Visit Characteristics Research Articles

The Impact of Alcohol Sales in A College Football Stadium on Healthcare Utilization.

In 2021, a large Midwestern university began selling alcohol to spectators within the football stadium for the first time. The stadium routinely hosts >65,000 spectators, and drinking alcohol is highly prevalent at pre-game tailgating events. Our goal in this study was to determine the impact of in-stadium alcohol sales on the incidence of alcohol-related emergency department (ED) visits and local emergency medical services (EMS) calls. We hypothesized that the availability of alcohol throughout the stadium would lead to an increase in alcohol-related patient presentations. This was a retrospective study including patients who used local EMS and presented to the ED on football Saturdays in the 2019 and 2021 seasons. There were 11 Saturday games with seven home games each year. The 2020 season was excluded due to the impact of COVID-19- related restrictions on attendance. Trained extractors using predefined criteria reviewed records for each patient to determine whether the visit was alcohol related. Using logistic regression analysis we examined the odds of an EMS call and ED visit being alcohol-related before and after the start of stadium alcohol sales. We compared characteristics of visits before and after the onset of stadium alcohol sales using Student's t-test for continuous variables and chi-square test for categorical variables. In 2021, after the onset of in-stadium alcohol sales, there were a total of 505 emergency calls to local EMS on football Saturdays (home and away), and 29% of them were for alcohol-related incidents down from 36% of 456 calls in 2019. After adjustment for covariates, the odds of a call being alcohol-related were lower in 2021 than 2019, but this difference was not significant (adjusted odds ratio [aOR] 0.83, 95% CI 0.48-1.42). Looking specifically at the seven home games each season, the difference was more pronounced (31% of calls in 2021 compared to 40% in 2019) but not statistically significant after adjustment for covariates (aOR 0.54, 95% CI 0.15-2.03). In the ED, 1,414 patients were evaluated on game days in 2021 and 8% of them for alcohol-related reasons. This is similar to 2019, when 9% of the 1,538 patients presented due to alcohol-related complaints. After adjustment for covariates, the odds of an ED visit being alcohol-related were similar in 2021 and 2019 (aOR 0.98, 95% CI 0.70-1.38). There was a decrease in alcohol-related EMS calls on home game days in 2021, although the result was not statistically significant. In-stadium alcohol sales had no significant impact on the frequency or proportion of alcohol-related ED visits. The reason for this outcome is unclear, but it is possible that fans drank less at tailgate parties knowing they could consume more once the game started. Long lines and a two-beverage limit at stadium concessions may have kept patrons from consuming excessively. The results of this study may inform similar institutions regarding the safe implementation of alcohol sales during mass-gathering events.

Adverse outcomes associated with opioid prescription by dentists in the Veterans Health Administration: A national cross-sectional study from 2015 to 2018.

Opioids prescribed by dentists have been associated with serious adverse events, including opioid-related overdose and mortality. However, the downstream outcomes of opioids prescribed by dentists to Veterans who are at high risk for opioid misuse and overdose have yet to be determined. This was a national cross-sectional analysis of opioids associated with dental visits within the Veterans Health Administration from 2015 to 2018. Overprescribing was defined per guidelines as >120 morphine milligram equivalents (MME) or >3 days supply. The association of dental visit and patient characteristics was modeled separately for opioid-related poisoning and all-cause mortality using logistic regression. Of 137,273 Veterans prescribed an opioid by a dentist, 0.1% and 1.1% were associated with opioid-related poisoning and mortality, respectively. There was no difference in opioid poisoning within 6months for Veterans with opioid prescriptions >120 MME (aOR=1.25 [CI: 0.89-1.78]), but poisoning decreased in Veterans prescribed opioids >3-days supply (aOR=0.68 [CI: 0.49-0.96]). However, Veterans with opioids >120 MME were associated with higher odds of mortality within 6months (aOR=1.17 [95% CI: 1.05-1.32]) while there was no difference in prescriptions >3-days supply (aOR=1.12 [CI: 0.99-1.25]). Serious opioid-related adverse events were rare in Veterans and lower than other reports in the literature. Since nonopioid analgesics have superior efficacy for the treatment of acute dental pain, prescribing opioid alternatives may decrease opioid-related poisoning. Strategies for dentists to identify patients at high risk should be incorporated into the dental record.

Effects of process changes on emergency department crowding in a changing world: an interrupted time-series analysis

BackgroundDuring a 6-year period, several process changes were introduced at the emergency department (ED) to decrease crowding, such as the implementation of a general practitioner cooperative (GPC) and additional medical staff during peak hours. In this study, we assessed the effects of these process changes on three crowding measures: patients’ length of stay (LOS), the modified National ED OverCrowding Score (mNEDOCS), and exit block while taking into account changing external circumstances, such as the COVID-19 pandemic and centralization of acute care.MethodsWe determined time points of the various interventions and external circumstances and built an interrupted time-series (ITS) model per outcome measure. We analyzed changes in level and trend before and after the selected time points using ARIMA modeling, to account for autocorrelation in the outcome measures.ResultsLonger patients’ ED LOS was associated with more inpatient admissions and more urgent patients. The mNEDOCS decreased with the integration of the GPC and the expansion of the ED to 34 beds and increased with the closure of a neighboring ED and ICU. More exit blocks occurred when more patients with shortness of breath and more patients > 70 years of age presented to the ED. During the severe influenza wave of 2018–2019, patients’ ED LOS and the number of exit blocks increased.ConclusionsIn the ongoing battle against ED crowding, it is pivotal to understand the effect of interventions, corrected for changing circumstances and patient and visit characteristics. In our ED, interventions which were associated with decreased crowding measures included the expansion of the ED with more beds and the integration of the GPC on the ED.

Interdisciplinary feeding clinic during the coronavirus disease 2019 pandemic: Implementing telehealth and social determinants of health screening.

Interdisciplinary feeding clinic during the coronavirus disease 2019 pandemic: Implementing telehealth and social determinants of health screening.

Recording early deaths following emergency department visits in inpatient data: An observational study using data of 16 German hospitals

ObjectiveIn German hospital emergency departments (EDs), no definite reimbursement rules exist for patients who die within 24 hours after arrival. Our study aimed to assess whether these cases were recorded and billed as inpatient stays. Furthermore, characteristics of patients who die within 24 hours following arrival at the ED were investigated for all ED visits, as well as for the subgroup of ED visits with an ED diagnosis or inpatient principal diagnosis of acute myocardial infarction. MethodsThis study was part of the INDEED project, which aimed to explore utilization and trans-sectoral patterns of care for patients treated in EDs in Germany. The study population includes ED visits of adult patients in 2016 in 16 German hospitals participating in the project. In the data set of combined ED, inpatient, and outpatient treatment information early deaths were classified as patients who died in the ED or in the hospital within 24 hours after arrival. Characteristics of visits followed by early death were analyzed descriptively. Mode of billing as inpatient or outpatient was validated by identifying corresponding billing information using linked inpatient and outpatient data. ResultsIn 2016, 454,747 ED visits of adult patients occurred in the participating hospitals and 42.8% resulted in inpatient admission. Among these inpatients 8,317 (4.3%) died during the overall hospital stay, and 1,302 (0.7%) died within 24 hours following arrival. The proportion of early deaths among all deaths in patients with a diagnosis of acute myocardial infarction was higher (27%) compared to the overall patient population (16%). Although all cases of early death were classified as inpatients the corresponding inpatient data was missing in 1.9% of all early deaths and in 3.4% of early deaths with a diagnosis of acute myocardial infarction. Outpatient billing information suggesting that these cases were billed as outpatients, was found in 0.3% of all early deaths and in 0.8 to 1.7% of early deaths with a diagnosis of acute myocardial infarction, respectively. ConclusionIn-hospital mortality might be biased by incomplete recording of early deaths in inpatient data. However, the proportion of patients with early death who were billed as outpatients was marginal in the investigated study population of 16 hospitals. Although the study results are limited by restricted generalizability and subpar data quality, this finding indicates that early deaths might be almost completely recorded in German inpatient data. Nevertheless, data quality should be enhanced by establishing general billing rules for cases with a short treatment duration due to early death.

Emergency Department Visits During Pregnancy.

Pregnant women often seek care in an emergency department (ED). We sought to describe the frequency, characteristics, and factors associated with increased ED visits during pregnancy. We conducted a retrospective cohort study using administrative health data of all pregnancies resulting in a live birth at 20 or more weeks of gestation in Alberta, Canada, from 2011 to 2017. The primary outcome was the occurrence of any ED visit during pregnancy. The secondary outcomes were ED visit characteristics and discharge disposition. We calculated rate ratios (RRs) and 95% confidence intervals (CIs) for associations between sociodemographic and clinical factors and increased ED visits during pregnancy using random-effect negative binomial regression adjusting for multiple pregnancies per person during the study period. We included 255,929 pregnancies from 193,965 women. Of all the pregnancy episodes followed, 37.3% (95% CI 37.1 to 37.5) had at least 1 ED visit, resulting in a total of 226,811 ED visits and an overall ED visit rate of 94.0 visits per 100 pregnancies (95% CI 93.6 to 94.3). Most visits were nonobstetric (46.4%) and resulted in ED discharge (85.3%). Increased ED visits were associated with living in remote (RR 6.9; 95 %CI 6.7 to 7.1) or rural (RR 3.4; 95% CI 3.4 to 3.5) areas, younger age (RR 1.9; 95% CI 1.8 to 2.0), intensive prenatal care (RR 1.5; 95% CI 1.5 to 1.5), major/moderate health conditions (RR 1.6; 95% CI 1.6 to 1.6), mental health conditions (RR 1.6; 95% CI 1.5 to 1.6), and high antepartum risk score (RR 1.1; 95% CI 1.1 to 1.1). Approximately 1 in 3 women in our sample visited the ED during pregnancy. A higher number of visits occurred in those with rural/remote residence, younger maternal age, and concomitant health conditions.

Characteristics of visits from otolaryngological patients before and during three waves of the COVID-19 pandemic: A retrospective study.

COVID-19 pandemic has had a significant impact on healthcare systems around the world. The rapid spread of the virus caused several restrictions, including limited access to outpatient clinics. The purpose of the study was to compare the characteristics and reasons of the visits of otolaryngological patients conducted during the first three waves of the COVID-19 pandemic with those of the prepandemic period. Volume, demographic data, type of visits, additional tests, referral types, and reasons for consultation were analyzed. There were 1578 visits performed before the pandemic and, respectively, 434, 1198 and 1299 during the first, second and third waves. The patients in the first and second waves were older than the patients before the pandemic (mean age 59, 56, and 52 years, respectively, for both comparisons p<0.0001). Regarding the type of visit, the vast majority were in-person visits in all groups. The highest percentage of teleconsultations was in the first wave and was equal to 3.46%. Before the pandemic, patients were admitted mainly due to upper respiratory system diseases (52.15%), while during the first wave the main reasons were tumors (39.86%, malignant and benign tumors comprised 29.26% and 10.6%, respectively). The COVID-19 pandemic, especially the first wave, changed the profile of ambulatory patients. In the first wave, a higher prevalence of tumor patients and a lower prevalence of patients with diseases of the upper respiratory system were observed. The COVID-19 pandemic caused an increase in number of teleconsultations, but its role was limited.

Trends and Characteristics of Potentially Preventable Emergency Department Visits Among Patients With Cancer in the US

An initial step to reducing emergency department (ED) visits among patients with cancer is to identify the characteristics of patients visiting the ED and examine which of those visits could be prevented. To explore nationwide trends and characteristics of ED visits and examine factors associated with potentially preventable ED visits and unplanned hospitalizations among patients with cancer in the US. This cross-sectional study used data on ED visits from the National Hospital Ambulatory Medical Care Survey from January 1, 2012, to December 31, 2019; US Cancer Statistics reports were used to estimate new cancer cases each year. Frequencies and trends among 35 510 014 ED visits by adult patients (aged ≥18 years) with cancer were calculated. The primary outcome was potentially preventable ED visits, and secondary outcomes were unplanned hospitalizations and the immediacy of the ED visits. Potentially preventable ED visits were identified using the Centers for Medicare & Medicaid Services definition. The Emergency Severity Index, a triage algorithm that ranks patients based on the urgency of their health care condition, was used to measure the immediacy of ED visits (immediate [most urgent], emergent, urgent, less urgent, and nonurgent), with the categories of immediate and emergent classified as high acuity. The Wilcoxon rank sum test was used to calculate trends in ED visits among patients with cancer over time. Multivariable logistic regression analyses were performed to examine the associations of patient, hospital, and temporal factors with potentially preventable ED use and ED use resulting in hospitalization. Among 854 911 106 ED visits, 35 510 014 (4.2%) were made by patients with cancer (mean [SD] age, 66.2 [16.2] years); of those, 55.2% of visits were among women, 73.2% were among non-Hispanic White individuals, 89.8% were among patients living in a private residence, and 54.3% were among Medicare enrollees. A total of 18 316 373 ED visits (51.6%) were identified as potentially preventable, and 5 770 571 visits (21.3%) were classified as high acuity. From 2012 to 2019, potentially preventable ED visits increased from 1 851 692 to 3 214 276. Pain (36.9%) was the most common reason for potentially preventable ED visits. The number of patients who visited an ED because of pain increased from 1 192 197 in 2012 to 2 405 849 in 2019 (a 101.8% increase). Overall, 28.9% of ED visits resulted in unplanned hospitalizations, which did not change significantly over time (from 32.2% in 2012 to 26.6% in 2019; P = .78 for trend). Factors such as residence in a nursing home (odds ratio, 1.73; 95% CI, 1.25-2.41) were positively associated with having a potentially preventable ED visit, and factors such as the presence of more than 1 comorbidity (odds ratio, 1.82; 95% CI, 1.43-2.32) were positively associated with having an unplanned hospitalization. In this study, 51.6% of ED visits among patients with cancer were identified as potentially preventable, and the absolute number of potentially preventable ED visits increased substantially between 2012 and 2019. These findings highlight the need for cancer care programs to implement evidence-based interventions to better manage cancer treatment complications, such as uncontrolled pain, in outpatient and ambulatory settings.

Doctor for Every Citizen: Telehealth Visits at Dubai Health Authority during COVID-19 Pandemic in Dubai, United Arab Emirates.

Digital health significantly affects healthcare delivery. Moreover, empirical studies on the utilization of telehealth in Dubai are limited. Accordingly, this study examines the utilization of telehealth services in Dubai Health Authority (DHA) facilities and the factors associated with telehealth appointment completion and turnaround time. This cross-sectional study examines patients who used telehealth services in DHA from 2020 through 2021 using 241,822 records. A binary logistic regression model was constructed to investigate the association between appointment turnaround time as a dependent variable and patient and visit characteristics as independent variables. Of the total scheduled telehealth visits, more than three-quarter (78.55%) were completed. Older patients, non-Emiratis, patients who had their visits in 2020, patients who had video visits, and those who sought family medicine as a specialty had a shorter turnaround time to receive their appointment. This study identifies several characteristics associated with the turnaround time. Moreover, technological improvements focusing on specialties that can readily be addressed through telehealth and further research in this domain will improve service provision and support building an evidence-base in the government sector of the emirate of Dubai.

Analysis of Emergency Department Use by Non-Urgent Patients and Their Visit Characteristics at an Academic Center

We studied the extent and reasons for non-urgent emergency department (ED) visits in a single university hospital, their predictors, and patient outcomes to propose solutions suitable for Middle Eastern healthcare systems. We conducted a retrospective review of electronic medical records, including all non- and less-urgent ED visits with complete triage records (levels 4 and 5 triage based on the Canadian Triage and Acuity Scale (CTAS) over one year. The data on patient demographics, visit characteristics, and patient disposition were analyzed using SPSS software. The study was conducted in the ED at King Abdullah Bin Abdul-Aziz University Hospital (KAAUH), a Saudi university hospital located within the campus of Princess Nourah Bint Abdulrahman University. A chart review was carried out for 18,880 patients with CTAS 4 or 5 visiting the KAAUH ED between July 2020 and July 2021. Additionally, a total of "11,857" patients with missing triage acuity or CTAS levels 1, 2, or 3 were excluded from the study. The majority (61.4%) of the 30,737 ED visits were less-urgent or non-urgent. The most common reasons for non-urgent visits were routine examination/investigation (40.9%), medication refilling (14.6%), and upper respiratory tract infection/symptoms (9.9%). Most visits (73.4%) were during weekdays and resulted in the prescription of medication (94.2%), laboratory tests (62.8%), sick leaves (4.7%), radiology examinations (3.6%), and a visit to primary healthcare clinics (family medicine) within a week of the emergency visit (3.6%). Less- and non-urgent ED visits often did not need any further follow-ups or admission and represented a burden better managed by a primary healthcare center. Policymakers should mitigate unnecessary ED visits through public awareness, establish clear regulations for ED visits, improve the quality of care in primary healthcare centers, facilitate booking for outpatient department appointments, and regulate the systems of payment coverage/insurance and referral by other organizations.

Two‐Layer Location‐Routing Problem Based on Heuristic Hybrid Algorithm

Location‐routing problem (LRP) thoroughly considers location allocation problem (LAP) and vehicle routing problem (VRP) which has been an integral part applied in modern logistics. A number of researchers at home and aboard have put forward their views by establishing fine models. On the basis of studying the previous research results by classification, summary, and comparative analysis, this study hence proposes a new solution‐fuzzy clustering model and algorithm to resolve two‐layer location‐routing problem based on a heuristic hybrid algorithm: Designing a hybrid genetic and simulated annealing algorithm (GASA) to optimize the initial value of the fuzzy C‐means clustering algorithm (FCM); considering the roving visit characteristics of vehicles to design the path by employing a special VRP problem—the multiple traveling salesman problem (MTSP). Theoretical analysis and experimental results show that the algorithm used in this study has the advantages of fast convergence speed and less iterations, which significantly improve the quality of the initial solution of FCM in LAP, shorten the vehicle patrol cycle in VRP to a great extent, improve the vehicle utilization, and save the vehicle patrol costs. A specific example is programmed by MATLAB to verify the feasibility of this method.

Influence of prior internist encounter on glycaemic control among patients with type 2 diabetes mellitus at a family practice setting in Nigeria.

The huge global diabetes burden and the paucity of diabetes specialists make primary care physicians important stakeholders in controlling diabetes. Hence, we examined the predictors of glycaemic control among primary care patients with type 2 diabetes mellitus (T2DM), highlighting the influence of prior internist encounters during the preceding year on glycaemic control. This questionnaire-based cross-sectional study involved 276 T2DM patients systematically recruited from attendees of a general outpatient clinic (GOPC) in Kano, Nigeria. Data regarding their sociodemographic, clinical and internist encounter and GOPC visit characteristics were collected. Data were subjected to descriptive and inferential statistical analysis. Most participants (56.5%) were females; their mean age was 57.7 ± 9.6 years, mean glycated haemoglobin level was 7.3 ± 1.9%. Age, educational level, ethnicity, insurance status, current blood pressure (BP), treatment type, medication adherence, awareness of the importance of diet in DM control, specialist diabetic clinic visited, number of GOPC visits and prior encounter with an internist in the preceding year were associated with glycaemic control after bivariate analysis (P < 0.05). On multivariate regression, low education, retirees, being self-employed, uninsured, overweight, having optimal BP, using metformin alone, sulphonylurea-metformin and insulin-based treatments and prior encounter with the internist in the preceding year were predictors of optimal glycaemic control. There are multiple predictors of glycaemic control in this setting. These predictors should be considered in glycaemic control risk stratification towards quality individualised care, which includes establishing referral protocols to available specialists. Regular training of primary care physicians on diabetes care is also required.

Opioid Prescription Patterns and Disparities During Ambulatory Encounters in Patients With Cirrhosis

The opioid epidemic causes significant morbidity and mortality in the United States,1 and individuals with chronic liver disease receive a high burden of opioid prescriptions,2 despite elevated risk of harm with use in cirrhosis. Characteristics associated with opioid prescriptions in the US cirrhosis population are unknown. Our study sought to describe patient and provider-related characteristics of national ambulatory visits involving cirrhosis and opioid prescriptions, and to identify predictors of and reasons for prescriptions.

Patient and Visit Characteristics Associated With Physical Restraint Use in the Emergency Department.

Objective Physical restraints are used in emergency departments (EDs) to address behavioral emergencies in situations in which less restrictive methods have failed. The objective of this study was to evaluate for associations between patient/visit characteristics and physical restraint use. Study Design This study was designed as a cross-sectional, retrospective study of all encounters at Kaiser Permanente Northern California EDs from January 1, 2016, to December 31, 2019, to evaluate differences in patient and visit characteristics between visits involving physical restraint use and those without. Methods Using electronic health record data, this study identified physical restraint use among ED encounters and extracted demographic, clinical, and facility characteristics. The authors calculated odds ratios for physical restraint placement, adjusting for patient and visit characteristics and accounting for within-patient clustering. Results Among 4,410,816 encounters (representing 1,791,673 patients), 6369 encounters (0.1%) involved physical restraint use among 5,554 patients (0.3%). Variables associated with the lowest odds of physical restraint included female sex, presentation to the ED in more recent years, and presence of intentional self-harm/suicidal ideation. Variables associated with the highest odds of physical restraint included higher visit acuity and weekend presentations to the ED. Discussion This study, which leveraged a large, diverse patient sample generalizable to the Northern California population, found several patient and visit characteristics associated with physical restraint use in the ED. Conclusion Results of this study may help identify patient groups and situational factors that are most likely to lead to physical restraint use and structural factors contributing to disparities in care, thereby informing interventions to reduce physical restraint use when possible.

Impact of COVID-19 on the associated complications of high-risk conditions in a statewide pediatric emergency network.

The COVID-19 pandemic affected the volume and epidemiology of pediatric emergency department (ED) visits. We aimed to determine the rate of associated complications for 16 high-risk conditions in a Michigan statewide network of academic and community EDs during the pandemic. We conducted a cross-sectional study of pediatric ED visits among a network of 5 Michigan health systems during the pre-pandemic (March 1, 2019-March 10, 2020) and pandemic (March 11, 2020-March 31, 2021) periods. Data were collected from the medical record and included patient demographics, ED visit characteristics, procedure codes, and final International Classification of Diseases, 10th Revision, Clinical Modification diagnosis codes. Selection of codes for 16 high-risk conditions and diagnostic complications were identified using previously described methods. Characteristics of ED visits were compared before versus during the pandemic using χ2 and Fisher's exact tests. We used multilevel logistic regression to analyze covariates and potential confounders for being diagnosed with a high-risk condition or a complication of a high-risk condition. A total of 417,038 pediatric ED visits were analyzed. The proportion of patients presenting with 10 of 16 high-risk conditions (including appendicitis, sepsis, and stroke) was higher in the pandemic period compared with pre-pandemic (P < 0.01). Despite this, there was no significant increase in the frequency of complications for any of the 16 high-risk conditions during the pandemic. The adjusted odds of being diagnosed with appendicitis (pre-pandemic 0.23% vs pandemic 0.52%; odds ratio [OR], 1.19 [95% confidence interval, CI, 1.00-1.41]), diabetic ketoacidosis (pre-pandemic 0.16% vs pandemic 0.52%; OR, 2.40 [95% CI, 2.07-2.78]), intussusception (pre-pandemic 0.05% vs pandemic 0.07%; OR, 1.64 [95% CI, 1.22-2.21)], and testicular torsion (pre-pandemic 0.10% vs pandemic 0.14%; OR, 1.64 [95% CI, 1.18-2.28]) was higher during the pandemic. Despite a higher proportion of ED visits attributed to high-risk conditions, there was no increase in complications, suggesting minimal impact of the pandemic on outcomes of pediatric ED visits.

Understanding characteristics of persons with early onset dementia in the UCLA Alzheimer’s and Dementia Care Program

AbstractBackgroundAlthough early onset dementia (EOD) accounts for approximately 5% of persons living with dementia (PLWD), there is limited understanding of their demographic characteristics, behavioral symptoms, and caregiver measures, especially in comparison to persons with older onset dementia (OOD).MethodThe UCLA Alzheimer’s and Dementia Care Program is a comprehensive dementia care management program that has served over 3450 PLWD since 2012. This retrospective study compares baseline visit characteristics of participants with EOD (≤ 65 years of age) to participants with OOD (≥ 80 years of age). Variables include patient and caregiver demographics, Neuropsychiatric Inventory Questionnaire (NPI‐Q) scores, Mini Mental State Exam (MMSE), Modified Caregiver Strain Index (MCSI), caregiver PHQ‐9, and insurance status. Fisher exact tests were used to test differences between age groups.ResultThe attached table presents comparisons of the 177 participants with EOD and 731 with OOD. Compared to OOD, persons with EOD were more likely to be men, college graduates, dually insured, have unpaid caregivers, live alone, and be married. Caregivers for persons with EOD were most often spouses, whereas caregivers for persons with OOD were more often children. Although participants had similar MMSE scores, NPI‐Q severity and NPI‐Q distress scores were higher among persons with OOD compared to EOD.ConclusionThere are important differences in demographic characteristics, caregiving status, and behavioral symptoms among persons with EOD compared to those with OOD. Understanding the unique challenges, needs, and resources of persons with EOD may provide valuable insight to adapt dementia care to better meet their needs.

Emergency Department Experience and the Use of Non-Pharmacologic Treatment for Acute Pain Among Patients with Sickle Disease

Background: Appropriate management for patients presenting to the Emergency Department (ED) with acute pain from vaso-occlusive episodes (VOE) primarily includes treatment with parenteral opioid and non-opioid analgesia and fluids if the episode is uncomplicated. Non-pharmacological strategies that significantly affect non-physical aspects of behavioral, social, and cultural life, have been studied for pain treatment in sickle cell patients; however, the data on the effectiveness of these methods are limited. Objectives: This work aims to assess the overall ED experience among patients seeking care for acute VOE. We also aim to assess any effective alternative pain management strategies used by patients to treat their acute pain symptoms. Methods: We conducted ED follow up assessments for patients who sought care in the ED for acute pain from vaso-occlusive episodes from January 1, 2022- July 15, 2022. These were brief individual phone interviews. The semi-structured interview guide was created using a hospital specific patient experience questionnaire in addition to questions pertaining to pain management in the acute and day-to-day settings, demographic data including, age, sex, emergency department visit characteristics (length of stay (LOS), emergency severity index assignment (ESI), time to first opioid). The interviews were analyzed using a framework matrix analysis. This qualitative data reduction technique was used to review, summarize, and classify the interview data. NVivo 20 qualitative data analysis software includes a framework matrix tool used to manage data and facilitate this analysis in which participant comments about key content were aggregated and entered for review. Results: Overview: Among the 21 patients who met study criteria, eight participants are included in this analysis. Six participants identified as male, and two participants identified as female. ED Experience: Patients rated their ED care from a 3/10 to a 10/10 (avg 6.4, +/- 2.6). Common themes included prolonged wait times for pain management (6/8 participants). Five of the eight patients interviewed expressed gratitude for the care provided though noted some room for improvement. One participant noted "they could have been nicer to me. It's like they don't talk to each other" (2/8 participants). Patients also expressed frustration when intravenous access issues arise and compounding delays in treatment. Pain management: Three of the eight patients interviewed reported using scheduled opioids (oxycodone-5 patients, and methadone-2 patients) at home every 3-8 hours. One patient declined to answer questions about home opioid use. All patients received hydromorphone for acute management in the ED. Two of the eight patients expressed knowledge of their care coordination pain management plan. Alternative pain management: Five of the eight patients used heat or hot packs as their primary alternative pain management and specifically referenced this as an intervention that they would find helpful in the ED. Two patients prioritized distractions such as video games or other screen time. One patient relied on family support, massages, and meditation. Conclusions: Patients experiencing acute pain from VOE rely on the ED for care. Optimizing that care will not only improve patient's health, but also their well-being. Considering complementary alternatives for acute pain management including heat therapy (packs, blankets) as well as massage (heated chair) or distractions (video games, reading or movies) may provide additional benefits while patients seek care for acute pain crises.

Characteristics of Pediatric Primary Healthcare Visits in a University-Based Primary Healthcare Center in Saudi Arabia.

This study aimed to identify the characteristics of pediatric primary health care (PHC) visits and evaluate the outcomes of patients presenting with complaints along with their referral and consultation capabilities. This was a retrospective medical record-based study. The study population included any pediatric patient (≤14 years old), including females and males, Saudis, and non-Saudis. Research data were gathered for visits from 2016-2021. Sampling was performed using a stratified random sample based on age groups, followed by simple random sampling with proportional allocation to different age groups. The number of pediatric visits included was 1439 (males, 52.2%). The most common age group was toddlers, and 60% of the total sample was from Saudi Arabia. The most common cause of visits was vaccination (32%), followed by general checkups and/or a well-baby visit (25.4%), and fever (11.2%). Approximately 10% of visits needed referral to other subspecialties. Approximately 50% of visits with complaints concerning ophthalmology, cardiology, and surgical intervention were referred to a specialized department. More awareness needs to be raised about the important role of PHC services in the pediatric age group, as it was capable of handling approximately 90% of their cases.

Characteristics, Hospital Length of Stay, and Readmissions Among Individuals Undergoing Abdominal Ostomy Surgery: Review of a Large US Healthcare Database.

The purpose of this study was to examine patient characteristics, length of stay (LOS), hospital revisits, and complications of patients undergoing abdominal ostomy surgery. Retrospective cohort study. Data were extracted from the PINC AI Healthcare Database (PHD), a large archive that stores data from 25% of all US inpatient hospital discharges. Patients were admitted to 658 hospitals in the United States between December 1, 2017, and November 30, 2018. The sample comprised 27,658 adult patients; 15,512 underwent creation of a colostomy, 10,207 underwent ileostomy construction, and 1930 had a urostomy procedure. Their median age was 64 years (interquartile range [IQR] = 19 years). Emergent admission type was 71.2% for patients who underwent a colostomy procedure, 49.4% for ileostomy, and 9.9% for urostomy. The majority of patients underwent open surgery (77.7%); 22.3% of procedures used an endoscopic approach. Patients were identified as having undergone abdominal ostomy surgery via ICD-10-PCS (International Classification of Diseases, Tenth Revision, Procedure Coding System) procedure codes. Demographic, visit, hospital and clinical characteristics, LOS, and hospital revisits (ie, readmissions and emergency department [ED]) were captured for qualifying patients. Data were evaluated using unadjusted descriptive analyses. The median LOS of 9 days (IQR = 9 days) varied by ostomy surgery; the cumulative postsurgical LOS was 7 days (IQR = 5 days). The most frequent underlying diagnoses resulting in ostomy surgery were diverticulitis of the large bowel (19.6%) managed by colostomy, colorectal cancer managed by ileostomy (22.5%), or urothelial cancer managed by urostomy (78.1%). Slightly less than a quarter (23.7%) of patients were discharged home without home care, 43.0% went home with home healthcare, and 29.6% were discharged to a non-acute care facility. Hospital readmission within 120 days of discharge was 36.3% for patients with a colostomy, 52.3% for those with an ileostomy, and 34.6% for patients with a urostomy. Ostomy complications were identified as the reason for readmission in 62.4% of patients. Slightly more than 1 in 5 patients (20.7%) had a subsequent ED visit within 120 days, 39.7% of which involved ostomy complication. Characteristics of patients undergoing abdominal stoma surgery varied based on underlying diagnosis and ostomy type. The median hospital LOS was more than 1 week. Patients experienced high rates of healthcare utilization (hospital admission or ED visits) during the 120 days following surgery.

Intimate Partner Violence-Related Emergency Department and Hospital Visits in California Following the ICD-10-CM Transition, 2016-2018.

With the transition to the International Classification of Diseases and Related Health Problems, 10th Revision, Clinical Modification (ICD-10-CM), additional research is needed to understand which diagnostic codes for intimate partner violence (IPV) are being used. The current study examined characteristics of IPV visits and frequency of diagnostic codes to identify IPV in all emergency department (ED) and inpatient hospital visits for adults in California from 2016-2018, after ICD-10-CM implementation. Five ICD-10-CM codes outlined in the Uniform Data System Reporting Instructions were used to identify IPV. Fewer than 0.1% of visits (17,347 ED visits and 1,430 hospitalizations) included documentation of IPV. Visits with documented IPV were more common among patients who were younger, female, Black, primarily English-speaking, and publicly insured compared to visits with no documented IPV. There were fairly consistent patterns over time in the specific ICD-10-CM codes used for IPV between 2016 and 2018. Physical and sexual abuse were the most common codes for types of abuse. Among the 15 EDs and 15 hospitals in California with the highest volume of IPV visits, there was variability in the use of ICD-10-CM codes for IPV visits. Accurate documentation of IPV in administrative data may improve patient care and increase understanding of the burden and effects of IPV on individuals and communities.