Outpatient Care Research Articles

Impact of Symptom Distress on the Quality of Life of Oncology Palliative Care Patients: A Portuguese Cross-Sectional Study

Introduction: Uncontrolled symptoms are widely recognized as one of the main challenges in oncology palliative care patients. The central aim of palliative care is to improve the patient’s quality of life. In recent years, there has been a growing use of patient-reported outcome measures in palliative care, particularly to evaluate symptoms, quality of care, and well-being. Aim: To evaluate the sociodemographic and clinical profile, symptom distress, and perceived quality of life in oncology palliative care patients admitted to a specialized palliative care unit in Portugal. Methods: This study was cross-sectional, descriptive, and correlational, carried out in the inpatient setting of the palliative care unit at a tertiary oncology hospital (at admission). The evaluated protocol included a sociodemographic and clinical questionnaire, as well as two measurement instruments: the Edmonton Symptom Assessment Scale (ESAS) and the Palliative Care Outcome Scale (POS), both filled out by the patients. Data analysis was conducted using IBM SPSS® Statistics version 25.0, with a significance level set at 5% (p < 0.05). Results: The majority of participants in this sample were male (61.7%), with a mean age of around 72 years. More than half of the patients admitted (n = 34; 56.7%) were being monitored in outpatient care. Digestive and head and neck cancers were the most commonly found in the sample (41.7% and 20%, respectively). A significant correlation was found between high symptom intensity and poorer quality of life and care (p < 0.01). This association was particularly pronounced for symptoms such as pain, weakness, depression, anxiety, and anorexia. Conclusions: This study revealed a positive correlation between overall symptom severity and a perceived deterioration in quality of life, well-being, and quality of care. Future studies should consider utilizing alternative assessment tools for evaluating symptoms and quality of care. Additionally, including non-cancer palliative patients in similar studies may provide further valuable insights.

A bivariate reference interval for TSH and free thyroxine

Frequently, the serum concentrations of TSH (s-TSH) and free thyroxine (s-FT4) are interpreted together when a physician considers the patient’s thyroid status. Then, each measurement is compared with its univariate reference interval. However, a pair of s-TSH and s-FT4 may be more appropriately assessed if compared with a bivariate reference interval. We constructed a bivariate reference interval for s-TSH and s-FT4 from their measurements in 495 healthy blood donors. After Box-Cox transformation, we estimated the Mahalanobis distances from each pair of s-TSH and s-FT4 to the center of the bivariate distribution. The 95 percentile in the distribution of the Mahalanobis distances was defined as the limit of the bivariate reference interval. Univariate reference intervals comprising the central 95% (2.5–97.5 percentile) and 97.5% (1.25–98.75 percentile) of reference values were estimated from the same data. Normal thyroid function was defined as both s-TSH and s-FT4 within their respective univariate reference intervals, or as a Mahalanobis distance within the 95% bivariate reference interval. In 177,514 specimens from adult individuals in out-patient care, 76.6% were classified as bivariate normal. The corresponding figures for the 95% and 97.5% univariate reference intervals were 68.9% and 76.2%, respectively. The kappa statistics for classification agreement between the bivariate 95% reference interval and the 95% and 97.5% univariate reference intervals were 0.790 and 0.881, respectively. We thought the bivariate reference interval to be clinically most accurate but were unable to prove it.

Time as a significant factor in the release of potassium from lithium heparin plasma and serum.

In most countries the majority of patients are in outpatient care. In difference to hospitalized patients, their blood samples often take hours after collection to centrifugation. The study investigates the release of potassium and the development of pseudohyperkalemia in lithium heparin (Li-Hep) and serum blood collection tubes over time. From 201 donors 4 serum and 4 Li-Hep blood collection tubes were taken each. After 0.5, 4, 6 and 8h whole blood was centrifuged, and potassium levels were determined. To simulate the preanalytic conditions, the samples with a storage time >0.5h were shaken on a standard shaker for 1h and stored at 4-8°C for the remaining time. Over time, significant more potassium was released before centrifugation from the Li-Hep plasma than from serum (1.21 vs 0.94 mmol/L). After 6h, the two groups were no longer highly statistically significantly different (potassium mean: 5.01 mmol/L in serum group, 4.92 mmol/L in Li-Hep group). In the Li-Hep group 164 donors developed a pseudohyperkalemia after 8h, compared to 76 in the serum group. The decision as to which material is best suited should not only be based on which value comes closest to the physiological situation immediately after blood collection. The subsequent preanalytic circumstances must also be considered. Serum tubes appear to be at least as suitable for potassium determination as Li-Hep tubes. In terms of patient blood management, serum provides the possibility of performing a wider range of analyses in the outpatient setting.

Use of Emergency Telemedicine Physicians for Telephone Triage Disposition of Pediatric Patients.

Telemedicine is a growing field, with limited data around its utility supporting pediatric emergency care telephone triage. We instituted telemedicine physician support for nurse telephone triage decisions. When the nursing protocols recommended urgent or emergent care, a telemedicine physician reviewed and modified care urgency if appropriate. Our primary study objectives were to evaluate the proportion of patients who were downgraded to less urgent care and assess for potential harm related to the downgrade in care urgency. We conducted a retrospective observational cohort study of pediatric telephone calls to the Mayo Clinic Health System nurse triage line that were directed to the emergency department telemedicine physician from January 1, 2019, to December 31, 2019. Electronic medical records of patients whose care urgency was downgraded and presented to medical care within 72 hours of the triage call were reviewed. There were 8559 nurse line calls regarding pediatric patients, 882 of which were referred to the telemedicine physician. Among these, 396/882 (44.9%, 95% confidence interval 41.6-48.3) were downgraded. Of downgraded cases, 198 (50.0%) patients sought care within 72 hours of the original call, of which 193 (97.5%) patients were discharged home from that medical visit and 5 (2.5%) patients required admission. No patients were determined to have suffered harm due to the downgrade of visit urgency. Our data suggests that telemedicine physicians can safely downgrade nurse triage care recommendations for pediatric patients. Most downgraded patients sought outpatient care, avoiding unnecessary utilization of the emergency department without evidence of associated harm.

Contributions of Pediatric Hematology/Oncology to the Diagnosis, Treatment, and Cure of Acute Lymphoblastic Leukemia-Part 2b (Numbers 16 to 20).

This offering represents part 2b of a second set of 5 additional contributions of pediatric hematology/oncology to the diagnosis, treatment, and potential cure of precursor B-cell acute lymphoblastic leukemia. It contains numbers 16 to 20 and includes (16) allogeneic hematopoietic stem cell transplantation, newer immunotherapies including (17) blinatumomab, and (18) inotuzumab ozogamicin, (19) ploidy, and (20) creation of the "day hospital" to administer outpatient care to children with acute lymphoblastic leukemia and other cancers. These and the other reviewed contributions have had a significant role in improving the quality and duration of the lives of children, most of whom faced tragic and painful death back in the 1950s and 1960s. Most of our early optimistic goals were achieved and have benefitted substantially our patients, providing those of us who participated in many of these key clinical trials, a profound sense of accomplishment.

Older Adults' Experiences of Emergency Department Admission Decisions: A Qualitative Study in a Public Safety Net Hospital.

Hospital admission is a significant event in the healthcare trajectory of older adults (age 60 +). Numerous harms such as delirium, falls, and adverse medication events can arise that outweigh the benefits of admission. Little is known about how older adults feel about being hospitalized or what they think admission will achieve for them. These issues are particularly important to understand in socioeconomically disadvantaged patients, who have poor access to outpatient care and higher hospitalization rates. We performed semi-structured interviews with emergency department (ED) patients aged 60 and older who were being admitted. The study site was a public hospital serving a socioeconomically disadvantaged, predominantly Hispanic and Black patient population. Interviews focused on experiences of the admission decision, expectations of hospitalization, and health outcome goals. We coded data using an inductive approach. Twenty-seven older adults were interviewed about their experiences. Most participants belonged to minoritized racial or ethnic groups (70%, n = 19), and 41% (n = 11) spoke Spanish as their primary language. Approximately one-third were admitted for ambulatory care-sensitive conditions, i.e., conditions that can be managed in the outpatient setting to prevent hospitalization. Four themes emerged: (1) participants felt that clinicians made admission decisions for, rather than with, them; (2) participants sought to avoid admission due to family caregiving and work obligations; (3) participants with chronic conditions viewed their admission as resulting from poor access to care over the longer term; (4) participants expected hospitalization to improve their chronic symptom burden, mobility, and abilities to perform activities of daily living. Older adults' expectations of hospitalization exceed stabilization of acute illness. Hospital admission of older adults presents an opportunity for shared decision-making and communication about likely outcomes of hospitalization. Incorporating patient-centered outcomes into admission decisions may help align care with older adults' priorities in the ED.

Is the use of antibiotic stewardship measures in the context of specialized outpatient palliative care sensible and feasible? An interview-based study

BackgroundSpecialized outpatient palliative care (SAPV) is a component of palliative care in Germany, which assists approximately 10% of palliative patients. The majority of these patients have a malignant disease and are at increased risk of complications or severe infection. Antibiotic stewardship (ABS) measures are implemented to optimize antibiotic administration; however, there is little data available in this area, particularly for SAPV. Therefore, we examined the extent to which ABS measures can be meaningfully used or implemented in SAPV.MethodsAfter establishing a corresponding interview guide, 15 experts from specialized areas were interviewed on this subject by the Institute for Market Research in Healthcare Munich (IMIG) through audio-registered individual interviews. The interviews were analyzed using the qualitative content analysis method according to Mayring.ResultsAll 15 experts participated. The primary benefits cited were greater safety in the prescription and decision-making process for antibiotics in the areas of SAPV and improved quality of life. The implementation of continuous ABS measures for SAPV was considered difficult in some cases and linked to certain prerequisites, such as supportive advice from existing systems. The possibility of further training for SAPV members in the area of ABS was considered particularly advantageous.ConclusionsThe implementation of ABS measures in SAPV is feasible in principle; however, it is difficult to implement under the current conditions. Close cooperation with an existing external ABS expert/team will be helpful. This will provide more security for a small, but relevant proportion of SAPV patients, and for the SAPV team treating them.

A COMPARATIVE ANALYSIS OF ACCESS TO SPECIALIZED OUTPATIENT MEDICAL CARE IN BULGARIA AND THE USA

The patient's access to medical care is a fundamental component of assessing public health systems. We conducted a questionnaire-style survey in Bulgaria and the USA in order to analyze the access to specialized outpatient care and determine whether there are inequities in access present. The questionnaire was anonymous and was distributed in the March 2023 - May 2023 period via the use of the Google Forms online platform among 395 adult citizens of Bulgaria and 387 adult citizens of the USA. The results show that, according to the respondents, there are inequities present in specialized outpatient medical care (SOMC). In Bulgaria, every fifth participant (20.42%) was xamined by a specialist physician one day after acquiring a referral from the GP, and 35.74% waited over a week. In the USA, the largest portion of the respondents (42.64%) were examined by a specialist a month after and 26.43% after 2-3 months. In the context of the COVID-19 pandemic, the largest portion of respondents in Bulgaria (49.87 %) experienced access to specialist becoming harder, while the largest portion of respondents from the USA didn't experience changes in access.

Validation of Parkinson's Disease Ascertainment in the Veterans Administration Electronic Medical Record.

Electronic medical record (EMR)-based studies hold great potential for epidemiologic investigations of Parkinson's disease (PD) causal factors and phenomenology, but diagnostic misclassification may obscure or bias inferences. The aims were to determine the validity of PD diagnostic codes in the Veterans Administration (VA) national electronic medical databases and develop recommendations for maximizing ascertainment accuracy. We investigated a cohort of 146,776 veterans who utilized VA healthcare between 1999 and 2021. We reviewed the medical records of individuals with a PD International Classification of Diseases (ICD) code in outpatient, inpatient, or community care encounters to assign a gold-standard diagnosis. We determined diagnostic accuracy based on provider type, coding frequency, medications, and potentially exclusionary ICD codes overall and by race. A total of 377 of 810 (46.5%) with a PD ICD code had PD. Veterans whose PD was coded by a PD-specialist neurologist were most likely to have PD (83.6%), but sensitivity was low (15.0%). Diagnostic accuracy decreased for PD coded by any neurologist (66.9%), but sensitivity improved (69.4%). Requiring two or more PD codes in combination with two or more levodopa prescriptions improved accuracy, particularly among nonneurologists. Neuroleptic-induced parkinsonism was the most frequent diagnosis in those without PD (15.6%). Accuracy was lower in Black (29.0%) than White (50.5%) veterans regardless of provider type (miscoding odds ratio 2.5, 95% confidence interval 1.7-3.6). These results highlight the limitations of EMR-based PD ascertainment. Researchers can maximize accuracy by considering provider specialty, coding frequency, pharmacy data, and exclusionary diagnoses, but some degree of record review is required to ensure high accuracy. Higher miscoding among Black veterans warrants further study. © 2024 The Author(s). Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society. This article has been contributed to by U.S. Government employees and their work is in the public domain in the USA.

Prenatal Exposure to Proton Pump Inhibitors and Risk of Serious Infections in Offspring During the First Year of Life: A Nationwide Cohort Study.

Proton pump inhibitor (PPI) use in children increases the risk of infections, prompting inquiry into the impact of prenatal PPIs exposure on serious infections in offspring. As a research gap in this area exists, this study aimed to address it by assessing the association between prenatal PPIs exposure and serious infections in infants during their first year of life. Using the French health insurance data warehouse (SNDS) (2013-2018), we conducted a retrospective cohort study on singleton, full-term liveborn non-immunocompromised infants, stratified by PPI use during the first three months of life (early-life use). Proton pump inhibitor dispensing in ambulatory care settings during pregnancy defined exposure. Outcomes concerned any serious infections in offspring aged between 3 and 12 months. Adjusted odds ratios (aORs) were estimated using logistic regression with multivariable models to control for potential confounders. Of the 2,485,545 infants included, 497,060 (23.3%) were prenatally exposed to PPIs and 97,767 (4.6%) had PPI use during the first three months of life. Prenatal PPI exposure was associated with serious infections in offspring (aOR, 1.09 [95% CI, 1.07-1.10]) in infants without early-life PPIs use. No association was found for infants with early-life PPI use (aOR, 1.05 [95% CI, 1.00-1.11]). Gastrointestinal infections were the sole site with persistent significance. Prenatal PPI exposure is common and is not associated with a major risk of serious infections in infants during their first year. However, even after adjusting for several confounding factors, a weak association remains, especially in infants without early-life PPI use. While offering reassurance, adherence to clinical guidelines is still crucial.

Practice networks in Germany: structure, cooperation and priorities

The outpatient sector in Germany is characterised by special features, including organisational separation from the inpatient sector, the free choice of doctor for patients and the lack of standardised communication channels between service providers (1). This makes coordination and continuity of care more difficult, which can ultimately lead to cuts in the quality of care for patients. Examples of negative consequences of uncoordinated care include excessive utilisation of healthcare services, interruptions to treatment pathways or incorrect medication. In particular, multimorbid patients with a high demand for healthcare services are at risk of inappropriate care. There is potential for development with regard to collaborative professional practice in the outpatient sector and care models are needed that improve cooperation and coordination in care.

Type 2 Diabetes Health Care Outcomes for Patients with Alcohol Use Disorder Starting Addiction Treatment.

Alcohol use disorder (AUD) is common and may complicate type 2 diabetes (T2DM) management. Little research has examined diabetes outcomes for people with T2DM and AUD, including during the window when patients start specialty addiction treatment. To examine diabetes-related health monitoring, clinical outcomes, and acute health care use among patients with T2DM and AUD newly accessing specialty addiction treatment. This retrospective cohort study included electronic health record data from a large, integrated health care delivery system. Adults with T2DM and an index outpatient health care visit during 2016-2021 were included. Patients whose index visit was an initial AUD-related visit in specialty addiction treatment were in the AUD group. The comparison group had no AUD or addiction medicine visits. Outcomes were diabetes-related health monitoring, achievement of treatment targets, complications, and acute health care use during the 12months post-index visit. The study included 222,334 adults with T2DM, 1,998 with AUD. Relative to the comparison group, participants with AUD had elevated risk for hypoglycemia (adjusted risk ratio [aRR] = 2.14; 95% confidence interval [CI] = 1.49, 3.08), cardiovascular complications (aRR = 1.43; 95% CI = 1.34, 1.53), and neuropathy (aRR = 1.26; 95% CI = 1.14, 1.41), and were less likely to be non-smokers (aRR = 0.88; 95% CI = 0.86, 0.90), after adjusting for confounding factors. In adjusted models, the AUD versus comparison group had similar or higher rates of diabetes monitoring (e.g., any glycemic test, aRR = 1.19; 95% CI = 1.17, 1.22) and metabolic control (e.g., hemoglobin A1c < 8.0%, aRR = 1.14; 95% CI = 1.11, 1.18). Patients with co-occurring T2DM and AUD in an integrated health care delivery system are vulnerable to diabetes complications that could be addressed during the early phase of specialty addiction treatment.

Основные направления совершенствования диабетологической помощи в условиях поликлиники (по результатам социологического исследования).

A sociological assessment of satisfaction with outpatient care for patients with diabetes mellitus in the Republic of North Ossetia-Alania was carried out. The results of the study make it possible to identify the main problems faced by patients at the primary health care level and identify possible ways to level them. The purpose of the study: to assess the satisfaction of patients with diabetes mellitus with the quality of medical care provided in outpatient settings. Materials and methods. The questionnaires of 450 patients with diabetes mellitus, urban (66%) and rural (34%) residents were analyzed. Of these, 45% are men and 55% are women aged 39–59 years (39.0%), 60–79 years (36.0%), over 80 years (6.0%). The questionnaire included 12 questions on various aspects of the clinic’s activities. Data processing and analysis were performed using the IBM SPSS Statistics 27.0.1 software and analytical complex. Results. A study of the satisfaction of patients with diabetes mellitus with outpatient medical care has revealed a number of organizational and medical problems. The regularity of visits to the endocrinologist by patients is one of their main conditions for the effectiveness of therapeutic and preventive measures and dispensary supervision. A fairly high percentage (72%) visit the clinic from 2 to 5 times a year. It is alarming that 28% of patients visit an endocrinologist only once a year, which is a sign of low adherence to treatment on the part of patients. Rural residents visit an endocrinologist less often than urban residents. Young people are more often dissatisfied with the time that the doctor spends at the reception and more often face rude treatment from the medical staff. The comorbidity of diabetes mellitus requires the provision of high-quality medical care in accordance with the expectations of patients, which is provided with logistical equipment and staffing Conclusion. The results obtained are an indicator of the quality of medical care and indicate the presence of problem areas in the activities of medical organizations providing outpatient care to patients with diabetes mellitus. Special attention should be paid to the organization of dispensary follow-up in order to reduce the risks of developing complications of the disease. It is necessary to increase the availability of primary health care by making appropriate management decisions at the level of regional health authorities.

Establishing a telemedical supported trans-sectoral collaboration network from community support to emergency care for outpatient care recipients: study protocol of a prospective non-randomized complex intervention study with a pragmatic approach, Stay@Home – Treat@Home

BackgroundDemographic changes in Germany are increasing the number of outpatient care recipients, who often resort to emergency care due to difficulties accessing timely outpatient medical care. Previous studies suggest that early detection and telemedical interventions could reduce unnecessary hospitalizations. The new form of healthcare aims to provide continuous, flexible healthcare for outpatient care recipients using digital technologies to detect health deteriorations and facilitate interventions at home. The goal of our study is to evaluate, whether the number of emergency situations and hospital stays will be reduced, and health outcomes will be improved compared to standard care.MethodsIn this prospective non-randomized complex intervention study with a pragmatic approach, we aim to evaluate a new form of healthcare focused on establishing an interdisciplinary network for outpatient care in the homes of care-dependent individuals. Utilizing a digital interactive health diary, health data will be gathered from participants, caregivers, and healthcare providers, covering both stable primary care and acute situations. A telemedical network will coordinate measures, including non-medical aid, nursing care, and medical assistance. A total of 1,500 participants will be recruited for the intervention group, matched with a control group from health insurance data. A second control group with n=300 will provide self-reported measures. The study is planned to span eight quarters, with data collected from the digital interactive health diary and health insurance records. Evaluation perspectives include health insurance, patients, and healthcare providers, assessing utilization and costs compared to standard care, health status, health-related quality of life, care dependency, interdisciplinary cooperation, and usability of the new technology.DiscussionDemographic change results in a larger older people population, exacerbating mobility issues and care dependency, worsened by the shortage of medical personnel. Stay@Home – Treat@Home aims to enable home health monitoring and care, reducing hospitalizations. The digital interactive health diary supports direct communication, allows remote monitoring, and empowers patients and caregivers to manage health changes. Nursing aid personnel and physicians can access entries for informed interventions. The development of the digital interactive health diary aims to improve the situation of care-dependent individuals. Evaluating its effectiveness and efficiency is crucial for the development and implementation of new technologies.Trial registrationGerman Clinical Trials Register, ID: DRKS00034260, registered on May 14, 2024 (retrospectively registered): https://drks.de/search/de/trial/DRKS00034260 and https://who.int/clinical-trials-registry-platform/network/who-data-set.

Socioeconomic, health status and hospitalization aspects of adult patients referred to the social service of a tertiary hospital

ObjectiveThe aim of this study is to record and analyze socioeconomic, demographic and health profiles of adult patients referred to the Social Service of a tertiary Hospital, as well as to present additional hospitalization conditions.MethodsA retrospective hospital archive study containing all patients referred to the Social Service during a four-year period was conducted.ResultsThe study consisted of 350 patients (168 males) with mean age 70.1 years. Most of the patients were of Greek origin and singles or divorced. 184 patients (52.6%) were retired. The participants’ average income ranged between 500 and 1000 euro/month. Most of the patients were insured by the Government (public health insurance) and were hospitalized in Pathology and Covid Clinics, with a mean hospitalization level of 17.6 days. The main reasons for referral were admission to an Aged Care Unit and the need to investigate network support. The most frequently recorded diagnosis was Covid-19, while 103 (29.4%) patients had a mental illness problem. The analysis of associations between demographic characteristics with health dimensions showed significant differences.ConclusionsChanges in socioeconomic conditions have an impact on outpatient and inpatient care as well as on Greek social work practice and pose enormous challenges to social work professionals.

Changes in emergency healthcare use following intervention by Navigator, an emergency department social support programme: a multi-centre retrospective before-and-after study.

Patients living with social deprivation, and those with experiences of violence, substance misuse, mental ill-health and homelessness are known to use emergency departments (EDs) more often. It is not known whether a programme of social support initiated during ED attendance may lead to a reduction in healthcare use. The objective of this study is to determine the change in emergency, inpatient and outpatient healthcare use following a social support programme, Navigator, initiated during an ED attendance. Retrospective before-and-after study. Adult patients ≥16 years, attending EDs in the West of Scotland from 14th September 2016 to 10th March 2023, with a Navigator programme encounter. The Navigator social support programme, delivered by trained support workers, initiated during ED attendance, and targeting patients affected by issues including violence, substance misuse, mental ill-health, domestic abuse and homelessness. Healthcare use rates in the 365 days following intervention, as change compared to those in the 365 days prior to the intervention. The primary outcome was the number of ED attendances in the year following intervention compared with the year prior to intervention. Secondary outcomes included inpatient admissions, inpatient bed days, outpatient appointments and outpatient appointments where the patient did not attend. Changes in use rates were analysed with negative binomial regression and reported as incidence rate ratios for interpretation as percentage change. Analysis was repeated for a subgroup of frequent attenders to the ED. Of 1421 Navigator programme encounters, 1056 were included for analysis. Median attendance in the year prior to intervention was 3 [interquartile range (IQR) 1-5], and in the year following intervention was 2 (IQR 0-4). Negative binomial regression demonstrated that in the year following Navigator intervention, there was a 29% (95% confidence interval: 24-33%) reduction in ED attendances. The Navigator programme was associated with reduced emergency and acute healthcare use in the year following intervention, with increased scheduled outpatient care. There is the potential for a social support programme, delivered from the ED, to change patterns of healthcare use, and future work should consider prospectively assessing the impact of such an intervention.

Association between insurance type, clinical characteristics, and healthcare use in adults with congenital heart disease

IntroductionAdults with congenital heart disease (CHD) represent a heterogeneous and growing population with high healthcare utilization. We sought to understand the association between insurance type, healthcare use, and outcomes among adults with CHD in Oregon. MethodsThe Oregon All Payers All Claims database from 2010-2017 was queried for adults aged 18-65 in 2014 with ICD-9 or 10 codes consistent with CHD; patient demographics, comorbidities, healthcare use, and disease severity were identified. Insurance type was categorized as either public (Medicare and Medicaid) or private (commercial). Descriptive statistics were used to compare groups. Use rates and odds ratios were calculated representing probability of at least one event per person-year using logistic regression with clustering on patients. ResultsOf 13,792 adults with CHD, 48% had a form of public insurance. More publicly insured patients had moderate or severe anatomic complexity (29.5% vs. 23.0%; p < 0.0001), treatment for drug and alcohol use (25.0% vs. 7.2%; p < 0.0001), and mental health diagnoses (66.6% vs. 51.0%; p < 0.0001). They were more likely to reside in a rural area (24.5% vs. 16.1%; p < 0.0001). Adjusted for age and CHD severity, publicly insured patients were less likely to access overall ambulatory care (aOR 0.72, 99% CI 0.66 to 0.80) but more likely to access emergency (aOR 3.86, 99% CI 3.62 to 4.12) and inpatient (aOR 3.06, 99% CI 2.81 to 3.33) care, as shown in Figure 1. Length of hospital stay (5.7 vs. 4.4 days, p<0.0001) and rates of 30-day readmission (17.1% vs. 11.0%, p<0.001) were higher in those with public insurance. However, individuals with public insurance were significantly more likely to undergo their annual guideline-indicated echocardiogram (aOR 1.49, 99% CI 1.23 to 1.80) and attend their annual ACHD visits (aOR 1.62, 99% CI 1.40 to 1.87). ConclusionsOur study shows that publicly insured adults with CHD in Oregon have more anatomically complex disease, more comorbidities, and higher healthcare use. While they were more likely to receive guideline-indicated ACHD care, they were also higher utilizers of emergency room and inpatient resources, implying that they may benefit from targeted interventions to improve outcomes and decrease unplanned healthcare use.

Assessing Whole-Person Outcomes During Routine Clinical Care: A Rapid Scoping Review.

To identify and describe research conducted on the implementation, validity, and utility of whole-person outcome measures administered during routine inpatient or outpatient care. Incorporating information about patients' overall health, health-related quality of life, and global well-being into health care delivery has the potential to increase referral rates, enhance doctor-patient communication, and improve the detection of untreated symptoms. Assessment of these whole-person outcomes during routine clinical care is of broad interest to health care providers and health systems. We employed a scoping review design and searched Ovid MEDLINE, APA PsycINFO, and CINAHL for relevant English-language primary studies and systematic reviews published through November 13, 2023. Screening for inclusion and data abstraction were conducted by 1 investigator then checked by another. Study risks of bias and the strength of available evidence were not assessed. Of 1327 potentially relevant publications, 44 primary studies and 5 systematic reviews met eligibility criteria. Assessment of global well-being was comparatively less researched than overall health or health-related quality of life. Available research provided a range of perspectives on the performance, feasibility, acceptability, implementation, and clinical utility of whole-person outcome measures. No studies reported change in patient health or disease outcomes attributed to whole person outcome assessment (directly or through changes to care delivery). Currently available evidence provides insights about the performance and implementation of whole-person outcome measures during routine clinical care, but no studies are available that examine the impact of assessing whole-person outcomes on clinical or patient outcomes.

Challenges and opportunities at the interface between hospitals, outpatient care services/caregivers and community pharmacies (CAPAA)? A qualitative study

Challenges and opportunities at the interface between hospitals, outpatient care services/caregivers and community pharmacies (CAPAA)? A qualitative study

Strategies for Promoting Timely Palliative Care in Outpatient Clinics

With cancer now the leading cause of death, the importance of palliative care importance is increasingly evident. However, the focus of current policies is on inpatient and home-based care, which neglects the specialized needs of outpatients and results in many not receiving timely palliative care. Integrating palliative care into outpatient clinics using standardized referral criteria and automated systems will allow for timely patient selection and intervention, early symptom management, and psychological support as well as promote patient autonomy in treatment decision-making. Specialized oncology palliative care nurses play a crucial role in related assessment, care planning, and implementation activities. They help patients and families cope with disease progression and end-of-life care through education and support. Early outpatient palliative care benefits many patients and families, realizing a holistic and comprehensive care model.