scholarly journals INDEED–Utilization and Cross-Sectoral Patterns of Care for Patients Admitted to Emergency Departments in Germany: Rationale and Study Design

2021 ◽  
Vol 9 ◽  
Author(s):  
Antje Fischer-Rosinský ◽  
Anna Slagman ◽  
Ryan King ◽  
Thomas Reinhold ◽  
Liane Schenk ◽  
...  
Keyword(s):  
Health Care ◽  
Emergency Departments ◽  
Outpatient Care ◽  
Large Scale ◽  
Health Care Use ◽  
Complex Data ◽  
Central Research ◽  
Hospital Data ◽  
Before And After ◽  
Research Institute

Introduction: The crowding of emergency departments (ED) has been a growing problem for years, putting the care of critically ill patients increasingly at risk. The INDEED project's overall aim is to get a better understanding of ED utilization and to evaluate corresponding primary health care use patterns before and after an ED visit while driving forward processes and methods of cross-sectoral data merging. We aim to identify adequate utilization of EDs and potentially avoidable patient contacts as well as subgroups and clusters of patients with similar care profiles.Methods: INDEED is a joint endeavor bringing together research institutions and hospitals with EDs in Germany. It is headed by the Charité–Universitätsmedizin Berlin, collaborating with Otto von Guericke University Magdeburg, Technische Universität Berlin, the Central Research Institute of Ambulatory/Outpatient Health Care in Germany (Zi), and the AOK Research Institute as part of the Federal Association of AOK, as well as experts in the technological, legal, and regulatory aspects of medical research (TMF). The Institute for Information Technology (OFFIS) was involved as the trusted third party of the project. INDEED is a retrospective study of approximately 400,000 adult patients with statutory health insurance who visited the ED of one of 16 participating hospitals in 2016. The routine hospital data contain information about treatment in the ED and, if applicable, about the subsequent hospital stay. After merging the patients' hospital data from 2016 with their outpatient billing data from 2 years before to 1 year after the ED visit (years 2014–2017), a harmonized dataset will be generated for data analyses. Due to the complex data protection challenges involved, first results will be available in 2021.Discussion: INDEED will provide knowledge on extracting and harmonizing large scale data from varying routine ED and hospital information systems in Germany. Merging these data with the corresponding outpatient care data of patients offers the opportunity to characterize the patient's treatment in outpatient care before and after ED use. With this knowledge, appropriate interventions may be developed to ensure adequate patient care and to avoid adverse events such as ED crowding.

scholarly journals Emergency Health Care Use among Sociodemographic Groups of Children Presenting to Emergency Departments for Self-Harm in Alberta

CJEM ◽  
2015 ◽  
Vol 17 (5) ◽  
pp. 497-506
Author(s):  
Amanda S. Newton ◽  
Conrad I. Tsang ◽  
Rhonda J. Rosychuk
Keyword(s):  
Health Care ◽  
First Nations ◽  
Emergency Departments ◽  
Population Based ◽  
Health Care Use ◽  
Administrative Databases ◽  
Sociodemographic Differences ◽  
Kaplan Meier ◽  
Self Harm

AbstractObjectiveTo examine sociodemographic variations among children <18 years in (1) rates of self-harm visits to emergency departments (EDs) and (2) physician follow-up after the self-harm visit in Alberta.MethodsA retrospective, population-based cohort (2002–2011) of ED visits for self-harm by individuals <18 years was conducted using administrative databases from Alberta, Canada. Individuals were grouped by First Nations status or type of health care premium subsidy (family receipt of government subsidy, human services program subsidy, no subsidy received). Visits from 104 EDs were summarized by crude and directly standardized visit rates (DSVRs) per 100,000 individuals. Kaplan-Meier estimates for median estimated time to physician follow-up were calculated with 95% confidence intervals (CIs).ResultsDuring the study period, visit rates decreased with the exception of children from families receiving government-sponsored program subsidy (DSVRs 163/100,000 to 250/100,000;p=0.032). First Nations children had disproportionately fewer follow-up visits compared to other children. The median time to follow-up for First Nations children was 39 days (95% CI: 32, 48) compared to 16 days for children from families receiving no subsidy (95% CI: 14, 19), who had the shortest follow-up time after an ED visit.ConclusionsSociodemographic differences were evident in ED visit rates as well as the number of and time to physician follow-up visit. The disparities experienced by First Nations children in the follow-up period highlight an opportunity for culturally-grounded risk and needs assessment in the ED to determine and facilitate timely and appropriate follow-up care.

scholarly journals Health care utilization among patients with oesophageal and gastric cancer: the impact of initial treatment strategy and assignment of a contact nurse

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Karin Dalhammar ◽  
Marlene Malmström ◽  
Magnus Sandberg ◽  
Dan Falkenback ◽  
Jimmie Kristensson
Keyword(s):  
Gastric Cancer ◽  
Health Care ◽  
Treatment Strategy ◽  
Outpatient Care ◽  
Initial Treatment ◽  
Palliative Treatment ◽  
Health Care Use ◽  
Curative Treatment ◽  
Hospital Stays ◽  
The Impact

Abstract Background Patients diagnosed with oesophageal and gastric cancer face a poor prognosis and numerous challenges of symptom management, lifestyle adjustments and complex treatment regimens. The multifaceted care needs and rapid disease progression reinforce the need for proactive and coherent health care. According to the national cancer strategy, providing coherent health care and palliative support is an area of priority. More knowledge is needed about health care utilization and the characteristics of the health care service in order to understand the readiness, accessibility and quality of current health care. The aim of this study was to describe individuals’ health care use from the time of treatment decision until death, and investigate the impact of the initial treatment strategy and assignment of a contact nurse (CN) on health care use among patients with oesophageal and gastric cancer. Methods This population-based cohort study included patients who died from oesophageal and gastric cancer in Sweden during 2014–2016. Through linking data from the National Register for Oesophageal and Gastric Cancer, the National Cause of Death Register, and the National Patient Register, 2614 individuals were identified. Associations between the initial treatment strategy and CN assignment, and health care use were investigated. Adjusted incidence rate ratios (IRRs) with 95% confidence intervals (CIs) were calculated using Poisson regression. Results Patients receiving palliative treatment and those receiving no tumour-directed treatment had a higher IRR for unplanned hospital stays and unplanned outpatient care visits compared with patients who received curative treatment. Patients receiving no tumour-directed treatment also had a lower IRR for planned hospital stays and planned outpatient care visits compared with patients given curative treatment. Compared with this latter group, patients with palliative treatment had a higher IRR for planned outpatient care visits. Patients assigned a CN had a higher IRR for unplanned hospital stays, unplanned outpatient care visits and planned outpatient care visits, compared with patients not assigned a CN. Conclusions A palliative treatment strategy and no tumour-directed treatment were associated with higher rates of unplanned health care compared with a curative treatment strategy, suggesting that a proactive approach is imperative to ensure quality palliative care.

Health Care Use Before and After Entering Long-Term Services and Supports

2016 ◽  
Vol 37 (1) ◽  
pp. 26-40 ◽  
Author(s):  
Robert Newcomer ◽  
Charlene Harrington ◽  
Denis Hulett ◽  
Taewoon Kang ◽  
Michelle Ko ◽  
...  
Keyword(s):  
Health Care ◽  
Acute Care ◽  
Long Term Care ◽  
Health Care Use ◽  
Care Providers ◽  
Term Care ◽  
Before And After ◽  
Ed Visits ◽  
Post Acute Care

Objective: We examined the health care utilization patterns of Medicare and Medicaid enrollees (MMEs) before and after initiating long-term care in the community or after admission to a nursing facility (NF). Method: We used administrative data to compare hospitalizations, emergency department (ED) visits, and post-acute care use of MMEs receiving long-term care in California in 2006-2007. Results: MMEs admitted to a NF for long-term care had much greater use of hospitalizations, ED visits, and post-acute care before initiating long-term care than those entering long-term care in the community. Post-entry, community service users had less than half the average monthly hospital and ED use compared with the NF cohort. Conclusion: Hospital and ED use prior to and following NF and personal care program entry suggest a need for reassessing the monitoring of these high-risk populations and the communication between health and community care providers.

scholarly journals Emergency health care use and follow-up among sociodemographic groups of children who visit emergency departments for mental health crises

2012 ◽  
Vol 184 (12) ◽  
pp. E665-E674 ◽  
Author(s):  
A. S. Newton ◽  
R. J. Rosychuk ◽  
K. Dong ◽  
J. Curran ◽  
M. Slomp ◽  
...  
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Emergency Departments ◽  
Health Care Use ◽  
Emergency Health Care

The Effects of Survey Enhancements on the Quality of Reporting in the Medical Expenditure Panel Survey, 2008–2015

2019 ◽  
Vol 8 (3) ◽  
pp. 589-616 ◽  
Author(s):  
Samuel H Zuvekas ◽  
Adam I Biener ◽  
Wendy D Hicks
Keyword(s):  
Health Care ◽  
Data Quality ◽  
Large Scale ◽  
Medical Expenditure Panel Survey ◽  
Lessons Learned ◽  
Health Care Use ◽  
Medical Expenditure ◽  
Panel Survey ◽  
Quality Of Reporting

Abstract It is well established that survey respondents imperfectly recall health care use in surveys. However, careful attention to both survey design and fielding procedures can enhance recall. We examine the effects of a comprehensive, multi-pronged approach to changing field procedures in the Medical Expenditure Panel Survey (MEPS) to improve quality of health care use reporting. Conducted annually since 1996, the MEPS is the leading large-scale nationally representative health survey with detailed individual and household information on health care use and expenditures. These survey enhancements were undertaken in 2013–2014 because of concerns over a drop in the quality of reporting in 2010 that persisted into 2011–2012. The approach combined focused retraining of field supervisors and interviewers, developing quality metrics and reports for ongoing monitoring of interviewers, and revising advanced letters and materials sent to respondents. We seek to determine the extent to which changes in field procedures and trainings improved interviewer and respondent behaviors associated with better reporting, and more importantly, improved reporting accuracy. We use longitudinal MEPS data from 2008 through 2015, combining household reported use with sociodemographic and health status characteristics, and paradata on the characteristics of the interviews and interviewers. We exploit the longitudinal data and timings of major trainings and changes in field procedures in regression models, separating out the effects of the trainings and other fielding changes to the extent possible. We find that the 2013–2014 data quality improvement activities substantially improved reporting quality. Positive interviewer behaviors increased substantially to above pre-2010 levels, and utilization reporting has recovered to above pre-2010 levels, returning MEPS to trend. Importantly, these substantial gains occurred in 2013, prior to extensive in-person training for most of the field force. We examine the lessons learned from this data quality initiative both for the MEPS program and for other large household surveys.

Nutritional risk and health care use before and after an acute hospitalization among the elderly

Nutrition ◽  
2009 ◽  
Vol 25 (4) ◽  
pp. 415-420 ◽  
Author(s):  
Ilana Feldblum ◽  
Larissa German ◽  
Natalya Bilenko ◽  
Avner Shahar ◽  
Roni Enten ◽  
...  
Keyword(s):  
Health Care ◽  
The Elderly ◽  
Health Care Use ◽  
Nutritional Risk ◽  
Acute Hospitalization ◽  
Before And After
Sign in / Sign up

Export Citation Format

Share Document