scholarly journals Urgent and non-emergent telehealth care for seniors: Findings from a multi-site impact study

2021 ◽  
pp. 1357633X2110043
Author(s):  
Paul Bernstein ◽  
Kelly J Ko ◽  
Juhi Israni ◽  
Alexandria O Cronin ◽  
Michael M Kurliand ◽  
...  
Keyword(s):  
International Classification Of Diseases ◽  
Geographic Region ◽  
Impact Study ◽  
Healthcare Organizations ◽  
Global Pandemic ◽  
Classification Of Diseases ◽  
Episodes Of Care ◽  
Study Population

Introduction The global pandemic has raised awareness of the need for alternative ways to deliver care, notably telehealth. Prior to this study, research has been mixed on its effectiveness and impact on downstream utilization, especially for seniors. Our multi-institution study of more than 300,000 telehealth visits for seniors evaluates the clinical outcomes and healthcare utilization for urgent and non-emergent symptoms. Methods We conducted a retrospective cohort study from November 2015 to March 2019, leveraging different models of telehealth from three health systems, comparing them to in-person visits for urgent and non-emergent needs of seniors based on International Classification of Diseases, 10th edition diagnoses. The study population was adults aged 60 years or older who had access to telehealth and were affiliated with and resided in the geographic region of the healthcare organization providing telehealth. The primary outcomes of interest were visit resolution and episodes of care for those that required follow-up. Results In total, 313,516 telehealth visits were analysed across three healthcare organizations. Telehealth encounters were successful in resolving urgent and non-emergent needs in 84.0–86.7% of cases. When visits required follow-up, over 95% were resolved in less than three visits for both telehealth and in-person cohorts. Discussion While in-person visits have traditionally been the gold standard, our results suggest that when deployed within the confines of a patient’s existing primary care and health system provider, telehealth can be an effective alternative to in-person care for urgent and non-emergent needs of seniors without increasing downstream utilization.

Urgent and non-emergent telehealth care for seniors: Findings from a multi-site impact study

2021 ◽  
pp. 1357633X2098538
Author(s):  
Paul Bernstein ◽  
Kelly J Ko ◽  
Juhi Israni ◽  
Alexandria O Cronin ◽  
Michael M Kurliand ◽  
...  
Keyword(s):  
International Classification Of Diseases ◽  
Geographic Region ◽  
Impact Study ◽  
Healthcare Organizations ◽  
Global Pandemic ◽  
Classification Of Diseases ◽  
Episodes Of Care ◽  
Study Population

Introduction The global pandemic has raised awareness of the need for alternative ways to deliver care, notably telehealth. Prior to this study, research has been mixed on its effectiveness and impact on downstream utilization, especially for seniors. Our multi-institution study of more than 300,000 telehealth visits for seniors evaluates the clinical and utilization outcomes for urgent and non-emergent symptoms. Methods We conducted a retrospective cohort study from November 2015 to March 2019, leveraging different models of telehealth from three health systems, comparing them to in-person visits for urgent and non-emergent needs of seniors based on International Classification of Diseases, 10th edition diagnoses. The study population was adults aged 60 years or older who had access to telehealth, and were affiliated with and resided in the geographic region of the healthcare organization providing telehealth. The primary outcomes of interest were visit resolution and episodes of care for those that required follow-up. Results In total, 313,516 telehealth visits were analysed across three healthcare organizations. Telehealth encounters were successful in resolving urgent and non-emergent needs in 84.0–86.7% of cases. When visits required follow-up, over 95% were resolved in less than three visits for both telehealth and in-person cohorts. Discussion While in-person visits have traditionally been the gold standard, our results suggest that when deployed within the confines of a patient’s existing primary care and health system provider, telehealth can be an effective alternative to in-person care for urgent and non-emergent needs of seniors without increasing downstream utilization.

Abstract 14682: Impact of Atrial Fibrillation in Aortic Stenosis Patients: Insights From the United States Readmissions Database

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Shashank Shekhar ◽  
Anas M Saad ◽  
Toshiaki Isogai ◽  
Mohamed M Gad ◽  
Keerat Ahuja ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Aortic Stenosis ◽  
Hospital Mortality ◽  
Large Scale ◽  
International Classification Of Diseases ◽  
The United States ◽  
Large Scale Data ◽  
Classification Of Diseases

Introduction: Even though atrial fibrillation (AF) is present in >30% of patients with aortic stenosis (AS), it is not typically included in the decision-making algorithm for the timing or need for aortic valve replacement (AVR), either by transcatheter (TAVR) or surgical (SAVR) approaches. Large scale data on how AF affects outcomes of AS patients remain scarce. Methods: From the Nationwide Readmissions Database (NRD), we retrospectively identified AS patients aged ≥18years, with and without AF admitted between January and June in 2016 and 2017 (to allow for a six month follow up), using the International Classification of Diseases-10 th revision codes. Multivariable logistic regression was performed to examine the predictors of in-hospital mortality during index hospitalization. In-hospital complications and 6 month in-hospital mortality during any readmission after being discharged alive were compared in patients with and without AF, for patients undergoing TAVR, SAVR or no-AVR. Results: We identified 403,089 AS patients, of which 41% had AF. Patients with AF were older (median age in years: 83 vs. 79) and were more frequently females (52% vs. 48%; p<0.001). Table summarizes outcomes of AS patients with and without AF. TAVR in patients with AF was associated with higher in-hospital mortality and follow-up mortality as compared to patients without AF. Although AF did not influence in-hospital mortality in SAVR population, follow-up mortality was also significantly higher after SAVR in patients with AF compared to patients without AF. For patients not undergoing AVR, in-hospital and follow-up mortality were higher in AF population compared to no AF and was higher than patients undergoing AVR (Table). Conclusions: AF is associated with worse outcomes in patients with AS irrespective of treatment (TAVR, SAVR or no-AVR). More studies are needed to understand the implications of AF in AS population and whether earlier treatment of AS in patients with AF can improve outcomes.

scholarly journals Progress of Diabetic Severity and Risk of Dementia

2015 ◽  
Vol 100 (8) ◽  
pp. 2899-2908 ◽  
Author(s):  
Wei-Che Chiu ◽  
Wen-Chao Ho ◽  
Ding-Lieh Liao ◽  
Meng-Hung Lin ◽  
Chih-Chiang Chiu ◽  
...  
Keyword(s):  
Severity Index ◽  
International Classification Of Diseases ◽  
Population Based ◽  
International Classification ◽  
Diabetic Patients ◽  
Research Database ◽  
Classification Of Diseases ◽  
New Onset

Context: Diabetes is a risk factor for dementia, but the effects of diabetic severity on dementia are unclear. Objective: The purpose of this study was to investigate the association between the severity and progress of diabetes and the risk of dementia. Design and Setting: We conducted a 12-year population-based cohort study of new-onset diabetic patients from the Taiwan National Health Insurance Research Database. The diabetic severity was evaluated by the adapted Diabetes Complications Severity Index (aDCSI) from the prediabetic period to the end of follow-up. Cox proportional hazard regressions were used to calculate the hazard ratios (HRs) of the scores and change in the aDCSI. Participants: Participants were 431,178 new-onset diabetic patients who were older than 50 years and had to receive antidiabetic medications. Main Outcome: Dementia cases were identified by International Classification of Diseases, ninth revision, code (International Classification of Diseases, ninth revision, codes 290.0, 290.1, 290.2, 290.3, 290.4, 294.1, 331.0), and the date of the initial dementia diagnosis was used as the index date. Results: The scores and change in the aDCSI were associated with the risk of dementia when adjusting for patient factors, comorbidity, antidiabetic drugs, and drug adherence. At the end of the follow-up, the risks for dementia were 1.04, 1.40, 1.54, and 1.70 (P &lt; .001 for trend) in patients with an aDCSI score of 1, 2, 3, and greater than 3, respectively. Compared with the mildly progressive patients, the adjusted HRs increased as the aDCSI increased (2 y HRs: 1.30, 1.53, and 1.97; final HRs: 2.38, 6.95, and 24.0 with the change in the aDCSI score per year: 0.51–1.00, 1.01–2.00, and &gt; 2.00 vs &lt; 0.50 with P &lt; .001 for trend). Conclusions: The diabetic severity and progression reflected the risk of dementia, and the early change in the aDCSI could predict the risk of dementia in new-onset diabetic patients.

scholarly journals Dental Calculus Is Associated with Death from Heart Infarction

2014 ◽  
Vol 2014 ◽  
pp. 1-5 ◽  
Author(s):  
Birgitta Söder ◽  
Jukka H. Meurman ◽  
Per-Östen Söder
Keyword(s):  
Cardiac Death ◽  
International Classification Of Diseases ◽  
Dental Calculus ◽  
Chi Square ◽  
Heart Infarction ◽  
Classification Of Diseases ◽  
The Difference ◽  
The Relationship

Objectives. We studied whether the amount of dental calculus is associated with death from heart infarction in the dental infection—atherosclerosis paradigm.Materials. Participants were 1676 healthy young Swedes followed up from 1985 to 2011. At the beginning of the study all subjects underwent oral clinical examination including dental calculus registration scored with calculus index (CI). Outcome measure was cause of death classified according to WHO International Classification of Diseases. Unpairedt-test, Chi-square tests, and multiple logistic regressions were used.Results. Of the 1676 participants, 2.8% had died during follow-up. Women died at a mean age of 61.5 years and men at 61.7 years. The difference in the CI index score between the survivors versus deceased patients was significant by the year 2009 (P<0.01). In multiple regression analysis of the relationship between death from heart infarction as a dependent variable and CI as independent variable with controlling for age, gender, dental visits, dental plaque, periodontal pockets, education, income, socioeconomic status, and pack-years of smoking, CI score appeared to be associated with 2.3 times the odds ratio for cardiac death.Conclusions. The results confirmed our study hypothesis by showing that dental calculus indeed associated statistically with cardiac death due to infarction.

A retrospective audit of joint mother–baby admissions to the Werribee Mercy mother and baby unit (MBU) and of the severity of maternal depression over the course of admission

2019 ◽  
Vol 28 (2) ◽  
pp. 220-225
Author(s):  
Imogen Wang ◽  
Carolyn Breadon
Keyword(s):  
Depressive Symptoms ◽  
Average Length ◽  
International Classification Of Diseases ◽  
Maternal Depressive Symptoms ◽  
Average Length Of Stay ◽  
Retrospective Audit ◽  
Mother And Baby Unit ◽  
Classification Of Diseases ◽  
Study Population

Objectives: This study examined (i) the demographic and illness profiles of mothers admitted to Werribee Mercy MBU in Victoria, Australia and (ii) the severity of maternal depressive symptoms over the course of admission. Method: A retrospective audit was conducted on consecutively admitted mother–baby dyads between January 2011 and June 2015. Routinely collected maternal Beck Depression Inventory, second edition (BDI-II) scores were analysed for severity and change. Results: A total of 307 mother–baby dyads were admitted during the study period. The majority of mothers was partnered and educated young adults. The average length of stay was 4.4 weeks. The mean age of babies was 3.3 months. One-third of mothers met International Classification of Diseases, 10th edition criteria for two or more psychiatric diagnoses. Unipolar major depression was the commonest diagnosis. Of the 307 mothers, 125 mothers completed BDI-II on admission and on discharge, which showed a mean reduction of 16 points ( p < 0.001) on discharge. Conclusions: This study notes the similarities between the clinical profiles of the study population with mother–baby admissions to MBUs worldwide. Maternal depressive symptoms improved by 16 points on the BDI-II over the course of MBU admission, which shows the utility of MBU admission on maternal depressive symptoms.

scholarly journals Incidence of COVID-19 in patients exposed to chloroquine and hydroxychloroquine: results from a population-based prospective cohort in Catalonia, Spain, 2020

2021 ◽  
Vol 26 (9) ◽  
Author(s):  
Rosa Maria Vivanco-Hidalgo ◽  
Israel Molina ◽  
Elisenda Martinez ◽  
Ramón Roman-Viñas ◽  
Adrián Sánchez-Montalvá ◽  
...  
Keyword(s):  
Care Service ◽  
International Classification Of Diseases ◽  
Population Based ◽  
Health Administration ◽  
Risk Of Infection ◽  
Control Cohort ◽  
Male Population ◽  
Classification Of Diseases

Background Several clinical trials have assessed the protective potential of chloroquine and hydroxychloroquine. Chronic exposure to such drugs might lower the risk of infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) or severe coronavirus disease (COVID-19). Aim To assess COVID-19 incidence and risk of hospitalisation in a cohort of patients chronically taking chloroquine/hydroxychloroquine. Methods We used linked health administration databases to follow a cohort of patients with chronic prescription of hydroxychloroquine/chloroquine and a control cohort matched by age, sex and primary care service area, between 1 January and 30 April 2020. COVID-19 cases were identified using International Classification of Diseases 10 codes. Results We analysed a cohort of 6,746 patients (80% female) with active prescriptions for hydroxychloroquine/chloroquine, and 13,492 controls. During follow-up, there were 97 (1.4%) COVID-19 cases in the exposed cohort and 183 (1.4%) among controls. The incidence rate was very similar between the two groups (12.05 vs 11.35 cases/100,000 person-days). The exposed cohort was not at lower risk of infection compared with controls (hazard ratio (HR): 1.08; 95% confidence interval (CI): 0.83–1.44; p = 0.50). Forty cases (0.6%) were admitted to hospital in the exposed cohort and 50 (0.4%) in the control cohort, suggesting a higher hospitalisation rate in the former, though differences were not confirmed after adjustment (HR: 1·46; 95% CI: 0.91–2.34; p = 0.10). Conclusions Patients chronically exposed to chloroquine/hydroxychloroquine did not differ in risk of COVID-19 nor hospitalisation, compared with controls. As controls were mainly female, findings might not be generalisable to a male population.

scholarly journals Outcomes of Admissions for Preterm Labor

2017 ◽  
Vol 07 (02) ◽  
pp. e116-e123
Author(s):  
Michael Kuzniewicz ◽  
Libby Black ◽  
Eileen Walsh ◽  
Sherian Li ◽  
Mara Greenberg
Keyword(s):  
Preterm Labor ◽  
Admission Rate ◽  
International Classification Of Diseases ◽  
High Rate ◽  
Kaiser Permanente ◽  
Total Study Population ◽  
Classification Of Diseases ◽  
Integrated Health Care System ◽  
Study Population

Objective This study aims to quantitate the incidence of preterm labor (PTL) admissions and determine the frequency and predictors of preterm delivery (PTD) during these admissions. Study Design Retrospective cohort of singleton pregnancies within Kaiser Permanente Northern California, 2001 to 2011. PTL admissions were defined as inpatient encounters > 24 hours with an International Classification of Diseases, 9th Revision code for PTL. Results Total study population was 365,897 with PTL admission rate 11%. PTD occurred in 85% of pregnancies with PTL admission. Delivery occurred within 48 hours of admission in 96% ≥34 weeks, 67% 31 to 33 weeks, and 51.9% <31 weeks. Predictors of delivery during PTL admission included gestational age 34 to 36 weeks (adjusted odds ratio [aOR], 6.90), chorioamnionitis (aOR, 105.58), and preterm rupture of membranes (aOR 19.29). Conclusion We demonstrate a high rate of PTD per PTL admission in a highly integrated health care system. More work is needed to determine optimal practices for hospitalization and treatment of women diagnosed with PTL.

scholarly journals Medicaid Eligibility and Time to Re-incarceration Among Previously Incarcerated Subjects With Schizophrenia

10.36469/9845 ◽  
2016 ◽  
Vol 3 (1) ◽  
pp. 97-107
Author(s):  
Chris Kozma ◽  
Michael Dickson ◽  
Jacqueline Pesa ◽  
Carmela J. Benson
Keyword(s):  
Cox Regression ◽  
International Classification Of Diseases ◽  
Cumulative Number ◽  
Federal Law ◽  
Classification Of Diseases ◽  
Medicaid Eligibility ◽  
The Relationship ◽  
Lower Hazard

Background: Many persons with severe mental illness qualify for Medicaid coverage. However, under federal law, states must either suspend or terminate eligibility once they are incarcerated. We hypothesize that prompt re-acquisition of Medicaid eligibility following release from incarceration lowers the risk of re-incarceration. Objectives: To assess the relationship between Medicaid eligibility and risk of re-incarceration among previously incarcerated schizophrenia diagnosed subjects. Methods: Study subjects were selected between January 1, 2006 and September 30, 2011 from a single state Medicaid database that was combined with department of corrections data. Subjects were included if they had a schizophrenia diagnosis (International Classification of Diseases, 9th Revision, Clinical Modification [ICD- 9-CM] code 295.xx), were between the ages of 18 and 62, and had been released from incarceration. Covariates included age, race, gender, marital status, and reason for incarceration. Time to Medicaid eligibility after release from incarceration, cumulative days of eligibility, and whether they were eligible on the re-incarceration date were evaluated in independent models. One and three-year Cox Regression models analyses (p&lt;0.05) were used to evaluate the hazard for re-incarceration. Results: The 932 subjects were 26.5% white, 73.7% male and were, on average, 37.6 years old on their index date (i.e., incarceration release date). They were 73.5% single or divorced and 12.7% were incarcerated for a substance abuse violation. In the 1-year follow-up period, 110 subjects (11.8%) were re-incarcerated. In the 3-year follow-up period 209 (22.4%) were re-incarcerated. Age (in years) was the only significant predictor of re-incarceration for the 1-year models (hazard ratio [HR]=0.976; confidence interval [CI]=0.957, 0.994). Eligibility was a significant predictor in the 3-year follow-up models. A longer ‘time to first eligibility’ (HR=1.046; CI=1.017, 1.075 was associated with a greater hazard for re-incarceration. Being eligible at the time of re-incarceration (HR=0.659; CI=0.498, 0.870) was associated with a lower hazard, and the cumulative number of months of eligibility (HR=0.978; CI=0.958, 0.997) and age were associated with a lower hazard for re-incarceration (HR=0.986; CI=0.973, 0.999). Conclusions: Access to Medicaid health services post-release may reduce the risk of re-incarceration.

scholarly journals Association of Tramadol and Hypoglycemia in Diabetic Asians

2018 ◽  
Vol 7 (11) ◽  
pp. 380 ◽  
Author(s):  
Shang-Yi Li ◽  
Hsin-Hung Chen ◽  
Cheng-Li Lin ◽  
Su-Yin Yeh ◽  
Chia-Hung Kao
Keyword(s):  
Claims Data ◽  
International Classification Of Diseases ◽  
Diabetic Patients ◽  
Research Database ◽  
Control Frequency ◽  
Classification Of Diseases ◽  
Multivariable Analyses ◽  
Baseline Characteristics

To evaluate the association between tramadol and hypoglycemia in diabetic Asians. The data adopted in this study were derived from a subset of the National Health Insurance (NHI) Research Database, which comprises data on one million randomly sampled beneficiaries enrolled in the NHI program. Patients diagnosed with diabetes (according to the International Classification of Diseases, Ninth Revision, Clinical Modification code 250) were identified from claims data between 1998 and 2011. Diabetic patients aged 20 years or older and prescribed tramadol constituted the tramadol group and other diabetic patients without tramadol use constituted the non-tramadol group. For each tramadol case, one non-tramadol control frequency matched according to age (every 5 years), sex and the year of tramadol use was identified. The tramadol group comprised 12,446 patients and non-tramadol group comprised 11,982 patients. During a mean follow-up of 2 years for the patients in the tramadol group and 2.79 years for those in the non-tramadol group, the overall incidences of hypoglycemia (per 1000 person-years) were 7.37 and 3.77, respectively. According to the multivariable analyses, after baseline characteristics were controlled, the tramadol group exhibited a significantly greater risk of hypoglycemia (hazard ratio (HR) = 1.34, 95% confidence interval (CI) = 1.05–1.71) compared with the non-tramadol group. Tramadol use increases hypoglycemia in diabetic Asians. Greater attention must be paid to diabetic Asians with tramadol use.

Sign in / Sign up

Export Citation Format

Share Document