scholarly journals Evaluating the Impact of a Risk Assessment System With Tailored Interventions in Germany: Protocol for a Prospective Study With Matched Controls (Preprint)

2019 ◽  
Author(s):  
Marten Pijl ◽  
Jorn op den Buijs ◽  
Andreas Landgraf
Keyword(s):  
Health Care ◽  
Health Care Utilization ◽  
Hospital Admissions ◽  
Intervention Group ◽  
Case Manager ◽  
The Elderly ◽  
Risk Scores ◽  
Care Utilization ◽  
Hospital Transport ◽  
Care Costs

BACKGROUND With a worldwide increase in the elderly population, and an associated increase in health care utilization and costs, preventing avoidable emergency department visits and hospitalizations is becoming a global priority. A personal emergency response system (PERS), consisting of an alarm button and a means to establish a live connection to a response center, can help the elderly live at home longer independently. Individual risk assessment through predictive modeling can help indicate what PERS subscribers are at elevated risk of hospital transport so that early intervention becomes possible. OBJECTIVE The aim is to evaluate whether the combination of risk scores determined through predictive modeling and targeted interventions offered by a case manager can result in a reduction of hospital admissions and health care costs for a population of German PERS subscribers. The primary outcome of the study is the difference between the number of hospitalizations in the intervention and matched control groups. METHODS As part of the Sicher Zuhause program, an intervention group of 500 PERS subscribers will be tracked for 8 months. During this period, risk scores will be determined daily by a predictive model of hospital transport, and at-risk participants may receive phone calls from a case manager who assesses the health status of the participant and recommends interventions. The health care utilization of the intervention group will be compared to a group of matched controls, retrospectively drawn from a population of PERS subscribers who receive no interventions. RESULTS Differences in health care utilization and costs between the intervention group and the matched controls will be determined based on reimbursement records. In addition, qualitative data will be collected on the participants’ satisfaction with the Sicher Zuhause program and utilization of the interventions offered as part of the program. CONCLUSIONS The study evaluation will offer insight into whether a combination of predictive analytics and case manager-driven interventions can help in avoiding hospital admissions and health care costs for PERS subscribers in Germany living at home independently. In the future, this may lead to improved quality of life and reduced medical costs for the population of the study. CLINICALTRIAL Deutsches Register Klinischer Studien (DRKS), DRKS00017328; https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00017328 INTERNATIONAL REGISTERED REPORT DERR1-10.2196/17584

scholarly journals Evaluating the Impact of a Risk Assessment System With Tailored Interventions in Germany: Protocol for a Prospective Study With Matched Controls

10.2196/17584 ◽  
2020 ◽  
Vol 9 (10) ◽  
pp. e17584
Author(s):  
Marten Pijl ◽  
Jorn op den Buijs ◽  
Andreas Landgraf
Keyword(s):  
Health Care ◽  
Health Care Utilization ◽  
Hospital Admissions ◽  
Intervention Group ◽  
Case Manager ◽  
The Elderly ◽  
Risk Scores ◽  
Care Utilization ◽  
Hospital Transport ◽  
Care Costs

Background With a worldwide increase in the elderly population, and an associated increase in health care utilization and costs, preventing avoidable emergency department visits and hospitalizations is becoming a global priority. A personal emergency response system (PERS), consisting of an alarm button and a means to establish a live connection to a response center, can help the elderly live at home longer independently. Individual risk assessment through predictive modeling can help indicate what PERS subscribers are at elevated risk of hospital transport so that early intervention becomes possible. Objective The aim is to evaluate whether the combination of risk scores determined through predictive modeling and targeted interventions offered by a case manager can result in a reduction of hospital admissions and health care costs for a population of German PERS subscribers. The primary outcome of the study is the difference between the number of hospitalizations in the intervention and matched control groups. Methods As part of the Sicher Zuhause program, an intervention group of 500 PERS subscribers will be tracked for 8 months. During this period, risk scores will be determined daily by a predictive model of hospital transport, and at-risk participants may receive phone calls from a case manager who assesses the health status of the participant and recommends interventions. The health care utilization of the intervention group will be compared to a group of matched controls, retrospectively drawn from a population of PERS subscribers who receive no interventions. Results Differences in health care utilization and costs between the intervention group and the matched controls will be determined based on reimbursement records. In addition, qualitative data will be collected on the participants’ satisfaction with the Sicher Zuhause program and utilization of the interventions offered as part of the program. Conclusions The study evaluation will offer insight into whether a combination of predictive analytics and case manager-driven interventions can help in avoiding hospital admissions and health care costs for PERS subscribers in Germany living at home independently. In the future, this may lead to improved quality of life and reduced medical costs for the population of the study. Trial Registration Deutsches Register Klinischer Studien (DRKS), DRKS00017328; https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00017328 International Registered Report Identifier (IRRID) DERR1-10.2196/17584

scholarly journals The Effect of Noninvasive Telemonitoring for Chronic Heart Failure on Health Care Utilization: Systematic Review (Preprint)

2020 ◽  
Author(s):  
Stefan L Auener ◽  
Toine E P Remers ◽  
Simone A van Dulmen ◽  
Gert P Westert ◽  
Rudolf B Kool ◽  
...  
Keyword(s):  
Heart Failure ◽  
Health Care ◽  
Chronic Heart Failure ◽  
Health Care Utilization ◽  
Health Care Costs ◽  
Emergency Department Visits ◽  
Care Utilization ◽  
Controlled Trials ◽  
Randomized Controlled ◽  
Care Costs

BACKGROUND Chronic heart failure accounts for approximately 1%-2% of health care expenditures in most developed countries. These costs are primarily driven by hospitalizations and comorbidities. Telemonitoring has been proposed to reduce the number of hospitalizations and decrease the cost of treatment for patients with heart failure. However, the effects of telemonitoring on health care utilization remain unclear. OBJECTIVE This systematic review aims to study the effect of telemonitoring programs on health care utilization and costs in patients with chronic heart failure. We assess the effect of telemonitoring on hospitalizations, emergency department visits, length of stay, hospital days, nonemergency department visits, and health care costs. METHODS We searched PubMed, Embase, and Web of Science for randomized controlled trials and nonrandomized studies on noninvasive telemonitoring and health care utilization. We included studies published between January 2010 and August 2020. For each study, we extracted the reported data on the effect of telemonitoring on health care utilization. We used <i>P</i>&lt;.05 and CIs not including 1.00 to determine whether the effect was statistically significant. RESULTS We included 16 randomized controlled trials and 13 nonrandomized studies. Inclusion criteria, population characteristics, and outcome measures differed among the included studies. Most studies showed no effect of telemonitoring on health care utilization. The number of hospitalizations was significantly reduced in 38% (9/24) of studies, whereas emergency department visits were reduced in 13% (1/8) of studies. An increase in nonemergency department visits (6/9, 67% of studies) was reported. Health care costs showed ambiguous results, with 3 studies reporting an increase in health care costs, 3 studies reporting a reduction, and 4 studies reporting no significant differences. Health care cost reductions were realized through a reduction in hospitalizations, whereas increases were caused by the high costs of the telemonitoring program or increased health care utilization. CONCLUSIONS Most telemonitoring programs do not show clear effects on health care utilization measures, except for an increase in nonemergency outpatient department visits. This may be an unwarranted side effect rather than a prerequisite for effective telemonitoring. The consequences of telemonitoring on nonemergency outpatient visits should receive more attention from regulators, payers, and providers. This review further demonstrates the high clinical and methodological heterogeneity of telemonitoring programs. This should be taken into account in future meta-analyses aimed at identifying the effective components of telemonitoring programs.

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

2018 ◽  
Vol 49 (1) ◽  
pp. 37-50
Author(s):  
Janko Janković ◽  
Sladjana Šiljak ◽  
Jelena Marinković ◽  
Bojan Kovač ◽  
Slavenka Janković
Keyword(s):  
Health Care ◽  
Health Care Utilization ◽  
National Health ◽  
Health Survey ◽  
Hospital Admissions ◽  
National Health Survey ◽  
Urgent Care ◽  
Noncommunicable Diseases ◽  
Care Utilization ◽  
The Relationship

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

scholarly journals Pharmacist Clinical Interventions and Discharge Counseling in Medical Rehabilitation Wards in a Local Hospital: A Prospective Trial

Geriatrics ◽  
2018 ◽  
Vol 3 (3) ◽  
pp. 53 ◽  
Author(s):  
Rosanna Nga Suet Ip ◽  
Justin Wade Tenney ◽  
Angus Chun Kwok Chu ◽  
Pauline Lai Ming Chu ◽  
Grace Wai Man Young
Keyword(s):  
Health Care ◽  
Medication Adherence ◽  
Health Care Utilization ◽  
Usual Care Group ◽  
Medication Reconciliation ◽  
Intervention Group ◽  
Medical Rehabilitation ◽  
Care Group ◽  
Care Utilization ◽  
Utilization Rate

Patients undergoing rehabilitation experience numerous changes in medication regimens during care transitions, exposing these patients to an increased risk of drug-related problems (DRPs). A prospective, non-randomized, quasi-experimental study was conducted in medical rehabilitation wards to evaluate the impact of pharmacist-delivered interventions and counseling on 30-day unplanned health care utilization and medication adherence for selected rehabilitation patients. A pharmacist provided medication reconciliation and counseling before discharge. Phone follow-up was completed 30 days after discharge to assess for unplanned health care utilization rate and medication adherence. A total of 85 patients (n = 43 in prospective intervention group and n = 42 in historical usual care group) were included. Among the intervention group, 23 DRPs were identified in 14 (32.6%) patients, resulting in 51 interventions. The intervention group had a significantly lower unplanned health care utilization rate than the usual care group (25.6% vs. 47.6%, p = 0.035). The risk of unplanned health care utilization was reduced by over 60% (Odds ratio (OR) = 0.378; 95% CI = 0.15–0.94). Patients reporting medium to high medication adherence increased from 23.6% to 88.4% 30 days after counseling (p < 0.05). Pharmacist medication reconciliation and discharge counseling reduced unplanned health care utilization 30 days after discharge and improved medication adherence.

scholarly journals Comprehensive Support for Family Caregivers: Impact on Veteran Health Care Utilization and Costs

2017 ◽  
Vol 76 (1) ◽  
pp. 89-114 ◽  
Author(s):  
Courtney Harold Van Houtven ◽  
Valerie A. Smith ◽  
Karen M. Stechuchak ◽  
Megan Shepherd-Banigan ◽  
Susan Nicole Hastings ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Utilization ◽  
Family Caregivers ◽  
Health Care Costs ◽  
Care Utilization ◽  
Control Group ◽  
Veteran Health ◽  
Primary Specialty ◽  
Veteran Health Care ◽  
Care Costs

This study aimed to examine the early impact of the Program of Comprehensive Assistance for Family Caregivers (PCAFC) on Veteran health care utilization and costs. A pre-post cohort design including a nonequivalent control group was used to understand how Veterans’ use of Veteran Affairs health care and total health care costs changed in 6-month intervals up to 3 years after PCAFC enrollment. The control group was an inverse probability of treatment weighted sample of Veterans whose caregivers applied for, but were not accepted into, PCAFC. Veterans in PCAFC had similar acute care utilization postenrollment when compared with those in the control group, but significantly greater primary, specialty, and mental health outpatient care use at least 30, and up to 36, months postenrollment. Estimated total health care costs for PCAFC Veterans were $1,500 to $3,400 higher per 6-month interval than for control group Veterans. PCAFC may have increased Veterans’ access to care.

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

2019 ◽  
Vol 3 (s1) ◽  
pp. 91-91
Author(s):  
Frances Loretta Gill
Keyword(s):  
Health Care ◽  
Health Care Utilization ◽  
Hospital Admissions ◽  
Community Partnerships ◽  
Care Utilization ◽  
Consult Service ◽  
Utilization Patterns ◽  
Ed Visits ◽  
Hospital Days ◽  
The Impact

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

scholarly journals A generalized semiparametric mixed model for analysis of multivariate health care utilization data

2015 ◽  
Vol 26 (6) ◽  
pp. 2909-2918 ◽  
Author(s):  
Zhuokai Li ◽  
Hai Liu ◽  
Wanzhu Tu
Keyword(s):  
Health Care ◽  
Health Care Utilization ◽  
Mixed Model ◽  
Hospital Admissions ◽  
Likelihood Method ◽  
Care Utilization ◽  
Services Research ◽  
Modeling Framework ◽  
Smooth Functions ◽  
Ed Visits

Health care utilization is an outcome of interest in health services research. Two frequently studied forms of utilization are counts of emergency department (ED) visits and hospital admissions. These counts collectively convey a sense of disease exacerbation and cost escalation. Different types of event counts from the same patient form a vector of correlated outcomes. Traditional analysis typically model such outcomes one at a time, ignoring the natural correlations between different events, and thus failing to provide a full picture of patient care utilization. In this research, we propose a multivariate semiparametric modeling framework for the analysis of multiple health care events following the exponential family of distributions in a longitudinal setting. Bivariate nonparametric functions are incorporated to assess the concurrent nonlinear influences of independent variables as well as their interaction effects on the outcomes. The smooth functions are estimated using the thin plate regression splines. A maximum penalized likelihood method is used for parameter estimation. The performance of the proposed method was evaluated through simulation studies. To illustrate the method, we analyzed data from a clinical trial in which ED visits and hospital admissions were considered as bivariate outcomes.

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