scholarly journals Increased Health Care Cost Associated with Venous Thromboembolism in Patients with Malignant Glioma

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 3524-3524
Author(s):  
Heather Wright ◽  
Chris E. Holmes ◽  
Alissa Thomas
Keyword(s):  
Health Care ◽  
Venous Thromboembolism ◽  
Emergency Room ◽  
Malignant Glioma ◽  
Emergency Room Visits ◽  
Total Cost ◽  
Therapeutic Anticoagulation ◽  
Increased Risk ◽  
Inpatient Hospitalizations ◽  
Cancer Types

Abstract Background: The cumulative incidence of symptomatic venous thromboembolism (VTE) among patients with malignant glioma (MG) is high, with estimates ranging from 20-35% during the course of therapy. VTE is the second leading cause of death among ambulatory patients receiving cancer chemotherapy, with a 2-fold or greater increase in mortality compared to those without VTE, even after adjusting for stage. In patients with MG and VTE the chance of two-year survival is significantly reduced. The development of VTE is also associated with increased morbidity, including increased risk of hospitalization, delays in cancer treatment, and an increased risk of complications including pain, bleeding, and bruising from high dose therapeutic anticoagulation. The economic burden of VTE in cancer patients is estimated at a 2-fold increase in cost. Data regarding VTE burden encompasses all cancer types and additional data is needed to characterize VTE burden in specific cancer types, particularly rarer cancers. The aim of this study was to assess the healthcare burden associated with the development of VTE in patients with MG. Methods: A retrospective chart review of patients with MG at an academic medical center was conducted from 2009-2017. Sixty-seven patients, age 18 years and older, with a histologic diagnosis of MG (WHO grade III-IV) were assessed. The number of office visits, emergency room visits, and inpatient hospitalizations with the associated costs of VTE management and its complications were collected. Using SPSS, linear regression models and descriptive statistics were used to determine the relationship between the development of VTE and healthcare consumption. Results: Of the 67 patients in the study, 18 developed VTE (27%). All patients who developed a VTE were placed on therapeutic anticoagulation. Fifty percent of patients developed complications related to anticoagulation, including gastrointestinal, retroperitoneal and intracranial bleeding events. Two patients required placement of an IVC filter after experiencing a bleeding complication. Patients that developed VTE had an increase in inpatient days (16.6 inpatient days) as compared to their non-VTE counterparts (8.8 inpatient days), (p=0.012). There was increased utilization of the emergency room with an average of 3.94 visits in those patients with VTE as compared to those without (1.84), (p=0.003). A full cost analysis found that the average primary total cost for ED visits and inpatient hospitalizations in patients with VTE was $48,863 while those without VTE averaged $35,948. This represented a 26% increase in the average primary total cost in those patients with VTE. Discussion: The development of VTE in patients with MG increases inpatient admissions days and incurs additional pharmaceutical costs related to anticoagulation. This study represents the first assessment of VTE-associated health care burden specific to primary brain cancer. We confirm that VTE affects a large number of patients with MG (27%) and limits the time spent at home due to increased hospitalizations and emergency room visits. VTE may be a preventable complication and further studies are needed to investigate safe prevention strategies for patients with MG. Disclosures No relevant conflicts of interest to declare.

scholarly journals Effect of Air Quality on the Risk of Emergency Room Visits in Patients With Atrial Fibrillation

2021 ◽  
Vol 8 ◽  
Author(s):  
Bin Liang ◽  
Xiaonan He ◽  
Xin Du ◽  
Xiaoxia Liu ◽  
Changsheng Ma
Keyword(s):  
Atrial Fibrillation ◽  
Air Quality ◽  
Emergency Room ◽  
Time Lag ◽  
Emergency Room Visits ◽  
Monsoon Climate ◽  
Climate Region ◽  
Increased Risk ◽  
Increase In Risk ◽  
Pm2.5 Concentration

Background: We investigated the effect of particulate matter with aerodynamic diameter <2.5 μm (PM2.5) and meteorological conditions on the risk of emergency room visits in patients with atrial fibrillation (AF) in Beijing, which is considered as a monsoon climate region.Methods: In this case-crossover design study, medical records from patients with AF who visited the Critical Care Center in the Emergency Department of Anzhen Hospital from January 2011 through December 2014 and air quality and meteorological data of Beijing during the same period were collected and analyzed using Cox regression and time-series autocorrelation analyses.Results: A total of 8,241 patients were included. When the average PM2.5 concentration was >430 μg/m3, the risk of emergency room visits for patients with uncomplicated AF, AF combined with cardiac insufficiency, and AF combined with rheumatic heart disease increased by 12, 12, and 40%, respectively. When the average PM2.5 concentration was >420 μg/m3, patients with AF combined with diabetes mellitus had a 75% increased risk of emergency room visits, which was the largest increase in risk among all types of patients with AF. When the average PM2.5 concentration was >390 μg/m3, patients with AF combined with acute coronary syndrome had an approximately 30% increased risk of emergency room visits, which was the highest and fastest increase in risk among all types of patients with AF. The risk of emergency room visits for patients with AF was positively correlated with air quality as the time lag proceeded, with an autocorrelation coefficient of 0.223 between the risk of emergency room visits and air quality in patients with AF on day 6 of the time lag.Conclusion: Exposure to certain concentrations of PM2.5 in a monsoon climate region significantly increased the risk of emergency room visits in patients with AF.

scholarly journals Incidence, Therapy, and Bleeding Risk—Cancer- Associated Thrombosis in Patients with Glioblastoma

Cancers ◽  
2020 ◽  
Vol 12 (6) ◽  
pp. 1354 ◽  
Author(s):  
Viktoria Muster ◽  
Thomas Gary
Keyword(s):  
Brain Tumors ◽  
Bleeding Risk ◽  
Low Molecular Weight ◽  
Limited Data ◽  
Primary Brain Tumors ◽  
Therapeutic Anticoagulation ◽  
Increased Risk ◽  
Cancer Types ◽  
Thrombogenic Potential ◽  
Cancer Associated Thrombosis

Cancer is an independent risk factor for the development of venous thromboembolism (VTE). Glioblastomas are amongst cancer types with the most thrombogenic potential and patients are at a particularly high risk of VTE with an incidence up to 20–30% per year. Currently, major efforts are underway to gain novel insights into risk factors and pathomechanisms to provide a better understanding of development of VTE in patients with primary brain tumors. Treatment of VTE requires therapeutic anticoagulation, which accordingly to recently-published guidelines should be performed using low molecular weight heparin or, in case of low bleeding risk, using a direct oral anticoagulant. However, this can be very challenging due to an increased risk of intracranial hemorrhage in this patient group. Furthermore, limited data are available on the subgroup of patients with primary brain tumors.

Encouraging Self—Care within a Primary Health Care Framework

2007 ◽  
Vol 20 (2) ◽  
pp. 28-33 ◽  
Author(s):  
Mary Lou O'Neill ◽  
Evelyn Kennedy ◽  
Cyndee MacPhee
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Emergency Room ◽  
Self Care ◽  
Health Problems ◽  
Perceived Usefulness ◽  
Emergency Room Visits ◽  
Primary Health ◽  
Study Results

This study was undertaken primarily to evaluate Do I Need to See the Doctor?, a book designed to assist young families to self-manage common health problems. In addition, the study sought to determine whether providing an introductory explanation to the book had an impact on the respondents' perceived usefulness of it. Comparisons of emergency room visits were made for the timeframe of the study and for the previous year. Study results support the book's usefulness in increasing respondents' confidence to make knowledgeable, informed self-care decisions. Providing explanations did not affect the book's usefulness. A link between emergency room visits and the book requires further study.

Early use of home health care on health care utilization for patients with advanced lung cancer.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e19015-e19015
Author(s):  
Steven Rousey ◽  
Kiran Krishan Lassi ◽  
Jodi Wieczorek ◽  
James Essler ◽  
Marie Brown ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Health Care ◽  
Home Care ◽  
Emergency Room ◽  
Home Health Care ◽  
Home Health ◽  
Advanced Lung Cancer ◽  
Control Group ◽  
Emergency Room Visits ◽  
Early Use

e19015 Background: Patients with advanced lung cancer historically have required significant use of health care resources including hospitalizations, ICU admissions and emergency room visits which are often related to inadequately controlled symptoms. Most patients with advanced lung cancer prefer to remain in their own home as much as possible and are willing to work with home nursing resources, if available. The purpose of this pilot study was to determine the effect of early use of home health care on health care utilization for patients with advanced lung cancer. Methods: Betweem May 2011 and May 2012, 18 patients were enrolled in a pilot program to explore early use of home care for individuals with advanced lung cancer. Inclusion criteria consisted of a diagnosis of stage III/IV lung cancer (any histology) and home care eligibility using Medicare criteria. The endpoints were hospitalization rate, number of ICU admissions and emergency room visits. The results were compared to an historical control group (562 patients with advanced lung cancer diagnosed between 2006 and 2011). Binomial confidence interval (CI) was used to estimate the 95% CIs and Fisher's exact test was used to assess the p-values. Results: Results at one year showed the hospitalization rates for the pilot group and the control group were 44% (95% CI, 22-69) and 78% (95% CI, 74-81), respectively (p<0.01) and the ER visit rate was 17% (95% CI, 4-41) and 41% (95% CI, 37-45), respectively (p=0.049). The ICU admission rates were 0% and 11% in the two groups, respectively, and this difference was not statistically significant. Home care visits ranged from 1-77 with an average of 12 visits per patient. The estimated cost of the home care program for the duration of enrollment was $2,330 per patient. Conclusions: Early use of home health care for patients with advanced lung cancer appears to reduce the rates of hospitalization and emergency room visits when compared with historical controls, and though the results were not statistically significant, none of the 18 patients in the pilot group were admitted to the ICU. A larger multi-institutional study will examine the potential of this simple intervention for cost saving, enhanced care quality and improved patient satisfaction.

scholarly journals The Utility of Hereditary Thrombophilia Testing Among Hospitalized Patients: A Single Center Experience

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 2231-2231
Author(s):  
Omar Abughanimeh ◽  
Mohammad Tahboub ◽  
Anahat Kaur ◽  
Mouhanna Abu Ghanimeh ◽  
Zhang Zhiheng ◽  
...  
Keyword(s):  
Health Care ◽  
Retrospective Study ◽  
Venous Thromboembolism ◽  
Health Care System ◽  
Protein C ◽  
Thromboembolic Disease ◽  
Hospitalized Patients ◽  
Positive Test ◽  
P Value ◽  
Total Cost

Abstract Background: Hereditarythrombophilias (HT) are a group of inherited diseases that predispose to venous thromboembolism (VTE). It can increase the risk of VTE by 3 to 20-fold compared to general population. HT are common and present in 7% of the population. Testing for HT is routine but knowing when to order the tests and how to interpret the results can be challenging. In the United Kingdom, it is estimated that 30,000 tests are done each year to screen for HT with an annual cost of 15,000,000 Euros. This led the British Committee For Standards in Haematology (BCSH) to release guidelines in 2010 that recommends against testing patients at the time of acute venous thrombosis as it will not influence the initial treatment. In the United States there are no clear guidelines regarding testing for HT. We performed a retrospective study to look at the utilization of HT tests among hospitalized patients. This study attempts to address the clinical utility of these tests and concurrent costs to the health care system. Methods: This is a retrospective study. We reviewed 2402 patient charts with at least one HT test ordered between 2/2016-1/2018 in St Luke's Health Care System records in Kansas City, MO. The following HT tests were included: Activated protein C resistance, antiphospholipid panel, antithrombin III level, factor V Leiden mutation, factor VIII level, homocysteine level, protein C level, protein S level, and prothrombin 20210 mutation. Only patients who had testing done during hospitalization were included. Positive actionable tests were analyzed to determine the clinical benefit of ordering the tests. A positive actionable test was defined as a positive test that changed the anticoagulation intensity, type or duration. Patients with history of previous thromboembolic disease, ongoing medical condition requiring life-long anticoagulation (such as atrial fibrillation), or unprovoked thromboembolic disease were considered non actionable. We also documented the total number of positive tests, ordering providers, and total cost related to ordering these tests (total cost of tests+ cost of hematology consult after an abnormal test). Results: A total of 2402 patients were reviewed. 954 patients were included with a mean age of 54 years. 397 (41.6%) were ordered for venous thromboembolism (VTE) (Deep vein thrombosis, pulmonary embolism or both). Among the included patients, 634 had at least one positive test (Table-1). Only 89 positive tests were actionable (14% of the positive tests and 9.3% of the total ordered tests). There was a statistically significant association between increasing age and having both a positive test result (P-value 0.006), and an actionable test (P-value 0.046). The chance of having actionable tests was more if the test was done in an inpatient setting rather that in the emergency room (OR 0.361, CI 95% (0.177-0.737)). The total cost of ordering these tests was estimated to be $551,218.1 and the cost of subsequent hematology consults was $15,367 leading to total cost of $566,585 during our study period. Conclusion: Inpatient testing for thrombophilia is associated with increased health care cost and did not change management in many situations. The decision of ordering these tests should be based on a clinical risk assessment. Disclosures No relevant conflicts of interest to declare.

scholarly journals Association between Ambient Temperature, Particulate Air Pollution and Emergency Room Visits for Conjunctivitis

2021 ◽  
Author(s):  
soltan khalaila ◽  
Tara Coreanu ◽  
Alina Vodonos ◽  
Itai Kloog ◽  
Alexandra Shtein ◽  
...  
Keyword(s):  
Air Pollution ◽  
Particulate Matter ◽  
Emergency Room ◽  
Ambient Temperature ◽  
Medical Center ◽  
Financial Burden ◽  
Positive Association ◽  
Emergency Room Visits ◽  
Increased Risk ◽  
Coarse Particulate Matter

Abstract Background: Numerous studies have confirmed the association of ambient temperature and air pollution with a higher risk of morbidities, yet few have addressed their effect on the ocular system. The purpose of this study was to assess the association between temperature, air pollution, and emergency room visits for conjunctivitis.Methods: In this case-crossover study, the records of all emergency room visits to Soroka University Medical Center (SUMC) from 2009 to 2014 were reviewed for patients with conjunctivitis. Daily exposure to fine and coarse particulate matter and temperature were determined by a hybrid model involving satellite sensors.Results: 6001 patients were diagnosed with conjunctivitis in the SUMC emergency room. We discovered a positive association between temperature increments and incidence of conjunctivitis. The strongest effect was found during summer and autumn, with an immediate (lag0) incidence increase of 8.1% for each 1 °C increase in temperature (OR 1.088 95%CI 1.046;1.132) between 24 and 28 °C in the summer and 7.2% for each 1 °C increase in temperature (OR 1.072 95%CI 1.036;1.108) between 13 and 23 °C in the autumn. There was no statistically significant association between fine and coarse particulate matter and conjunctivitis incidence.Conclusion: Temperature increases during summer and autumn are significantly associated with an increased risk of conjunctivitis. Conjunctivitis is not associated with non-anthropogenic air pollution. These findings may help community clinics and hospital emergency rooms better predict conjunctivitis cases and will hopefully lead to improved prevention efforts that will lower the financial burden on both the individual and the public.

Physician Reimbursement

PEDIATRICS ◽  
1988 ◽  
Vol 82 (2) ◽  
pp. 282-282
Author(s):  
GEORGE J. COHEN
Keyword(s):  
Health Care ◽  
American Academy ◽  
Emergency Room ◽  
Cost Control ◽  
Emergency Room Visits ◽  
Physician Reimbursement ◽  
American Academy Of Pediatrics

To the Editor.— In the excellent study of physician reimbursement by Hickson et al (Pediatrics 1987;80:344-350), there seems to be an implication that more health care visits than stated in the American Academy of Pediatrics' guidelines constitute excessive cost and perhaps unnecessary patient-doctor interaction. The suggestion that limiting compensation to just the visits in the guidelines might be a technique of cost control is really self-defeating. The authors have already demonstrated that more well-child visits decrease the number of emergency room visits, which are far more expensive.

scholarly journals GERIATRICS PREVENTABLE ADMISSIONS CARE TEAM (GERIPACT): A HIGH-RISK INTENSIVE AMBULATORY GERIATRICS PROGRAM

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S147-S147
Author(s):  
Stephanie W Chow ◽  
Lizette Munoz ◽  
Susana Lavayen ◽  
Shamsi Fani ◽  
Blair MacKenzie ◽  
...  
Keyword(s):  
Health Care ◽  
Social Work ◽  
High Risk ◽  
Emergency Room ◽  
Older Patients ◽  
Care Team ◽  
Emergency Room Visits ◽  
Telephone Hotline ◽  
Ed Visits ◽  
Preventable Admissions

Abstract The Geriatrics Preventable Admissions Care Team (GERIPACT) is an inter-professional team of 2 clinicians, 1 social worker, and 1 care coordinator, dedicated to offering temporary intensive ambulatory care services to complex older patients at high-risk for incurring expensive health care (ie. frequent emergency room visits or hospitalizations). GERIPACT services include frequent office visits for medical and social work needs, frequent telephone contact, home visits, specialty visit accompaniment, and a 24/7 telephone hotline. Use of this innovative model aims to serve communities lacking in geriatrician and geriatric social work providers, with a main goal of serving the highest risk older population. We reviewed the healthcare utilization of GERIPACT enrollees 6 months prior-to-enrollment and compared with 6 months following graduation from GERIPACT from 2016 to 2018. 78 patients were evaluated, with 49 total ED visits prior to enrollment and 35 post-graduation, saving 14 ED visits for a ratio of 18 saved ED visits per 100 GERIPACT patients. There were 45 hospitalizations prior to enrollment with 29 hospitalizations post-graduation, saving 16 hospitalizations, or 20 hospitalizations per 100 GERIPACT patients. Hospital days were reduced by 237 days post-graduation. An intensive ambulatory program for high risk geriatrics patients may be shown to be an efficient model of care for targeting those older patients who potentially incur greater expenses to the health care system. This focused team may be deployed to primary care communities with complex elderly patients in need of geriatricians and geriatric social workers, and may reduce unnecessary emergency room visits and inpatient stays.

Additional Disease Burden from Hay Fever and Sinusitis Accompanying Asthma

2009 ◽  
Vol 118 (9) ◽  
pp. 651-655 ◽  
Author(s):  
Neil Bhattacharyya ◽  
Lynn J. Kepnes
Keyword(s):  
Health Care ◽  
Allergic Rhinitis ◽  
Emergency Room ◽  
National Health Interview Survey ◽  
Disease Burden ◽  
Health Care Expenditures ◽  
Hay Fever ◽  
Health Care Spending ◽  
Emergency Room Visits ◽  
Interview Survey

Objectives: We sought to determine the additional disease burden imparted by sinusitis and hay fever (allergic rhinitis) to patients with asthma. Methods: Patients with a diagnosis of asthma, hay fever, or sinusitis were extracted from the National Health Interview Survey for the 1997 to 2006 adult sample. Disease groups consisting of patients with asthma alone, asthma + hay fever, asthma + sinusitis, and asthma + hay fever + sinusitis were assembled. Disease groups were then compared according to total health-care visits per year, emergency room visits per year, health-care spending per year, and number of workdays lost per year to determine the disease burden. Results: We identified 11,813 patients (mean age, 45.5 years) who reported active asthma with or without hay fever or sinusitis comorbidity. Of these, 5,931 patients (50%) were identified with asthma alone, 1,134 (10%) with combined asthma + hay fever, 2,461 (21%) with asthma + sinusitis, and 2,287 (19%) with combined asthma + hay fever + sinusitis. Patients with asthma + sinusitis and those with asthma + sinusitis + hay fever had more total health-care visits and emergency room visits than did those with asthma alone (p < 0.001). All three groups with comorbidities had higher health-care expenditures than did the group with asthma alone (p ≤ 0.002). Patients with asthma + sinusitis and those with asthma + hay fever + sinusitis missed more workdays than did patients in the group with asthma alone (10.0 and 13.1 versus 7.2, respectively; p < 0.001). Comorbid hay fever alone did not increase workdays lost (6.6 days; p = 0.983). Conclusions: The additional disease burden of sinusitis on asthma is greater than that of hay fever. These data highlight the importance of identifying comorbid diagnoses with asthma.

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