Changes In Health Care Utilization Research Articles

Who took care of patients with diabetes during the COVID-19-pandemic? A registry-based study

Abstract Background The rise of people with chronic diseases strains our healthcare system. Chronic disease management programs (CDMP) provide accessible care for patients with a chronic disease, aiming to prevent further development of the disease and avoid the need for (more costly and severe) hospital treatments. During the COVID-19 pandemic, CDMP provided at general practices (GP) for diabetic patients were downscaled. It remains unknown whether this downsizing led to increased care in other healthcare settings. We examined the changes in healthcare utilization by Dutch diabetic patients in 2020 and 2021 compared to 2019 regarding; 1) CDMP consultations, 2) hospital care for diabetes and 3) regular GP care. Methods In this retrospective observational study, data from electronic health records of GPs, participating in Nivel Primary Care Database, of 15,247 Dutch diabetic patients who were enrolled in CDMP, were linked to hospital claims data. Differences in healthcare utilization in 2020 and 2021 compared to 2019 were assessed quarterly using regression analyses. Results Results show that CDMP care was notably lower in 2020 and 2021, compared to 2019 (-35%). From Q1 2021 onwards, patients received more hospital care for diabetes (+13%) and regular GP care increased from Q3 2020 onwards (+14%). Compared to 2019, reduced CDMP contacts in 2020 were significantly associated (p = 0.001) with increased regular GP care in 2021. In the short-term, decreased CDMP in the first half of 2021 was significantly associated with increased regular GP care (p = 0.033) and hospital care (p = 0.037) in the second half of 2021. Conclusions Temporarily downscaling CDMP care during the COVID-19-pandemic was associated with increased hospital and regular GP care for diabetic patients. These findings contribute to making informed decisions regarding measures during future pandemics. Key messages • Chronic disease management programs at GPs appear to be effective in preventing disease exacerbations, and may help prevent (expensive) utilization of hospital care. • This research prompts further investigation into the desirability of CDMPs among patients, GPs, hospitals and policymakers, crucial for assessing undesirable healthcare shifts in diabetic patients.

Treatment and Outcome Metrics for Speech-Language Pathology Treatment of Upper Airway Disorders: A Systematic Review.

Clinical treatment strategies and progress metrics for patients with inducible laryngeal obstruction (ILO) and exercise-induced laryngeal obstruction (EILO) have not been systematically applied across clinics. The goals of this review were to identify the intervention strategies used to treat upper airway disorders and determine the clinical metrics by which improvement or resolution of ILO/EILO is determined in clinical studies of speech-language pathology intervention. A systematic review was conducted using the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Systematic Reviews Checklist. English language, full-text publications were identified through MEDLINE (Ovid), APA PsycINFO, and Web of Science for publications that described clinical outcomes following behavioral treatment for ILO provided by a speech-language pathologist (SLP). A total of 238 sources were retrieved, of which 75 were duplicates. Titles and abstracts of 163 were screened, with 22 sources included for full-text review. Citation review yielded nine additional resources. Thirty-one sources were included for data extraction. Most sources described use of respiratory/laryngeal retraining. There was a lack of consistency for clinical and standardized metrics used to evaluate improvement or resolution of upper airway symptoms. Behavioral and standardized outcome metrics for evaluating therapy outcomes from SLP behavioral intervention of ILO/EILO are not consistently applied. Clinical metrics standards for clinicians are needed to provide a means to evaluate graded improvement in treatment and changes in health care utilization as well as for training less-experienced clinicians. https://doi.org/10.23641/asha.27172683.

Changes in Healthcare Utilization After the 2022 Seoul Metropolitan Flood: Applying a Generalized Synthetic Control Approach.

Floods can have adverse health effects and impose a burden on healthcare systems. However, the potential consequences of floods on specific medical causes in densely populated metropolitan cities has not been characterized yet. Therefore, we evaluate the changes in healthcare utilization patterns after the 2022 Seoul flood using nationwide health insurance data. Based on the flood inundation map, districts within the flooded municipalities of Seoul were classified as severe-(n=12), mild-(n=22), or non-(n=38) flood-affected districts. Capitalizing on the timing of the flood as a natural experiment, a generalized synthetic control method was applied to estimate changes in the number of disease-specific hospital visits in flood-affected districts during 2weeks after the flood. We found excess hospital visits for external injuries (20.2 visits, 95% CI: -6.0, 45.2) and fewer visits for pregnancy and puerperium (-3.0 visits, 95% CI: -5.1, -0.5) in residents of flooded districts. When comparing severe- and non-flood districts, the increase in hospital visits for external injuries (56.2 visits, 95% CI: 17.2, 93.2) and a decrease in hospital visits related to pregnancy and puerperium (-5.3 visits, 95% CI: -8.4, -1.6) were prominent in residents living in severe-flood affected districts. Disease specific analysis showed an increase in hospital visits for injuries to the elbow and forearm, ankle and foot injuries, and chronic lower respiratory diseases in severe-flood-affected districts. However, these impacts were not observed when comparing the mild- and non-flood-affected districts. Our study suggests an immediate and substantial change in medical demand following flood exposure, highlighting the importance of public health responses after flood events.

Health-Care Utilisation and Costs of Transition from Paliperidone Palmitate 1-Monthly to 3-Monthly Treatment for Schizophrenia: A Real-World, Retrospective, 24-Month Mirror-Image Study.

Poor adherence to antipsychotics in patients with schizophrenia is a leading cause of relapse and functional deterioration. Long-acting injectable paliperidone may reduce relapse risks, health-care utilisation, and health-care costs in these patients. In this 24-month mirror-image study, we compared health-care utilization and costs before and after the initiation of paliperidone palmitate 3-monthly (PP3M) treatment in patients with schizophrenia spectrum disorders. Before the initiation of PP3M, the patients received paliperidone 1-monthly (PP1M) treatment. The primary study outcomes were changes in health-care utilisation and costs over the study period. This study included 34 patients with schizophrenia spectrum disorders. During the 12-months period after the initiation of PP3M treatment, the mean duration of hospitalisation decreased from 57.7 to 28.5 days (p = 0.03). Moreover, significant reductions were noted in emergency room visits (PP1M vs PP3M: 0.3 vs 0.0, respectively; p = 0.05) and health-care costs (PP1M vs PP3M: 107,328.8 vs 57,848.6, respectively; p = 0.03). PP3M may significantly reduce hospitalisation duration, emergency room visits, and health-care costs in patients with schizophrenia.

Impact of post-COVID-19 changes in outpatient chronic patients’ healthcare-seeking behaviors on medical utilization and health outcomes

IntroductionThis study comprehensively investigates the changes in healthcare utilization among chronic patients with regular outpatient visits to hospitals after the occurrence of Covid-19. The research examines whether patients altered their originally regular medical attendance frequencies due to the pandemic and explores potential negative impacts on the health conditions of those irregular attendees post-pandemic.MethodsData for this study were sourced from a database at a medical center in Taiwan. The subjects were chronic patients with regular hospital outpatient visits before the Covid-19 outbreak. The study tracked medical utilization patterns from 2017 to 2022 for different patient characteristics and outpatient behaviors, employing statistical methods such as Repeated Measures ANOVA and Generalized Estimating Equation to analyze changes in healthcare utilization and health status during the post-pandemic period.ResultsThe results reveal that, compared to the regular group, chronic patients with irregular outpatient visits during the post-pandemic period exhibited a decrease of 5.85 annual outpatient visits, a reduction of NT$20,290.1 in annual medical expenses, and a significantly higher abnormality rate in average biochemical test results by 0.9%.ConclusionsThe findings contribute to understanding the impact of the Covid-19 pandemic on healthcare utilization and health conditions among outpatient chronic disease populations. In response to the new medical landscape in the post-pandemic era, proactive suggestions are made, including providing telemedicine outpatient services and referral-based medical care to meet the needs of the target population, ensuring a continuous and reassuring healthcare model for chronic patients, and mitigating the operational impacts of public health emergencies on hospitals.

Changes in Utilization and Expenditures Among Commercially Insured U.S. Adults With Diabetes During the COVID-19 Pandemic: Preliminary Findings

IntroductionPeople with diabetes were among the populations that experienced the most profound impacts during the COVID-19 pandemic. We estimated changes in healthcare utilization and expenditures for commercially insured adults aged 18-64 years with diabetes during the pandemic. MethodsMedical claims data were from IQVIA PharMetrics Plus. Linear regressions were used to estimate the changes in utilization (per 1,000 individuals) for inpatient stays, emergency room (ER) visits, physician office visits, and ambulatory surgery center (ASC) procedures. Changes in expenditures, in total and out-of-pocket, were estimated using generalized linear models. Expenditures were adjusted to 2021 U.S. dollars using the Consumer Price Index. ResultsUtilization was reduced significantly for all service types during the pandemic. While the largest reduction occurred between 03/2020-05/2020, the decrease persisted throughout 2021. During 03/2020-05/2020, ASC procedures were reduced by 4.7 visits per 1,000 individuals. The reduction ranged between 0.7 and 1.3 visits per 1,000 individuals subsequently. Expenditures declined for all service types during 03/2020-05/2020. However, after May 2020, the reduction remained statistically significant only for physician office visits for all months, with varying changes in expenditures for other service types. ConclusionHealthcare utilization and expenditures reduced among commercially insured adults with diabetes during the COVID-19 pandemic.

Assessing secular trends in lung cancer stage in the United States community oncology setting from 2013 to 2023.

11178 Background: Detecting disease at an early stage is critical to improving lung cancer (LC) survival, as reflected in guidelines recommending screening with low dose computed tomography for individuals at high risk by clinical societies including the NCCN (2011) and US Preventive Services Task Force (2013, updated 2021). Presenting stage distribution may also be impacted by healthcare utilization changes following the COVID-19 pandemic. Real-world data (RWD)-based investigations are important complements to national cancer registries to provide insight into this potentially changing diagnostic landscape, especially given utilization, practice and referral patterns unique to community settings. We thus assessed LC stage from 2013-23 in a large, nationally representative sample of community oncology practices leveraging RWD. Methods: This is a retrospective observational cohort study of patients within The US Oncology Network and non-Network practices, which include a nationally representative network of over 3,700 providers and more than 1 million patients seen annually in community-based oncology practices. All adult (≥18 years) patients diagnosed with non-small cell LC (NSCLC) or small-cell LC (SCLC) who had a first observed stage available in the community oncology setting within 2013 to 2023 were included. Demographics and medical history data were sourced from structured data fields in iKnowMed, an oncology-specific electronic health record system. Time trends of patient diagnosis and characteristics were descriptively evaluated. Results: The analysis included 98,806 patients with LC (84,023 [85.0%] NSCLC and 14,783 [15.0%] SCLC). Approximately half were female (49.7% and 50.3% in each disease), three-fourths were White (72.7% and 77.0%, respectively), and mean ages at diagnosis were 69.9 and 68.1 years. From 2013 to 2023, there was an increase in the total number of patients observed in the database with a documented stage, from 7,159 to 9,115 (27.3% increase) for NSCLC and from 1,162 to 1,595 (37.3% increase) for SCLC. This was largely driven by an absolute increase in advanced stage diagnoses. The proportion of patients diagnosed with Stage IV NSCLC increased from 43.3% in 2013 to 49.3% in 2023, while the proportions of Stage 0/I and II diagnoses decreased. A similar trend was observed for SCLC, with 60.3% of patients diagnosed with Stage IV in 2013 compared to 68.2% in 2023. The proportion of Stage IV NSCLC cancers increased in the pandemic period, from 48.0% in 2019 to 51.6% in 2020 and 50.6% in 2021. Conclusions: Over the last decade, the proportion of advanced stage LC cases has increased, possibly reflecting changes in referral patterns and utilization specific to the community setting, including those related to the COVID-19 pandemic. The burden of advanced disease highlights the need for continuous investment in advanced-stage treatments as well as early detection efforts.

Is gender dysphoria associated with increased hospital cost per stay among patients hospitalized for depression? Focus on the racial and regional variance in US hospitals

IntroductionIndividuals with gender dysphoria do not identify with their sex assigned at birth and face societal and cultural challenges, leading to increased risk for depression, anxiety, and suicide. Gender dysphoria is a DSM-5 diagnosis but is not necessary for transition therapy. Additionally, individuals with gender dysphoria or who identify as gender diverse/nonconforming may experience “minority stress” from increased discrimination, leading to a greater risk for mental health problems. This study aimed to identify possible health disparities in patients hospitalized for depression with gender dysphoria across the United States. Depression was selected because patients with gender dysphoria are at an increased risk for it. Various patient and hospital-related factors are explored for their association with changes in healthcare utilization for patients hospitalized with depression.MethodsThe National Inpatient Sample was used to identify nationwide patients with depression (n = 378,552, weighted n = 1,892,760) from 2016 to 2019. We then examined the characteristics of the study sample and investigated how individuals’ gender dysphoria was associated with healthcare utilization measured by hospital cost per stay. Multivariate survey regression models were used to identify predictors.ResultsAmong the 1,892,760 total depression inpatient samples, 14,145 (0.7%) patients had gender dysphoria (per ICD-10 codes). Over the study periods, depression inpatients with gender dysphoria increased, but total depression inpatient rates remained stable. Survey regression results suggested that gender dysphoria, minority ethnicity or race, female sex assigned at birth, older ages, and specific hospital regions were associated with higher hospital cost per stay than their reference groups. Sub-group analysis showed that the trend was similar in most racial and regional groups.ConclusionDifferences in hospital cost per stay for depression inpatients with gender dysphoria exemplify how this community has been disproportionally affected by racial and regional biases, insurance denials, and economic disadvantages. Financial concerns can stop individuals from accessing gender-affirming care and risk more significant mental health problems. Increased complexity and comorbidity are associated with hospital cost per stay and add to the cycle.

The association between postpartum depressive symptoms and contraception

BackgroundPostpartum depression affects 10-20% of birthing people and is associated with changes in healthcare utilization. Little is known about the association between postpartum depressive symptoms and choice to use contraception, however both un- or under-treated depression and short interpregnancy intervals pose significant perinatal health risks. ObjectiveTo evaluate whether postpartum depressive symptoms are associated with changes in decisions to use any method of contraception. Study DesignThis retrospective cohort study included birthing people who delivered between 2017-2022 and were referred to a collaborative care program for mental health care. Through this program, birthing people with mental health conditions have access to specialized perinatal mental health care and prospective symptoms monitoring via a patient registry. Postpartum depressive symptoms are assessed via the Patient Health Questionnaire-9 (PHQ-9) and scores were stratified by severity according to clinical cutoffs. Contraceptive method choice was determined by documentation in the electronic health record and dichotomized as “none” if the participant declined all forms of contraception both at delivery and at the postpartum visit. Bivariable and multivariable analyses were performed. ResultsOf the 1871 participants that met inclusion criteria, 160 (8.5%) had postpartum PHQ-9 scores > 14, representing moderately severe or worse depressive symptoms and 43 (2.3%) had severe (PHQ-9 > 19) depressive symptoms. Compared to birthing people with PHQ-9 ≤ 14, those with higher PHQ-9 scores were more likely to have medical comorbidities, have a higher body mass index, to self-identify as Black, Native Hawaiian or Pacific Islander, or Hispanic/Latina, have a preterm delivery, and less likely to be married or nulliparous. There were no differences in any other sociodemographic or clinical characteristics. The choice to use any contraceptive method decreased with increasing depressive symptoms in bivariable and multivariable analyses, reaching statistical significance in birthing people with severe depressive symptoms (aOR 2.92, 95% CI 1.46-5.84). ConclusionSevere perinatal depressive symptoms are associated with a declination of any form of postpartum contraception. This finding becomes increasingly relevant as abortion access continues to be threatened across the US, compounding the potential impact of opting not to use contraception.

Impact of COVID-19 on healthcare utilization among chronic disease patients in South Korea

BackgroundFrom 2020 to 2022, South Korea has experienced significant direct and indirect damage because of the coronavirus pandemic. Preventive measures aimed at controlling the spread of the virus have inadvertently limited healthcare accessibility for patients without COVID-19, leading to detrimental consequences, particularly for patients with chronic diseases. Hence, there is a growing need to comprehensively examine the changes in healthcare utilization among patients with chronic diseases owing to the COVID-19 pandemic, along with the associated factors and health outcomes. MethodsTo examine changes in healthcare utilization among patients with chronic diseases and their impact on health outcomes, we used the NHIS database. Logistic regression analysis was used to investigate changes in healthcare utilization, and a two-part model was applied to explore the effects of reduced healthcare utilization on hospitalization status and length of hospital stay. ResultsSince the onset of the pandemic, the likelihood of hospitalization has been 1.10 times higher than that during pre-pandemic times in the population groups with a 20 % decrease in outpatient healthcare utilization. Notably, individuals belonging to the low-income group exhibited a 1.77-fold higher likelihood of hospitalization than those in the high-income group. Furthermore, in cases where hospitalization could have been avoided, low-income individuals had an extended hospital stay of 16.7 days compared with high-income individuals. ConclusionThere is a need for a more proactive approach for classifying patients with chronic diseases based on various vulnerability factors to effectively respond to future novel infectious diseases and reduce the long-term burden on the nation.

Co-located Heroin Assisted Treatment within primary care: A preliminary analysis of the implications for healthcare access, cost, and treatment delivery in the UK

BackgroundThe UK is experiencing its highest rate of drug related deaths in 25 years. Poor and inconsistent access to healthcare negatively impacts health outcomes for people who use drugs. Innovation in models of care which promote access and availability of physical treatment is fundamental. Heroin Assisted Treatment (HAT) is a treatment modality targeted at the most marginalised people who use drugs, at high risk of mortality and morbidity. The first service-provider initiated HAT service in the UK ran between October 2019 and November 2022 in Middlesbrough, England. The service was co-located within a specialist primary care facility offering acute healthcare treatment alongside injectable diamorphine. MethodsAnalysis of anonymised health records for healthcare costs (not including drug treatment) took place using descriptive statistics prior and during engagement with HAT, at both three (n=15) and six (n=12) months. Primary outcome measures were incidents of wound care, skin and soft tissue infections (SSTIs), overdose (OD) events, unplanned overnight stays in hospital, treatment engagement (general and within hospital care settings) and ambulance incidents. Secondary outcome measures were costs associated with these events. ResultsA shift in healthcare access for participants during HAT engagement was observed. HAT service attendance appeared to support health promoting preventative care, and reduce reactive reliance on emergency healthcare systems. At three and six months, engagement for preventative wound care and treatment for SSTIs increased at the practice. Unplanned emergency healthcare interactions for ODs, overnight hospital stays, serious SSTIs, and ambulance incidents reduced, and there was an increase in treatment engagement (i.e. a reduction in appointments which were not engaged with). There was a decrease in treatment engagement in hospital settings. Changes in healthcare utilisation during HAT translated to a reduction in healthcare costs of 58% within six months compared to the same timeframe from the period directly prior to commencing HAT. ConclusionThis exploratory study highlights the potential for innovative harm reduction interventions such as HAT, co-located with primary care services, to improve healthcare access and engagement for a high-risk population. Increased uptake of primary healthcare services translated to reductions in emergency healthcare use and associated costs. Although costs of HAT provision are substantial, the notable cost-savings in health care should be an important consideration in service implementation planning.

Health care utilization and mortality for people with epilepsy during COVID-19: A population study.

This study was undertaken to characterize changes in health care utilization and mortality for people with epilepsy (PWE) during the COVID-19 pandemic. We performed a retrospective study using linked, individual-level, population-scale anonymized health data from the Secure Anonymised Information Linkage databank. We identified PWE living in Wales during the study "pandemic period" (January 1, 2020-June 30, 2021) and during a "prepandemic" period (January 1, 2016-December 31, 2019). We compared prepandemic health care utilization, status epilepticus, and mortality rates with corresponding pandemic rates for PWE and people without epilepsy (PWOE). We performed subgroup analyses on children (<18 years old), older people (>65 years old), those with intellectual disability, and those living in the most deprived areas. We used Poisson models to calculate adjusted rate ratios (RRs). We identified 27 279 PWE who had significantly higher rates of hospital (50.3 visits/1000 patient months), emergency department (55.7), and outpatient attendance (172.4) when compared to PWOE (corresponding figures: 25.7, 25.2, and 87.0) in the prepandemic period. Hospital and epilepsy-related hospital admissions, and emergency department and outpatient attendances all reduced significantly for PWE (and all subgroups) during the pandemic period. RRs [95% confidence intervals (CIs)] for pandemic versus prepandemic periods were .70 [.69-.72], .77 [.73-.81], .78 [.77-.79], and .80 [.79-.81]. The corresponding rates also reduced for PWOE. New epilepsy diagnosis rates decreased during the pandemic compared with the prepandemic period (2.3/100 000/month cf. 3.1/100 000/month, RR = .73, 95% CI = .68-.78). Both all-cause deaths and deaths with epilepsy recorded on the death certificate increased for PWE during the pandemic (RR = 1.07, 95% CI = .997-1.145 and RR = 2.44, 95% CI = 2.12-2.81). When removing COVID deaths, RRs were .88 (95% CI = .81-.95) and 1.29 (95% CI = 1.08-1.53). Status epilepticus rates did not change significantly during the pandemic (RR = .95, 95% CI = .78-1.15). All-cause non-COVID deaths did not increase but non-COVID deaths associated with epilepsy did increase for PWE during the COVID-19 pandemic. The longer term effects of the decrease in new epilepsy diagnoses and health care utilization and increase in deaths associated with epilepsy need further research.

Impact of evidence-based guidelines on healthcare utilisation and costs for disc related sciatica in the Netherlands: a population-based, cross-sectional study

ObjectiveThe aim of this study was to assess the impact of high-quality evidence supporting surgical treatment of lumbar disc herniation (LDH) on healthcare practice in the Netherlands by examining changes...

SARS-CoV-2 pandemic effect on pediatric asthma health care utilization in an urban hospital

The "September epidemic" is a well-described phenomenon of increased pediatric asthma-related health care utilization from August to September each year. The coronavirus disease 2019 (COVID-19) pandemic has brought about significant changes in health care utilization, warranting an investigation into its impact on the September epidemic. Our aim was to identify the impact of COVID-19 in asthma-related health care utilization, specifically in the September epidemic. Our study involved a retrospective analysis of data from a Children's Hospital in New York City. We compared the change in asthma-related health care utilization during August and September 2020 with the average change in utilization during the same period in 2017-2019 and 2021-2022. Stratified analyses based on age and sex were conducted by using chi-square tests to determine variations in health care utilization. During September 2020, there was a marked reduction in emergency department (ED) visits related to asthma, with only a 6% rise from the preceding month. This stands in contrast to the observed increases from 89% to 193% in the other years studied (P< .05 for all). This pattern was seen in both sexes and in children under 13 years old (P< .05). No significant variation was found for those older than 13 years (P> .05). Despite an overall reduction in health care utilization over the first year of the COVID-19 pandemic, the decline in ED visits related to asthma during the September epidemic was significantly more pronounced. These results suggest that there may be remediable risk factors contributing to the September epidemic that can be used to guide future interventions for managing pediatric asthma.

Home-Based Pediatric Hospice and Palliative Care Provider Visits: Effects on Healthcare Utilization

ObjectiveThis hypothesis-generating study sought to assess the impact of home-based hospice and palliative care (HBHPC) provider home visits (HV) on healthcare utilization. Study designRetrospective review of individuals ages 1 month to 21 years receiving an in-person HBHPC provider (MD/DO or APN) home visit through two HBHPC programs in the Midwest from 1/1/2013 through 12/31/2018. Descriptive statistics were calculated for healthcare utilization variables. Paired t-test or Wilcoxon signed-rank test compared the changes in healthcare utilization the year prior to and year after initial provider home visits. ResultsThe cohort included 195 individuals (49% female), with diagnoses comprised of 49% neurologic, 30% congenital chromosomal, 11% oncologic, 7% cardiac, and 3% other. After implementation of HBHPC services, these patients showed reductions in median [IQR] number of ICU days (before HV 12 [4, 37] after HV 0 [0, 8], p<0.001); inpatient admissions (before HV 1 [1, 3] after HV 1 [0, 2], p=0.005); and number of inpatient days (before HV 5 [1, 19] after HV 2 [0, 8], p=0.009). There was an increase in clinically relevant phone calls (CRPC) to the HBHPC team (before HV 1 [0, 4] vs after HV 4 [1, 7], p<0.001) and calls to the HBHPC team before emergency department visits (before HV 0 [0, 0] vs after HV 1 [1, 2], p<0.001). ConclusionHBHPC provider home visits were associated with decreased inpatient admissions, hospital days, and ICU days, and increased CRPC and phone calls prior to emergency department visit. These findings indicate that HBHPC HV may contribute to decreased inpatient utilization and increased utilization of the HBHPC team.

Effects of an integrated ambulatory care program on healthcare utilization and costs in older patients with multimorbidity: a propensity score-matched cohort study

BackgroundPopulation aging has increased the prevalence of multimorbidity, jeopardizing the sustainability and efficiency of healthcare systems. This study aimed to evaluate the effects of an integrated ambulatory care program (IACP) on healthcare utilization and costs among older patients with multimorbidity while accounting for the confounding effects of frailty.MethodsA retrospective cohort study using propensity matching including patients aged 65 or older with two or more chronic conditions attending the outpatient clinic at our hospital between June 1 and December 31, 2019, was conducted. Exposure was defined as receipt of IACP care. Patients not undergoing the IACP comprised the unexposed group and were matched at a ratio of 1:4 to patients undergoing the IACP group according to sex, age, Charlson Comorbidity Index score, multimorbidity frailty index score, and number of outpatient visits within 6 months before the index date. Outcomes were changes in healthcare utilization and related costs between 6 months before and after receiving IACP care. Multivariate regression analyses were used for data analysis and the Generalized Estimation Equation method was used to fit the regression models.ResultsA total of 166 (IACP) and 664 (non-exposed) patients were analyzed. The mean participant baseline ages were 77.15 ± 7.77 (IACP) and 77.28 ± 7.90 years (unexposed). In univariate analyses, the IACP group demonstrated greater reductions than the unexposed group in the frequency of outpatient visits (-3.16 vs. -1.36, p < 0.001), number of physicians visited (-0.99 vs. -0.17, p < 0.001), diagnostic fees (-1300 New Taiwan Dollar [NTD] vs. -520 NTD, p < 0.001), drug prescription fees (-250 NTD vs. -70 NTD, p < 0.001), and examination fees (-1620 NTD vs. -700 NTD, p = 0.014). Multivariate analyses demonstrated that patients in the IACP group experienced significant reduction in the frequency of outpatient visits (95% CI: -0.357 to -0.181, p < 0.001), number of physicians visited (95% CI: -0.334 to -0.199, p < 0.001), and overall outpatient costs (95% CI: -0.082 to -0.011, p = 0.01). However, emergency department utilization, hospitalization, and costs did not differ significantly.ConclusionsExpanding IACPs may help patients with multimorbidity reduce their use of outpatient clinics at the 6-month follow-up, reduce care fragmentation, and promote sustainability of the healthcare system.

Trends in maternal opioid use disorder and neonatal abstinence syndrome in Maine, 2016-2022.

To estimate trends in maternal opioid use disorder (OUD) and neonatal abstinence syndrome (NAS) in Maine using the most recent data available. We used hospital discharge data to estimate the annual prevalence of maternal OUD and NAS between 2016 and 2022. In addition, we used birth certificate-linked Medicaid data to estimate related trends among Medicaid enrollees. From 2016 to 2022, the prevalence of maternal OUD decreased from 35.3 to 18.8 per 1000 deliveries and the prevalence of NAS decreased from 33.2 to 14.0 per 1000 newborns (linear trend p values <0.01). Decreasing trends were also found among Medicaid enrollees. In Maine between 2016 and 2022, there was a decrease in maternal OUD and NAS diagnoses recorded in administrative datasets. These findings should be interpreted with caution due to changes in how OUD and NAS diagnoses are recorded and COVID-related changes in healthcare utilization.

Changes in Medication Utilization and Adherence Associated with Homeless Adults' Entry into Permanent Supportive Housing.

Permanent supportive housing (PSH) programs, which have grown over the last decade, have been associated with changes in health care utilization and spending. However, little is known about the impact of such programs on use of prescription drugs critical for managing chronic diseases prevalent among those with unstable housing. To evaluate the effects of PSH on medication utilization and adherence among Medicaid enrollees in Pennsylvania. Difference-in-differences study comparing medication utilization and adherence between PSH participants and a matched comparison cohort from 7 to 18months before PSH entry to 12months post PSH entry. Pennsylvania Medicaid enrollees (n = 1375) who entered PSH during 2011-2016, and a propensity-matched comparison cohort of 5405 enrollees experiencing housing instability who did not receive PSH but received other housing services indicative of episodic or chronic homelessness (e.g., emergency shelter stays). Proportion with prescription fill, mean proportion of days covered (PDC), and percent adherent (PDC ≥ 80%) for antidepressants, antipsychotics, anti-asthmatics, and diabetes medications. The PSH cohort saw a 4.77% (95% CI 2.87% to 6.67%) relative increase in the proportion filling any prescription, compared to the comparison cohort. Percent adherent among antidepressant users in the PSH cohort rose 7.41% (95% CI 0.26% to 14.57%) compared to the comparison cohort. While utilization increased in the other medication classes among the PSH cohort, differences from the comparison cohort were not statistically significant. PSH participation is associated with increases in filling prescription medications overall and improved adherence to antidepressant medications. These results can inform state and federal policy to increase PSH placement among Medicaid enrollees experiencing homelessness.

Impact of the COVID-19 Pandemic on Health Care Utilization in the Vaccine Safety Datalink: Retrospective Cohort Study.

Understanding the long-term impact of the COVID-19 pandemic on health care utilization is important to health care organizations and policy makers for strategic planning, as well as to researchers when designing studies that use observational electronic health record data during the pandemic period. This study aimed to evaluate the changes in health care utilization across all care settings among a large, diverse, and insured population in the United States during the COVID-19 pandemic. We conducted a retrospective cohort study within 8 health care organizations participating in the Vaccine Safety Datalink Project using electronic health record data from members of all ages from January 1, 2017, to December 31, 2021. The visit rates per person-year were calculated monthly during the study period for 4 health care settings combined as well as by inpatient, emergency department (ED), outpatient, and telehealth settings, both among all members and members without COVID-19. Difference-in-difference analysis and interrupted time series analysis were performed to assess the changes in visit rates from the prepandemic period (January 2017 to February 2020) to the early pandemic period (April-December 2020) and the later pandemic period (July-December 2021), respectively. An exploratory analysis was also conducted to assess trends through June 2023 at one of the largest sites, Kaiser Permanente Southern California. The study included more than 11 million members from 2017 to 2021. Compared with the prepandemic period, we found reductions in visit rates during the early pandemic period for all in-person care settings. During the later pandemic period, overall use reached 8.36 visits per person-year, exceeding the prepandemic level of 7.49 visits per person-year in 2019 (adjusted percent change 5.1%, 95% CI 0.6%-9.9%); inpatient and ED visits returned to prepandemic levels among all members, although they remained low at 0.095 and 0.241 visits per person-year, indicating a 7.5% and 8% decrease compared to pre-pandemic levels among members without COVID-19, respectively. Telehealth visits, which were approximately 42% of the volume of outpatient visits during the later pandemic period, were increased by 97.5% (95% CI 86.0%-109.7%) from 0.865 visits per person-year in 2019 to 2.35 visits per person-year in the later pandemic period. The trends in Kaiser Permanente Southern California were similar to those of the entire study population. Visit rates from January 2022 to June 2023 were stable and appeared to be a continuation of the use levels observed at the end of 2021. Telehealth services became a mainstay of the health care system during the late COVID-19 pandemic period. Inpatient and ED visits returned to prepandemic levels, although they remained low among members without evidence of COVID-19. Our findings provide valuable information for strategic resource allocation for postpandemic patient care and for designing observational studies involving the pandemic period.

How COVID-19 has changed the utilization of different health care services in Poland

BackgroundThe COVID-19 pandemic has affected health care systems in many ways, including access to and the use of non-COVID services. The aim of the study was to assess the impact of the pandemic on the utilization of different public health care services in Poland.MethodsThe aggregated data on health care users and provided services for the years 2015/2016–2021 were used to analyse the changes in health care utilization during the pandemic and deviations from pre-pandemic utilization trends. Quantitative analysis was complemented with qualitative descriptions of the changes in principles of health care provision during the pandemic.ResultsThe results show a considerable drop in the provision of most health care services in 2020 that in some cases disturbed pre-pandemic utilization trends and was not made up for in 2021. The most significant decrease has been observed in the field of preventive and public health services, as well as rehabilitation. The provision of these services was put on hold during the pandemic.ConclusionsThe accumulated COVID-19-related “health debt” urgently calls for government actions to strengthen disease prevention and health promotion in Poland.