadian Population

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.

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