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Raj Chovatiya ◽  
Wendy Smith Begolka ◽  
Isabelle J. Thibau ◽  
Jonathan I. Silverberg

AbstractBlack race is associated with increased atopic dermatitis (AD) severity and healthcare resource utilization. However, the burden of out-of-pocket (OOP) expenses among black individuals with AD is not well understood. We sought to characterize the categories and impact of OOP healthcare expenses associated with AD management among black individuals. A 25-question voluntary online survey was administered to National Eczema Association members (N = 113,502). Inclusion criteria (US residents age ≥ 18 years; self-report of AD or primary caregivers of individuals with AD) was met by 77.3% (1118/1447) of respondents. Black individuals with AD were younger, had lower household income, Medicaid, urban residence, poor AD control and frequent skin infections (P ≤ 0.02). Blacks vs. non-blacks reported more OOP costs for prescription medications covered (74.2% vs. 63.6%, P = 0.04) and not covered (65.1% vs. 46.5%, P = 0.0004) by insurance, emergency room visits (22.1% vs. 11.8%, P = 0.005), and outpatient laboratory testing (33.3% vs. 21.8%, P = 0.01). Black race was associated with increased household financial impact from OOP expenses (P = 0.0009), and predictors of financial impact included minimally controlled AD (adjusted OR [95% CI] 13.88 [1.63–117.96], P = 0.02), systemic therapy (4.34 [1.63–11.54], 0.003), > $200 monthly OOP expenses (14.28 [3.42–59.60], P = 0.0003), and Medicaid (4.02 [1.15–14.07], P = 0.03). Blacks with Medicaid had higher odds of harmful financial impact (3.32 [1.77–6.24], P = 0.0002) than those of black race (1.81 [1.04–3.15], P = 0.04) or with Medicaid (1.39 [1.02–1.88], P = 0.04) alone. Black race is associated with increased OOP costs for AD and significant household financial impact. Targeted interventions are needed to address financial disparities in AD.

2021 ◽  
Vol 39 (28_suppl) ◽  
pp. 336-336
Safiya Karim ◽  
Bailey Paterson ◽  
Shiying Kong ◽  
Alyson Mahar ◽  
Colleen Webber ◽  

336 Background: Pancreatic cancer is a leading cause of cancer death, largely due to vague presenting symptoms and late stage at diagnosis. Population-based administrative data can be a valuable resource for studying the diagnostic interval. The objective of this study was to determine the first encounter in the diagnostic interval and to calculate that interval in a cohort of patients with pancreatic cancer using an empirical approach. Methods: This is a retrospective, cohort study of patients diagnosed with pancreatic ductal adenocarcinoma (PDAC) from 2007 – 2015 in Alberta, Canada. We used the Alberta Cancer Registry (ACR), physician billing claims, hospital discharge and emergency room visits to identify health encounters that occurred more frequently in the 3 months prior to diagnosis compared to those in the 3-24 months prior to diagnosis. We used statistical control charts to define the lookback period for each encounter category and identify the earliest encounter that represented the start of the diagnostic interval (index contact date). The end of the interval was the diagnosis date. Quantile regression was used to determine factors associated with the diagnostic interval. Results: We identified 3142 patients with PDAC. Median age of diagnosis was 71 (IQR 61-80). We identified an index contact date in 96.5% of the patients. The median length of the diagnostic interval was 76 days (IQR 21-191; 90th percentile 276 days). A higher Elixhauser comorbidity score (+18.57 days/ 1 point increase, 95% CI 16.07-21.07, p < 0.001) and stage 3 disease (+22.55 days, 95% CI 5.02-40.08, p = 0.01) was associated with a longer diagnostic interval. Conclusions: In this cohort of patients with pancreatic cancer, there was a wide range in the diagnostic interval with 10% of patients having a diagnostic interval approaching one year. Diagnostic interval research using administrative databases can understand variations in diagnosis times, can inform early detection efforts and can improve quality of care.

2021 ◽  
Vol 39 (28_suppl) ◽  
pp. 304-304
Lawson Eng ◽  
Rinku Sutradhar ◽  
Yue Niu ◽  
Ning Liu ◽  
Ying Liu ◽  

304 Background: ICIs are becoming a common therapeutic option for many solid tumors. Prior studies have shown that ATB exposure can negatively impact ICI outcomes through gut microbiome changes leading to poorer overall survival; however, less is known about the potential impact of ATB exposure on toxicities from ICI. We undertook a population-based retrospective cohort study in patients receiving ICIs to evaluate the impact of ATB exposure on early acute care use, defined as emergency department visit or hospitalization, within 30 days of initiation of ICI therapy. Methods: Administrative data was utilized to identify a cohort of cancer patients > 65 years of age receiving ICIs from June 2012 to October 2018 in Ontario, Canada. We linked databases deterministically to obtain socio-demographic and clinical co-variates, ATB prescription claims and acute care utilization. Patients were censored if they died within 30 days of initiating ICI therapy. The impact of ATB exposure within 60 days prior to starting ICI on early acute care use was evaluated using multi-variable logistic regression models, adjusted for age, gender, rurality, recent hospitalization within 60 days prior to starting ICI and comorbidity score. Results: Among 2737 patients (median age 73 years), 43% received Nivolumab, 41% Pembrolizumab and 13% Ipilimumab, most commonly for lung cancer (53%) or melanoma (34%). Of these patients, 19% had ATB within 60 days prior to ICI with a median ATB treatment duration of 9 days (SD = 13). 647 (25%) patients had an acute care episode within 30 days of starting ICIs; 182 (7%) patients passed away within 30 days without acute care use and were censored from further analyses. Any ATB exposure within 60 days prior to ICI was associated with greater likelihood of acute care use (aOR = 1.34 95% CI [1.07-1.67] p = 0.01). A dose effect was seen based on weeks of ATB exposure within 60 days prior to ICI (aOR = 1.12 per week [1.04-1.21] p = 0.004) and early acute care use. ATB class analysis identified that exposure to penicillins (aOR = 1.54 [1.11-2.15] p = 0.01) and fluoroquinolones (aOR = 1.55 [1.11-2.17] p = 0.01) within 60 days of starting ICIs were associated with a greater likelihood of acute care use, while there was no significant association between cephalosporin exposure and early acute care use (p > 0.05). Conclusions: Exposure to ATBs, specifically fluoroquinolones and penicillins, prior to ICI therapy is associated with greater likelihood of hospitalization or emergency room visits within 30 days after initiation of ICIs, even after adjustment for relevant co-variates including age, comorbidity score and recent hospitalization prior to ICI initiation. Further studies are required to better understand the mechanisms of recent ATB exposure on early acute care use among patients receiving ICIs.

2021 ◽  
Samuel J Mann ◽  
Kaushal V Solanki

There is no widely recognized preventive treatment for patients with paroxysmal hypertension (pseudopheochromocytoma) who suffer recurrent and often severe paroxysmal elevation of blood pressure, repeated emergency room visits and, in many cases, hospitalizations. In this case series we assessed the effectiveness of treatment with an antidepressant in preventing recurrent paroxysms. A secondary exploratory objective was to examine the psychological profile of patients with paroxysmal hypertension and its relationship to response to treatment. Medical records of patients seen between 2004 and 2019 with a diagnosis of paroxysmal hypertension were reviewed; the effectiveness in preventing paroxysms was assessed in those treated with an antidepressant. The charts of 66 patients with who reported having experienced at least 3 symptomatic episodes characterized by sudden onset of symptoms and blood pressure elevation that was not related to perceived emotional distress were selected. Of these, treatment follow-up data were available in 52. Treatment with an antidepressant was offered to 37 patients. Two patients refused treatment, 6 were unable to tolerate an effective dose, 3 were lost to follow-up, and 1 was non-compliant with the medication. Of the remaining 25 evaluable patients, 92% (23/25) responded, with 80% (21/25) achieving complete and persisting cessation of paroxysms, and 8% (2/25), a reduction in frequency. Importantly, an antidepressant was effective in nearly all patients who reported that they were not suffering from anxiety or depression. The data were insufficient to determine superiority of any one antidepressant versus another. We conclude that treatment with an antidepressant is effective in preventing hypertensive paroxysms in a high proportion of patients with paroxysmal hypertension. Given the absence of any other pharmacologic intervention capable of preventing recurrent paroxysms, the similarly high response rate observed in previous reports, and the relatively safe profile of antidepressant agents, the findings support more widespread use of an antidepressant in patients with this disorder to prevent years of continued hypertensive paroxysms and their consequences.

Cancers ◽  
2021 ◽  
Vol 13 (18) ◽  
pp. 4615
Luís Lizán ◽  
Lucía Pérez-Carbonell ◽  
Marta Comellas

Background: To describe the benefit of patient-reported symptom monitoring on clinical, other patient-reported, and economic outcomes. Methods: We conducted a systematic literature review using Medline/PubMed, limited to original articles published between 2011 and 2021 in English and Spanish, and focused on the benefit of patient-reported symptom monitoring on cancer patients. Results: We identified 16 reports that deal with the benefit of patient-reported symptom monitoring (collected mostly electronically) on different outcomes. Five studies showed that patient-reported symptom surveillance led to significantly improved survival compared with usual care—mainly through better symptom control, early detection of tumor recurrence, and extended chemotherapy use. Additionally, three evaluations demonstrated an improvement in Health-Related Quality of Life (HRQoL) associated with this monitoring strategy, specifically by reducing symptom severity. Additionally, six studies observed that this monitoring approach prevented unplanned emergency room visits and hospital readmissions, leading to a substantial decrease in healthcare usage. Conclusions: There is consistent evidence across the studies that patient-reported symptom monitoring might entail a substantial survival benefit for cancer patients, better HRQoL, and a considerable decrease in healthcare usage. Nonetheless, more studies should be conducted to demonstrate their effectiveness in addition to their cost-effectiveness in clinical practice.

2021 ◽  
Yaqi Liu ◽  
Yi Jiang ◽  
Manyi Wu ◽  
Sunghar Muheyat ◽  
Dongai Yao ◽  

Abstract Background There are few studies focused on the correlations between ambient air pollution and abdominal pain, especially in emergency departments in China. Method: Daily data (from January 1, 2016 to December 31, 2018), including air pollution concentration (SO2, NO2, PM2.5, PM10, CO, and O3) and meteorological variables, for daily emergency room visits (ERVs) were collected in Wuhan, China. We conducted a time-series study to investigate the potential correlation between six ambient air pollutants and ERVs for abdominal pain and their effects, in different genders, ages and seasons. Results A total of 16,306 abdominal pain ERVs were identified during the study period. A 10-µg/m3 increase in concentration of SO2, NO2, PM2.5, PM10, CO, and O3 corresponded respectively to incremental increases in abdominal pain of 6.12% (95% confidence interval [CI]: -0.44-13.12), 1.65% (95%CI: -0.25-3.59), 1.12% (95%CI: -0.18-2.44), 0.38% (95%CI: -1.09-1.87), 9.87% (95%CI:3.14–17.05) and 1.11% (95%CI: 0.03–2.21). We observed significant correlations between CO and O3 and daily abdominal pain ERVs increase, and positive but insignificant correlations between the other pollutants and ERVs. The effects were stronger mainly for females (especially SO2 and O3) and younger people (especially CO and O3). The correlations of PM2.5 and PM10 were stronger in cool seasons, while the correlation of CO was stronger in warm seasons. Conclusion Our time-series study suggested that short-term exposure to air pollution (especially CO and O3) was positively correlated with ERVs for abdominal pain in Wuhan, China, and that their effects varied by season, gender and age. These data can add evidence on how air pollutants affect the human body, and may prompt hospitals to take specific precautions on polluted days and maintain order in emergency departments made busier due to the pollution.

2021 ◽  
Vol 8 ◽  
Jing-wen Lu ◽  
Yu Wang ◽  
Yue Sun ◽  
Qin Zhang ◽  
Li-ming Yan ◽  

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).

2021 ◽  
Yang Zhang ◽  
Wenjing Ge ◽  
Ning Chen ◽  
Jian Guo ◽  
Muke Zhou ◽  

Abstract Background:Migraine is the most common cause of headache patients for medical consultation to emergency department (ED). However, the management and cost of those patients are less known. Our study aimed to survey detailed diagnosis, clinical characteristics, management, and cost of migraine patients in the emergency department in ChinaMethods:We performed a retrospective study from April 1, 2014, and September 31, 2020, at West China Hospital. This study enrolled patients with migraine diagnoses and analyzed their investigations, medical treatment and cost during their stay at ED. Results:Our study included 300 patients, 77.3% were female and the mean age was 38 years. 36% were conducted cranial CT scan. Non-steroidal anti-inflammatory drugs (NSAIDs) were the most used at ED. We found that none of the patients received triptans nor prophylaxis medicine. The mean cost of emergency room visits was 57.17USD.Conclusion:Our study found that most migraine patients who came to the ED were not receiving the evidence-based acute treatment. A timely referral system should be established to minimize the disease costs of patients.

2021 ◽  
Vol 21 (1) ◽  
Lisa M Hess ◽  
Siew Hoong Wong-Jacobson ◽  
Patrick M Peterson

Abstract Purpose Cancer diagnosis is known to affect the family; however, administrative claims data are not commonly used to evaluate the broader impact of cancer diagnosis. This study was designed to evaluate the feasibility of using claims data to explore the impact of cancer diagnosis on the caregiver. Methods IBM Marketscan data were used to identify eligible cancer patients, who were required to have a second adult over the age of 18 (defined as “caregiver” for this study) covered by the same the healthcare policy. Eligible control pairs included any two adults in the same policy with no evidence of cancer; for each pair one adult was randomly assigned to be the “patient control” while their partner was assigned as “caregiver control”. Probabilistic stratified sampling was used select control pairs for analysis by matching the relative frequencies within sex and age group strata to those of patient/caregiver pairs. Eligible control pairs were probabilistically sampled without replacement until the stratum with at least 0.5 % relative frequency had been completely sampled. Caregiver and caregiver control healthcare resource utilization (HCRU), new diagnoses, and healthcare costs were compared during the 12-month post-diagnosis period. Subgroup analyses were conducted by cancer subtypes (breast, colorectal, lung, gastric, sarcoma) and by sex of the patient and caregiver. Results A total of 62,893 patient/caregiver pairs and 449,177 control pairs were included. Overall, caregivers used slightly fewer healthcare resources and expended less costs during the 12-month period after the cancer diagnosis than controls (physician visits; 85.8 % vs. 95.7 %; hospitalizations 5.4 % vs. 7.0 %; emergency room visits 15.7 % versus 16.2 %, all p ≤ 0.001). This finding was consistent in all subgroup analyses. New diagnoses were lower in the caregiver cohort, except for mental disorders, which were higher than controls (14.3 % vs. 9.9 %, p < 0.0001). Psychotherapeutic/antidepressant utilization occurred among 21.0 % of caregivers versus 17.2 % of caregiver controls during this period. Conclusions It is feasible to use administrative claims data to evaluate the impact of a cancer diagnosis on the caregiver to evaluate outcomes such as HCRU, diagnoses and costs. These findings raise hypotheses about deferment of health care and increased mental distress during the caregiving period.

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