Utilization Of Emergency Services Research Articles

Assessment of Medical Test Overuse and Its Impact on Pediatric Emergency Department Outcomes in Upper Respiratory Tract Infections in a University Hospital in Lithuania.

Medical overuse poses potential risks to patients and contributes to increasing healthcare costs, pediatric emergency departments (PED) in particular. Often, upper respiratory tract infection (URTI) cases are viral-induced and self-limiting, and they do not require specific investigations or treatment. We conducted a retrospective study from 1 December 2021 to 31 January 2022, thereby aiming to identify the common tests and factors influencing specific diagnostic and treatment decisions for URTI in PED. In total, 307 (74.9%) URTI cases underwent complete blood count (CBC) tests, 312 (76.1%) were subjected to C-reactive protein (CRP) tests, and 110 (26.8%) received urinalysis tests. Patients with a longer duration of fever and a physician's suspicion of bacterial infection were more likely to receive CBC, CRP, and/or urinalysis tests (p < 0.05). Moreover, 75.1% of the cases were classified as viral URTIs, 9.8% were bacterial URTIs, and 15.1% were unspecified. Notably, 86 (20.1%) children received antibiotics and antibiotic prescription correlated with age, tonsillitis diagnosis, CRP values higher than 30 mg/L, and a CBC of p < 0.05. Patients triaged in the second or third categories were three times more likely to be observed for 24 h compared to patients with URTI and the fourth triage category (p < 0.05). This study highlights the need for interventions to improve the appropriateness of emergency service utilization, thereby emphasizing the importance of judicious decision making in managing pediatric URTIs.

Short- and mid-term morbidity and primary-care burden due to infant respiratory syncytial virus infection: A Spanish 6-year population-based longitudinal study.

The morbidity burden of respiratory syncytial virus (RSV) in infants extends beyond hospitalization. Defining the RSV burden before implementing prophylaxis programs is essential for evaluating any potential impact on short- to mid-term morbidity and the utilization of primary healthcare (PHC) and emergency services (ES). We established this reference data using a population-based cohort approach. Infants hospitalized for RSV from January 2016 to March 2023 were matched with non-hospitalized ones based on birthdate and sex. We defined the exposure as severe RSV hospitalization. The main study outcomes were as follows: (1) PHC and ES visits for RSV, categorized using the International Classification of Primary Care codes, (2) prescriptions for respiratory airway obstructive disease, and (3) antibacterial prescriptions. Participants were followed up from 30 days before hospitalization for severe RSV until the outcome occurrence or end of the study. Adjusted incidence rate ratios (IRRs) of the outcomes along with their 95% confidence intervals (CI) were estimated using Poisson regression models. Stratified analyses by type of PHC visit (nurse, pediatrician, or pharmacy) and follow-up period were undertaken. We defined mid-term outcomes as those taking place up to 24 months of follow-up period. The study included 6626 children (3313 RSV-hospitalized; 3313 non-hospitalized) with a median follow-up of 53.7 months (IQR = 27.9, 69.4). After a 3-month follow-up, severe RSV was associated with a considerable increase in PHC visits for wheezing/asthma (IRR = 4.31, 95% CI: 3.84-4.84), lower respiratory infections (IRR = 4.91, 95% CI: 4.34-5.58), and bronchiolitis (IRR = 4.68, 95% CI: 2.93-7.65). Severe RSV was also associated with more PHC visits for the pediatrician (IRR = 2.00, 95% CI: 1.96-2.05), nurse (IRR = 1.89, 95% CI: 1.75-1.92), hospital emergency (IRR = 2.39, 95% CI: 2.17-2.63), primary healthcare emergency (IRR: 1.54, 95% CI: 1.31-1.82), as well as with important increase in prescriptions for obstructive airway diseases (IRR = 5.98, 95% CI: 5.43-6.60) and antibacterials (IRR = 4.02, 95% CI: 3.38-4.81). All findings remained substantial until 2 years of post-infection. Severe RSV infection in infants significantly increases short- to mid-term respiratory morbidity leading to an escalation in healthcare utilization (PHC/ES attendance) and medication prescriptions for up to 2 years afterward. Our approach could be useful in assessing the impact and cost-effectiveness of RSV prevention programs.

Who do freestanding emergency departments treat? Comparing Texas hospitals to satellite and independent freestanding departments in 2021 and 2022.

The objective was to describe characteristics of emergency department visits to Texas satellite and independent freestanding emergency departments (FrEDs) relative to hospital emergency departments (EDs). The study used all 2021-2022 hospital and FrED discharges from the publicly available Texas Emergency Department Public Use Data Files (PUDF). We conducted a descriptive analysis, comparing patient and visit characteristics at satellite and independent FrEDs and hospital EDs using chi-square tests. We characterized the top 20 diagnoses and procedures ranked by volume, treatment intensity, and potentially avoidable ED use. Discharge data from 2021 to 2022 were combined for the analysis, and ED data at critical access hospitals were excluded. Our sample consisted of 21,605,421 ED visits, 76% occurring at hospitals, 12% at satellite FrEDs, and 12% at independent FrEDs. Compared with hospitals and satellite FrEDs, patients to independent FrEDs were younger, healthier, more likely covered by private insurance, and less likely to be identified as non-Hispanic Black or Hispanic. Visits at satellite and independent FrEDs were more likely to be of moderate and low intensity and potentially avoidable. Our results underscore the need to address potentially avoidable utilization of emergency services.

Factors Impacting the Implementation of Mobile Integrated Health Programs for the Acute Care of Older Adults

Objective Emergency services utilization is increasing in older adult populations. Many such encounters may be preventable with better access to acute care in the community. Mobile integrated health (MIH) programs leverage mobile resources to deliver care and services to patients in the out‐of‐hospital environment and have the potential to improve clinical outcomes and decrease health care costs; however, they have not been widely implemented. We assessed barriers, potential facilitators, and other factors critical to the implementation of MIH programs with key vested partners. Methods Professional and community-member partners were purposefully recruited to participate in recorded structured interviews. The study team used the Practical Robust Implementation and Sustainability Model (PRISM) framework to develop an interview guide and codebook. Coders employed a combination of deductive and inductive coding strategies to identify common themes across partner groups. Results The study team interviewed 22 participants (mean age 56, 68% female). A cohort of professional subject matter experts included physicians, paramedics, public health personnel, and hospital administrators. A cohort of lay community partners included patients and caregivers. Coders identified three prominent themes that impact MIH implementation. First, MIH is disruptive to existing clinical workflows. Second, using MIH to improve patients’ experience during acute care encounters is key to intervention adoption. Finally, legislative action is needed to augment central financial and regulatory policies to ensure the adoption of MIH programs. Conclusions Common themes impacting the implementation of MIH programs were identified across vested partner groups. Multilevel strategies are needed to address patient adoption, clinical partners’ workflow, and legislative policies to ensure the success of MIH programs.

Police-mental health co-response versus police-as-usual response to behavioral health emergencies: A pragmatic randomized effectiveness trial

BackgroundPeople with mental illness are overrepresented in United States (US) criminal legal systems. In response, alternatives to traditional police response to behavioral health emergencies have become more common, despite limited evidence for their effectiveness. We conducted the first randomized controlled trial of a police-mental health co-response team to determine program effectiveness relative to a police-as-usual response on key outcomes identified by community stakeholders. MethodsBetween January 2020 and March 2021, we randomized behavioral health emergency calls for service in one of six police districts in Indianapolis, Indiana to receive a co-response or police-as-usual response during operational hours between 10 a.m. and 5 p.m. Mondays – Fridays. Eligible calls for service were determined via pre-specified phrases indicating a behavioral health incident over the police dispatch radio. Researchers then communicated random assignment with the co-response team to indicate whether they should respond or withhold. Logistic and negative binomial regression were used to assess group differences in emergency medical services (EMS) events within 12 months of the randomized incident along with jail booking, outpatient encounters, and emergency department visits. FindingsWe randomized 686 calls for service with co-response completed in 264 cases and police-as-usual response in 267 cases. The overall rate of attrition was similar across conditions and the final sample included 211 co-responses and 224 police-as-usual responses. We found no significant differences in any EMS event (odds ratio [OR]: 1.26; 95% confidence interval [CI]: 0.85–1.88, p = .246) or event counts (incidence rate ratio [IRR]: 0.85; 95% CI: 0.52–1.37, p = .504). We also found no differences in secondary outcomes (jail booking, outpatient encounters, and emergency department visits). DiscussionA police-mental health co-response team model was not more effective than traditional police response on key outcomes. Co-response team models, such as the one reported here, may unintentionally foster emergency services utilization among persons with behavioral health needs. Without a functioning national mental health system, communities in the US will continue to struggle to identify solutions to meet the needs of community members with complex behavioral health issues.

COST-DRIVERS OF HEALTHCARE EXPENDITURES IN INFLAMMATORY BOWEL DISEASE

Abstract INTRODUCTION Inflammatory bowel diseases (IBD) are gastrointestinal (GI) conditions associated with significant costs. Effective management of IBD should focus on improving patient symptoms and outcomes while containing healthcare costs. To develop high-value treatment strategies and influence policy on high-value care, we must first have a better understanding of the primary drivers of cost in this population. METHODS We conducted a real-world descriptive cohort study using data from IBM Watson, which is a nationwide insurance claims database covering millions of commercially insured individuals across the US. We identified adult patients aged 18 to 65 years with encounters associated with a diagnosis of IBD in the primary or secondary position from January 2019 to January 2020 based on ICD-10-CM codes for Crohn's disease (555.x) and ulcerative colitis (556.x). Analysis of IBD prevalence, costs, and service utilization was based on ICD, CPT, and NDC codes related to IBD conditions and services. All other codes without an associated GI diagnosis in the primary or secondary position were attributed to all-cause costs. Measures of cost and utilization were calculated as a per member per year (PMPY). RESULTS 105,496 patients with IBD were identified (Table 1). The mean PMPY total costs were $40,842 of which $31,051 (76%) were directly related to GI-related costs. Mean PMPY total costs in this population ranged from $1,178 to $144,945, with 15% of members experiencing costs &amp;gt; $76,346 PMPY. The main drives of GI-related costs can be divided into the following three categories: Inpatient costs ($8,206 [26%]), outpatient medical service costs ($11,306 [36%]), and drug costs ($11,539 [37%]) (Table 2). Per member utilization includes: 0.22 inpatient admissions, 0.10 surgeries, 1.02 GI visits, 2.87 non-gastroenterologist GI visit (which could include a visit to a primary medical doctor, rheumatologist, dietician, etc), 4.57 GI-testing, 0.48 GI imaging, 0.61 GI endoscopy, and 1.07 biologic medication prescriptions. CONCLUSIONS IBD care carries a significant financial burden on the US healthcare system. Unplanned emergency service and medication utilization continue to make up the majority of costs of IBD care and need to be the focus of value-based interventions. While appropriate high-cost pharmaceutical utilization should not be reduced, innovative strategies leveraging more cost-effective medication delivery may provide an important opportunity to curb costs. Furthermore, the high rate of non-gastroenterologist GI visits suggests that there is a potential for optimizing care pathways, by incorporating multidisciplinary care including, PCPs, mid-level providers, and other ancillary services into the IBD care model.

Socio-Demographic and Behavioral Predictors of Admission for Kidney Disease in an Urban Hospital in Northwest Indiana

Background: The CDC estimates more than 1 in 7 American adults have Chronic Kidney Disease (CKD) and nearly 800,000 live with End-Stage Renal Disease (ESRD); the majority of whom require dialysis. Current literature demands further exploration on how social determinants of health (SDOH) influence inpatient and emergency services utilization for CKD/ESRD-related exacerbations. This study examined socio-demographic and behavioral factors associated with hospital admission for CKD/ESRD. It is part of a three-phased Community-Based Participatory Research (CBPR) partnership between IUSM-NW and St. Mary Medical Center (SMMC) to examine and address relationships between SDOH, patient demographics, health behaviors, and health outcomes from January 2022-January 2025.&#x0D; Methods: This retrospective study analyzed a limited dataset generated by SMMC from EPIC™ with SDOH, demographic, health behavior, and health outcomes data obtained from adult inpatients between January 2021 and March 2023. CKD/ESRD was determined by admission diagnosis ICD-10 Code N18. Data analysis utilized SPSS 29.0 to produce frequencies, Chi-Square tests (p&lt;0.05), and a binary logistic regression (p&lt;0.05). This study was exempted by Indiana University Human Research Protection Program (IRB # 14040).&#x0D; Results: This study included 10,953 inpatient admissions involving predominantly white (78.4%) and older adult (68 ± 21) patients. CKD/ESRD represented 96 admissions. The bivariate analysis found a significant association between CKD/ESRD admissions and age (p&lt;0.001), race (p&lt;0.001), sex (p=0.008), insurance type (p=0.030), and smoking tobacco use (p=0.004). After adjusting for all factors, being Asian (OR=12.172, p&lt;0.001), Black (OR=3.702; p&lt;0.001), female (OR=0.518; p=0.003), publicly insured (OR=2.76; p=0.014), and former smoking (OR=1.606; p=0.045) were significantly associated with CKD/ESRD admission.&#x0D; Conclusions: This study revealed several demographics, SDOH, and health behaviors associated with CKD/ESRD admission in an urban hospital. Uncovering predictors of CKD/ESRD admission enables focused interventions to decrease admissions. The next CBPR phases will apply advanced statistical analyses to further explore these relationships and codevelop interventions.

Emergency services utilization by patients with alcohol-associated hepatitis: An analysis of national trends.

Hospitalization and mortality in patients with alcohol-associated hepatitis (AH), a severe form of liver disease, continue to increase over time. Given the severity of the illness, most hospitalized patients with AH are admitted from the emergency department (ED). However, there are no data on ED utilization by patients with AH. Thus, the Nationwide Emergency Department Sample (NEDS) dataset was analyzed to determine the ED utilization for AH. Temporal trends (2016-2019) and outcomes of ED visits for AH were determined. Primary or secondary AH diagnoses were based on coding priority. Numbers of patients evaluated in the ED, severity of disease, complications of liver disease, and discharge disposition were analyzed. Crude and adjusted rates were examined, and temporal trends evaluated using logistic regression with orthogonal polynomial contrasts for each year. There were 466,014,370 ED visits during 2016-2019, of which 448,984 (0.096%) were for AH, 85.0% of which required hospitalization. The rate of visits for AH (primary and secondary) between 2016 and 2019 increased from 85 to 106.8/100,000 ED visits. The rate of secondary AH increased more than the rate of primary AH (from 68.6 to 86.5 vs. from 16.4 to 20.3/100,000 ED visits). Patients aged 45-64 years had the highest rate of ED visits for AH, which decreased during the study period, while the rate of ED visits for AH increased in those aged 25-44 years (from 38.5% to 42.9%).The severity of disease (ascites, hepatic encephalopathy, and acute kidney injury) also increased over time. Medicaid and private insurance were the most common payors for patients seeking care in the ED for AH. Temporal trends show an overall increase in ED utilization rates for AH, more patients requiring hospitalization, and an increase in the proportion of younger patients presenting to the ED with AH.

Abstract 338: Temporal Characteristics of a Smartphone Alert System for CPR in a Mid-Sized Metropolitan Area

Introduction: Smartphone alert systems (SAS) mobilize trained volunteers to initiate CPR prior to Emergency Medical Services (EMS) arrival. Among the potential factors affecting the probability of a successful response is time; time of day, day of the week, and season each present plausible barriers to response. We sought to examine the temporal characteristics of an SAS in order to better understand this relationship between time and system performance. Methods: Operational records were obtained from the PulsePoint deployment in Allegheny County, Pennsylvania, USA for the period June 2016 to May 2023. PulsePoint sends alerts including nearby AED locations to volunteer responders within a 400m radius of public cardiac arrest events. Case data included alert time and number of responders and AEDs within range of the event. We associated each PulsePoint event with an 8-hour Timeframe (TF) {1 (00:00-07:59), 2 (08:00-15:59), and 3 (16:00-23:59)}, a day of the week, and a season. For each, we calculated the median number of associated responders and AEDs, and the total number of events. We then compared each across each time variable with a Mann-Whitney U-test or Kruskal-Wallis test. Results: There were a total of 2354 events in the capture period. Alerts were least common on Sundays (12.4%) and most common on Tuesday (15.6%). Alerts most frequently occurred in TF2 (45.6% vs TF1: 18.3, TF3: 36.1) and were similar between seasons. Weekday alerts had a higher median number of responders than weekend alerts {3 (1-5) vs 2 (1-4), p=0.004}. Responder count was lower for TF1 than TF2 and TF3 {2 (1-4) vs 3(1-5) vs 3(1-5), p &lt; 0.001}. Count of proximal AEDs did not vary by any of the temporal characteristics. Conclusion: Both event frequency and number of notified responders were associated with day of the week and time of day. Either feature is more complicated than meets the eye, and may include associations with diurnal population movement cycles, overall patterns in emergency services utilization, and responder device configuration preferences. All could be influential in optimizing such SAS deployments.

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.

SAT351 Utilization of Emergency Services by Transgender People in the United States, 2006-2018

Abstract Disclosure: D. Stroumsa: None. E.E. Marsh: None. P.N. Pfeiffer: None. C. Jiang: None. A. Vrolijk: None. M.B. Moravek: None. Bridging the Gap: Utilization of Emergency Services by Transgender People in the United States, 2006-2018Introduction: Transgender or nonbinary (Trans) people face significant health disparities, including in access to primary and preventive care. These disparities are driven by structural, interpersonal, and individual stigma, which lead to barriers accessing care and avoidance of primary care, and to increased reliance on emergency care. We aimed to characterize ED use by Trans patients, and changes in such use over time. Methods: Data was obtained from the Nationwide Emergency Department Sample (NEDS) , which is a weighted stratified sample of hospital-based ED visits. Using gender-dysphoria related ICD-9 and ICD-10 diagnostic codes, we compared visits among trans people to those without such a diagnosis, adjusting for age, region, urbanicity, primary payer, and income quartile. We evaluated rates of chronic condition and mental health conditions as primary diagnosis at presentation and at admission. Presence of chronic conditions was assessed using the ICD-9 Chronic Condition Indicator for 2006-2014. Results: There was a rapid temporal increase in the proportion of visits with a trans-related diagnosis, from 0.001% of visits in 2006 to 0.016% in 2018. There were significant demographic differences between trans people and others. Trans people were significantly more likely to be admitted, adjusting for payment, age group, region, income and mental health condition (overall 52.4% vs. 17.3%, adjusted OR= 7.368 95% CI (6.771, 8.017)). A large proportion of ED visits by trans individuals was associated with a mental health diagnosis (28.7%, compared with 3.9% for others, p&amp;lt;0.001; adjusted OR =2.01, 95% CI 1.91-2.11) and/or with a chronic condition (58.2% vs. 19.2%, p&amp;lt;0.001; adjusted OR =3.65, 95% CI 3.61-3.69). Similarly, hospital admission among trans people was much more likely to be linked to a mental health condition (37.2% vs. 5.3% , p&amp;lt;0.001; adjusted OR = 2.78, 95% CI 2.44-3.16) or chronic condition (67.3% vs 41.3%, p&amp;lt;0.001; adjusted OR = 2.21, 95% CI 1.78-2.75) Discussion: The high admission rates, and high proportion of trans people with a chronic condition or with mental illness, may represent worse overall health due lack of primary care, or a delay in seeking emergency care among Trans people. Lastly, these findings could be a manifestation of a higher likelihood of a trans-related diagnostic code being charted among trans people at admission, or bias towards higher likelihood of trans people receiving a mental-health related diagnosis. There is a need for increasing access to affirming primary and mental health care among trans people, and increased training of emergency clinicians. Presentation Date: Saturday, June 17, 2023

Non-face-to-face care management and service utilization in patients with diabetes.

In 2015, CMS implemented reimbursement for non-face-to-face chronic care management (NFFCCM) for beneficiaries with multiple chronic conditions, including diabetes. This analysis estimated the association between NFFCCM and utilization of inpatient, outpatient, and emergency services. We implemented a doubly robust estimator using propensity score matching in a regression context to compare eligible patients who used NFFCCM (n = 282) with eligible patients who did not use NFFCCM (n = 26,759). We tested 4 definitions of treatment: having any NFFCCM encounters and having 1 NFFCCM encounter per month, per 2 months, and per 3 months. Two-tailed statistical inference testing was conducted at the 5% level. We examined the utilization differences among patients with diabetes 65 years and older using merged electronic health records for 4 health systems in Louisiana from the Research Action for Health Network database in 2013 through 2018. We found NFFCCM was associated with increased utilization of care in the outpatient setting by 0.056 visits per month (95% CI, 0.027-0.086) and with lower utilization in the inpatient setting (-0.024 visits per month; 95% CI, -0.038 to -0.010) and in the emergency department setting (-0.017 visits per month; 95% CI, -0.031 to -0.003). Alternative specifications of treatment showed similar associations. CMS implementation of reimbursement codes for NFFCCM, and subsequent utilization of that reimbursement by health systems, was associated with a shift in patient utilization from high-cost settings (inpatient and emergency department) to a lower-cost setting (outpatient office).

Demographic predictors of emergency service utilization patterns in youth at risk of suicide.

To explore demographic predictors of Emergency Department (ED) utilization among youth with a history of suicidality (i.e., ideation or behaviors). Electronic health records were extracted from 2017 to 2021 for 3094 8-22 year-old patients with a history of suicidality at an urban academic medical center ED in the Mid-Atlantic. Logistic regression analyses were used to assess for demographic predictors of ED utilization frequency, timing of subsequent visits, and reasons for subsequent visits over a 24-month follow-up period. Black race (OR = 1.45, 95% CI = 1.11-1.92), Female sex (OR = 1.59, 95% CI = 1.26-2.03), and having Medicaid insurance (OR = 1.71, 95% CI = 1.37-2.14) were associated with increased utilization, while being under 18 was associated with lower utilization (<12: OR = 0.38, 95% CI = 0.26-0.56; 12-18: OR = 0.47, 95% CI = 0.35-0.63). These demographics were also associated with ED readmission within 90 days, while being under 18 was associated with a lower odds of readmission. Among patients with a history of suicidality, those who identify as Black, young adults, patients with Medicaid, and female patients were more likely to be frequent utilizers of the ED within the 2 years following their initial visit. This pattern may suggest inadequate health care access for these groups, and a need to develop better care coordination with an intersectional focus to facilitate utilization of other health services.

Shared Decision-making Lowers Medical Expenditures and the Effect is Amplified in Racially-Ethnically Concordant Relationships.

Racial-ethnic disparities are pervasive in health care. One mechanism that may underlie disparities is variation in shared decision-making (SDM), which encompasses high-quality clinician-patient communication, including deliberative discussions about treatment options. To determine whether SDM has causal effects on outcomes and whether these effects are stronger within racial-ethnic concordant clinician-patient relationships. We use instrumental variables to estimate the causal effect of SDM on outcomes. A total of 60,584 patients from the 2003-2017 Integrated Public Use Microdata Series Medical Expenditure Panel Survey. Years 2018 and 2019 were excluded due to changes in the Medical Expenditure Panel Survey that omitted essential parts of the SDM index. Our key variable of interest is the SDM index. Outcomes included total, outpatient, and drug expenditures; physical and mental health; and the utilization of inpatient and emergency services. SDM lowers annual total health expenditures for all racial-ethnic groups, but this effect is only moderated among Black patients seen by Black clinicians, more than doubling in size relative to Whites. A similar SDM moderation effect also occurs for both Black patients seen by Black clinicians and Hispanic patients seen by Hispanic clinicians with regard to annual outpatient expenditures. There was no significant effect of SDM on self-reported physical or mental health. High-quality SDM can reduce health expenditures without negatively impacting overall physical or mental health, supporting a business case for health care organizations and systems to improve racial-ethnic clinician-patient concordance for Black and Hispanic patients.

(011) Female Sexual Dysfunction Associated with Decreased Cardiovascular Risk – A US Claims Database Analysis

Abstract Introduction Erectile dysfunction can be a harbinger of underlying cardiovascular (CVD) risk factors in men. Despite the higher prevalence of sexual dysfunction among women than men, the association between vascular impairment and female sexual dysfunction (FSD) as well as the pathophysiology of FSD remains understudied. Objective Our objective was to assess the association of FSD with major adverse cardiac events (MACE) using a large claims database. Methods A US-based claims database network (TriNetX Diamond Network) was queried from 2009 to 2022 to create our cohorts. Our study cohort included adult (age 18+) females diagnosed with FSD (ICD-10 F52) excluding those with heart failure (I50) or unstable angina (I20.0). Our control cohort excluded females diagnosed with FSD, heart failure, or unstable angina. Propensity-matching between the cohorts for age, ethnicity, race, BMI, family history of CVD (Z82.4), tobacco usage (Z72.0), type 2 diabetes (E11), hyperlipidemia (E78), hypertension (I10), and utilization of inpatient (1013659), outpatient (1013626), or emergency services (1013711) was conducted. MACE was defined as heart attack (I21, I22), stroke (I60, I61, I62, I63), or death within five years of FSD diagnosis. A sub-analysis by age (18-40 years, 41-55 years, and &amp;gt;55 years) was conducted. Amongst the &amp;gt;55 years cohort, the effect of ≥3 vaginal estrogen prescriptions on MACE was evaluated. Results All results are reported for our study cohorts in comparison to an equivalent number of propensity-matched controls. Adult females diagnosed with FSD (n=65,265) had significantly lower odds of heart attack (odds ratio (OR) 0.26 [95% CI 0.22 – 0.30]), stroke (OR 0.29 [0.26 – 0.32]), death (OR 0.46 [0.41 – 0.51]), and any MACE event (OR 0.32 [0.30 – 0.34]) (Table 1). This trend remained in females aged 18-40 years (n=18,473) and diagnosed with FSD (Table 2); they had significantly lower odds of heart attack (OR 0.31 [0.16 – 0.59]), stroke (OR 0.27 [0.18 – 0.39]), death (OR 0.36 [0.21 – 0.63]), and any MACE event (OR 0.30 [0.22, 0.39]). Among 41–55-year-olds (n=21,648) with FSD, (Table 2) we found our study cohort to have significantly lower odds of heart attack (OR 0.21 [0.15 – 0.29]), stroke (OR 0.26 [0.22 – 0.32]), death (OR 0.39 [0.30 – 0.50]), and any MACE event (OR 0.28 [0.24 – 0.32]) (Table 2). Finally, the population of individuals aged &amp;gt; 55 years (n=25,144) were found to have significantly lower odds of heart attack (OR 0.30 [0.25 – 0.36]), stroke (OR 0.35 [0.31 – 0.39]), death (OR 0.54 [0.47 – 0.62]), and any MACE event (OR 0.38 [0.36 – 0.42]). There was no difference in the odds of MACE event by vaginal estrogen usage in this age-group (OR 0.66 [0.31 – 1.38]). Conclusions In this large claims-based analysis, we demonstrated that females diagnosed with FSD had lower odds of MACE. Though screening for CV risk should be discussed with all patients, our results suggest that vascular impairment may not have a role in the pathophysiology of FSD. Disclosure No

"Another tool in the toolkit"-Perceptions, suggestions, and concerns of emergency service providers about the implementation of a supervised consumption site.

As Supervised Consumption Sites (SCS) are implemented in the United States, it is important to consider the needs and perceptions of impacted stakeholders. Emergency service providers (ESP) have a central role in responding to the overdose epidemic. This study intended to assess the how ESP perceive the potential implementation of an SCS in their community, as well as solicit program design and implementation-related concerns and suggestions. In-depth interviews were conducted by videoconference with 22 ESP, including firefighters, paramedics, police, and social workers in King County, Washington, USA. Data were analyzed using a thematic analysis approach. Participants expressed the importance of feeling safe while responding to calls where drug use is involved and highlighted how this perception would be linked to ESP response times to calls from an SCS. Suggestions for improving the perceived safety of an SCS included training program staff in de-escalation as well as planning the layout of the SCS to accommodate ESP. The inadequacy of the emergency department as a point of care for PWUD was also identified as a theme, and some participants expressed enthusiasm regarding the prospect of the SCS as an alternative destination for transport. Finally, support for the SCS model was conditional on the appropriate utilization of emergency services and a reduction in call volume. Participants listed clarifying roles and pursuing opportunities for collaboration as ways to ensure appropriate utilization and maintain positive working relationships. This study builds on literature regarding stakeholder perceptions of SCS by focusing on the perceptions of a critically important stakeholder group. Results enhance understanding of what motivates ESP to support SCS implementation in their community. Other novel insights pertain to ESP thoughts about alternative care delivery models and strategies for emergency department visit diversion.

Psychosis among individuals with methamphetamine use disorder is associated with elevated rates of hospitalizations and emergency department visits across an academic health care system

IntroductionMethamphetamine (MA) is increasingly available in the United States and manufactured with increasing potency. Although psychosis is a known harm related to MA use, we know little about the clinical outcomes and prognosis of individuals who use MA and experience psychosis. Some evidence exists that psychosis among people who use methamphetamine leads to a high utilization of emergency and acute inpatient services, but the extent of this use is unclear. MethodsUsing an electronic health record (EHR) database, this study assessed acute care visits of individuals receiving diagnostic codes of the following disorders: methamphetamine use disorder with undifferentiated psychosis (MUDp), schizophrenia (MUDs) and no history of psychosis (MUD) in addition to individuals without MUD diagnosis but with diagnoses of either undifferentiated psychosis (Psy) or schizophrenia (Scz) from 2006 to 2019. The study explored potential clinical risk factors associated with rate of acute care visits. ResultsReceiving diagnoses of psychotic disorders and MUD were both associated with high rates of acute care utilization. The incidence rate ratio (IRR) was highest in the MUDp group 6.30 (95% CI: 5.73, 6.93) followed by the MUDs group 4.03 (95% CI: 3.87, 4.20), the Psy group 3.77 (95% CI: 3.45, 4.11), the Scz group 3.11 (95% CI: 2.99, 3.23), and the MUD group 2.17 (95% CI: 2.09, 2.25). Receiving another SUD diagnosis was identified as a risk factor for acute care visits in the MUDp group, and mood and anxiety disorder diagnoses were a risk factor in the MUDs group. ConclusionsIn a general health care system, individuals receiving diagnoses of MUD and co-occurring psychotic disorders were observed to have particularly high rates of acute care service utilization, suggesting a high degree of disease burden and the need for development of targeted treatment interventions with both MUD and psychosis.

Variations in Emergency Service Utilization among Cancer Survivors: Results from the Pan-Canadian Experiences of Cancer Patients in Transition Study Survey.

The objective of this study was to examine variations in emergency service utilization (ESU) among cancer survivors during the first year after completing primary cancer treatment. In 2016, the Canadian Partnership Against Cancer collected survey responses from cancer survivors across Canada about self-reported ESU after completing primary cancer treatment. We included survey respondents diagnosed with nonmetastatic breast, hematologic, colorectal, melanoma, or prostate cancer. Multivariable, multinomial logistic regression analysis was used to examine factors associated with cancer survivors' ESU. Of the 5,774 cancer survivors included in our analysis, 22% reported ESU during the first year after completing their primary cancer treatment, 16% reported ESU one to three times, and 6% reported ESU more than three times. Factors significantly associated with frequent ESU included younger age, colorectal and hematologic cancers, more frequent primary care provider and oncology specialist visits, single or retired status, lower income, and self-reported lower quality of life. Our study identified factors associated with more frequent ESU among cancer survivors in the first year after completing primary cancer treatment. These factors highlight differences in cancer survivors' demographics, their ability to access and need for healthcare services, and the complexity of using ESU as a metric for quality improvement in survivorship care. These variations must be considered in quality improvement initiatives.

Physical distancing and emergency services utilization by self-harm patients in Korea during the early COVID-19 pandemic: A nationwide quantitative study

Physical distancing and emergency services utilization by self-harm patients in Korea during the early COVID-19 pandemic: A nationwide quantitative study

Physical distancing and emergency services utilization by self-harm patients in Korea during the early COVID-19 pandemic: A nationwide quantitative study

Physical distancing and emergency services utilization by self-harm patients in Korea during the early COVID-19 pandemic: A nationwide quantitative study