scholarly journals Exploring trajectories of emergency department visits using a laboratory-based indicator of serious illness

2019 ◽  
Vol 26 (1) ◽  
pp. 205-217
Author(s):  
Ofir Ben-Assuli ◽  
Rema Padman ◽  
Itamar Shabtai
Keyword(s):  
Emergency Department ◽  
Medical Condition ◽  
Developmental Trajectories ◽  
Emergency Department Visits ◽  
Future Research ◽  
Electronic Health Record Data ◽  
Serious Illness ◽  
Targeted Interventions ◽  
The Stability ◽  
Over Time

Repeated emergency department visits have become a serious challenge worldwide. Despite prior research indicating that laboratory results may provide early alerts about such patients on their upcoming adverse events, few studies have examined their role as a critical indicator of the stability of a patient’s medical condition over time. We model and analyze the developmental trajectories of patients’ creatinine levels, a key laboratory marker of serious illness, as a potential risk stratification mechanism across many emergency department visits. We apply group-based statistical methodology to electronic health record data of 70,385 patients, with 3–15 emergency department visits, to identify and profile these trajectories for the entire population, for males and for females. Results reveal three distinct creatinine-based trajectory groups over time with significantly differing characteristics that may enable targeted interventions for each group. Future research will incorporate additional disease markers to identify longitudinal factors leading to repeated emergency department visits.

Emergency Department Visits due to Scabies in the United States: A Retrospective Analysis of a Nationally Representative Emergency Department Sample

2019 ◽  
Author(s):  
Raghav Tripathi ◽  
Konrad D Knusel ◽  
Harib H Ezaldein ◽  
Jeremy S Bordeaux ◽  
Jeffrey F Scott
Keyword(s):  
United States ◽  
Emergency Department ◽  
Retrospective Analysis ◽  
The United States ◽  
Cost Of Care ◽  
Emergency Department Visits ◽  
Limited Information ◽  
Targeted Interventions ◽  
Ed Visits ◽  
Nationally Representative

Abstract Background Limited information exists regarding the burden of emergency department (ED) visits due to scabies in the United States. The goal of this study was to provide population-level estimates regarding scabies visits to American EDs. Methods This study was a retrospective analysis of the nationally representative National Emergency Department Sample from 2013 to 2015. Outcomes included adjusted odds for scabies ED visits, adjusted odds for inpatient admission due to scabies in the ED scabies population, predictors for cost of care, and seasonal/regional variation in cost and prevalence of scabies ED visits. Results Our patient population included 416 017 218 ED visits from 2013 to 2015, of which 356 267 were due to scabies (prevalence = 85.7 per 100 000 ED visits). The average annual expenditure for scabies ED visits was $67 125 780.36. The average cost of care for a scabies ED visit was $750.91 (±17.41). Patients visiting the ED for scabies were most likely to be male children from lower income quartiles and were most likely to present to the ED on weekdays in the fall, controlling for all other factors. Scabies ED patients that were male, older, insured by Medicare, from the highest income quartile, and from the Midwest/West were most likely to be admitted as inpatients. Older, higher income, Medicare patients in large Northeastern metropolitan cities had the greatest cost of care. Conclusion This study provides comprehensive nationally representative estimates of the burden of scabies ED visits on the American healthcare system. These findings are important for developing targeted interventions to decrease the incidence and burden of scabies in American EDs.

A quality improvement intervention in geriatric psychiatry care: Results of a pre-post design study

2016 ◽  
Vol 33 (S1) ◽  
pp. S84-S84
Author(s):  
E. Albuquerque ◽  
S. Fernandes ◽  
J. Cerejeira
Keyword(s):  
Emergency Department ◽  
Behavioral Problems ◽  
Hospital Admissions ◽  
Emergency Department Visits ◽  
Quality Improvement Intervention ◽  
Future Research ◽  
Elderly Subjects ◽  
Psychiatric Ward ◽  
Design Study ◽  
Emergency Visits

IntroductionInnovative approaches are needed to respond to the increasing number of elderly subjects with complex psychiatric conditions who require flexible and rapid responses, avoiding unnecessary hospital admissions. A new organizational model was implemented in our psychogeriatric service in September 2011 consisting of:– a comprehensive multidisciplinary geriatric assessment;– a helpline for caregivers for management of acute behavioral problems;– programmed visits to nursing homes.AimsTo evaluate whether the implementation of this program was associated with a reduction in hospital admissions and emergency department visits.MethodsThis is a pre-post test design study, involving 1197 patients who attended the Old Age Psychiatric (OAP) Unit three years before and three years after the implementation of the organizational intervention (1.09.2008 to 1.10.2014). An index of patient × year was calculated considering the period during which the patient was followed in OAP Unit. Data was obtained from the medical files of all eligible patients regarding demographic variables, number and type of hospital admissions and emergency department visits.ResultsDuring the 3 years before the intervention 671.2 patients × years were included (mean age of 75.8 years) while after the intervention this reached 2010.1 patients × years (mean age of 77.8 years). The intervention was associated with a decrease of 44% in psychiatry emergency visits, 48% in general emergency visits, 44% in psychiatric ward admissions and 51% in geriatric ward admissions.ConclusionsThe implementation of this new model was associated with significant reduction of hospital-based service utilization. Future research should determine if this was coupled with increased health outcomes.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Corporate dividend policy revisited

2015 ◽  
Vol 41 (2) ◽  
pp. 126-144 ◽  
Author(s):  
H. Kent Baker ◽  
Rob Weigand
Keyword(s):  
Dividend Policy ◽  
Payout Policy ◽  
Future Research ◽  
Stylized Facts ◽  
Content Type ◽  
Dividend Policies ◽  
Popular View ◽  
The Stability ◽  
Practical Implications ◽  
Over Time

Purpose – The purpose of this paper is to provide an overview and synthesis of some important literature on dividend policy, chronicle changing perspectives and trends, provide stylized facts, offer practical implications, and suggest avenues for future research. Design/methodology/approach – The authors provide a survey of literature surveys with a focus on insights for paying cash dividends. Findings – The analysis of literature surveys on dividend policy provides some stylized facts. For example, US evidence indicates that the importance of cash dividends as a part of investors’ total returns has declined over time. Share repurchases now play an increasingly important role in payout policy in countries permitting stock buybacks. The popular view is that dividend policy is important, as evidenced by the large amount of money involved and the attention that firms, security analysts, and investors give to dividends. Firms tend to follow a managed dividend policy rather than a residual dividend policy, which involves paying dividends from earnings left over after meeting investment needs while maintaining its target capital structure. Certain determinants of cash dividends are consistently important over time in shaping actual dividend policies including the stability of past dividends and current and anticipated earnings. No universal set of factors is appropriate for all firms because dividend policy is sensitive to numerous factors including firm characteristics, market characteristics, and substitute forms of dividends. Universal or one-size-fits-all theories or explanations for why companies pay dividends are too simplistic. Practical implications – The dividend puzzle remains an important topic in modern finance. Originality/value – This is the first a survey of literature surveys on cash dividends.

scholarly journals Defining, quantifying, and characterizing adult frequent users of a suburban Canadian emergency department

CJEM ◽  
2013 ◽  
Vol 15 (04) ◽  
pp. 214-226 ◽  
Author(s):  
Jessica Moe ◽  
Allan L. Bailey ◽  
Ryan Oland ◽  
Linda Levesque ◽  
Heather Murray
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Administrative Database ◽  
Fiscal Year ◽  
Future Research ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Frequent Users ◽  
Targeted Interventions ◽  
Admission Rates

ABSTRACTIntroduction:Frequent emergency department (ED) users are inconsistently defined and poorly studied in Canada. The purpose of this study was to develop uniform definitions, quantify ED burden, and characterize adult frequent users of a suburban community ED.Methods:We retrospectively reviewed the administrative database of the WestView ED in Alberta for patients ≥ 18 years of age presenting during the fiscal year of 2010. Adult frequent users and extreme frequent users were defined as patients with yearly visit numbers greater than the 95th and 99th percentiles, respectively. Demographic information including age, sex, ED length of stay, diagnoses, Canadian Triage and Acuity Scale (CTAS) level, and disposition were collected and stratified by ED frequency of use categories.Results:The study included 22,333 ED visits by 14,223 patients. Frequent users represented 3.1% of patients and 13.8% of visits. Extreme frequent users represented 0.8% of patients, 5.4% of visits, and 568,879 cumulative ED minutes (395 days). Nonfrequent users had one to four, frequent users had five or more, and extreme frequent users had eight or more visits over a 12-month period. Frequent users and extreme frequent users had a significantly longer ED length of stay overall and in most age categories. Alcohol-related behavioural disorders, anxiety, nausea/vomiting, and chronic obstructive pulmonary disease were prominent diagnoses, suggesting that psychiatric, somatic, and chronic illnesses may underlie recurrent visits. Admission rates were significantly higher for frequent compared to nonfrequent users.Conclusions:We propose reproducible definitions for adult frequent and extreme frequent ED users and provide information on the characteristics and burden of care of these groups at a community Canadian suburban ED. Adoption of these definitions would allow comparison across centres in future research and facilitate targeted interventions for frequent and extreme frequent ED users.

scholarly journals P086: Emergency department visits for upper gastrointestinal bleeding: a population-based Alberta cohort

CJEM ◽  
2018 ◽  
Vol 20 (S1) ◽  
pp. S87-S87
Author(s):  
E. S. Lang ◽  
G. Kaplan ◽  
D. Tanyingoh ◽  
K. Novak ◽  
S. Veldhuyzen van Zanten ◽  
...  
Keyword(s):  
Emergency Department ◽  
Gastrointestinal Bleeding ◽  
Emergency Departments ◽  
Upper Gastrointestinal Bleeding ◽  
Medical Condition ◽  
Large Population ◽  
Population Based ◽  
Emergency Department Visits ◽  
Fiscal Year ◽  
Upper Gastrointestinal

Introduction: Upper gastrointestinal bleeding (UGIB) is a common medical condition presenting to emergency departments (ED) and associated with substantial morbidity, mortality, and healthcare expenditures. Our aim was to evaluate the incidence of patients presenting to ED with UGIB in a large population-based surveillance cohort. Methods: The National Ambulatory Care Reporting System (NACRS) was used to identify all presentations to emergency departments for UGIB in Alberta from fiscal year 2010 to 2015 (n=56519) using the International Classification of Diseases Codes (ICD-10) in any diagnostic position. Baseline characteristics and UGIB incidence were calculated using descriptive statistics. Joinpoint regression models were used to calculate the average annual percent change (AAPC) with 95% confidence intervals (CI). Results: The median age of 56519 UGIB presentations was 56 years (interquartile range: 41 to 74 years), 56% were male, and 245% had at least one comorbidity. At time of disposition from the ED , 48.3% were admitted to or transferred to another hospital, 51.4% discharged, and 0.3% died in the emergency department. Further, 10.8% underwent upper endoscopy during their admission to the emergency department. The annual incidence of UGIB were 230.6 (2010), 232.8 (2011), 241.0 (2012), 242.2 (2013), 244.6 (2014), and 242.2 (2015) per 100,000 person-years. Between 2010 and 2015 the incidence of UGIB presenting to ED significantly increased overtime (AAPC=1.1; 95% CI: 0.3 to 2.0). Conclusion: UGIB is a common presentation to emergency departments and has been increasing overtime. Future studies are necessary to evaluate the underlying cause of UGIB and to determine its burden to Albertas healthcare system.

Medical Visits From Birth to 6 Months Predict Child Maltreatment Diagnoses Up to Age 5

2020 ◽  
Vol 59 (14) ◽  
pp. 1258-1264
Author(s):  
Sonya Negriff ◽  
Mercie J. DiGangi ◽  
Adam L. Sharp ◽  
Jun Wu
Keyword(s):  
Emergency Department ◽  
Primary Care Providers ◽  
Emergency Department Visits ◽  
Early Infancy ◽  
Medical Utilization ◽  
Care Providers ◽  
Electronic Health Record Data ◽  
Kaiser Permanente ◽  
Medical Visits ◽  
Key Variables

Electronic health record data for pediatric members of Kaiser Permanente Southern California were used to identify key variables (ie, the number of emergency department visits and the number of providers) available in early infancy (0-6 months) placing children at higher risk of a maltreatment diagnosis in the first 5 years of life. The analytic sample included 96 462 children age 0 to 5 years born from January 1, 2009, to June 30, 2018. Poisson regression showed that children with ≥2 emergency department visits from birth to 6 months were at twice the risk of a maltreatment diagnosis before age 2 and 5 years compared with those children with no emergency department visits. Children with more continuity of primary care providers (0-5 providers) in the first 6 months of life were at lower risk of a maltreatment diagnosis at 2 years and 5 years than those children who saw multiple providers (6+). Information about medical utilization in early infancy may help physicians and other medical providers identify children at higher risk of maltreatment and prevent future incidents.

scholarly journals RATES OF HOSPITALIZATION AND EMERGENCY DEPARTMENT VISITS AND THE QUALITY OF NURSING HOMES IN THE U.S.

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S688-S688
Author(s):  
Ian Breunig ◽  
Qing Zheng ◽  
Alan White ◽  
Christianna Williams ◽  
Allison Muma
Keyword(s):  
Emergency Department ◽  
Acute Care ◽  
Hospital Admissions ◽  
Emergency Department Visits ◽  
National Database ◽  
Future Research ◽  
Short Stay ◽  
Data Set ◽  
For Profit ◽  
Provider Characteristics

Abstract CMS strives to reduce costs and improve care for nursing home (NH) residents by reducing acute care transfers. We used a national database of Medicare claims and the Minimum Data Set to build NH stays from July 2017 through June 2018 and identify dates of hospital admissions and emergency department visits without hospitalization (ED) among all residents. We calculated rates of 30-day re-hospitalization and ED among short-stay (rehabilitation) residents, and the number of hospitalizations or ED per long-stay resident day (LSRD), then examined associations with NH Five-Star ratings (data.medicare.gov) and other provider characteristics available from Medicare administrative data. We identified 1.79 million short-stays and 898,290 long-stays at 15,576 NHs. Nationally, the 30-day re-hospitalization rate is 22.6%, the short-stay ED rate is 12.0%, there was one hospitalization every 561 LSRD (1.8 per 1000 LSRD), and there was one ED every 617 LSRD (1.6 per 1000 LSRD). Median facility rates were 22.3% (IQR=17.8%, 27.1%) for 30-day re-hospitalizations, 12.0% (IQR=8.7%, 16.1%) for short-stay EDs, 1.6 hospitalizations per 1000 LSRD (IQR=1.1, 2.3), and 1.4 ED per 1000 LSRD (IQR =0.9, 2.2). Higher rates were strongly associated with lower Five-Star ratings, particularly staffing ratings, and larger, for-profit, non-hospital facilities; even after risk-adjustment. NH variation and associations with provider characteristics suggest it is possible to further reduce acute care transfers. CMS incorporated these measures into the Five-Star rating system, providing greater transparency for residents and possibly incentivizing NHs to improve through competition. Future research should monitor success or identify the need for other avenues to improve.

scholarly journals Exploratory Research on the Health and Social Outcomes of Public Housing

2019 ◽  
Vol 4 (3) ◽  
Author(s):  
Mark Smith ◽  
Aynslie Hinds ◽  
Heather Prior ◽  
Dan Chateau
Keyword(s):  
Emergency Department ◽  
Criminal Justice ◽  
Criminal Justice System ◽  
Public Housing ◽  
Administrative Data ◽  
Justice System ◽  
Emergency Department Visits ◽  
Social Outcomes ◽  
The Impact ◽  
Over Time

BackgroundUnder the National Housing Strategy, the Canadian government will make historic investments in housing over the next decade. The Canadian Mortgage and Housing Corporation is leading a research strategy to evaluate the impact of these investments. As part of this initiative, the Manitoba Center for Health Policy is conducting a pilot study to determine whether administrative data can be used to assess impacts, specifically looking at health, education and involvement in the justice system. ApproachUsing administrative data we tested for changes in healthcare use and justice involvement in the two years before and after a cohort of individuals moved into public housing. Additionally, to determine if changes in the outcomes over time were unique to public housing, we included a matched comparison group of individuals who did not reside in public housing. GLM with generalized estimating equations tested for differences over time and between cohorts in the number of hospitalizations, inpatient days, emergency department visits, and contacts with the criminal justice system. The data were modeled using a Poisson distribution (rate ratio, RR). Results Compared to the matched cohort, individuals accepted into public housing showed a significant decline in number of hospitalizations (pre RR=1.58 (1.53, 1.63), post RR=1.23 (1.19, 1.27), days in hospital (pre RR=1.66 (1.64, 1.68), post RR=1.24 (1.23, 1.26) and visits to the emergency department (pre RR=1.57 (1.52, 1.62), post RR=1.42 (1.38, 1.47). A trend towards fewer involvements with the criminal justice system was also observed (pre RR=1.37 (1.32, 1.43), post RR=1.28 (1.22, 1.34). No significant differences were noted for total respiratory morbidity or high school grades. ConclusionAdministrative data show good potential to be used for the evaluation of public housing impacts on a wide range of health and social outcomes. Additional indicator comparisons will be reported at the conference.

Impact of emergency department visit on disease self-management in adults with depression

2016 ◽  
Vol 23 (4) ◽  
pp. 588-597 ◽  
Author(s):  
Neeraj Bhandari ◽  
Yunfeng Shi ◽  
Larry R Hearld ◽  
Megan McHugh
Keyword(s):  
Emergency Department ◽  
Emergency Department Visit ◽  
Behavioral Change ◽  
Emergency Department Visits ◽  
Self Management ◽  
Teachable Moment ◽  
Targeted Interventions ◽  
Percentage Points ◽  
Health Related ◽  
Behavior Health

Unexpected health-endangering events that lead to an emergency department visit may be perceived as “wake-up calls” and induce significant changes in health-related behavior (“health shock” effect). This study uses two waves of a survey of 826 adults with depression and finds that having an emergency department visit(s) increased medication adherence by 7.6 percentage points ( p < 0.05) relative to non-emergency department visitors but had no significant effect on counseling attendance (0.02% points, p = 0.380). Emergency department visits may provide an opportune teachable moment to initiate targeted interventions for positive behavioral change in adults with depression.

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