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.

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 > 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.

Palliative care and end-of-life health utilization in elder patients with pancreatic cancer.

2018 ◽  
Vol 36 (4_suppl) ◽  
pp. 488-488
Author(s):  
Nizar Bhulani ◽  
Ang Gao ◽  
Arjun Gupta ◽  
Jenny Jing Li ◽  
Chad Guenther ◽  
...  
Keyword(s):  
Health Care ◽  
Pancreatic Cancer ◽  
Intensive Care Unit ◽  
Palliative Care ◽  
Intensive Care ◽  
Health Care Utilization ◽  
End Of Life ◽  
Cancer Patients ◽  
Cost Of Care ◽  
Care Utilization

488 Background: Prospective trials have shown that palliative care is associated with improved survival and quality of life, with lower rate of end-of-life health care utilization and cost. We examined trends in palliative care utilization in older pancreatic cancer patients. Methods: Pancreatic cancer patients with and without palliative care consults were identified using the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database between 2000 and 2009. Trend of palliative care use was studied. Emergency room and Intensive Care utilization and costs in the last 30 days of life were assessed. Statistical analyses were performed with SAS version 9.4 (SAS Institute, Inc., Cary, NC). Results: Of the 72205 patients with pancreatic cancer, 3383 (4.1%) received palliative care. The proportion of patients receiving palliative care increased from 1.8% in 2000 to 7.8% in 2009 (p for trend < 0.001). Patients with palliative care were more likely to be Asian and women. Of those who received palliative care, 73% received it in the last 30 days of life, and only 11% at least 12 weeks before death. The average number of visits to the ED in the last 30 days of life were significantly higher for patients who received palliative care (0.93±0.62) versus those who did not (0.79±0.61), p < 0.001, and had a significantly higher cost of care ($1317 vs $842, p < 0.001). Intensive care unit length of stay in the last 30 days of life did not differ between patients who did and did not receive palliative care (1.14 days vs 1.04 days, p 0.08). Intensive care unit cost of care was significantly higher for patients with palliative care compared to their counterparts ($5202.641 vs $3896.750, p < 0.001). Conclusions: Palliative care use for pancreatic cancer patients has increased between 2000 and 2009 in this study of Medicare patients. However, it was largely offered close to the end of life and was not associated with reduced health care utilization or cost. Early palliative care referral may be more beneficial.

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.

Inpatient Health Care Utilization By Medically Complex Children Admitted to the Pediatric Intensive Care Unit

PEDIATRICS ◽  
2016 ◽  
Vol 137 (Supplement 3) ◽  
pp. 267A-267A
Author(s):  
Titus Chan ◽  
Jonathan Rodean ◽  
Troy Richardson ◽  
Reid W.D. Farris ◽  
Jane L. Di Gennaro ◽  
...  
Keyword(s):  
Health Care ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Health Care Utilization ◽  
Pediatric Intensive Care Unit ◽  
Pediatric Intensive Care ◽  
Care Utilization

scholarly journals Impact of frailty on periprocedural health care utilization in patients undergoing transcatheter edge-to-edge mitral valve repair

2020 ◽  
Author(s):  
Christos Iliadis ◽  
Leandra Schwabe ◽  
Dirk Müller ◽  
Stephanie Stock ◽  
Stephan Baldus ◽  
...  
Keyword(s):  
Health Care ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Mitral Valve ◽  
Health Care Utilization ◽  
Mitral Valve Repair ◽  
Care Utilization ◽  
Valve Repair ◽  
Frail Patients ◽  
Intermediate Intensive Care Unit

Abstract Background Frailty is a common characteristic of patients undergoing transcatheter mitral valve repair (TMVR). It is unclear whether the physical vulnerability of frail patients translates into increased procedural health care utilization. Methods and results Frailty was assessed using the Fried criteria in 229 patients undergoing TMVR using the MitraClip system at our institution and associations with total costs and costs by cost centers within the hospital incurred during periprocedural hospitalization were examined. Frail patients (n = 107, 47%) compared to non-frail patients showed significantly higher total costs [median/interquartile range, excluding implant costs: 7,337 € (5,911–9,814) vs 6,238 € (5,584–7,499), p = 0.001], with a difference in means of 2,317 €. Frailty was the only clinical baseline characteristic with significant association with total costs. Higher total costs in frail patients were attributable primarily to longer stay on intermediate/intensive care unit (3.8 ± 5.7 days in frail vs 2.1 ± 1.7 days in non-frail, p = 0.003), but also to costs of clinical chemistry and physiotherapy. The prolonged stay on intermediate/intensive care unit in frail patients was attributable to postprocedural complications such as bleeding, kidney injury, infections and cardiovascular instability. Conclusion Frailty is associated with a mean 32% increase of hospital costs in patients undergoing TMVR, which is primarily the result of a prolonged recovery and increased vulnerability to complications. These findings are valuable for a hospital’s total cost calculation and resource allocation planning. Since frailty is regarded a potentially reversible health state, preventive interventions may help reduce costs in frail patients. Graphic abstract

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 Health care utilization before and after intensive care unit admission in multiple sclerosis

2015 ◽  
Vol 4 (4) ◽  
pp. 296-303 ◽  
Author(s):  
Ruth Ann Marrie ◽  
Charles N. Bernstein ◽  
Christine A. Peschken ◽  
Carol A. Hitchon ◽  
Hui Chen ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Health Care ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Intensive Care Unit Admission ◽  
Health Care Utilization ◽  
Care Utilization ◽  
Before And After

scholarly journals Integrated, Accountable Care For Medicaid Expansion Enrollees: A Comparative Evaluation of Hennepin Health

2018 ◽  
Vol 77 (1) ◽  
pp. 46-59 ◽  
Author(s):  
Katherine D. Vickery ◽  
Nathan D. Shippee ◽  
Jeremiah Menk ◽  
Ross Owen ◽  
David M. Vock ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Emergency Department ◽  
Managed Care ◽  
Health Care Utilization ◽  
Emergency Department Visits ◽  
Care Utilization ◽  
Care Organization ◽  
Medicaid Expansion ◽  
Accountable Care

Hennepin Health, a Medicaid accountable care organization, began serving early expansion enrollees (very low-income childless adults) in 2012. It uses an integrated care model to address social and behavioral needs. We compared health care utilization in Hennepin Health with other Medicaid managed care in the same area from 2012 to 2014, controlling for demographics, chronic conditions, and enrollment patterns. Homelessness and substance use were higher in Hennepin Health. Overall adjusted results showed Hennepin Health had 52% more emergency department visits and 11% more primary care visits than comparators. Over time, modeling a 6-month exposure to Hennepin Health, emergency department and primary care visits decreased and dental visits increased; hospitalizations decreased nonsignificantly but increased among comparators. Subgroup analysis of high utilizers showed lower hospitalizations in Hennepin Health. Integrated, accountable care under Medicaid expansion showed some desirable trends and subgroup benefits, but overall did not reduce acute health care utilization versus other managed care.

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.

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