scholarly journals The influence of integrated geriatric outpatient clinics on the health care utility of older people

2020 ◽  
Author(s):  
Yu-Ju Wei ◽  
Cheng-Fang Hsieh ◽  
Yu-Ting Huang ◽  
Ming-Shyan Huang ◽  
Tzu-Jung Fang
Keyword(s):  
Health Care ◽  
Emergency Department ◽  
Health Care Utilization ◽  
Older People ◽  
Outpatient Clinic ◽  
Emergency Department Visits ◽  
Care Utilization ◽  
Second Year ◽  
Clinic Visits

Abstract Background: The number of people aged greater than 65 years is growing in many countries. Taiwan will be a superaged society in 2026, and health care utilization will increase considerably. Our study aimed to evaluate the efficacy of the geriatric integrated outpatient clinic model for reducing health care utilization by older people.Methods: This was a retrospective case-control study. Patients aged greater than 65 years seen at the geriatric outpatient clinic (Geri-OPD) and non-geriatric outpatient clinic (non-Geri-OPD) at a single medical centre were age and sex matched. Data on the number of outpatient clinic visits, emergency department visits, hospitalizations and medical expenditures were collected during the first and second years. A subgroup analysis by Charlson comorbidity index (CCI) and older age (age≧80 years) was performed, and the results were compared between the Geri-OPD and non-Geri-OPD groups.Results: A total of 6723 patients were included (3796 women and 2927 men). The mean age was 80.42 ± 6.39 years. There were 1291 (19.2%) patients in the Geri-OPD group and 5432 (80.8%) patients in the non-Geri-OPD group. After one year of regular follow-up, the Geri-OPD patients showed a significant reduction in the types of drugs included in each prescription (5.62±10.85) and the number of clinic visits per year (18.18 ± 48.85) (P<0.01). After a two-year follow-up, the number of clinic visits, emergency department visits, and hospitalizations and the annual medical costs were still decreased in the Geri-OPD patients. The Geri-OPD patients had more comorbidities and a higher rate of health care utilization than the non-Geri-OPD patients. In the subgroup analysis, patients with more comorbidities (CCI≧2) and an older age (≧80 years) in the Geri-OPD group showed a significant reduction in health care utilization. The Geri-OPD patients also showed a significant decrease in medical utilization in the second year compared with the non-Geri-POD patients.Conclusion: The Geri-OPD reduced medical costs, the number of drugs prescribed, and the frequency of outpatient clinic visits, emergency department visits and hospitalizations in older patients with complicated conditions. The effect was even better in the second year.

scholarly journals The influence of integrated geriatric outpatient clinics on the health care utility of older people

2020 ◽  
Author(s):  
YU-JU WEI ◽  
Cheng-Fang Hsieh ◽  
Yu-Ting Huang ◽  
Ming-Shyan Huang ◽  
Tzu-Jung Fang
Keyword(s):  
Health Care ◽  
Emergency Department ◽  
Health Care Utilization ◽  
Older People ◽  
Outpatient Clinic ◽  
Emergency Department Visits ◽  
Care Utilization ◽  
Second Year ◽  
Clinic Visits

Abstract Background: The number of people aged greater than 65 years is growing in many countries. Taiwan will be a superaged society in 2026, and health care utilization will increase considerably. Our study aimed to evaluate the efficacy of the geriatric integrated outpatient clinic model for reducing health care utilization by older people. Methods: This was a retrospective case-control study. Patients aged greater than 65 years seen at the geriatric outpatient clinic (Geri-OPD) and non-geriatric outpatient clinic (non-Geri-OPD) at a single medical centre were age and sex matched. Data on the number of outpatient clinic visits, emergency department visits, hospitalizations and medical expenditures were collected during the first and second years. A subgroup analysis by Charlson comorbidity index (CCI) and older age (age≧80 years) was performed, and the results were compared between the Geri-OPD and non-Geri-OPD groups. Results: A total of 6723 patients were included (3796 women and 2927 men). The mean age was 80.42 ± 6.39 years. There were 1291 (19.2%) patients in the Geri-OPD group and 5432 (80.8%) patients in the non-Geri-OPD group. After one year of regular follow-up, the Geri-OPD patients showed a significant reduction in the types of drugs included in each prescription (5.62±10.85) and the number of clinic visits per year (18.18 ± 48.85) (P<0.01). After a two-year follow-up, the number of clinic visits, emergency department visits, and hospitalizations and the annual medical costs were still decreased in the Geri-OPD patients. The Geri-OPD patients had more comorbidities and a higher rate of health care utilization than the non-Geri-OPD patients. In the subgroup analysis, patients with more comorbidities (CCI≧2) and an older age (≧80 years) in the Geri-OPD group showed a significant reduction in health care utilization. The Geri-OPD patients also showed a significant decrease in medical utilization in the second year compared with the non-Geri-POD patients. Conclusion: The Geri-OPD reduced medical costs, the number of drugs prescribed, and the frequency of outpatient clinic visits, emergency department visits and hospitalizations in older patients with complicated conditions. The effect was even better in the second year.

scholarly journals The influence of integrated geriatric outpatient clinics on the health care utilization of older people

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Yu-Ju Wei ◽  
Cheng-Fang Hsieh ◽  
Yu-Ting Huang ◽  
Ming-Shyan Huang ◽  
Tzu-Jung Fang
Keyword(s):  
Health Care ◽  
Emergency Department ◽  
Health Care Utilization ◽  
Older People ◽  
Outpatient Clinic ◽  
Emergency Department Visits ◽  
Care Utilization ◽  
Second Year ◽  
Clinic Visits

Abstract Background The number of people aged greater than 65 years is growing in many countries. Taiwan will be a superaged society in 2026, and health care utilization will increase considerably. Our study aimed to evaluate the efficacy of the geriatric integrated outpatient clinic model for reducing health care utilization by older people. Methods This was a retrospective case-control study. Patients aged greater than 65 years seen at the geriatric outpatient clinic (Geri-OPD) and non-geriatric outpatient clinic (non-Geri-OPD) at a single medical centre were age and sex matched. Data on the number of outpatient clinic visits, emergency department visits, hospitalizations and medical expenditures were collected during the first and second years. A subgroup analysis by Charlson comorbidity index (CCI) and older age (age≧80 years) was performed, and the results were compared between the Geri-OPD and non-Geri-OPD groups. Results A total of 6723 patients were included (3796 women and 2927 men). The mean age was 80.42 ± 6.39 years. There were 1291 (19.2%) patients in the Geri-OPD group and 5432 (80.8%) patients in the non-Geri-OPD group. After one year of regular follow-up, the Geri-OPD patients showed a significant reduction in the types of drugs included in each prescription (5.62 ± 10.85) and the number of clinic visits per year (18.18 ± 48.85) (P < 0.01). After a two-year follow-up, the number of clinic visits, emergency department visits, and hospitalizations and the annual medical costs were still decreased in the Geri-OPD patients. The Geri-OPD patients had more comorbidities and a higher rate of health care utilization than the non-Geri-OPD patients. In the subgroup analysis, patients with more comorbidities (CCI≧2) and an older age (≧80 years) in the Geri-OPD group showed a significant reduction in health care utilization. The Geri-OPD patients also showed a significant decrease in medical utilization in the second year compared with the non-Geri-POD patients. Conclusion The Geri-OPD reduced medical costs, the number of drugs prescribed, and the frequency of outpatient clinic visits, emergency department visits and hospitalizations in older patients with complicated conditions. The effect was even better in the second year.

scholarly journals The influence of integrated geriatric outpatient clinics on the health care utilization of older people

2020 ◽  
Author(s):  
YU-JU WEI ◽  
Cheng-Fang Hsieh ◽  
Yu-Ting Huang ◽  
Ming-Shyan Huang ◽  
Tzu-Jung Fang
Keyword(s):  
Health Care ◽  
Emergency Department ◽  
Health Care Utilization ◽  
Outpatient Clinic ◽  
Emergency Department Visits ◽  
Outpatient Clinics ◽  
Care Utilization ◽  
Second Year ◽  
Clinic Visits

Abstract Background: The number of people above the age of 65 years is growing in many countries. Taiwan will be a superaged society in 2026, and health care utilization will increase considerably. Our study aimed to evaluate the efficacy of the geriatric integrated outpatient clinic model for reducing health care utilization by in older people.Methods: This was a retrospective case-control study. Patients aged more than 65 years seen at the geriatric outpatient clinic (Geri-OPD) and non-geriatric outpatient clinics (non-Geri-OPD) at a single medical centre were age- and sex-matched. Data on the number of outpatient clinic visits, emergency department visits, and hospitalizations and medical expenditures were collected in the first and second years. A subgroup analysis by Charlson comorbidity index (CCI) and older age (age≧80 years old) was performed, and the results were compared between the Geri-OPD and non-Geri-OPD groups.Results: A total of 6723 patients were included (3796 women and 2927 men). The mean age was 80.42 ± 6.39 years. There were 1291 (19.2%) patients from the Geri-OPD group and 5432 (80.8%) patients from the non-Geri-OPD group. After one year of regular follow-up, the Geri-OPD patients showed a significant reduction in the types of drugs included in each prescription (5.62±10.85) and the number of clinic visits per year (18.18 ± 48.85) (P<0.01). After a two-year follow-up, the number of clinic visits, emergent department visits, and hospitalizations and the annual medical costs were still decreased in the Geri-OPD patients. The Geri-OPD patients had more comorbidities and a higher rate of health care utilization than the non-Geri-OPD patients. In the subgroup analysis, patients with more comorbidities (CCI≧2) and older age (≧80 years old) in the Geri-OPD group showed a significant reduction in health care utilization. The Geri-OPD patients also showed a significant decrease in medical utilization in the second year compared to the non-Geri-POD patients.Conclusion: The Geri-OPD reduced medical costs, the number of drugs prescribed, and the frequency of outpatient clinic visits, emergency department visits and hospitalizations in complicated elderly patients. The effect was even better in the second year.Trial registration: Not applicable

scholarly journals The influence of integrated geriatric outpatient clinic on the health care utility of elderly

2020 ◽  
Author(s):  
YU-JU WEI ◽  
Cheng-Fang Hsieh ◽  
Yu-Ting Huang ◽  
Ming-Shyan Huang ◽  
Tzu-Jung Fang
Keyword(s):  
Health Care ◽  
Emergency Department ◽  
Medical Cost ◽  
Outpatient Clinic ◽  
Subgroup Analysis ◽  
Older Age ◽  
Medical Expenditure ◽  
Second Year ◽  
Clinic Visits

Abstract Background: People above age 65 are growing in many countries. Taiwan will be a super-aged society in 2026 and the utility of health care will increase considerably. Our study was aimed to evaluate the efficacy of the geriatric integrated outpatient clinic on health care utility reduction of the elderly. Methods: This was a retrospective case-control study. The patients with age more than 65 years old in the geriatric outpatient clinic (Geri-OPD) and non-geriatric outpatient clinic (non-Geri OPD) with age and sex-matched in a single medical center were included. The numbers of outpatient clinic visits, emergency department visits, hospitalization, and medical expenditure data were collected in the first year and second year. The subgroup analysis by Charlson comorbidity index (CCI) and older age (age≧80 years old) was done between Geri-OPD and non-Geri OPD. Results: Total 6723 patients were included (3796 women and 2927 men). The mean age was 80.42 ± 6.39 years old. There were 1291 (19.2%) patients from the Geri-OPD and 5432 (80.8%) patients from the non-Geri OPD. After one year regular follow-up, those Geri-OPD patients had significantly reduced 5.62±10.85 kinds of drugs in each prescription and 18.18 ± 48.85 clinic visits per year (P<0.01). After two-year follow-up, the clinic visits, emergent department visits, hospitalizations, and the annual medical cost still decreased in the Geri-OPD patients. The Geri-OPD patients have more co-morbidities and higher health care utility than the non-Geri OPD patients. In the subgroup analysis, the patients with higher comorbidities (CCI≧2) and older age (≧80 years old) have significant health care utility reduction in Geri-OPD. The medical utility difference between the Geri-OPD and non-Geri OPD patients also decreased significantly. Conclusion: The geriatric integrated outpatient clinic reduced the medical cost, drug numbers, and the frequency of outpatient clinic visit, emergency department visit and hospitalization in the complicated elder patients. The effect was even better in the second year.

scholarly journals PEER TO PEER SUPPORT AND HEALTH CARE UTILIZATION AMONG COMMUNITY-DWELLING OLDER ADULTS

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S857-S857
Author(s):  
Elizabeth A Jacobs ◽  
Rebecca Schwei ◽  
Scott Hetzel ◽  
Jane Mahoney ◽  
KyungMann Kim
Keyword(s):  
Older Adults ◽  
Health Care ◽  
Emergency Department ◽  
Health Care Utilization ◽  
Peer Support ◽  
Peer Group ◽  
Peer To Peer ◽  
Emergency Department Visits ◽  
Urgent Care ◽  
Care Utilization

Abstract The majority of older adults want to live and age in their communities. Some community-based organizations (CBOs) have initiated peer-to-peer support services to promote aging in place but the effectiveness of these programs is not clear. Our objective was to compare the effectiveness of a community-designed and implemented peer-to-peer support program vs. access to standard community services, in promoting health and wellness in vulnerable older adult populations. We partnered with three CBOs, one each in California, Florida, and New York, to enroll adults 65 &gt; years of age who received peer support and matched control participants (on age, gender, and race/ethnicity) in an observational study. We followed participants over 12 months, collecting data on self-reported urgent care and emergency department visits and hospitalizations. In order to account for the lack of randomization, we used a propensity score method to compare outcomes between the two groups. We enrolled 222 older adults in the peer-to-peer group and 234 in the control group. After adjustment, we found no differences between the groups in the incidence of hospitalization, urgent and emergency department visits, and composite outcome of any health care utilization. The incidence of urgent care visits was statistically significantly greater in the standard community service group than in the peer-to-peer group. Given that the majority of older adults and their families want them to age in place, the question of how to do this is highly relevant. Peer-to-peer services may provide some benefit to older adults in regard to their health care utilization.

scholarly journals Relationship Between Intensive Care Unit Delirium Severity and 2-Year Mortality and Health Care Utilization

2020 ◽  
Vol 29 (4) ◽  
pp. 311-317
Author(s):  
Patricia S. Andrews ◽  
Sophia Wang ◽  
Anthony J. Perkins ◽  
Sujuan Gao ◽  
Sikandar Khan ◽  
...  
Keyword(s):  
Health Care ◽  
Intensive Care Unit ◽  
Emergency Department ◽  
Intensive Care ◽  
Health Care Utilization ◽  
Mortality Risk ◽  
Hazard Ratio ◽  
Emergency Department Visits ◽  
Care Utilization ◽  
Increased Risk

Background Critical care patients with delirium are at an increased risk of functional decline and mortality long term. Objective To determine the relationship between delirium severity in the intensive care unit and mortality and acute health care utilization within 2 years after hospital discharge. Methods A secondary data analysis of the Pharmacological Management of Delirium and Deprescribe randomized controlled trials. Patients were assessed twice daily for delirium or coma using the Richmond Agitation-Sedation Scale and the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). Delirium severity was measured using the CAM-ICU-7. Mean delirium severity (from time of randomization to discharge) was categorized as rapidly resolving, mild to moderate, or severe. Cox proportional hazards regression was used to model time to death, first emergency department visit, and rehospitalization. Analyses were adjusted for age, sex, race, Charlson Comorbidity Index, Acute Physiology and Chronic Health Evaluation II score, discharge location, diagnosis, and intensive care unit type. Results Of 434 patients, those with severe delirium had higher mortality risk than those with rapidly resolving delirium (hazard ratio 2.21; 95% CI, 1.35-3.61). Those with 5 or more days of delirium or coma had higher mortality risk than those with less than 5 days (hazard ratio 1.52; 95% CI, 1.07-2.17). Delirium severity and number of days of delirium or coma were not associated with time to emergency department visits and rehospitalizations. Conclusion Increased delirium severity and days of delirium or coma are associated with higher mortality risk 2 years after discharge.

Opioid Prescribing for Proximal Row Carpectomy versus Four-Corner Arthrodesis

2021 ◽  
Author(s):  
Thomas E. Moran ◽  
Sheriff D. Akinleye ◽  
Alex J. Demers ◽  
Grace L. Forster ◽  
Brent R. DeGeorge
Keyword(s):  
Risk Factors ◽  
Health Care ◽  
Emergency Department ◽  
Health Care Utilization ◽  
Hospital Readmissions ◽  
Emergency Department Visits ◽  
Prescribing Patterns ◽  
Care Utilization ◽  
Proximal Row Carpectomy ◽  
Opioid Prescribing

Abstract Background Proximal row carpectomy (PRC) and four-corner arthrodesis (4-CA) represent motion-sparing procedures for addressing degenerative wrist pathologies. While both procedures demonstrate comparable functional outcomes, postoperative pain presents a surgical challenge that often necessitates the use of opioids. Objectives The aim of this study was to (1) compare opioid prescribing patterns surrounding PRC and 4-CA, (2) identify risk factors predisposing patients to increased perioperative and prolonged postoperative opioids, and (3) examine the association between opioids and perioperative health care utilization. Patients and Methods PearlDiver Patients Records Database was used to retrospectively identify patients undergoing primary PRC and 4-CA between 2010 and 2018. Patient demographics, comorbidities, prescription drug usage, and perioperative health care utilization were evaluated. Perioperative opioid prescriptions and post-operative opioid prescriptions were recorded. Logistic regression analysis evaluated the association of patient risk factors. Results There was no significant difference in perioperative (PRC [odds ratio {OR}: 0.84, p = 0.788]; 4-CA [OR: 0.75, p = 0.658]) or prolonged postoperative opioid prescriptions (PRC [OR: 0.95, p = 0.927]; 4-CA [OR: 0.99, p = 0.990]) between PRC and 4-CA. Chronic back pain and use of benzodiazepines or anticonvulsants were associated with increased risks of prolonged postoperative opioids. Prolonged postoperative opioids presented increased risks of emergency department visits (OR: 2.09, p = 0.019) and hospital readmissions (OR: 10.2, p = 0.003). Conclusion No significant differences exist in the prescription of opioids for PRC versus 4-CA. Both procedures have high amounts of prolonged postoperative opioid use, which is associated with increased risks of emergency department visits and hospital readmissions. Level of Evidence This is a level III, retrospective comparative study.

Utilization of Systemic Therapy in Patients With Cancer Near the End of Life in the Pre- Versus Postimmune Checkpoint Inhibitor Eras

2021 ◽  
pp. OP.20.01050
Author(s):  
Ali Raza Khaki ◽  
Shasank Chennupati ◽  
Catherine Fedorenko ◽  
Li Li ◽  
Qin Sun ◽  
...  
Keyword(s):  
Health Care ◽  
Emergency Department ◽  
Cell Death ◽  
Health Care Utilization ◽  
Systemic Therapy ◽  
Emergency Department Visits ◽  
Cancer Surveillance ◽  
Care Utilization ◽  
Annual Prevalence ◽  
Cell Death Protein

PURPOSE: Systemic therapy use in the last 30 days of life (DOL) for patients with advanced cancer is a low-value medical practice. We hypothesized that systemic therapy use in the last 30 DOL increased after approval of antiprogrammed cell death protein 1 immune checkpoint inhibitors (ICIs) and has contributed to increased health care utilization and spending. METHODS: We investigated the change in prevalence of any systemic therapy use in the last 30 DOL among patients with advanced solid tumors in the 4 years before and after antiprogrammed cell death protein 1 ICI approval in 2014. We used cases from the Western Washington Cancer Surveillance System linked to commercial and Medicare insurance. We calculated the difference in prevalence between the pre- and post-ICI periods. We also calculated the annual prevalence of any systemic therapy and ICI use in the last 30 DOL and measured health care utilization (emergency department visits and hospitalizations) and costs during the last 30 DOL. RESULTS: Eight thousand eight hundred seventy-one patients (median age 73 years) were included; 34% and 66% in the pre-and post-ICI period, respectively. Systemic therapy use in the last 30 DOL was lower in the post-ICI versus pre-ICI period (12.4% v 14.4%; difference −2.0% [95% CI, −3.5 to −0.5]). The annual prevalence of systemic therapy use in the last 30 DOL also declined, although ICI use rose. Patients treated with ICIs in last 30 DOL had more emergency department visits, hospitalizations, and higher costs. CONCLUSION: Systemic therapy use in the last 30 DOL was lower in the period after ICI approval. However, ICI use rose over time and had higher utilization and costs in the last 30 DOL. Systemic therapy use in the last 30 DOL warrants monitoring, especially as more ICI indications are approved.

scholarly journals Personal health record use for children and health care utilization: propensity score-matched cohort analysis

2015 ◽  
Vol 22 (4) ◽  
pp. 748-754 ◽  
Author(s):  
Yi Yvonne Zhou ◽  
Wendy M Leith ◽  
Hui Li ◽  
Jeffrey O Tom
Keyword(s):  
Health Care ◽  
Propensity Score ◽  
Health Care Utilization ◽  
Outpatient Clinic ◽  
Pediatric Patients ◽  
Personal Health Record ◽  
Care Utilization ◽  
Personal Health ◽  
Care Providers ◽  
Clinic Visits

Abstract Objectives To examine the association between caregiver personal health record (PHR) use and health care utilization by pediatric patients. Design, Setting, and Participants We conducted a retrospective observational cohort study of 2286 pediatric members aged six months to 2.5 years of Kaiser Permanente Hawaii and Northwest Regions in 2007-2011, using propensity score matching methods and t and chi-square tests to examine associations between PHR use and health care utilization. We used ANOVA to examine utilization across quartiles of PHR use. Main Outcome Measures Outpatient clinic visits, telephone encounters, and emergency department visits. Results PHR-registered children, compared with propensity score-matched nonregistered children, had 21% (95% CI, 14-28; P &lt; .0001) more outpatient clinic visits and 26% (95% CI, 16-37; P &lt; .0001) more telephone encounters. Utilization differences were more pronounced with nonprimary care providers than with primary care providers. Outpatient clinic visits and telephone encounters increased among the quartile with the highest PHR use; no utilization differences occurred in the 3 lowest-use quartiles. Conclusions PHR use by caregivers was associated with statistically significant increases in outpatient clinic visits and telephone encounters among pediatric patients.

scholarly journals Outcomes of Asthma Education: Results of a Multisite Evaluation

2004 ◽  
Vol 11 (4) ◽  
pp. 291-297 ◽  
Author(s):  
Wilma M Hopman ◽  
Nancy Garvey ◽  
Jennifer Olajos-Clow ◽  
Andrea White-Markham ◽  
M Diane Lougheed
Keyword(s):  
Health Care ◽  
Observational Study ◽  
Health Care Utilization ◽  
Education Program ◽  
Leisure Time ◽  
Emergency Department Visits ◽  
Care Utilization ◽  
Asthma Education ◽  
Sf 36

BACKGROUND:This observational study compared the effectiveness of a standardized adult asthma education program administered in a variety of sites and practice settings on health care utilization, absenteeism, amount of leisure time missed and quality of life (using the Medical Outcomes Study 36-Item Short Form 1.0 [SF-36]).METHODS:Seven asthma centres participated in an uncontrolled, multicentre, prospective, observational study using a pre-post design. Variables included hospital- and community-based centres, an academic hospital setting and the presence or absence of physician attendance. Trained asthma educators administered a guided self- management education program, and standardized questionnaires were used for patient assessment at baseline and six months after education.RESULTS:Of the 517 patients enrolled at baseline, 396 were eligible for the six-month follow-up. Follow-up data were available for 252 patients. SF-36 data were collected for 241 patients at six sites, with follow-up data available for 103 of 155 eligible patients. Asthma education was associated with substantial improvements in scheduled and unscheduled physician visits, unscheduled specialist visits, emergency department visits, hospital admissions, hospitalized days, missed work or school days and missed days of leisure time. There were also statistically significant improvements in all but one SF-36 domain. These improvements were comparable across all geographical sites and physical settings.CONCLUSIONS:Standardized asthma education appears to be effective when administered in a variety of practice settings, and may be associated with significant improvements in patient outcomes. The significant decline in health care utilization implies that substantial health care savings may occur as a result of the implementation of standardized asthma education programs.

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