scholarly journals Trends in Hydroxyurea Utilization for the Treatment of Sickle Cell Anemia in Florida

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 2293-2293
Author(s):  
Vandy Black ◽  
Jasmine A Mack ◽  
Jaclyn Hall ◽  
Heather Morris ◽  
Elizabeth Shenkman ◽  
...  
Keyword(s):  
Emergency Department ◽  
Sickle Cell ◽  
Sickle Cell Anemia ◽  
Research Funding ◽  
Emergency Department Visits ◽  
Research Network ◽  
Common Data Model ◽  
Icd 10 ◽  
Acute Healthcare ◽  
The Impact

Background: Hydroxyurea (HU) has emerged as an important disease-modifying therapy for children and adults with sickle cell anemia (SCA), but has traditionally been underutilized. Consensus, evidence-based guidelines published by the National Heart, Lung, and Blood Institute (NHLBI) in 2014 recommended broadening the use of HU for SCA, but the impact of these recommendations on HU utilization is unknown. The objective of this abstract is to determine if HU utilization in children and adults with SCA living in Florida increased following publication of the 2014 Guidelines. We hypothesized that limitations in care coordination and implementation resulted in minimal increases in the rates of HU utilization. We further hypothesized that individuals living more than 45 minutes from a comprehensive sickle cell center would be less likely to be prescribed HU in the prior 12 months. Methods: This study is a cross sectional analysis utilizing the OneFlorida Clinical Data Research Network (CDRN), which provides access to electronic health record and claims data for over 15.4 million patient records standardized to the PCORnet Common Data Model v4.1. Possible SCA cases were identified by International Classification of Diseases, 9th (ICD-9) and 10th (ICD-10) revision codes. Patients were eligible if they were at least 9 months of age and had two or more health encounters in which an ICD-9 or ICD-10 code for SCA was used. The primary endpoint was one or more HU prescriptions written or filled in a given calendar year between 2012 and 2017. In order to examine trends in HU utilization, segmented regression analyses of an interrupted time series were conducted. Logistic regression was performed to identify patient characteristics independently associated with HU utilization in 2017. Covariates of interest included age, gender, acute healthcare utilization (emergency department visits and hospitalizations), and distance to comprehensive sickle cell care (defined by zip code+4). Adjusted Odds Ratios (OR) and 95% confidence intervals (CI) were reported. Thirteen comprehensive sickle cell centers were identified based on local expert opinion, review of the American Society of Hematology Find a Hematologist database, and involvement in recent multicenter clinical trials. Results: 9,532 unique patients were identified with a mean age in 2017 of 21 years (SD 17.6). 57.4% were female, 76.2% were Black, 6% were Hispanic, 65.2% had three or more acute healthcare visits, 23% lived more than 45 minutes from a comprehensive sickle cell center, and approximately 73% were insured by Medicaid. Between 2012 and 2017, there was a 4.7% increase in HU utilization (12.7% vs. 17.4%, p<0.0001); see figure for trends in prescriptions written per quarter for each year stratified by age. Patients 6-17 years (OR 1.95, 95% CI 1.71-2.22, p<0.0001) and 18-21 years (OR 2.32, 95% CI 1.89-2.85, P<0.0001) were more likely to be prescribed HU compared to patients 22 years of age and older. Patients less than 6 years of age were less likely to be prescribed HU (0.81, 95% CI 0.68-0.97, p=0.02). Males (OR 1.47, 95% CI 1.31-1.65, p<0.0001) and individuals with three or more acute healthcare visits in a year (OR 22.56, 95% CI 17.03-29.89, p<0.0001) were more likely to be prescribed HU. No differences in HU utilization in 2017 were identified for individuals living 45 minutes or more from a comprehensive sickle cell center (OR 0.89, 95% CI 0.78-1.02, P=0.09). Conclusions: These findings suggest there has been a slight, but statistically significant, increase in HU utilization in children and adults with SCA in Florida since publication of the 2014 NHLBI Guidelines. HU is being prescribed to more pediatric patients less than 18 years of age. However, HU remains drastically underutilized and appears to be preferentially prescribed to patients with three or more hospitalizations or emergency department visits per year. Additional research is needed to determine predictors of HU utilization and implementation strategies to improve prescribing rates. The OneFlorida CDRN provides an excellent resource to track quality metrics for SCA in Florida. Figure Disclosures Black: Micelle BioPharma: Research Funding; Prolong Pharmaceuticals: Consultancy; Sanofi: Consultancy; Sancilio and Company: Research Funding; NHLBI: Research Funding; Pfizer: Research Funding; Novartis: Research Funding; HRSA: Research Funding. OffLabel Disclosure: Hydroxyurea for children less than 2 years of age

scholarly journals Interrupted time series design to evaluate ICD-9-CM to ICD-10-CM coding changes on trends in Colorado emergency department visits related to traumatic brain injury

2021 ◽  
Vol 8 (1) ◽  
Author(s):  
Lauren Alexis De Crescenzo ◽  
Barbara Alison Gabella ◽  
Jewell Johnson
Keyword(s):  
Public Health ◽  
Traumatic Brain Injury ◽  
Emergency Department ◽  
Brain Injury ◽  
Interrupted Time Series ◽  
Emergency Department Visits ◽  
Control And Prevention ◽  
Icd 10 ◽  
Ed Visits ◽  
The Impact

Abstract Background The transition in 2015 to the Tenth Revision of the International Classification of Disease, Clinical Modification (ICD-10-CM) in the US led the Centers for Disease Control and Prevention (CDC) to propose a surveillance definition of traumatic brain injury (TBI) utilizing ICD-10-CM codes. The CDC’s proposed surveillance definition excludes “unspecified injury of the head,” previously included in the ICD-9-CM TBI surveillance definition. The study purpose was to evaluate the impact of the TBI surveillance definition change on monthly rates of TBI-related emergency department (ED) visits in Colorado from 2012 to 2017. Results The monthly rate of TBI-related ED visits was 55.6 visits per 100,000 persons in January 2012. This rate in the transition month to ICD-10-CM (October 2015) decreased by 41 visits per 100,000 persons (p-value < 0.0001), compared to September 2015, and remained low through December 2017, due to the exclusion of “unspecified injury of head” (ICD-10-CM code S09.90) in the proposed TBI definition. The average increase in the rate was 0.33 visits per month (p < 0.01) prior to October 2015, and 0.04 visits after. When S09.90 was included in the model, the monthly TBI rate in Colorado remained smooth from ICD-9-CM to ICD-10-CM and the transition was no longer significant (p = 0.97). Conclusion The reduction in the monthly TBI-related ED visit rate resulted from the CDC TBI surveillance definition excluding unspecified head injury, not necessarily the coding transition itself. Public health practitioners should be aware that the definition change could lead to a drastic reduction in the magnitude and trend of TBI-related ED visits, which could affect decisions regarding the allocation of TBI resources. This study highlights a challenge in creating a standardized set of TBI ICD-10-CM codes for public health surveillance that provides comparable yet clinically relevant estimates that span the ICD transition.

scholarly journals Measuring the impact of an acute visiting scheme on emergency department attendances – a pre-post cohort design

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Axel Kaehne ◽  
Paula Keating
Keyword(s):  
Emergency Department ◽  
Service Use ◽  
Emergency Department Visits ◽  
Service Utilisation ◽  
Specific Patient ◽  
Access Points ◽  
Latent Demand ◽  
Frequent Attenders ◽  
Cohort Design ◽  
The Impact

Abstract Background Emergency department (ED) attendances are contributing to rising costs of the National Health Service (NHS) in England. Critically assessing the impact of new services to reduce emergency department use can be difficult as new services may create additional access points, unlocking latent demand. The study evaluated an Acute Visiting Scheme (AVS) in a primary care context. We asked if AVS reduces overall ED demand and whether or not it changed utilisation patterns for frequent attenders. Method The study used a pre post single cohort design. The impact of AVS on all-cause ED attendances was hypothesised as a substitution effect, where AVS duty doctor visits would replace emergency department visits. Primary outcome was frequency of ED attendances. End points were reduction of frequency of service use and increase of intervals between attendances by frequent attenders. Results ED attendances for AVS users rose by 47.6%. If AVS use was included, there was a more than fourfold increase of total service utilisation, amounting to 438.3%. It shows that AVS unlocked significant latent demand. However, there was some reduction in the frequency of ED attendances for some patients and an increase in time intervals between ED attendances for others. Conclusion The study demonstrates that careful analysis of patient utilisation can detect a differential impact of AVS on the use of ED. As the new service created additional access points for patients and hence introduces an element of choice, the new service is likely to unlock latent demand. This study illustrates that AVS may be most useful if targeted at specific patient groups who are most likely to benefit from the new service.

scholarly journals Multisite medical record review of emergency department visits for traumatic brain injury

2021 ◽  
Vol 27 (S1) ◽  
pp. i42-i48
Author(s):  
Barbara A Gabella ◽  
Jeanne E Hathaway ◽  
Beth Hume ◽  
Jewell Johnson ◽  
Julia F Costich ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Emergency Department ◽  
Brain Injury ◽  
Skull Fracture ◽  
Signs And Symptoms ◽  
International Classification Of Diseases ◽  
Emergency Department Visits ◽  
Intracranial Injury ◽  
Imaging Results ◽  
Icd 10

BackgroundIn 2016, the CDC in the USA proposed codes from the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) for identifying traumatic brain injury (TBI). This study estimated positive predictive value (PPV) of TBI for some of these codes.MethodsFour study sites used emergency department or trauma records from 2015 to 2018 to identify two random samples within each site selected by ICD-10-CM TBI codes for (1) intracranial injury (S06) or (2) skull fracture only (S02.0, S02.1-, S02.8-, S02.91) with no other TBI codes. Using common protocols, reviewers abstracted TBI signs and symptoms and head imaging results that were then used to assign certainty of TBI (none, low, medium, high) to each sampled record. PPVs were estimated as a percentage of records with medium-certainty or high-certainty for TBI and reported with 95% confidence interval (CI).ResultsPPVs for intracranial injury codes ranged from 82% to 92% across the four samples. PPVs for skull fracture codes were 57% and 61% in the two university/trauma hospitals in each of two states with clinical reviewers, and 82% and 85% in the two states with professional coders reviewing statewide or nearly statewide samples. Margins of error for the 95% CI for all PPVs were under 5%.DiscussionICD-10-CM codes for traumatic intracranial injury demonstrated high PPVs for capturing true TBI in different healthcare settings. The algorithm for TBI certainty may need refinement, because it yielded moderate-to-high PPVs for records with skull fracture codes that lacked intracranial injury codes.

scholarly journals Commonly Used Agent for Acute Pain Management of Sickle Cell Anemia in Saudi Emergency Department: a Narrative Review

2021 ◽  
Author(s):  
Reem A. Hejazi ◽  
Nameer A. Mandourah ◽  
Aryaf S. Alsulami ◽  
Hussain T. Bakhsh ◽  
Reem M. Diri ◽  
...  
Keyword(s):  
Emergency Department ◽  
Pain Management ◽  
Sickle Cell ◽  
Sickle Cell Anemia ◽  
Acute Pain ◽  
Narrative Review ◽  
Acute Pain Management

scholarly journals COVID-19: Stroke Admissions, Emergency Department Visits, and Prevention Clinic Referrals

2020 ◽  
Vol 47 (5) ◽  
pp. 693-696 ◽  
Author(s):  
Maria Bres Bullrich ◽  
Sebastian Fridman ◽  
Jennifer L. Mandzia ◽  
Lauren M. Mai ◽  
Alexander Khaw ◽  
...  
Keyword(s):  
Emergency Department ◽  
Stroke Prevention ◽  
Stroke Unit ◽  
Emergency Department Visits ◽  
Related Factors ◽  
Hospital Policies ◽  
The Government ◽  
Stroke Center ◽  
The Impact ◽  
Prevention Clinic

Abstract:We assessed the impact of the coronavirus disease 19 (COVID-19) pandemic on code stroke activations in the emergency department, stroke unit admissions, and referrals to the stroke prevention clinic at London’s regional stroke center, serving a population of 1.8 million in Ontario, Canada. We found a 20% drop in the number of code strokes in 2020 compared to 2019, immediately after the first cases of COVID-19 were officially confirmed. There were no changes in the number of stroke admissions and there was a 22% decrease in the number of clinic referrals, only after the provincial lockdown. Our findings suggest that the decrease in code strokes was mainly driven by patient-related factors such as fear to be exposed to the SARS-CoV-2, while the reduction in clinic referrals was largely explained by hospital policies and the Government lockdown.

The Impact of the Affordable Care Act Insurance Expansions on Opioid‐Related Emergency Department Visits

2021 ◽  
Vol 56 (S2) ◽  
pp. 64-64
Author(s):  
Sandra Decker ◽  
Michael Dworsky ◽  
Teresa Gibson ◽  
Rachel Henke ◽  
Kimberly McDermott
Keyword(s):  
Emergency Department ◽  
Affordable Care Act ◽  
Emergency Department Visits ◽  
The Affordable Care Act ◽  
The Impact

Validating the primary provider theory in emergency medicine

2008 ◽  
Vol 21 (2) ◽  
pp. 120-130 ◽  
Author(s):  
Joseph S. Guarisco ◽  
Stefoni A. Bavin
Keyword(s):  
Emergency Department ◽  
Patient Satisfaction ◽  
Pay For Performance ◽  
Medical Center ◽  
Waiting Times ◽  
Emergency Department Visits ◽  
Business Success ◽  
Content Type ◽  
The Impact

PurposeThe purpose of this paper is to provide a case study testing the Primary Provider Theory proposed by Aragon that states that: disproportionate to any other variables, patient satisfaction is distinctly and primarily linked to physician behaviors and secondarily to waiting times.Design/methodology/approachThe case study began by creating incentives motivating physicians to reflect and improve behaviors (patient interactions) and practice patterns (workflow efficiency). The Press Ganey Emergency Department Survey was then utilized to track the impact of the incentive programs and to ascertain any relationship between patient satisfaction with the provider and global patient satisfaction with emergency department visits by measuring patient satisfaction over an eight quarter period.FindingsThe findings were two‐fold: firstly, the concept of “pay for performance” as a tool for physician motivation was valid; and secondly, the impact on global patient satisfaction by increases in patient satisfaction with the primary provider was significant and highly correlated, as proposed by Aragon.Practical implicationsThese findings can encourage hospitals and physician groups to place a high value on the performance of primary providers of patient care, provide incentives for appropriate provider behaviors through “pay for performance” programs and promote physician understanding of the links between global patient satisfaction with physician behaviors and business growth, malpractice reduction, and other key measures of business success.Originality/valueThere are no other case studies prior to this project validating the Primary Provider Theory in an urban medical center; this project adds to the validity and credibility of the theory in this setting.

scholarly journals Emergency department visits for children with acute asthma: discharge instructions, parental plans, and follow-through of care—a prospective study

CJEM ◽  
2014 ◽  
Vol 16 (06) ◽  
pp. 467-476 ◽  
Author(s):  
Pat G. Camp ◽  
Seamus P. Norton ◽  
Ran D. Goldman ◽  
Salomeh Shajari ◽  
M. Anne Smith ◽  
...  
Keyword(s):  
Emergency Department ◽  
Acute Care ◽  
Family Doctor ◽  
Emergency Department Visits ◽  
Upper Respiratory Tract ◽  
Asthma Exacerbations ◽  
Initial Care ◽  
Children With Asthma ◽  
Tract Infections ◽  
The Impact

Abstract Objective: Communication between emergency department (ED) staff and parents of children with asthma may play a role in asthma exacerbation management. We investigated the extent to which parents of children with asthma implement recommendations provided by the ED staff. Method: We asked questions on asthma triggers, ED care (including education and discharge recommendations), and asthma management strategies used at home shortly after the ED visit and again at 6 months. Results: A total of 148 children with asthma were recruited. Thirty-two percent of children were not on inhaled corticosteroids prior to their ED visit. Eighty percent of parents identified upper respiratory tract infections (URTIs) as the primary trigger for their child’s asthma. No parent received or implemented any specific asthma strategies to reduce the impact of URTIs; 82% of parents did not receive any printed asthma education materials. Most (66%) parents received verbal instructions on how to manage their child’s future asthma exacerbations. Of those, one-third of families were told to return to the ED. Parents were rarely advised to bring their child to their family doctor in the event of a future exacerbation. At 6 months, parents continued to use the ED services for asthma exacerbations in their children, despite reporting feeling confident in managing their child’s asthma. Conclusion: Improvements are urgently needed in developing strategies to manage pediatric asthma exacerbations related to URTIs, communication with parents at discharge in acute care, and using alternate acute care services for parents who continue to rely on EDs for the initial care of mild asthma exacerbations.

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