Health care utilization after referral from a hospital emergency department

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.

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PEER TO PEER SUPPORT AND HEALTH CARE UTILIZATION AMONG COMMUNITY-DWELLING OLDER ADULTS

Innovation in Aging ◽

10.1093/geroni/igz038.3151 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S857-S857

Author(s):

Elizabeth A Jacobs ◽

Rebecca Schwei ◽

Scott Hetzel ◽

Jane Mahoney ◽

KyungMann Kim

Keyword(s):

Older Adults ◽

Health Care ◽

Emergency Department ◽

Health Care Utilization ◽

Peer Support ◽

Peer Group ◽

Peer To Peer ◽

Emergency Department Visits ◽

Urgent Care ◽

Care Utilization

Abstract The majority of older adults want to live and age in their communities. Some community-based organizations (CBOs) have initiated peer-to-peer support services to promote aging in place but the effectiveness of these programs is not clear. Our objective was to compare the effectiveness of a community-designed and implemented peer-to-peer support program vs. access to standard community services, in promoting health and wellness in vulnerable older adult populations. We partnered with three CBOs, one each in California, Florida, and New York, to enroll adults 65 > years of age who received peer support and matched control participants (on age, gender, and race/ethnicity) in an observational study. We followed participants over 12 months, collecting data on self-reported urgent care and emergency department visits and hospitalizations. In order to account for the lack of randomization, we used a propensity score method to compare outcomes between the two groups. We enrolled 222 older adults in the peer-to-peer group and 234 in the control group. After adjustment, we found no differences between the groups in the incidence of hospitalization, urgent and emergency department visits, and composite outcome of any health care utilization. The incidence of urgent care visits was statistically significantly greater in the standard community service group than in the peer-to-peer group. Given that the majority of older adults and their families want them to age in place, the question of how to do this is highly relevant. Peer-to-peer services may provide some benefit to older adults in regard to their health care utilization.

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Relationship Between Intensive Care Unit Delirium Severity and 2-Year Mortality and Health Care Utilization

American Journal of Critical Care ◽

10.4037/ajcc2020498 ◽

2020 ◽

Vol 29 (4) ◽

pp. 311-317

Author(s):

Patricia S. Andrews ◽

Sophia Wang ◽

Anthony J. Perkins ◽

Sujuan Gao ◽

Sikandar Khan ◽

...

Keyword(s):

Health Care ◽

Intensive Care Unit ◽

Emergency Department ◽

Intensive Care ◽

Health Care Utilization ◽

Mortality Risk ◽

Hazard Ratio ◽

Emergency Department Visits ◽

Care Utilization ◽

Increased Risk

Background Critical care patients with delirium are at an increased risk of functional decline and mortality long term. Objective To determine the relationship between delirium severity in the intensive care unit and mortality and acute health care utilization within 2 years after hospital discharge. Methods A secondary data analysis of the Pharmacological Management of Delirium and Deprescribe randomized controlled trials. Patients were assessed twice daily for delirium or coma using the Richmond Agitation-Sedation Scale and the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). Delirium severity was measured using the CAM-ICU-7. Mean delirium severity (from time of randomization to discharge) was categorized as rapidly resolving, mild to moderate, or severe. Cox proportional hazards regression was used to model time to death, first emergency department visit, and rehospitalization. Analyses were adjusted for age, sex, race, Charlson Comorbidity Index, Acute Physiology and Chronic Health Evaluation II score, discharge location, diagnosis, and intensive care unit type. Results Of 434 patients, those with severe delirium had higher mortality risk than those with rapidly resolving delirium (hazard ratio 2.21; 95% CI, 1.35-3.61). Those with 5 or more days of delirium or coma had higher mortality risk than those with less than 5 days (hazard ratio 1.52; 95% CI, 1.07-2.17). Delirium severity and number of days of delirium or coma were not associated with time to emergency department visits and rehospitalizations. Conclusion Increased delirium severity and days of delirium or coma are associated with higher mortality risk 2 years after discharge.

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Regular source of ambulatory care and medical care utilization by patients presenting to a public hospital emergency department

JAMA ◽

10.1001/jama.271.24.1909 ◽

1994 ◽

Vol 271 (24) ◽

pp. 1909-1912 ◽

Cited By ~ 43

Author(s):

D. W. Baker

Keyword(s):

Emergency Department ◽

Medical Care ◽

Ambulatory Care ◽

Public Hospital ◽

Care Utilization ◽

Hospital Emergency Department ◽

Hospital Emergency ◽

Medical Care Utilization ◽

Regular Source

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Depression in Emergency Department Patients and Association With Health Care Utilization

Academic Emergency Medicine ◽

10.1111/acem.13726 ◽

2019 ◽

Vol 26 (8) ◽

pp. 878-888 ◽

Cited By ~ 5

Author(s):

David G. Beiser ◽

Charlotte E. Ward ◽

Milkie Vu ◽

Neda Laiteerapong ◽

Robert D. Gibbons

Keyword(s):

Health Care ◽

Emergency Department ◽

Health Care Utilization ◽

Care Utilization ◽

Emergency Department Patients

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

Journal of Pediatric Psychology ◽

10.1093/jpepsy/jsz049 ◽

2019 ◽

Vol 44 (9) ◽

pp. 1097-1110 ◽

Cited By ~ 2

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.

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Tobacco Smoke Exposure and Health-Care Utilization Among Children in the United States

American Journal of Health Promotion ◽

10.1177/0890117116686885 ◽

2017 ◽

Vol 32 (1) ◽

pp. 123-130 ◽

Cited By ~ 7

Author(s):

Ashley L. Merianos ◽

Cathy Odar Stough ◽

Laura A. Nabors ◽

E. Melinda Mahabee-Gittens

Keyword(s):

Health Care ◽

Emergency Department ◽

Health Care Utilization ◽

Medical Care ◽

Tobacco Smoke ◽

Smoke Exposure ◽

Tobacco Smoke Exposure ◽

Care Utilization ◽

Care Visit ◽

Health Advice

Purpose: The purpose of this study was to assess patterns of health-care utilization among children who potentially had tobacco smoke exposure (TSE) compared to those who were not exposed. Design: A secondary data analysis of the 2011 to 2012 National Survey on Children’s Health was performed. Setting: Households nationwide were selected. Participants: A total of 95 677 children aged 0 to 17 years. Measures: Sociodemographic characteristics, TSE status, and health-care visits were measured. Analysis: Multivariable logistic regression models were performed. Results: A total of 24.1% of children lived with smokers. Approximately 5% had home TSE. Participants who lived with a smoker were significantly more likely to have had a medical care visit (odds ratio [OR] = 1.22, confidence interval [CI] = 1.21-1.22) and were more likely to seek sick care or health advice at an emergency department (OR = 1.23, CI = 1.23-1.24) but were less likely to have had a dental care visit (OR = 0.82, CI = 0.82-0.83) than those who did not live with a smoker. Similar findings were found among participants who had home TSE. Conclusion: TSE is a risk factor for increased use of pediatric medical care. Based on the high number of children who potentially had TSE and received sick care or health advice at an emergency emergency department, this setting may be a venue to deliver health messages to caregivers.

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