Disease-specific Hospital Research Articles

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.

LoSNet: A Tailored Deep Neural Network Framework for Precise Length of Stay Prediction in Disease-Specific Hospitalization

During the COVID-19 pandemic, the healthcare sector faced unprecedented challenges in effectively managing hospital resources. A crucial aspect of resource planning and allocation is the ability to predict the expected length of a patient’s stay. Detecting whether a patient requires extended hospitalization or a shorter stay becomes vital for efficient hospital resource allocation and utilization. This paper aims to build a deep learning-based analytical model named LoSNet that predicts the length of stay for each patient at the time of admission to the Hospital. The early prediction of the length of stay requirement would aid healthcare professionals in optimizing the utility of hospital beds and other resources. In this direction, this paper compares the prediction ability of various machine-learning models including Random Forest, Decision Tree, Logistic Regression, and Naïve Bayes with a customized deep neural network model. The dataset used for this analysis includes ground truth on 3,18,438 patients’ length of stay categorized into eleven classes such as 0-10 days being one class, 11-20 days being another class, and so on to more than 100 days. The methodology employed in this study involves data collection, data transformation, and training LoSNet, a deep neural network with no attention mechanisms. The results indicate impressive performance over other models and a random classifier, with a cross-entropy loss of 1.531 and an accuracy of 0.408 in predicting hospitalization durations in an 11-class classification setup, highlighting the framework’s effectiveness in healthcare management.

A comparison of methods for the measurement of adherence to antihypertensive multidrug therapy and the clinical consequences: a retrospective cohort study using the Korean nationwide claims database.

In observational studies, the methods used to measure medication adherence may affect assessments of the clinical outcomes of drug therapy. This study estimated medication adherence to multidrug therapy in patients with hypertension using different measurement methods and compared their impacts on clinical outcomes. This was a retrospective cohort study using the Korean National Health Insurance Service-National Sample Cohort database (2006-2015). Adults diagnosed with hypertension who initiated multidrug antihypertensive therapy in the index year 2007 were included. Adherence was defined as over 80% compliance. Adherence to multidrug antihypertensive therapy was measured in 3 ways using the proportion of days covered (PDC) with 2 approaches to the end-date of the study observations: PDC with at least one drug (PDCwith≥1), PDC with a duration weighted mean (PDCwm), and the daily polypharmacy possession ratio (DPPR). The primary clinical outcome was a composite of cardiovascular and cerebrovascular disease-specific hospitalizations or all-cause mortality. In total, 4,226 patients who initiated multidrug therapy for hypertension were identified. The mean adherence according to the predefined measurements varied from 72.7% to 79.8%. Non-adherence was associated with an increased risk of a primary outcome. The hazard ratios (95% confidence intervals, CIs) primary outcomes varied from 1.38 (95% CI, 1.19 to 1.59) to 1.44 (95% CI, 1.25 to 1.67). Non-adherence to multidrug antihypertensive therapy was significantly associated with an increased risk of a primary clinical outcome. Across the varying estimates based on different methods, medication adherence levels were similar. These findings may provide evidence to support decision-making when assessing medication adherence.

Summarizing multiple networks based on their underlying clustering structure to guide joint clustering of hospitals admissions

Healthcare services planning and regulation involve finding patterns in hospitals admission to detect their needs in a timely manner. Admission patterns for certain diseases are more precise than a general pattern including all diseases. Towards the objective of clustering hospitals based on their monthly admission behavior for different diseases, this study investigates the similarity among multiple disease-specific hospital networks to guide a joint clustering of hospitals. In this paper, the disease super network is generated from health records data using graph matching instead of relying on biomedical literature that is used in the previous work. The health records-based disease network is constructed using more than 7 million discharge records that are extracted from the California State Inpatient Database between 2009 and 2011. Comparison of the disease network results obtained using health records of different years shows consistency in clustering structure despite temporal changes in admission data. We show that the joint clustering guided by the health records-based similarity improves clustering group homogeneity measures as compared to the clustering guided by literature-based similarity (average homogeneity 53% vs 41%, respectively). The code used to conduct this work is available at https://github.com/Nouf-Barakati/JointCLusteringofHospitals.

Nationwide hospital admission data statistics and disease-specific 30-day readmission prediction.

PurposeHospital readmission prediction uses historical patient visit data to train machine learning models to predict risk of patients being readmitted after the discharge. Data used to train models, such as patient demographics, disease types, localized distributions etc., play significant roles in the model performance. To date, many methods exist for hospital readmission prediction, but answers to some important questions still remain open. For example, how will demographics, such as gender, age, geographic, impact on readmission prediction? Do patients suffering from different diseases vary significantly in their readmission rates? What are the nationwide hospital admission data characteristics? and how do hospital speciality, ownership, and locations impact on their readmission rates? In this study, we carry systematic investigations to answer the above questions, and propose a predictive modeling framework to predict disease-specific 30-day hospital readmission.MethodsWe first implement statistics analysis by using National Readmission Databases (NRD) with over 15 million hospital visits. After that, we create features and disease-specific readmission datasets. An ensemble learning framework is proposed to conduct hospital readmission prediction and Friedman test and Nemenyi post-hoc test is used to validate our proposed method.ResultsUsing National Readmission Databases (NRD), with over 15 million hospital visits, as our testbed, we summarize nationwide patient admission data statistics, in related to demographic, disease types, and hospital factors. We use feature engineering to design 526 representative features to model each patient visit. Our studies found that readmission rates vary significantly from diseases to diseases. For six diseases studied in our research, their readmission rates vary from 1.832 (Pneumonia) to 8.761% (Diabetes). Using random sampling and voting approaches, our study shows that soft voting outperforms hard voting on majority results, especially for AUC and balanced accuracy which are the main measures for imbalanced data. Random under sampling using 1.1:1 for negative:positive ratio achieves the best performance for AUC, balanced accuracy, and F1-score.ConclusionThis paper carries out systematic studies to understand US nationwide hospital readmission data statistics, and further designs a machine learning framework for disease-specific 30-day hospital readmission prediction. Our study shows that hospital readmission rates vary significantly with respect to different disease types, gender, age groups, any other factors. Gradient boosting achieves the best performance for disease specific hospital readmission prediction.

The Impact of COVID-19 on Pediatric Healthcare Utilization and Disease Dynamics: An Observational Study From Western Odisha.

IntroductionChildren were affected by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus during the first and second waves of the coronavirus disease 2019 (COVID-19 pandemic. Although the severity was less in children, the fear of contracting SARS-CoV-2 at the hospital might have led to a delayed health-seeking attitude. The objective of the study was tailored around emergency health care utilization affecting outcomes. The study was done to compare the trend concerning the utilization of pediatric healthcare and immunization services, changes in the profile of diseases, and the outcomes between the pre-COVID-19 period and the COVID-19 period in a tertiary care hospital.MethodsThis retrospective observational study was conducted in a tertiary care hospital in western Odisha. Data were collected retrospectively from different hospital registers (outpatient register, inpatient register, and immunization records) and analyzed between the pre-COVID-19 period (April 2019 to March 2020) and the COVID-19 period (April 2020 to March 2021) with appropriate statistical procedures.ResultsThere was a 60%, 49.8%, 51.1%, and 25.5% reduction in outpatient attendance, indoor pediatric admissions, nutritional rehabilitation centre admissions, and newborn admissions, respectively in COVID-19 period as compared to the pre-COVID-19 period. The pediatric bed occupancy rate was reduced by 54.5%. Unfavourable outcomes (death, left against medical advice, and referral) were significantly high in hospitalized children (24% vs. 18.1%, p < 0.001). The reduction in hospitalization due to common conditions like acute respiratory tract infections, bronchiolitis and asthma, and acute gastroenteritis during COVID-19 was 76.5%, 86.2%, and 39.5%, respectively. A higher percentage of low birth weight and preterm (<34 weeks) babies were admitted to special neonatal care unit (SNCU) during the pandemic (61.8% vs. 58%, p < 0.05; 18.9% vs. 15.8%; p < 0.05 respectively).ConclusionThe COVID-19 pandemic and the associated lockdown led to a significant decrease in pediatric and neonatal healthcare utilization. The impact of lower care-seeking and attendance resulting in poor patient-related outcomes (malnutrition, upsurge of vaccine-preventable diseases, disease-specific hospitalization, and mortality) post-pandemic is a real threat.

Technical feasibility and perioperative outcome of laparoscopic resection rectopexy with natural orifice specimen extraction (NOSE) and intracorporeal anastomosis (ICA)

PurposeLaparoscopic rectosigmoid resection rectopexy (LRR) is the most effective treatment of obstructive defecation syndrome but is associated with a higher postoperative morbidity compared to transanal approaches. Natural orifice specimen extraction (NOSE) has been described as a promising technique to lower morbidity in colorectal cancer surgery. In this study, we analyze the technical challenges of adapting this technique to LRR and compare the perioperative results to the conventional laparoscopic technique with specimen extraction via minilaparotomy and extracorporeal anastomosis.MethodsWe retrospectively analyzed 45 patients who underwent laparoscopic rectosigmoid resection rectopexy due to obstructive defecation syndrome at our institutions. From September 2020 to July 2021, we treated 17 consecutive patients with NOSE-LRR and compared the results to a historic cohort of 28 consecutive patients treated with conventional laparoscopic rectosigmoid resection rectopexy plus minilaparotomy (LAP-LRR) for specimen extraction between January 2019 and July 2020. Assessed were patient- and disease-specific parameters, operative time, hospital and postoperative complications and subjective patient satisfaction after 6 months of follow-up.ResultsBoth groups were comparable in terms of gender distribution, age, and comorbidities. The median operating time was similar and the perioperative morbidity was comparable in both groups. The length of stay in hospital was significantly shorter in the NOSE-LRR group (median 6 vs 8 days).ConclusionNOSE-LRR can be implemented safely, performed in a comparable operating time, and is associated with a comparable rate of postoperative complications. The technique offers the a potentially fast postoperative recovery compared to the conventional laparoscopic technique.

Real-World Evaluation of Calcimimetics for the Treatment of Secondary Hyperparathyroidism in Chronic Kidney Disease, in an Italian Clinical Setting.

This Italian real-world data analysis evaluated the pharmaco-utilization of calcimimetics, cinacalcet or etelcalcetide, and the economic burden of secondary hyperparathyroidism (SHPT) in chronic kidney disease (CKD) patients. From 1 January 2010 to 30 June 2020, adult patients with: (i) ≥1 prescription of etelcalcetide or cinacalcet, (ii) ≥3 hemodialysis/week, and (iii) without parathyroidectomy, were included. Based on the drug firstly prescribed, patients were allocated into etelcalcetide- and cinacalcet-treated cohorts, and the propensity score matching (PSM) methodology was applied to abate potential cohorts’ unbalances. Overall, 1752 cinacalcet- and 527 etelcalcetide-treated patients were enrolled. In cinacalcet- and etelcalcetide-treated patients, respectively, the most frequent comorbidities were hypertension (75.3% and 74.4%), diabetes mellitus (21.0% and 21.3%), and cardiovascular disease (18.1% and 13.3%, p < 0.01). In covariate-balanced cohorts, the treatment adherence and persistence rates were significantly higher in the etelcalcetide-treated (80.1% and 62.7%, respectively) vs. cinacalcet-treated cohort (62.3% and 54.7%, respectively). After PSM, the total costs for the management of cinacalcet- and etelcalcetide-treated patients, respectively, averaged EUR 23,480 and EUR 22,958, with the disease-specific drug costs (EUR 2629 vs. EUR 2355, p < 0.05) and disease-specific hospitalization costs (EUR 1241 vs. EUR 855) in cinacalcet- and etelcalcetide-treated patients. These results showed that, in etelcalcetide-treated patients, a higher treatment adherence and persistence was found, with disease-specific costs savings, especially those related to drugs and hospitalizations.

Long-Term Risk of Hospitalization for Somatic Diseases Among Survivors of Childhood Acute Lymphoblastic Leukemia.

BackgroundSurvivors of childhood acute lymphoblastic leukemia (ALL) may be at increased long-term risk of hospitalization for somatic diseases. However, large population-based cohort studies with risk estimates for survivors successfully cured without experiencing a relapse or requiring hematopoietic stem cell transplantation (HSCT) are lacking.MethodsDanish and Swedish patients diagnosed with ALL before age 20 years in 1982-2008 were identified in the national cancer registries. Five-year survivors and matched population comparisons without childhood cancer were followed for hospitalization for 120 somatic disease categories in the national hospital registries from 5 years postdiagnosis until 2017, and disease-specific hospitalization rate ratios (RR) were calculated. The mean cumulative count method was used to estimate the mean number of multiple and recurrent disease-specific hospitalizations per individual.ResultsA total of 2024 5-year survivors and 9797 population comparisons were included. The overall hospitalization rate was more than twice as high compared with comparisons (RR = 2.30, 95% confidence interval [CI] = 2.09 to 2.52). At 30 years postdiagnosis, the mean cumulative hospitalization count was 1.69 (95% CI = 1.47 to 1.90) per survivor and 0.80 (95% CI = 0.73 to 0.86) per comparison. In the subcohort without relapse or HSCT (n = 1709), the RR was 1.41 (95% CI = 1.27 to 1.58).ConclusionsSurvivors of childhood ALL were at increased long-term risk for disease-specific hospitalizations; however, in survivors without relapse or HSCT, the rate was only modestly higher than in population comparisons without a childhood cancer. The absolute mean numbers of multiple and recurrent hospitalizations were generally low.

Increased aortic repair in Germany correlates with reduction of death caused by aortic aneurysms but not aortic dissections.

We asked if there is a significant correlation between the increasing trend in aortic repair (AR) and decreasing aortic aneurysm (AA) and aortic dissection (AD) mortality? Therefore, we retrospectively analyzed all aortic repairs in patients with AA and AD and its correlation with disease-specific death rates and hospitalizations for ruptured AA and AD in Germany. We retrieved the number of cases hospitalized for AA and AD as well as the procedures in these cases from the Federal Bureau of Statistics (DRG statistics) and death rates from the national mortality statistic published by the Federal Statistical Office in Germany for the years 2006-2017. From 2006 to 2017, the total number of hospitalized cases admitted with principal diagnosis of AA increased by 25.8% and that of AD by 56.7%. That of cases with the principal diagnosis of ruptured AA (rAA) remained unchanged (-2.5%) and that with rAD increased by 54.6%. The number of (open and endovascular) procedures in cases hospitalized for AA increased by 39.4% and for AD by 126.4%. The age-adjusted death rates in Germany for AA decreased from 4.0 to 2.9 per 100,000 inhabitants and that for AD increased from 1.0 to 1.4. The decrease in death attributed to AA cases can be described by linear regression as y = -0.0003*y + 6.7076 (p < 0.0001). Accepting this association between increased elective procedures and reduced AA mortality, each/all 1000 procedures save 0.3 lives per 100,000 inhabitants. Despite increasing numbers of AR for AA and AD, only the mortality rate for all AAs decreased, while we did not observe a decrease in overall mortality of AD in Germany.

Integrated disease management interventions for patients with chronic obstructive pulmonary disease.

People with chronic obstructive pulmonary disease (COPD) show considerable variation in symptoms, limitations, and well-being; this often complicates medical care. A multi-disciplinary and multi-component programme that addresses different elements of care could improve quality of life (QoL) and exercise tolerance, while reducing the number of exacerbations. To compare the effectiveness of integrated disease management (IDM) programmes versus usual care for people with chronic obstructive pulmonary disease (COPD) in terms of health-related quality of life (QoL), exercise tolerance, and exacerbation-related outcomes. We searched the Cochrane Airways Group Register of Trials, CENTRAL, MEDLINE, Embase, and CINAHL for potentially eligible studies. Searches were current as of September 2020. Randomised controlled trials (RCTs) that compared IDM programmes for COPD versus usual care were included. Interventions consisted of multi-disciplinary (two or more healthcare providers) and multi-treatment (two or more components) IDM programmes of at least three months' duration. Two review authors independently assessed trial quality and extracted data. If required, we contacted study authors to request additional data. We performed meta-analyses using random-effects modelling. We carried out sensitivity analyses for the quality of included studies and performed subgroup analyses based on setting, study design, dominant intervention components, and region. Along with 26 studies included in the 2013 Cochrane Review, we added 26 studies for this update, resulting in 52 studies involving 21,086 participants for inclusion in the meta-analysis. Follow-up periods ranged between 3 and 48 months and were classified as short-term (up to 6 months), medium-term (6 to 15 months), and long-term (longer than 15 months) follow-up. Studies were conducted in 19 different countries. The mean age of included participants was 67 years, and 66% were male. Participants were treated in all types of healthcare settings, including primary (n =15), secondary (n = 22), and tertiary care (n = 5), and combined primary and secondary care (n = 10). Overall, the level of certainty of evidence was moderate to high. We found that IDM probably improves health-related QoL as measured by St. George's Respiratory Questionnaire (SGRQ) total score at medium-term follow-up (mean difference (MD) -3.89, 95% confidence interval (CI) -6.16 to -1.63; 18 RCTs, 4321 participants; moderate-certainty evidence). A comparable effect was observed at short-term follow-up (MD -3.78, 95% CI -6.29 to -1.28; 16 RCTs, 1788 participants). However, the common effect did not exceed the minimum clinically important difference (MCID) of 4 points. There was no significant difference between IDM and control for long-term follow-up and for generic QoL. IDM probably also leads to a large improvement in maximum and functional exercise capacity, as measured by six-minute walking distance (6MWD), at medium-term follow-up (MD 44.69, 95% CI 24.01 to 65.37; 13 studies, 2071 participants; moderate-certainty evidence). The effect exceeded the MCID of 35 metres and was even greater at short-term (MD 52.26, 95% CI 32.39 to 72.74; 17 RCTs, 1390 participants) and long-term (MD 48.83, 95% CI 16.37 to 80.49; 6 RCTs, 7288 participants) follow-up. The number of participants with respiratory-related admissions was reduced from 324 per 1000 participants in the control group to 235 per 1000 participants in the IDM group (odds ratio (OR) 0.64, 95% CI 0.50 to 0.81; 15 RCTs, median follow-up 12 months, 4207 participants; high-certainty evidence). Likewise, IDM probably results in a reduction in emergency department (ED) visits (OR 0.69, 95%CI 0.50 to 0.93; 9 RCTs, median follow-up 12 months, 8791 participants; moderate-certainty evidence), a slight reduction in all-cause hospital admissions (OR 0.75, 95%CI 0.57 to 0.98; 10 RCTs, median follow-up 12 months, 9030 participants; moderate-certainty evidence), and fewer hospital days per person admitted (MD -2.27, 95% CI -3.98 to -0.56; 14 RCTs, median follow-up 12 months, 3563 participants; moderate-certainty evidence). Statistically significant improvement was noted on the Medical Research Council (MRC) Dyspnoea Scale at short- and medium-term follow-up but not at long-term follow-up. No differences between groups were reported for mortality, courses of antibiotics/prednisolone, dyspnoea, and depression and anxiety scores. Subgroup analysis of dominant intervention components and regions of study suggested context- and intervention-specific effects. However, some subgroup analyses were marked by considerable heterogeneity or included few studies. These results should therefore be interpreted with caution. This review shows that IDM probably results in improvement in disease-specific QoL, exercise capacity, hospital admissions, and hospital days per person. Future research should evaluate which combination of IDM components and which intervention duration are most effective for IDM programmes, and should consider contextual determinants of implementation and treatment effect, including process-related outcomes, long-term follow-up, and cost-effectiveness analyses.

Initial treatment of diabetes in Italy. A nationwide population-based study from of the ARNO Diabetes Observatory

Background and aimsTo investigate diabetes treatment initiation and continuation in the next sixth months in newly diagnosed Italian subjects. Methods and resultsWe analyzed administrative claims of 11,300,750 Italian residents. Subjects with incident diabetes were identified by glucose lowering drug prescriptions, disease-specific co-payment exemptions and hospital discharge codes occurring in 2018 but not in 2017. Incident cases were 65,932 of whom 91.4% received the prescription of a glucose lowering drug. Among the latter, those receiving a prescription of a noninsulin medication but no insulin were 84.8%, those receiving a prescription of insulin only were 9.4%, and those receiving prescriptions of both insulin and noninsulin drugs were 5.8%. Metformin was the most frequently drug initially prescribed in noninsulin treated subjects (~85%) and sulphonylurea receptor (SUR) agonists collectively ranked as second (~13%). Lispro (35%) and glargine (34%) were the most frequently prescribed molecules in subjects who were insulin treated. Differences in prescriptions were found in age categories, with increased use of SUR agonists across decades. In the first six months, as many as 50% of noninsulin treated patients continued with the initial drug, ~15% added a second agent, ~5% switched to another medication, and ~30% discontinued any glucose lowering treatment. ConclusionsThese data document that current guidelines are often neglected because prescriptions of SUR agonists as first agent are still quite common and insulin is prescribed more than expected. They point out the urgent need to improve the dissemination and implementations of guidelines in diabetes care.

Human papillomavirus in Italy: retrospective cohort analysis and preliminary vaccination effect from real-world data

IntroductionThe objective of this study was to estimate the lifetime risk of hospitalization associated with all major human papillomavirus (HPV)-related diseases in Italy. Moreover, a preliminary vaccination effect was also performed.MethodsA retrospective, nonrandomized, observational study was developed based on patients hospitalized between 2006 and 2018 in Italy. All hospitalizations were identified through administrative archives, according to the International Classification of Diseases (ICD-9 CM). Information related to the hospital discharges of all accredited public and private hospitals, both for ordinary and day care regimes, was taken into account. We included hospitalizations related to resident patients presenting one of the ICD-9-CM codes as primary or secondary diagnosis: genital warts (GW); ‘cervical intraepithelial neoplasia (CIN)’ (067.32–067.33); ‘condyloma acuminatum’ (078.11); ‘anal cancers’ (AC) (154.2–154.8); oropharyngeal cancers (OC): ‘oropharyngeal cancer’(146.0–146.9) and ‘head, face and neck cancers’ (171.0); genital cancers (GC): ‘penis cancer’ (187.1–187.9) and ‘cervical cancer’ (180.0–180.9). Data were stratified by birth year and divided into two groups: (a) cohort born before 1996 (not vaccinable) and (b) cohort born after 1997 (vaccinable—first cohort that could be vaccinated at the beginning of immunization schedule in girls since 2008 in Italy). Disease-specific hospitalization risks for both groups were estimated by sex, year and age.ResultsEpidemiological data demonstrate that the peak hospitalization risk occurred at 24–26 years of age for GW (both male and female); 33–41 and 47–54 years for AC males and females, respectively; 53–59 and 52–58 years for OC males and females, respectively; and 54–60 and 39–46 years for GC males and females, respectively. Focusing on GW and GC, vaccinable females demonstrate a significant reduction in hospitalization risks (− 54% on average) compared to nonvaccinable females until 21 years of age (maximum follow-up available for girls born after 1997). Comparing the same birth cohort of males, no differences in hospitalization risk were found.ConclusionsThese results support the importance of primary prevention strategies in Italy and suggest that increased VCRs and time of observation (genital cancers for which vaccination is highly effective, have a latency of some decades) will provide useful information for decision-makers.

Incidence of diabetes mellitus in Italy in year 2018. A nationwide population-based study of the ARNO Diabetes Observatory

Backgrounds and aimsTo assess incidence of diabetes in Italy in 2018 by the use of administrative claims from several million residents. Differences in rates in men and women across decades of age were investigated. Incident rates of insulin or noninsulin treated subjects were also examined. Methods and resultsWe analyzed administrative healthcare claims of 11,300,750 subjects monitored by the ARNO Diabetes Observatory. Incident cases of diabetes were identified by glucose lowering drug prescriptions, disease-specific co-payment exemptions and hospital discharge codes related to diabetes occurring in 2018 but not in 2017.We identified 697,208 subjects with ascertained diabetes. Incident cases were 65,932, with a rate of 5.83 per 1000 person-years (p-y). Incidence of drug-treated diabetes (n = 60,271) was 5.33 per 1000 p-y. Subjects receiving only insulin prescriptions were 5652 (rate 0.50 per 1000 p-y) and those receiving only prescriptions of noninsulin medications were 51,085 (rate 4.52 per 1000 p-y). Incidence rates progressively increased across decades until age 80 and then dropped by 25–30%. Overall, incident rates were generally higher in women aged 11–40 and in men aged ≥51. ConclusionsRecent cases represented ~10% of the population of diabetic subjects. Incidence of noninsulin-treated diabetes was almost 10-fold higher than incidence of insulin-treated diabetes. Substantial differences in incidence rates were observed in men and women of several decades of age: women more affected in adolescence and young adult age, men more affected in mature and advanced age. These data provide further understanding on the epidemiological burden of the disease in Italy.

Fine Particle Exposure and Clinical Aggravation in Neurodegenerative Diseases in New York State.

Background:Adult-onset neurodegenerative diseases affect millions and negatively impact health care systems worldwide. Evidence suggests that air pollution may contribute to aggravation of neurodegeneration, but studies have been limited.Objective:We examined the potential association between long-term exposure to particulate matter in aerodynamic diameter [fine particulate matter ()] and disease aggravation in Alzheimer’s (AD) and Parkinson’s (PD) diseases and amyotrophic lateral sclerosis (ALS), using first hospitalization as a surrogate of clinical aggravation.Methods:We used data from the New York Department of Health Statewide Planning and Research Cooperative System (SPARCS 2000–2014) to construct annual county counts of first hospitalizations with a diagnosis of AD, PD, or ALS (total, urbanicity-, sex-, and age-stratified). We used annual concentrations estimated by a prediction model at a resolution, which we aggregated to population-weighted county averages to assign exposure to cases based on county of residence. We used outcome-specific mixed quasi-Poisson models with county-specific random intercepts to estimate rate ratios (RRs) for a 1-y exposure. We allowed for nonlinear exposure–outcome relationships using penalized splines and accounted for potential confounders.Results:We found a positive nonlinear association that plateaued above (, 95% CI: 1.04, 1.14 for a increase from 8.1 to ). We also found a linear positive association (, 95% CI: 1.01, 1.09 per increase), and suggestive evidence of an association with AD. We found effect modification by age for PD and ALS with a stronger positive association in patients of age but found insufficient evidence of effect modification by sex or urbanization level for any of the outcomes.Conclusion:Our findings suggest that annual increase in county-level concentrations may contribute to clinical aggravation of PD and ALS. Importantly, the average annual concentration in our study was , below the current American national standards, suggesting the standards may not adequately protect the aging population. https://doi.org/10.1289/EHP7425

CLINICAL OUTCOMES AND HEALTHCARE RESOURCE UTILIZATION IN ADULT HIGH-RISK PATIENTS WITH NONCYSTIC FIBROSIS BRONCHIECTASIS USING HIGH FREQUENCY CHEST WALL OSCILLATION AND POSITIVE EXPIRATORY PRESSURE THERAPY

SESSION TITLE: Obstructive Lung Disease Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: In current clinical practice, airway clearance therapy is important in the overall management of patients with bronchiectasis. We aimed to compare healthcare resource utilization (HCRU) and costs among adults with high risk bronchiectasis after initiation of high frequency chest wall oscillation (HFCWO) and positive expiratory pressure (PEP) therapy. METHODS: A pre-post analysis of two mutually exclusive cohorts was conducted using the PharMetrics Health Plan Claims Database. Adult patients with Non-CF bronchiectasis, a high-risk Bronchiectasis Aetiology and Comorbidity Index (BACI) score of >6, and a claim for HFCWO or PEP between 2009 - 2018 were included. Clinical outcomes, HCRU and costs were measured in the 12-months pre- and post-index periods in each cohort. Comparisons to baseline data were conducted using McNemar’s test for categorical and Wilcoxon signed-rank test for continuous variables. RESULTS: In the HFCWO cohort (N=147), the mean age was 56.4 years (SD=14); 64% were females. COPD (88%) and asthma (72%) were common comorbidities. At one-year follow-up from initiation of HFCWO therapy, there was a statistically significant reduction in mean all-cause (22%, P=0.04) and disease-specific hospitalizations, (73%, P=0.01) compared to baseline. All-cause and disease-specific bronchoscopies reduced by 69% (P<0.0001) and 75% (P<0.001), respectively. Chest X-ray use reduced by 25% (P<0.001) and 38% (P=0.02), respectively. Disease-specific laboratory use decreased by 31% (P<0.01). Oral and IV antibiotics use reduced by 8% (P=0.03) and 63% (P=0.01), respectively. Pulmonologist visits reduced by 11% (P<0.01). Disease-specific ED visits trended down. All-cause inpatient costs decreased significantly from $23,774 to $12,028 (P<.01). In the PEP cohort (N=138), mean age was 63.7 years (SD=14); 59% were females. COPD (74%) and asthma (58%) were common comorbidities. At one-year follow-up from initiation of PEP therapy, mean all-cause and disease-specific hospitalizations trended up. Physician office visits increased by 17% (P=0.03). Use of hypertonic saline nebulization increased (P=0.01). Oral antibiotic use reduced by 11% (P=0.02) while IV antibiotic use did not change. All-cause and disease-specific bronchoscopies trended down. Disease-specific ED visits, chest X-ray, and laboratory use all trended up. Mean disease specific outpatient costs increased (P=0.04). Median disease-specific total costs increased significantly (P=0.04) CONCLUSIONS: In high risk bronchiectasis patients, HFCWO significantly improves clinical outcomes by reducing hospitalizations, antibiotics use and other health care resource utilization measures. High risk bronchiectasis patients started on PEP therapy had less favorable outcomes. CLINICAL IMPLICATIONS: In bronchiectasis patients with a high risk BACI score, HFCWO therapy should be considered for airway clearance as it has been shown to improve clinical and economic outcomes. DISCLOSURES: Advisory Board relationship with Insmed Please note: $1001 - $5000 by Ashwin Basavaraj, source=Web Response, value=Honoraria Consultant relationship with Hill-Rom Please note: $1001 - $5000 by Ashwin Basavaraj, source=Web Response, value=Consulting fee Employee relationship with Hill-Rom Company Inc. Please note: >$100000 Added 06/01/2020 by Brian Becker, source=Web Response, value=Salary Stock Ownership relationship with Hill-Rom Company Inc. Please note: $20001 - $100000 Added 06/01/2020 by Brian Becker, source=Web Response, value=Stock Ownership No relevant relationships by Mitch Dekoven, source=Web Response Employee relationship with Hillrom Please note: >$100000 Added 06/01/2020 by Angela Murray, source=Web Response, value=Salary No relevant relationships by Drishti Shah, source=Web Response Employee relationship with Hillrom Please note: >$100000 Added 06/01/2020 by Carlos Urrea, source=Web Response, value=Salary Employee relationship with Hill-Rom Inc Please note: >$100000 Added 05/31/2020 by Missy Wanjala, source=Web Response, value=Salary

TWO YEAR CLINICAL OUTCOMES AND HEALTHCARE RESOURCE UTILIZATION IN ADULT PATIENTS WITH HIGH-RISK NONCYSTIC FIBROSIS BRONCHIECTASIS ON HIGH FREQUENCY CHEST WALL OSCILLATION

SESSION TITLE: Obstructive Lung Disease Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: In current clinical practice, High Frequency Chest Wall Oscillation (HFCWO) is prescribed for patients with moderate to severe Non-CF bronchiectasis. This study aimed to evaluate the clinical and economic outcomes of adult bronchiectasis patients with a high five-year morbidity and mortality risk, using HFCWO for airway clearance. METHODS: A Pre-Post study was conducted using the PharMetrics Health Plan Claims Database. Adult patients with bronchiectasis and a claim for HFCWO in 2009 to 2018 were included in the study. High risk status was determined by a Bronchiectasis Aetiology and Comorbidity Index (BACI) score of >6. All-cause and disease-specific healthcare care resource utilization and costs, as well as clinical outcomes, were measured at one and two-year follow-up periods, and compared to baseline. McNemar’s test was used for categorical variables, while Wilcoxon signed-rank test was used for continuous variables. RESULTS: Eighty patients met inclusion criteria. The mean age was 58 [13] years; 66.3% were female. Fifty-one percent of patients were diagnosed by a pulmonologist, who also prescribed 31.3% of devices. The proportion of all-cause oral antibiotic use reduced by 13% (P=0.03) in year two compared to baseline. IV antibiotic use trended down. All cause ER visits reduced by 37% in the second year compared to baseline (P=0.01). Laboratory use reduced by 5% in both years (P=0.05). Use of chest X-ray reduced by 21% in one-year follow-up(P=0.02) and 24% in year two (P=0.01). Bronchoscopy use reduced by 63% in one-year follow-up (P<0.01) and 68% in year two (P<0.001). There was a downward trend in all-cause hospitalizations in both years, compared to baseline. The proportion of disease specific physician office visits reduced by 13% (P=0.02) in one-year follow-up and 21% (P<0.01) in year two, compared to baseline. Laboratory use reduced by 33% in one-year follow-up (P=0.02) and 60% (P<.0001) in year two. Radiology use reduced by 43% in one-year follow-up (P<0.01) and 31% in year two (P<0.01). Bronchoscopy use reduced by 82% in one-year follow-up (P<0.01) and 91% in year two (P<0.01). Ancillary services use increased in year one by 19% (P<0.01) but reduced in year two by 17% (P=0.04). There was a trend towards reduced disease-specific hospitalizations in both the first and second year, compared to baseline. A trend towards reduced total all-cause costs in one-year and two-year follow-up was seen, compared to baseline. Disease-specific costs increased from a baseline of $4,811 to $11,633 in the first year (P<0.0001), likely due to device costs, then reduced significantly in the second year to $2,793 (P=0.04). CONCLUSIONS: In patients with bronchiectasis at high risk of morbidity and mortality, initiation of HFCWO therapy results in improvement in clinical and economic outcomes. CLINICAL IMPLICATIONS: Our findings lend support to the routine use of HFCWO in high risk bronchiectasis patients. DISCLOSURES: Advisory Board relationship with Insmed Please note: $1001 - $5000 by Ashwin Basavaraj, source=Web Response, value=Honoraria Consultant relationship with Hill-Rom Please note: $1001 - $5000 by Ashwin Basavaraj, source=Web Response, value=Consulting fee Employee relationship with Hill-Rom Company Inc. Please note: >$100000 Added 06/01/2020 by Brian Becker, source=Web Response, value=Salary Stock Ownership relationship with Hill-Rom Company Inc. Please note: $20001 - $100000 Added 06/01/2020 by Brian Becker, source=Web Response, value=Stock Ownership No relevant relationships by Mitch Dekoven, source=Web Response Employee relationship with Hillrom Please note: >$100000 Added 06/01/2020 by Angela Murray, source=Web Response, value=Salary No relevant relationships by Drishti Shah, source=Web Response Employee relationship with Hillrom Please note: >$100000 Added 06/01/2020 by Carlos Urrea, source=Web Response, value=Salary Employee relationship with Hill-Rom Inc Please note: >$100000 Added 05/31/2020 by Missy Wanjala, source=Web Response, value=Salary

A view on the quality of diabetes care in Italy and the role of Diabetes Clinics from the 2018 ARNO Diabetes Observatory

Backgrounds and aimsTo investigate relevant indicators of quality of care in a large population-based sample of people with diabetes representative of clinical practice in Italy in 2018. Methods and resultsWe analyzed data from 11,300,750 subjects. All administrative healthcare claims collected in 2018 were scrutinized to identify subjects with diabetes and investigate several indicators of quality of care. Subjects with diabetes were identified by anti-hyperglycemic drug prescriptions, disease-specific co-payment exemption and hospital discharge codes. Indicators of quality of care pertained to monitoring (HbA1c, creatinine, lipid profile, microalbuminuria, eye examination, ECG, ultrasonography of carotid and lower limb arteries) and diabetes treatment (anti-hyperglycemic agents in subjects with cardiovascular disease, CVD). Subjects attending and nonattending Diabetes Clinics were compared.We identified 697,208 individuals with diabetes. HbA1c was assessed at least once in the year in 62.7%, creatinine in 62.3%, total cholesterol in 59.6%, microalbuminuria in 34.3%. Frequency of eye examination was 8.2%, ECG 23.5%, carotid ultrasonography 14.3%, lower limb ultrasonography 7.6%. Among anti-hyperglycemic drugs, SGLT-2 inhibitors were prescribed to ~5% and GLP-1 receptor agonists to ~5% although the proportion of subjects with CVD was ~45%. Subjects attending Diabetes Clinics had higher figures for all these monitoring and treatment indicators. ConclusionsThe implementation of national and international guidelines regarding disease monitoring and treatment is far from being satisfactory, especially among subjects nonattending Diabetes Clinics. Further efforts and investments are needed for better disseminating guidelines, more efficaciously engaging healthcare professionals and more strongly empowering the healthcare system to improve diabetes care.

Remote monitoring in peritoneal dialysis: benefits on clinical outcomes and on quality of life.

BackgroundAutomated peritoneal dialysis (APD) has been proved benefit from remote monitoring (RM), but evidences are limited. In this study, we compared clinical outcomes and quality of life (QoL) in two group of patients undergoing APD, with and without exposure of RM.MethodsThis is a retrospective cohort study, comparing outcomes in two groups of APD patients monitored during 6 months with RM (group A: n = 35) or standard care (group B: n = 38 patients). In our clinical practice, we assign the RM system to patients who live more distant from the PD center or difficulty in moving. We evaluated emergency visits, hospitalizations, peritonitis, overhydration, and dropout. QoL was assessed with the Kidney Disease Quality of life-Short Form (KDQOL-SF). We included four additional questions focused on patient’s perception of monitoring, safety and timely problems solution (Do you think that home-therapy monitoring could interfere with your privacy? Do you think that your dialysis sessions are monitored frequently enough? Do you think that dialysis-related issues are solved timely? Do you feel comfortable carrying out your home-based therapy?).ResultsThe case group presented a higher comorbidity score, according to Charlson Comorbidity Index (group A: 5.0; IQR 4.0–8.0 versus group B: 4.0; IQR 3.0–6.0) (p = 0.042). The results in group A showed a reduction in the urgent visits due to acute overhydration (group A: 0.17 ± 0.45 versus group B: 0.66 ± 1.36) (p: 0.042) and in the number of disease-specific hospitalization (group A n = 2.0; 18.2% versus group B n = 7.0; 77.8%) (p = 0.022). We did not find any difference between the two groups in terms of hospitalization because of all-cause, peritonitis, overhydration, and dropout. The analysis of KDQOL-SF subscales was similar in the two groups; on the contrary, the answers of our pointed questions have showed a significant difference between the two groups (group A: 100 IQR 87.5–100.0 versus group B 87.5; IQR 75.0–100.0) (p: 0.018).ConclusionRM improved clinical outcomes in PD patients, reducing the emergency visits and the hospitalizations, related to nephrological problems, especially in patients with higher comorbidity score. The acceptance and satisfaction of care were better in patients monitored with RM than with standard APD.

Clinical burden of diabetes in Italy in 2018: a look at a systemic disease from the ARNO Diabetes Observatory

IntroductionDiabetes is a highly prevalent disease worldwide and represents a challenge for patients and healthcare systems. This population-based study evaluated diabetes burden in Italy in 2018 by assessing all aspects...