Trends in Health Care Use and Spending for Young Children With Neurologic Impairment

PEDIATRICS ◽  
2021 ◽  
Author(s):  
Nathaniel D. Bayer ◽  
Matthew Hall ◽  
Yue Li ◽  
James A. Feinstein ◽  
Joanna Thomson ◽  
...  
Keyword(s):  
Health Care ◽  
Confidence Interval ◽  
Odds Ratio ◽  
Service Use ◽  
Care Home ◽  
Outpatient Service ◽  
Health Care Use ◽  
Outpatient Services ◽  
Neurologic Impairment ◽  
Inpatient Services

BACKGROUND AND OBJECTIVES: Children with neurologic impairment (NI) are a growing subset of children who frequently use health care. We examined health care use and spending trends across services for children with NI during their first 5 years of life. METHODS: This was a retrospective study of 13 947 children with NI in the multistate IBM Medicaid MarketScan Database (2009–2017). We established birth cohorts of children with NI and analyzed claims from birth to 5 years. NI, identified by using International Classification of Diseases, 9th Revision, diagnosis codes, was defined as ≥1 neurologic diagnosis that was associated with functional and/or intellectual impairment. We measured annual health care use and per-member-per-year spending by inpatient, emergency department (ED), and outpatient services. Population trends in use and spending were assessed with logistic and linear regression, respectively. RESULTS: During their first versus fifth year, 66.8% vs 5.8% of children with NI used inpatient services, and 67.8% vs 44.4% used ED services. Annual use in both categories decreased over 0–5 years (inpatient odds ratio: 0.35, 95% confidence interval: 0.34 to 0.36; ED odds ratio: 0.78, 95% confidence interval: 0.77 to 0.79). The use of outpatient services (primary care, specialty care, home health) decreased gradually. Per-member-per-year spending on inpatient services remained the largest spending category: $83 352 (90.2% of annual spending) in the first year and $1944 (25.5%) in the fifth year. CONCLUSIONS: For children with early-onset NI from 0–5 years, use and spending on inpatient services decreased dramatically; ED and outpatient service use decreased more gradually. These findings may help systems, clinicians, and families optimize care by anticipating and adjusting for shifting use of health care services.

Accessibility, Mobility and Spatial Patterns of Primary Health Care use in Ajedabiya: a Household Interview Survey

2010 ◽  
Vol 41 ◽  
pp. 47-62
Author(s):  
Salem F. Salem
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Service Use ◽  
Primary Objective ◽  
Health Care Use ◽  
International Standards ◽  
Consultation Rate ◽  
General Evaluation ◽  
Primary Health ◽  
Time Required

AbstractThe primary objective of this study is to examine the type of Primary Health Care (PHC) facility used by a sample of households in Ajedabiya, taking into account the respondents' living standards and their perception of the quality of the care provided, as well as the mode of travel and travel time required to reach the health care centres. The overall level of service use has been increasing over time, reaching an annual consultation rate of up to four visits per person per year, a high level by international standards. Three major groupings of disease were identified for which the four selected PHC facilities were preferred. Satisfaction with care was analysed by looking at key variables, including staff behaviour, availability of doctors, vector distance to the PHC facility, general evaluation of health services and qualified doctors. Household incomes did not appear to be an important factor except for attending private clinics. Unlike income, distance had a strong effect on utilisation, leading to the conclusion that PHC should continue to be provided within the community, and developed further to achieve equity, effectiveness and affordability.

Creating a Culture of Continuous Improvement in Outpatient Laboratories: Effects on Wait Times, Employee Engagement, and Efficiency

2018 ◽  
Vol 34 (4) ◽  
pp. 389-397
Author(s):  
Joseph Featherall ◽  
Alexander Chaitoff ◽  
Anthony Simonetti ◽  
James Bena ◽  
Daniel Kubiak ◽  
...  
Keyword(s):  
Health Care ◽  
Confidence Interval ◽  
Employee Engagement ◽  
Continuous Improvement ◽  
Cultural Change ◽  
Odds Ratio ◽  
Health Care Quality ◽  
Care Quality ◽  
Wait Times ◽  
Full Time

Transforming health care remains a challenge as many continuous improvement (CI) initiatives fail or are not sustained. Although the literature suggests the importance of culture, few studies provide evidence of cultural change creating sustained CI. This improvement initiative focused on creating cultural change through goal alignment, visual management, and empowering frontline employees. Data included 113 133 encounters. Cochran-Armitage tests and X-bar charting compared wait times during the CI initiative. Odds of waiting <15 minutes increased in both phase 2 (odds ratio = 3.57, 95% confidence interval = [3.43-3.71]) and phase 3 (odds ratio = 5.39, 95% confidence interval = [5.07, 5.74]). At 3 years follow-up, 95% of wait times were <15 minutes. Productivity increased from 519 to 644 patients/full-time equivalent/month; 33/42 Press Ganey employee engagement components significantly improved. This study demonstrates the efficacy of a culture of CI approach to sustain wait time improvement in outpatient laboratory services, and should be considered for application in other areas of health care quality.

scholarly journals Impact of the Health Transformation Plan on the Number of Surgical Operations and Their Cancelation

2019 ◽  
Vol 56 ◽  
pp. 004695801984638
Author(s):  
MahmoodReza Miri Bonjar ◽  
Mohammad Khammarnia ◽  
Mahdie Bakhshi ◽  
Alireza Ansari-Moghaddam ◽  
Hassan Okati–Aliabad ◽  
...  
Keyword(s):  
Health Insurance ◽  
Confidence Interval ◽  
Odds Ratio ◽  
Outpatient Service ◽  
Public Hospitals ◽  
Inpatient Service ◽  
Treatment Needs ◽  
Study Population ◽  
The Impact ◽  
Surgical Operations

Operation cancelations are a serious problem with undesirable consequences. The Health Transformation Plan was launched in the health system of Iran on May 5, 2014, to enhance the efficiency and quality of services in public hospitals. Comprehensive coverage of patients’ basic treatment needs and reduction of patients’ out-of-pocket expenditures through insurance for all are other objectives of Health Transformation Plan as well. Then, the present study aimed to determine the impact of the Health Transformation Plan on the number of surgical operations and the cancelation of elective surgeries within public hospitals of Iran. This retrospective comparative study was conducted in 2017 within 2 tertiary public hospitals in the South-East of Iran. Using systematic random sampling method and census, 8138 scheduled surgical files and all canceled operations files were reviewed from April 2012 to March 2017, respectively. A standard checklist was used for data collection. The data were analyzed using χ2 test and a logistic regression model in SPSS, version 21. The study population was 8138 patients with mean age of 33 ± 19 years. Female patients comprised about 51% of the study population (n = 4115), and nearly two-third of them were married (n = 5192 [63.79%]). Coverage by Iranian health insurance was reported in more than half of patients (n = 4415 [54.79%]). The common reason for surgeries was injury and poisoning (n = 2814 [34.52%]) followed by delivery (n = 1747 [21.46%]). The number of operations increased from 26 677 before Health Transformation Plan (cancelation rate = 1.5%) to 33 190 after Health Transformation Plan (cancelation rate = 2.0%). The cancelation rate had a significant relationship with age (odds ratio = 1.009; confidence interval: 1.00-1.01), health insurance status (odds ratio = 2.12; confidence interval: 1.33-3.38), outpatient service referrals (odds ratio = 0.5; confidence interval: 0.43-0.62), inpatient service referrals (odds ratio = 1.5; confidence interval: 1.36-1.77), and surgical types ( P < .05). In general, the Health Transformation Plan was markedly associated with a rise in the number of surgeries and cancelation rate in the public hospitals. The information obtained in the present study concerning the causes of operation cancelations can be used to decrease the number of future cancelations.

scholarly journals Low rates of prior HIV testing among HIV-positive adults accessing outpatient services in Eswatini

2019 ◽  
Vol 16 (1) ◽  
Author(s):  
Harriet Nuwagaba-Biribonwoha ◽  
Yingfeng Wu ◽  
Averie Baird Gachuhi ◽  
Margaret L. McNairy ◽  
Veli Madau ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Hiv Testing ◽  
Family Support ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Hiv Positive ◽  
Outpatient Services ◽  
Hiv Positive Adults

AbstractPrior HIV testing and awareness of HIV-positive status were assessed among HIV-positive adults at 20 clinics in Eswatini. Of 2196 HIV-positive adults, 1183 (53.8%) reported no prior HIV testing, and 1948 (88.7%) were unaware of their HIV-positive status. Males [adjusted odds ratio, AOR, (95% confidence interval): 0.7 (0.5–0.9)], youth 18–25 years [AOR 0.6 (0.4–0.95)], adults ≥ 50 years [AOR 0.5 (0.3–0.9)], those needing family support [AOR 0.6 (0.5–0.8)], and those living ≥ 45 min from clinic [AOR 0.5 (0.4–0.8)] were less likely to know their HIV-positive status. More HIV testing is needed to achieve 95-95-95 targets, with targeted strategies for those less likely to test for HIV.

scholarly journals Inequity in Access to Transplantation in the United Kingdom

2020 ◽  
Vol 15 (6) ◽  
pp. 830-842 ◽  
Author(s):  
Rishi Pruthi ◽  
Matthew L. Robb ◽  
Gabriel C. Oniscu ◽  
Charles Tomson ◽  
Andrew Bradley ◽  
...  
Keyword(s):  
Health Care ◽  
United Kingdom ◽  
Kidney Transplantation ◽  
Confidence Interval ◽  
Odds Ratio ◽  
Practice Patterns ◽  
Universal Health Care ◽  
The United Kingdom ◽  
Universal Health Care System ◽  
Universal Health

Background and objectivesDespite the presence of a universal health care system, it is unclear if there is intercenter variation in access to kidney transplantation in the United Kingdom. This study aims to assess whether equity exists in access to kidney transplantation in the United Kingdom after adjustment for patient-specific factors and center practice patterns.Design, setting, participants, & measurements In this prospective, observational cohort study including all 71 United Kingdom kidney centers, incident RRT patients recruited between November 2011 and March 2013 as part of the Access to Transplantation and Transplant Outcome Measures study were analyzed to assess preemptive listing (n=2676) and listing within 2 years of starting dialysis (n=1970) by center.ResultsSeven hundred and six participants (26%) were listed preemptively, whereas 585 (30%) were listed within 2 years of commencing dialysis. The interquartile range across centers was 6%–33% for preemptive listing and 25%–40% for listing after starting dialysis. Patient factors, including increasing age, most comorbidities, body mass index >35 kg/m2, and lower socioeconomic status, were associated with a lower likelihood of being listed and accounted for 89% and 97% of measured intercenter variation for preemptive listing and listing within 2 years of starting dialysis, respectively. Asian (odds ratio, 0.49; 95% confidence interval, 0.33 to 0.72) and Black (odds ratio, 0.43; 95% confidence interval, 0.26 to 0.71) participants were both associated with reduced access to preemptive listing; however Asian participants were associated with a higher likelihood of being listed after starting dialysis (odds ratio, 1.42; 95% confidence interval, 1.12 to 1.79). As for center factors, being registered at a transplanting center (odds ratio, 3.1; 95% confidence interval, 2.36 to 4.07) and a universal approach to discussing transplantation (odds ratio, 1.4; 95% confidence interval, 1.08 to 1.78) were associated with higher preemptive listing, whereas using a written protocol was associated negatively with listing within 2 years of starting dialysis (odds ratio, 0.7; 95% confidence interval, 0.58 to 0.9).ConclusionsPatient case mix accounts for most of the intercenter variation seen in access to transplantation in the United Kingdom, with practice patterns also contributing some variation. Socioeconomic inequity exists despite having a universal health care system.

scholarly journals Knowledge of preconception care and associated factors among maternal health care providers working in urban public health institutions of Eastern Ethiopia

2021 ◽  
Vol 17 ◽  
pp. 174550652110461
Author(s):  
Seboka Abebe Sori ◽  
Kedir Teji Roba ◽  
Tesfaye Assebe Yadeta ◽  
Hirut Dinku Jiru ◽  
Keyredin Nuriye Metebo ◽  
...  
Keyword(s):  
Health Care ◽  
Maternal Health ◽  
Confidence Interval ◽  
Health Care Providers ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Preconception Care ◽  
Maternal Health Care ◽  
Good Knowledge ◽  
Care Providers

Background: Provision of preconception care is significantly affected by the health care provider’s knowledge of preconception care. In Ethiopia, preconception care is rare, if even available, as part of maternal health care services. Thus, this study aimed to determine the level of knowledge of preconception care and associated factors among health care providers working in public health facilities in Eastern Ethiopia. Methods: A multicenter cross-sectional study was conducted from 1 March to 1 April 2020. A simple random sampling technique was used to select a total of 415 maternal health care providers. We utilized a structured, pretested, and self-administered questionnaire to collect data. Data were entered into EpiData (version 3.1) and exported to STATA (version 16) for analysis. Descriptive statistics and bivariate and multivariate logistic regression analyses were performed. All covariates with a p value ⩽0.20 in bivariate logistic regression were entered into a multivariate logistic regression analysis to control the confounding variables; variables with a p value <0.05 were considered statistically significant. Results: Out of 410 respondents, 247 (60.2%; 95% confidence interval: 55.4–65.1) had good knowledge of preconception care. Having an educational level of Bachelor of Science degree and above (adjusted odds ratio: 6.97, 95% confidence interval: 3.85–12.60), 5 or more years work experience (adjusted odds ratio: 2.60, 95% confidence interval: 1.52–4.49), working in a hospital (adjusted odds ratio: 2.50, 95% confidence interval: 1.25–4.99), reading preconception care guidelines (adjusted odds ratio: 3.06, 95% confidence interval: 1.40–6.68), and training on preconception (adjusted odds ratio: 2.90, 95% confidence interval: 1.37–6.15) were significantly associated with good knowledge of preconception care. Conclusions and Recommendations: Three out of five maternal health care providers in this study had good knowledge of preconception care. Facilitating continuous refreshment training and continuous professional development for health workers, preparing comprehensive preconception care guidelines for health institutions, and reading preconception care guidelines were highly recommended.

Ethnic Disparities in the Use of Nicotine Replacement Therapy for Smoking Cessation in an Equal Access Health Care System

2005 ◽  
Vol 20 (2) ◽  
pp. 108-116 ◽  
Author(s):  
Steven S. Fu ◽  
Scott E. Sherman ◽  
Elizabeth M. Yano ◽  
Michelle van Ryn ◽  
Andy B. Lanto ◽  
...  
Keyword(s):  
Health Care ◽  
African American ◽  
Confidence Interval ◽  
Replacement Therapy ◽  
Nicotine Replacement Therapy ◽  
Health Care System ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Equal Access ◽  
Quit Attempt

Purpose. To examine ethnic variations in the use of nicotine replacement therapy (NRT) in an equal access health care system. Design. Cross-sectional survey. Setting. Eighteen Veterans Affairs medical and ambulatory care centers. Subjects. A cohort of male current smokers (n = 1606). Measures. Use of NRT (nicotine patch or nicotine gum), ethnicity, sociodemographics, health status, smoking-related history, and facility prescribing policy. Results. Overall, only 34% of African-American and 26% of Hispanic smokers have ever used NRT as a cessation aid compared with 50% of white smokers. In the past year, African-American smokers were most likely to have attempted quitting. During a serious past-year quit attempt, however, African-American and Hispanic smokers reported lower rates of NRT use than white smokers (20% vs. 22% vs. 34%, respectively, p = .001). In multivariate analyses, ethnicity was independently associated with NRT use during a past-year quit attempt. Compared with white smokers, African-American (adjusted odds ratio, .53; 95% confidence interval, .34–.83) and Hispanic (adjusted odds ratio, .55; 95% confidence interval, .28–1.08) smokers were less likely to use NRT. Conclusions. Assessment of variations in use of NRT demonstrates that African-American and Hispanic smokers are less likely to use NRT during quit attempts. Future research is needed on the relative contributions of patient, physician, and system features to gaps in guideline implementation to provide treatment for ethnic minority smokers.

Health professionals’ attitude and associated factors toward cytotoxic drug handling in University of Gondar specialized hospital: Institution-based cross-sectional study

2021 ◽  
pp. 107815522110404
Author(s):  
Wudneh Simegn ◽  
Baye Dagnew ◽  
Henok Dagne ◽  
Berhanemeskel Weldegerima
Keyword(s):  
Health Care ◽  
Confidence Interval ◽  
Health Professionals ◽  
Work Experience ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Cytotoxic Drug ◽  
Cytotoxic Drugs ◽  
Cross Sectional ◽  
Drug Handling

Background Studies have shown that cytotoxic drugs are dangerous to health care workers. Health care professionals’ attitude to cytotoxic drugs is vital to apply safety protocols in the prevention of cytotoxicity. The current study aimed to assess health professionals’ desirable attitude and associated factors toward cytotoxic drugs handling in the University of Gondar Specialized Hospital. Methods An institution-based cross-sectional study was conducted on 412 health professionals from June to August 2019. Simple random sampling was used to select participants and a self-administered questionnaire was used to collect data. Epi Info and SPSS 20 were used for data entry and analysis, respectively. Variables with a p value < 0.05 were declared as determinants. Results The number of health professionals included was approximately 412. The mean age of participants was 29.9 ± 5.4 years. The proportion of participants with desirable attitude toward cytotoxic drugs handling was 224 (54.4%) (95% confidence interval: 51.95–56.85). Male (adjusted odds ratio = 1.69, 95% confidence interval:[1.08–2.65]), work experience of 5–8 years (adjusted odds ratio = 1.92, 95% confidence interval: [1.10–3.34]), weekly working hours of 44–55 (adjusted odds ratio = 2.25, 95% confidence interval: [1.02–4.96]), medium work stress (adjusted odds ratio = 1.67, 95% confidence interval: [1.01–2.69]), and good practice of cytotoxic drug handling (adjusted odds ratio = 1.67, 95% confidence interval: [1.04–2.67]) were significantly associated with the attitude of health professionals. Conclusion A significant proportion of health care workers did not have desirable attitude to handle cytotoxic drugs. Thus, strategies are suggested to improve the positive attitude of health professionals to cytotoxic drug handling. Female health professionals, those who had work experience of less than 2 years and those with higher work stress demand special attention.

scholarly journals The impact of adverse childhood experiences on health service use across the life course using a retrospective cohort study

2017 ◽  
Vol 22 (3) ◽  
pp. 168-177 ◽  
Author(s):  
Mark Bellis ◽  
Karen Hughes ◽  
Katie Hardcastle ◽  
Kathryn Ashton ◽  
Kat Ford ◽  
...  
Keyword(s):  
Health Care ◽  
Life Course ◽  
Hospital Stay ◽  
Adverse Childhood Experiences ◽  
Service Use ◽  
Health Care Use ◽  
Life Course Perspective ◽  
Childhood Experiences ◽  
Adverse Childhood ◽  
The Impact

Objectives The lifelong health impacts of adverse childhood experiences are increasingly being identified, including earlier and more frequent development of non-communicable disease. Our aim was to examine whether adverse childhood experiences are related to increased use of primary, emergency and in-patient care and at what ages such impact is apparent. Methods Household surveys were undertaken in 2015 with 7414 adults resident in Wales and England using random probability stratified sampling (age range 18–69 years). Nine adverse childhood experiences (covering childhood abuse and household stressors) and three types of health care use in the last 12 months were assessed: number of general practice (GP) visits, emergency department (ED) attendances and nights spent in hospital. Results Levels of use increased with increasing numbers of adverse childhood experiences experienced. Compared to those with no adverse childhood experiences, odds (±95% CIs) of frequent GP use (≥6 visits), any ED attendance or any overnight hospital stay were 2.34 (1.88–2.92), 2.32 (1.90–2.83) and 2.67 (2.06–3.47) in those with ≥ 4 adverse childhood experiences. Differences were independent of socio-economic measures of deprivation and other demographics. Higher health care use in those with ≥ 4 adverse childhood experiences (compared with no adverse childhood experiences) was evident at 18–29 years of age and continued through to 50–59 years. Demographically adjusted means for ED attendance rose from 12.2% of 18-29 year olds with no adverse childhood experiences to 28.8% of those with ≥ 4 adverse childhood experiences. At 60–69 years, only overnight hospital stay was significant (9.8% vs. 25.0%). Conclusions Along with the acute impacts of adverse childhood experiences on child health, a life course perspective provides a compelling case for investing in safe and nurturing childhoods. Disproportionate health expenditure in later life might be reduced through childhood interventions to prevent adverse childhood experiences.

Continuity of Care, Systems Integration and Patient Transitions: Central or Local Psychiatric Beds? The VELO-Project

2009 ◽  
Vol 24 (S1) ◽  
pp. 1-1
Author(s):  
L.H.R. Myklebust ◽  
S. Bjorbekkmo ◽  
A. Nymann ◽  
S. Molvik ◽  
R. Olstad ◽  
...  
Keyword(s):  
Mental Health ◽  
Continuity Of Care ◽  
Service Use ◽  
Mental Health Problems ◽  
Outpatient Service ◽  
Systems Integration ◽  
Integrated System ◽  
Outpatient Services ◽  
Individual Level ◽  
Care Systems

Background:Although scientifically controversial, continuity of care for patients with serious mental illness has long been a key-concept in the evaluation of deinstitutionalized mental health services. It is associated with systems integration, and particularly relevant in transitions from in- to outpatient status at the individual level. The theme is highlighted in a close to natural experiment that was part of the VELO-project, were two neighboring mental health service-systems diverge concerning their organization of in- and outpatient services.Aim:To investigate the significance of systems integration of inpatient and outpatient services on continuity of care for individual patients.Method:244 inpatients from the services case-registry (2005) were followed concerning their pattern of both inpatient and outpatient service use. The results were controlled for length of hospitalization, diagnosis and demographical variables.Results:Overall for inpatients, the low-integrated system shows significantly less outpatient activity than the high-integrated system. This pattern is not associated with differences in general service profile of the systems, and holds up for patients suffering from schizophrenia and anxiety, but not for affective disorders.Discussion:The results may be explained by differences in geographical and managerial organization of the two systems.Conclusion:High level of systems integration is important in reducing the risk of discontinuity of care for patients suffering from severe mental health problems. Level of integration may interact with differences in vulnerability for transitions of individual patients.

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