Utilizing Telemedicine in a New-Onset Diabetes Education Program for Youth With Type 1 Diabetes.

Hospital-Based, Acute Care Use Among Patients Within 30 Days of Discharge After Coronary Artery Bypass Surgery

Patterns of readmission and reoperation within 90 days after Roux-en- Y gastric bypass

Urolithiasis is a common complication of primary hyperparathyroidism (PHPT). Parathyroidectomy has been shown to decrease the rate of stone formation. The purpose of this study was to evaluate healthcare resource utilization before and after parathyroidectomy and identify predictors of increased healthcare utilization. A retrospective analysis of patients who had a parathyroidectomy for PHPT in Nova Scotia from 2013-2018 was performed. Data from five years before parathyroidectomy to three years after were included. Outcomes included emergency department (ED) visits and the number of urologic interventions. Random-effects Poisson regression models were used to calculate the primary outcomes, ED visits, and the number of urologic interventions while adjusting for prespecified characteristics. Fifty patients (62% female) with a mean age of 60±11 years were identified. ED visits were 0.42 per year before parathyroidectomy and 0.20 per year after in a multivariate analysis (incidence rate ratio [IRR] 0.48, confidence interval [CI] 0.25-0.91, p=0.024). There was no statistical difference between male and female ED visits (p=0.6719). There was no difference in the rate of ED visits for non-urologic reasons after parathyroidectomy (p=0.0749). The incidence of urologic intervention for stones was 1.24 per year before parathyroidectomy and 0.53 per year after (IRR 0.42, CI 0.26-0.68, p=0.0005). Healthcare resource utilization, in terms of ED visits and urologic intervention, significantly decreased after parathyroidectomy. Sex showed no statistical difference in predicting healthcare utilization, while non-urologic ED visits remained the same after surgery. Expedited parathyroidectomy for PHPT patients may decrease urologic interventions and ED visits, resulting in less healthcare utilization.

Hospital readmission rates are publicly reported by the Centers for Medicare & Medicaid Services (CMS); however, the implications of emergency department (ED) visits following hospital discharge on readmissions are uncertain. We describe the frequency, diagnoses, and hospital-level variation in ED visitation following hospital discharge, including the relationship between risk-standardized ED visitation and readmission rates. This is a cross-sectional analysis of Medicare beneficiaries hospitalized for acute myocardial infarction (AMI), heart failure, and pneumonia between July 2011 and June 2012. We used Medicare Standard Analytic Files to identify admissions, readmissions, and ED visits consistent with CMS measures. Postdischarge ED visits were defined as treat-and-discharge ED services within 30 days of hospitalization without readmission. We utilized hierarchical generalized linear models to calculate hospital risk-standardized postdischarge ED visit rates and readmission rates. We included 157,035 patients hospitalized at 1656 hospitals for AMI, 391,209 at 3044 hospitals for heart failure, and 342,376 at 3484 hospitals for pneumonia. After hospitalization for AMI, heart failure, and pneumonia, there were 14,714 (9%), 31,621 (8%), and 26,681 (8%) ED visits, respectively. Hospital-level variation in postdischarge ED visit rates was substantial: AMI (median: 8.3%; 5th and 95th percentile: 2.8%-14.3%), heart failure (median: 7.3%; 5th and 95th percentile: 3.0%-13.3%), and pneumonia (median: 7.1%; 5th and 95th percentile: 2.4%-13.2%). There was statistically significant inverse correlation between postdischarge ED visit rates and readmission rates: AMI (-0.23), heart failure (-0.29), and pneumonia (-0.18). Following hospital discharge, ED treatand- discharge visits are half as common as readmissions for Medicare beneficiaries. There is wide hospital-level variation in postdischarge ED visitation, and hospitals with higher ED visitation rates demonstrated lower readmission rates.

Hospital Utilization in Sickle Cell Disease Patients: A One-Year Retrospective Study in Urban Underserved Communities

Emergency visits by older adults decreased during COVID-19 but increased in the oldest old.

As the U.S. homeless population grows, so has the challenge of providing effective care to homeless individuals. Understanding hospitals that achieve better outcomes after hospital discharge for homeless patients has important implications for making our health system more sustainable and equitable. To determine whether homeless patients experience higher rates of readmissions and emergency department (ED) visits after hospital discharge than non-homeless patients, and whether the homeless patients exhibit lower rates of readmissions and ED visits after hospital discharge when they were admitted to hospitals experienced with the treatment of the homeless patients ("homeless-serving" hospitals-defined as hospitals in the top decile of the proportion of homeless patients). A population-based longitudinal study, using the data including all hospital admissions and ED visits in FL, MA, MD, and NY in 2014. Participants were 3,527,383 patients (median age [IQR]: 63 [49-77] years; 1,876,466 [53%] women; 134,755 [4%] homeless patients) discharged from 474 hospitals. Risk-adjusted rates of 30-day all-cause readmissions and ED visits after hospital discharge. After adjusting for potential confounders, homeless patients had higher rates of readmissions (adjusted rate, 27.3% vs. 17.5%; adjusted odds ratio [aOR], 1.93; 95% CI, 1.69-2.21; p < 0.001) and ED visits after hospital discharge (37.1% vs. 23.6%; aOR, 1.98; 95% CI, 1.74-2.25; p < 0.001) compared with non-homeless patients. Homeless patients treated at homeless-serving hospitals exhibited lower rates of readmissions (23.9% vs. 33.4%; p < 0.001) and ED visits (31.4% vs. 45.4%; p < 0.001) after hospital discharge than homeless patients treated at non-homeless-serving hospitals. Homeless patients were more likely to be readmitted or return to ED within 30 days after hospital discharge, especially when they were treated at hospitals that treat a small proportion of homeless patients. These findings suggest that homeless patients may receive better discharge planning and care coordination when treated at hospitals experienced with caring for homeless people.

Background: With continued advancements in Enhanced Recovery Pathway (ERP) protocols, we have noticed a significant decrease in colorectal surgery emergency department (ED) visits and readmissions. When considering same-day discharge after colorectal surgery in ERP patients, it would be important to know if early discharge is associated with increased ED visits and readmissions. This study is to determine if discharge on postoperative days (POD) one or two is associated with increased rates of ED visits and hospital readmissions after left and right colectomy. Methods: This is a single institution analysis of a prospectively maintained institutional colorectal surgery database between 07/01/2018 and 07/15/2022. The primary outcomes were ED visit and readmission rates for enhanced recovery open and minimally invasive right and left colectomy using logistic regressions models. Results: 820 patients met inclusion criteria; mean age 62.8 years; 47.4% ASA-3, and 83.2% had a minimally invasive surgical approach. Hospital length-of-stay decreased over the study period. There were significant differences in discharge-day by diagnosis - 58.5% of patients with Crohn’s disease were discharged on POD≥4 and 21.6% of those with benign colon neoplasia were discharged on POD 0-1 (p &lt; 0.001). ED visits occurred in 12.9% of the study population and were not significantly different between discharge-day groups (p=0.096). Overall readmission rate was 8.5% and significantly different between discharge-day groups (0% POD-0 vs 8.3% POD-1 vs 5.8% POD-2 vs 6.9% POD-3 vs 12.9% POD≥4, p=0.041). Logistic regression showed that ED visits and readmissions for longer discharge-days (POD-2, POD-3, POD≥4) were not significantly different than POD-0-1. Readmission diagnoses for the study population were higher for ileus (17.1%) and SSI III (22.9%) than for AKI (1.4%) and SSI I/II (1.4%). Readmissions were not related to discharge day of the week (p=0.494). Conclusions: Early discharge after left and right colectomy is not associated with increased rates of ED visits and readmissions. Same-day discharge may be feasible in selected enhanced recovery patients. Risks and benefits associated with same-day discharge require further investigation.

Emergency department (ED) visits and readmissions following benign foregut surgery (BFS) represent a burden on patients and the health care system. The objective of this study was to identify differences in ED visits and readmissions before and after implementation of an early postoperative telehealth visit protocol for BFS. We hypothesized that utilization of telehealth visits would be associated with reduced post-operative ED and hospital utilization. An early postoperative telehealth protocol was initiated in 2020 at an academic medical center to provide a video conference within the first postoperative week. Consecutive elective BFS including fundoplication, Linx, paraesophageal hernia repair, and Heller myotomy performed between 2018 and 2022 were included. Outcomes included ED visits and 30-day readmission. Bivariate analyses were performed using Chi-squared testing for categorical variables. The association between telehealth visits and outcomes were evaluated using multivariable logistic regression. 616 patients underwent BFS during the study period. 310 (50.3%) were performed prior to the implementation of telehealth visits and 306 (49.7%) were after. 241 patients in the telehealth visit group (78.8%) completed their telehealth visit. A total of 34 patients (5.5%) had ED visits without readmission while 38 patients (6.2%) were readmitted within the first 30days. The most common cause of ED visits and readmissions included pain (n = 18, 25%) and nausea/vomiting (n = 12, 16%). There was a significant reduction in ED visits without admission following telehealth visit implementation (7.4% vs 3.6%; OR 2.20, 95% CI 1.04-4.65, p = 0.04). There was no difference in readmission rates (6.1% versus 6.5%; OR 0.89, 95% CI 0.46-1.73, p = 0.73). The telehealth cohort had significantly lower ED visits for pain (31% vs 16.7%, p = 0.04) and nausea/vomiting (23.8% vs 6.7%, p = 0.02). Early telehealth follow-up was associated with a significant decrease in ED visits following BFS. The majority of this was attributable to a reduction in ED visits for pain, nausea, and vomiting. These results provide a possible avenue for improving quality and cost-effectiveness within this patient population.

306. Opioid-limiting legislation effectively decreases 30-day opioid utilization following anterior cervical decompression and fusion

The implications of extreme heat for physical health outcomes have been well documented. However, the association between elevated ambient temperature and specific mental health conditions remains poorly understood. To investigate the association between ambient heat and mental health-related emergency department (ED) visits in the contiguous US among adults overall and among potentially sensitive subgroups. This case-crossover study used medical claims data obtained from OptumLabs Data Warehouse (OLDW) to identify claims for ED visits with a primary or secondary discharge psychiatric diagnosis during warm-season months (May to September) from 2010 through 2019. Claims for adults aged 18 years or older with commercial or Medicare Advantage health insurance who were living in 2775 US counties were included in the analysis. Emergency department visits were excluded if the Clinical Classifications Software code indicated that the visits were for screening for mental health outcomes and impulse control disorders. County-specific daily maximum ambient temperature on a continuous scale was estimated using the Parameter-Elevation Relationships on Independent Slopes model. Extreme heat was defined as the 95th percentile of the county-specific warm-season temperature distribution. The daily incidence rate of cause-specific mental health diagnoses and a composite end point of any mental health diagnosis were assessed by identifying ED visit claims using primary and secondary discharge diagnosis International Classification of Diseases, Ninth Revision and International Statistical Classification of Diseases and Related Health Problems, Tenth Revision codes. Conditional logistic regression models were used to estimate the incidence rate ratio (IRR) and 95% CIs for the association between daily temperature and incidence rates of ED visits. Data from 3 496 762 ED visits among 2 243 395 unique individuals were identified (56.8% [1 274 456] women; mean [SD] age, 51.0 [18.8] years); of these individuals, 14.3% were aged 18 to 26 years, 25.6% were aged 27 to 44 years, 33.3% were aged 45 to 64 years, and 26.8% were aged 65 years or older. Days of extreme heat were associated with an IRR of 1.08 (95% CI, 1.07-1.09) for ED visits for any mental health condition. Associations between extreme heat and ED visits were found for specific mental health conditions, including substance use disorders (IRR, 1.08; 95% CI, 1.07-1.10); anxiety, stress-related, and somatoform disorders (IRR, 1.07; 95% CI, 1.05-1.09); mood disorders (IRR, 1.07; 95% CI, 1.05-1.09); schizophrenia, schizotypal, and delusional disorders (IRR, 1.05; 95% CI, 1.03-1.07); self-harm (IRR, 1.06; 95% CI, 1.01-1.12); and childhood-onset behavioral disorders (IRR, 1.11; 95% CI, 1.05-1.18). In addition, associations were higher among men (IRR, 1.10; 95% CI, 1.08-1.12) and in the US Northeast (IRR, 1.10; 95% CI, 1.07-1.13), Midwest (IRR, 1.11; 95% CI, 1.09-1.13), and Northwest (IRR, 1.12; 95% CI, 1.03-1.21) regions. In this case-crossover study of a large population of US adults with health insurance, days of extreme heat were associated with higher rates of mental health-related ED visits. This finding may be informative for clinicians providing mental health services during periods of extreme heat to prepare for increases in health service needs when times of extreme heat are anticipated.

130 Background: Cancer clinical trial participants often require frequent outpatient monitoring to evaluate the safety and efficacy of experimental therapies. Healthcare utilization among cancer clinical trial participants vs non-participants remains poorly characterized. Cancer clinical trial participation may lead to more frequent acute care visits and inpatient admissions for the management of treatment-related toxicities. In this analysis, we compared differences in acute care health utilization among newly diagnosed lung cancer patients (pts) who enrolled vs did not enroll in interventional cancer clinical trials. Methods: We used SEER-Medicare data to identify pts with a new diagnosis of lung cancer in 2016. Clinical trial participants were defined as pts with a Medicare claim that included a National Clinical Trial identifier corresponding to an interventional cancer clinical trial within 1 year of diagnosis. Frequency of emergency department (ED) visits and inpatient admissions were evaluated from diagnosis through 6 month follow-up. Clinical trial pts were matched with non-clinical trial pts based on month of diagnosis, age at diagnosis, marital status, race, median income, Charlson Comorbidity Index, and stage. Univariable negative binomial models were built to quantify associations of clinical trial status with ED visits and inpatient admissions. Standardized Mean Differences (SMD) between groups were calculated to determine balance post-matching. A p-value less than &lt; 0.05 was considered statistically significant. Statistical analyses were conducted using R (version 4.4.1, R Core Development Team, Vienna, Austria) and SAS 9.4 (SAS Institute, Cary, NC). Results: 188 newly diagnosed lung cancer pts participating on interventional clinical trials were identified and matched with 450 non-clinical trial pts and the groups were adequately balanced. Most pts did not have any inpatient admissions (62% among clinical trial pts vs 60% non-clinical pts, p = 0.7). Mean inpatient visits were similar among clinical trial pts vs non-clinical trial pts [Mean = 0.61 (SD = 0.96) vs 0.67 (SD = 1.04); Incidence Rate Ratio (IRR) = 0.9, 95% CI (0.69, 1.19); p = 0.5]. Most pts did not have any ED visits (50% among clinical trial pts vs 53% non-clinical trial pts, p = 0.5). Mean ED visits were also similar among clinical trial pts v non-clinical trial pts [Mean = 0.80 (SD = 0.98) vs 0.81 (SD = 1.19); IRR = 0.98, 95% CI (0.78, 1.24); p = 0.9]. Conclusions: We found no difference in acute healthcare utilization among newly diagnosed lung cancer pts that participated vs did not participate in an interventional cancer clinical trial. Despite the risk of treatment-related toxicities and adverse events associated with experimental cancer therapeutics, our data suggests this does not result in a higher burden of ED visits or inpatient admissions.

BackgroundDuring the COVID-19 pandemic, many non-COVID-19 emergency department (ED) visits were indirectly affected. ED visits and mortality were assessed during different pandemic time periods compared with pre-pandemic.MethodsThe study used data from 41 million Iran Health Insurance Organization members. The outcomes were non-COVID-19 ED visits and associated mortality in 956 hospitals. An analysis of ED visits was conducted both for all-cause and cause-specific conditions: cardiovascular diseases (CVD), mental and substance use disorders, unintentional injuries, and self-harm. In addition, total in-hospital ED mortality was analyzed. A negative binomial regression and a Poisson regression with a log link were used to estimate the incidence rate ratio (IRR) of visits and mortality relative risk (RR).Results1,789,831 ED visits and 12,377 deaths were reported during the study. Pre-pandemic (Sep 2019 to Feb 2020), there were 2,767 non-COVID-19 visits rate per million person-month, which decreased to 1,884 during the first COVID-19 wave with a national lockdown from Feb 20 to Apr 19, 2020 (IRR 0.68, [0.56–0.84]). The non-COVID-19 ED mortality risk was 8.17 per 1,000 visit-month during the pre-pandemic period, rising to 12.80 during the first wave of COVID-19 (RR 1.57, [1.49–165]). Non-COVID-19 ED visit rates decreased during the first pandemic year from Sep 2020 to Feb 2021 (IRR 0.73, [0.63–0.86]), but increased after COVID-19 vaccination two years later from Sep 2021 to Feb 2022 (IRR 1.11, [0.96–0.17]). The total ED mortality risk for non-COVID-19 was significantly higher after the COVID-19 outbreak in the first (RR 1.66, [1.59–1.72]) and second years (RR 1.27, [1.22–1.32]) of the pandemic. The visit incidence rate for mental health and substance use disorders declined from 8.18 per million person-month to 4.57 (IRR 0.53, [0.32 to 0.90]) in the first wave. In the second year, unintentional injury visits increased significantly compared with pre-pandemic (IRR 1.63, [1.30–2.03]). As compared to before the pandemic, there was no significant change in CVD and self-harm visit rates during the pandemic. Cardiac arrest was the leading cause of death in Iran hospitals’ EDs.ConclusionIn the first year of the COVID-19 pandemic, non-COVID-19 hospital ED visits declined and mortality risk increased. Despite two years since the COVID-19 outbreak, non-COVID-19 ED mortality risk remains high.

The coronavirus disease 2019 (COVID-19) pandemic has significantly affected health care utilization in the United States. Although reductions in routine outpatient visits and elective procedures were intentional in preparation for increases in COVID-19-related volume,1 National Syndromic Surveillance Program data indicate that weekly emergency department (ED) visits decreased 42% during the early stages of the pandemic.2 This reduction may have been driven by a public fear of seeking care,3,4 ultimately delaying interventions for time-sensitive serious conditions.

Healthcare Utilization Patterns and Health Quality Indicators in Sickle Cell Disease Patients Transitioning from Pediatric to Adulthood