scholarly journals Postoperative Home Monitoring After Joint Replacement: Retrospective Outcome Study Comparing Cases With Matched Historical Controls (Preprint)

2018 ◽  
Author(s):  
Homer Yang ◽  
Geoff Dervin ◽  
Susan Madden ◽  
Ashraf Fayad ◽  
Paul Beaulé ◽  
...  
Keyword(s):  
Emergency Room ◽  
Descriptive Analysis ◽  
Home Monitoring ◽  
Standard Of Care ◽  
Control Group ◽  
Emergency Room Visits ◽  
American Society ◽  
Patient Readmissions ◽  
The Cost ◽  
Historical Controls

BACKGROUND A retrospective cohort study was conducted in patients undergoing postoperative home monitoring (POHM) following elective primary hip or knee replacements. OBJECTIVE The objectives of our study were to compare the cost per patient, readmissions rate, emergency room visits, and mortality within 30 days to the historical standard of care using descriptive analysis. METHODS After Research Ethics Board approval, patients who were enrolled and had completed a POHM study were individually matched to historical controls by age, American Society of Anesthesiology class, and procedure at a ratio 1:2. RESULTS A total of 54 patients in the study group and 107 in the control group were eligible for the analysis. Compared with the historical standard of care, the average cost per case was Can $5826.32 (SD 1418.89) in the POHM group and Can $9198.58 (SD 1513.59) for controls. After 30 days, there were 2 emergency room visits (3.7%) and 0 readmissions in the POHM group, whereas there were 8 emergency room visits (7.5%) and 2 readmissions (1.9%) in the control group. No mortalities occurred in either group. CONCLUSIONS The POHM study offers an early hospital discharge pathway for elective hip and knee procedures at a 38% reduction of the standard of care cost. The multidisciplinary transitional POHM team may provide a reliable forum to minimize readmissions, and emergency room visits within 30 days postoperatively. CLINICALTRIAL ClinicalTrials.gov NCT02143232; https://clinicaltrials.gov/ct2/show/NCT02143232 (Archived by WebCite at http://www.webcitation.org/73WQ9QR6P)

Early use of home health care on health care utilization for patients with advanced lung cancer.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e19015-e19015
Author(s):  
Steven Rousey ◽  
Kiran Krishan Lassi ◽  
Jodi Wieczorek ◽  
James Essler ◽  
Marie Brown ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Health Care ◽  
Home Care ◽  
Emergency Room ◽  
Home Health Care ◽  
Home Health ◽  
Advanced Lung Cancer ◽  
Control Group ◽  
Emergency Room Visits ◽  
Early Use

e19015 Background: Patients with advanced lung cancer historically have required significant use of health care resources including hospitalizations, ICU admissions and emergency room visits which are often related to inadequately controlled symptoms. Most patients with advanced lung cancer prefer to remain in their own home as much as possible and are willing to work with home nursing resources, if available. The purpose of this pilot study was to determine the effect of early use of home health care on health care utilization for patients with advanced lung cancer. Methods: Betweem May 2011 and May 2012, 18 patients were enrolled in a pilot program to explore early use of home care for individuals with advanced lung cancer. Inclusion criteria consisted of a diagnosis of stage III/IV lung cancer (any histology) and home care eligibility using Medicare criteria. The endpoints were hospitalization rate, number of ICU admissions and emergency room visits. The results were compared to an historical control group (562 patients with advanced lung cancer diagnosed between 2006 and 2011). Binomial confidence interval (CI) was used to estimate the 95% CIs and Fisher's exact test was used to assess the p-values. Results: Results at one year showed the hospitalization rates for the pilot group and the control group were 44% (95% CI, 22-69) and 78% (95% CI, 74-81), respectively (p<0.01) and the ER visit rate was 17% (95% CI, 4-41) and 41% (95% CI, 37-45), respectively (p=0.049). The ICU admission rates were 0% and 11% in the two groups, respectively, and this difference was not statistically significant. Home care visits ranged from 1-77 with an average of 12 visits per patient. The estimated cost of the home care program for the duration of enrollment was $2,330 per patient. Conclusions: Early use of home health care for patients with advanced lung cancer appears to reduce the rates of hospitalization and emergency room visits when compared with historical controls, and though the results were not statistically significant, none of the 18 patients in the pilot group were admitted to the ICU. A larger multi-institutional study will examine the potential of this simple intervention for cost saving, enhanced care quality and improved patient satisfaction.

scholarly journals Effectiveness of Telemonitoring for Reducing Exacerbation Occurrence in COPD Patients With Past Exacerbation History: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 8 ◽  
Author(s):  
Jing-wen Lu ◽  
Yu Wang ◽  
Yue Sun ◽  
Qin Zhang ◽  
Li-ming Yan ◽  
...  
Keyword(s):  
Systematic Review ◽  
Emergency Room ◽  
Acute Exacerbation ◽  
Systematic Reviews ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Control Group ◽  
Chronic Obstructive ◽  
Emergency Room Visits ◽  
Hospital Days

Background: Although an increasing number of studies have reported that telemonitoring (TM) in patients with chronic obstructive pulmonary disease (COPD) can be useful and efficacious for hospitalizations and quality of life, its actual utility in detecting and managing acute exacerbation of COPD (AECOPD) is less established. This meta-analysis aimed to identify the best available evidence on the effectiveness of TM targeting the early and optimized management of AECOPD in patients with a history of past AECOPD compared with a control group without TM intervention.Methods: We systematically searched PubMed, Embase, and the Cochrane Library for randomized controlled trials published from 1990 to May 2020. Primary endpoints included emergency room visits and exacerbation-related readmissions. P-values, risk ratios, odds ratios, and mean differences with 95% confidence intervals were calculated.Results: Of 505 identified citations, 17 original articles with both TM intervention and a control group were selected for the final analysis (N = 3,001 participants). TM was found to reduce emergency room visits [mean difference (MD) −0.70, 95% confidence interval (CI) −1.36 to −0.03], exacerbation-related readmissions (risk ratio 0.74, 95% CI 0.60–0.92), exacerbation-related hospital days (MD −0.60, 95% CI −1.06 to −0.13), mortality (odds ratio 0.71, 95% CI 0.54–0.93), and the St. George's Respiratory Questionnaire (SGRQ) score (MD −3.72, 95% CI −7.18 to −0.26) but did not make a difference with respect to all-cause readmissions, the rate of exacerbation-related readmissions, all-cause hospital days, time to first hospital readmission, anxiety and depression, and exercise capacity. Furthermore, the subgroup analysis by observation period showed that longer TM (≥12 months) was more effective in reducing readmissions.Conclusions: TM can reduce emergency room visits and exacerbation-related readmissions, as well as acute exacerbation (AE)-related hospital days, mortality, and the SGRQ score. The implementation of TM intervention is thus a potential protective therapeutic strategy that could facilitate the long-term management of AECOPD.Systematic Review Registration: This systematic review and meta-analysis is reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement and was registered at International Prospective Register of Systematic Reviews (number: CRD42020181459).

scholarly journals Evaluation of Aminophylline for the Treatment of Acute Kidney Injury in Pediatric Hematology/Oncology Patients

2021 ◽  
Vol 26 (5) ◽  
pp. 484-490
Author(s):  
Hannah E. Sauer ◽  
Kristine R. Crews ◽  
Jennifer L. Pauley ◽  
Melissa S. Bourque ◽  
Allison W. Bragg ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Kidney Injury ◽  
Standard Of Care ◽  
Primary Diagnosis ◽  
Hematopoietic Cell ◽  
Control Group ◽  
Cell Transplant ◽  
Hematopoietic Cell Transplant ◽  
Pediatric Hematology ◽  
Historical Controls

OBJECTIVE The purpose of this study was to compare acute kidney injury (AKI)–related outcomes of patients who received aminophylline in addition to standard of care with matched historical controls who received standard of care alone. METHODS This was a single center, retrospective, historical control cohort study that included patients treated for AKI. Patients who received aminophylline from January 2017 to June 2018 were matched for age, sex, primary diagnosis, and hematopoietic cell transplant history in a 1:2 ratio to historical controls treated for AKI from July 2015 to September 2016. The primary outcome was improvement in AKI stage at 5 and 10 days from treatment initiation. RESULTS Twenty-seven patients who received aminophylline were matched to 54 historical controls. Fifty-eight patients (72%) had recently undergone hematopoietic cell transplant. At day 5, improvement in AKI stage was observed in 56% of patients in each group (p = 1.0); at day 10, improvement in AKI stage was observed in 75% of patients in the aminophylline group vs 70% of historical controls (p = 0.76). By day 10, serum creatinine levels had returned to baseline in 21% of patients in the aminophylline group and 34% of patients in the control group (p = 0.37). CONCLUSIONS Findings of this study demonstrated no difference in the rate of AKI resolution or in the proportion of patients with resolved AKI when aminophylline was added to standard of care for the treatment of AKI in this pediatric hematology/oncology population.

scholarly journals Increased Outpatient Care Can Reduce Hospital Stays for Sickle Cell Patients

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 5578-5578
Author(s):  
Danny A. Landau ◽  
Kaitlyn Steininger ◽  
Erica Landis
Keyword(s):  
Emergency Room ◽  
Sickle Cell ◽  
Conflicts Of Interest ◽  
Length Of Hospital Stay ◽  
Hospital Charge ◽  
Pain Medication ◽  
Emergency Room Visits ◽  
Hospital Stays ◽  
The Cost ◽  
Hospital Days

Abstract Introduction: Sickle cell disease is associated with frequent hospitalizations and emergency room visits when patients enter vasooclusive crisis. This is associated with lengthy hospitalization that can be time life interrupting for patients, increase hospital cost, and limit bed availability for other patients. Some patients with sickle cell have higher inpatient requirements than others due to the frequency of crisis. Recognizing the issues associated with this, we began scheduling patients for frequent outpatient IV fluids and pain medication to try and prevent ER visits and lengthy hospital stays. We are reporting the experience of three of our patients who have had the most frequent hospitalizations and emergency room visits. Methods: Patients who had the highest rate of hospitalizations and emergency room visits were offered regular outpatient intravenous and pain medication during the week (up to four times per week) on an as needed basis. Chairs were reserved for these purposes so on demand therapy could be offered without significant delays. The number of ER visits and hospital stays were counted from 12 months before and 12 months after we started offering this. For one of the three patients, data on length of hospital stay could not be accurately determined due to a lengthy hospitalization for infection rather than sickle cell pain crisis, but his emergency room visits were still counted. Basic hospitalization cost for daily hospital charge was also considered, but additional costs such as drug administration, diet, imaging, etc. were not. Results: In the 12 months prior to starting regular outpatient IV fluids, there were 48 aggregate emergency room visits compared to 26 in the 12 months after, a reduction of 38%. Inpatient hospital days before were 91 before and 46 post (49%). Cost for hospital days were reduced from $224497 to $113480 (49%). Conclusion: While offering more outpatient support to our sickle cell patients with the highest hospital demand, we can cut hospital days in half, and limit ER visits and also reduce the cost for inpatient care. Increasing outpatient support, when feasible, should be considered for sickle cell patients who require regular hospitalizations. Figure 1. Figure 1. Disclosures No relevant conflicts of interest to declare.

Economic Burden of Sickle Cell Disease among Children and Adults.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 958-958 ◽  
Author(s):  
Abraham G. Hartzema ◽  
Teresa L. Kauf ◽  
Thomas D. Coates ◽  
Liu Huazhi ◽  
Nakita Mody-Patel
Keyword(s):  
Sickle Cell Disease ◽  
Emergency Room ◽  
Medical Care ◽  
Resource Utilization ◽  
Sickle Cell ◽  
Economic Burden ◽  
Medical Costs ◽  
Emergency Room Visits ◽  
Cell Disease ◽  
The Cost

Abstract Background: The economic burden of sickle cell disease (SCD) has not been determined. Cost-of-care estimates improve health care planning, inform research priorities, and contribute to an understanding of the cost-effectiveness of new SCD treatments. The objectives of this study were examine resource utilization in the Florida Medicaid population; to estimate the cost of medical care for SCD patients; and to examine the proportion of medical care costs attributable to SCD versus other morbidities. Methods: Pediatric (0 – 19 years; y) and adult (> 20 y) patients with a diagnosis of SCD between 1/2001–12/2005 were identified from Florida Medicaid claims. Patients with at least 1 inpatient or 2 outpatient SCD claims at least 30 days apart and ≥6 Medicaid-eligible months, not necessarily consecutive, were included in the analysis. Medicaid administrative data consist of medical and pharmacy utilization and reimbursement claims for medically-needy and low-income recipients. Resource utilization and costs were estimated using paid claims for hospitalizations, emergency room visits, outpatient visits, pharmacy claims, and other care (blood transfusions, hydroxyurea, iron chelation, serum ferritin tests). Claims containing a primary or secondary ICD-9 code indicating SCD were considered “SCD-related”; all other claims were classified as “non-SCD-related”. Individuals aged >65 y and/or dually eligible for Medicare or other health insurance were excluded. Annualized costs were estimated by multiplying mean cost per patient-month by 12. All costs were inflated to 2005 US$ using the medical care component of the Consumer Price Index. Results: A total of 4,294 individuals met study inclusion criteria. Mean age at first claim was 14.5 y (range: 0–64 y; SD 13.2); 55.8% were female; 79.1% African-American. Mean SCD-related costs for pediatric (0–9 y) and adolescent (10–19 y) patients were estimated at $5,292 and $11,508 per year, respectively. Overall, 66% of total medical costs were related to SCD. The distribution of SCD-related costs was bimodal, with the youngest (0–9 y) and oldest (50–64 y) having the lowest proportion of SCD-related costs (53.7% and 35.3%, respectively). Non-SCD-related costs increased with age, ranging from $4,548 annually for ages 0–9 to $16,656 for ages 50–64. While SCD accounted for the largest proportion of total medical costs for patients 10–19 y (77.27%; $11,508), absolute SCD costs were highest for patients 30–39 y (67.1%; $21,792). Cost distributions were similar for males and females. Hospitalizations accounted for 80.5% of all SCD-related costs; emergency room visits, 3.2%; office visits, 0.9%; outpatient drugs, 3.6%; other medical care, 11.7%. Total discounted medical costs (3%) for a SCD patient from birth through age 45 were estimated at $448,460, with 67% of costs related to SCD. Conclusion: Our results suggest that the burden of SCD is substantial. Moreover, non-SCD-related medical costs for SCD patients are considerably higher than expenditures reported for the general US population. While our results reflect the payer’s perspective, the clinical, humanistic, and economic burden of care on individual patients also is likely high. Interventions designed to prevent SCD complications and keep patients out of the hospital may reduce the significant economic burden of the disease.

scholarly journals Can a Self-Management Education Program for Patients with Chronic Obstructive Pulmonary Disease Improve Quality of Life ?

2011 ◽  
Vol 18 (5) ◽  
pp. e77-e81 ◽  
Author(s):  
Manon Labrecque ◽  
Khalil Rabhi ◽  
Catherine Laurin ◽  
Helene Favreau ◽  
Gregory Moullec ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Emergency Room ◽  
Management Education ◽  
Intervention Group ◽  
Self Management ◽  
Control Group ◽  
Chronic Obstructive ◽  
Emergency Room Visits ◽  
Obstructive Pulmonary Disease

OBJECTIVE: To assess the effects of a self-management program on health-related quality of life (HRQoL) and morbidity commonly associated with chronic obstructive pulmonary disease (COPD).METHODS: A total of 57 outpatients with stable COPD received four weeks of self-management education, while 45 patients received usual care. Patients were evaluated at baseline, at three months and one year following the educational intervention. The primary outcome variable was HRQoL measured by the St George’s Respiratory Questionnaire (SGRQ). The secondary outcome variables were number of emergency room visits and hospitalizations for exacerbation.RESULTS: The intervention group’s HRQoL improved significantly at three months (total score A=−5.0 [P=0.006]) and 12 months (total score A=−6.7 [P<0.001]), as evidenced by decreased scores on the SGRQ. In contrast, the SGRQ scores increased significantly in the control group at three months (total score A=+3.7 [P= 0.022]) and 12 months (total score A=+3.4 [P=0.032]). Global impact appeared to be responsible for the change in the intervention group. Moreover, in the intervention group, the number of hospitalizations dropped from 0.7/person/year to 0.3/person/year (P=0.017), and emergency room visits dropped from 1.1 person/year to 0.2/person/year (P=0.002), while subjects in the control group did not experience any significant decreases in these parameters.CONCLUSIONS: A planned education program improved HRQoL while decreasing the number of emergency room visits and hospitalizations in patients with stable COPD; this improvement persisted at 12 months.

scholarly journals Measuring the Barriers to Adherence With Neurology Clinic Appointments for Children With Epilepsy: A Pilot Study

2021 ◽  
Vol 8 ◽  
pp. 2329048X2110125
Author(s):  
Jason Bailey ◽  
Melanie West ◽  
Rajkumar Agarwal ◽  
Gogi Kumar
Keyword(s):  
Emergency Department ◽  
Emergency Room ◽  
Social Determinants Of Health ◽  
Social Determinants ◽  
Determinants Of Health ◽  
Control Group ◽  
Study Group ◽  
Emergency Room Visits ◽  
Missed Appointments ◽  
Neurology Clinic

Introduction: Epilepsy is one of the most common neurological disorders in children. Missed appointments reflect missed opportunity to provide care for children with epilepsy. The objective of this study was to identify social determinants of health (SDH) and other factors associated with missed appointments in children with epilepsy and measure the relation between missed appointments and frequency of emergency room (ER) visits and inpatient admissions. Methods: This was a prospective study conducted in the neurology division at a level 4 epilepsy center. Children (0 to < 18 years of age) with a diagnosis of epilepsy were included and a semi-structured questionnaire was provided to the families. Patients with 2 or more missed neurology clinic appointments in the previous year (“study group”, n = 36) were compared to those with 1 or zero missed appointments (“control group”, n = 49). A comparison of the clinical characteristics, emergency room visits and hospitalizations in the past year as well as SDH was performed. Statistical analysis was performed using SPSS and p < 0.05 was considered significant. Results: The mean age, gender distribution and presence of medical refractoriness were comparable between the 2 groups. Families in the study group reported a higher likelihood of having to make special work arrangements for clinic appointments. Children in the study group were noted to have a significantly higher frequency of single mother households, presence of public insurance, father not graduating from high school and household income less than 50,000 dollars. Within the preceding year, children in the study group were noted to have a higher frequency of visits to the emergency department as well as 6 times higher likelihood of inpatient hospitalization for seizures. Conclusions: Social determinants of health play an important role in determining adherence with neurology clinic visits in children with epilepsy. Children with more missed appointments are likely to have a higher frequency of visits to the emergency department as well as a higher incidence of hospitalization for seizures. Identification of high-risk families and implementation of early interventions may improve adherence to office visits and decrease emergency room visits and hospitalization for seizures.

scholarly journals Effects of the Interactive Web-Based Video “Mon Coeur, Mon BASIC” on Drug Adherence of Patients with Myocardial Infarction: A Randomized Study (Preprint)

2020 ◽  
Author(s):  
Christel Bruggmann ◽  
Julien Adjedj ◽  
Sylvain Sardy ◽  
Olivier Muller ◽  
Pierre Voirol ◽  
...  
Keyword(s):  
Emergency Room ◽  
Interactive Video ◽  
Randomized Study ◽  
Intervention Group ◽  
Control Group ◽  
Drug Adherence ◽  
Emergency Room Visits ◽  
Web Based ◽  
The Difference ◽  
The Impact

BACKGROUND Secondary prevention strategies after acute coronary syndrome (ACS) presentation with the use of drug combinations are essential to reduce the recurrence of cardiovascular events. However, the lack of drug adherence is known to be common in this population, and to be related to treatment failure. To improve drug adherence, we developed the “Mon Coeur, Mon BASIC” web-based interactive video to inform patients about ACS and their drug treatments. OBJECTIVE To assess the impact of the web-based video on drug adherence. METHODS This randomized study was conducted with consecutive patients admitted to Lausanne University Hospital for ACS. We randomized patients to an intervention group, which had access to the video, and a control group receiving usual care. The primary outcome was the difference in drug adherence, assessed with the Adherence to Refills and Medication Scale [ARMS; nine multiple-choice questions, scores ranging from 12 (perfect adherence) to 48 (lack of adherence)], between groups at 1, 3, and 6 months. We assessed the difference in ARMS score between both groups with Wilcoxon rank sum test. Secondary outcomes were differences in knowledge and readmissions and emergency room visits between groups, and patients’ satisfaction with the video. RESULTS Sixty patients were included at baseline. The median age of the participants was 59 (IQR 49–69) and 85% were male. At 1 month, 51 patients participated in the follow up, 50 patients participated at 3 months, and 47 patients participated at 6 months. The mean ARMS scores at 1 and 6 months did not differ between the intervention and control groups (13.24 and 13.15, 13.52 and 13.68, respectively). At 3 months, this score was significantly lower in the intervention group than in the control group (12.54 vs. 13.75, P = .034). We observed significant increases in knowledge from baseline to 1 and 3 months, but not to 6 months, in the intervention group. Readmissions and emergency room visits have been very rare and the proportion was not different among groups. Patients in the intervention group were highly satisfied with the video. CONCLUSIONS The “Mon Coeur, Mon BASIC” web-based interactive video improved patients’ knowledge and seemed to have an impact on drug adherence. These results are encouraging, and the video will be offered to all patients admitted to our hospital with ACS. CLINICALTRIAL ClinicalTrials.gov NCT03949608; https://clinicaltrials.gov/ct2/show/NCT03949608

Capecitabine (X) vs. bolus 5-FU/LV as adjuvant chemotherapy for patients (pts) with Dukes’ C colon cancer: economic evaluation in an Italian hospital setting

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 13518-13518
Author(s):  
F. Di Costanzo ◽  
A. Sobrero ◽  
C. Twelves ◽  
J. Douillard ◽  
G. Giuliani ◽  
...  
Keyword(s):  
Colon Cancer ◽  
Emergency Room ◽  
Treatment Period ◽  
Societal Perspective ◽  
Safety Profile ◽  
Cost Savings ◽  
Emergency Room Visits ◽  
Free Survival ◽  
Physician Consultation ◽  
The Cost

13518 Background: In the X-ACT adjuvant trial, X showed consistent benefits over bolus 5-FU/LV, with at least equivalent disease-free survival (DFS) and an improved safety profile [Twelves et al. 2005]. In addition, X demonstrated superior relapse-free survival (65.5% vs. 61.9% at 3 years follow-up; p=0.0407) and improved covariate-adjusted overall survival (p=0.0208). We used the results from X-ACT to assess the cost-effectiveness of X from the Italian hospital and societal perspective. Methods: Trial-based data were collected on treatment period medical resource use. Unit costs for drug administration, hospitalizations, emergency room visits, and concomitant medications were considered using published sources in Italy. Cost for physician consultation visits, pt time and travel were also considered in the societal perspective. A health-state transition model was used to estimate incremental cost impact and the effectiveness in terms of gains in quality-adjusted life months (QALMs). Costs and effectiveness were discounted at 3.5%. Results: Mean duration of treatment was similar with X and 5-FU/LV; pts received 92% and 93% of planned treatments, respectively. Administration of X required fewer clinic visits per pt (7.4 vs. 28.0 with 5-FU/LV). Acquisition costs of X were higher than 5-FU/LV, approximately 2533 vs. 231€, but this difference was more than fully offset by the difference in administration cost of 5-FU/LV (4338 vs. 152€ for X). Total hospital days for treatment-related adverse events (AEs) and medication costs for treating AEs were higher for 5-FU/LV than X. The cost of emergency room visits for treating AEs and physician consultation did not differ. Compared with 5-FU/LV, X is projected to increase QALMs by 6.5 months, with overall treatment period cost savings of 2234€ for the hospital. From a societal perspective, the cost savings increase to 3976€. These findings show that X is a dominant (cost-saving and more effective) treatment in this setting. Conclusions: X as adjuvant treatment for pts with colon cancer is clinically effective with an improved safety profile vs. 5-FU/LV and is also a dominant choice from an economic perspective. [Table: see text]

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