Emergency Department Utilization Research Articles

Comparative Effectiveness of Amniotic and Chorionic Grafts in the Treatment of Lower-Extremity Diabetic Ulcers Using U.S. Medicare Real-World Evidence (2018-2022): A Retrospective Observational Cohort.

Objective: Lower-extremity diabetic ulcers (LEDUs) affect more than 500,000 U.S. Medicare beneficiaries each year. Dehydrated human amnionic and chorionic allografts (DHACAs) are clinically effective complements to standard of care (SoC; e.g., surgical debridement, offloading, infection, and moisture control) when treating LEDUs. However, Medicare and commercial payer coverage have restricted access to DHACAs. Our objective was to compare the effectiveness of DHACAs versus SoC among Medicare beneficiaries with LEDUs for reduction of adverse outcomes such as mortality, recurrency, and major amputation. Approach: We analyzed a retrospective cohort of U.S. Medicare claims for LEDUs between 2018 and 2022. LEDU claims were collapsed into episodes of care (EOC). Frequency distribution of characteristics was compared using univariate and bivariate statistics. Zero-inflated binomial regression with 1:1 nearest-neighbor propensity score matching evaluated six main outcome measures: mortality; wound recurrence; major amputation; minor amputation; emergency department (ED) utilization; and readmission. Results: There were 25,760 Medicare EOCs between 2018 and 2022 representing 12,880 matched samples in the DHACA and SoC cohorts. DHACAs were associated with a 20% reduction in 30-day mortality (95% confidence interval [CI]:10%, 29%), 28% reduction in risk of major amputation (95% CI: 19%, 36%), 9% reduction in ED utilization (95% CI: 3%,14%), and 8% reduction in 30-day readmission (95% CI: 2%, 13%). DHACAs were noninferior for minor amputation rates and wound recurrence compared to SoC cohort. Conclusion: Beneficiaries with LEDUs benefit significantly from DHACAs on multiple outcomes, including a lower risk of mortality. Providers should examine the appropriateness of DHACAs for patients with LEDU as part of wound management. Medicare and commercial payers should consider improved outcomes when defining coverage policies that restrict access to DHACAs given the observed benefits.

Emergency department utilization by youth before and after firearm injury.

Emergency department (ED) visits may serve as opportunities for firearm injury prevention and intervention efforts. Our objective was to determine ED utilization by youth before and after firearm injury. We performed a retrospective cohort study of ED encounters by youth (0-18 years old) with firearm injury from eight states using the 2019 State ED and Inpatient Databases. Our primary outcome was an ED encounter (1) 90 days before or (2) 90 days after index injury. We used generalized estimating equations, accounting for hospital clustering, to determine associations between ED utilization and ED type (pediatric vs. general), youth age, sex, race and ethnicity, urbanicity, and insurance status. We identified 1035 ED encounters for firearm injury (median [IQR] age 17 (15-18) years, 85.3% male, 63.3% non-Hispanic Black, 68.6% publicly insured, 90.5% living in a metropolitan area, 52.8% general ED). In the 90 days before an index injury, 12.8% of youth had an ED encounter; of these, 68.2% occurred in general EDs, and 18.2% were for trauma. In the 90 days after an index injury, 22.1% of youth had an ED encounter; of these, 50.0% occurred in general EDs, and 22.6% were for trauma. We found no significant association between ED type and ED utilization patterns. Few youths changed ED type across longitudinal encounters. Youth have high rates of ED utilization before and after firearm injury. Half of firearm-injured youth receive their emergency care exclusively in general EDs. Implementing firearm injury prevention and intervention efforts in all ED settings is critical.

Application of the Diagnosis Grouping System to Pediatric Emergency Department Encounters.

Diagnosis grouping systems are essential for health services and epidemiological and health outcomes research. The Diagnosis Grouping System (DGS) was developed to classify International Classification of Diseases, 10th Revision diagnosis codes for pediatric emergency department (ED) encounters. We applied and compared the DGS to large samples of US ED encounters for children using 3 large health system databases. We conducted a retrospective cross-sectional study of children (younger than age 18years) between 2016 and 2021 using 3 ED datasets: the National Hospital Ambulatory Medical Care Survey (NHAMCS; a complex survey of US ED encounters), COMPdata (a dataset of encounters for Illinois), and the Pediatric Health Information Systems (PHIS; an administrative database of US children's hospitals). We categorized principal diagnoses using the DGS and compared their distribution. We included 181 607 978 survey-weighted encounters from NHAMCS, 5 352 016 encounters from COMPdata, and 20 859 019 encounters from PHIS. A higher proportion of encounters in the PHIS sample were admitted or transferred (12.7%) compared with those in the NHAMCS (6.1%) or COMPdata (4.2%) samples. Trauma was the most common major group identified among all datasets (22.0% in NHAMCS, 22.2% in COMPdata, and 17.0% in PHIS). Some conditions, such as sickle cell anemia, diabetes mellitus, appendicitis, seizures, and asthma, presented more frequently among children presenting to the PHIS hospitals. We identified comparable diagnostic distributions across different datasets, with differences that are likely attributable to specific characteristics of the data source. Our findings provide a baseline for pediatric diagnoses to facilitate future research on pediatric ED utilization.

Potentially Avoidable Emergency Department Utilization by Persons with Psoriatic Arthritis and Ankylosing Spondylitis: A Population-Based Cohort Study.

Greater accessibility to ambulatory services may mitigate emergency department (ED) presentations for lower acuity issues. This study examined ED utilization patterns for individuals with psoriatic arthritis (PsA) and ankylosing spondylitis (AS) in a universal access healthcare setting. Linked population-based administrative datasets in Alberta, Canada (fiscal years 2008-2017) were assessed for yearly ED visit frequency, timing, triage acuity, most responsible diagnoses, and disposition for persons with PsA and AS. A total of 4,984 individuals with PsA and 14,690 with AS had 53,174 and 124,037 unique ED encounters, respectively. On average, 47.6% of persons with PsA and 35.7% with AS accessed the ED annually. Low acuity encounters (triaged as less urgent or non-urgent) were common, comprising 44.2% and 50.3% of visits for PsA and AS cohorts, respectively. Infection and injury were the most common responsible diagnoses. Presentations for arthritis flares were infrequent (1.2% and 2.0% for PsA and AS cohorts, respectively) with no significant differences by sex or urbanicity. Rural patients had nearly twice the mean number of visits per year, had a higher frequency of less acute presentations, and were admitted less often in both disease cohorts. Sex differences included differential timing of presentation to EDs, and females with PsA had a lower frequency of admission relative to males. ED use for less and non-urgent health concerns was frequent for persons with PsA and AS, particularly in rural settings. These data can inform tailored health service delivery including access solutions for persons residing in rural areas.

The effect of inpatient brief cognitive-behavioral therapy for suicide prevention on post-discharge emergency department utilization: Secondary analysis of a randomized clinical trial.

Diefenbach and colleagues (2024) found that inpatient Brief Cognitive-Behavioral Therapy for Suicide Prevention (BCBT-I) reduced the rate of six-month post-discharge psychiatric readmissions compared to treatment as usual (TAU). This treatment effect; however, was limited to inpatients, whom were not diagnosed with substance use disorder (SUD). The aim of this secondary analysis was to determine BCBT-I treatment effects and SUD moderation on post-discharge emergency department (ED) utilization. Inpatients with a history of suicide attempt were assigned to BCBT-I+TAU (n=94) or TAU alone (n=106). Presence and number of ED visits were determined via self-report and electronic medical record review for six months after discharge. Generalized linear models for count and binary data were conducted. Adding BCBT-I to TAU reduced the odds and rate of post-discharge ED visits by three quarters [Odds Ratio estimate=0.25, 95% CI:(0.12, 0.46); Rate Ratio estimate=0.24, 95% CI:(0.11, 0.53)], but only among participants without SUD. Over one-third (36%) of ED visits were related to suicide. Findings for suicide-related ED visits mirrored those of all-cause ED visits. Adding BCBT-I to TAU reduced post-discharge ED utilization in participants without SUD. Additional research is needed to improve the efficacy of BCBT-I for patients with SUD.

A new model-based approach for estimating rural hospital markets.

To provide a new approach for defining rural hospital markets. First, we estimated models of hospital choice. We defined hospitals in the choice set using nationwide hospital data from the Healthcare Cost Report Information System (HCRIS). We modeled hospital choice using conditional logit regression and 2019 Medicare Fee-for-Service (FFS) claims data from the Centers for Medicare & Medicaid Services (CMS) Virtual Research Data Center. Next, we calculated estimated inpatient and emergency department utilization by patient ZIP code. We then estimated the total Medicare FFS volume for each hospital as well as the percent of each hospital's volume attributable to each ZIP code. We sorted ZIP codes by the patient volume attributable to the given hospital (from most volume to least volume) and then added ZIP codes to the market until at least 50% of the hospital's total patient volume was represented. The average rural hospital market included three ZIP codes, an estimated population total of 37,221, and an estimated 5385 Medicare FFS beneficiaries. Furthermore, the average rural hospital had an estimated market share of 29%. A lower estimated market population was found for Critical Access Hospitals, hospitals unaffiliated with a system, hospitals with a smaller number of acute beds, and hospitals with fewer staff. We developed a new approach for defining rural hospital markets. This approach can be used to inform health services researchers, policymakers, and communities about key market predictors of rural hospital financial distress, populations adversely affected by rural hospital closure, and more.

Impact of the COVID-19 pandemic on emergency department utilization of initial fibrinolysis for the treatment of STEMI.

Fibrinolysis is generally considered an alternative to percutaneous coronary intervention (PCI) for ST-Segment Elevation Myocardial Infarction (STEMI) when PCI is not immediately feasible. The COVID-19 pandemic may have impacted the timeliness of PCI. We sought to compare the rate of fibrinolysis use before vs. during the COVID-19 pandemic in US emergency departments (EDs). Characteristics of patients and EDs with fibrinolysis use prior to vs. during the COVID-19 pandemic were also compared. We identified adult patients presenting to US EDs for STEMI using the Nationwide Emergency Department Sample (NEDS) database. The cohort was restricted to individuals receiving fibrinolysis. Patients were divided into two cohorts based on receipt of fibrinolysis during the pre-pandemic (April 2018-December 2019) and pandemic (April 2020-December 2021) time periods. In the period prior to the COVID-19 pandemic, fibrinolysis use was identified in 1593 ED encounters, representing a rate of 24.5 per 1000 STEMI encounters in the database. In the COVID-19 pandemic period, fibrinolysis use was identified in 1700 encounters, representing a rate of 28.2 per 1000 STEMI encounters in the database. This corresponded to a rate difference of 3.7 per 1000 STEMI encounters (95% confidence interval: 1.9-5.5, p<0.001). Most ED and patient characteristics were similar prior to vs during the pandemic among included cohorts. Fibrinolytic therapy use increased, but only slightly, during the COVID-19 pandemic. This suggests that the healthcare system adapted quickly to changes during the pandemic in the setting of STEMI treatment.

Association of Opioid Use Disorder-Related Service Trajectories during Pregnancy and Postpartum Health Service Use: A Group-Based Multitrajectory Modeling Study.

The aim of the study was to examine the relationship between opioid use disorder (OUD)-related service trajectories during pregnancy and postpartum emergency department (ED) and hospitalizations. We used the Merative MarketScan Commercial Claims and Encounters Database (2013-2021) to identify a cohort of pregnant individuals with OUD. We used group-based multitrajectory modeling to identify opioid-related treatment and service trajectories during pregnancy and examined their association with postpartum ED and hospital utilization. Seven opioid-related treatment and service trajectories were identified in our cohort of 2,531 pregnant individuals with OUD. Compared to individuals initiating medications for OUD (MOUD) halfway through pregnancy but maintaining high adherence without ancillary services, those receiving only services throughout pregnancy had a higher risk of postpartum ED visits (HRED = 1.34). This latter group also faced significantly higher risks of postpartum hospitalizations, compared to adherent MOUD use (proportion of days covered ≥80%) alone, both throughout or in the latter half of pregnancy (HRHOS = 1.93; HRHOS = 1.60), and patients without MOUD or services (HRHOS = 1.43). Individuals initiating MOUD late in pregnancy with poor adherence and infrequent service use faced significantly higher risks of postdelivery hospitalization compared to consistent MOUD users throughout pregnancy (HRHOS = 2.33), or in the latter half, with or without services (HRHOS = 2.02; HRHOS = 1.93), and those not receiving MOUD or services (HRHOS = 1.73). Adherent MOUD use either throughout pregnancy or the latter half of pregnancy, irrespective of other service use, was associated with better postpartum outcomes defined by fewer ED visits and hospitalizations.

Frailty in older adults with systemic lupus erythematosus and emergency department utilization: an administrative claims data analysis of Medicare beneficiaries.

While presence of concomitant SLE and frailty has been associated with greater emergency department (ED) use than SLE alone in young/mid-aged adults, whether frailty increases ED use in older adults with SLE remains unknown. In a nationally representative United States administrative claims dataset, we investigated the association of frailty duration with use of ED services in the SLE population compared with individuals without systemic rheumatic disease (SRD). We identified Medicare beneficiaries ≥ 65years with SLE and matched them (1:4) by age and gender with non-SRD comparators with osteoarthritis. Frailty was determined using a claims-based index and examined each study year (1/2006-9/2015). We used mixed-effect Poisson regression to ascertain the effect of frailty duration exposure on the risk of ED visits in those with SLE and in non-SRD participants, adjusting for covariates. At baseline (2006), frailty prevalence was similar in participants with SLE (N = 1338; 43.7%) and no SRD (N = 5352; 42.4%) (p = 0.37). Frailty prevalence significantly increased and diverged over time between participants with SLE versus no SRD (67.6% versus 63.7% in 2010 and 83.5% versus 78.1% in 2014) (p < 0.05). As frailty duration increased, risk of ED visits increased in both groups, including after covariate adjustment (SLE: incidence rate ratio [IRR] 1.10, 95% confidence interval [CI] 1.09-1.12; non-SRD: IRR 1.09, 95% CI 1.08-1.10). In this cohort of older adults, duration of frailty conferred similar increased risk of ED visits among those with and without SLE. This underscores the importance of measuring frailty in older populations with SLE. Key Points • Frailty prevalence was similar at baseline, and increased over time, in participants with SLE and those with no systemic rheumatic disease; however, frailty prevalence increased to a greater extent in those with SLE. • Frailty duration conferred similar increased risk of ED visits among older adults with and without SLE. • This underscores the importance of identifying, preventing, and/or reversing frailty in older populations with SLE and not assuming that SLE alone adequately explains health risks.

Emergency department use during pregnancy by Medicaid type.

Background: Emergency department (ED) use is common among patients with Medicaid insurance during pregnancy. However, it is unknown how ED utilization differs among those with different types of Medicaid such as Emergency Medicaid, with which access to outpatient care is more restricted. Objective: We sought to compare differences in ED use during between pregnant persons with Emergency Medicaid and Traditional Medicaid and pregnancy outcomes by ED utilization. Study Design: This was a retrospective cohort study of all births among Medicaid recipients in South Carolina from 2010 to 2019. The main comparator was type of Medicaid. Our primary outcome was an ED visit during pregnancy. Secondary outcomes included average number of visits, perinatal outcomes, and prenatal and hospital charges. Results: There were 240,597 births that met inclusion criteria for this analysis. Over the study period, the proportion of patients with at least one ED visit increased for all groups. A higher proportion of patients with Traditional Medicaid had at least one ED visit compared with Emergency Medicaid (58.2% versus 22.7%). Patients who had at least one ED visit were more likely to be younger, of Black race, live rurally, nulliparous, have lower or higher body mass index, and have a higher prevalence of pre-existing medical co-morbidities. Conclusion: We found that individuals with Traditional Medicaid were more likely to have an antenatal ED visit than individuals with Emergency Medicaid.

Development and launch of a regional learning network to improve physical and mental health outcomes

AbstractBackgroundCare gaps in routine and preventive care are common among youth. To close care gaps, health systems should take a population health approach and create opportunities for partnership, collaboration, shared learning, and scale via learning networks (LNs).MethodsWe describe the Pediatric Improvement Network for Quality (PINQ), a regional population health LN with the aim of closing well‐child and mental and behavioral health (MBH) care gaps. We initially launched PINQ with 2 primary care domains: well‐child care (WCC) and MBH and later added the third domain of PINQ focused on community MBH organizations. We defined measures for the primary care WCC (well‐child visits for infants 0–15 months; lead screening by 2 years of age, childhood immunization status 3 completion) and MBH domains (depression screening in youth 12–17 years, 30‐day follow‐up for positive depression screen, mental health emergency department utilization) and established system‐level key drivers.ResultsPINQ launched in September 2022 with 7 teams (5 in primary care WCC and 2 in primary care MBH domains, respectively). All teams participate in a monthly meeting that alternates between the Action Period call and Solutions Labs. We highlight two case studies that illustrate the impact of shared learning and quality improvement support on Improvement Team efforts.ConclusionWe foresee PINQ as a means of moving the needle toward high quality, comprehensive health care for Greater Cincinnati youth. The next steps include growing PINQ by adding Improvement Teams and expanding the network focus to include other primary care‐centric metrics and conditions.

CT Pulmonary Angiogram Clinical Pretest Probability Tool: Impact on Emergency Department Utilization

ObjectiveCurrently, computed tomographic pulmonary angiogram (CTPA) for evaluating acute pulmonary embolism (PE) in Emergency Departments (EDs) is overused and with low yields. The goal of this study is to assess the impact of an evidence-based clinical decision support (CDS) tool, aimed at optimizing appropriate use of CTPA for evaluating PE. MethodsThe study was performed at EDs in a large healthcare system and included 9 academic and community hospitals. The primary outcome was the percent difference in utilization (number of CTPA performed/number of ED visits) and secondary outcome was yield (percentage of CTPA positive for acute PE), comparing 12 months before (6/1/2021-5/31/2022) vs. 12 months after (6/1/2022-5/31/2023) a system-wide implementation of the CDS. Univariate and multivariable analyses using logistic regression were performed to assess factors associated with diagnosis of acute PE. Statistical process control (SPC) charts were used to assess monthly trends in utilization and yield. ResultsAmong 931,677 visits to Emergency Departments, 28,101 CTPAs were performed on 24,675 patients. 14,825 CTPAs were performed among 455,038 visits (3.26%) pre-intervention; 13,276 among 476,639 visits (2.79%) post-intervention, a 14.51% relative decrease in CTPA utilization (chi-square, p<0.001). CTPA yield remained unchanged (1371/14825=9.25% pre- vs. 1184/13276=8.92% post-intervention; chi-square, p=0.34). Patients with COVID diagnosis prior to CTPA had higher probability of acute PE. SPC charts demonstrated seasonal variation in utilization (Friedman test, p=0.047). DiscussionImplementing a CDS based on validated decision rules was associated with a significant reduction in CTPA utilization. The change was immediate and sustained for 12 months post-intervention.

Evaluating estimated health care resource utilization and costs in patients with myelofibrosis based on transfusion status and anemia severity: A retrospective analysis of the Medicare Fee-For-Service claims data.

Myelofibrosis (MF) is a rare but aggressive myeloproliferative neoplasm that commonly affects older patients, with a mean age of onset of older than 60 years. At least a third of patients with primary MF are anemic at diagnosis, and nearly all patients become anemic over time; approximately half require red blood cell transfusions within a year of diagnosis. Anemia and transfusion dependence are leading negative prognostic factors for overall survival and are associated with diminished quality of life and increased health care-related economic burden in patients with MF. To describe baseline characteristics, health care resource utilization (HCRU), and costs as a function of transfusion status and anemia severity in patients diagnosed with MF among the US Medicare Fee-For-Service (FFS) population. This retrospective cohort study included patients diagnosed with MF appearing in the 100% Medicare FFS database enrolled between January 1, 2012, and December 31, 2020. Patients were segmented into hemoglobin level cohorts (no, mild, moderate, and severe anemia) and transfusion status cohorts (transfusion independent [TI], transfusion requiring [TR], or transfusion dependent [TD]). Across cohorts, demographics and disease characteristics were assessed at baseline; per patient per month all-cause HCRU and medical and pharmacy costs were reported during follow-up. All results were summarized descriptively. The transfusion status cohort (N = 1,749) included TI (n = 980), TR (n = 559), and TD (n = 210) patients; the anemia severity cohort (N = 365) included patients with no (n = 100), mild (n = 128), moderate (n = 99), and severe (n = 38) anemia. On average, TR and TD patients or those with moderate or severe anemia had numerically higher Deyo-Charlson Comorbidity Index scores than those who were TI or had mild or no anemia. TR and TD cohorts reported numerically greater all-cause outpatient, inpatient, and emergency department utilization vs the TI cohort. All-cause costs were numerically higher in the TD and TR cohorts vs the TI cohort ($14,655 and $14,249 vs $8,191). Incremental increases in HCRU and costs were also observed with increasing anemia severity. All-cause medical and pharmacy costs for no, mild, moderate, and severe anemia cohorts were $4,689, $7,268, $10,439, and $13,590, respectively. This retrospective analysis of the US Medicare FFS database descriptively evaluated patients by transfusion status and anemia severity and showed that costs and HCRU were numerically lower for patients with transfusion independence compared with those with transfusion dependence. Similar trends were seen when comparing patients based on anemia status, with numerically lower HCRU and cost observed with decreasing anemia severity.

Emergency department utilization patterns for pediatric urinary stone patients in the United States.

The prevalence of pediatric urolithiasis has increased rapidly, leading to more emergency department (ED) visits across the United States. The purpose of this study was to determine emergency care practices for children and adolescents with urinary stones and characteristics associated with management. We performed a cross-sectional study of the 2021 Nationwide Emergency Department Sample to identify pediatric patients (≤21 years) presenting to an ED in the United States with a primary diagnosis of urinary stone disease. The primary outcome was patient disposition. Multivariable logistic regression was used to identify patient and hospital characteristics associated with hospital admission. Imaging utilization was a secondary outcome of the study. There were 57 pediatric ED visits for urinary stone disease per 100,000 population in the study (mean age 17.7 years; 59.6% female). Most patients (91.2%) were treated and discharged, while 6.9% were admitted to the same hospital. Computed tomography was the primary imaging modality (60.2%), with utilization increasing with age. Considerable variability in disposition and imaging utilization was observed, with hospital admission rates ranging from 1.3% to 55.1% and CT use from 1.7% to 77.5% among patient and hospital subgroups. This study reveals a high rate of pediatric urinary stone presentations to United States EDs. Significant variations in disposition and imaging utilization across different patient and hospital characteristics highlight the need for standardized, evidence-based approaches to pediatric urinary stone care.

A systematic review of depressive and anxiety symptoms in caregivers of dementia patients.

The current number of dementia cases in Europe stands at 7.7 million, a figure projected to double by 2050. Caregivers of individuals with dementia experience a heightened burden compared to those caring for other chronically ill individuals, increasing the risk of depression and stress disorders. This systematic literature review, following PRISMA guidelines, explores the prevalence of anxiety and depressive symptoms in dementia caregivers. Searches in academic databases, restricted to studies from the last 15 years, identified 85 articles with 16 meeting the inclusion criteria. Results indicate significant caregiver burden, diminished self-reported quality of life, and a propensity for clinical depression. Depression and anxiety symptoms were more pronounced among female caregivers. Caregiver depression correlated with increased emergency department utilization by dementia patients, with a surge in depressive symptoms reported during the COVID-19 pandemic. Caregiving for dementia patients was associated with burnout, adversely impacting caregiver quality of life. Depression and anxiety symptoms in caregivers correlated with substance use. Sociodemographic variables, including low socioeconomic status, high urbanization levels, and older age, were associated with caregiver depression. Caregivers of individuals with Alzheimer's disease reported higher anxiety, burden, and depression scores compared to those assisting individuals with other dementias, particularly when neuropsychiatric symptoms were evident. The identification of the factors that are linked to the mental burden of caregivers allows mental health professionals to enhance symptom detection and provide tailored support, ultimately alleviating caregiver burden and improving dementia care quality. Systematic professional assistance and training opportunities through health policies can effectively alleviate caregiver burden.

Effect of Emergency Departments Utilization Knowledge and Attitude Among City population: A Cross-sectional Study.

Effect of Emergency Departments Utilization Knowledge and Attitude Among City population: A Cross-sectional Study.

Impact of Integrated Pharmacist-Nurse-Radiology-Dietitian Teams on Polypharmacy Patient Outcomes: A Comprehensive Analysis

Polypharmacy, defined as the concurrent use of five or more medications, is a significant challenge in modern healthcare. It affects 10-20% of community-dwelling adults and 40-50% of people aged 65 years and older. This study presents a comprehensive assessment of the impact of integrated healthcare teams comprising pharmacists, nurses, radiologists, and dietitians on polypharmacy patient outcomes. The results indicated significant improvements across multiple domains: medication appropriateness scores increased by 65%, adverse drug events decreased by 45%, and hospital readmission rates decreased by 40%. Each professional contributed something unique: pharmacists reduced inappropriate medications through comprehensive medication reviews by 65%; hospital readmissions were reduced by nurses, who applied quality-enhanced care coordination for the best interest of the patient by 35%; radiologists increased treatment accuracy by 40%, providing advanced diagnostic support; and dietitians decreased drug-nutrient interaction complications by 55%. Economic analysis revealed substantial cost savings of approximately $2,500 per patient annually, and a 35% reduction in emergency department utilization. Patient-centered outcomes demonstrated a 55% increase in health-related quality of life and 60% improvement in medication adherence. Implementation barriers, resource constraints, and limitations in the reimbursement structure exist, but evidence strongly supports the effectiveness of such integrated healthcare teams in polypharmacy patient management. The study concluded that such collaborative care models are vital for better patient outcomes and healthcare resource utilization in an evolving practice around advanced medication management.

Patterns of emergency department utilization in adults with sickle cell disease

Patterns of emergency department utilization in adults with sickle cell disease

Preventable Emergency Department Utilization Among Patients With Foster Care History Compared to Patients Without Foster Care History

Emergency department (ED) utilization for preventable reasons by patients with foster care history is unexplored. Medical records of ED encounters from primary care patients were pulled from a southwestern children’s hospital system. Necessity of ED encounter was categorized using the New York University- ED Algorithm into emergent, intermediate, or non-emergent. Associations were explored at the encounter- and patient-level. Partial proportional logistic models generated odds of preventable (i.e., intermediate or nonemergent) ED utilization among encounters, and Poisson models determined incidence of preventable ED use at the patient level. Findings suggested that when a patient with history in foster care used the ED, the odds that it was preventable were lower than if the child did not have such experience. Further, patients with foster care history were less likely to use the ED for concerns that did not need immediate attention but were more likely to use the ED for intermediate reasons.

Full-endoscopic spine-surgery in the elderly and patients with comorbidities

Due to demographic changes, a growing number of elderly patients with comorbidities will require spine surgery in the next decades. However, age and multimorbidity have been associated with considerably worse postoperative outcomes, and is often associated with surgical invasiveness. Full-endoscopic spine-surgery (FESS), as a cornerstone of contemporary minimally invasive surgery, has the potential to mitigate some of these disparities. Thus, we conducted an analysis of all FESS cases at a national center. Utilizing the Charlson Comorbidity index (CCI) ≥ 3 as a frailty surrogate we separated patients in two groups for patients with and without comorbidities. Patients with (CCI) ≥ 3 exhibited a higher age (p < 0.001), and number of comorbidities (p < 0.001) than the control group. Thereafter, a propensity score matching was done to adjust for potential confounders. Postoperative safety measures in emergency department utilization, and clinic readmission did not significantly differ between the groups. Furthermore, patients of both groups reported similar postoperative pain improvements. However, patients with a (CCI) ≥ 3 were treated as inpatients more often (p < 0.001), had a higher length of stay (p < 0.001) and a smaller functional improvement after at a chronic postoperative timepoint (p = 0.045). The results underline safety and efficacy of FESS in patients with comorbidities. Additionally, they provide guidance for preoperative patient counselling and resource utilization when applying FESS in frail patients.