Care Settings Research Articles

Nonpharmacological Prevention and Management of Delirium: Past, Present, and Future.

Delirium has been recognized, documented, and examined for centuries. In 500 BC Hippocrates described hyper- and hypoactive forms of delirium. As medicine, surgery, and critical care have accelerated over the last century, so too has our understanding of delirium and its profound risks to patients, families, and health care teams. It has also been increasingly understood that it is the accumulation of risk factors that ultimately precipitates delirium and nonpharmacological interventions to reduce these risks remain the cornerstone of delirium prevention and management. However, over the last three decades, these nonpharmacological strategies have moved from a single-component approach to a multicomponent approach, targeting multiple risk factors. Additionally, our understanding of what constitutes a risk factor for delirium has evolved, and in particular, it has been recognized that delirium can sometimes be a byproduct of our interventions and health care systems. In the surgical setting, for example, optimization of risk factors prior to surgery, when possible, is now seen as a key way to prevent postoperative delirium. Similarly, critical care medicine now operates with the appreciation of the profound risk to patients of prolonged mechanical ventilation, sedation, and immobilization and seeks to minimize each to reduce the risk of delirium, among other negative effects. The future of delirium prevention and management lies in both better implementation of best practices that have been defined over the last three decades as well as taking more of a whole patient view. This includes harnessing the electronic medical record, artificial intelligence, and so on to risk assess and individualize care for each patient; restructuring care to reduce deliriogenic practices and care environments; redefining what usual care looks like (e.g., utilizing music and involving loved ones, etc.); policy changes to change systematic priorities. In this paper, we will explore the past, present, and future of nonpharmacological prevention and management of delirium across care settings.

Assessing the harmonization of structured electronic health record data to reference terminologies and data completeness through data provenance

AbstractIntroduction(1) Assess the harmonization of structured electronic health record data (laboratory results and medications) to reference terminologies and characterize the severity of issues. (2) Identify issues of data completeness by comparing complementary data domains, stratifying by time, care setting, and provenance.MethodsQueries were distributed to 3 Data Partners (DP). Using harmonization queries, we examined the top 200 laboratory results and medications by volume, identifying outliers and computing summary statistics. The completeness queries looked at 4 conditions of interest and related clinical concepts. Counts were generated for each condition, stratified by year, encounter type, and provenance. We analyzed trends over time within and across DPs.ResultsWe found that the median number of codes associated with a given laboratory/medication name (and vice versa) generally met expectations, though there were DP‐specific issues that resulted in outliers. In addition, there were drastic differences in the percentage of patients with a given concept depending on provenance.ConclusionsThe harmonization queries surfaced several mapping errors, as well as issues with overly specific codes and records with “null” codes. The completeness queries demonstrated having access to multiple types of data provenance provides more robust results compared with any single provenance type. Harmonization errors between source data and reference terminologies may not be widespread but do exist within CDMs, affecting tens of thousands or even millions of records. Provenance information can help identify potential completeness issues with EHR data, but only if it is represented in the CDM and then populated by DPs.

Societal Discrimination, Vigilance, and Patient-Provider Relationships Among Perinatal Women: A Mixed Methods Study.

In the United States, maternal mortality is high and patterned by race and socioeconomic status (SES). Patient-provider relationships and societal discrimination have been separately associated with poor maternal outcomes, but it is not clear how such mechanisms may be interrelated. Thus, the present study investigates how societal experiences of discrimination are associated with and manifest in patient-provider relationship quality among perinatal women. The study uses a mixed methods design with an explanatory-sequential approach. First, a path analysis using structural equation modeling of a cross-sectional representative survey of 244 perinatal women in Kalamazoo County, Michigan, was conducted. Second, a thematic qualitative analysis was conducted of focus groups composed of survey participants (n = 34). In the quantitative analyses, race and SES were associated with experiences of societal discrimination in the expected directions (race: b, 1.87; SE, 0.58; P =.001; SES: b, 2.18; SE, 0.60; P <.001), discrimination positively predicted vigilant behaviors (b, 0.81; SE, 0.15; P <.001), and more vigilant behaviors predicted worse patient-provider relationship quality (b, 0.18; SE, 0.07; P <.001). In the qualitative findings, we found detailed accounts linking provider discrimination, vigilance, and patient-provider relationships among focus groups composed of only women of color (n = 9). Overall, the quantitative analyses find support for the conceptual model showing race and SES are associated with societal discrimination, which is associated with vigilant behaviors and, in turn, quality of patient-provider relationships. The qualitative analyses provide preliminary evidence for how these pathways manifest in care settings and demonstrate the importance of establishing trust in patient-provider relationships, especially among women of color.

Physical abuse by staff and co-residents of older people and people with intellectual disabilities

Summary Physical abuse in care settings is a social problem with detrimental effects for residents, but effective prevention is dependent on staff reporting. In Sweden, designated officials, commonly social workers, are required to investigate reports of mistreatment. The aim of this study was to analyze what designated officials considered serious in reported incidents of physical abuse in two different care settings: care for older people and care for people with intellectual disabilities. Similar cases of physical abuse were chosen to demonstrate differences between judgments and provide a picture of how designated officials judge the relative seriousness of abusive situations. Interpretative content analysis and analytic induction were used to analyze reports of staff-to-resident abuse and resident-to-resident abuse in the two care areas. Findings There were no differences between incidents described as serious and those described as non-serious. Resident-to-resident abuse was the most commonly reported incident, particularly in dementia care and care for people with intellectual disabilities, and was rarely considered serious. Older people in dementia care were the highest risk group. In staff-to-resident abuse, staff were singled out as scapegoats. Organizational issues, rather than the details of abusive incidents, guided investigators’ judgments of seriousness. Tendencies to normalize violence and apply a narrow understanding of violence were found in the investigator’s judgments, particularly in resident-to-resident abuse. Applications Safeguarding adults from physical abuse in institutional settings is dependent on staff reporting and thorough investigations. This study shows that more training in assessing violence for social workers investigating reports is needed.

The influence of artificial intelligence within health-related risk work: a critical framework and lines of empirical inquiry

In this editorial we highlight the need for empirical studies into the growing use of artificial intelligence (AI) technology in healthcare and social work settings, especially studies which are theoretically informed by critical social science studies of risk and uncertainty. In setting out the importance of interpretative and critical traditions for research into such AI-oriented forms of risk work, we propose three important conceptual lines of inquiry which empirical studies might follow. First, we sketch ways in which the enactment of AI in healthcare work may be changing how risk is handled amid professional decision-making, and creating new categories of patient/service-user. Patients may be evaluated as being at lower or higher risk depending, respectively, upon their engagement or non-engagement with AI-technologies. These questions of (non-)engagement lead us to consider, second, the trust and distrust dynamics around AI-technologies, exploring the potential inequalities that can emerge as a result of (non) engagement. We then consider drivers of this technological embrace in terms of hope and magical thinking in technological-imaginaries, connecting these cultural tendencies to broader structures of ideology and political-economic interests. We conclude this editorial with a plea to social scientists to be cautious to avoid both techno-optimistic narratives and alarmist warnings regarding the implications of artificial intelligence (AI). Instead, we argue that our focus should be a theoretically informed and detailed examining of how expectations (pertaining to risk, trust, and hope) materialise in practice, particularly in the daily experiences of those who develop and enact AI technologies in care settings.

Symptom management for people with advanced dementia who are receiving end of life care.

This review aims to synthesise contemporary research on symptom management for people with advanced dementia who are thought to be in the final year of life. It highlights the unique challenges faced by palliative care and dementia care specialists, offering insights into the clinical decision-making required to support those with advanced dementia in various care settings. Recent studies indicate that people with advanced dementia often experience significant unmet palliative care needs, particularly regarding symptom management. Pain, breathlessness, and psychological distress are frequently mismanaged, which contributes to suboptimal care. Moreover, the unpredictable trajectory of dementia complicates the identification of end-of-life needs, which can result in fragmented care. Caregivers, both professional and family, struggle with managing complex symptoms, while family caregivers in home settings face added burdens in providing care without sufficient support. Palliative care for people with advanced dementia is currently inadequate due to a lack of tailored interventions, poor symptom management, and disjointed care systems. Enhancing training for caregivers, fostering interdisciplinary collaboration, and focusing on integrated care approaches across home and institutional settings are crucial to improving quality of life and symptom control for people with advanced dementia.

Organizational health literacy in German hospitals: a cross-sectional survey among hospital managers

BackgroundOrganizational health literacy (OHL) describes conditions and measures in healthcare institutions to enable patients to make good health-related decisions. By providing easy access to and appropriate communication of understandable information to use and navigate the facility, healthcare organizations can contribute to strengthening patients’ health literacy and self-management. The extent of OHL implementation in German hospitals remains largely unknown. This study aims to fill this gap in our knowledge by investigating OHL-related activities reported by hospital managers.MethodsBetween November and December 2022, we conducted a national online survey among medical, nursing and administrative hospital managers with hospitals that operate more than 50 beds. The data were collected via the health literate health care organization ten item questionnaire (HLHO-10) and supplemented by sociodemographic questions and an open-ended question. We applied variance and correlation analyses to investigate the data.ResultsOf 3,301 invited hospital managers, 371 participated in the survey (response rate 11%). The overall mean score for HLHO-10 was 4.6 (SD = 1.1) on a 7-point Likert scale, indicating a moderate level of OHL implementation. Hospital managers stated that hospitals concentrate on helping patients find their way around and communicating the costs of treatment transparently and clearly; conversely, that active patient participation in the design and evaluation of health information is rare in care settings, and that health information is seldom provided to patients through a range of media. For the practical implementation of the OHL, most hospital managers mentioned activities regarding communication standards, such as providing information materials.ConclusionsGiven their unique position as hubs of human interaction, hospitals provide an ideal opportunity to promote the adoption of OHL. By actively involving patients, hospitals can better tailor their approaches to meet patient needs and preferences. Compared to studies from oncology centres in Germany and 20 Italian hospitals, the average HLHO-10 score of this study is lower. While some aspects of OHL are already embedded in inpatient care, it is imperative that OHL is thoroughly embedded in the hospitals’ organizational culture and plays a fundamental role in the daily operations of the institution. This could be done, for instance, by more explicitly addressing the topic of health literacy in staff communication training.

Closing the Dissemination Gap: Accessible Toolkits for the Rapid Replication of Evidence-Informed Interventions to Improve Health Outcomes Among People with HIV.

Despite advances in HIV care and treatment in the U.S., disparities in outcomes along the HIV care continuum persist. The widespread replication of effective and sustainable interventions that prioritize the engagement of underserved populations has been identified as a promising path to ending the HIV epidemic in the U.S. Intervention dissemination products, however, rarely provide the comprehensive and accessible information needed to replicate interventions within community settings. To bridge the divide between research and community-based implementation, the Using Evidence-informed Interventions to Improve Health Outcomes among People Living with HIV (E2i) initiative-grounded in the HIV/AIDS Bureau Implementation Science Framework-created a suite of tools to promote the rapid replication of interventions focused on transgender women, Black men who have sex with men, behavioral health integration, and identifying and addressing trauma. The resulting dissemination products are detailed and digestible multimedia toolkits that follow adult learning theory principles and align with the Template for Intervention Description and Replication criteria for adapting non-pharmacological interventions. Each E2i toolkit consists of five components: implementation guides, narrative videos of site implementation, best practice demonstration videos, interactive learning modules, and recruitment posters and brochures. Over 2 years (2022-2024), the E2i toolkit webpages amassed 7703 unique users and 17,666 pageviews. These toolkits can serve as a blueprint for designing comprehensive and accessible dissemination products for replication of HIV interventions in care settings. Dissemination products that bridge the gap between intervention research and replication in community settings are a crucial missing tool for ending the HIV epidemic.

Older adults and robot literacy

ABSTRACT Robots have acquired roles in the provision of information and services. Older adults may interact with robots in many settings, including their homes and public places and, for example, care settings in or outside their homes. In older adults’ care, robots are used to assist their daily tasks, such as cleaning, eating, dressing, bathing, social interaction, entertainment, and medication taking. Consequently, older adults are required to have robot literacy, which has been suggested as a subset of media literacy. However, up to date, only a few researchers have defined robot literacy. In this conceptual article, we first discuss robots in the everyday lives of older adults. Second, drawing on previous studies on media literacies, digital competences, human-robot interaction and other relevant research fields, we define robot literacy as a multidimensional set of skills comprising the following seven skill dimensions: 1) awareness of robots; 2) interaction with robots; 3) understanding and evaluation of the information provided by robots; 4) understanding the data security and privacy of robots; 5) programming of robots; 6) ethical reflection; and 7) providing and receiving social support. Finally, we discuss the applicability of the concept of robot literacy and the limitations of our definition of the concept.

Developing & Validating a Clinical Decision Support Tool for ER-targeted PET Imaging with 16α-18F-Fluoro-17β-Fluoroestradiol

BackgroundEstrogen receptor (ER) status in breast cancer (BC) is routinely determined by immunohistochemistry (IHC); however, this technique is not without limitations, including false results. Imaging of CeriannaTM (fluoroestradiol F18) injection provides high diagnostic accuracy of ER expression, supplementing information from biopsy. A Clinical Decision Support (CDS) tool was developed to better assess its clinical usefulness in metastatic and recurrent breast cancer management. This study evaluated a conceptual tool that reflects clinical practice variables. MethodsIndividual patient characteristics - candidacy for therapeutic treatment and rate of recurrence - determined initial eligibility. The CDS tool uses rules (IF-THEN statements) to produce an output on the diagnostic accuracy of ER status based on tumor burden, anatomical location(s) of metastasis, heterogeneity, and confidence in sample collection & pathology accuracy (CSC & PA). An Excel-based probability decision tree calculates the accuracy of ER expression. Results360 oncologists in the United States participated in the survey study. 223 respondents identified as medical oncologists (62%), 77 as clinical oncologists (21%), and 60 as hematologic oncologists (17%). 93% of respondents found the CDS tool intuitive and easy to follow with medical and clinical oncologists favoring the tool more than hematologic oncologists. Individual CDS attributes - clinical criteria, diagnostic comparator, true positive and true negative, patient inclusion and exclusion, and clinical patient level inputs - were tested with overall positive feedback. ConclusionsBased on respondent feedback, further development of CDS tools are warranted for potential use in patients’ diagnostic workup. Micro abstractCorrect identification of estrogen receptor (ER) status in breast cancer is critical to optimal treatment decisions. While ER status is routinely determined by biopsy and immunohistochemistry (IHC), this technique may yield false positive or negative results. Cerianna (fluoroestradiol F18) injection provides high diagnostic accuracy of ER expression, supplementing the information obtained by IHC. A Clinical Decision Support tool was developed to help identify the contribution that Cerianna may contribute to the management of metastatic and recurrent breast cancer. This study incorporated the feedback of 360 Oncologists representing several sub-specialties, settings of care, and other variables. The results confirmed the validity of the CDS tool concluding that it resonates with clinical practice today, is complete and would be used in clinical practice.

Realising the right to rehabilitation-commentary on 'reablement, rehabilitation, recovery: everyone's business'.

Rehabilitation is a core component of comprehensive geriatric assessment and should be central to integrated care and support across the whole system. Yet access barriers and ageist practices still prevail within many rehabilitation services. This commentary reflects on a report and recommendations published by the British Geriatrics Society in May 2024. As lead author for the report, I share my personal reflection on the key messages and take this opportunity to thank the multidisciplinary contributors. Reablement, Rehabilitation, Recovery: everyone's business describes why rehabilitation matters to older people and their caregivers. It provides evidence and examples of practice at different care touchpoints and makes the case that rehabilitation is everyone's business and knows no boundaries, whether by condition, profession, care setting or taxonomy. The report sets out 12 key actions for health and care systems to deliver effective and integrated rehabilitation as a right for all older people, wherever and whenever they need it. To realise that right, health and care professionals must work together, and with their local community partners, to build capacity and capability for reablement, rehabilitation and recovery across the whole workforce. With population ageing and many more people living with frailty or multimorbidity, there is an urgent need for greater investment in rehabilitation to prevent, delay or reduce disability, caregiver burden and demand for long-term care. This timely BGS report should be essential reading for all who plan, commission, provide or assure health and care services for older people.

Physical activity and social-emotional learning in Canadian children: Multilevel perspectives within an early childhood education and care setting

Early childhood education and care programs can support physical activity and socio-emotional skills development. However, limited research has investigated the longitudinal associations between these constructs and whether they vary across child-specific and classroom-wide levels of analysis. The present study evaluated three-month trajectories of social and emotional competencies, with an emphasis on associations with physical activity. Participants were children enrolled in a licensed not-for-profit early childhood education and care provider in Canada. Educators (n = 37) across 22 classrooms completed monthly assessments of children (N = 235) from January–March 2020. Intraclass correlation coefficients revealed that significant variability in socio-emotional strengths could be attributed to between- and within-classroom differences (21 % and 47 %, respectively), and change over time (32 %). In three-level random-slopes growth curve models, socio-emotional strengths increased over time, with significant between-classroom differences in initial averages and rates of change. Child-specific and classroom-average levels of physical activity were also associated with socio-emotional strengths. These findings underscore the importance of considering child and classroom differences in early learning contexts. Moreover, incorporating physical activity in these settings holds promise as an accessible strategy to support children’s social and emotional development.

Pharmacogenomic augmented machine learning in electronic health record alerts: A health system-wide usability survey of clinicians.

Pharmacogenomic (PGx) biomarkers integrated using machine learning can be embedded within the electronic health record (EHR) to provide clinicians with individualized predictions of drug treatment outcomes. Currently, however, drug alerts in the EHR are largely generic (not patient-specific) and contribute to increased clinician stress and burnout. Improving the usability of PGx alerts is an urgent need. Therefore, this work aimed to identify principles for optimal PGx alert design through a health-system-wide, mixed-methods study. Clinicians representing multiple practices and care settings (N = 1062) in urban, rural, and underserved regions were invited to complete an electronic survey comparing the usability of three drug alerts for citalopram, as a case study. Alert 1 contained a generic warning of pharmacogenomic effects on citalopram metabolism. Alerts 2 and 3 provided patient-specific predictions of citalopram efficacy with varying depth of information. Primary outcomes included the System's Usability Scale score (0-100 points) of each alert, the perceived impact of each alert on stress and decision-making, and clinicians' suggestions for alert improvement. Secondary outcomes included the assessment of alert preference by clinician age, practice type, and geographic setting. Qualitative information was captured to provide context to quantitative information. The final cohort comprised 305 geographically and clinically diverse clinicians. A simplified, individualized alert (Alert 2) was perceived as beneficial for decision-making and stress compared with a more detailed version (Alert 3) and the generic alert (Alert 1) regardless of age, practice type, or geographic setting. Findings emphasize the need for clinician-guided design of PGx alerts in the era of digital medicine.

만 5세 유아의 문제해결중심 협동동작활동과 교사주도 협동동작활동의 효과비교: 자아존중감, 또래상호작용, 창의적 리더십을 중심으로

Objectives This study was to coMpare between ProbleM Solving-based Collaborative MoveMent Activities and Teacher-based AssessMent Collaborative MoveMent Activities and to exaMine the effects of ProbleM Solving- based Collaborative MoveMent Activities on self-esteeM, peer interaction, creative leadership of 5-year-old children. Methods A total of 12 experiMental treatMents were conducted on 20 children aged 5 (experiMental group) and 20 children aged 5 (control group) at Daycare Center I in Seoul, Korea. Self-esteeM, peer interaction, and creative leadership of the experiMental and control groups were Measured and coMpared before and after the experiMent, and the collected data were analyzed using independent saMples t-test. Results ProbleM Solving-based Collaborative MoveMent Activities were associated with higher Mean scores in children's self-esteeM, peer interaction, and creative leadership coMpared to teacher-led collaborative activities, and these differences were statistically significant. Conclusions The findings suggest that early childhood education and care settings need to provide probleM-solving opportunities for young children to solve their own probleMs, challenge theMselves to find answers to probleMs, and experiMent.

Developing methods to identify resilience and improve communication about diagnosis in pediatric primary care.

Communication underlies every stage of the diagnostic process. The Dialog Study aims to characterize the pediatric diagnostic journey, focusing on communication as a source of resilience, in order to ultimately develop and test the efficacy of a structured patient-centered communication intervention in improving outpatient diagnostic safety. In this manuscript, we will describe protocols, data collection instruments, methods, analytic approaches, and theoretical frameworks to be used in to characterize the patient journey in the Dialog Study. Our approach to characterization of the patient journey will attend to patient and structural factors, like race and racism, and language and language access, before developing interventions. Our mixed-methods approach is informed by the Systems Engineering Initiative for Patient Safety (SEIPS) 3.0 framework (which describes the sociotechnical system underpinning diagnoses within the broader context of multiple interactions with different care settings over time) and the Safety II framework (which seeks to understand successful and unsuccessful adaptations to ongoing changes in demand and capacity within the healthcare system). We will assess the validity of different methods to detect diagnostic errors along the diagnostic journey. In doing so, we will emphasize the importance of viewing the diagnostic process as the product of communications situated in systems-of-work that are constantly adapting to everyday challenges.

“A footnote in the file”: are we Doing enough to attend to children’s experiences of intimate partner violence in out-of-home care settings?

ABSTRACT During the past few decades, there has been an increasing recognition that many youth in out-of-home treatment settings have experienced complex trauma due to childhood experiences of intimate partner violence (CEIPV). These experiences may contribute to the internalizing and externalizing problematic behaviors that precipitate their placement in such programs. Using retrospective file review, this exploratory study aimed to explore the mechanisms within children’s mental health settings for determining CEIPV, including screening, assessment and other avenues of disclosure and to consider possible avenues for addressing CEIPV. Fifty files were selected for review, and after screening for CEIPV, 26 files remained in the sample and underwent a detailed review and data extraction process. The review identified significant gaps in documentation related to CEIPV, specific to identification and assessment, which may interfere with important intervention and prevention efforts within such settings. Practice implications and recommendations for improving assessment and intervention efforts to address these issues within out-of-home care settings are discussed.

Simplifying Serious Illness Communication: Preparing or Deciding.

Clinicians have a sincere desire to ensure that the decision-making processes of seriously ill patients are well informed throughout illness trajectories. A quagmire of variable terminology (e.g., advance care planning, serious illness conversations, goals-of-care discussions, etc.), however, currently predominates the field of serious illness communication. This creates uncertainty among clinicians as to the overall purpose, tasks, and specific outcomes of conversations that address serious illness. The Preparing or Deciding model is a unifying framework that provides conceptual clarity by helping clinicians understand their role in leading these important conversations. The Preparing or Deciding model simply posits that conversations with seriously ill patients are about either preparing or deciding. It considers these tasks to be mutually exclusive, which can help bypass many of the barriers to having these conversations. The Preparing or Deciding model compliments all existing resources and frameworks and is applicable to all healthcare practitioners in every care setting. To help move forward serious illness communication education and research, as well as process improvement efforts more effectively, here, we describe the Preparing or Deciding model.

Photobiomodulation as Medicine: Low-Level Laser Therapy (LLLT) for Acute Tissue Injury or Sport Performance Recovery.

Background/Objectives: Low-level laser therapy (LLLT) has gained traction in sports and exercise medicine as a non-invasive therapeutic for preconditioning the body, exertion recovery, repair and injury rehabilitation. LLLT is hypothesized to modulate cellular metabolism, tissue microenvironment(s) and to decrease inflammation while posing few adverse risks. This review critically examines the evidence-base for LLLT effectiveness focusing on immediate care settings and acute/subacute applications (<6 months post-injury). Methods: A comprehensive literature search was conducted, prioritizing systematic reviews, meta-analyses and their primary research papers. Results: Findings are relevant to trainers and athletes as they manage a wide range of issues from superficial abrasions to deeper tissue concerns. LLLT parameters in the research literature include wide ranges. For body surface structures, studies show that LLLT holds promise in accelerating wound healing. In sport performance studies, LLLT is typically delivered pre-exercise and reveals beneficial effects on exertion recovery, improvements in muscle strength, endurance and reduced fatigue. Evidence is less convincing for acute, deep tissue injury models, where most studies do not report significant benefits for functional outcomes over conventional therapeutic modalities. Conclusions: Variability in LLLT delivery parameters and findings across studies underscores a need for clear treatment guidelines for the profession. Technical properties of laser light delivery to the body also differ materially from LED devices. Sport physiotherapists, team physicians, trainers and athletes should understand limitations in the current evidence-base informing photobiomodulation use in high-performance sport settings and weigh potential benefits versus shortcomings of LLLT use in the mentioned therapeutic contexts.

Clinical manifestations, healthcare resource utilization, and costs among patients with long-chain fatty acid oxidation disorders: a retrospective claims database analysis

Objective Long-chain fatty acid oxidation disorders (LC-FAOD) are a group of rare genetic inborn errors of metabolism. Clinical manifestations may result in frequent healthcare visits, hospitalizations, and early death. This retrospective cohort study assessed manifestations, healthcare resource use (HRU), direct medical costs, and the impact of COVID-19 on HRU among patients with LC-FAOD. Methods The IQVIA PharMetrics Plus database was searched for pediatric (0–17 years) and adult (≥18 years) patients with confirmed LC-FAOD (ICD-10-CM Diagnosis Code E71.310) and ≥12 months continuous enrollment (CE) between January 2016-February 2020. A non–LC-FAOD general population cohort was randomly selected and matched using 1:20 exact matching on age, gender, payer type, and CE start year. Manifestations were identified via ICD-10 diagnosis codes (any billing position). Overall HRU and attributable costs were stratified by care setting. Pre-COVID-19 (March 2019–February 2020) and during COVID-19 (March 2020-February 2021) HRU was assessed among a subgroup of patients and the general population. Outcomes were evaluated among children and adults, respectively. Results 423 patients with LC-FAOD (47% female; 79.7% children) were included. The mean enrollment duration was 2.6 ± 1.2 years. 22.6% of children with LC-FAOD had at least one major clinical event (MCE), consisting of rhabdomyolysis (10.1%), hypoglycemia (9.8%), or cardiomyopathy (8.6%) versus 1.5% overall occurrence in the general population. Adults with LC-FAOD had a higher incidence of MCEs (37.2%) than children with LC-FAOD. Annualized all-cause HRU in all care settings and mean total annualized medical costs (children: $17,082 vs $4144; adults: $43,602 vs $3949) were higher in patients with LC-FAOD versus the general population. Patients with LC-FAOD had substantially fewer healthcare visits during COVID-19 across care settings than during the pre-COVID-19 period. Conclusions LC-FAOD impart a high burden on patients. Extended hospital stays and increased outpatient management were especially pronounced for adults and for patients with ≥1 MCE, resulting in substantially higher medical costs than the general population.

Correction to “Development and application of quality measures of clinical pharmacist services provided in inpatient/acute care settings”

Correction to “Development and application of quality measures of clinical pharmacist services provided in inpatient/acute care settings”