scholarly journals Healthcare spending in U.S. emergency departments by health condition, 2006–2016

PLoS ONE ◽  
2021 ◽  
Vol 16 (10) ◽  
pp. e0258182
Author(s):  
Kirstin Woody Scott ◽  
Angela Liu ◽  
Carina Chen ◽  
Alexander S. Kaldjian ◽  
Amber K. Sabbatini ◽  
...  
Keyword(s):  
Emergency Department ◽  
Health Spending ◽  
Healthcare Spending ◽  
The United States ◽  
Health Condition ◽  
Rate Of Change ◽  
Nationally Representative ◽  
National Emergency ◽  
The U.S ◽  
Over Time

Background Healthcare spending in the emergency department (ED) setting has received intense focus from policymakers in the United States (U.S.). Relatively few studies have systematically evaluated ED spending over time or disaggregated ED spending by policy-relevant groups, including health condition, age, sex, and payer to inform these discussions. This study’s objective is to estimate ED spending trends in the U.S. from 2006 to 2016, by age, sex, payer, and across 154 health conditions and assess ED spending per visit over time. Methods and findings This observational study utilized the National Emergency Department Sample, a nationally representative sample of hospital-based ED visits in the U.S. to measure healthcare spending for ED care. All spending estimates were adjusted for inflation and presented in 2016 U.S. Dollars. Overall ED spending was $79.2 billion (CI, $79.2 billion-$79.2 billion) in 2006 and grew to $136.6 billion (CI, $136.6 billion-$136.6 billion) in 2016, representing a population-adjusted annualized rate of change of 4.4% (CI, 4.4%-4.5%) as compared to total healthcare spending (1.4% [CI, 1.4%-1.4%]) during that same ten-year period. The percentage of U.S. health spending attributable to the ED has increased from 3.9% (CI, 3.9%-3.9%) in 2006 to 5.0% (CI, 5.0%-5.0%) in 2016. Nearly equal parts of ED spending in 2016 was paid by private payers (49.3% [CI, 49.3%-49.3%]) and public payers (46.9% [CI, 46.9%-46.9%]), with the remainder attributable to out-of-pocket spending (3.9% [CI, 3.9%-3.9%]). In terms of key groups, the majority of ED spending was allocated among females (versus males) and treat-and-release patients (versus those hospitalized); those between age 20–44 accounted for a plurality of ED spending. Road injuries, falls, and urinary diseases witnessed the highest levels of ED spending, accounting for 14.1% (CI, 13.1%-15.1%) of total ED spending in 2016. ED spending per visit also increased over time from $660.0 (CI, $655.1-$665.2) in 2006 to $943.2 (CI, $934.3-$951.6) in 2016, or at an annualized rate of 3.4% (CI, 3.3%-3.4%). Conclusions Though ED spending accounts for a relatively small portion of total health system spending in the U.S., ED spending is sizable and growing. Understanding which diseases are driving this spending is helpful for informing value-based reforms that can impact overall health care costs.

Accepting Regional Zero: Nuclear Weapon Free Zones, U.S. Nonproliferation Policy and Global Security, 1957–1968

2015 ◽  
Vol 17 (2) ◽  
pp. 36-72 ◽  
Author(s):  
James Stocker
Keyword(s):  
Latin America ◽  
Nuclear Weapon ◽  
Security Policy ◽  
The United States ◽  
Nuclear Nonproliferation ◽  
Nuclear Strategy ◽  
The World ◽  
History Of ◽  
The U.S ◽  
Over Time

Nuclear weapon free zones (NWFZs) were an important development in the history of nuclear nonproliferation efforts. From 1957 through 1968, when the Treaty of Tlatelolco was signed, the United States struggled to develop a policy toward NWFZs in response to efforts around the world to create these zones, including in Europe, Africa, Latin America, and the Middle East. Many within the U.S. government initially rejected the idea of NWFZs, viewing them as a threat to U.S. nuclear strategy. However, over time, a preponderance of officials came to see the zones as advantageous, at least in certain areas of the world, particularly Latin America. Still, U.S. policy pertaining to this issue remained conservative and reactive, reflecting the generally higher priority given to security policy than to nuclear nonproliferation.

101 National Trends in Emergency Department Ondansetron Use and Clinical Outcomes Among Children with Acute Gastroenteritis

2021 ◽  
Vol 26 (Supplement_1) ◽  
pp. e72-e73
Author(s):  
Sarah Rogers ◽  
Stephen Freedman ◽  
Terry Klassen ◽  
Brett Burstein
Keyword(s):  
Emergency Department ◽  
Acute Gastroenteritis ◽  
Multivariable Analysis ◽  
Population Level ◽  
Subject Area ◽  
Fluid Administration ◽  
Cross Sectional ◽  
Ed Visits ◽  
Nationally Representative ◽  
Over Time

Abstract Primary Subject area Emergency Medicine - Paediatric Background Acute gastroenteritis (AGE) is among the most common illnesses for which children are evaluated in the Emergency Department (ED). Among children with AGE, ondansetron has been shown to reduce vomiting, intravenous (IV) fluid administration and hospitalizations when administered in the ED. Objectives To determine whether increasing ondansetron administration is associated with a concomitant decline in IV rehydration and hospitalization among children presenting with AGE in a broad, nationally representative ED sample. Design/Methods This was a cross-sectional analysis of the US Centers for Disease Control and Prevention (CDC) National Hospital Ambulatory Medical Care Survey (NHAMCS) database from 2006 to 2015. Children < 18 years old with a discharge diagnosis of AGE were included for analysis. Survey weighting procedures were applied to generate population-level estimates and to perform multivariable logistic regression to identify factors associated with ondansetron administration. Results There were an estimated 15.1 million (95% CI 13.5-16.7) visits for AGE during the 10-year study period. AGE visits increased as a proportion of all pediatric ED visits over time (4.6% in 2006, 5.7% in 2015; p-trend=0.013). The mean patient age was 4.7 (95% CI 4.5-5.0) years, and most visits were to non-teaching (86.6%, 95% CI 83.3-89.3%) and non-pediatric (83.4%, 95% CI 78.2-87.5%) hospitals. The proportion of patients receiving ondansetron increased over time (11.8% in 2006, 62.5% in 2015; p-trend < 0 .001), both in the ED (10.6% in 2006, 55.5% in 2015; p-trend < 0 .001) and as outpatient prescriptions (3.3% in 2006, 45.3% in 2015; p-trend < 0 .001). Over the same period, there was no change in hospitalizations (2.9% overall, 95% CI 2.2-3.7%; p-trend=0.144). IV hydration for AGE decreased (31.8% in 2006, 24.9% in 2015; p-trend < 0 .048), as did IV fluid administration across all other pediatric ED visits (10.3% in 2006, 7.8% in 2015; p-trend < 0 .023). After adjustment for patient- and hospital-level factors, the odds ratio for IV rehydration among children with AGE was 0.97 (95% CI 0.92-1.01). Multivariable analysis found younger age (aOR 0.94, 95% CI 1.04-1.09), Medicaid/Medicare insurance (aOR 0.74; 95% CI 0.57-0.97), and presentation to a teaching hospital (aOR 0.74; 95% CI 0.54-0.99) were inversely associated with ondansetron administration. Other antiemetics most commonly used were promethazine (7.4%, 95% CI 5.9-9.2%), metoclopramide (1.8%, 95% CI 1.3-2.5%) and trimethobenzamide (1.5%, 95% CI 1.1-2.1%). Antimotility agents, H2-receptor blockers, and probiotics were infrequently used. Conclusion Both ED and outpatient prescribing of ondansetron for children with AGE increased; however, no concomitant decline was observed in hospitalizations or IV rehydration. Guidelines and quality improvement efforts are needed to target ondansetron administration to children most likely to benefit to minimize adverse events and costs associated with overuse.

Government Employees’ Experience and Expectation of COVID-19 Hardships: The Moderating Role of Gender and Race in the United States

2021 ◽  
pp. 027507402110492
Author(s):  
JungHo Park ◽  
Yongjin Ahn
Keyword(s):  
Gender Gap ◽  
The United States ◽  
Census Bureau ◽  
Government Employees ◽  
Income Loss ◽  
Gender And Race ◽  
Nationally Representative ◽  
Moderating Role ◽  
The U.S

This article examines government employees’ experience and expectation of socioeconomic hardships during the COVID-19 pandemic—employment income loss, housing instability, and food insufficiency—by focusing on the role of gender and race. Employing the Household Pulse Survey, a nationally representative and near real-time pandemic data deployed by the U.S. Census Bureau, we find that government employees were less affected by the pandemic than non-government employees across socioeconomic hardships. However, female and racial minorities, when investigated within government employees, have a worse experience and expectation of pandemic hardships than men and non-Hispanic Whites. Our findings suggest a clear gender gap and racial disparities in the experience and expectation of pandemic hardships.

Introduction

2013 ◽  
Author(s):  
Noel Maurer
Keyword(s):  
United States ◽  
Latin America ◽  
West Africa ◽  
Institutional Reform ◽  
The United States ◽  
American Government ◽  
Foreign Investors ◽  
The U.S ◽  
Over Time

This introductory chapter discusses the shift from politicized confrontations like the imbroglio of 1900 to legalized disputes like the more orderly affair of 2007. It advances four basic findings. First, American government intervention on behalf of U.S. foreign investors was astoundingly successful at extracting compensation through the 1980s. Second, American domestic interests trumped strategic concerns again and again, for small economic gains relative to the U.S. economy and the potential strategic losses. Third, the United States proved unable to impose institutional reform in Latin America and West Africa even while American agents were in place. Finally, the technology that the U.S. government used to protect American property rights overseas changed radically over time.

A History of Interprofessional Education and Assessment at WesternU

2020 ◽  
pp. 286-310
Author(s):  
David N. Dickter ◽  
Daniel C. Robinson
Keyword(s):  
Interprofessional Education ◽  
Growth And Development ◽  
The United States ◽  
Health Sciences ◽  
Early History ◽  
Patient Centered ◽  
Education Practice ◽  
History Of ◽  
The U.S ◽  
Over Time

This chapter traces the early history and progress of a pioneering interprofessional practice and education (IPE) program at Western University of Health Sciences (WesternU), whose growth and development can be viewed in the context of the broader IPE field, that of a nascent movement within the United States to recognize and facilitate collaborative, patient-centered healthcare. This chapter provides some of the background and details from the early design years at WesternU. The IPE movement in the U.S. worked with general principles and broad conceptual outcomes such as safety and quality but it took time to delineate more specific guidelines and practices. Over the years, frameworks and standards for education, practice, and outcomes assessment have developed that have helped to guide the program. Similarly, WesternU has developed and refined its education and assessment methods over time.

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.

Field Decontamination and Triage in Chemical Emergencies

1987 ◽  
Vol 3 (1) ◽  
pp. 37-39
Author(s):  
Constance J. Doyle
Keyword(s):  
United States ◽  
Emergency Department ◽  
Environmental Protection Agency ◽  
Hazardous Materials ◽  
The United States ◽  
Protection Agency ◽  
Environmental Cleanup ◽  
Materials Handling ◽  
Toxic Materials ◽  
The U.S

Triage and rescue of casualties from accidents involving hazardous materials is a challenge for many emergency medical services (EMS) personnel. With very toxic materials, the untrained and unprepared rescuer may become a victim. In addition, few hospitals in the United States have decontamination units attached to their emergency departments and emergency department personnel may become exposed if the casualty is not decontaminated. Many environmental cleanup teams, including the U.S. Environmental Protection Agency (EPA) team, are well trained in materials handling but are not immediately available when a hazardous materials spill with personal injuries occurs.

scholarly journals Disintermediating your friends: How online dating in the United States displaces other ways of meeting

2019 ◽  
Vol 116 (36) ◽  
pp. 17753-17758 ◽  
Author(s):  
Michael J. Rosenfeld ◽  
Reuben J. Thomas ◽  
Sonia Hausen
Keyword(s):  
United States ◽  
Online Dating ◽  
The United States ◽  
Heterosexual Couples ◽  
Nationally Representative ◽  
First Time ◽  
Over Time

We present data from a nationally representative 2017 survey of American adults. For heterosexual couples in the United States, meeting online has become the most popular way couples meet, eclipsing meeting through friends for the first time around 2013. Moreover, among the couples who meet online, the proportion who have met through the mediation of third persons has declined over time. We find that Internet meeting is displacing the roles that family and friends once played in bringing couples together.

scholarly journals Latin American Immigration to the United States

Daedalus ◽  
2013 ◽  
Vol 142 (3) ◽  
pp. 48-64 ◽  
Author(s):  
Marta Tienda ◽  
Susana M. Sánchez
Keyword(s):  
United States ◽  
Latin American ◽  
The United States ◽  
Children Of Immigrants ◽  
Foreign Born ◽  
Cumulative Impact ◽  
Political Conflicts ◽  
Latin American Immigration ◽  
The U.S ◽  
Over Time

This essay provides an overview of immigration from Latin America since 1960, focusing on changes in both the size and composition of the dominant streams and their cumulative impact on the U.S. foreign-born population. We briefly describe the deep historical roots of current migration streams and the policy backdrop against which migration from the region surged. Distinguishing among the three major pathways to U.S. residence – family sponsorship, asylum, and unauthorized entry – we explain how contemporary flows are related both to economic crises, political conflicts, and humanitarian incidents in sending countries, but especially to idiosyncratic application of existing laws over time. The concluding section highlights the importance of investing in the children of immigrants to meet the future labor needs of an aging nation.

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