Although contaminated blood cultures are known to result in billions of dollars in annual health care costs in the United States due to excess health care utilization and antibiotic exposure, the burden in pediatrics is not well described. Retrospective cohort study of 128 524 blood cultures obtained from 2010 to 2022 in outpatient and hospital settings in a multicenter health care system. Cultures with commensal organisms were considered contaminated after excluding patients with high-risk conditions, including immunodeficiencies, malignancy, and indwelling catheters. Health care utilization and cost assessment were analyzed and compared between patients with contaminated blood cultures and patients with true positive or negative blood cultures. Contaminated blood cultures resulted in 15-fold (odds ratio [OR] = 15.10; 95% CI: 13.50-17.00) higher odds of emergency department (ED) visits, 6-fold (OR = 5.71; 95% CI: 4.63-7.05) higher odds of admissions, and 32% longer length of stay (risk ratio = 1.32; 95% CI: 1.26-1.39) compared with age-matched noncontaminated negative blood cultures. This resulted in approximately $980 in ED costs per contaminant for outpatients and $2500 in hospital costs per contaminant for inpatients, a total of $1.5 million in ED costs over the study. Patients with contaminated cultures received more antibiotics and underwent more blood draws than patients with negative blood cultures. Pediatric blood culture contamination results in excess reutilization with significant economic costs and impact on patients.

Effective communication is essential to patient-provider interactions, chronic disease self-management, and ultimately reducing excess healthcare utilization. This study investigated whether hearing loss was associated with hospitalizations among adults managing heart failure. Nationally representative prospective cohort data from the 1998 to 2020 Health and Retirement Study (HRS) were used to examine adults who were diagnosed with heart failure (n = 3274) and followed every 2 years for up to 8 years. Hearing status was ascertained at each wave by patient-reported hearing and hearing aid use (normal hearing, unaided hearing loss, aided hearing loss). Hospitalizations were assessed at each wave from participants' reported number of all-cause hospital admissions in the prior 2 years. Negative binomial mixed models examined numbers of hospitalizations over time among patients with normal hearing, unaided hearing loss, and aided hearing loss. Among study participants (mean age 71.5 years [± 10.6]), approximately 63.8% reported normal hearing, 28.5% had unaided hearing loss, and 7.6% had aided hearing loss. Adults with unaided hearing loss had significantly more hospitalizations than adults with normal hearing (incidence-rate ratio [IRR] = 1.14, 95% CI = 1.07-1.22, P < .001). The association was partly attenuated after adjusting for the sociodemographic and health-related characteristics of adults with heart failure (IRR = 1.07, 95% CI = 1.00-1.14, P = .040). Adults with aided hearing loss had no significant difference in hospitalizations compared to adults with normal hearing. Among heart failure patients with hearing loss, those who were unaided had significantly more hospitalizations compared to those who wore hearing aids (IRR = 1.26, 95% CI = 1.06-1.49, P = .008). The associations were consistent over the course of the illness and did not vary across major demographic groups. Unaided hearing loss was associated with increased hospitalizations among adults with heart failure. Healthcare providers should consider routine hearing assessments in heart failure patients to identify those who may benefit from hearing aids to potentially reduce their risk of preventable hospitalizations.

Abstract Effective communication is essential to patient-provider interactions, chronic disease self-management, and ultimately reducing excess healthcare utilization. This study investigated whether hearing loss (HL) was associated with hospitalizations among adults managing heart failure (HF). Nationally-representative prospective cohort data from the 1998-2020 Health and Retirement Study (HRS) were used to examine adults who were diagnosed with HF (n = 3,274). Hearing status was ascertained at each wave by patient-reported hearing and hearing-aid (HA) use (normal hearing, unaided HL, aided HL). Hospitalizations were assessed at each wave from participants’ reported number of hospital admissions in the prior two years. Negative binomial mixed models examined numbers of hospitalizations over time by hearing status. Among study participants (mean age 71.46 years [±10.59]), approximately 63.84% reported normal hearing, 28.53% had unaided HL, and 7.64% had aided HL. Adults with unaided HL had significantly more hospitalizations than adults with normal hearing (incidence-rate ratio [IRR]=1.14, 95% CI = 1.07-1.22, P&amp;lt;.001). The association was partly attenuated after adjusting for the sociodemographic and health-related characteristics of adults with HF (IRR=1.07, 95% CI = 1.00-1.14, P=.040). Adults with aided HL had no significant difference in hospitalizations compared to adults with normal hearing. Among HF patients with HL, those who were unaided had significantly more hospitalizations compared to those who wore HAs (IRR=1.26, 95% CI = 1.06-1.49, P=.008). Associations were consistent over the course of the illness and did not vary across demographic groups. Healthcare providers should consider routine hearing assessments in HF patients to identify those who may benefit from HAs to reduce their risk of potentially preventable hospitalizations.

545 Background: Cancer survivors face disproportionately high burdens of mental health concerns relative to the general population. Many seek empowering peer relationships to get support after treatment. Research suggests that these relationships are helpful, but that access to psychoeducation could also be beneficial. However, few programs combine these two powerful components, and access to structured evidence-based peer groups that focus on evidence-based skills are limited and can vary significantly by location or treatment center. Methods: We conducted an IRB-approved prospective randomized pilot study to examine the impact of Color Cancer Connect, a virtual, group-based peer-led mental wellness program for cancer survivors on depression, anxiety, and loneliness (NCT#: NCT06353178). This program is an adaptation of previously peer-reviewed programs targeting other populations, like pediatric palliative caregivers. This program is supervised by a psychologist and part of a 50-state Virtual Cancer Clinic. It encourages sharing experiences, disseminates evidence-based education about coping skills and wellness, and guides skills practice in a supportive adult-learning environment. Participants were randomized to start the program immediately (“intervention group”; n = 12) or after a delay (“waitlist group”; n = 13). Surveys were completed at baseline (T0) and after three months (T1) with the Patient Health Questionnaire-8 (PHQ-8), Generalized Anxiety Disorder-7 (GAD-7) and the Three-Item Loneliness scale. Facilitators were trained to respond to severe psychiatric symptoms by referring to a supervisor or appropriate emergency service; this did not occur during the study. Two sample t-tests were conducted to compare differences between T1 &amp; T0. Results: The “intervention group” reported 36% improvement in anxiety symptoms from T0 to T1, which was significantly different from the “waitlist group” from T0 to T1 ( t (23) = -1.725, p = 0.049); 67% of intervention participants met the minimally clinically important difference (MCID) for anxiety. Program participants also experienced a 36% and 10% decrease in depressive and loneliness symptoms, respectively; these differences were not statistically significant. Conclusions: This study demonstrates the effectiveness of a virtual peer-led, skills-based support program designed for cancer survivors to improve mental health. Virtual behavioral health interventions may deliver a scalable improvement in mental health outcomes for cancer survivors, potentially curbing excess healthcare utilization. Clinical trial information: NCT06353178 .

Major depressive disorder affects approximately 10% of all adults in the United States, but the condition remains underdiagnosed for patients with degenerative spine disease and radicular pain. The impact of comorbid undiagnosed depression on postoperative outcomes after lumbar fusion is not well characterized and may contribute to excessive health care utilization. This study isolates the relationship between undiagnosed depression, assessed by the Patient Health Questionnaire 2 (PHQ-2) screening tool, and short-term postoperative outcomes after single-level posterior lumbar fusion. PHQ-2 data were prospectively collected, and retrospectively reviewed, among consecutive patients (n = 3225) undergoing single-level posterior-only lumbar spinal fusion surgery over 10 years at a multihospital academic medical center. Coarsened exact matching analysis was performed to match patients on factors known to affect outcome, isolating the impact of PHQ-2 scores. Matched characteristics included sex, race, body mass index, smoking status, median household income, and medical comorbidities determined by the Charlson Comorbidity Index. Primary outcomes were emergency department visits, readmission, and discharge disposition after surgery. Secondary outcomes included reoperation, intraoperative complications, and length of postoperative stay. Amongst all patients undergoing surgery, 306 (9.5%) patients showed risk for depression (PHQ-2 scores of 3-6). High-risk patients had significantly more 90-day postoperative emergency department visits ( P = .0348, odds ratio = 1.93 [1.04, 3.61]) when compared with otherwise matched patients with no risk factors for depression (PHQ-2 score 0). There were no differences in intraoperative complications, length of stay, discharge disposition, readmissions, or reoperations. Elevated preoperative PHQ-2 depression screening scores are associated with increased postoperative resource utilization after lumbar spinal fusion. The PHQ-2, as a predictor of undiagnosed depression, may identify high-risk populations before surgery. Prospective studies to assess mitigation strategies to improve outcomes, and reduce resource utilization, are warranted.

The Impact of Cognitive Impairment on Cardiovascular Disease.

IntroductionFrailty likely contributes to disproportionate health care utilization among people living with chronic kidney disease (CKD) and undergoing hemodialysis (HD); but this is poorly captured in nephrology clinical and research practice. We examined Fried frailty phenotype among participants with CKD or on HD and explored associations with health care utilization. We examined frailty transitions in relation to hospitalization.MethodsWe conducted a prospective observational single-center study of patients with advanced CKD or undergoing HD. Frailty was assessed at baseline, 6 and 12 months. Demographic and clinical data, including comorbid burden, disability, and laboratory parameters were recorded. Data linkage with tertiary hospital captured emergency department (ED) presentations, hospital admissions, and days of hospital stay, excluding admissions for maintenance HD. Negative binomial regression was used to model health care utilization patterns. Frailty progression over study follow-up was described using Cox proportional hazards modelling.ResultsAmong 256 participants, frailty (36.3%) and prefrailty (46.5%) were highly prevalent. Frailty independently predicted ED presentation (incidence rate ratio [IRR]: 1.25, 95% confidence interval [CI]: 1.09–1.43), hospitalization (IRR: 1.22, 95% CI: 1.08–1.37), and total days of hospitalization (IRR: 1.29, 95% CI: 1.06–1.57) independent of demographics, comorbidity, disability, and inflammation. The median occurrence of hospitalization events was 152 days (interquartile range [IQR]: 44–251) after enrolment, suggesting a window of opportunity where frailty recognition might prompt targeted intervention to prevent frailty-related sequelae. Frailty was highly dynamic; frailty progression was not associated with hospitalization or length of stay.ConclusionFrailty is a major contributor to excess health care utilization among people with kidney disease. Recognition of the prognostic implications of frailty might allow timely introduction of interventions to improve patient outcomes.

Prophylactic drain use during primary bariatric surgeries continues despite previous literature cautioning against their routine use. Modern drain utilization and associated outcomes remain largely poorly studied which limits selective utilization and perhaps may lead to excess morbidity and healthcare resource utilization. This study aimed to reassess current trends of drain use in primary bariatric procedures, factors driving surgeons to place drains, and patient outcomes associated with drain placement. Patients undergoing the most common primary bariatric surgery operations from 2020 to 2022 were included using the Metabolic and Bariatric Accreditation and Quality Improvement Program (MBSAQIP) database. Two cohorts were created, a drain placed (DP) cohort and no drain (ND) cohort, which were then compared in terms of baseline characteristics, rates of complications, and length of stay. Multivariate modeling was performed to assess the effect of drains on various complications and factors associated with drain placement. Of 526,723 included patients, drain utilization decreased across operative years (8.7% in 2020 to 6.1% in 2022, p < 0.001). Factors associated with drain placement in multivariate models included older age, higher BMI, partially dependent functional status, renal insufficiency, venous thromboembolism, hypoalbuminemia, and non-sleeve anastomotic procedures. Drain placement was associated with increased risk of numerous complications on bivariate analysis, which was still significant in multivariate analysis, including 30-day serious complications (adjusted odds ratio [aOR] 1.24, p < 0.001), anastomotic leak (aOR 2.1, p < 0.001), organ space infection (aOR 2.0, p < 0.001), reoperation (aOR 1.2, p = 0.036), and excess length of stay (LOS, aOR 1.45, p < 0.001). The frequency of prophylactic drain placement during primary bariatric surgical procedures has decreased in recent years and patients with drain placement seem to have increased 30-day morbidity, includinglonger length of stay. Independent predictors of drain placement include increased age and metabolic burden along with anastomotic procedures. Surgeons should be judicious in selecting patients for drain placement and future prospective, controlled studies may better answer drain placement association with complications.

The incidence of chronic subdural hematomas (cSDHs) is rising, leading to an increased reliance on imaging for diagnosis and management. CT imaging is commonly used in the evaluation of these patients, but transient enhancement of chronic subdural collections can mimic acute-on-chronic subdural hematomas, potentially leading to misdiagnosis. To describe cases of transient enhancement of cSDHs after contrast administration. A case series of three patients with pre-existing cSDHs was analyzed. One patient underwent middle meningeal artery embolization (MME), and two patients received contrast-enhanced CT (CECT) for other indications. Changes in subdural collection attenuation were assessed on serial imaging. These three patients with cSDH demonstrated transient enhancement of their subdural collections, which could be mistaken for acute or acute-on-chronic hemorrhage. Recognition of this pattern is critical to avoid misinterpretation, unnecessary radiation exposure, excessive healthcare utilization, and potentially invasive procedures. Awareness of transient enhancement in chronic subdural collections on CECT is essential for accurate diagnosis. Differentiating this benign imaging artifact from true hemorrhage can prevent unnecessary interventions and optimize patient care.

The increasing prevalence of chronic conditions is a significant challenge for healthcare systems worldwide, not only from a public health perspective but also for the aggregate cost that these represent. This paper estimates the additional use of healthcare services due to chronic health conditions and their associated costs in nine European countries. We analyzed inpatient and outpatient healthcare utilization using longitudinal data (Survey of Health, Ageing and Retirement in Europe [SHARE]). We implemented a difference-in-differences approach across multiple time periods. Monetary estimates were derived using WHO-CHOICE healthcare service costs. To compare countries, we calculated the healthcare cost burden of chronic conditions as a percentage of total health expenditure. People with chronic conditions require significantly more healthcare services than those without such conditions, averaging three additional outpatient visits and one extra overnight inpatient stay annually. These patterns vary across countries. In Germany, outpatient care usage is particularly high, with an average of four additional visits, while Switzerland leads in inpatient care with two extra overnight stays. The associated costs also differ widely, influenced by variations in healthcare demand, service pricing, and the prevalence of chronic conditions in each country. Chronic conditions significantly increase healthcare utilization, and demographic trends suggest this demand will continue to grow steadily. This rising pressure poses serious challenges for healthcare systems, necessitating a shift toward more efficient service delivery models.

(Abstracted from Urogynecology (Phila) 2024;30:888–895) Standard care after pelvic surgical procedures often includes assessing for postoperative urinary retention, which is evaluated using postoperative trials of void (TOV). Accuracy of TOV findings is needed to limit both excess catheterization and health care utilization.

Background/Objectives: Moral hazard represents a significant challenge in healthcare systems globally, reflecting the tendency of insured individuals to over-utilize medical services when shielded from the full costs of care. Methods: This paper investigates the dynamics and implications of moral hazard within the Romanian public hospital sector, offering practical recommendations for healthcare policymakers to mitigate the financial risks associated with excessive healthcare utilization and ensure long-term sustainability. To achieve the objectives of this study, a quantitative research approach utilizing vignettes was employed. Vignettes allow for the simulation of real-world decision-making under conditions of insurance coverage, capturing nuanced behaviors that traditional surveys may overlook. Results: The study examined patient behaviors in the context of moral hazard in public hospitals in Romania, employing a quantitative approach based on vignettes. A total of 303 valid responses were collected. The findings indicate a significant tendency among insured patients, both publicly and privately insured, to opt for more expensive treatments compared to uninsured patients, who preferred more affordable options such as medication or physiotherapy. In the case of treatments for severe conditions, insured patients frequently chose combinations of higher-cost therapies, while uninsured individuals either delayed treatment or opted for less expensive alternatives. These results highlight the impact of moral hazard, driven by a reduced sensitivity to costs in the presence of insurance, and underscore the need for cost-sharing policies to mitigate the overutilization of medical resources. Conclusions: This paper uniquely contributes to the understanding of moral hazard by integrating insights from both Romanian public hospitals and international case studies, offering practical policy recommendations for mitigating the financial risks associated with excessive healthcare utilization.

Diabetes and heart disease do not affect short-term lumbar fusion outcomes accounting for other risk factors in a matched cohort analysis

The authors of previous work have associated the Childhood Opportunity Index (COI) with increased hospitalizations for ambulatory care sensitive conditions (ACSC). The burden of this inequity on the health care system is unknown. We sought to understand health care resource expenditure in terms of excess hospitalizations, hospital days, and cost. We performed a retrospective cross-sectional study of the Pediatric Health Information Systems database, including inpatient hospitalizations between January 1, 2016 and December 31, 2022 for children <18 years of age. We compared ACSC hospitalizations, mortality, and cost across COI strata. We identified 2 870 121 hospitalizations among 1 969 934 children, of which 44.5% (1 277 568/2 870 121) were for ACSCs. A total of 49.1% (331 083/674 548) of hospitalizations in the very low stratum were potentially preventable, compared with 39.7% (222 037/559 003) in the very high stratum (P < .001). After adjustment, lower COI was associated with higher odds of potentially preventable hospitalization (odds ratio 1.18, 95% confidence interval [CI] 1.17-1.19). Compared with the very high COI stratum, there were a total of 137 550 (95% CI 134 582-140 517) excess hospitalizations across all other strata, resulting in an excess cost of $1.3 billion (95% CI $1.28-1.35 billion). Compared with the very high COI stratum, there were 813 (95% CI 758-871) excess deaths, with >95% from the very low and low COI strata. Children with lower neighborhood opportunity have increased risk of ACSC hospitalizations. The COI may identify communities in which targeted intervention could reduce health care utilization and costs.

IntroductionDepression continues to present significant economic burdens to the Canadian healthcare system. Novel therapies, including those that incorporate psychoactive substances such as ketamine, present an opportunity to evaluate both clinical and economic effectiveness against current standards of care, which may be repeatedly proving ineffective in treating depression for some individuals.ObjectivesThis paper evaluates the cost-effectiveness of the Roots to Thrive ketamine program compared to group psychotherapy covered through the medical services plan in British Columbia, Canada.MethodsA discrete-time Markov-model is used to estimate depressive states over five cycles for a treatment cohort and a synthetic control cohort. The transition probabilities for the treatment cohort are calculated from Roots to Thrive program data (n = 62) over the past 3 years, with the control cohort using published values from the literature. Both cohorts use the same starting state distribution, excess healthcare utilization rates for each severity level of depression, and utility outcomes based on depression state severity.ResultsCompared to the control cohort, the Roots to Thrive program was less expensive and produced better outcomes as measured by PHQ-9 scores and Quality-Adjusted life years over 5 treatment cycles. On average, the Roots to Thrive program would save $14,481 and produce 0.94 additional QALY’s per individual compared to group psychotherapy of three patients per provider in the current standard of care.ConclusionsFrom an economic perspective, incorporating the Roots to Thrive program - or a program like it - into care in British Columbia would provide both an improvement in health outcomes and reduce expenditure by the ministry of health. These funds could be reinvested into other areas of the healthcare system to improve the lives of all British Columbians, even those that do not engage in psychedelic-assisted psychotherapy.Disclosure of InterestNone Declared

ObjectivesExtreme heat events (EHEs) are associated with excess healthcare utilization but specific impacts on emergency department (ED) operations and throughput are unknown. In 2021, the Pacific Northwest experienced an unprecedented heat dome that resulted in substantial regional morbidity and mortality. The aim of this study was to examine its impact on ED utilization, unplanned hospitalization, and hospital operations in a large academic healthcare system.MethodsRetrospective electronic medical records from three Seattle‐area hospitals were used to compare healthcare utilization during the EHE compared to a pre‐event reference period within the same month. Interrupted time series analysis was used to evaluate the association between EHE exposure and ED visits and hospitalizations. Metrics of ED crowding for the EHE were compared to the reference period using Student's t‐tests and chi‐squared tests. Additionally, multivariable Poisson regression was used to identify risk factors for heat‐related illness and hospital admission.ResultsInterrupted time series analysis showed an increase of 21.7 ED visits per day (95% confidence interval [CI] = 14.7, 28.6) and 9.9 unplanned hospitalizations per day (95% CI = 8.3, 11.5) during the EHE, as compared to the reference period. ED crowding and process measures also displayed significant increases, becoming the most pronounced by day 3 of the EHE; the EHE was associated with delays in ED length of stay of 1.0 h (95% CI = 0.4, 1.6) compared to the reference period. Higher incidence rate ratios for heat‐related illness were observed for patients who were older (incidence rate ratio [IRR] = 1.02; 95% CI = 1.01,1.03), female (IRR = 1.47; 95% CI = 1.06, 2.04), or who had pre‐existing diabetes (IRR = 3.19; 95% CI = 1.47, 6.94).ConclusionsThe 2021 heat dome was associated with a significant increase in healthcare utilization including ED visits and unplanned hospitalizations. Substantial impacts on ED and hospital throughput were also noted. These findings contribute to the understanding of the role extreme heat events play on impacting patient outcomes and healthcare system function.

RationaleThere is a lack of real-world characterization of healthcare costs and associated cost drivers in patients with pulmonary hypertension secondary to chronic obstructive pulmonary disease (PH-COPD).ObjectivesTo examine (1) excess healthcare resource utilization (HCRU) and associated costs in patients with PH-COPD compared to COPD patients without PH; and (2) patient characteristics that are associated with higher healthcare costs in patients with PH-COPD.MethodsThis study analyzed data from the IQVIA PharMetrics® Plus database (OCT2014-MAY2020). Patients with PH-COPD were identified by a claims-based algorithm based on PH diagnosis (ICD-10-CM: I27.0, I27.2, I27.20, I27.21, I27.23) after COPD diagnosis. Patients aged ≥40 years and with data available ≥12 months before (baseline) and ≥6 months after (follow-up) the first observed PH diagnosis were included. Patients with other non-asthma chronic pulmonary diseases, PH associated with other causes, cancer, left-sided heart failure (HF), PH before the first observed COPD diagnosis, or right-sided/unspecified HF during baseline were excluded. Patients in the PH-COPD cohort were matched 1:1 to COPD patients without PH based on propensity scores derived from baseline patient characteristics. Annualized all-cause and COPD/PH-related (indicated by a primary diagnosis of COPD or PH) HCRU and costs during follow-up were compared between the matched cohorts. Baseline patient characteristics associated with higher total costs were examined in a generalized linear model in the PH-COPD cohort.ResultsA total of 2,224 patients with PH-COPD were identified and matched to COPD patients without PH. Patients with PH-COPD had higher all-cause HCRU and annual healthcare costs ($51,435 vs. $18,412, p<0.001) than matched COPD patients without PH. Among patients with PH-COPD, costs were primarily driven by hospitalizations (57%), while COPD/PH-related costs accounted for 13% of all-cause costs. Having a higher comorbidity burden and a prior history of COPD exacerbation were major risk factors for higher total all-cause costs among patients with PH-COPD. ConclusionsTreatment strategies focusing on preventing hospitalizations and managing comorbidities may help reduce the burden of PH-COPD.

Pharmacokinetic-Guided Hydroxyurea to Reduce Transfusion Requirements in Ugandan Children with Sickle Cell Anemia: Baseline Data from the Alternative Dosing and Prevention of Transfusions (ADAPT) Trial

Influenza Vaccine Administration and Effectiveness Among Children and Adults With Glomerular Disease

Distressed Communities Demonstrate Increased Readmission and Healthcare Utilization Following Shoulder Arthroplasty.