Mothers of children with major congenital anomalies have increased health care utilization over a 20-year post-birth time horizon

Objective This population-based, matched cohort study aimed to evaluate utilization of health care services by mothers of children with major congenital anomalies (MCAs), compared to mothers of children without MCAs over a 20-year post-birth time horizon in Denmark. Methods Our analytic sample included mothers who gave birth to an infant with a MCA (n = 23,927) and a cohort of mothers matched to them by maternal age, parity and infant’s year of birth (n = 239,076). Primary outcomes were period prevalence and mothers’ quantity of health care utilization (primary, inpatient, outpatient, surgical, and psychiatric services) stratified by their child’s age (i.e., ages 0–6 = before school, ages 7–13 = pre-school + primary education, and ages 14–18 = secondary education or higher). The secondary outcome measure was length of hospital stays. Outcome measures were adjusted for maternal age at delivery, parity, marital status, income quartile, level of education in the year prior to the index birth, previous spontaneous abortions, maternal pregnancy complications, maternal diabetes, hypertension, alcohol-related diseases, and maternal smoking. Results In both cohorts the majority of mothers were between 26 and 35 years of age, married, and employed, and 47% were primiparous. Mothers of infants with anomalies had greater utilization of outpatient, inpatient, surgical, and psychiatric services, compared with mothers in the matched cohort. Inpatient service utilization was greater in the exposed cohort up to 13 years after a child’s birth, with the highest risk in the first six years after birth [adjusted risk ratio, 1.13; 95% confidence interval (CI), 1.12–1.14], with a decrease over time. Regarding the quantity of health care utilization, the greatest difference between the two groups was in inpatient service utilization, with a 39% increased rate in the exposed cohort during the first six years after birth (adjusted rate ratio, 1.39; 95% CI, 1.37–1.42). During the first 6 years after birth, mothers of children with anomalies stayed a median of 6 days (interquartile range [IQR], 3–13) in hospital overall, while the comparison cohort stayed a median of 4 days (IQR, 2–7) in hospital overall. Rates of utilization of outpatient clinics (adjusted rate ratio, 1.36; 95% CI, 1.29–1.42), as well as inpatient (adjusted rate ratio, 1.77; 95% CI, 1.68–1.87), and surgical services (adjusted rate ratio, 1.33; 95% CI, 1.26–1.41) was higher in mothers of children with multiple-organ MCAs during 0 to 6 years after birth. Among mothers at the lowest income levels, utilization of psychiatric clinic services increased to 59% and when their child was 7 to 13 years of age (adjusted rate ratio, 1.59; 95% CI, 1.24–2.03). Conclusion Mothers of infants with a major congenital anomaly had greater health care utilization across services. Health care utilization decreased over time or remained stable for outpatient, inpatient, and surgical care services, whereas psychiatric utilization increased for up to 13 years after an affected child’s birth. Healthcare utilization was significantly elevated among mothers of children with multiple MCAs and among those at the lowest income levels.

Health economic analysis for the ‘CURE Project’ pilot: a hospital-based tobacco dependency treatment service in Greater Manchester

IntroductionTreating tobacco dependency in patients admitted to acute care National Health Service (NHS) trusts is a key priority in the NHS 10-year plan. This paper sets out the results of a health economic analysis for ‘The CURE Project’ pilot; a new hospital-based tobacco dependency service.MethodsA health economic analysis to understand the costs of the intervention (both for the inpatient service and postdischarge costs), the return on investment (ROI) and the cost per quality-adjusted life year (QALY) of the CURE Project pilot in Greater Manchester. ROI and cost per QALY were calculated using the European Study on Quantifying Utility of Investment in Protection from Tobacco and Greater Manchester Cost Benefit Analysis Tools.ResultsThe total intervention costs for the inpatient service in the 6-month CURE pilot were £96 224 with a cost per patient who smokes of £40.21. The estimated average cost per patient who was discharged on pharmacotherapy was £97.40. The cost per quit (22% quit rate for smokers at 12 weeks post discharge) was £475. The gross financial ROI ratio was £2.12 return per £1 invested with a payback period of 4 years. The cashable financial ROI ratio was £1.06 return per £1 invested with a payback period of 10 years. The public value ROI ratio was £30.49 per £1 invested. The cost per QALY for this programme was £487.DiscussionThe CURE Project pilot has been shown to be exceptionally cost-effective with highly significant ROI in this health economic analysis. This supports the NHS priority to embed high-quality tobacco addiction treatment services in acute NHS trusts, and the CURE Project provides a blueprint and framework to achieve this.

Who Have a Higher Risk of Falling Into Catastrophic Health Expenditures?

Catastrophic health expenditure is one of the challenges Indonesia faces in achieving Universal Health Coverage. Aside from being a financial disaster, the incident caused by out-of-pocket health expenditure exceeding a fixed limit can drive people into poverty. Unfortunately, the availability of the data causes the limitation of the study in Indonesia. This study aims to analyze the association between catastrophic health expenditure and several social-economic factors by using the latest data of out-of-pocket expenditure collected at the individual level from the 2019 Susenas Module of Health and Housing. Using the Chi-square test, this study confirms a significant association between catastrophic health expenditures and the following social-economic factors: outpatient and inpatient service use, health insurance ownership, age, sex, marital status, educational level, work status, welfare status, type of area, and geographic location. From the logistic regression, the probability of the population to experience catastrophic health expenditure is higher for people in the following categories: use inpatient or outpatient services, do not have health insurance, are elderly, ever-married, not working, not poor, and live in the rural areas or Java island. Disaggregation by outpatient and inpatient service use shows the large gap in the probability of falling into catastrophic health expenditures. The probability for people who used inpatient service is more than four times people who never used the service. Meanwhile, for outpatient service, the probability is almost three times. Therefore, people can strengthen preventive care, especially those with low or no cost, to avoid falling into catastrophic health expenditure.

Abstract 12134: Risk of In-Hospital Deterioration for Children With Single Ventricle Physiology

Introduction: Children with single ventricle physiology (SV) are at high risk of in-hospital morbidity and mortality, with much of that increased risk coming in the first year of life. Understanding which children are at the highest risk for clinical deterioration may allow for increased monitoring and earlier escalation of care, with associated decreased mortality. Methods: We conducted a retrospective chart review of all admissions to the pediatric cardiology non-ICU inpatient service from 2014 - 2018 for children < 18 years old. Clinical deterioration was defined as an unplanned transfer to the ICU or inpatient mortality. Children with SV were selected by diagnosis codes. Results: From the entire cohort of 1612 pediatric cardiology admissions (56 % male, 25% SV), 288 admissions had a deterioration event including 26 deaths. Infants less than one year with SV (n = 197 admissions) were significantly more likely to have a deterioration event (107 events over 62 admissions with an event) than the overall pediatric cardiology cohort (OR 2.11, 95% CI 1.52-2.93). Among infants with SV, those with a deterioration event were significantly younger (median 1.7 v 4.3 months, p < 0.001). Further, at baseline they had significantly lower oxygen saturation (84% v 87%, p < 0.01), lower systolic blood pressure (85mmHg v 90mmHg, p< 0.02), higher respiration rate (48 v 44, p < 0.01), and higher hematocrit (44.0 v 40.2, p < 0.005) compared to those who remained stable. Mean Pediatric Early Warning Scores (PEWS) were significantly higher for infants with SV who had a deterioration event (1.4 v 0.9, p < 0.001) and PEWS scores significantly increased in the 48 hours prior to an event (p < 0.001). Of the 104 non-death events, 61 required an increase in oxygen support and 51 required a fluid bolus prior to the event (p < 0.001). Conclusions: Infants with SV are at high risk for clinical deterioration. There are baseline differences in vital signs and lab work between those that remain stable and those that have a deterioration event. PEWS scores and oxygen and fluid treatment significantly increase prior to deterioration events. Leveraging data from the Electronic Medical Record to identify the highest risk patients may allow for earlier detection and intervention to prevent clinical deterioration.

Toward more accurate documentation in neurosurgical care

OBJECTIVE Accurate clinical documentation is foundational to any quality improvement endeavor as it is ultimately the medical record that is measured in assessing change. Literature on high-yield interventions to improve the accuracy and completeness of clinical documentation by neurosurgical providers is limited. Therefore, the authors sought to share a single-institution experience of a two-part intervention to enhance clinical documentation by a neurosurgery inpatient service. METHODS At an urban, level I trauma, academic teaching hospital, a two-part intervention was implemented to enhance the accuracy of clinical documentation of neurosurgery inpatients by residents and advanced practice providers (APPs). Residents and APPs were instructed on the most common neurosurgical complications or comorbidities (CCs) and major complications or comorbidities (MCCs), as defined by Medicare. Additionally, a “system-based” progress note template was changed to a “problem-based” progress note template. Prepost analysis was performed to compare the CC/MCC capture rates for the 12 months prior to the intervention with those for the 3 months after the intervention. RESULTS The CC/MCC capture rate for the neurosurgery service line rose from 62% in the 12 months preintervention to 74% in the 3 months after intervention, representing a significant change (p = 0.00002). CONCLUSIONS Existing clinical documentation habits by neurosurgical residents and APPs may fail to capture the extent of neurosurgical inpatients with CC/MCCs. An intervention that focuses on the most common CC/MCCs and utilizes a problem-based progress note template may lead to more accurate appraisals of neurosurgical patient acuity.

74. Evaluation of the Differences in Appropriateness of BioFire® FilmArray® Gastrointestinal Panel Testing between Emergency Department and Inpatient Services

Background Use of rapid molecular diagnostic panels in the evaluation of diarrhea provides increased sensitivity for organism identification and decreased time to results. However, their inappropriate use can lead to unnecessary expenditures and antimicrobial exposures. We aimed to characterize the appropriateness of testing using the BioFire® FilmArray® Gastrointestinal Panel (SFA) in different clinical settings and to describe the impact of SFA results on patient care. Methods Retrospective study of adult patients presenting to hospitals part of an integrated health system in Des Moines, Iowa, between July 30 and September 30, 2019, and who had a SFA ordered and collected in the Emergency Department (ED) or an inpatient service. The appropriateness of SFA testing was determined according to adherence to a local algorithm available through the hospital’s intranet (Figure 1). Reason for testing, appropriateness of SFA test, molecular targets identified, and antibiotic exposures were collected. Results We identified 257 patients, 111 (43.2%) who had SFA done in the ED and 146 (56.8%) as inpatients. Testing was deemed inappropriate in 46 (41.4%) of ED patients compared to 100 (68.5%) of inpatients (p&lt; 0.0001). Documented indications for SFA are presented in Table 1. Among ED patients testing was most frequently considered inappropriate due to absence of diarrhea on the day of test collection (41.3%), and among inpatients due to the use of SFA for assessment of hospital-onset diarrhea (47.0%) (Table 2). Overall, there were 94 (36.6%) positive SFA (Figure 2). Among ED patients, the percentage of positive SFA samples was 30.4% and 50.8% for inappropriate and appropriate testing respectively (p=0.03), while for inpatients it was 33.0% for inappropriate orders and 30.4% for appropriate orders (p=0.76). Antibiotics were prescribed to 28.2% and 28.1% of patients tested in the ED and inpatient service respectively. Conclusion High proportions of inappropriate SFA testing were identified both in the ED and inpatient services, with distinct issues in each site. Characterization of the reasons underlying inappropriate use of SFA can aid in the design of diagnostic stewardship interventions tailored to each clinical setting. Disclosures All Authors: No reported disclosures

1375. Professional Status of Infectious Disease Specialists in Korea: A Nationwide Cross-sectional Study

Background Emergence of more antimicrobial-resistant pathogens and repeated occurrence of infectious disease (ID) outbreaks highlight the importance of ID specialists. This study aimed to assess the working status of ID specialists and identify problems faced by ID professionals in Korea. Methods An online-based survey was conducted over 11 days (from December 17–27, 2020), targeting all active adult (n=281) and pediatric (n=71) ID specialists in Korea (total=352). An online-based survey link was forwarded to them via text messages and e-mails by the office of the Korean Society of Infectious Diseases and the Korean Society of Pediatric Infectious Diseases. Questions regarding the practice areas of the specialists were divided into five categories: (1) clinical practices of outpatient care, inpatient care, and consultations; (2) infection control; (3) antibiotic stewardship; (4) research; and (5) education and training. We investigated the weekly time-use patterns for these areas of practice. Results A total of 144/281 (51.2%) adult ID specialists and 51/71 (71.8%) pediatric ID specialists participated in the survey. Among them, 144 (73.8%) respondents were involved in all practice categories investigated. The most common practice area was outpatient service (93.8%), followed by consultation (91.3%) and inpatient service (87.7%)(Table 1). Specialists worked a median of 57 (interquartile range: 50–65) hours weekly: patient care, 29 (14–37) hours; research 11 (5–19) hours; infection control 4 (2–10) hours; antibiotic stewardship, 3 (1–5) hours; and education/training, 2 (2–6) hours (Table 2). Conclusion We identified areas of practice and patterns of time use among adult and pediatric ID specialists in Korea. Most experts were in charge of all necessary areas (including treatment, education, research, infection control, and antibiotic stewardship) in medical institutions with limited resources. It is expected that these problems can be solved by appropriately compensating individuals and medical institutions for their invisible activities (including infection control and antibiotic stewardship) and by securing additional human resources. Disclosures All Authors: No reported disclosures

Will Multidisciplinary Collaboration Reduce the Disability Rate of Diabetic Foot (2009–2019)?—A Study Based on the Perspective of Organizational Reform

Objectives: Discuss the experience and practice of multidisciplinary cooperation of diabetic foot in China and analyze its impact on the quality of care.Methods: This study observed the medical procedure by interviewing 12 key personnel in-depth. We extracted data from medical records and assessed the effect of MDT in three dimensions: quality, efficiency, and cost, to eventually achieve a final conclusion.Results: The studied reform includes the following three aspects: the adjustment of hospital buildings layout and disciplines, one-stop outpatient, and one-stop inpatient service. After the multidisciplinary collaboration, the rate of above-knee amputation is reduced by 3.63%, the disability score per 100 diabetic foot patients decreases by 6.12, the average length of stay decreases significantly, and the cost of hospitalization shows an increasing trend.Conclusions: Multidisciplinary collaboration is performed based on spatial layout adjustment and clinical pathway optimization, which provide more comprehensive and integrated care than a general medical team or a single specialist, thereby reducing the rate of disability, shortening the length of hospitalization. Besides, the new measurable indicator called disability score per 100 diabetic foot patients has been verified to evaluate the living ability of patients after surgery. This paper provides a reference for organizational reform of multidisciplinary diseases to support treatment and management of other multiorgan diseases.