scholarly journals Differences in healthcare visit frequency and type one year prior to stroke among young versus middle-aged adults

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Brandi L. Vollmer ◽  
Xing Chen ◽  
Erin R. Kulick ◽  
Mitchell S. V. Elkind ◽  
Amelia K. Boehme
Keyword(s):  
Risk Factors ◽  
Emergency Department ◽  
Healthcare Utilization ◽  
Preventive Care ◽  
Age Groups ◽  
Emergency Department Visits ◽  
The Us ◽  
Potential Risk Factors ◽  
One Year ◽  
Middle Aged Adults

Abstract Background The incidence and prevalence of stroke among the young are increasing in the US. Data on healthcare utilization prior to stroke is limited. We hypothesized those < 45 years were less likely than those 45–65 years old to utilize healthcare in the 1 year prior to stroke. Methods Patients 18–65 years old who had a stroke between 2008 and 2013 in MarketScan Commercial Claims and Encounters Databases were included. We used descriptive statistics and logistic regression to examine healthcare utilization and risk factors between age groups 18–44 and 45–65 years. Healthcare utilization was categorized by visit type (no visits, inpatient visits only, emergency department visits only, outpatient patient visits only, or a combination of inpatient, outpatient or emergency department visits) during the year prior to stroke hospitalization. Results Of those 18–44 years old, 14.1% had no visits in the year prior to stroke compared to 11.2% of individuals aged 45–65 [OR = 1.30 (95% CI 1.25,1.35)]. Patients 18–44 years old had higher odds of having preventive care procedures associated with an outpatient visit and lower odds of having cardiovascular procedures compared to patients aged 45–65 years. Of stroke patients aged 18–45 and 45–65 years, 16.8 and 13.2% respectively had no known risk for stroke. Conclusions Patients aged 45–65 were less commonly seeking preventive care and appeared to be seeking care to manage existing conditions more than patients aged 18–44 years. However, as greater than 10% of both age groups had no prior risk, further exploration of potential risk factors is needed.

scholarly journals Risk Factors of Fall-Related Emergency Department Visits by Fall Location of Older Adults in the US

2021 ◽  
Vol 22 (4) ◽  
pp. 988-999
Author(s):  
Uma Kelekar ◽  
Debasree Das Gupta ◽  
Jewel Shepherd ◽  
Anupam Sule
Keyword(s):  
Risk Factors ◽  
Older Adults ◽  
Emergency Department ◽  
Rural Areas ◽  
National Level ◽  
Multivariable Analysis ◽  
Geographic Area ◽  
Emergency Department Visits ◽  
Primary Data ◽  
The Us

Introduction: Prior evidence indicates that predictors of older adult falls vary by indoor-outdoor location of the falls. While a subset of United States’ studies reports this finding using primary data from a single geographic area, other secondary analyses of falls across the country do not distinguish between the two fall locations. Consequently, evidence at the national level on risk factors specific to indoor vs outdoor falls is lacking. Methods: Using the 2017 Nationwide Emergency Department Sample (NEDS) data, we conducted a multivariable analysis of fall-related emergency department (ED) visits disaggregated by indoor vs outdoor fall locations of adults 65 years and older (N = 6,720,937) in the US. Results: Results are compatible with findings from previous primary studies. While women (relative risk [RR] = 1.43, 95% confidence interval [CI], 1.42-1.44) were more likely to report indoor falls, men were more likely to present with an outdoor fall. Visits for indoor falls were highest among those 85 years and older (RR = 2.35, 95% CI, 2.33-2.37) with outdoor fall visits highest among those 84 years and younger. Additionally, the probabilities associated with an indoor fall in the presence of chronic conditions were consistently much higher when compared to an outdoor fall. We also found that residence in metropolitan areas increased the likelihood of an indoor elderly fall compared to higher outdoor fall visits from seniors in non-core rural areas, but both indoor and outdoor fall visits were higher among older adults in higher income ZIP codes. Conclusion: Our findings highlight the contrasting risk profile for elderly ED patients who report indoor vs outdoor falls when compared to the elderly reporting no falls. In conjunction, we highlight implications from three perspectives: a population health standpoint for EDs working with their primary care and community care colleagues; an ED administrative vantage point; and from an individual emergency clinician’s point of view.

scholarly journals 1352. The Burden of Active Tuberculosis in an Integrated Healthcare System, 1997–2016: Incidence, Mortality, and Excess Healthcare Utilization

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S489-S489
Author(s):  
Paul Wada ◽  
Christian Lee-Rodriguez ◽  
Yun-Yi Hung ◽  
Jacek Skarbinski
Keyword(s):  
Emergency Department ◽  
Healthcare Utilization ◽  
Program Implementation ◽  
Latent Tuberculosis ◽  
Active Tuberculosis ◽  
Emergency Department Visits ◽  
Matched Cohort ◽  
Kaiser Permanente ◽  
Ltbi Screening ◽  
One Year

Abstract Background Active tuberculosis (TB) often results from reactivation of latent tuberculosis infection (LTBI). This can be prevented through LTBI screening and treatment, yet only 12% of Californians have undergone LTBI therapy. Updated estimates on the complete burden of active TB are needed to rationally allocate resources for LTBI program implementation. Methods We identified all patients with microbiologically confirmed active TB in a large, integrated health system (Kaiser Permanente Northern California, or KPNC) from 1997 to 2016. We calculated active TB incidence in KPNC and measured this against California’s reported cases. Within KPNC, we compared mortality, hospital, emergency department, and ambulatory care use among persons with active TB to age-, sex-, and year-of-diagnosis-matched cohort of persons without active TB. Results Active TB incidence was lower in KPNC (3.4/100,000 person-years) than in California (7.2/100,000 person-years). Among 2,522 active TB cases, early and delayed mortality was high with 7.0% dying within 1 year of diagnosis and 6.2% dying 1–5 years post-diagnosis. Of the 1,957 active TB patients who continued to receive care through KPNC for at least one year post-diagnosis, 603 (30.8%) had at least one hospitalization. In KPNC, active TB patients had higher healthcare utilization than the matched cohort in the one year following diagnosis: 0.6 vs. 0.1 hospitalizations, 9.5 vs. 4.6 days mean length-of-stay, 0.8 vs. 0.3 emergency department visits, and 14.6 vs. 5.9 ambulatory visits. Conclusion Patients with active TB disease have substantial mortality and high inpatient and outpatient healthcare utilization. By improving LTBI screening and treatment, large healthcare systems may be able to reduce the burden and costs associated with active TB. Disclosures All authors: No reported disclosures.

scholarly journals COVID-19 related reduction in pediatric emergency healthcare utilization – a concerning trend

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Christian Dopfer ◽  
Martin Wetzke ◽  
Anna Zychlinsky Scharff ◽  
Frank Mueller ◽  
Frank Dressler ◽  
...  
Keyword(s):  
Emergency Department ◽  
Healthcare Utilization ◽  
Pediatric Emergency ◽  
Emergency Department Visits ◽  
Adolescent Medicine ◽  
Medical Attention ◽  
Pediatric Emergency Department ◽  
Patient Morbidity ◽  
One Year ◽  
The Impact

Abstract Background The COVID-19 pandemic has disrupted healthcare systems worldwide. In addition to the direct impact of the virus on patient morbidity and mortality, the effect of lockdown strategies on health and healthcare utilization have become apparent. Little is known on the effect of the pandemic on pediatric and adolescent medicine. We examined the impact of the pandemic on pediatric emergency healthcare utilization. Methods We conducted a monocentric, retrospective analysis of n = 5,424 pediatric emergency department visits between January 1st and April 19th of 2019 and 2020, and compared healthcare utilization during the pandemic in 2020 to the same period in 2019. Results In the four weeks after lockdown in Germany began, we observed a massive drop of 63.8% in pediatric emergency healthcare utilization (mean daily visits 26.8 ± SEM 1.5 in 2019 vs. 9.7 ± SEM 1 in 2020, p < 0.005). This drop in cases occurred for both communicable and non-communicable diseases. A larger proportion of patients under one year old (daily mean of 16.6% ±SEM 1.4 in 2019 vs. 23.1% ±SEM 1.7 in 2020, p < 0.01) and of cases requiring hospitalisation (mean of 13.9% ±SEM 1.6 in 2019 vs. 26.6% ±SEM 3.3 in 2020, p < 0.001) occurred during the pandemic. During the analysed time periods, few intensive care admissions and no fatalities occurred. Conclusions Our data illustrate a significant decrease in pediatric emergency department visits during the COVID-19 pandemic. Public outreach is needed to encourage parents and guardians to seek medical attention for pediatric emergencies in spite of the pandemic.

Risk factors of hospital admissions and recurrent emergency department visits among pediatric asthma patients

2020 ◽  
pp. 1011-1015
Author(s):  
Abdullah Aldamigh ◽  
Afaf Alnefisah ◽  
Abdulrahman Almutairi ◽  
Fatima Alturki ◽  
Suhailah Alhtlany ◽  
...  
Keyword(s):  
Risk Factors ◽  
Emergency Department ◽  
Hospital Admissions ◽  
Pediatric Asthma ◽  
Emergency Department Visits ◽  
Asthma Patients

scholarly journals Emergency Department Visits During Outpatient Parenteral Antimicrobial Therapy: A Cohort Study

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S333-S334
Author(s):  
So Lim Kim ◽  
Angela Everett ◽  
Susan J Rehm ◽  
Steven Gordon ◽  
Nabin Shrestha
Keyword(s):  
Risk Factors ◽  
Emergency Department ◽  
Hospital Admission ◽  
Vascular Access ◽  
Antimicrobial Therapy ◽  
Cleveland Clinic ◽  
Emergency Department Visits ◽  
Outpatient Parenteral Antimicrobial Therapy ◽  
Ed Visits ◽  
Access Complications

Abstract Background Outpatient parenteral antimicrobial therapy (OPAT) carries risk of vascular access complications, antimicrobial adverse effects, and worsening of infection. Both OPAT-related and unrelated events may lead to emergency department (ED) visits. The purpose of this study was to describe adverse events that result in ED visits and risk factors associated with ED visits during OPAT. Methods OPAT courses between January 1, 2013 and December 31, 2016 at Cleveland Clinic were identified from the institution’s OPAT registry. ED visits within 30 days of OPAT initiation were reviewed. Reasons and potential risk factors for ED visits were sought in the medical record. Results Among 11,440 OPAT courses during the study period, 603 (5%) were associated with 1 or more ED visits within 30 days of OPAT initiation. Mean patient age was 58 years and 57% were males. 379 ED visits (49%) were OPAT-related; the most common visit reason was vascular access complication, which occurred in 211 (56%) of OPAT-related ED visits. The most common vascular access complications were occlusion and dislodgement, which occurred in 99 and 34 patients (47% and 16% of vascular access complications, respectively). In a multivariable logistic regression model, at least one prior ED visit in the preceding year (prior ED visit) was most strongly associated with one or more ED visits during an OPAT course (OR 2.96, 95% CI 2.38 – 3.71, p-value &lt; 0.001). Other significant factors were younger age (p 0.01), female sex (p 0.01), home county residence (P &lt; 0.001), and having a PICC (p 0.05). 549 ED visits (71%) resulted in discharge from the ED within 24 hours, 18 (2%) left against medical advice, 46 (6%) were observed up to 24 hours, and 150 ED visits (20%) led to hospital admission. Prior ED visit was not associated with hospital admission among patients who visited the ED during OPAT. Conclusion OPAT-related ED visits are most often due to vascular access complications, especially line occlusions. Patients with a prior ED visit in the preceding year have a 3-fold higher odds of at least one ED visit during OPAT compared with patients without a prior ED visit. A strategy of managing occlusions at home and a focus on patients with prior ED visits could potentially prevent a substantial proportion of OPAT-related ED visits. Disclosures All authors: No reported disclosures.

scholarly journals Prevalence of diarrhoea, and associated risk factors, in children aged 0-5 years, at two hospitals in Umuahia, Abia, Nigeria

2017 ◽  
Vol 9 (1) ◽  
pp. 7-14
Author(s):  
Adanma Florence Nwaoha ◽  
Camelita Chima Ohaeri ◽  
Ebube Charles Amaechi
Keyword(s):  
Risk Factors ◽  
Health Workers ◽  
Age Groups ◽  
Medical Centers ◽  
Faecal Samples ◽  
Potential Risk Factors ◽  
Stool Samples ◽  
The Government ◽  
Associated Risk Factors ◽  
And Control

Diarrhoea is the second leading cause of infectious mor­bidity and mortality in children under five years of age. This study aimed at identifying the most common parasites and potential risk factors for diarrhoea among children 0-5 years attending Abia State Specialist hospital and Federal Medical Centre, Umuahia, in south east­ern Nigeria. We used 400 faecal samples from children with diarrhoea –and 200 without– in combination with hospital-based case control and a questionnaire Stool samples were processed with direct normal saline and formal-ether sedimentation method for parasitological stud­ies. More males than females were infected in nearly all age groups in both diarrhoeal and control groups (X2=23.04, df=1, P<0.05: X2=11.52, df=1, P<0.05 respectively). Amachara had more infections (X2=0.15, df=1, P< 0.05). January had the highest rate of infection (22.5%). Main clinical features were watery depositions over 3 times a day, diarrhoea lasting for days, fever, vomiting, and dehydration. Mothers learned about the problem through health workers, television and in medical centers. Risk correlated with mother’s education, occupation, latrine type, waste water disposal, hand washing, kitchen cleaning; sources and storage of water; and bottle milk (P< 0.05).Ignorance greatly con­tributed to the spread of parasitic disease in the area: the government should improve education and other strategies to alleviate the spread of the disease..

Abstract P168: Impact of Oral Anticoagulation Choice on Healthcare Utilization for the Primary Treatment of Venous Thromboembolism

Circulation ◽  
2020 ◽  
Vol 141 (Suppl_1) ◽  
Author(s):  
Rob F Walker ◽  
Richard F Maclehose ◽  
J'Neka Claxton ◽  
Terrence Adam ◽  
Alvaro Alonso ◽  
...  
Keyword(s):  
Emergency Department ◽  
Healthcare Utilization ◽  
Oral Anticoagulation ◽  
Primary Treatment ◽  
Emergency Department Visits ◽  
Office Visits ◽  
International Classification Of Disease ◽  
Hospitalization Rates ◽  
The Impact

Introduction: Little is known about the impact of oral anticoagulation (OAC) choice on healthcare encounters during the primary treatment of VTE. Hypothesis: Among anticoagulant-naïve VTE patients we tested the hypotheses that the number of hospitalizations, days hospitalized, emergency department visits, and outpatient office visits would be lower among users of rivaroxaban or apixaban than among users of warfarin. Methods: MarketScan databases for years 2016 and 2017 were used to identify VTE cases and comorbidities using international classification of disease codes, and prescriptions for OACs via outpatient pharmaceutical claims data. Healthcare utilization was identified in the first 6 months after initial VTE diagnoses. Results: The 23,864 individuals with VTE cases were on average (± standard deviation) 55.7 ± 16.1 years old and 50.6% female. Participants had on average 0.2 ± 0.5 hospitalizations, spent 1.3 ± 5.2 days in the hospital, had 5.7 ± 5.1 outpatient encounters, and visited an emergency department 0.4 ± 1.1 times. As compared to warfarin, rivaroxaban and apixaban were associated with fewer hospitalizations, days hospitalized, office visits and emergency department visits, after accounting for age, sex, comorbidities and medications (Table 1). For example, hospitalization rates were 24% lower [IRR: 0.76 (95% CI: 0.69, 0.83)] for patients prescribed rivaroxaban and 22% lower [IRR: 0.78 (95% CI: 0.71, 0.87)] for patients prescribed apixaban, as compared to those prescribed warfarin. When comparing apixaban to rivaroxaban, there were no differences in healthcare utilization. Conclusions: VTE patients prescribed rivaroxaban and apixaban had lower healthcare utilization than did those prescribed warfarin, while there was no difference when comparing apixaban to rivaroxaban. These findings complement existing literature supporting the use of direct OACs over warfarin given their similar effectiveness, slightly better safety profile, and perceived lower patient burden.

scholarly journals Pediatric emergency department visits for pedestrian and bicyclist injuries in the US

2017 ◽  
Vol 4 (1) ◽  
Author(s):  
Katherine Wheeler-Martin ◽  
Stephen J. Mooney ◽  
David C. Lee ◽  
Andrew Rundle ◽  
Charles DiMaggio
Keyword(s):  
Emergency Department ◽  
Pediatric Emergency ◽  
Emergency Department Visits ◽  
Pediatric Emergency Department ◽  
The Us
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