Impact of diabetes and hyperglycemia on health care utilization, infection risk, and survival in patients with cancer receiving glucocorticoids with chemotherapy.

19 Background: Glucocorticoid (GC) use is commonly used in chemotherapy regimens and may lead to hyperglycemia and increased infection rates. We assessed the impact of diabetes (DM) and hyperglycemia on rates of health-care utilization, infections and survival among patients with cancer receiving chemotherapy. Methods: We performed a retrospective analysis on 1,781 patients who received intravenous chemotherapy with GC between 2010 and 2015. Demographic, clinical, and health-care utilization (HCU) data was obtained using electronic medical record, billing modules, and the tumor registry; HCU included tallies of emergency room, urgent care, and inpatient visits. Logistic regression models were used to compare survival and new infections between patients with and without DM, after adjusting for demographic and cancer-related variables. Results: In the first 12 months following chemotherapy, patients with DM (n = 330) had higher rates of hospital admissions (70.9% vs 57.4%, p< 0.001), more infection-related admissions (37.0% vs 29.2%, p = 0.007), and increased rates of new infections (61.2% vs 49.2%, p < 0.001) when compared to patients without DM (n = 1,451). One-year survival rate was worse among patients with DM (67.3% vs 78.3%, p < 0.001), as well as patients with at least one glucose reading above 300 mg/dL following chemotherapy (60.8% vs 78.5, p < 0.001). After adjusting for cancer stage, age, and gender, we found DM history increased the odds of dying within one year after diagnosis by 86% (OR 1.86, 95% CI (1.37 2.52), p < 0.001) and of new infections by 68% (OR 1.68, 95% CI (1.26 2.24), p < 0.001). Conclusions: Among patients with cancer receiving intravenous chemotherapy with GC we demonstrate patients with DM have more hospital admissions, increased rates of infections, and worse survival. Prospective studies are urgently needed to elucidate what level of glycemic control is needed to potentially improve outcomes for patients with DM receiving chemotherapy with GC.

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Patterns of Health Care Utilization for Noncommunicable Diseases in a Transitional European Country: Results From the National Health Survey

International Journal of Health Services ◽

10.1177/0020731418762717 ◽

2018 ◽

Vol 49 (1) ◽

pp. 37-50

Author(s):

Janko Janković ◽

Sladjana Šiljak ◽

Jelena Marinković ◽

Bojan Kovač ◽

Slavenka Janković

Keyword(s):

Health Care ◽

Health Care Utilization ◽

National Health ◽

Health Survey ◽

Hospital Admissions ◽

National Health Survey ◽

Urgent Care ◽

Noncommunicable Diseases ◽

Care Utilization ◽

The Relationship

This study aimed to assess possible differences in health services utilization among people living with noncommunicable diseases (NCDs) in the Republic of Srpska (RS), Bosnia and Herzegovina, with special reference to NCD multimorbidity. In addition, the relationship between self-perceived health and health care utilization was assessed. Data were retrieved from the 2010 National Health Survey. A cross-sectional study design was used. A total of 4,673 persons aged 18 years and older were identified in the households, of which 4,128 were interviewed. Logistic regression analyses were used to estimate the effects of NCDs on health care utilization in RS. Respondents with NCD multimorbidity more frequently visited family physicians (odds ratio [OR], 2.74; 95% confidence interval [CI], 2.34 − 3.19), dentists (OR, 1.57; CI, 1.28 − 1.92), private doctors (OR, 2.14; CI, 1.74 − 2.64), and urgent care departments (OR, 2.30; CI, 1.75 − 3.03) than their counterparts without NCDs. They also had more hospital admissions (OR, 2.03; CI, 1.56 − 2.64). This is the first study to address the relationship between health care utilization and NCDs in the population of RS. Further research is needed to explore how best to organize health care to meet the needs of people in RS with NCDs, especially with NCD multimorbidity.

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3247 Implementing an Interdisciplinary, Student-Run Consult Service for Homeless Patients: The Critical Role of Community Partnerships

Journal of Clinical and Translational Science ◽

10.1017/cts.2019.210 ◽

2019 ◽

Vol 3 (s1) ◽

pp. 91-91

Author(s):

Frances Loretta Gill

Keyword(s):

Health Care ◽

Health Care Utilization ◽

Hospital Admissions ◽

Community Partnerships ◽

Care Utilization ◽

Consult Service ◽

Utilization Patterns ◽

Ed Visits ◽

Hospital Days ◽

The Impact

OBJECTIVES/SPECIFIC AIMS: Elucidate the unique challenges associated with hospital discharge planning for patients experiencing homelessness. Assess the impact of robust community partnerships and strong referral pathways on participating patients’ health care utilization patterns in an interdisciplinary, student-run hospital consult service for patients experiencing homelessness. Identify factors (both patient-level and intervention-level) that are associated with successful warm hand-offs to outside social agencies at discharge. METHODS/STUDY POPULATION: To assess the impact of participation in HHL on patients’ health care utilization, we conducted a medical records review using the hospital’s electronic medical record system comparing patients’ health care utilization patterns during the nine months pre- and post- HHL intervention. Utilization metrics included number of ED visits and hospital admissions, number of hospital days, 30-day hospital readmissions, total hospital costs, and follow-up appointment attendance rates, as well as percentage of warm hand-offs to community-based organizations upon discharge. Additionally, we collected data regarding patient demographics, duration of homelessness, and characteristics of homelessness (primarily sheltered versus primarily unsheltered, street homeless versus couch surfing, etc) and intervention outcome data (i.e. percentage of warm hand-offs). This study was reviewed and approved by the Tulane University Institutional Review Board and the University Medical Center Research Review Committee. RESULTS/ANTICIPATED RESULTS: For the first 41 patients who have been enrolled in HHL, participation in HHL is associated with a statistically significant decrease in hospital admissions by 49.4% (p < 0.01) and hospital days by 47.7% (p < 0.01). However, the intervention is associated with a slight, although not statistically significant, increase in emergency department visits. Additionally, we have successfully accomplished warm hand-offs at discharge for 71% percent of these patients. Over the next year, many more patients will be enrolled in HHL, which will permit a more finely grained assessment to determine which aspects of the HHL intervention are most successful in facilitating warm hand-offs and decreased health care utilization amongst patients experiencing homelessness. DISCUSSION/SIGNIFICANCE OF IMPACT: Providing care to patients experiencing homelessness involves working within complex social problems that cannot be adequately addressed in a hospital setting. This is best accomplished with an interdisciplinary team that extends the care continuum beyond hospital walls. The HHL program coordinators believe that ED visits amongst HHL patients and percentage of warm hand-offs are closely related outcomes. If we are able to facilitate a higher percentage of warm hand-offs to supportive social service agencies, we may be able to decrease patient reliance on the emergency department as a source of health care, meals, and warmth. Identifying the factors associated with successful warm hand-offs upon discharge from the hospital may assist us in building on the HHL program’s initial successes to further decrease health care utilization while offering increased interdisciplinary educational opportunities for medical students.

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The Impact of Depression on Health Care Utilization in Patients with Cancer

Journal of Palliative Medicine ◽

10.1089/jpm.2020.0329 ◽

2021 ◽

Author(s):

Star Ye ◽

Courtney P. Williams ◽

Aidan D. Gilbert ◽

Chao-Hui Huang ◽

Terri L. Salter ◽

...

Keyword(s):

Health Care ◽

Health Care Utilization ◽

Care Utilization ◽

Patients With Cancer ◽

The Impact

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Resource Use and Expenditures Among Adult Sickle Cell Patients with and without Depression

Blood ◽

10.1182/blood.v116.21.1534.1534 ◽

2010 ◽

Vol 116 (21) ◽

pp. 1534-1534 ◽

Cited By ~ 1

Author(s):

Shital Kamble ◽

Shelby D Reed ◽

Charlene Flahiff ◽

Soheir Adam ◽

Laura M DeCastro

Keyword(s):

Health Care ◽

Health Care Utilization ◽

Resource Use ◽

Hospital Admissions ◽

Study Entry ◽

Care Utilization ◽

Outpatient Visits ◽

Ed Visits ◽

Time Periods ◽

One Year

Abstract Abstract 1534 Objective: Depression is commonly associated with less favorable medical outcomes among patients with sickle cell disease (SCD), yet little is known about its associated impact on medical resource use and expenditures. In this study, we descriptively compared inpatient stays, number of hospital admissions, emergency department (ED) visits, outpatient visits, and expenditures for SCD patients with and without depression. Methods: 150 adult SCD patients were prospectively enrolled in a cross-sectional cohort study in 2009 to evaluate the prevalence of depression and its association with quality of life, disease severity scores measuring end organ damage, and health care utilization. Detailed cost accounting and administrative physician billing records from the Duke University Health System were obtained for all enrolled patients and used to generate estimates of medical care utilization and costs. Indexing on the enrollment date, we included data representing one year prior to and six months following study entry. Based on the Beck Depression Inventory (BDI) scores, we categorized SCD patients into those with depression (BDI score ≥14) and those without depression (BDI score <14). Given the skewed distributions of resource use and expenditures, we used generalized linear regression models (GLM) with negative binomial distributions and log links to compare inpatient stays, number of hospital admissions, ED visits, and outpatient visits and GLMs with gamma distributions and log links to compare costs associated with each resource use category between patients with and without depression. Results: Data from 142 patients analyzed, 81 females and 61 males with a mean age of 34.2 years. We identified 50 patients with depression and 92 patients without depression. At study entry, females represented 72% of SCD patients with depression and 49% of SCD patients without depression (P< 0.01). Median age was 32.5 years among patients with depression and 29.5 years among those without depression (P= 0.22). Hospital admissions, ED visits, and outpatient visits were generally similar between patients with and without depression one year prior to and six months after study entry. Patients with depression spent more days in the hospital during both time periods. Total inpatient expenditures, including physician fees paid, were higher for patients with depression than those without depression for both time periods (Table). Conclusion: SCD patients with depression incur higher expenditures and longer stays than SCD patients without depression. Efforts should be made for early diagnosis and active therapeutic intervention for depression among SCD patients, to decrease health care utilization and cost. Disclosures: No relevant conflicts of interest to declare.

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