Average Number Of Outpatient Visits Research Articles

Medical Expenses of North Korean Defectors with Post-Traumatic Stress Disorder

ObjectiveThe purpose of this study was to establish the prevalence of PTSD among North Korean defectors who visited the National Medical Center, Seoul, South Korea over a period of approximately 10 years by examining their medical records and to examine differences in the medical service usage patterns of patients with and without PTSD. MethodsData from North Korean defectors who used outpatient services at the National Medical Center during a period of 10 years and 3 months (January 1 2006 to February 28, 2016) were analyzed. The general characteristics of the defectors were analyzed by frequency analyses, and descriptive statistics were generated. Additionally, independent t-tests and chi square analyses were performed to examine differences between PTSD patients and those without PTSD. Linear regression analysis was performed to examine factors affecting the mental health of North Korean defectors suffering from PTSD. ResultsThis study assessed the correlations between PTSD, the average number of outpatient visits, and the total revenue. The regression analysis showed a relationship between PTSD and the average number of outpatient visits. There was also a correlation between PTSD and total revenue. The average number of outpatient visits was 41.8 for PTSD patients, whereas it was 33.2 for those without PTSD. The total revenue visit was 953.6 USD for PTSD sufferers and 231.1 USD for those without PTSD. ConclusionThis study found that the majority of North Korean defectors visit psychiatry departments, and that PTSD patients use outpatient services more frequently and have higher total revenue than those without PTSD. Additionally, patients with PTSD used a greater variety of medical services. Considering the high medical care expenses of North Korean defectors residing in South Korea, future investigations should examine the medical service usage patterns of such patients, especially those diagnosed with PTSD, in greater detail.

ASSOCIATION OF RISK FACTORS FOR NON-COMMUNICABLE DISEASES WITH HEALTH CARE RESOURCES UTILIZATION AND TEMPORARY DISABILITY ACCORDING TO DATA OF POPULATION STUDY IN RUSSIAN FEDERATION

Aim. To analyze the associations of health care system resources utilization and temporary disability (TD) with the main risk factors (RF) for cardiovascular diseases (CVD) in working age population based on ESSE-RF study data. Material and methods . The analysis was based on ESSE-RF study data (13 regions of the Russian Federation). Standard epidemiological survey methods and evaluation criteria were used. The analysis included results of a survey of the ESSE-RF study participants about the utilization of health services and TD during last 12 months. Average number of outpatient visits, hospitalizations (including duration of in-hospital treatment and number of cases), ambulance calls and TD (a number of days and cases) per one study participant and associations with RF for CVD were estimated. We conducted a comparative analysis of the utilization of health services and TD in association with cardiovascular RF, also logistic regression analysis was performed to predicting the likelihood of outpatient visits, hospitalizations, ambulance calls and TD. Results. A total of 21,923 individuals in the 25-64 age group were included: men – 8,373 (38%) and women – 13,550 (62%). Number of men who was hospitalized significantly increased in group with tobacco consumption (1,41; p<0,05) and obesity (1,32; p<0,05), also number of participants who call to ambulance increased among smoking men (1,41; p<0,05) and with hyperglycemia (1,38; p<0,05), at the same time number of persons with cases of TD significantly increased just only among smokers (1,29; p<0,05). At the same time, number of women who used health services (exclude in-hospital treatment) and who had a case of TD was significantly increased just only among smokers. The frequency of the utilization of health services and TD cases, the average number of days of hospitalizations and days of TD cases for 1 person depending on the presence/absence of RF had small difference in both men and women. Female obesity is the most resource-intensive RF, as well as male smoking, and was associated with an increase in the likelihood of using all types of medical care and TD cases. Smoking and hyperglycemia significantly increased the likelihood of utilization the most of health services in women, whereas in men hyperglycemia increased only the probability of ambulance calls (1,38; p<0,05), and obesity – only hospitalizations (1,32; p<0,05). Hypertension significantly affected only to ambulance calls in both men and women. Hypercholesterolemia was associated with decreased likelihood of the utilization health services in men. Conclusion . So, there is a significant association of the health care utilization with the RF depending on the type of medical care, sex and RF.

Health-seeking behavior and medical facility choice in Samsun, Turkey

ObjectiveExamining the factors that play a role in determining patient preferences for different healthcare institutions. MethodThis descriptive study was conducted in five family health centers (FHC) and in six hospitals in Samsun Province in Turkey. The data were collected from 1700 volunteer patients by using a structured questionnaire, while they were waiting for consultation. ResultThe average number of out-patient visits was 9.5±6.4 per person in 2012. Individuals aged less than 18 and more than 65 years old had higher preferences for FHCs, while those aged 19–64 years preferred primarily private hospitals. The order of preferences for FHC, public and private hospitals did not vary with the educational level. An increase in educational level was associated with a decrease in the preference for FHCs and in increase in the preference for private hospitals. The first three reasons given for preferring a hospital were ‘the presence of a specialist’, ‘availability of good equipment and technology’, and ‘trust on the diagnosis and treatment’, while ‘proximity’, ‘receiving adequate information’, and ‘being treated well’ were the reasons given by participants who preferred a FHC. ConclusionProviding medical equipment and staff support for improving diagnostic capacity of FHCs can accommodate patient expectations and shift the demand from hospitals to FHCs.

Survival and medical utilization of children and adolescents with prolonged ventilator-dependent and associated factors.

Over the course of a year, more than 20,000 patients in Taiwan require prolonged mechanical ventilation (PMV). Data from the National Health Insurance Research Database for patients between 2005 and 2011 were used to conduct a retrospective analysis on ventilator dependence. The study subjects were PMV patients aged <17 years in Taiwan. A multiple regression model employing general estimating equations was applied to investigate the factors affecting the use of medical resources by children and adolescent PMV patients. A Cox proportional hazard model was incorporated to explore the factors affecting the survival of these patients. Data were collected for a total of 1,019 children and adolescent PMV patients in Taiwan. The results revealed that the average number of outpatient visits per subject was 32.1 times per year, whereas emergency treatments averaged 1.56 times per year per subject and hospitalizations averaged 160.8 days per year per subject. Regarding average annual medical costs, hospitalizations accounted for the largest portion at NT$821,703 per year per subject, followed by outpatient care at NT$123,136 per year per subject and emergency care at NT$3,806 per year per subject. The demographic results indicated that the patients were predominately male (61.24%), with those under 1 year of age accounting for the highest percentage (36.38%). According to the Kaplan—Meier curve, the 1-year and 5-year mortality rates of the patients were approximately 32% and 47%, respectively. The following factors affecting the survival rate were considered: age, the Charlson Comorbidity Index (CCI), diagnosis type necessitating ventilator use, and whether an invasive ventilator was used. This study investigated the use of medical resources and the survival rates of children and adolescent PMV patients. The findings of this study can serve as a reference for the National Health Insurance Administration in promoting its future integrated pilot projects on ventilator dependency.

Associations between Medical Conditions and Breast Cancer Risk in Asians: A Nationwide Population-Based Study in Taiwan

BackgroundThe breast cancer incidence in Asia is rising. To explore whether the etiology of breast cancer is different from the known risk factors from studies in Western countries, we conducted a nested case-control study using data from the Taiwan National Health Insurance Research Database (NHIRD).MethodsAll medical conditions based on the first three digits of the ICD-9 and a list of medical conditions based on literature review were retrieved for each case and control. The odds ratios (OR) and 95% confidence intervals (CI) of the associations between medical conditions and breast cancer risks were estimated using conditional logistic regression and adjusted for occupation, number of breast cancer screening, and the average number of outpatient visits prior the diagnosis. The associations were also estimated for younger (<50 years old) and older subjects separately.ResultsThe analyses included 4,884 breast cancer cases and 19,536 age-matched controls. Prior breast diseases (OR, 95% CI: 2.47, 2.26–2.71), obesity (1.43, 1.04–1.96), endometriosis (1.44, 1.15–1.80), uterine leiomyoma (1.20, 1.03–1.40), hypertensive diseases (1.14, 1.05–1.25), and disorders in lipid metabolism (1.13, 1.04–1.24) were associated with increased breast cancer risk. No heterogeneity was observed between age groups (<50 and ≥50 years old).ConclusionsIn addition to benign breast diseases, obesity, endometriosis, uterine leiomyoma, hypertensive diseases, and disorders of lipid metabolism were associated with a subsequent breast cancer risk.ImpactsOur results suggest that estrogen related factors may play an important role in breast cancer risks in the Taiwanese female population.

Tuberculosis Control Program and patient satisfaction, Rio de Janeiro, Brazil.

OBJECTIVE To evaluate factors associated with users’ satisfaction in the Tuberculosis Control Program.METHODS A cross-sectional study of 295 patients aged ≥ 18 years, with two or more outpatient visits in the Tuberculosis Control Program, in five cities in the metropolitan region of Rio de Janeiro, RJ, Southeastern Brazil, in 2010. Considering an estimated population of 4,345 patients, the sampling plan included 15 health care units participating in the program, divided into two strata: units in Rio de Janeiro City, selected with probability proportional to the monthly average number of outpatient visits, and units in the other four cities. In the units, four temporal clusters of five patients each were selected with equal probability, totaling 300 patients. A questionnaire investigating the users’ clinical and sociodemographic variables and aspects of care and service in the program relevant to user satisfaction was applied to the patients. Descriptive statistics about users and their satisfaction with the program were obtained, and the effects of factors associated with satisfaction were estimated.RESULTS Patients were predominantly males (57.7%), with a mean age of 40.9 and with low level of schooling. The mean treatment time was 4.1 months, mostly self-administered (70.4%). Additionally, 25.8% had previously been treated for tuberculosis. There was a high level of satisfaction, especially regarding medication provision, and respect to patients by the health professionals. Patients who were younger (≤ 30), those on self-administered treatment, and with graduate level, showed less satisfaction. Suggestions to improve the services include having more doctors (70.0%), and offering exams in the same place of attendance (55.1%).CONCLUSIONS Patient satisfaction with the Tuberculosis Control Program was generally high, although lower among younger patients, those with university education and those on self-administered treatment. The study indicates the need for changes to structural and organizational aspects of care, and provides practical support for its improvement.

PND33 - Drivers Of Utilization Among Patients With Mucopolysaccharidosis In The Hospital Setting

Mucopolysaccharidosis (MPS) is a rare metabolic disorder with a wide spectrum of symptoms affecting the bone, skeletal system, and organs of affected individuals. The severity of symptoms varies widely. The objective of this study is to examine drivers of hospital utilization in MPS patients. A retrospective descriptive study was conducted on a cross-section of MPS discharges in the MedAssets health system data for inpatient (N=527) and outpatient (N=10450) visits from 2009 through 2013. Negative binomial multivariable regression was used to identify significant drivers of inpatient and outpatient visits and inpatient length of stay (LOS). The sample included 1454 unique patients from 216 hospitals. More than half of thedischarges (66.7%) were male with 87.3% less than 18 years old and 8.7% between the ages of 18 and 29. The most common comorbid conditions in inpatients were chronic obstructive pulmonary disease (27.1%), respiratory failure (24.1%), pneumonia (20.5%), heart valve disorders (18.6%), epilepsy and seizures (17.8%), and hypertension (16.1%). In outpatients the most common comorbidities were delayed mental development (7.9%), musculoskeletal disorders (6.9%), hypertension (6.9%), and heart valve disorders (5.7%). The average number of outpatient visits was 7.1 with primary drivers including esophageal reflux (IRR=1.73, p<.001), lack of development (IRR=1.69, p<.001), gastrointestinal issues (IRR=1.47, p<.01), and hydrocephalus (IRR=1.52, p<.05). While the average number of inpatient visits was less than 1 the average LOS was 11.47. Respiratory failure (IRR=1.58, p<.001) and vein disorders (IRR=1.71, p<.01) were associated with inpatient visits. In addition to teaching status and region drivers of LOS were hypertension (IRR=1.64, p<.001), respiratory failure (IRR=1.50, p<.01), cardiovascular disorders (IRR=3.91, p<.01), pneumonia (IRR=1.40, p<.05), and vein disorders (IRR=1.71, p<.05). MPS patients average more than one outpatient visit per year and when hospitalized have long LOS. Drivers of utilization vary in the inpatient and outpatient setting.

A50: Mental Health and Healthcare Utilization in Children with SLE and MCTD

Background/Purpose:Depression and anxiety are prevalent in children with systemic lupus erythematosus (SLE), representing a health‐related burden. SLE healthcare utilization is high, and the impact of these disorders on utilization is unclear. We aimed to characterize the association of depression and anxiety with healthcare utilization in children with SLE and the SLE‐like syndrome of mixed connective tissue disease (MCTD).Methods:We conducted a cross‐sectional analysis of pediatric‐onset SLE and MCTD patients with disease duration &gt;=6 months, consecutively recruited from CHOP rheumatology and nephrology outpatient clinics. The Patient Health Questionnaire 9 (PHQ‐9) and the Screen for Child Anxiety Related Disorders (SCARED) were used to measure depression and anxiety, respectively. The primary outcome was average outpatient visits per person‐year, measured as a composite of rheumatology, nephrology, primary care and emergency department (ED) visits within the preceding year. Secondary outcomes were average hospital visits and telephone consultations to rheumatology/nephrology per person‐year, within the preceding year. Multivariable negative binomial regression analysis was performed including the following covariates: age, race/ethnicity, education level, disease duration and disease activity.Results:We recruited 42 patients, with a median SLEDAI (SLE Disease Activity Index) score of 2 (IQR 0,4) and median physician VAS (visual assessment score) of 0 (IQR 0,1). We identified symptoms of depression in 8 patients (19%), anxiety in 9 patients (21%), and comorbid depression and anxiety in 4 patients (10%). Only 14% of patients with positive screens for depression and/or anxiety had previous mental health care. The average number of outpatient visits per person‐year was 4.6 [95% confidence interval (CI) 3.4–6.2], hospitalizations 0.2 (95% CI 0.09–0.66) and phone consultations 0.8 (95% CI 0.53–1.35). In multivariable analysis, there was a statistically significant decrease in outpatient visits for those with depressive symptoms compared to those without (IRR = 0.6, 95%CI 0.4–0.9, p = 0.02). Secondary analysis showed a statistically significant decrease in primary care provider (PCP) visits in the depressed group (IRR = 0.33, 95%CI 0.16–0.7, p &lt; 0.01); however, there was no difference in rheumatology, nephrology or ED visits. Depressive symptoms were also not associated with differences in hospitalizations or phone consultations. There was no significant association of anxiety symptoms with the healthcare utilization outcomes.Conclusion:Depression and anxiety symptoms were prevalent in this cohort of children with minimally active SLE and MCTD. Those with depressive symptoms had significantly decreased outpatient visits, particularly to the PCP. Rheumatology and nephrology providers are therefore an important point of contact for identifying mental health disorders in these patients. Further investigation is needed to understand the patient and caregiver factors contributing to differences in healthcare provider contact for pediatric SLE patients with depressive symptoms.

Resource Utilization and Direct Medical Costs of Chronic Hepatitis C in Thailand: A Heavy but Manageable Economic Burden

ObjectiveTo estimate the cost for the management of chronic hepatitis C (CHC) and related morbidities by using a payer perspective in Thailand. MethodsData elements were extracted from medical records of 542 patients newly diagnosed with CHC in five tertiary care hospitals across Thailand. All patients were divided into five health states: noncirrhotic CHC, hepatitis C virus (HCV)-related compensated cirrhosis, HCV-related decompensated cirrhosis, HCV-related hepatocellular carcinoma, and HCV-related liver transplantation. Resource utilization data for each patient during a 12-month follow-up study period were compiled, and reference prices published by the Thai government were used to estimate the cost for each health state. The average cost was calculated and categorized into various groups, for example, laboratory and diagnostic tests, procedures, medication, and hospitalization. ResultsThe average number of outpatient visits per patient was approximately six visits in all cohorts. The HCV-related hepatocellular carcinoma and liver transplantation cohorts had a higher average number of inpatient admissions per patient. The average number of days per admission varied from fewer than 3 days to 1 week or more across all the health states. The average annual total cost per patient varied across all health states from approximately 170,000 to 600,000 baht, and medication cost was the largest portion in every cohort, except the HCV-related liver transplantation cohort in year 1. Among all medications, the average annual antiviral medication cost per patient was the largest portion in the noncirrhotic CHC and HCV-related compensated cirrhosis cohorts. ConclusionsCHC was a costly disease in Thailand. The average annual medication cost was the largest portion in every health state, except HCV-related liver transplantation.

PHP46 Burden of Herpes Zoster in Population with Compromised Immune System in South Korea

To estimate the annual prevalence, the related medical costs, and health care resource utilization of patients diagnosed as herpes zoster (HZ) and post-herpetic neuralgia (PHN), respectively, with different immune status in South Korea. This study is a retrospective analysis using the Korean National Patients Sample 2009 database of the Health Insurance Review and Assessment Service (HIRA K-NPS). Results of the sample database were extrapolated to the total Korean population aged ≥ 40 years. HZ and PHN patients were identified from diagnostic codes, and categorized into three subgroups based on the severity of immune status; non-compromised, mild to moderate and severe status. Medical costs included all HZ- or PHN-related costs incurred at medical facilities and medication costs. The prevalence of HZ (or PHN) was 15.53 (or 2.13) per 1000 persons among those aged ≥ 40 years in South Korea. The annual medical costs per patient for HZ (or PHN) management were US$191 (or $177). The average number of outpatient visits, emergency department visits and hospital admissions of HZ (or PHN) patients were 3.75, 0.01, and 0.05 (4.44, 0.01, and 0.03) per annum, respectively. With regard to the severity of immunodeficiency, patients with severe conditions were related to higher prevalence rate, medical costs and health care utilization. HZ and PHN cause considerable disease burden in South Korea, especially among immunocompromised population. Considering rapidly aging population and increasing prevalence of immunosuppressive conditions, the disease burden is likely to increase. The findings of the present study can serve as important baseline data for policy decision making to reduce the burden, such as the development of a HZ vaccination recommendation.

Characteristics and Trends in Ambulatory Otolaryngology Visits and Practices

To determine characteristics and trends for outpatient otolaryngology visits and practices in the United States. Cross-sectional analysis of national survey database. Ambulatory care settings in the United States. Outpatient otolaryngology records from 2005 to 2009 were extracted from the National Ambulatory Medical Care Survey. Visit characteristics were assessed for patient type (established versus new), expected source of payment, and average time spent with the physician. Provider characteristic variables were assessed for practice type (solo versus group), employment status of the physician, electronic claims submission, and the use of electronic medical records in the practice. Trends were analyzed for the above and the average number of outpatient visits per otolaryngologist per year. A total of 98.8 ± 7.0 million outpatient otolaryngology office visits, consisting of 27.9 ± 2.1 million new patient visits and 70.9 ± 5.3 million established patient visits, were studied. Expected sources of payment consisted of private insurance (65.1%), Medicare (21.1%), Medicaid (9.2%), and self-pay (2.0%). These sources did not change over the 5 calendar years (P = .301). Practitioners consisted of solo (30.7%) and group (69.3%) practices. Electronic medical records were in use in 40.2%. Electronic medical record penetration did significantly increase over the 5 years to 57.7% in 2009 (P = .002). The number of outpatient visits per otolaryngologist per year remained remarkably consistent over the years at about a mean of 3325 ± 299 visits seen per year (P = .580). Characteristics of otolaryngology outpatient visits have remained largely consistent over the past 5 years. Electronic medical record penetration has noticeably increased. These results help validate prior Academy socioeconomic surveys.

Impact of air pollution control measures and weather conditions on asthma during the 2008 Summer Olympic Games in Beijing

The alternative transportation strategy implemented during the 2008 Summer Olympic Games in Beijing provided an opportunity to study the impact of the control measures and weather conditions on air quality and asthma morbidity. An ecological study compared the 41 days of the Olympic Games (8 August-17 September 2008) to a baseline period (1-30 June). Also, in order to emphasize the impact of weather conditions on air quality, a pollution linking meteorological index (Plam) was introduced to represent the air pollution meteorological condition. Our study showed that the average number of outpatient visits for asthma was 12.5 per day at baseline and 7.3 per day during the Olympics-a 41.6% overall decrease. Compared with the baseline, the Games were associated with a significant reduction in asthma visits (RR 0.58, 95%CI: 0.52-0.65). At 16.5 visits per day, asthma visits were also significantly higher, during the pre-Olympic period (RR 1.32, 95% CI: 1.15-1.52). The study also showed that the RR of asthma events on a given day, as well as the average daily peak ozone concentration during the preceding 48-72 h, increased at cumulative ozone concentrations of 70 to 100 ppb and 100 ppb or more compared with ozone concentrations of less than 70 ppb (P < 0.05). We concluded that along with "good" weather conditions, efforts to reduce traffic congestion in Beijing during the Olympic Games were associated with a prolonged reduction in air pollution and significantly lower rates of adult asthma events. These data provide support for efforts to reduce air pollution and improve health via reductions in motor vehicle traffic.

Demographics, nature and treatment of orthopaedic trauma injuries occurring in an agricultural context in the West of Ireland

Farming is a major industry in the West of Ireland. This prospective study examined the age profile, nature and treatment of orthopaedic injuries occurring in agricultural surroundings presenting at the Orthopaedic Unit of Merlin Park Hospital, Galway. The cohort consisted of 70 direct or indirect farm employees presenting with orthopaedic injuries caused in an accident occurring on a farm. There were significantly (P < 0.01) more male than female farmers (73 vs. 27%) with a mean age of 63 years (ranging from 13 to 87 years). Average number of out-patient visits related to the injury was 3.6. Injuries involving livestock resulted in the majority of accidents (P < 0.05) with a significant rise in the number of visits with increasing age (P < 0.01) with older patients having more severe injuries. Soft tissue injuries and fractures were commonly encountered. Complex fractures were the slowest injury to heal requiring eight subsequent out-patient visits.

Impact of practice recommendations on patient follow‐up and cystic fibrosis centres' activity in France

The French cystic fibrosis (CF) practice recommendations were published at the end of 2002. They advise each patient to be checked up at least once every 3 months in a reference centre for cystic fibrosis. To describe the activity of the four reference centres in the Rhône-Alpes area and the patients' follow-up. All patients with cystic fibrosis consulting one of the four CF centres between 1996 and 2005 were retrospectively included. All outpatient visits were recorded and classified according to (i) patient and year; and (ii) month and year. The two series were assessed graphically to determine a transition threshold, that is, the 2 consecutive years between which practices differed the most. A total of 616 patients were included, representing 17 594 outpatient visits. The average number of visits per patient increased from 3.7 in 1996 to 5.0 in 2005, the graphical representation showed a sharp change between 2000 and 2001. Among patients with less than 4 visits in 2000, 88 of them visited a centre 4 times or more in 2001 (44%). The annual number of outpatient visits went from 1035 to 2420. The monthly average number of outpatient visits was 86 in 1996 and 202 in 2005. The graphical representation of activity also showed a sharp change from 2001. We showed that the implementation of guidelines occurred the year before its official publication. We also showed that the growth of this implementation was sharp rather than gradual.

Cost-effectiveness of a new combined immunosuppressive and anti-infectious regimen in kidney transplantation

The aims of this study were to assess the 1-year cost-effectiveness of a new combined immunosuppressive and anti-infectious regimen in kidney transplantation to prevent both rejection and infectious complications. Patients (pts) transplanted from January 2000 to March 2003 (Group A) and treated with a conventional protocol were compared with pts submitted to a combined regimen including universal cytomegalovirus (CMV) prophylaxis between April 2003 and July 2005 (Group B). Costs were computed from the hospital accounting system for hospital stays, and official tariffs for outpatient visits. Patients with incomplete costs data were excluded from analysis. Fifty-three patients were analyzed in Group A, and 60 in Group B. Baseline characteristics including CMV serostatus were not significantly different between the two groups. Over 12 months after transplantation, acute rejections decreased from 41.5 percent in Group A to 6.7 percent in Group B (p < .001), and CMV infections from 47 percent to 15 percent (p < .001). Overall, readmissions decreased from 68 percent to 55 percent (p = .160), and average hospital days from 28 +/- 19 to 20 +/- 11 days (p < .007). The average number of outpatient visits decreased from 49 +/- 10 to 39 +/- 8 (p < .001). Average 1-year immunosuppressive and CMV prophylaxis costs (per patient) increased from CHF20,402 +/- 7,273 to 27,375 +/- 6,063 (p < .001), graft rejection costs decreased from CHF4,595 +/- 10,182 to 650 +/- 3,167 (p = .005), CMV treatment costs from CHF2,270 +/- 6,161 to 101 +/- 326 (p = .008), and outpatient visits costs from CHF8,466 +/- 1'721 to 6,749 +/- 1,159 (p < .001). Altogether, 1-year treatment costs decreased from CHF39'957 +/- 16,573 to 36,204 +/- 6,901 (p = .115). The new combined regimen administered in Group B was significantly more effective, and its additional costs were more than offset by savings associated with complications avoidance.

Vagus nerve stimulation therapy for pharmacoresistant epilepsy: Effect on health care utilization

We retrospectively analyzed the effects of vagus nerve stimulation (VNS) therapy on utilization of medical services by 138 patients in a large staff-model health maintenance organization. We compared average quarterly rates for 12 months before device implantation with quarterly rates during 48 months of follow-up. Wilcoxon matched-pairs signed-ranks tests comparing pre-VNS with post-VNS utilization rates showed statistically significant reductions in numbers of emergency department visits, hospitalizations, and hospital lengths of stay, beginning with the first quarter after implantation ( P < 0.05 for all post-implantation quarters for these three aspects). For the first two quarters after implantation, the average number of outpatient visits was significantly greater than the pre-implant quarterly average (quarter 1: P < 0.0001; quarter 2: P = 0.0067), but the average was 12.2% less by the fourth quarter of the first year after implantation and significantly less beginning with the first quarter of the second year ( P = 0.0017) and continuing through the end of the study ( P < 0.0001 for all subsequent quarters). A comparison of time spent on epilepsy-related tasks during the year before implantation with the year after implantation also revealed significant decreases in the average number of days on which patients could not work because of health-related concerns, from 3.67 to 1.04 days ( P = 0.002, paired Student’s t test) and the average time spent caring for health problems, from 352.6 to 136.1 minutes per week ( P < 0.001). VNS therapy had a positive effect on both the utilization of health care services and the time spent on epilepsy-related tasks for these patients with pharmacoresistant epilepsy.

Diabetes-related utilization and costs for inpatient and outpatient services in the Veterans Administration.

-The purpose of this study was to calculate the total number of inpatient hospitalizations, outpatient clinic visits, and total direct health care costs associated with veterans with diabetes receiving care in Veterans Administration (VA) facilities. RESEARCH DESIGN AND METHODS-The number of inpatient hospitalizations is tracked for years 1994-1998, and outpatient clinic visits are tracked for years 1997 and 1998. Trends in utilization across different age and racial groups, as well as total direct inpatient and outpatient costs for 1998, are presented. -Between 1994 and 1998, hospitalization rates decreased from 1.68 to 1.61. The average number of outpatient visits was 4.5 in 1997 and 4.6 in 1998. VA incurred $214.8 million in outpatient expenditures and $1.45 billion in inpatient expenditures for veterans with diabetes receiving VA care. -Health care delivery systems and payors track the cost and utilization of services by specific patient groups to support disease management, quality improvement, external reporting, and cost containment. Tracking the utilization and cost of diabetes care is necessary to understand the financial impact of diabetes on health care systems and the overall burden of diabetes on individuals.

Changing medical doctor productivity and its affecting factors in rural China.

Using the data collected from the health facility-based survey, part of the national health service survey conducted in 1993 and 1998, this paper tries to examine changes in labour productivity among the county-level hospitals and township health centres in rural China, and to analyse factors affecting the changes. The results presented in the paper show that the average number of outpatient visits per doctor per day and the average number of inpatient days per doctor per day declined significantly over the period from 1986 to 1997. The main factors resulting in the reduction of productivity are associated with the increase of inappropriate staff recruitment in these health facilities, the significant decline of rural population covered by health insurance, particularly rural cooperative medical schemes (CMS), and the rapid rise of health care costs. The latter two factors also have brought about a reduction in the use of these health facilities by the rural population. The paper suggests that the government should tighten up the entrance of health and non-health staff into the rural health sector and develop effective measures aimed to avoid providing pervasive financial incentives to the over-provision of services and over-use of drugs. In addition, other measures that help to increase the demand for health services, such as the establishment of rural health insurance, should be considered seriously.

Utilization of Mental Health Services by Low-Income Pregnant and Postpartum Women on Medical Assistance

ABSTRACT This paper examines mental health service use among publicly insured white and African-American pregnant and postpartum women who live in a metropolitan area. The study examines the extent to which ethnicity, physical health problems, and behavioral health risk factors are associated with the probability of service use during the pre-natal-postpartum period. It also analyzes the patterns of service utilization for those women who used mental health services. Medicaid claims and eligibility data, County Reporting System claims and admissions data, and Pennsylvania State Vital Birth Records were integrated using a unique algorithm. Logistic regression was employed to estimate the probability of mental health service use among 3,841 low-income women residing in Philadelphia who were continuously enrolled in Medicaid for 9 months preceding delivery and 6 months postpartum. Analyses were also conducted on the intensity and location of service use, as well as psychiatric diagnosis, during pregnancy and the postpartum period. About 10% of the women used mental health services during the study period. Women were more likely to use services if they were Caucasian, had a number of chronic diseases, had a number of pregnancy complications, and smoked. Among users, the same proportion (ca. 6%) used services during pregnancy and postpartum, with the average number of outpatient visits slightly higher during pregnancy than during the postpartum period. Most outpatient services (86%) were delivered in the specialty sector. Most women who used mental health services (84%) were diagnosed with minor psychiatric disorders including minor depression and anxiety disorders. Women who used services during the postpartum only were more likely to be diagnosed with major depression, whereas women who used services throughout the perinatal period were more likely to be diagnosed with severe mental disorders. Health providers can use information generated in this study to identify women who are likely to have a need for mental health services.

Differences in Prescription of Antiretroviral Therapy in a Large Cohort of HIV-Infected Patients

The objective of this study was to determine factors associated with prescription of highly active antiretroviral therapy (HAART). The authors observed 9530 patients eligible for antiretroviral therapy (ART) in more than 100 hospitals and clinics in 10 US cities. Multiple logistic regression analysis was used to assess factors associated with HAART prescription, stratifying patients by no history versus history of ART to assess the association between prescription and CD4, viral load, and outpatient visits. Overall, female gender (odds ratio [OR], 0.68; 95% confidence interval [CI], 0.60-0.76) and alcoholism (OR, 0.85; 95% CI, 0.74-0.99) were associated with decreased likelihood of HAART prescription. Enrollment at a private facility (OR, 1.33; 95% CI, 1.14-1.56), heterosexual exposure (OR, 1.34; 95% CI, 1.13-1.58), and Hispanic ethnicity (OR, 1.19; 95% CI, 1.04-1.37) were associated with prescription. For patients with no history of prescribed ART, CD4 <500 cells/microL (OR, 3.94; 95% CI, 2.02-7.66), and high viral load were associated with increased likelihood of prescription; for patients with history of ART prescription, those whose outpatient visits averaged > or =2 per 6-month interval (OR, 1.30; 95% CI, 1.10-1.54) were more likely and those with high viral load were less likely to be prescribed HAART (OR, 0.50; 95% CI, 0.44-0.56). The authors found differences in HAART prescription by gender, race, exposure mode, alcoholism, and provider type for all patients, by CD4 and viral load for patients with no history of ART prescription, and by average number of outpatient visits and viral load for patients with history of ART prescription.