Differences In Hospitalization Rates Research Articles

SARS-CoV-2 strains and clinical profiles of COVID-19 patients in a Southern Brazil hospital

IntroductionThe COVID-19 pandemic had a widespread global impact and presented numerous challenges. The emergence of SARS-CoV-2 variants has changed transmission rates and immune evasion, possibly impacting the severity. This study aims to investigate the impact of variants on clinical outcomes in southern Brazil.MethodsIn total, samples from 277 patients, hospitalized and non-hospitalized, were collected between March 2020 and March 2021, before the vaccine was made widely available to the general population in Brazil. Whole genome sequencing of SARS-CoV-2 was performed and bioinformatics and biostatistics analyses were implemented on molecular and clinical data, respectively.ResultsThe study identified significant demographic and clinical differences. The hospitalized group exhibited a higher proportion of males (51.9%) and an increased prevalence of comorbidities, including hypertension (66.0%), obesity (42.6%), and chronic kidney disease (23.6%). Patients were identified with twelve SARS-CoV-2 strains, predominantly B.1.1.28 and B.1.1.33 in the early 2020 first wave, and P.1 overlapping in the late 2020 and early 2021 second wave of COVID-19. Significant differences in hospitalization rates were found among patients infected with the different SARS-CoV-2 lineages: B.1.1.33 (46.0%), B.1.1.28 (65.9%), and P.1 (97.9%). Severity markers, such as pneumonia (62.5%, p=0.002), acute respiratory distress syndrome (ARDS, 72.9%, p<0.001), and oxygen support >6 L/min O2 (64.6%, p<0.001), were more frequent in patients from the second wave. These findings highlight the impact of different variants on the clinical evolution and prognosis of COVID-19, especially when comparing the first and second waves of the pandemic.ConclusionsThe study underscores the association between SARS-CoV-2 strains and COVID-19 severity by integrating clinical and viral data for public health responses during different pandemic phases, highlighting the importance of adapting pandemic strategies as the pandemic evolves.

Transcatheter closure of patent ductus arteriosus with mitral regurgitation in children: Clinical outcome and improvement of mitral regurgitation after procedure with echocardiogram follow-up

Background: Patent ductus arteriosus (PDA) is a prevalent pediatric heart condition, often causing heart failure and pulmonary hypertension. Mitral regurgitation, a common occurrence, may be improved by CMRI after PDA closure, suggesting improved follow-up. Objectives: The purpose of this retrospective study is to evaluate the clinical outcomes and follow-up echocardiogram results following transcatheter PDA closure in these patients, with the view of proposing an effective treatment strategy. On other words, the goal is to improve the follow-up of children with PDA and mitral regurgitation five years after PDA closure in which the issue of long-term follow-up of these children still needs to be assessed. Methods: The Queen Alia Heart Institute conducted retrospective study that examined the outcomes and follow-up of children with open PDA with only mitral regurgitation (MR) who underwent closure, outcomes, and follow-up by echocardiography from January 2018 to March 2022. The patient cohort included 46 children who were discussed in heart team meetings and were candidates for catheterization for device closure due to no resolution of the shunts proposed for transcatheter closure of PDA with color Doppler echocardiography. Transcatheter closure was performed with general anesthesia or conscious sedation, and continuous hemodynamic monitoring was performed for at least 30 minutes to ensure stabilization. The study also reviewed the management and outcomes of children with isolated MR and no intervention for PDA. Current intervention techniques for transcatheter closure in patients diagnosed with PDA and MR are divided into four main strategies: Lesson-Severn wire-controlled occlusion, Sideris muscular device implantation, inter-procedural MR availability assessment before device deployment, and secondary transcatheter or interventional strategy due to remaining MR. Advances in treatment have allowed patients to receive intervention at younger ages and benefit from a reduced dose of radiation. Results: A study comparing children with and without PDA and MDI showed significant improvements in post-intervention EROA, RV volume, RVEF, LVEDVi, and LVFS compared to pre-intervention values. The subgroup analysis revealed that after PDA closure, MR drainage volume decreased, while ventricular volume and function were compensated. The study also found that the improvement and EROA reduction might be related to sex rather than age. The results showed no statistical difference in hospitalization rates between the two groups, but the DuctAngio group had a higher proportion of patients with symptoms and poor health. The study also found that patients with MR showed better patient experience, highlighting the potential improvements in pediatric cardiology. Conclusions: The study found that transcatheter closure of significant PDA with MR improved MR in most patients rapidly and at midterm follow-up, with immediate symptomatic improvement and cardiac remodeling, without long-term MR progression.

Impact of supportive oncology (SO) visits on healthcare utilization.

199 Background: Palliative care (PC) has demonstrated a reduction in acute care utilization for health systems. PC input for patients with cancer has been associated with fewer emergency room visits, hospitalizations and hospital deaths in the last 30 days of life. Less is known about the upstream effects of PC referral on healthcare utilization (HCU). We examined HCU among patients in the 90 days after first SO appointment and predictors of high HCU. Methods: Patients ≥18 years with first SO consult between 01/01/2021-06/30/2023 were included. Patients who died within 90 days of their first SO appointment and incomplete utilization data were censored. Data on patient demographics, acute healthcare and hospice utilization, cancer treatment and mortality was extracted from the electronic health record (EHR). Number of ED visits in 90 days before and after first SO visit were recorded. We used descriptive statistics to describe patients’ sociodemographics, clinical characteristics and healthcare utilization. High HCU was defined as patients in the top 10% of ED visits and IP stays. Logistic regression was employed to assess whether being a high utilizer is associated with baseline characteristics. Results: We included 859 patients. On average, there were approximately 0.12, 95%CI: [0.07,0.17] more ED visits in the 90 days before the first SO appointment compared to 90 days after. There was no difference in hospitalization rates before and after the first SO appointment. Overall, 45 patients met the criteria for high HCU. The median number of ED visits and hospitalizations of high utilizers was 6 visits, compared to 1 visit for remainder of the population. There was a significant association with ethnicity with those identified as Hispanic (60%) being high HCU. There was no significant association between age, insurance status, cancer type, primary language and high HCU. High utilizers were 189% more likely to die in hospital although this did not meet statistical significance (p= 0.242). Conclusions: The findings reveal significant variations in healthcare utilization, particularly among Hispanic patients, indicating a need for targeted interventions to address these disparities. Despite no observed changes in hospitalization rates, the study emphasizes the need for further research to understand the underlying factors contributing to high healthcare utilization. Future efforts should focus on developing tailored strategies to optimize PC referrals and enhance patient outcomes across diverse populations. Race/ethnicity by utilization group. Category <90th Percentile Utilization (n=814) % >90th Percentile Utilization (n=45) % P value Race (%) <0.001 Asian 97 (11) 0 (0) Black or African American 173 (21) 8 (18) Hispanic 198 (24) 27 (60) Other 50 (6) 3 (7) White 296 (36) 7 (16)

Abstract C170: Unveiling sex differences in hospitalization rates for immune-related adverse events in older lung cancer patients treated with ICIs: A SEER-Medicare analysis

Abstract Introduction Immune checkpoint inhibitors (ICIs) offer substantial benefits for older adults with lung cancer (LCa) but they also pose risks of immune-related adverse events (irAEs), necessitating investigation into the demographic influences on hospitalization rates. Sex differences among older adults within this cohort are understudied. Our study aims to explore the gender differences in irAE-related hospitalizations among older adults. Methods We utilized Surveillance, Epidemiology, and End Results (SEER)-linked Medicare data to identify older adults diagnosed with primary LCa from 1999 to 2017 and treated with ICIs between 2011 and 2019. Patients were steroid-naïve and chemo-naïve for 3 and 12 months, respectively, prior to ICI initiation. ICD-9/10 diagnosis codes were used to identify irAEs post-ICI initiation and these diagnosis were flagged during the pre-ICI period for comparison. An adjusted negative binomial model compared irAE-hospitalization rates in the post-ICI period (0-6, 7-12, and 13-24 months) to those in the pre-ICI period (6 months prior), accounting for confounders. An interaction term between gender and treatment period was included to compare differences in rates between males and females. Results Of the 1,089 patients, 54% were female, 79.6% had Charlson Comorbidity Index (CCI) ≥1. Females had 59% higher rates of irAE-hospitalizations at baseline (95% CI: 1.18 – 2.14, p<0.001). Patients with CCI≥3 had a 141% higher rate for irAE- hospitalization compared to those with CCI=0. Specifically for males, compared to 6-months pre-ICI, the irAE-hospitalization rates were 187% higher 0-6 months post-ICI (IRR = 2.87, 95% CI: 1.20-3.74), 134% higher 7-12 months post-ICI (IRR = 2.34, 95% CI: 1.66-3.31), and 122% higher 13-24 months post-ICI (IRR = 2.22, 95% CI: 1.53-3.28). Similarly for females, compared to 6-months pre-ICI, the irAE-hospitalization rates were 123% higher 0-6 months post-ICI (IRR = 2.23, 95% CI: 1.27-3.75), 69% higher 7-12 months post-ICI (IRR = 1.69, 95% CI: 1.27-3.37), and 11% higher 13-24 months post-ICI (IRR = 1.11, 95% CI: 1.03-2.37). Age and race did not impact irAE-hospitalization rates among LCa patients. Conclusions The incidence of irAEs following ICI treatment is notably higher in the first six months post-ICI for both males and females, with males experiencing a higher rate of events across all post-treatment periods. Key factors influencing the rate of irAE-hospitalizations include the CCI and pre-treatment gender differences. These findings underscore the need for tailored post-ICI monitoring strategies to mitigate adverse events in vulnerable populations. Citation Format: Fnu Nikita, Swapnil Sharma, Amy Shaver, Krupa Gandhi, Scott W. Keith, Christina Steinbock- Malfer, Jennifer M. Johnson, Sarah Gordon, Grace Lu-Yao. Unveiling sex differences in hospitalization rates for immune-related adverse events in older lung cancer patients treated with ICIs: A SEER-Medicare analysis [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr C170.

Association between preferred language and use of mental health services among home care recipients with schizophrenia spectrum and other psychotic disorders: A retrospective cohort study in Ontario, Canada, 2010 to 2015

Language is an important demographic factor that may impact patients’ interactions with the healthcare system. This may become more apparent for individuals with a mental illness. The objective of this study was to evaluate whether individual language was associated with the use of inpatient and outpatient psychiatric services among home care recipients with schizophrenia spectrum and other psychotic disorders. We conducted a population-based retrospective cohort study using health administrative data. The study population included all individuals aged 18–105 with schizophrenia spectrum and other psychotic disorders, identified via a validated algorithm, who were receiving home care in Ontario, Canada between January 1, 2010 and December 31, 2015. Home care data was used to identify patients’ primary language, categorized as Anglophone, Francophone, or Allophone. Mental health service use was evaluated over a one-year period following their first home care assessment in the study period and included the rate of outpatient psychiatrist visits and mental health-related emergency department (ED) visits and hospitalizations. Multivariable regression evaluated the association between primary language and mental health service use. The cohort consisted of 9,436 patients (85.8% Anglophones, 3.3% Francophones, 11.0% Allophones). Mental health service use was low among all linguistic groups during the one-year study period, with 53.4% with no outpatient psychiatrist visits and 83.3% and 83.0% with no mental health-related hospitalizations or ED visits, respectively. Francophones had a higher rate of mental health-related hospitalizations compared to Anglophones (adjusted relative risk = 1.36, 95% confidence interval 1.02–1.80), with no differences in hospitalization rates between Allophones and Anglophones. Language was not associated with the rate of outpatient psychiatrist visits or mental health-related ED visits. Mental health service use among homecare patients with schizophrenia spectrum and other psychotic disorders was low. While Francophones had a higher hospitalization rate than Anglophones, language was otherwise not associated with mental health service use.

Human brucellosis and associated risk factors in the Middle East region: A comprehensive systematic review, meta-analysis, and meta-regression

IntroductionHuman brucellosis, caused by the bacteria Brucella, is a significant infectious disease globally, also known as Mediterranean fever or Malta fever. MethodsThis meta-analysis and systematic review focuses on the prevalence rate, risk factors, and diagnostic methods of human brucellosis in Middle Eastern countries, where the disease remains a significant public health issue. The analysis included 92 studies conducted between 1993 and 2024, following specified inclusion and exclusion criteria among symptomatic patients across these countries. The prevalence rate was calculated by dividing positive samples by total samples. The I2 index and Chi-squared test assessed study heterogeneity. Significant heterogeneity occurred when I2 exceeded 50 %. ResultsThe highest prevalence rate was observed in Oman, Lebanon, and Kuwait countries, emphasizing a notable burden of Brucella infection in these regions. Risk factors associated with human brucellosis were identified, with unpasteurized dairy consumption and close animal contact being predominant. Various professions such as farmers, dairy factory workers, and agriculture workers showed higher prevalence rate. Gender analysis indicated a prevalence rate of 18.02 % (95 % CI: 11.55–25.51 %) in males and 13.61 % (95 % CI: 10.8–16.68 %) in females, with no significant difference in hospitalization rates. The prevalence rate of Brucella spp. was varied across detection methods, with immunocapture agglutination assay (Brucellacapt) showing the highest estimated prevalence rate of (44.04 %, 95 % CI: 27.71–61.04), followed by PCR (39.84 %, 95 % CI: 20.14–61.39) and culture (29.22 %, 95 % CI: 17.89–42.03). Among Brucella species, Brucella melitensis (B. melitensis) and Brucella abortus (B. abortus) were the highest prevalence rate. Although statistically insignificant, the meta-analysis also revealed an upward trend in prevalence rate from 1993 to 2024, (P value = 0.277). DiscussionThis comprehensive review emphasizes the need for tailored strategies to control brucellosis in the Middle East, highlighting the importance of timely diagnosis, public awareness, and effective treatment protocols. These findings provide valuable insights for policymakers and healthcare professionals working to mitigate the impact of this disease in the region.

#1899 Transitional care clinic for incident hemodialysis patients : the Singapore experience

Abstract Background and Aims The period of transition from chronic kidney disease (CKD) to End stage kidney disease (ESKD) presents significant morbidity and mortality risk to the patients. This higher mortality risk is largely contributed by cardiovascular factors and infection. The last 2 decades have seen a remarkable succession of programs to improve outcome in incident dialysis patients. One such initiative is the use of ‘fistula first’ policy. In Singapore, pre-emptive access creation among ESKD patients continues to be low, with up to 80% of incident dialysis patients being commenced on hemodialysis (HD) via a dialysis catheter. Ensuring that incident dialysis patients have definitive vascular access, early referral to transplantation and adequate psychosocial support, amongst other factors, is an important consideration in their journey towards improved health outcomes. In order to achieve this, meticulous care coordination and a multifaceted approach is required. This realization is what led to the inception of our transition care clinic (TCC) in 2019. Conducted bi-monthly by a multidisciplinary team of nephrologists and renal coordinators, with inputs from pharmacists and medical social workers as needed, the TCC engages patients within 4-6 weeks post-hospital discharge. Its focus includes vascular access, dietary and fluid compliance, blood pressure control, HD adherence, transplantation referral, and medication reconciliation. Method A retrospective analysis of 314 ESKD patients who initiated HD between September 2019 and September 2022 compared outcomes between TCC attendees (n=164) and non-attendees Results TCC attendees exhibited a lower 1- year mortality rate (p=0.002) and higher rates for vascular access creation within first 6 months (p=0.001) as compared to non-attendees. However, no statistical differences were observed in hospitalization rates in the first year (p=0.760) and kidney transplantation referrals (p=0.20) between the two groups. Conclusion While notable improvements were observed in mortality rates and vascular access creation, there was no significant difference in hospitalization rates or kidney transplantation referrals between the two groups. In spite of the limitations due to its retrospective nature, this study clearly demonstrates the effectiveness of TCC in enhancing patient outcomes during the critical initial phase of hemodialysis. The study highlights the importance of setting up, refinement and expansion of such services in improving the outcome of this vulnerable patient group.

The effect of sodium-glucose co-transporter 2 inhibitors on outcomes after cardiac resynchronization therapy.

The trials upon which recommendations for the use of cardiac resynchronization therapy (CRT) in heart failure used optimal medical therapy (OMT) before sodium-glucose co-transporter 2 inhibitors (SGLT2i). Moreover, the SGLT2i heart failure trials included only a small proportion of participants with CRT, and therefore, it remains uncertain whether SGLT2i should be considered part of OMT prior to CRT. We compared electrocardiogram (ECG) and echocardiographic responses to CRT as well as hospitalization and mortality rates in consecutive patients undergoing implantation at a large tertiary centre between January 2019 to June 2022 with and without SGLT2i treatment. Three hundred seventy-four participants were included aged 74.0±11.5years (mean±standard deviation), with a left ventricular ejection fraction (LVEF) of 31.8±9.9% and QRS duration of 161±29ms. The majority had non-ischaemic cardiomyopathy (58%) and were in NYHA Class II/III (83.6%). These characteristics were similar between patients with (n=66) and without (n=308) prior SGLT2i treatment. Both groups demonstrated similar evidence of response to CRT in terms of QRS duration shortening, and improvements in LVEF, left ventricular end-diastolic inner-dimension (LVIDd) and diastolic function (E/A and e/e'). While there was no difference in rates of hospitalization (for heart failure or overall), mortality was significantly lower in patients treated with SGLT2i compared with those who were not (6.5 vs. 16.6%, P=0.049). We observed an improvement in mortality in patients undergoing CRT prescribed SGLT2i compared with those not prescribed SGLT2i, despite similar degrees of reverse remodelling. The authors recommend starting SGLT2i prior to CRT implantation, where it does not delay implantation.

Effects of colchicine on the prevention of AF recurrence after atrial ablation: a systematic review and meta-analysis.

Catheter ablation has become a widely accepted treatment for atrial fibrillation, but early recurrences remain a challenge, often attributed to inflammatory responses triggered during the procedure. This systematic review and meta-analysis aimed to evaluate the effectiveness of colchicine in preventing short-term AF recurrence post-ablation. PubMed, Embase, and Cochrane Library were searched for studies comparing use of colchicine and placebo in patients after AF ablation. Outcomes included AF recurrence, GI side effects, and hospitalization. R program (version 4.3.2) was used for statistical analysis. Heterogeneity was assessed with I2 statistics. Five studies, including 1592 patients, were analyzed. Pooled results revealed no statistically significant decrease in AF recurrence (OR 0.74; 95% CI 0.48-1.12; p = 0.153) and pericarditis rates (OR 0.67; 95% CI 0.26-1.72; p = 0.403) with colchicine use. No significant difference in hospitalization rates was observed between colchicine and placebo groups (OR 1.00; 95% CI 0.63-1.59; p = 0.996). In addition, gastrointestinal side effects were notably higher in the colchicine group (OR 4.84; 95% CI 2.58-9.05; p < 0.001). Prophylactic use of colchicine after atrial ablation was not associated with a reduction in AF recurrence and pericarditis rates. In addition, there was no difference in the rate of all-cause hospitalization between the groups, and colchicine use was associated with gastrointestinal adverse events.

Effect of long-acting antipsychotic treatment on psychiatric hospitalization rate in early psychosis patients: a naturalistic study.

The effectiveness of long-acting injectable (LAI) antipsychotics in preventing relapses of first-episode psychosis is currently debated. The study aimed to investigate the number of psychiatric hospitalizations comparing the LAI cohort versus the oral cohort during different phases of the illness, pre-LAI treatment, during LAI treatment, and after LAI treatment. A naturalistic study was conducted on two independent cohorts of early psychosis patients receiving treatment from a specific early intervention service. The first cohort comprised 228 patients who received LAIs, while the second cohort comprised 667 patients who had never received LAIs. This study was designed as a longitudinal observational study conducted within a naturalistic clinical setting in two cohorts of early psychosis patients. Repeated series ANCOVA (ANCOVA-r) was used to study the number of hospitalizations in the different study periods (T1 = from the date of the first psychiatric record to the beginning of the mirror period; T2 = the mirror period; T3 = from the LAI implementation to the LAI discontinuation; and T4 = from the LAI discontinuation to the end). In all cases, discontinuation of LAI involved the return to oral treatment. In all, 35 patients had not T4 as they were still on LAI treatment at the time of database closing (September 2020), and their data were not included in the analysis of the effect of the LAI discontinuation. The patients in the LAI cohort were younger, more frequently males, presented more schizophrenia diagnoses, and had a higher number of hospitalizations (2.50 ± 2.61 versus 1.19 ± 1.69; p < 0.001) than the oral cohort. The number of hospitalizations at the end of the follow-up was higher in the LAI cohort [0.20 (standard deviation (SD)) = 0.79] versus 0.45 [SD = 0.45 (SD = 1.13); F(23.90), p < 0.001]. However, after the introduction of LAIs, the differences in hospitalization rates between the two cohorts became less pronounced. Once LAI treatment was ceased, the hospitalization rate increased again. In our study, early psychosis patients receiving LAIs experienced a greater decrease in hospitalizations after introducing the LAI treatment than those treated solely with oral medication. These findings support using LAIs as a viable strategy for preventing rehospitalization and improving the overall course of treatment for individuals with early psychosis.

465. Use of Monoclonal Antibodies for COVID-19 in Solid Organ Transplant Recipients: A Single-Center Experience

Abstract Background The use of coronavirus disease 2019 (COVID-19) monoclonal antibody (mAb) treatment in solid organ transplant (SOT) patients have been shown to reduce the rates of hospitalization, Emergency Department (ED) visits, and mortality in previous studies. However, most of these studies provide little or no data in minority patients, specifically Hispanic patients, a group that has been associated with worse outcomes with COVID-19. Our study describes the use of COVID-19 mAbs in the SOT recipients at our institution, where a majority of patients are of Hispanic ethnicity. Methods We performed a retrospective chart review of all adult SOT patients who received COVID-19 mAbs from December 2020 to December 2022. Results We identified 54 patients who were SOT recipients. The mean age was 46.3 (IQR 33-59), and 30 (55.6%) were male. Of the 54 patients, 34 (63.0%) identified as Hispanic, 17 (31.5%) as White, 2 (3.7%) as Asian, and 1 (1.9%) as Black. There were 23 (42.6%) heart, 22 kidney (40.7%), 6 liver (11.1%), 2 (3.7%) combined kidney and liver, and 1 (1.9%) combined kidney and pancreas recipients. There were four mAbs available during the study period. Of the 54 SOT recipients, 16 (29.6%) received casirivimab/imdevimab, 5 (9.3%) received bamlanivimab, 19 (35.2%) received bebtelovimab, and 14 (25.9%) received sotrovimab. Average time from symptom onset to receipt of infusion was 4 (IQR 1-5) days. The 30-day hospitalization rate due to COVID-19 from time of diagnosis in our cohort was 5.6%. There were 3 (5.6%) patients who visited the ED due to COVID-19 within 30 days of diagnosis and there were no deaths due to COVID-19 within 30 days of diagnosis. When comparing between the Hispanic and non-Hispanic groups in our cohort, the 30-day hospitalization rate due to COVID-19 from time of diagnosis was not statistically significant (5.6% vs 0, p=0.29). There was one patient who had an infusion reaction and 3 patients who developed allograft rejection within 90 days of mAb infusion. Conclusion In our small cohort of SOT recipients, the majority of which are Hispanic, use of COVID-19 mAbs had low rate of poor outcomes and adverse events. There was no statistically significant difference in hospitalization rate following mAb infusions between the Hispanic and non-Hispanic SOT recipients in our group. Disclosures All Authors: No reported disclosures

Ambulatory Intensive Care for Medically Complex Patients at a Health Care Clinic for Individuals Experiencing Homelessness

Intensive primary care interventions have been promoted to reduce hospitalization rates and improve health outcomes for medically complex patients, but evidence of their efficacy is limited. To assess the efficacy of a multidisciplinary ambulatory intensive care unit (A-ICU) intervention on health care utilization and patient-reported outcomes. The Streamlined Unified Meaningfully Managed Interdisciplinary Team (SUMMIT) randomized clinical trial used a wait-list control design and was conducted at a health care clinic for patients experiencing homelessness in Portland, Oregon. The first patient was enrolled in August 2016, and the last patient was enrolled in November 2019. Included patients had 1 or more hospitalizations in the prior 6 months and 2 or more chronic medical conditions, substance use disorder, or mental illness. Data analysis was performed between March and May 2021. The A-ICU included a team manager, a pharmacist, a nurse, care coordinators, social workers, and physicians. Activities included comprehensive 90-minute intake, transitional care coordination, and flexible appointments, with reduced panel size. Enhanced usual care (EUC), consisting of team-based primary care with access to community health workers and mental health, addiction treatment, and pharmacy services, served as the comparator. Participants who received EUC joined the A-ICU intervention after 6 months. The main outcome was the difference in rates of hospitalization (primary outcome), emergency department (ED) visits, and primary care physician (PCP) visits per person over 6 months (vs the prior 6 months). Patient-reported outcomes included changes in patient activation, experience, health-related quality of life, and self-rated health at 6 months (vs baseline). We performed an intention-to-treat analysis using a linear mixed-effects model with a random intercept for each patient to examine the association between study group and outcomes. This study randomized 159 participants (mean [SD] age, 54.9 [9.8] years) to the A-ICU SUMMIT intervention (n = 80) or to EUC (n = 79). The majority of participants were men (102 [65.8%]) and most were White (121 [76.1%]). A total of 64 participants (41.0%) reported having unstable housing at baseline. Six-month hospitalizations decreased in both the A-ICU and EUC groups, with no difference between them (mean [SE], -0.6 [0.5] vs -0.9 [0.5]; difference, 0.3 [95% CI, -1.0 to 1.5]). Emergency department use did not differ between groups (mean [SE], -2.0 [1.0] vs 0.9 [1.0] visits per person; difference, -1.1 [95% CI, -3.7 to 1.6]). Primary care physician visits increased in the A-ICU group (mean [SE], 4.2 [1.6] vs -2.0 [1.6] per person; difference, 6.1 [95% CI, 1.8 to 10.4]). Patients in the A-ICU group reported improved social functioning (mean [SE], 4.7 [2.0] vs -1.1 [2.0]; difference, 5.8 [95% CI, 0.3 to 11.2]) and self-rated health (mean [SE], 0.7 [0.3] vs -0.2 [0.3]; difference, 1.0 [95% CI, 0.1 to 1.8]) compared with patients in the EUC group. No differences in patient activation or experience were observed. The A-ICU intervention did not change hospital or ED utilization at 6 months but increased PCP visits and improved patient well-being. Longer-term studies are needed to evaluate whether these observed improvements lead to eventual changes in acute care utilization. ClinicalTrials.gov Identifier: NCT03224858.

Comparison between available early antiviral treatments in outpatients with SARS-CoV-2 infection: a real-life study

PurposeTo investigate the clinical impact of three available antivirals for early COVID-19 treatment in a large real-life cohort.MethodsBetween January and October 2022 all outpatients tested positive for SARS-CoV-2 referring to IRCCS S. Orsola hospital treated with an early antiviral therapy were enrolled. A comparison between patients treated with nirmatrelvir/ritonavir (NTV/r), molnupiravir (MPV) and remdesivir (RDV) was conducted in term of indications and outcome. To account for differences between treatment groups a propensity score analysis was performed. After estimating the weights, we fitted a survey-weighted Cox regression model with inverse-probability weighting with hospital admission/death versus clinical recovery as the primary outcome.ResultsOverall 1342 patients were enrolled, 775 (57.8%), 360 (26.8%) and 207 (15.4%) in MPV, NTV/r and RDV group, respectively. Median age was 73 (59–82) years, male sex was 53.4%. Primary indication was immunosuppression (438, 32.6%), the median time from symptom onset to drug administration was 3 [2–4] days. Overall, clinical recovery was reached in 96.9% of patients, with hospital admission rate of 2.6%. No significant differences were found in clinical recovery nor hospitalization. Cox regression showed a decreased probability of hospital admission/ death among prior vaccinated patients compared with unvaccinated (HR 0.31 [95%CI 0.14–0.70], p = 0.005]). No difference in hospitalization rates in early treatment compared to late treatment were found.ConclusionsNo differences among MPV, NTV/r and RDV in terms of clinical recovery or hospitalization were found. Patients not vaccinated had a significant increased risk of hospitalization.

Analisis Penerapan Metode Activity Based Costing System Dalam Penentuan Harga Pokok Kamar

This study aims to determine the cost of goods sold calculation of the room, how to calculate the activity based costing method in determining the cost of the room and to determine the magnitude of differences in hospitalization rates using companies and Activity Based Costing in the hotel The Royale Krakatoa. This study used a descriptive method that describes the actual situation existing at The Royale Krakatau, as for the techniques used to collect the data is Research Library (Library Research), field research (field research). It can be concluded, that the results of the calculation of the cost of the room by using the company for this type Standard room Rp 552,466, while for the ABC method for this type of Rp 447 271 standard rooms. From the results obtained can be compared to the difference in the cost of the room that the hotel management has determined Royale Krakatoa with the results of calculations using Activity Based approach Costing.dengan difference Rp. 105 195.

1138-P: INNOVATIONS—Improving Care of Patients with Type 1 Diabetes Mellitus through Utilization of Telemedicine and Outreach—Twelve-Month Outcomes

Despite advances in diabetes treatment options, many youth fail to meet glucose targets and remain at risk of developing complications. Additional diabetes support in the form of telehealth may help youth meet diabetes related goals. Eligible youth had insulin dependent diabetes, Medicaid insurance, were ages 8-18, and willing to use a continuous glucose monitor (CGM). The quality improvement project provided weekly check-ins with a diabetes educator and monthly video visits with a nurse practitioner. Participants also received visit reminder calls. We measured A1c at quarterly clinic visits and tracked ED/hospitalization rates. 12-month data presented. Youth (N=26, 65% female, 88% NHB), aged 8-18 yr, diabetes duration 6.3±4.3 years, 23% were on insulin pumps. There was a significant difference between baseline A1c (mean 12.3%) at 6 months (mean A1c 11.2%) (p=0.02) and at 9 months (mean A1c 11.2%) (p=0.02). There was no significant difference in hospitalization rates during the 12-month intervention. There was no difference in visit adherence at 3, 6, 9, or 12 months during the intervention compared to those times prior. Participants were wearing CGM significantly more 3 months into the intervention compared to 3 months prior (p=0.008). Although not statistically significant, more participants were using CGM consistently at 6, 9 and 12-month time points compared to prior. 27% of participants started insulin pumps during the intervention. An intensive telehealth intervention provided interim improvement in glycemic control. Although not statistically significant, more participants used CGM consistently during the intervention, which could have clinical significance over time. Efforts to improve the durability of technology use and glycemic control warrant exploration. Disclosure L.E.Rasbach: None. V.C.Purrington: None. D.Adkins: None. R.Benjamin: None. Funding Innovation Health Grant (2933476)

Decreased inpatient psychiatric admissions with telepsychiatry use during the COVID-19 pandemic.

This study examines the quality of care provided through telepsychiatry by comparing psychiatric hospitalization rates among patients receiving in-person psychiatric care prior to the COVID-19 pandemic with rates among patients receiving virtual psychiatric care during the COVID-19 pandemic. Mental health-related hospitalization rates among patients enrolled in a large academic hospital's outpatient psychiatry programs between March 1, 2018 and February 28, 2022 were retrospectively analyzed. Four time periods were created, spanning March 1 to February 28 of the following year. Demographic and clinical data were collected from the electronic health record, and descriptive statistics were calculated. Change in hospitalization rate between time periods was evaluated using McNemar's test. In the 2018 time period, 7.38% of all enrolled patients were hospitalized, compared to 7.70% hospitalized in the 2019 period, 5.74% in the 2020 period, and 5.38% in the 2021 period. Patients enrolled in both the 2018 and the 2019 periods saw no difference in hospitalization rate between the 2 years (2.93% in 2018, 2.83% in 2019; p = 0.830); patients enrolled in both 2019 and 2020 saw significantly lower hospitalization rates in 2020 (5.47% in 2019, 4.58% in 2020; p = 0.022); and patients enrolled in both 2020 and 2021 saw no difference (3.34% in 2020, 3.23% in 2021; p = 0.777). Psychiatric hospitalization rates significantly decreased between the 2019 and the 2020 periods, suggesting a decrease in admissions associated with adoption of telepsychiatry. Future research should differentiate the roles played by telepsychiatry and COVID-19-related factors in reducing hospitalization rates during the pandemic.

Neurologic manifestations in hospitalized patients with COVID‐19

AbstractBackgroundTo investigate the effect of pre‐existing neurological symptoms and disease in coronavirus disease 2019 (COVID‐19) health outcomes in a large Illinois‐based cohort.MethodA multicenter retrospective study analyzed differences in a cohort of COVID‐19 positive patients with and without baseline neurological symptoms or disease admitted to RUSH University Systems for Health from March to November 2020. We measured sex and health outcome differences in hospitalization rates, symptoms during initial admission, complications, readmissions, and mortality of the two groups.ResultOf the total of 1708 hospitalized COVID‐19 positive patients (mean age: 58.04, 930 males) — 31% [527] patients had a history of neurological symptoms and/or disease, 9% [140] with dementia. Nonspecific symptoms during hospitalization including myalgia (19%), headache (11%), epilepsy (0.8%), tremors (3%), and abdominal pain (11%) were reported more frequently in patients with a neurologic history. Female patients with pre‐existing neurological conditions were hospitalized more than their male counterparts (40% versus 24%). Compared to those with no neurological conditions, patients with neurological conditions had higher rates of complications, such as acute myocardial infarction (13% vs. 8%; p = 0.002) and deep vein thrombosis/pulmonary embolism (14% vs. 10%; p = 0.02). Multivariate analysis showed that history of stroke and migraines are independently associated with readmission to a hospital floor (generalized linear model, z = 2.092, z = 3.320, p = 0.036, p &lt; 0.001, respectively); of those readmitted, 13% had a history of dementia. Of the patients that died in hospital, 6% had a history of dementia.ConclusionNeurologic manifestations are common in hospitalized COVID‐19 positive patients and are associated with higher rates of complications during hospitalization. The increasing evidence for SARS CoV‐2’s impact on the central nervous system raises important questions on the long‐term consequences of this virus to patients with pre‐existing brain injury.

Real world effectiveness of tixagevimab/cilgavimab (Evusheld) in the Omicron era.

Pre-exposure prophylaxis for COVID-19 with tixagevimab/cilgavimab (T/C) received Emergency Use Authorization (EUA) based on results of a clinical trial conducted prior to the emergence of the Omicron variant. The clinical effectiveness of T/C has not been well described in the Omicron era. We examined the incidence of symptomatic illness and hospitalizations among T/C recipients when Omicron accounted for virtually all local cases. Through retrospective electronic medical record chart review, we identified patients who received T/C between January 1 -July 31, 2022 within our quaternary referral health system. We determined the incidence of symptomatic COVID-19 infections and hospitalizations due to or presumed to be caused by early Omicron variants before and after receiving T/C (pre-T/C and post-T/C). Chi square and Mann-Whitney Wilcoxon two-sample tests were used to examine differences between the characteristics of those who got COVID-19 before or after T/C prophylaxis, and rate ratios (RR) and 95% confidence intervals (CI) were calculated to assess differences in hospitalization rates for the two groups. Of 1295 T/C recipients, 105 (8.1%) developed symptomatic COVID-19 infection before receiving T/C, and 102 (7.9%) developed symptomatic disease after receiving it. Of the 105 patients who developed symptomatic infection pre-T/C, 26 (24.8%) were hospitalized, compared with six of the 102 patients (5.9%) who were diagnosed with COVID-19 post-T/C (RR = 0.24; 95% CI = 0.10-0.55; p = 0.0002). Seven of the 105 (6.7%) patients infected pre-T/C, but none of the 102 infected post-T/C required ICU care. No COVID-related deaths occurred in either group. The majority of COVID-19 cases among those infected pre-T/C treatment occurred during the Omicron BA.1 surge, while the majority of post-T/C cases occurred when Omicron BA.5 was predominant. In both groups, having at least one dose of vaccine strongly protected against hospitalization (pre-T/C group RR = 0.31, 95% CI = 0.17-0.57, p = 0.02; post-T/C group RR = 0.15; 95% CI = 0.03-0.94; p = 0.04). We identified COVID-19 infections after T/C prophylaxis. Among patients who received T/C at our institution, COVID-19 Omicron cases occurring after T/C were one-fourth as likely to require hospitalization compared to those with Omicron prior to T/C. However, due to the presence of changing vaccine coverage, multiple therapies, and changing variants, the effectiveness of T/C in the Omicron era remains difficult to assess.

Psychiatric Admission Among Migrants Before and During Pandemic: a Retrospective Study in Acute Psychiatric Ward in Bologna, Italy.

Previous evidence showed significant discrepancies in psychiatric services utilization between migrants and reference populations. Our study aims were to evaluate incidence and characteristics of psychiatric hospitalizations of migrant patients compared with reference populations and to assess how the COVID-19 pandemic affected admissions. All patients admitted to the psychiatric ward "SPDC-Malpighi" of the Bologna Mental Health Department from 01/01/2018 to 31/12/2020 were included. Differences in sociodemographic and clinical characteristics were tested by migrant status. Incidence rate ratios of hospital admissions by migrant status were estimated via Poisson regression considering population-at-risk, gender, and age-group. Migrants had higher hospitalization rates due to any psychiatric disorder (IRR = 1.16). The risk was especially pronounced among women (IRR = 1.25) and within the youngest age-group (IRR = 3.24). Young migrants had also a greater risk of compulsory admission (IRR = 3.77). Regarding admissions due to a specific diagnosis, we found relevant differences in hospitalization rates for psychosis, mood disorders, and personality disorders. Finally, migrants were more likely to be admitted via Emergency Department and less likely to be referred from a specialist. During the year of pandemic (2020) we observed an increase in the proportion of migrants admitted voluntarily or compulsorily. Migrants, especially those from the youngest age-group, had higher hospitalization rates for any disorder. Younger migrants were also at higher risk of compulsory treatment. The distribution of psychiatric admissions during the pandemic period seemed to have further increased discrepancies in mental healthcare needs and provision between migrants and the reference population. Tailored interventions and policies are urgently needed to address this issue.

Severe COVID-19 and breakthrough infections in vaccinated schizophrenia patients: A matched controlled cohort study

IntroductionSchizophrenia patients are at an increased risk for severe SARS-CoV-2 illness. Recent studies indicate that vaccines reduce morbidity gaps between schizophrenia patients and the general population; nonetheless, the ongoing emergence of COVID-19 variants and the increased frequency of breakthrough infections might lead to changes in these risk profiles.ObjectivesIn this study we aimed to bridge this gap by assessing the risk of COVID-19 infection, hospitalization, and mortality among vaccinated individuals with schizophrenia, as compared to vaccinated individuals with no schizophrenia, matched for age, sex, and vaccination coverage (first, second, and booster) throughout the first year of the vaccination plan.MethodsThe study included 50,958 vaccinated individuals: 25,479 individuals with schizophrenia and 25,479 without schizophrenia. Data were derived from the databases of Clalit Health Services, the largest healthcare organization in Israel.ResultsFindings indicated that differences among vaccinated schizophrenia patients and controls were non-significant after adjusting for infection (HR = 0.93, 95%CI 0.84-1.03, p = 0.14) and mortality rates (HR = 2.18, 95%CI 0.80-5.90, p = 0.12). Nonetheless, differences in rates of hospitalization remained significant even after controlling for demographic and clinical factors (HR = 2.68, 95%CI 1.75-4.08, p&lt;0.001). A longitudinal assessment of relative risk indicated that the rate ratio of differences between the groups increased during the fourth infection wave of the B.1.617.2 (delta) variant across all parameters, with schizophrenia patients demonstrating higher relative risk of hospitalization (RR = 4.19, 95%CI 2.41-7.23) and mortality (RR = 7.61, 95%CI 0.93-61.89) during the relevant periods.ConclusionsThese findings suggest that vaccination coverage is effective in narrowing overall morbidity and mortality gaps; nonetheless, individuals with schizophrenia are still at risk for severe COVID-19 outcomes.Disclosure of InterestNone Declared