Utilization Of Emergency Department Services Research Articles

Public Health Literacy and Emergency Department Utilization in Saudi Arabia: A Cross-Sectional Study.

Health literacy (HL) is the degree in which individuals are able to access, comprehend, and use publicly available health resources and services. A previous study was done in the Kingdom of Saudi Arabia (KSA) assessing the prevalence of HL, the study shows that almost half of KSA residents had limited HL. Most studies that show the level of HL and its relationship to emergency department (ED) utilization were conducted outside KSA. This study aims to assess the association between HL and utilization of ED services and to estimate the prevalence, factors, and outcomes of low HL in KSA. A cross-sectional study was conducted among 903 participants in KSA over a period of 2 months (April and May 2023) using an online survey. Participants were asked about sociodemographic characteristics (age, sex, nationality, marital status, education, work status, income), associated factors (chronic diseases, psychiatric disorders, Covid-19 infection, Covid-19 vaccination, ED visits), and Health Literacy (read, access, understand, evaluation, decision). A health literacy instrument for adults (HELIA), which consists of the previously mentioned five subscales, was used to estimate the level of HL and its association with the risk factors. Almost 529 (58.58%) and 374 (41.42%) had limited HL and adequate HL, respectively. Participants with limited HL were mostly aged 35-45 years (61.7%), men (p < 0.05) (68.9%), divorced (65.9%), non-Saudi (69.6%), and had elementary level of education (66.7%). Participants with adequate HL had master's and PhD degree (48.1%), were healthcare students or graduates (62.8%, p < 0.05), had an income >30 thousand riyals (55.6%, p < 0.05), were previously infected with COVID-19 (43%), and did not visit ED in the preceding year (42.3%). A high prevalence of low HL among KSA residents was observed. There was no significant difference in ED utilization between participants who had adequate and limited HL.

Examining the Role of Self-Harm in the Relationship between Emergency Department Service Utilization and Trauma-Induced Homelessness among Homeless Individuals in Texas.

Homelessness is a complex public health problem in the United States. Current or ongoing history of trauma among individuals adds to the complexity and challenges of homelessness. Our study assessed the moderating role of self-harm in the association between emergency department (ED) service utilization and trauma-induced homelessness (TIH) among adults in Texas. Homeless adults (N = 282) who completed their baseline Vulnerability Index Service Prioritization Decision Assistance Prescreen Tool survey between February 2021 and February 2022 at a Local Mental Health Authority in Texas were selected. The outcome variable, TIH, was assessed by current period of homelessness due to experiencing trauma or abuse. The main independent variable was ED utilization, while self-harm in the past year was assessed as the moderating variable. A multivariate logistic regression with a moderation analysis was conducted while adjusting for the covariates. Individuals who utilized ED services and engaged in self-harm and risky behaviors had greater odds of experiencing current period of TIH. Male respondents were less likely to experience TIH. Finally, engaging in self-harm significantly moderated the association between ED service use and TIH. This study may help inform efforts to develop tailored interventions and promote resilience-based approaches to improve health outcomes among individuals experiencing homelessness due to TIH.

Social Determinants of Health and Pediatric Emergency Department Outcomes: A Systematic Review and Meta-Analysis of Observational Studies

Social determinants of health contribute to disparities in pediatric health and health care. Our objective was to synthesize and evaluate the evidence on the association between social determinants of health and emergency department (ED) outcomes in pediatric populations. This review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses-Equity Extension guidelines. Observational epidemiological studies were included if they examined at least 1 social determinant of health from the PROGRESS-Plus framework in relation to ED outcomes among children <18 years old. Effect direction plots were used for narrative results and pooled odds ratios (pOR) with 95% confidence intervals (CI) for meta-analyses. Fifty-eight studies were included, involving 17,275,090 children and 103,296,839 ED visits. Race/ethnicity and socioeconomic status were the most reported social determinants of health (71% each). Black children had 3 times the odds of utilizing the ED (pOR 3.16, 95% CI 2.46 to 4.08), whereas visits by Indigenous children increased the odds of departure prior to completion of care (pOR 1.58, 95% CI 1.39 to 1.80) compared to White children. Public insurance, low income, neighborhood deprivation, and proximity to an ED were also predictors of ED utilization. Children whose caregivers had a preferred language other than English had longer length of stay and increased hospital admission. Social determinants of health, particularly race, socioeconomic deprivation, proximity to an ED, and language, play important roles in ED care-seeking patterns of children and families. Increased utilization of ED services by children from racial minority and lower socioeconomic status groups may reflect barriers to health insurance and access to health care, including primary and subspecialty care, and/or poorer overall health, necessitating ED care. An intersectional approach is needed to better understand the trajectories of disparities in pediatric ED outcomes and to develop, implement, and evaluate future policies.

Self-help measures as determinants of emergency department utilization among people with and without a migration history in Germany

We analyzed whether there were differences between people with and without migration history in their implementation of self-help measures before they accessed the services of an emergency department and if there was an association between self-help measures and an appropriate utilization of emergency departments. The data basis of this secondary analysis is the EUMaR study, which was conducted from July 2018 to July 2019 and aimed to identify causes contributing to inappropriate and frequent use of emergency departments by migrants. Our study aimed to analyze the differences in self-help measures carried out by the population groups using several multiple logistic regressions. The association between self-help measures implemented and appropriate emergency department utilization was quantified using a multiple logistic regression as well as interactions. The odds of first-generation migrants visiting an emergency department on their own initiative (OR=1.28; 95% CI, 1.01-1.61) was high compared to people without migrant history. Furthermore, the odds of their doing something by themselves against their complaints (OR=0.70; 95% CI, 0.56-0.86) were low. The odds of appropriate utilization of emergency services by respondents who self-initiated a visit to an emergency department were lower (OR=0.41; 95% CI, 0.34-0.50). The odds of appropriate utilization of emergency department services by respondents who had previously measured vital signs (e. g., blood pressure) were higher (OR=1.28; 95% CI, 1.02-1.59). Barriers to the health care system as well as to general practitioners, medicines or medical aids among first-generation migrants could explain the increased odds of their visiting an emergency department on their own and the lower odds of their doing something by themselves about their complaints. A hypothesis of our study is that measuring vital signs may help to better assess individual health status.

One-Year Medical Utilization and Mortality in Home Health and Nursing Home Care Recipients from Northern Taiwan.

Home health care (HHC) and nursing home care (NHC) are mainstays of long-term service in the aged population. Therefore, we aimed to investigate the factors associated with 1-year medical utilization and mortality in HHC and NHC recipients in Northern Taiwan. This study employed a prospective cohort design. We enrolled 815 HHC and NHC participants who started receiving medical care services from the National Taiwan University Hospital, Beihu Branch between January 2015 and December2017. Multivariate Poisson regression modeling was used to quantify the relationship between care model (HHC vs NHC) and medical utilization. Cox proportional-hazards modeling was used to estimate hazard ratios and factors associated with mortality. Compared with NHC recipients, HHC recipients had higher 1-year utilization of emergency department services [incidence rate ratio (IRR) 2.04, 95% CI 1.16-3.59] and hospital admissions (IRR 1.49, 95% CI 1.14-1.93), as well as longer total hospital length of stay (LOS) (IRR 1.61, 95% CI 1.52-1.71) and LOS per hospital admission (IRR 1.31, 95% CI 1.22-1.41). Living at home or in a nursing home did not affect the 1-year mortality. Compared with NHC recipients, HHC recipients had a higher number of emergency department services and hospital admissions, as well as longer hospital LOS. Policies should be developed to reduce emergency department and hospitalization utilization in HHC recipients.

Pain management and emergency care in adolescent patients with hidradenitis suppurativa: a cross-sectional hospital-based study.

Pain management and emergency care in adolescent patients with hidradenitis suppurativa: a cross-sectional hospital-based study.

A STUDY TO ASSESS PATIENT SATISFACTION IN EMERGENCY DEPARTMENT OF A TERTIARY CARE HOSPITAL IN KARACHI

The Emergency Department (ED) is a crucial medical treatment unit of hospital specializing in emergency medicine. EDs are responsible for providing immediate healthcare facilities to patients arriving without prior appointment. Thus, evaluating patient satisfaction is of immense importance for efficient service delivery. Very few studies are found in Pakistan, related to patients’ satisfaction and utilization of ED services both from demand and supply perspective of ED-Services Supply Chains (SSCs). Data was collected to assess 200 patient’s satisfaction towards quality of healthcare services of ED of Sindh Government Qatar Hospital, Orangi town-a tertiary care hospital in Karachi. Structured questionnaire was developed to interview patients and their attendants. Results of SPSS analysis revealed that 55% of patients were transferred to ED within 5 minutes, which shows efficient patient queues and flow management. 64.5% patient’s average LOS was between 40-60 minutes. 71% get the availability of basic facilities in ED. Majority of patients i.e. 96.5% and 90.5%, showed satisfaction with the time spent and treatment given by the doctor. Majority of the patients (96%) are satisfied with the services and performance of ED of a tertiary care hospital and 76% patients showed willingness to recommend ED of Government Qatar Hospital, Karachi to others.

331 Evaluation of Triage Screening for Influenza Vaccination Status in the Emergency Department

Seasonal influenza places significant burden on emergency medical care and is estimated to result in 3.9 million annual emergency department (ED) encounters. Lack of access to primary medical care is associated with greater utilization of ED services. Increasingly, the ED is providing preventive care to patients, such as influenza vaccines. The objective of this study was to evaluate vaccination screening at triage to determine the potential impact of an ED-based influenza vaccine program on unvaccinated patients. This was a retrospective study of ED encounters within a single health system between October 1, 2018 and April 30, 2019. All 19 EDs, 6 freestanding EDs and 13 hospital-based EDs, were included. Data was obtained from the electronic medical record (EPIC). Encounters were reviewed to determine if influenza vaccination status was assessed at ED triage. Assessment of vaccination status by registered nurses is encouraged but not mandatory during ED triage. Influenza vaccination is not routinely offered. Encounters in which triage screening was completed had responses categorized as vaccinated, unvaccinated, or vaccination status unknown. During the study period, 359, 310 encounters occurred across 19 EDs. Screening for vaccination status was completed for 204, 173 encounters, representing 56.8% of all encounters (95% CI 0.567 to 0.57). Screening was more frequent at freestanding EDs [60%, (95% CI 0.596 to 0.604)] compared to hospital based EDs [56.2%, (95% CI 0.56 to 0.563, p < 0.001)]. Of the encounters that were screened, 73, 311 patients reported being vaccinated against influenza [35.9%, (95% CI 0.357 to 0.361)] and 103, 276 patients reported being unvaccinated [50.6%, (95% CI 0.504 to 0.508)]. Patients 0-17 years [55.5%, (95% CI 0.55 to 0.561)] or 18-64 years [57.9%, (95% CI 0.577 to 0.582)] were more likely to report being unvaccinated against influenza compared to those 65 years or older [25.7%, (95% CI 0.253 to 0.261, p < .001)]. In total, 56.8% of patients were screened for vaccination status. Patient’s report being unvaccinated against influenza in more than half of all ED encounters. Pediatric patients and adults < 65 years of age are more likely to be unvaccinated against influenza and represent a target population for ED vaccination. Increased vaccination screening is needed to accurately assess opportunities for ED-based vaccination efforts.

Considering a risk profile based on emergency department utilization in young people with eating disorders: Implications for early detection.

While screening tools are available for the early identification of eating disorders, it may not be feasible to employ them in an emergency department (ED). Establishing a risk profile may improve the screening process. The purpose of this study was to investigate ED service utilization among patients with eating disorders and create a risk profile to help detect eating disorders at an earlier and more treatable stage. We applied a concurrent mixed methods research design, however, only the quantitative findings will be presented. Our study involved a retrospective cohort analysis of administrative ED health data for patients (n=243) aged 12-24 years in an eating disorders program. Two control groups: (1) all-cause (n =716), (2) and mental health (n =679) were included. 68.7% of eating disorder patients were discharged from the ED without follow-up being arranged. Comorbidities were recorded as the primary or secondary diagnosis, and patients presented with suicidality more frequently than controls (χ=31.2, p < .001). Patients accessed ED services five times more often than controls. Despite eating disorder patients accessing the ED more frequently than controls, eating disorder diagnoses were not always assigned or documented. Our findings highlight the importance of enhanced eating disorder training for ED health care staff to better understand the risk profile, and the consideration of comorbidities and suicide risk when assessing patients to ensure early detection. As eating disorders are often undetected, more comprehensive training and access to screening tools may help improve detection, mitigate symptom progression, and enhance patient safety.

Impact of the COVID-19 Pandemic on Healthcare-Seeking Behaviors among Frequent Emergency Department Users: A Cohort Study.

In 2020, Taiwan’s healthcare system faced a notable burden imposed by the coronavirus disease (COVID-19) pandemic. Emergency department (ED) is a high-risk area for severe acute respiratory syndrome coronavirus 2 transmission. The effect of COVID-19 on the utilization of ED services among frequent ED users remains unknown. This cohort study determined the impact of the COVID-19 pandemic on healthcare-seeking behaviors among frequent ED users at Taipei City Hospital, Taiwan. We included ED users aged ≥ 18 years admitted to Taipei City Hospital during February 2019–January 2020 (before the pandemic) and February 2020–January 2021 (during the pandemic). Frequent ED users were patients with four or more ED visits per year. Stepwise logistic regression was performed to identify predictors of frequent ED use during the COVID-19 pandemic. Frequent ED users had shorter hospital stays in the ED during the pandemic. After adjusting for sociodemographic factors and other covariates, patients with a triage status of level 4–5, pneumonia diagnosis, giddiness, or dyspnea were more likely frequent ED visitors during the COVID-19 pandemic. To reduce the risk of acquiring COVID-19, it is important to utilize territorial healthcare or telehealth to avoid inappropriate ED visits for patients with a low level of risk or chronic disease.

The impact of the COVID-19 pandemic on the utilization of emergency department services for the treatment of injuries.

ContextThe global COVID-19 pandemic has had a major impact on the utilization of healthcare services; however, the impact on population-level emergency department (ED) utilization patterns for the treatment of acute injuries has not been fully characterized.ObjectiveThis study examined the frequency of North Carolina (NC) EDs visits for selected injury mechanisms during the first eleven months of the COVID-19 pandemic.MethodsData were obtained from the NC Disease Event Tracking and Epidemiologic Collection Tool (NC DETECT), NC's legislatively mandated statewide syndromic surveillance system for the years 2019 and 2020. Frequencies of January – November 2020 NC ED visits were compared to frequencies of 2019 visits for selected injury mechanisms, classified according to International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) injury diagnosis and mechanism codes.ResultsIn 2020, the total number of injury-related visits declined by 19.5% (N = 651,158) as compared to 2019 (N = 809,095). Visits related to motor vehicle traffic crashes declined by a greater percentage (29%) and falls (19%) declined by a comparable percentage to total injury-related visits. Visits related to assault (15%) and self-harm (10%) declined by smaller percentages. Medication/drug overdose visits increased (10%), the only injury mechanism studied to increase during this period.ConclusionBoth ED avoidance and decreased exposures may have contributed to these declines, creating implications for injury morbidity and mortality. Injury outcomes exacerbated by the pandemic should be addressed by timely public health responses.

Emergency Department Visits Following Suboccipital Decompression for Adult Chiari Malformation Type I

INTRODUCTIONThe unnecessary overuse of ED services in the United States leads to an estimated wasteful spending of $38 billion yearly. The burden of these visits is multiplied in pandemics and times of crisis, such as the COVID-19 pandemic, during which ED resources may already be overwhelmed. Post-operative Emergency Department (ED) visits following suboccipital decompression in CM-1 patients are not well described.METHODSA prospectively maintained database of CM-1 patients seen at our institution between January 1, 2006 and December 31, 2019 was used. Pre-operatively and post-operatively prior to hospital discharge, patients are counselled extensively on activity restrictions after surgery, incision care, expectations of severe headache and neck stiffness for the first few weeks after surgery, the variability in degree and timing of symptom improvement from patient to patient, and the proper intake of analgesics, as prescribed. ED visits occurring within 30 days after surgery were tracked for postoperative patients, while comparing clinical, imaging, and operative characteristics between patients with and without an ED visit. Clinical improvement at last follow-up was compared between both groups of patients in a univariable and multivariable analysis using the Chicago Chiari Outcome Scale (CCOS).RESULTSIn 175 surgically treated patients, 44 (25%) visited an ED in the 1-month period after surgery. The most common reason for seeking care was isolated headache (41%). Concentration disturbance at presentation was the only factor significantly associated with a post-operative ED visit (P = .023). The occurrence of a post-operative ED visit was independently associated with a lower chance of clinical improvement at last follow-up (adjusted OR of CCOS≥13 = 0.35, P = .021; adjusted OR of CCOS≥14 = 0.38, P = .016).CONCLUSIONAdult CM-1 patients undergoing surgery at a tertiary referral center have an elevated rate of post-operative ED visits, which are mostly due to pain-related complaints, despite preoperative and postoperative counselling. Such visits are hard to predict but are associated with worse long-term clinical outcome. Interventions that decrease the magnitude of post-operative ED service utilization are warranted.

Emergency Department Visits Following Suboccipital Decompression for Adult Chiari Malformation Type I

BackgroundPostoperative emergency department (ED) visits following suboccipital decompression in Chiari malformation type I (CM-1) patients are not well described. We sought to evaluate the magnitude, etiology, and significance of postoperative ED service utilization in adult CM-1 patients at a tertiary referral center.MethodsA prospectively maintained database of CM-1 patients seen at our institution between January 1, 2006 and December 31, 2019 was used. ED visits occurring within 30 days after surgery were tracked for postoperative patients, while comparing clinical, imaging, and operative characteristics between patients with and without an ED visit. Clinical improvement at last follow-up was also compared between both groups of patients in a univariable and multivariable analysis using the Chicago Chiari Outcome Scale (CCOS).ResultsIn 175 surgically treated patients, 44 (25%) visited an ED in the 1-month period after surgery. The most common reason for seeking care was isolated headache (41%), and concentration disturbance at presentation was the only factor significantly associated with a postoperative ED visit (P = 0.023). The occurrence of a postoperative ED visit was independently associated with a lower chance of clinical improvement at last follow-up (adjusted odds ratio of CCOS ≥13 = 0.35, P = 0.021; adjusted odds ratio of CCOS ≥14 = 0.38, P = 0.016).ConclusionsAdult CM-1 patients undergoing surgery at a tertiary referral center have an elevated rate of postoperative ED visits, which are mostly due to pain-related complaints. Such visits are hard to predict but are associated with worse long-term clinical outcome. Interventions that decrease the magnitude of postoperative ED service utilization are warranted.

Combined Effect of Race/Ethnicity and Type of Insurance on Reuse of Urgent Hospital-Based Services in Children Discharged with Asthma.

Asthma is a leading cause of health disparity in children. This study explores the joint effect of race/ethnicity and insurance type on risk for reuse of urgent services within a year of hospitalization. Data were collected from 604 children hospitalized with asthma between 2012 and 2015 and stratified with respect to combination of patients’ insurance status (public vs. private) and race/ethnicity (white vs. nonwhite). Highest rates for at least one emergency department (ED) revisit (49.5%, 95% CI 42.5, 56.5) and for average revisits (1.03, 95% CI 0.83, 1.22) were recorded in nonwhite children with public insurance. Adjusted models revealed higher chance for ED reuse in white as well as nonwhite children covered by public insurance. Hospitalization rate was not dependent on the combination of social determinants, but on the number of post-discharge ED revisits. The combined effect of race/ethnicity and health insurance are associated with post-discharge utilization of ED services, but not with hospital readmission.

Medicaid Expansion Resulted in Decreased Odds of Frequent Emergency Department Use Among Medicaid Beneficiaries and the Uninsured in New York

Research ObjectiveFrequent emergency department (ED) use has been often cited as a marker of fragmented health care provision and is an indicator of poor quality of care. The Affordable Care Act (ACA) attempted to address the rising costs related to the utilization of ED services, among others, by expanding insurance coverage, by fortifying primary care, by supporting the development of integrated health care delivery models, and by introducing alternative quality‐adjusted payment models. The objective of this study is to describe and to compare frequent ED users before and after the Medicaid expansion under the ACA and to estimate the policy’s effect on the likelihood of frequent ED utilization in New York.Study DesignWe used the 2011 to 2016 Healthcare Cost and Utilization Project (HCUP) State Emergency Department Databases (SEDD) and State Inpatient Databases (SID) for New York. The number of ED visits per patient was calculated using a patient identifier across the HCUP SEDD and SID data. We defined frequent ED use as four or more visits in one year. Multivariate logistic regression was used to estimate the changes in the likelihood of frequent ED use in the post‐Medicaid expansion period. We conducted sensitivity analyses using alternative definitions of frequent use and falsification analyses examining only pre‐expansion years.Population StudiedIn‐state residents aged 18‐64, who had Medicaid or private coverage or were uninsured.Principal FindingsFrequent users represented 7.1% of all ED patients before and 7.3% after the policy implementation and accounted for 26.1% and 27.0% of all ED visits, respectively. Frequent users were mostly covered through Medicaid across all years (69% vs 35%, P &lt; .001) and had higher rates of comorbidities and chronic conditions compared with infrequent users. After controlling for patient and county‐level characteristics, the policy implementation was associated with 4% (P &lt; .001) and 12% (P &lt; .001) reductions in the likelihood of being a frequent ED user among Medicaid beneficiaries and the uninsured, respectively, while the likelihood of frequent use increased by 9% (P &lt; .001) for private insurance enrollees. Beyond the policy, high ED reliance was continuously associated with patients who had multiple comorbidities and chronic conditions, including mental health, substance, and alcohol use, as well as conditions that could be prevented and treated in non‐ED settings.ConclusionsAfter New York expanded Medicaid in 2014, the likelihood of frequent ED use declined among Medicaid beneficiaries and those remaining uninsured.Implications for Policy or PracticeThe high share of frequent users in Medicaid plans indicates the continuous need to address social determinants of health at community level, particularly for Medicaid patients.

The Healthcare Burden of Emergency Department Utilization for Multiple Myeloma: A Five Years U.S. Nationwide Study

▪Introduction:Multiple myeloma is comparatively uncommon cancer, but among blood malignancies it is still the second most common cancer after non-Hodgkin lymphoma. Patients with complications of multiple myeloma (MM) frequently present to the emergency department. There is a lack of data about the health care burden and trends of utilization of emergency department services by MM patients. The objective of this study is to investigate the recent trends in resource utilization in the emergency departments for MM. Furthermore, we aimed to look for the demographic characteristics associated with the subsequent hospitalization of MM patients. We hypothesized that there has been an increase in the utilization of emergency department services for the management of MM patients in recent years. We further hypothesized that subsequent hospitalization rate may be decreasing with the availability of more efficacious and potentially less toxic drugs.Methods:For this study we obtained the data from United States National Emergency Department Sample (NEDS) years 2010-2014. For categorical variables, frequencies and proportions were generated and statistical significance was tested using a chi-squared test. Rate of myeloma associated emergency department visits were estimated by using US census population. Patients and hospital characteristics were entered in univariate analysis to predict in-patient admissions from the ED. Multivariable logistic regression was used to predict in-patient admissions for the variables that were found statistically significant in univariate analysis. All tests were two-sided with the statistical significance set at p < 0.05. All analyses were conducted using STATA 14.2v and no missing data was imputed.Results:Between 2010 to 2014, approximately 443,214 patients visited emergency departments (ED) with the diagnosis of MM, that accounted for 0.06 % of all emergency department visits. There was an absolute increase of 22% in MM related visits from 80,466 in 2010 to 98,279 in 2014. While the rate of emergency department service utilization by myeloma patient increased significantly by 19% (p=0.04). Overall 73% of myeloma related visits resulted in hospitalization, but over the study period trend of hospitalization decreased. The percentage of patients treated and discharged to home increased from 23% to 29% between 2010 to 2014. Total charges associated with myeloma related visits increased significantly from $315 million to $626 million during 2010 to 2014, with an annual increase in the rate (19.26%: p<0.001). In the multivariable regression analysis several characteristics of patients and hospitals were found to be positively associated with the higher odds of hospitalization following a myeloma related visit. Male gender (OR 1.09, p<0.001), age category 18-64 years (OR 4.3, p=0.002), age of 65 and above (OR 4.7, p=0.001), Medicaid insurance (OR 1.38, p<0.001), northeast location of hospital (OR 2.51, p<0.001), metropolitan non-teaching hospitals (OR 1.18, p<0.001), more number of co-morbidities (OR 1.51, p<0.001) and profit ownership of hospital (OR 1.5, p<0.01).Conclusion:Multiple myeloma related emergency department service utilization and total charges are increasing over the observed time limit. While the incidence of hospitalization from emergency department is decreasing overtime. These findings can be explained on the basis of few facts. MM patients are living longer with the availability of newer drugs but remain uncured. Most patients will face relapse after the initial disease control, at which point they may need to utilize ED services more frequently. As better oral or intravenous drugs are available through oncology out-patient offices, limited MM drug choices are available in the hospital, majority of MM patients are discharged sooner from the hospitals resulting in reduced hospital admission rates as well as shorter hospital stay. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

Characterization of Health Care Resource Utilization Among Commercially Insured Relapsed Acute Myeloid Leukemia Patients in the United States

IntroductionRelapsed acute myeloid leukemia (AML) patients have poor prognosis and few treatment options. Limited data exists on the economic burden of patients with AML after relapsed from initial therapy. The objective of this study was to assess the health care resource utilization patterns of relapsed AML from US commercial payer perspective.Methods:A retrospective analysis was performed using the IQVIA™ Real-World Data Adjudicated Claims - US database. Patients were eligible if they had at least one inpatient claim associated with relapsed AML diagnosis as identified by ICD-9 (205.02) and ICD-10 (C92.02, C92.42, C92.52, C92.62, C92.A2) codes between 1/1/2010 to 9/30/2016, and did not have any inpatient claims associated with relapsed AML diagnosis in the 12 months before index inpatient relapsed AML claim. Inpatient, emergency department (ED) and outpatient health care visits and costs associated with chemotherapy administration, chemotherapy-related toxicity, bone marrow transplant (BMT), and graft versus host disease (GVHD) identified by corresponding procedure codes, ICD-9 or ICD-10 diagnosis codes during the 6 months after index inpatient claim were summarized.Results:The study sample consisted of 1,929 patients [47.3% females; 17.4% age ≥ 65 years]. During the 6-month follow-up period, 78.2%, 97.8%, 56.0% and 27.7% patients had medical claims associated with chemotherapy administration, chemotherapy-related toxicity, BMT and GVHD, respectively. Mean (SD) number of hospital admissions per patient was 2.92 (2.02) per patient, with 44.7% hospitalizations associated with chemotherapy administration, 82.5% hospitalizations associated with chemotherapy-related toxicity, 30.2% hospitalizations associated with BMT and 12.8% hospitalizations associated with GVHD diagnosis. Mean (SD) number of outpatient visits was 38.9 (33.2) per patient, with 16.2%, 31.2%, 14.3% and 4.3% of visits related to chemotherapy administration, chemotherapy-related toxicity, BMT and GVHD, respectively. Utilization of ED services was less common [mean (SD)=0.73 (1.78) visit per patient]; they were most often associated with chemotherapy-related toxicity (50.6%) and rarely associated with chemotherapy administration (1.7%), BMT (4.7%) or GVHD (0.9%).Mean (SD) total medical cost over the 6-month follow-up period was $291,165.37 (284,731.52) per patient, with 45.2% attributed to health care encounters with chemotherapy administration or toxicity without mentioning of BMT/GVHD diagnosis, 42.5% for health care encounters associated with diagnoses of both chemotherapy administration or toxicity and BMT/GVHD, 3.9% for BMT/GVHD without mentioning of chemotherapy administration or toxicity, and 8.4% unrelated to chemotherapy administration/toxicity, BMT or GVHD. Overall, 82.9% of total medical cost was for inpatient services, and 16.9% and 0.21% were for outpatient and ER visits, respectively.Conclusion:Inpatient admissions associated with chemotherapy administration and toxicity management represent a significant portion of health care expenditures among relapsed AML patients. Future treatments that simplify the route of administration, reduce the need for hospitalization and toxicity may offer the opportunity to reduce economic burden to the health care system. DisclosuresQian:Daiichi Sankyo, Inc.: Employment, Equity Ownership. Kwong:Daiichi Sankyo, Inc.: Employment, Equity Ownership.

Correlates of Emergency Department Service Utilization Among U.S. Chinese Older Adults.

Older adults visit emergency departments (EDs) at a disproportionally higher rate than other age groups. Prior studies examining racial disparities in ED utilization focus on African Americans and Hispanics. There is a dearth of information on ED utilization patterns among older Asian Americans despite the evidence that ED expenditures in Asian Americans are comparable to that of Caucasians. To address this knowledge gap, we examined factors associated with ED service utilization in the largest Asian subgroup, U.S. Chinese older adults. Cross-sectional data from the Population Study of Chinese Elderly in Chicago (PINE) (N = 3,157) were used. Multivariate negative binomial regression analyses were conducted to examine significant factors associated with ED use. Higher education (rate ratio [RR] = 1.03, 95% confidence interval [CI] 1.00-1.05) and acculturation levels (RR = 1.02, CI 1.00-1.04), fewer people in the household (RR = 0.94, CI 0.88-0.99), health insurance coverage (RR = 1.34, CI 1.01-1.78), lower income (RR = 0.89, CI 0.80-0.99), poorer perceived health (RR = 0.67, CI 0.58-0.77), more functional limitations (RR = 1.09, CI 1.06-1.13) and depressive symptoms (RR = 1.04, CI 1.02-1.07), and a history of heart disease (RR = 2.28, CI 1.83-2.84), stroke (RR = 1.68, CI 1.20-2.35), cancer (RR = 1.86, CI 1.31-2.63), and hip fracture (RR = 1.42, CI 1.02-1.98) were associated with higher rates of ED visits. Our findings highlight several significant correlates of ED use in U.S. Chinese older adults. Culturally-appropriate interventions modifying these factors have the potential to decrease ED visits and improve care outcomes in this population.

Utilization of emergency department services in the US amongst women with uterine fibroids (2006-2014)

Uterine fibroids are an extremely common benign condition among pre-menopausal women and are ideally managed in an outpatient setting or as a planned elective procedure. While there is an abundance of evidence on the prevalence of uterine fibroids, there is little data on where women seek care for these tumors. We investigated the trends in emergency department utilization for uterine fibroids from 2006-2014 and assessed estimated admission rates by insurance status, hospital location, and patient residence for the year 2014.

Fewer immigrants have preventable ED visits in the United States

ObjectiveThe aim of this study is to examine differences in having preventable emergency department (ED) visits between noncitizens, naturalized and US-born citizens in the United States. MethodsWe linked the 2008–2012 Medical Expenditure Panel Survey with National Health Interview Survey data to draw a nationally representative sample of US adults. Univariate analysis described distribution of preventable ED visits identified by the Prevention Quality Indicators across immigration status. We also assessed the association between preventable ED visits and immigration status, controlling for demographics, socioeconomic status, health service utilization, and health status. We finally applied the Oaxaca-Blinder decomposition method to measure the contribution of each covariate to differences in preventable ED services utilization between US natives, naturalized citizens, and noncitizens. ResultsOf US natives, 2.1% had any preventable ED visits within the past years as compared to 1.0% of noncitizens and 1.5% of naturalized citizens. Multivariate results also revealed that immigrants groups had significantly lower odds (adjusted OR: naturalized citizen 0.77 [0.61–0.96], noncitizen 0.62 [0.48–0.80]) of having preventable ED visits than natives. Further stratified analysis by insurance status showed these differences were only significant among the uninsured and public insurance groups. Race/ethnicity and health insurance explained about 68% of the difference in preventable ED service utilization between natives and noncitizens. ConclusionOur study documents the existing differences in preventable ED visits across immigration status, and highlights the necessity to explore unmet health needs among immigrants and eliminate disparities.