Assess Health Care Utilization Research Articles

#1002 End of life healthcare utilisation and costs of older patients receiving kidney replacement therapy—analysis of Dutch health insurance claims data

Abstract Background and Aims The increasing prevalence of chronic kidney disease (CKD), an aging population and advancements in treatment options collectively contribute to a rise in older patients with a functioning kidney transplant (KTX) or undergoing dialysis. These treatments are associated with extensive healthcare utilisation, placing substantial demands on both patients and the healthcare system. Healthcare utilisation typically increases near the end of life, and is associated with increased costs. However, little is known about the end-of-life healthcare utilisation of patients receiving kidney replacement therapy (KRT). Therefore, our study aims to assess healthcare utilisation and costs during the last year of life. Method We analysed Dutch health insurance claims data from patients aged >65 years on KRT who deceased between June 2016 and December 2021. We matched each patient with two controls, defined as individuals who died within the same calendar year without any insurance claims related to CKD or KRT. Matching was performed on sex, age and socio-economic status. The primary outcomes were healthcare utilisation and costs in the last twelve months of life for patients treated with different KRT modalities and compared to matched controls. Healthcare utilisation was detailed at hospital and intensive care unit (ICU) admissions, emergency department (ED) and outpatient department (OPD) visits, hospital daycare and institutionalised care. Healthcare costs encompassed costs related to primary care, hospital care (inpatient and outpatient), mental care, institutionalised care, prescription medication, transportation and other costs. Hospital care costs were categorised as KRT-related and -unrelated costs. Results In total 7279 decedents were included; 4614 haemodialysis patients (HD), 766 peritoneal dialysis (PD) patients and 1899 KTx recipients. KRT patients had a mean age of 77.6 ± 6.6 years, with 64% being male, and had significantly more comorbidities than the control group. In the year preceding death, KRT patients had significantly more hospital admissions, ICU admissions, ED visits, outpatient visits, hospital daycare and institutionalised care than controls (see Fig. 1). When comparing across KRT-modalities, KTx patients were more often admitted to the ICU than HD and PD patients (p = 0.001 and p = 0.024, respectively). For both HD, PD and KTx patients, the mean number of days admitted to the hospital and ICU, as well as ED visits and OPD visits significantly increased in last three months preceding death, compared to the initial nine months of the last year of life (p < 0.0001). Mean total healthcare costs in the last year of life were €59.489 for KTx patients, €108.294 for PD and €117.520 for HD patients, compared to €19.820 for the controls. The majority of costs for dialysis patients were attributed to KRT, accounting for 55.5% (€65.216) and 60.0% (€64.559) of the total expenditures for HD and PD patients, respectively. In contrast, KRT-related costs constituted 25.7% (€15.262) of the total expenses in KTx patients. Besides substantial KRT-related costs, KRT-patients also incurred higher costs for specialist care in the hospital, primary care, medication and transport, compared to controls. Conclusion Healthcare utilisation is substantial for older KRT patients and intensifies during the last year of life. This is accompanied with elevated costs. Further research is necessary to evaluate the impact of healthcare utilisation on the quality of life and whether advanced care planning could prevent overutilisation.

Healthcare utilization and expenditures among patients with venous thromboembolism following gastrointestinal cancer surgery

BackgroundWe sought to assess healthcare utilization and expenditures among patients who developed venous thromboembolism (VTE) after gastrointestinal cancer surgery. MethodsPatients who underwent surgery for esophageal, gastric, hepatic, biliary duct, pancreatic, and colorectal cancer between 2013 and 2020 were identified using the MarketScan database. Entropy balancing was performed to obtain a cohort that was well balanced relative to different clinical covariates. Generalized linear models were used to compare 1-year postdischarge costs among patients who did and did not develop a postoperative VTE. ResultsAmong 20,253 individuals in the analytical cohort (esophagus [n = 518 {2.6%}], stomach [n = 970 {4.8%}], liver [n = 608 {3.0%}], bile duct [n = 294 {1.5%}], pancreas [n = 1511 {7.5%}], colon [n = 12,222 {60.3%}], and rectum [n = 4130 {20.4%}]), 894 (4.4%) developed VTE. Overall, most patients were male (n = 10,656 [52.6%]), aged between 55 and 64 years (n = 10,372 [51.2%]), and were employed full time (n = 11,408 [56.3%]). On multivariable analysis, VTE was associated with higher inpatient (mean difference [MD], $17,547; 95% CI, $15,141-$19,952), outpatient (MD, $8769; 95% CI, $7045-$10,491), and pharmacy (MD, $2811; 95% CI, $2509-$3113) expenditures (all P < .001). Furthermore, patients who developed VTE had higher out-of-pocket costs for inpatient (MD, $159; 95% CI, $66-$253) and pharmacy (MD, $122; 95% CI, $109-$136) services (all P < .001). ConclusionAmong privately insured patients aged <65 years, VTE was associated with increased healthcare utilization and expenditures during the first year after discharge.

A study on health care utilization and out of pocket expenditure in rural central India: A cross-sectional study

Background Out-of-pocket health expenditures have significant adverse effects, potentially resulting in impoverishment and impacting the quality of life. Awareness of patterns of healthcare utilization and out-of-pocket expenses is essential for informing healthcare scheme decisions. According to estimates from the World Health Organization in 2005, illness and the financial strain of healthcare costs force 25 million households into poverty each year. The goal of the study is to assess the proportion of households incurring out-of-pocket expenditure (OOPE) and The mean quality expended by households on healthcare. Methods In Wardha district, a cross-sectional study will be conducted. The pre-tested semi-structured survey will be administered to examine a sample of adult age groups, to identify sociodemographic data, utilization of healthcare services, and OOPE. A sample of 246 participants was selected by random sample method. Conclusion This study will help to improve and assess healthcare utilization and reduce out-of-pocket expenditures that lead to catastrophe and impoverishment. Awareness of the participants about health insurance. And they were known about the healthcare services.

Abstract P234: Prison Inmate Awareness of Heart Disease Status While Incarcerated in State and Federal Prisons, 2016

Background: Heart disease (HD) is the leading cause of death of inmates incarcerated in state prisons in the US, as it is in the general population. However, in 2001-2019 the mortality rate of HD in incarcerated populations was reported to increase, while it decreased in the US population. . This is despite constitutionally mandated access to healthcare. There are few studies assessing healthcare utilization in prison populations. The 2016 Survey of Prison Inmates is exceptional in that it explores utilization across both state and federal prisons, and allows us to explore factors that may contribute to decreased understanding of health status. Methods: This study is a secondary analysis of the 2016 Survey of Prison Inmates collected by the Bureau of Justice Statistics, a cross sectional survey of the state and federal prison population across the United States. Data collection took place from January to October 2016. All participants were above 18 years of age, incarcerated across 1808 state and 193 federal institutions. All analysis was restricted to those with a reported history HD, which included heart attack, coronary heart disease, angina, congestive heart failure, or other heart problems. Awareness of their current heart disease status was operationalized by combining self-reported history and current heart disease status. Results: When asked, 27.9% of survey respondents reported a history of heart disease but denied currently having heart disease. Yet 89.3% of these unaware patients had seen a healthcare provider since incarceration. . Independent of age, those with difficulty walking/climbing stairs or doing activities alone, and older in age (all p&lt;0.01) were more likely to be aware of HD status. Factors including veteran status (OR=0.7; CI: 0.5-0.9), homeless 30 days prior to incarceration (37.8% vs 27.7%; p=0.036) and those experiencing homelessness before 18 years of age (40.4% vs 25.8%; p&lt;0.001) were associated with being unaware of heart disease status. Individuals with ADD/ADHD (prevalence=23.7%) had weaker (non-significant) association between awareness of their heart disease and healthcare utilizing behavior (Mantel-Haenszel test for heterogeneity; p=0.006). Meanwhile, those without ADD/ADHD had nearly 4 times the odds of correctly reporting their heart disease status if they had seen a provider (OR=3.90; CI: 2.32-6.59), compared to those who hadn’t seen one. Those with a history of ADD/ADHD were more likely to report experiencing homelessness prior to age 18 (p&lt;&lt;0.001), 30 days prior to arrest (p=0.002) and 12 months prior to arrest (p&lt;0.001). Conclusions: Awareness was associated with utilizing healthcare since incarceration, but only 72.4% were clear that HD is a chronic condition. The associations between awareness and disability and other life experiences show an influence from socioeconomic status which could inform much-needed health promotion programming.

Health Care Use Among Patients Retroactively Insured via a Hospital-Based Insurance Linkage Program.

Over 25% of the 27 million uninsured individuals in the United States are eligible for Medicaid. Many hospitals have insurance linkage programs that assist eligible patients with enrollment, but little is known about the impact of these programs on care utilization. This research assessed health care utilization and health outcomes among patients enrolled in Medicaid via a hospital-based insurance linkage program. This retrospective cohort study included adults aged 18-64 admitted to the hospital from 2016 to 2021. Those who obtained insurance retroactively via insurance linkage (RI) were compared with those who presented with Medicaid (MI) or remained uninsured (UI). The primary outcome was the presence of at least one visit with a primary care provider (PCP) in the 12months following index admission. Secondary outcomes included having an assigned PCP, ED revisits, and hospital readmissions. For patients with diabetes and hypertension, 12-month hemoglobin A1c (HbA1c) and blood pressure (BP) readings were tracked. Of 3882 patients admitted with no insurance, 2905 (74.8%) were enrolled in insurance (RI). In multivariable analysis, RI patients were 14% more likely (OR 1.14, p = 0.020) to have completed at least one PCP visit by 12months after index admission compared to those with preexisting Medicaid (MI), and uninsured patients were 29% less likely (OR 0.71, p = 0.003). MI and RI patients also had more ED revisits (p < 0.001) and greater 12-month reductions in blood pressure (p < 0.001) compared with uninsured patients. Hospital-based insurance linkage reached three-quarters of uninsured patients and was associated with increased utilization of acute and outpatient health care services. An acute care encounter represents an opportunity to connect patients to insurance, a key step toward improving their health outcomes.

A Retrospective Cohort Study of At-Home Catheter Removal After Urogynecologic Surgery.

In-office postoperative voiding trials (VTs) increase health care burden for patients and physicians. Adoption of an at-home VT option may decrease burden without increasing adverse events postoperatively. The purpose of this study was to compare 30-day postoperative outcomes between participants who performed an at-home autofill VT after catheter self-discontinuation during the Assessing Healthcare Utilization and Feasibility of Transurethral Catheter Self-discontinuation (FLOTUS) study and a "historic" control cohort of patients who presented to the office for backfill-assisted VT on postoperative day (POD) 1. This was a retrospective cohort study of women with postoperative urinary retention after urogynecologic surgery between June 2020 and March 2022. Outcomes from the FLOTUS study were compared with a "historic" control cohort of patients that were identified on chart review from the year before FLOTUS initiation. Demographic, medical history, and procedure-related data were collected. Thirty-day outcome data included office calls/messages, office visits, emergency department visits, complications, and catheterization outcomes. Forty-six participants were included in the FLOTUS cohort and 65 participants in the historic cohort. There was no difference in the POD1 VT pass rate, number of office calls/messages, emergency department visits, or postoperative complications between the 2 cohorts. The FLOTUS patients attended 1 less office visit (1 vs 2 office visits, P<0.001), and this difference persisted on regression analysis (-0.87 office visits; 95% CI, -1.18 to -0.56, P<0.001). Patients who had backfill-assisted VTs on POD1 attended 1 additional office visit compared with those who removed their catheters at home.

A Cross-Sectional Analysis of Cardiovascular and Bone Health Care Utilization During Treatment With Thyroid Hormone.

Combination therapy with levothyroxine and liothyronine (LT4 + LT3) and desiccated thyroid extract (DTE) make up >10% of new thyroid hormone (TH) prescriptions in the United States. To assess health care utilization related to cardiovascular disease (CVD) and bone health (BH) events (atrial fibrillation [AF], heart failure [HF], myocardial infarction [MI], stroke, and osteoporosis/fractures [FX]) in participants taking LT4+LT3 or DTE surveyed in the Medical Expenditure Panel Survey database. Multi-year cross-sectional analysis examining 5437 participants (≥18 years old) treated with LT4, LT4+LT3, or DTE between 2016 and 2020. Health care utilization was assessed through outpatient, emergency, and hospital visits for AF, HF, MI, stroke, FX, and a composite index. A weighted analysis provided national estimates of health care utilization parameters. Utilization was re-analyzed following propensity score-based matching to balance sociodemographic and clinical covariates between treatment groups. Additionally, provider type and specialty data were obtained from visits associated with TH prescriptions. 5106 participants were treated with LT4 monotherapy, 252 with DTE, and 79 with LT4 + LT3. Prevalence of combined outpatient CVD and BH-related care utilization was lower among DTE/LT4+LT3 vs LT4 users (3.5% vs 7.7%; P = .008). There were no differences in emergency/hospital events. After covariate balancing, CVD and BH-related care utilization was similar between groups in outpatient and emergency/hospital settings. LT3 and DTE made up 7.6% of all TH prescriptions. For visits associated with DTE prescriptions, nurse practitioners and alternative medicine professionals were more likely to be identified as the primary provider type. No significant differences in CVD- and BH-related health care utilization were identified between LT4 and DTE/LT4+LT3 users after covariate balancing. Non-MD providers were more likely to prescribe DTE.

Factitious disorder imposed on self: A retrospective study of 2232 cases from health insurance databases

ObjectivePatients with factitious disorder imposed on self (FDIS) seek medical care for deliberately falsified problems. Although a large amount of work has been published, the scientific literature lacks robust data on FDIS. The present study aimed to estimate the annual mean of in-hospital FDIS codings in France, describe the sociodemographic characteristics of subjects with FDIS, assess healthcare utilisation and medical nomadism, and describe the pathologies most frequently associated with FDIS. MethodSubjects with at least one coding of FDIS in French health insurance databases between January 1, 2009, and December 31, 2017 were included. Subjects younger than 18 years of age at the time of first coding were excluded from the study. Sociodemographic data of subjects and diagnoses associated with the first coding of FDIS were collected. Healthcare utilisation and medical nomadism were analysed descriptively from one year before to one year after the first FDIS coding. Results2232 subjects were included, representing an average of 248 new in-hospital FDIS codings per year. The subjects included were 58.2% female. The mean age at diagnosis was 48.5 years. In the year following the first coding of FDIS, 1268 subjects (56.8%) were re-hospitalised at least once, including 159 (7.1%) with at least one new coding for FDIS. From one year before to one year after the first coding of FDIS, 66% of the subjects included had received at least one prescription for benzodiazepines, 58.3% for antidepressants, and 42.6% for antipsychotics. ConclusionsOur findings bring new data working towards a better understanding of FDIS. The consumption of psychotropic drugs is particularly frequent in patients with FDIS.

Assessing Health Care Utilization and Spending Among Older Medicare Beneficiaries With and Without HIV.

Improvements in treatment have made HIV a manageable chronic condition, leading to increased life expectancy and a growing share of people with HIV who are older. Older people with HIV have higher rates of many chronic conditions, yet little is known about differences in health care utilization and spending. This study compared health care utilization and spending for Medicare beneficiaries with and without HIV, accounting for differential mortality. The data included demographic characteristics and claims-based information. Estimated cumulative spending for beneficiaries with HIV aged 67 to 77 years was 26% higher for Medicare Part A and 39% higher for Medicare Part B compared with beneficiaries without HIV; most of these differences would be larger if not for greater mortality risk among people with HIV (and therefore fewer years to receive care). Future research should disentangle underlying causes for this increased need and describe potential responses by policymakers and health care providers.

Assessing Health Care Utilization and Feasibility of Transurethral Catheter Self-Discontinuation

ABSTRACT Common issues after pelvic reconstructive surgery are incomplete bladder emptying and urinary retention, often resulting in placement of an indwelling transurethral Foley catheter, which then remains until a patient returns to the office. Catheterization is significantly distressing for women undergoing these procedures and burdensome due to travel to the office during the postoperative period. In addition, in-office voiding trials add to the workload of health care professionals and staff. A potential alternative is at-home self-discontinuation of the Foley catheter. This study's primary aim was the comparison of the rates of health care utilization (calls, messages, office visits, and emergency department [ED] visits) and postoperative complications within 30 days of surgery among patients with voiding trials on the day of surgery, versus those with Foley placement and void trials on postoperative day 1. Secondary objectives included identifying risk factors for unsuccessful voiding trials and exploring any complications associated with catheter self-discontinuation. This study was designed as a prospective observational cohort study at 1 academic institution and included outpatient women undergoing outpatient urogynecologic or minimally invasive gynecological surgery for benign indications between August 2021 and January 2022. Qualifying patients included cisgendered English-speaking women of at least 18 years of age who exhibited postoperative urinary retention on the day of surgery. Excluded were patients with any preoperative degree of urinary retention (defined as any observation of a postvoid residual more than 200 mL), known upper motor neuron disease, and patients undergoing surgeries with concomitant extra pelvic procedures or minor procedures not requiring a postoperative voiding trial. Based on the exploratory nature of this study, primarily for determining safety and feasibility, the convenience sample size of 50 was set, and patients were recruited at the time of their unsuccessful voiding trials on the day of surgery. On the day of surgery, medical staff performed voiding trials in the postoperative anesthesia care unit, backfilling the bladder with 200 mL of sterile fluid. The void trial was successful if this was followed by a patient void of at least 150–200 mL, otherwise the voiding trial was marked as unsuccessful. Unsuccessful trials resulted in the insertion of an indwelling Foley catheter, followed by verbal and written instruction for performing a home-based, patient-led catheter self-discontinuation at 6:00 am on postoperative day 1. Instructions for catheter removal included pictures and written information. After removal, if the patient failed to void 150 mL within 6 hours, they were instructed to return to the office for additional care. Perioperative data collected from charts included age, parity, body mass index, self-reported race, surgical location, smoking status, periprocedural antibiotics, operative indication, procedures performed, operative time, surgeon type, anesthesia type, estimated blood loss, and intraoperative complications. Results of the study demonstrated 140 patients eligible for day 0 postoperative voiding trials. Of these, most patients were postmenopausal, White, and one third were obese. A majority (82.8%) had a urogynecologist perform their surgery, and the overall rate of voiding trial failure on the day of surgery was 35.7%. The majority of patients (48/50) proceeded with at-home voiding trials according to protocol. Of these, 39 had no further voiding difficulty. Of the 9/50 (18.8%) requiring additional assessment, 6 had a repeat void trial in the office of which 4 were successful, 1 voided spontaneously in the office, 1 required prolonged clean intermittent self-catheterization, and 1 was successful with repeat Foley self-discontinuation on day 3 postoperatively. Only 2 of the 39 patients with successful self-discontinuation on postoperative day 1 had retention later, with 1 presenting to an ED and 1 presenting to the office. Patients with unsuccessful postoperative day 0 void trials had an average of 1 additional call or message to the office, and patients with unsuccessful postoperative day 1 void trials had an average of 1 additional office visit. Although both of these comparisons to those with successful day of surgery void trials were statistically significant, they did not indicate excessive care requirements. Risk factors for failure of day of surgery void trial included older age (also a risk factor for failure on the following day), smoking history, and vaginal hysterectomy. Strengths of the study include its diverse population of women undergoing a wide array of minimally invasive gynecological and urogynecologic surgeries, as well as its prospective nature. Limitations of the study include a lack of control groups, the singular institution in which the study was performed, and the small sample size that limited the potential identification of rare complications. These factors also limit the generalizability of the findings to other settings. Ultimately, catheter self-discontinuation was largely straightforward and efficient for patients and office staff, with low subsequent retention rates. Although further research is required, data currently point to catheter self-discontinuation as a safe and feasible option for women undergoing advanced gynecological surgery, providing a valuable management option for acute postoperative voiding dysfunction.

Functional neurological disorder: A common reason for a neurology inpatient referral.

In 2021, the European Academy of Neurology's training requirements were updated to include functional neurological disorder (FND) as a core topic for the first time. To reinforce these changes, we aimed to understand the proportion of inpatients (in non-neurology settings) who are diagnosed with FND. We prospectively collected data on diagnoses made after inpatient ward reviews from neurology trainees at three tertiary neurology centres in Scotland from April to September 2021. We assessed healthcare utilization data for patients with a diagnosis of FND, epilepsy and epileptic seizures, or a neuroinflammatory disorder over the preceding 12 months. There were 437 inpatient reviews for 424 patients by 13 trainees. The largest single diagnosis was FND (n = 80, 18%), followed by epilepsy (n = 64, 14%), primary headache disorder (n = 40, 9%) and neuroinflammatory disorders (n = 28, 6%). There was an uncertain diagnosis for 48 reviews (11%). Compared to patients with epilepsy or neuroinflammatory disorders, patients with FND had a similar number of admissions (2 vs. 2 vs. 1) and brain/spine imaging studies (2 vs. 1 vs. 2). In Scotland, FND was the most common diagnosis made after a request for an inpatient review by a neurologist from another department in the hospital. Patients with FND have similar health resource needs to those with other common neurological disorders when they present to hospitals with tertiary neurology centres. This data supports the inclusion of FND as a core curriculum topic in neurology training.

Outpatient Healthcare Utilisation among Elderly in Ambalappuzha North Panchayath, Kerala, India: A Cross-Sectional Study

Background: The rising elderly population in Kerala presents challenges in healthcare utilization due to factors such as accessibility, affordability, and availability. Many elderly individuals avoid seeking healthcare, and their satisfaction levels vary. This study aims to assess healthcare utilization among elderly residents of Ambalappuzha North Panchayath. Objectives: Primarily, to examine healthcare utilization patterns among elderly individuals in Ambalappuzha North Panchayath. Secondarily, to find the factors associated with the non-utilization of healthcare. Additionally, we sought to explore the correlation between satisfaction with the outcome of care and the type of healthcare facility, as well as the association between the type of facility and the perceived level of explanation and respect received by patients. Methods: A community-based cross-sectional study was conducted from October to November 2018 in Ambalappuzha North Panchayath. 500 elderly individuals aged 50 and above participated. Data were collected using a modified semi-structured SAGE questionnaire after obtaining informed verbal consent. The information encompassed demographics, healthcare utilization, quality, satisfaction, and reasons for not seeking healthcare. Results: The majority of participants (41.4%) were aged 50-60, with 53.6% males and 46.4% females. 55.4% were above the poverty line. Public hospitals (66.2%) and clinics (10.8%) were commonly utilized. Hypertension (16.5%), acute conditions (15.4%), diabetes (12.5%), and chronic joint pain (12.4%) were prevalent. 91% of the participants regularly utilized healthcare. Reasons for not seeking healthcare included perceived lack of severity, affordability, and past negative experiences. The cost of visits was covered by their children by 45.72%. Satisfaction was expressed by 91.5% of users, with 86.7% reporting improved outcomes. Female respondents utilized more healthcare compared to males. A positive association was found between satisfaction, treatment outcomes, and type of facility. Provider explanation and perceived respect were more in the private sector. Conclusion: The majority of elderly individuals in Ambalappuzha North Panchayath utilized healthcare, favoring the public sector. Hypertension, acute conditions, diabetes, and joint problems were common healthcare needs. Satisfaction correlated with treatment outcomes and the type of facility visited. Private sector providers demonstrated superior explanations and respect compared to the public sector. Future studies should focus on comparative studies across different regions and must delve deeper into socioeconomic factors of healthcare utilization.

Assessing Health Care Utilization and Feasibility of Transurethral Catheter Self-Discontinuation: Correction.

Assessing Health Care Utilization and Feasibility of Transurethral Catheter Self-Discontinuation: Correction.

EPH113 Healthcare Utilization Remains Elevated Among People Living with Post-COVID-19 Condition More Than One Year after Acute COVID-19 Illness

Healthcare systems require comprehensive data for long-term resource allocation planning to support people living with post-COVID-19 condition (PCC). Limited information is available on long-term PCC-associated healthcare utilization patterns. In this study, we assess healthcare utilization rates six and 12-18 months following acute COVID-19 illness among COVID-19 survivors in British Columbia (BC), Canada by PCC status. We used difference-in-difference analysis to assess healthcare utilization by all adult COVID-19 survivors in BC diagnosed with COVID-19 on/before November 18, 2021 during three time periods: (i) 26 weeks after the first 4 weeks of COVID-19 illness, and that exact period (ii) one or two years prior (baseline), and (iii) one year afterwards. PCC/non-PCC patients were matched 1:2 on age, sex, region, comorbidities, vaccination status, and COVID-19 index date ±14 days. The total number of daily healthcare encounters (medical visit, emergency department visit, hospitalization) per person was calculated. Rate ratios (RR) for PCC-associated healthcare utilization were estimated using weighted Poisson regression. The matched cohort (n= 7,092) included 2,364 PCC patients (54.9% female; mean age 39.8 [SD, 13.4] years). Healthcare utilization rates were comparable between the PCC and non-PCC groups at baseline (average: 39.3 vs. 32.7 visits per 1000 patients, respectively), but rose two-fold for the PCC group during the 26-week period post-acute illness (76.1 vs. 33.5). One year later, PCC-associated healthcare utilization rates declined but remained elevated relative to baseline rates (54.6 vs. 34.4). In multivariable Poisson regression models, PCC was associated with a 103% increase in healthcare utilization over 26 weeks post-acute illness (aRR: 2.03, 95% CI 1.71-2.41) and a 24% increase the next year (aRR: 1.24, 95% CI 1.03-1.48). The increased healthcare utilization rates noted among PCC patients one year following acute COVID-19 illness highlights the need for adequate planning to provide optimal support for people living with PCC.

SA33 Healthcare Utilization Among Veterans with Alzheimer's Disease Identified from Clinical Notes

To assess healthcare utilization among Veterans with Alzheimer's disease (AD) in the Department of Veterans Affairs (VA) healthcare system.

MP08-16 COMPARISON OF INTRAVESICAL THERAPY AND SURGERY AS TREATMENT OPTIONS FOR RECURRENT BLADDER CANCER (CISTO): COLLECTION OF PATIENT-REPORTED OUTCOMES

You have accessJournal of UrologyCME1 Apr 2023MP08-16 COMPARISON OF INTRAVESICAL THERAPY AND SURGERY AS TREATMENT OPTIONS FOR RECURRENT BLADDER CANCER (CISTO): COLLECTION OF PATIENT-REPORTED OUTCOMES John Gore, Erika Wolff, Michael Nash, Bryan Comstock, Kristin Follmer, Solange Mecham, Sung Min Kim, Christopher Nefcy, Angela Smith, and CISTO Collaborative John GoreJohn Gore More articles by this author , Erika WolffErika Wolff More articles by this author , Michael NashMichael Nash More articles by this author , Bryan ComstockBryan Comstock More articles by this author , Kristin FollmerKristin Follmer More articles by this author , Solange MechamSolange Mecham More articles by this author , Sung Min KimSung Min Kim More articles by this author , Christopher NefcyChristopher Nefcy More articles by this author , Angela SmithAngela Smith More articles by this author , and CISTO Collaborative More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003223.16AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Patients with recurrent non-muscle-invasive bladder cancer weigh the risk of cancer progression and loss of a window of potential cure with medical therapy against the risk of morbidity and loss of quality of life (QOL) with radical cystectomy. The pragmatic CISTO Study (NCT03933826) includes the collection of patient-reported outcomes to help future patients make this treatment decision. METHODS: 572 patients will be enrolled and complete baseline and follow up surveys quarterly for up to 4 years. Centralized collection of follow-up surveys utilizes several modalities for contacting participants (email, mail, phone, text) as well as completing the survey (online, paper). Baseline and follow up surveys assess QOL and physical functioning (EORTC QLQ-C30), urinary, sexual, and bowel function (Bladder Cancer Index, BCI), financial distress (Comprehensive Score for Financial Toxicity, COST), anxiety and depression (PROMIS), and generic QOL (EQ5D). Follow up surveys also assess healthcare utilization and decision regret. RESULTS: 337 participants have been enrolled. The completion rate for the primary endpoint of QOL at 12 months is 93%. Among returned surveys, the overall rate of missingness at baseline and 12-months was low (<5%) and there was no evidence of survey fatigue. The BCI had the highest missingness rate (4% and 7%, respectively). The 10 items with the most missingness were in the BCI sexual function domain (8-13% and 11-18%, respectively). CONCLUSIONS: Based on the high rate of survey completion, the CISTO Study will be powered to compare outcomes across a variety of domains, including QOL, urinary function, and anxiety. The missingness of questions relating to sexual function makes it unlikely that this study will yield valid and generalizable results in this specific domain. This, in combination with anecdotal evidence that participants find these questions upsetting, even when optional, and confusing, as there is no place to indicate that the questions do not apply if they are not sexually active, highlights the difficulty in researching this intensely personal outcome. Source of Funding: Research reported in this work was funded through a Patient-Centered Outcomes Research Institute (PCORI) Award (PCS-2017C3-9380) © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e100 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information John Gore More articles by this author Erika Wolff More articles by this author Michael Nash More articles by this author Bryan Comstock More articles by this author Kristin Follmer More articles by this author Solange Mecham More articles by this author Sung Min Kim More articles by this author Christopher Nefcy More articles by this author Angela Smith More articles by this author CISTO Collaborative More articles by this author Expand All Advertisement PDF downloadLoading ...

Health Services in Huntington Disease: A Systematic Literature Review.

Clinical trials for Huntington disease (HD) have primarily focused on managing chorea and, more recently, the development of disease-modifying therapies (DMTs). Nonetheless, understanding health services among patients with HD is essential for assessing new therapeutics, development of quality metrics, and overall quality of life of patients and families with HD. Health services assess health care utilization patterns, outcomes, and health care-associated costs, which can help shape the development of therapeutics and aid in policies that affect patients with a specific condition. In this systematic literature review, we analyze data of published studies looking at causes of hospitalization, outcomes, and health care costs in HD. The search yielded 8 articles published in the English language and comprising data from the United States, Australia, New Zealand, and Israel. The most common cause of hospitalization among patients with HD was dysphagia or dysphagia-related complications (e.g., aspiration pneumonia or malnutrition), followed by psychiatric or behavioral symptoms. Patients with HD had more prolonged hospitalizations than non-HD patients, and it was most prominent among those with advanced disease. Patients with HD were more likely to be discharged to a facility. A small percentage received inpatient palliative care consultation, and behavioral symptoms were a primary cause of discharge to another facility. Interventions such as gastrostomy tube placement had associated morbidity, and it was common among patients with HD with a diagnosis of dementia. Palliative care consultation and specialized nursing care were associated with more routine discharges and fewer hospitalizations. In terms of cost, patients with HD with private and public insurances had the highest expenditure with more advanced disease, and expenses were associated with hospitalization and medication costs. In addition to DMTs, HD clinical trial development should also consider the leading causes of hospitalization, morbidity, and mortality in patients with HD, including dysphagia and psychiatric disease. No research study, to our knowledge, has systematically reviewed health services research studies in HD. Evidence from health services research is needed to evaluate the efficacy of pharmacologic and supportive therapies. This type of research is also critical in understanding health care costs associated with the disease and to better advocate and shape policies that can benefit this patient population.

Healthcare utilization and costs among intracranial meningioma patients during long-term follow-up

PurposeFew studies have reported on healthcare utilization and costs for intracranial meningioma patients, while the tumor and its treatment profoundly affect patients’ functioning and well-being. Here we evaluated healthcare utilization and costs, including their determinants.MethodsA multicenter cross-sectional study of adult meningioma patients ≥ 5 years after intervention. Patients completed three validated patient-reported outcome measures (PROMs) assessing patients ‘functioning and wellbeing (SF-36, EORTC QLQ-BN20, and HADS) and a study-specific questionnaire assessing healthcare utilization over the previous twelve months. Healthcare costs of the twelve months prior were calculated using reported healthcare utilization ≥ 5 years after intervention by the Dutch Manual for Economic Evaluation in Healthcare. Determinants for healthcare utilization and costs were determined with regression analyses.ResultsWe included 190 patients with WHO grade I or II meningioma after a mean follow-up since intervention of 9.2 years (SD 4.0). The general practitioner (80.5%), physiotherapist (37.9%), and neurologist (25.4%) were visited most often by patients. Median annual healthcare costs were €871 (IQR €262–€1933). Main contributors to these costs were medication (45.8% of total costs, of which anti-seizure medication was utilized most [21.6%]), specialist care (17.7%), and physiotherapy (15.5%). Lower HRQoL was a significant determinant for higher healthcare utilization and costs.ConclusionIn patients with meningioma, medication costs constituted the largest expenditure of total healthcare costs, in particular anti-seizure medication. Particularly a lower HRQoL was a determinant for healthcare utilization and costs. A patient-specific approach aimed at improving patients’ HRQoL and needs could be beneficial in reducing disease burden and functional recovery.

Costs of Providing Preexposure Prophylaxis for HIV Prevention at Community Health Centers in the United States.

Preexposure prophylaxis (PrEP) is recommended for people at risk of acquiring HIV. We assessed billable costs associated with PrEP delivery at community health centers. The Sustainable Health Center Implementation PrEP Pilot (SHIPP) study is an observational cohort of people receiving daily oral PrEP at participating federally qualified health centers and other community health centers. We assessed health care utilization and billable costs of providing PrEP at 2 health centers, 1 in Chicago, Illinois, and 1 in Washington, DC, from 2014 to 2018. The health centers followed the clinical practice guidelines for PrEP provision, including regular visits with health care providers and ongoing laboratory monitoring. Using clinic billing records and Current Procedural Terminology (CPT) coding, we retrospectively extracted data on the frequency and costs (in 2017 US dollars) of PrEP clinic visits and laboratory screening, for each patient, for 12 months since first PrEP prescription. The average annual number of PrEP clinic visits and associated laboratory screens per patient was 5.1 visits and 25.2 screens in Chicago (n = 482 patients) and 5.4 visits and 24.8 screens in Washington, DC (n = 56 patients). The average annual PrEP billable cost per patient was $583 for clinic visits and $1070 for laboratory screens in Chicago and $923 for clinic visits and $1018 for laboratory screens in Washington, DC. The average annual total cost per patient was $1653 (95% CI, $1639-$1668) in Chicago and $1941 (95% CI, $1811-$2071) in Washington, DC. Our analysis, which provides PrEP billable cost estimates based on empirical data, may help inform health care providers who are considering implementing this HIV prevention strategy.

Healthcare utilization and costs associated with a diagnosis of incident atrial fibrillation

Abstract Background Atrial fibrillation (AF) is the most prevalent arrhythmia among adults worldwide and is associated with an increased risk of heart failure, stroke, and death. Prior studies have highlighted the healthcare burden associated with AF; however, contemporary data is lacking. As AF incidence and prevalence continue to increase due to the aging of the population, current estimates are needed for adequate healthcare resource allocation and policy decisions. Purpose The purpose of our study was to examine the healthcare utilization and cost burden associated with a diagnosis of incident AF in the United States (US). Methods Using the 2017–2020 Optum Clinformatics database, an administrative claims data of commercially insured individuals in the US, adult patients with an incident diagnosis of AF were identified. Adults with AF were matched on demographic and comorbid characteristics to those without AF using a propensity score greedy-matching algorithm with a 1:1 case to control ratio. Outcomes including medical services (inpatient admissions, emergency room [ER] visits, outpatients admissions, other services), utilization (all-cause, cardiovascular [CV]-related), and healthcare costs (sum of all medical services and prescription costs; adjusted for medical inflation and reported in 2021 US $) in the one-year post-incident diagnosis of AF were then compared among the matched cohort. Logistic and general linear modeling assessed healthcare utilization and cost outcomes. Results A total of 159,242 matched participants (79,621 AF cases and 79,621 non-AF controls) were identified. Among patients with AF, the mean age was 74 years, and 51% were females. Among the non-AF controls, the mean age was 73 years, and 50% were females. Patients with incident AF had significantly higher all-cause inpatient visits (relative risk [RR] 1.72; 95% confidence interval [CI]: 1.71–1.73), cardiovascular-related inpatient visits (RR 2.42; 95% CI: 2:41–2:44), as well as cardiovascular-related ER visits (RR: 2.36; 95% CI: 2:30–2:42) as compared to non-AF controls in the 1-year following diagnosis (Figure 1). The one-year mean total healthcare costs were $25,006 (95% CI $24,357-$26,912) higher among patients with AF as compared to non-AF controls ($63,031 vs $38,025, p&amp;lt;0.001). Conclusion Patients with AF had significantly higher medical services use than non-AF controls. The higher medical services utilization among the AF cohort translated into a considerably higher economic burden in this cohort. Timely management and treatment remain critical in alleviating the significant financial and health burden imposed by AF on patients, payers, and providers. Funding Acknowledgement Type of funding sources: Other. Main funding source(s): Johnson and Johnson