Amount Of Health Care Resources Research Articles

Association between energy surplus and intensive care unit length of stay in critically ill patients: A retrospective cohort study.

Patients experiencing persistent critical illness have poor short-term and long-term outcomes and consume disproportionate amounts of health care resources. Nutrition optimization may improve outcomes, though few data exist on resting energy expenditure and nutrition requirements. We hypothesized that increased energy surplus per day is associated with increased intensive care unit (ICU) length of stay (LoS) in critically ill patients. Patients from a single ICU at Royal London Hospital were included in this retrospective cohort study. energy surplus measured by serial indirect calorimetry (IC) and nutrition intake. mechanical ventilation of ≥3 days and expected to remain ventilated. ICU LoS. Across 30 patients (median LoS 21 days), increased ICU LoS was associated with actual daily energy intake surplus to resting energy expenditure (REE) (R2 0.16; P < 0.005). Median REE was less than predicted energy requirements: 24 kcal per day per kilogram of ideal body weight (IBW) (interquartile range [IQR], 20-28) vs 28 kcal/day/kg IBW (IQR, 26-29) (P < 0.001). Patients with COVID-19 had a median energy surplus (actual intake- REE) + 344 kcal/day (IQR 35-517) vs -57 kcal/day (IQR -324 to 211) in other patients (P = 0.011); however, they had a median LoS of 44 days (IQR 26-58) vs 10 days (IQR 7-24), respectively (P < 0.001). Patients with obesity had a median energy deficit of -32 kcal/day (IQR -384 to 335) vs +234 kcal/day (IQR -79 to 499) for nonobese patients (P = 0.021). Overfeeding represents an easily modifiable factor to improve outcomes in patients experiencing persistent critical illness, for which IC may be useful.

To study the role of sputum cytology in patients with bronchial asthma and COPD

COPD is the major cause of morbidity and mortality across the world. In addition to this, the major factor that is contributing in this disease is smoking. This kind of problem occurs due to airflow obstruction that influences the progressive and accompanied hyper-responsiveness. The patients with Asthma and COPD overlap (ACO) have a poor quality of life and more rapid decline in lung functions and high mortality. Also, they consume a disproportionate amount of health care resources. Moreover, sputum cell counts are extensively used in the treatment of asthma and COPD. The clinical application of sputum cell count in patients with both COPD and asthma remain elusive. The study aims to study the role of sputum cytology in patients with Bronchial Asthma and COPD. It was a prospective study carried out in the Department of Pulmonary Medicine, D Y Patil Medical College, Nerul, Navimumbai, Maharashtra, India. The period of the study was from January 2020 to June 2021. The number of healthy patients recruited for the current study was 20, along with 20 asthmatic patients and 30 COPD patients. Spirometry and body plethysmography was used to measure the capacity and volume of the lungs of all the patients. One-Way Analysis of Variance (ANOVA) test was conducted for counting the differences in counts of lung function variables and sputum cells. The mean age of healthy patients was 62.78±6.1 years, asthmatic patient was 55.9±12.8 years and COPD patients was 65.8±5.2 years. According to the analysis, the specific airway's conductance for aesthetic patients was [0.60±0.04 kPa.Sec⁻¹] and for the patient who was suffering from COPD, the score was [1.82±0.19 kPa.Sec⁻¹] and the outcome for healthy patients was [1.19±0.12 kPa.Sec⁻¹].The study has found a strong relationship between sGaw and neutrophil and the neutrophil-macrophage ratio of COPD patients. According to the analysis of the study outcome, eosinophils are important for the respiratory inflammatory infiltrates in asthma patients as well as in COPD.

Resource allocation in the Covid-19 health crisis: are Covid-19 preventive measures consistent with the Rule of Rescue?

The Covid-19 pandemic has led to a health crisis of a scale unprecedented in post-war Europe. In response, a large amount of healthcare resources have been redirected to Covid-19 preventive measures, for instance population-wide vaccination campaigns, large-scale SARS-CoV-2 testing, and the large-scale distribution of protective equipment (e.g., N95 respirators) to high-risk groups and hospitals and nursing homes. Despite the importance of these measures in epidemiological and economic terms, health economists and medical ethicists have been relatively silent about the ethical rationales underlying the large-scale allocation of healthcare resources to these measures. The present paper seeks to encourage this debate by demonstrating how the resource allocation to Covid-19 preventive measures can be understood through the paradigm of the Rule of Rescue, without claiming that the Rule of Rescue is the sole rationale of resource allocation in the Covid-19 pandemic.

The public health burden of obstructive sleep apnea.

Obstructive sleep apnea (OSA) is the most common respiratory disorder of sleep. The vast majority (>80%) of adults with moderate to severe OSA remain undiagnosed. The economic costs associated with OSA are substantial for both the individual and society as a whole; expenses are likely to be underestimated given that the disease remains undiagnosed in such a large percentage of individuals. The economic burden of motor vehicle collisions related to OSA alone is significant; it is estimated that 810,000 collisions and 1400 fatalities from car crashes in the United States were attributable to sleep apnea in 2000. The many health consequences of OSA include daytime sleepiness, reduced quality of life, decreased learning skills, and importantly, neurocognitive impairments that include impaired episodic memory, executive function, attention and visuospatial cognitive functions. Untreated OSA leads to numerous medical problems such as cardiovascular diseases that can potentially increase healthcare utilization. Untreated patients with sleep apnea consume a disproportionate amount of healthcare resources, expenditures that decrease after treatment. The gold-standard management of OSA remains treatment with CPAP (Continuous Positive Airway Pressure), which is effective in eliminating sleep fragmentation and preserving nocturnal oxygenation, thereby improving daytime sleepiness and quality of life. However, its impacts in reversing neurocognitive function are still uncertain. A significant impediment to CPAP effectiveness is low adherence rates (ranges from 50% to 75%). It is commonly accepted that CPAP improves excessive drowsiness; hence meliorates attention, and accumulating data suggest that CPAP improves a variety of other outcomes such as the risk of motor vehicle crashes.

Equity and efficiency of health care resource allocation in Jiangsu Province, China

BackgroundJiangsu was one of the first four pilot provinces to engage in comprehensive health care reform in China, which has been on-going for the past 5 years. This study aims to evaluate the equity, efficiency and productivity of health care resource allocation in Jiangsu Province using the most recent data, analyse the causes of deficiencies, and discuss measures to solve these problems.MethodsData were extracted from the Jiangsu Health/Family Planning Statistical Yearbook (2015–2019) and Jiangsu Statistical Yearbook (2015–2019). The Gini coefficient (G), Theil index (T) and health resource density index (HRDI) were chosen to study the fairness of health resource allocation in Jiangsu Province. Data envelopment analysis (DEA) and the Malmquist productivity index (MPI) were used to analyse the efficiency and productivity of this allocation.ResultsFrom 2014 to 2018, the total amount of health resources in Jiangsu Province increased. The G of primary resource allocation by population remained below 0.15, and that by geographical area was between 0.14 and 0.28; additionally, the G of health financial resources was below 0.26, and that by geographical area was above 0.39. T was consistent with the results for G and Lorenz curves. The HRDI shows that the allocated amounts of health care resources were the highest in southern Jiangsu, except for the number of health institutions. The average value of TE was above 0.93, and the DEA results were invalid for only two cities. From 2014 to 2018, the mean TFPC in Jiangsu was less than 1, and the values exceeded 1 for only five cities.ConclusionThe equity of basic medical resources was better than that of financial resources, and the equity of geographical allocation was better than that of population allocation. The overall efficiency of health care resource allocation was high; however, the total factor productivity of the whole province has declined due to technological regression. Jiangsu Province needs to further optimize the allocation and increase the utilization efficiency of health care resources.

The Use of Healthcare Services by Prostate Cancer Patients in the Last 12 Months of Life: How Do We Improve the Quality of Care During This Period?

Current research on prostate cancer is heavily focused on early detection and new treatments. There is a lack of research on the overall morbidity prostate cancer survivors face and the amount of healthcare treatment they receive toward the end of their lives. Identifying these care needs will allow appropriate healthcare modeling, resource allocation and service re-design to ensure higher quality care toward the end of life. The aim of this study is to quantify and analyze the use of healthcare services by patients dying with but not necessarily of prostate cancer. All patients who died with a diagnosis of prostate cancer during a 2-year period at a single hospital were included. Data on outpatient attendances, elective and emergency admissions and palliative care involvement in the 12 months prior to death were collected. A total of 77 patients were included and of these, 60 (78.0%) had 545 scheduled appointments with 473 (86.8%) attendances. More non-attendances occurred in the last 6 months of life; 56 vs 16, p < 0.001. Nurse led clinics doubled in the last 6 months of life, 117 vs 66. There were 173 admissions from 63 (81.8%) patients resulting in 1816 days inpatient stay. This averaged to 2.7 admissions per patient for 10.5 days per episode. 32 (41.6%) patients were seen by palliative care resulting in 192 visits in total. 78 (40.6%) were inpatient and 114 (59.4%) were community reviews. In the last year of life, prostate cancer patients use a considerable amount of healthcare resources. Understanding this clinical and economical burden is important for healthcare remodeling to provide better quality care that is cost effective.

Cost-Utility of Dialysis in Canada: Hemodialysis, Peritoneal Dialysis, and Nondialysis Treatment of Kidney Failure

Rationale & ObjectiveThe kidney failure population is growing, necessitating the expansion of dialysis programs. These programs are costly and require a substantial amount of health care resources. Tools that accurately forecast resource use can aid efficient allocation. The objective of this study is to describe the development of an economic simulation model that incorporates treatment history and detailed modality transitions for patients with kidney disease using real-world data to estimate associated costs, utility, and survival by initiating modality.Study DesignCost-utility model with microsimulation.Setting & PopulationAdult incident maintenance dialysis patients in Canada who initiated facility-based hemodialysis (HD) or home peritoneal dialysis (PD) between 2004 and 2013.InterventionHD and PD.OutcomesCosts (related to dialysis, transplantation, infections, and hospitalizations), survival, utility, and dialysis modality mix over time.Model, Perspective, & TimeframeThe model took the perspective of the health care payer. Patients were followed up for 10 years from initiation of dialysis. Our cost-utility analysis compared the intervention with receiving no treatment.ResultsDuring a 10-year time horizon, the cost-utility ratio for all patients initiating dialysis was $103,779 per quality-adjusted life-year (QALY) in comparison to no treatment. Patients who initiated with facility-based HD were treated at a cost-utility ratio of $104,880/QALY and patients who initiated with home PD were treated at a cost-utility ratio of $83,762/QALY. During this time horizon, the total mean cost and QALYs per patient were estimated at $350,774 ± $204,704 and 3.38 ± 2.05) QALYs respectively.LimitationsThe results do not include costs from the societal perspective. Rare patient trajectories were unable to be assessed.ConclusionsThis model demonstrates that patients who initiated dialysis with PD were treated more cost-effectively than those who initiated with HD during a 10-year time horizon.

Stopping the revolving door: An exploratory analysis of health care super-utilization in gynecologic oncology

Objective: Superutilizers constitute a small percentage of the population yet consume a disproportionate amount of health care resources. Our objective was to determine the prevalence of and risk factors for health care superutilization among gynecologic oncology patients.

Predictors of High Health Care Utilization in Patients With Inflammatory Bowel Disease Within 1 Year of Establishing Specialist Care.

A small proportion of patients with inflammatory bowel disease (IBD) consume a disproportionate amount of health care resources, with most of these spent on unplanned care in emergency room (ER) and hospital visits. Interventions in those at high risk in the outpatient setting could reduce the need for future inpatient care. We sought to describe the characteristics predictive of high health care utilization within 1 year after an initial IBD clinic encounter. This was a retrospective study of new IBD patients seen at the outpatient clinics of 2 tertiary IBD centers in the United States. Baseline sociodemographic and clinical characteristics were collected, and the number of IBD-related ER and hospital visits were recorded over the 1-year period after the initial clinic encounter. Patients with ≥2 visits (high utilizers) were compared with those with no visits. Of the 735 patients included in the final analysis, 106 (14.4%) were high utilizers, and they had a mean of 2.9 visits (maximum = 10) in the 1 year after their initial encounter. In multivariate analysis, insurance coverage through medical assistance (odds ratio [OR] 3.57; 95% confidence interval [CI], 1.38-9.20), steroid use (OR 1.83; 95% CI, 1.11-3.04), short inflammatory bowel disease questionnaire score <50 (OR 2.29; 95% CI, 1.23-4.27), and current ostomy (OR 4.82; 95% CI, 1.51-15.37) were independently associated with high utilization. Multidisciplinary care and resources should be preferentially channeled towards new clinic patients with severe disease and on medical assistance, as this could reduce future inpatient visits and result in cost savings.

PMH39 ECONOMIC BURDEN ASSOCIATED WITH MAJOR DEPRESSIVE DISORDER, GLOBAL ANXIETY DISORDER, AND POLY-NONCOMMUNICABLE CHRONIC DISEASE (NCCD) COMORBIDITY

Generalized Anxiety Disorder (GAD) and/or Major Depressive Disorder (MDD) impact healthcare resource utilization (HCRU) and associated healthcare costs. A high proportion of patients with GAD and/or MDD also have comorbid NCCDs. These poly-comorbid patients consume a disproportionate amount of health care resources. In a healthcare climate of increased scrutiny of spending, it is important to understand the relative economic impact of poly-comorbidity and MDD and/or GAD. Participants in the Medical Expenditures Panel Survey, a nationally representative health survey of U.S. individuals, from 2010-2017 with a diagnosis of MDD, GAD, or both MDD and GAD were identified. Participants were grouped according to their number of NCDs: 0, 1-2, or 3+. Comorbidities assessed included Cardiovascular Disease, Pain, Diabetes, High Cholesterol, Pulmonary Disorders, and Obesity. Demographics, HCRU, and Healthcare Costs were assessed across groups. Generalized linear models controlled for patient socio-demographics and clinical characteristics. 5,683 respondents were included, which, when weighted, represent 11,417,939 persons. In patients with MDD and/or GAD, ∼90% had at least one NCCD. A high frequency of patients with MDD and/or GAD had at least 3 or more NCCDs: MDD(49.9%), GAD(39.3%), and both MDD and GAD(51.7%). Analyses of HCRU showed that comorbid MDD and GAD was associated with significantly higher HCRU than MDD or GAD alone. Healthcare Costs in patients with 0 NCCDs were: MDD $4,328; GAD $3,419; both $6,039(P<0.05). Healthcare costs with 1-2 NCCDs: MDD $8,252; GAD $6,548; both $8,074(P>0.05). Healthcare costs with 3+NCCDs: MDD $13,861; GAD $12,186; both $16,719(P<0.05). Patients with MDD and/or GAD have high frequency of NCCD comorbidities. Having both MDD and GAD was associated with higher HCRU and associated healthcare costs. The results suggest that economic burden increases with an increase in the number of comorbidities. Therefore, coordination of care for these patients is a key metric to which policy makers should pay close attention.

Pharmacoeconomic Analysis of Acute Exacerbation of Chronic Obstructive Pulmonary Disease

Introduction: Chronic obstructive pulmonary disease (COPD) imparts a substantial economic burden on an individual and society. Exacerbation of COPD (ECOPD) is the primary cost driver for this burden as it usually associated with hospital admissions of COPD patients. The present study aimed to determine the direct costs of acute ECOPD among COPD patients.&#x0D; Methods: A total of 90 eligible patients with acute ECOPD who were admitted to the hospital were involved in this study. A convenient sampling technique was used during data collection. Cost data were collected according to the expenditures and existing information. Data were analyzed using Statistical Package for the Social Sciences (SPSS) version 23.0. The Spearman's rank test was used to observe the differences (correlations) between the Govt perspective and the patient perspective.&#x0D; Results: The direct costs per episode of acute ECOPD were determined according to the Anthonisen criteria for evaluating acute ECOPD. The mean direct costs for severity III, severity II and severity I were 89.1, 134.8 and 178.2 USD respectively. The cost of acute ECOPD was positively associated with disease severity, length of hospital stay and the number of co-morbidities.&#x0D; Conclusion: Acute ECOPD patients consume a considerable amount of healthcare resources and pose a significant economic burden on the government.

Predicting Factors of Pain Duration in Patients with Chronic Pain: A Large Population-based Study.

BackgroundChronic pain is the third main problem of global health and the most common cause of long-term disabilities. The duration that patients suffer from chronic pain is directly proportional to the extent of the suffering and to the amount of health care resources allocated to this problem. There is no research that has studied the risk factors associated with the long pain duration in chronic pain patients.MethodsWe investigated the potential risk factors associated with long pain duration in a population with diverse pain conditions in a cross-sectional study. We used a questionnaire that included a number of potential risk factors including sex, age, marital status, household condition, number of children, employment, education, body mass index (BMI), pain intensity, and the level of anxiety/depression. The data were analyzed by univariable and multivariable linear regression models.ResultsWe recruited 780 patients. The analyses showed that age and abnormal BMI had a positive correlation with pain duration.ConclusionsThe risk factors that might be associated with longer pain duration include older age and abnormal BMI.

How to Advance Research, Education, and Training in the Study of Rare Diseases

How to Advance Research, Education, and Training in the Study of Rare Diseases

All systems go: An ecological perspective of behavioral health for youth with type 1 diabetes.

Youth with type 1 diabetes (T1D) experiencing self-management difficulties are at risk of irreversible long-term health problems and consume a disproportionate amount of health care resources. Behavioral health interventions for this population have shown limited long-term effects, perhaps because of limited research on and intervention in relevant environments. To effectively intervene, providers must first thoroughly understand how risk factors interact with various contexts (e.g., school, home, hospital) to determine opportunities for the development of relevant interventions. This review utilized an ecological systems framework to examine the state of the literature with regard to risk factors for poor T1D outcomes and associated intervention. This review identified that, whereas risk factors in some systems (e.g., individual, family) have received disproportionate scrutiny, other environments and contexts (e.g., school, medical system) have been relatively neglected by researchers. Similarly, interventions that target understudied environments are lacking, and the majority of rigorously studied interventions only target a single context. Perhaps this accounts for the lack of interventions shown to have a long-term impact on glycemic control. Our review demonstrates that researchers and funding agencies should prioritize efforts that (a) examine the influence of underexamined environments (e.g., primary care clinics, schools) and interactions (e.g., health care provider to parent, school nurse to youth) on T1D outcomes, (b) place increased emphasis on inclusion of understudied populations (e.g., families of minority racial/ethnic backgrounds), and (c) develop and evaluate interventions that specifically are tailored for these settings, interactions, and populations. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

The Development of an Inclusion Health Integrated Care Programme for Homeless Adults in Dublin, Ireland

Introduction: Since 2013, the number of homeless adults in Dublin has doubled. Homeless people have higher morbidity and mortality, use a disproportionate amount of healthcare resources and generate a large volume of potentially preventable healthcare and other costs compared to more privileged individuals. Homeless people frequently need the input of multiple health and social care providers. We sought to develop and pilot a person-centred, multi-disciplinary approach to care delivery through an Inclusion Health Integrated Care Programme for homeless people attending St James’s Hospital. Methods: Action research approach: a programme was developed, and iteratively used and evaluated by the team at a weekly quality-improvement QI team meeting. Routinely collected administrative data was utilised to capture hospital presentations and length of stay for homeless individuals and the number of homeless people in the hospital catchment area. A survey was carried out to determine the views of hospital staff on the programme. Results: The Inclusion Health team, based in St James’s Hospital SJH, Dublin, was piloted from August 2016- August 2017. The team consisted of a part-time consultant physician and a full- time nurse manager funded by the National Nursing and Midwifery Planning and Development Unit. Patients were referred to the team by community-based health and social care providers or by hospital staff. The team reviewed patient cases during their inpatient admission, and continued to be involved in care co-ordination after discharge through a weekly inter-agency integrated care meeting. The team provided input to 360 homeless admissions during the one-year pilot. The approach was feasible and acceptable, with on-going engagement and attendance at weekly meetings by hospital and NGO staff. Feedback from community-based agencies and hospital staff was that the Programme delivered “a more coordinated approach to patient care, improved discharge planning with homeless services and streamlined admissions all of which have resulted in more positive patient outcomes.” During the pilot period, the number of homeless admissions to SJH fell from 0.03 to 0.017 per capita of homeless adults in Dublin per quarter. The mean length of stay for homeless adults in SJH fell from 16 days S.D 7 days to 7 days S.D. 2.5 days. The estimated bed days saving over the one-year pilot was 3,668. Limitations: A randomised controlled trial of integrated care versus no integrated care would enable more thorough assessment of intervention causality. A RCT design suitable for assessment of a complex intervention e.g. stepped wedge may be required. Conclusion: An Inclusion Health Integrated Care Programme is feasible and acceptable and offers benefits to patients and health care providers, with evidence of reduced need for costly unscheduled healthcare during the pilot programme.

Characteristics of Frequent Users of Emergency Medical Services in Singapore

Objectives: This study aims to describe frequent users of Emergency Medical Services (EMS) conveyed to a Singapore tertiary hospital, focusing on a comparison between younger users (age <65) and older users in diagnoses and admission rates. Methods: All patients conveyed by EMS to a tertiary hospital 4 times or more over a 1-year period in 2015 had their EMS ambulance charts and Emergency Department (ED) electronic records retrospectively analyzed (n = 243), with admission the primary outcome. Results: The 243 frequent users were analyzed with a combined total of 1,705 visits, out of a total of 10,183 patients with 12,839 visits conveyed by EMS to Singapore General Hospital (SGH) in 2015. Younger frequent users (<65 years age) were found to be predominantly male (79.6%, p = 0.001) and were on average responsible for more visits than elderly frequent users (8.6 vs. 5.7, p = 0.004). Medical co-morbidities were significantly more prevalent in older users. Younger frequent users were more likely to be smokers (60.2% vs. 22.3%), heavy drinkers (51.3% vs. 8.5%), substance abusers (12.4% vs. 0.8%), and bad debtors (49.6% vs. 20.0%, p < 0.001). A larger proportion presented with altered mental states (11.7% vs. 5.4%, p < 0.001) and alcohol related diagnoses (34.7% vs. 5.3%, p < 0.001). Many were picked up from public areas (45.5% vs. 19.6%, p < 0.001), and had lower acuity triage scores at both EMS (p < 0.001) and ED (p = 0.001). They had lower admission rates (40.5% vs. 78.7%, p < 0.001) and shorter length of stay (4.3 vs. 5.9 days, p < 0.001). Univariable and multivariable analysis showed alcohol related diagnoses, history of alcohol abuse and lower triage scores were less likely to require admissions. Conclusion: Frequent EMS users consume a disproportionate amount of healthcare resources. Two broad subgroups of patients were identified: younger patients with social issues and older patients with multiple medical conditions. EMS usage by older patients was significantly associated with higher rates of admission

Euthanasia, religiosity and the valuation of health states: results from an Irish EQ5D5L valuation study and their implications for anchor values

BackgroundThe Quality Adjusted Life Year influences the allocation of significant amounts of healthcare resources. Despite this surprisingly little research effort has been devoted to analysing how beliefs and attitudes to hastening death influence preferences for health states anchored at “dead” and “perfect health”. In this paper we examine how, inter alia, adherence to particular religious beliefs (religiosity) influences attitudes to euthanasia and how, inter alia, attitudes to euthanasia influences the willingness to assign worse than dead (WTD) values to health states using data collected as part of the Irish EQ5D5L valuation study.MethodsA sample of 160 respondents each supplied 10 composite time trade-off valuations and information on religiosity and attitudes to euthanasia as part of a larger national survey. Data were analysed using a recursive bivariate probit model in which attitudes to euthanasia and willingness to assign WTD values were analysed jointly as functions of a range of covariates.ResultsReligiosity was a significant determinant of attitudes to euthanasia and attitudes to euthanasia were a significant determinant of the likelihood of assigning WTD values. A significant negative correlation in errors between the two probit models was observed indicative of support for the hypothesis of endogeneity between attitudes to euthanasia and readiness to assign WTD values.ConclusionIn Ireland attitudes and beliefs play an important role in understanding health state preferences. Beyond Ireland this may have implications for: the construction of representative samples; understanding the values accorded health states and; the frequency with which value sets must be updated.

Role of management modalities in control and development of complications in diabetic patient ,in Thi-Qar province

Background: Diabetes mellitus keeps on developing in worldwide pervasiveness and consume amount of health care resources. The management of diabetes incorporates capacity to change lifestyle, and physical activity.Objectives:Evaluate of management role (counting adherence) in control status and appraisal of adherence in control status of diabetic. Method: A cross-sectional design was used a convenience sample of 139 subjects with type 1, type 2 diabetes, ≥25 years old, included residents of the community in the city of Nasiriyah only registered in the Diabetes Center for both gender (62male and77female), between March and September 2016.Questionnaire sheet was used designed for collect data. Results: The study results indicated that the persons with a mean age of 50.01 ±12.4years, the cause of disease for participants' more than half of them are hereditary (n=88;63.3%), Considering the uncontrolled more than half of them (n = 102 ; 73.4% ), less than half of them is within 10-14.9years duration of disease (n=46; 33.1%), more than half of them are used double hypoglycemic drug and poorly controlled in HbA1c (n= 111 ; 79.9%), (n =83 ;59.6%); respectively; there is a significant association of HbA1c with type of drug, significant association between determinants and duration of disease and type of drug with level of p-value ≤ 0.05. Conclusions. The majority of subjects haven’t their diabetes controlled; their low self-efficacy, and decline self-management. Therefore, strategies to promote self-management for patients are essential components of diabetes education programs, skill-building interventions are critical to be able to manage their diabetes.

Assessing Statewide All-Cause Future One-Year Mortality: Prospective Study With Implications for Quality of Life, Resource Utilization, and Medical Futility.

BackgroundFor many elderly patients, a disproportionate amount of health care resources and expenditures is spent during the last year of life, despite the discomfort and reduced quality of life associated with many aggressive medical approaches. However, few prognostic tools have focused on predicting all-cause 1-year mortality among elderly patients at a statewide level, an issue that has implications for improving quality of life while distributing scarce resources fairly.ObjectiveUsing data from a statewide elderly population (aged ≥65 years), we sought to prospectively validate an algorithm to identify patients at risk for dying in the next year for the purpose of minimizing decision uncertainty, improving quality of life, and reducing futile treatment.MethodsAnalysis was performed using electronic medical records from the Health Information Exchange in the state of Maine, which covered records of nearly 95% of the statewide population. The model was developed from 125,896 patients aged at least 65 years who were discharged from any care facility in the Health Information Exchange network from September 5, 2013, to September 4, 2015. Validation was conducted using 153,199 patients with same inclusion and exclusion criteria from September 5, 2014, to September 4, 2016. Patients were stratified into risk groups. The association between all-cause 1-year mortality and risk factors was screened by chi-squared test and manually reviewed by 2 clinicians. We calculated risk scores for individual patients using a gradient tree-based boost algorithm, which measured the probability of mortality within the next year based on the preceding 1-year clinical profile.ResultsThe development sample included 125,896 patients (72,572 women, 57.64%; mean 74.2 [SD 7.7] years). The final validation cohort included 153,199 patients (88,177 women, 57.56%; mean 74.3 [SD 7.8] years). The c-statistic for discrimination was 0.96 (95% CI 0.93-0.98) in the development group and 0.91 (95% CI 0.90-0.94) in the validation cohort. The mortality was 0.99% in the low-risk group, 16.75% in the intermediate-risk group, and 72.12% in the high-risk group. A total of 99 independent risk factors (n=99) for mortality were identified (reported as odds ratios; 95% CI). Age was on the top of list (1.41; 1.06-1.48); congestive heart failure (20.90; 15.41-28.08) and different tumor sites were also recognized as driving risk factors, such as cancer of the ovaries (14.42; 2.24-53.04), colon (14.07; 10.08-19.08), and stomach (13.64; 3.26-86.57). Disparities were also found in patients’ social determinants like respiratory hazard index (1.24; 0.92-1.40) and unemployment rate (1.18; 0.98-1.24). Among high-risk patients who expired in our dataset, cerebrovascular accident, amputation, and type 1 diabetes were the top 3 diseases in terms of average cost in the last year of life.ConclusionsOur study prospectively validated an accurate 1-year risk prediction model and stratification for the elderly population (≥65 years) at risk of mortality with statewide electronic medical record datasets. It should be a valuable adjunct for helping patients to make better quality-of-life choices and alerting care givers to target high-risk elderly for appropriate care and discussions, thus cutting back on futile treatment.

An analysis of the French healthcare system in the context of geriatric care

The geriatric population occupy a progressively greater portion of the Canadian demographic spectrum. They often present with multiple comorbidities and utilize a disproportionate amount of healthcare resources per capita. Keeping current Canadian healthcare practices may become unsustainable in the long run, and comparison with the French healthcare system may help with the identification of current shortfalls. The Canadian healthcare system lags behind the French counterpart in several key healthcare indicators, including per capita spending, growth in expenditure, and specialist wait time. The French healthcare system is characterized by a mix of public and private healthcare choices, greater emphasis on preventative health and an nationwide integration. All of these may have contributed to the French healthcare system’s better fiscal spending practices and healthcare outcomes. The Canadian healthcare system should take note of these differences and integrate positive elements to create a model better prepared for geriatric care in the foreseeable future. More in-depth studies may be needed to better assess the extent of adaptation for each of the aforementioned areas.