Health Resource Utilization Research Articles

Nationwide Epidemiology and Outpatient Healthcare Resource Use of Children with Respiratory Syncytial Virus from 2005 to 2021.

Respiratory syncytial virus (RSV) poses a global health challenge, particularly among younger children. While the disease burden in Japan has been preliminarily quantified in short-term or inpatient settings, a comprehensive understanding of outpatient settings at a national level is still lacking. In this retrospective cohort study, we followed 697,802 children until they reached 60 months of age, amounting to 25,680,468 million person-months, using two nationally representative databases from the fiscal years 2005-2021. We analyzed trends in the epidemiology of RSV infections and associated outpatient health resource use. Incidence rates of RSV and associated hospitalizations among infants showed fluctuations of 50-100 cases and 20-30 hospitalizations per 1000 person-years, respectively, during the 2010s. These rates dropped to 8.7 cases and 2.2 hospitalizations per 1000 person-years in 2020, then returned to the same levels in the 2010s. Similar patterns were noted for RSV testing, outpatient visits, healthcare cost and the proportion of cases hospitalized (case-hospitalization risk). Whereas antibiotic use decreased from 56.4% in 2005 to 27.8% in 2021, palivizumab use increased from 95.2-195.9 days of therapy per 1000 person-years. Applying the calculated incidence rates to national data, annual outpatient healthcare costs for RSV infections were estimated to be 7-9 billion JPY (50-64 million USD) for children aged <60 months in the late 2010s. Our study highlights the changes in epidemiology and outpatient health resource utilization for children with RSV infections. These findings are valuable for policymakers and clinicians aiming to develop strategies, including newly developed maternal vaccines and single-dose long-acting monoclonal antibodies.

Timing of Palliative Care, End-of-Life Quality Indicators, and Health Resource Utilization

Despite research supporting the benefits of early palliative care, timely initiation by gynecologic oncology patients is reportedly low, which may limit the effectiveness of palliative care. To investigate the association of the timing of palliative care initiation with the aggressiveness of end-of-life care using established quality indicators among patients with ovarian cancer. This population-based retrospective cohort study of ovarian cancer decedents used linked administrative health care data to identify palliative care provision across all health care sectors and health care professionals (specialist and nonspecialist) and end-of-life quality indicators in Ontario, Canada, from 2006 to 2018. Data analyses were performed July 12, 2024. The primary outcome was the associations between the timing of palliative care and end-of-life quality indicators, including emergency department use, hospital or intensive care unit admission in the last 30 days of life, chemotherapy in last 14 days of life, death in the hospital, and a composite measure of aggressive care. Late palliative care was defined as 3 months or less prior to death. There were 8297 ovarian cancer decedents. Their mean (SD) age at death was 69.6 (13.1) years, and their mean (SD) oncologic survival was 2.8 (3.9) years. Among 3958 patients with known cancer stage, 3495 (88.3%) presented with stage III or IV disease. One-third of patients (2667 [32.1%]) received late palliative care in the final 3 months of life. Results of multivariable regression analysis indicated that any palliative care initiated earlier than 3 months before death was associated with lower rates of aggressive end-of-life care (odds ratio [OR], 0.47 [95% CI, 0.37-0.60]), death in hospital (OR, 0.54 [95% CI, 0.45-0.65]), and intensive care unit admission (OR, 0.46 [95% CI, 0.27-0.76]). Specialist palliative consultation from 3 months up to 6 monts before death was associated with decreased likelihood of late chemotherapy (OR, 0.46 [95% CI, 0.24-0.88]). Findings from this cohort study suggested that early palliative care may be associated with less-aggressive end-of-life care than late palliative care. Implementation strategies for early palliative care initiation are needed to optimize care quality and health resource utilization at the end of life.

Leveraging digital platforms to improve Public Health in hospital smart buildings

Abstract The integration of digital platforms into hospital infrastructure represents a significant leap forward in public health management. This session explores how smart hospital buildings, equipped with advanced digital technologies, can enhance public health outcomes through more effective disease surveillance, improved environmental controls and enhanced patient care management. Smart hospital buildings utilize a range of new technologies such as IoT sensors, AI-driven analytics and big data solutions to monitor and optimize various aspects of hospital operations and care. These technologies enable real-time data collection on environmental conditions, patient health metrics and resource utilization, creating an ecosystem that not only supports the immediate health needs of patients but also contributes to broader public health goals. The session will address four key areas where digital platforms can make an impact: -Disease Surveillance and Management: Digital tools can track health data trends and patterns within hospital settings, enabling early detection of infectious outbreaks and more precise tracking of patient outcomes. -Environmental Monitoring: IoT sensors can continuously assess conditions such as air quality, temperature and humidity, which are critical for preventing hospital-acquired infections and ensuring a safe environment for patients and staff. -Resource Optimization: AI algorithms can analyse data to optimize resource allocation, ensuring that medical supplies and human resources are used efficiently, which is crucial in health emergencies. -Patient-Centred Care: Digital platforms can facilitate personalized patient care through real-time health monitoring and data analysis, ensuring timely medical interventions and better health management. This session will highlight case studies demonstrating successful implementation of digital technologies in smart hospital buildings and discuss the challenges and lessons learned from these initiatives.

Days at Home After Traumatic Brain Injury: Moving Beyond Mortality to Evaluate Patient-Centered Outcomes Using Population Health Data.

Administrative data are invaluable for assessing outcomes at the population level. However, there are few validated patient-centered outcome measures that capture morbidity following traumatic brain injury (TBI) using these data. We sought to characterize and validate days at home (DAH) as a measure to quantify population-level outcomes after moderate to severe TBI. We additionally assessed the earliest feasible outcome assessment period for patients with TBI using this outcome measure. This multicenter retrospective cohort study used linked health administrative data sources to identify adults with moderate to severe TBI presenting to trauma centers in Ontario, Canada, between 2009 and 2021. DAH at 180 days (DAH180 days) reflects the total number of days spent alive and at home excluding the days spent institutionalized across care settings. Construct validity was determined using hierarchical quantile regression to assess the associations between clinical and injury covariates with DAH180 days. Predictive validity was assessed using Spearman rank correlation. We estimated minimally important difference (MID) in DAH180 days to aid with outcome measure interpretability. There were 6,340 patients who met inclusion criteria. Median DAH180 days was 70 days (interquartile range 0-144). Mortality occurred in 2,162 (34.1%) patients within 90 days following injury. Patients in the lower DAH180 days group were more commonly older (absolute standardized difference [ASD] = 0.68) with higher preinjury health resource utilization (ASD = 0.36) and greater injury severity (ASD = 0.81). Increased baseline health resource utilization (-10.1 days, 95% CI -17.4 to -2.8, p = 0.0041), older age (-4.6 days, 95% CI -5.7 to -3.4, p < 0.001), higher cranial injury severity (-84.6 days, 95% CI -98.3 to -71.0, p < 0.001), and major extracranial injuries (-14.2 days, 95% CI -19.5 to -8.93, p < 0.001) were significantly associated with fewer DAH180 days. DAH180 days was positively correlated with DAH at up to 3 years (r = 0.91, 95% CI 0.90-0.92) and negatively correlated with direct health care expenditure (rs = -0.89, 95% CI -0.88 to -0.90). The average MID estimated from anchor-based and distribution-based methods was 18 days. We validate DAH180 days as a potentially useful outcome measure with construct, predictive, and face validity in a population with moderate to severe TBI. Given the intensity of acute care requirements for patients with TBI, our work highlights DAH180 days as a feasible and sufficiently responsive outcome measure.

The Impact of Wildfire Smoke on Asthma Control in California: A Microsimulation Approach.

Wildfire smoke exposure leads to poorer health among those with pre-existing conditions such as asthma. Particulate matter in wildfire smoke can worsen asthma control, cause acute exacerbations, and increase health resource utilization (HRU) and costs. Research to date has been retrospective with few opportunities to project changes in underlying asthma control and HRU given exposure to wildfire smoke. Using a microsimulation of 5,000 Californians with asthma, we calculated changes in asthma control distribution, risk of exacerbation, and HRU and cost outcomes in the 16weeks during and after a wildfire. The model was calibrated against empirical values on asthma control distribution and increased HRU after exposure to wildfire smoke. Without smoke exposure, 48% of the cohort exhibited complete or well control of asthma, and 8% required acute healthcare per cycle. Following two consecutive weeks of wildfire smoke, complete or well control of asthma fell to 27%, with an additional 4% HRU. This corresponds to total additional $601,250 in all-cause medical costs and eight fewer quality-adjusted life years over 16weeks of model time. Our model found increased asthma health and cost burden due to wildfire smoke that were aligned with empirical evidence from a historic wildfire event. This study establishes a framework for a more nuanced understanding of asthma impacts from wildfire smoke that can help inform the development of public health policies to mitigate harm and promote resilience among asthma patients in the face of climate change.

Clinical and Humanistic Burden of Non-inhibitor HaemophiliaA in Five European Countries: Insights from the CHESSII Study.

HaemophiliaA (HA) is a congenital bleeding disorder caused by a deficiency/absence of factorVIII (FVIII) and characterised by frequent, acute and prolonged spontaneous or traumatic bleeding events, often leading to haemophilic arthropathy and progressive joint deterioration. HA severity is characterized by endogenous FVIII activity: mild (> 5-40%), moderate (1-5%), or severe (< 1%). HA poses a substantial clinical and socioeconomic burden on people with HA (PWHA), their caregivers, and society. This analysis evaluates clinical and patient-centric outcomes of a cohort of individuals with non-inhibitor HA sampled from France, Germany, Italy, Spain, and the UK in the 'Cost of Haemophilia in Europe: A Socioeconomic Survey II' (CHESSII) study. CHESSII was a cross-sectional burden-of-illness study collecting clinical and socioeconomic data on adult (≥ 18years) individuals with haemophiliaA or B of any severity with or without inhibitors from eight European countries. Descriptive analyses were conducted examining physician-reported demographics, clinical and health resource utilisation information. PWHA-reported health-related quality of life (HRQoL) using the EQ-5D-5L and Work Productivity and Activity Impairment (WPAI) were also examined. Outcomes were stratified by HA severity and reported at country level. Demographics and clinical characteristics of the cohort (N = 880) were generally consistent across countries. Individuals with severe HA experienced more frequent bleeding events and joint disease despite broad use of factor replacement therapy long-term prophylaxis. A minority of those with mild or moderate HA also experienced such challenges. HRQoL and workforce participation diminished, and chronic pain increased, with increasing HA severity. This analysis provides up-to-date insights on the impact of HA across five European countries. Increasing HA severity was generally associated with worse clinical outcomes, HRQoL and workforce participation. These findings suggest a place for continued evidence-based tailored treatment and clinical management approaches in addressing the residual burden of HA.

Hospitalization and Health Resource Utilization in Emergency Department Cases of Diabetic Foot Infections in the U.S. from 2012 to 2021: A Nationally Representative Analysis.

Objectives: The objective of this paper was to assess hospitalizations and health resource utilization associated with diabetic foot infection (DFI)-related visits within emergency departments (EDs) in the U.S. Methods: This nationally representative, cross-sectional historical cohort utilized the Centers for Disease Control and Prevention's (CDC's) National Hospital Ambulatory Medical Care Survey across a ten-year period from 2012 to 2021. Inclusion criteria were as follows: adults ≥18 years of age; a diagnosis of Type 1 or Type 2 diabetes mellitus; presence of a DFI. Comparisons were drawn relative to a cohort of patients with diabetes without foot complications. Study outcomes included 72-hour (72 h) ED revisit, hospitalization, and length of stay (LOS). Top diagnoses and medications were also reported. Multivariable, generalized, linear regression analyses were employed, controlling for key demographics, health system factors, clinical characteristics, and year. Results: An estimated 150.6 million ED visits included a diabetes diagnosis, with 2.4 million involving a DFI (1.6%). Approximately half of DFI cases were hospitalized (43.7%). Anti-infective medications were prescribed in 83.1% of DFI cases, including vancomycin in 28.1%. Multivariable analyses observed that DFIs were associated with a 3.002 times higher odds of hospital admissions (CI: 2.145-4.203, p < 0.001) and a 55.0% longer LOS (IR = 1.550, CI: 1.241-1.936, p < 0.001). DFIs were not significantly associated with a 72 h ED revisit. Conclusions: This nationally representative study of 2.4 million DFI-related ED visits in the U.S. observed higher odds of hospital admissions and a longer LOS for DFIs versus diabetes without foot complications. Continued research should seek to assess prevention and coordinated treatment interventions prior to the emergence of DFIs requiring ED care.

Wastewater-based surveillance for SARS-CoV-2 in Alberta

ObjectiveAlberta's largest research universities collaborated to expand COVID-19 wastewater monitoring throughout the province to regularly provide evidence of SARS-CoV-2 burden in municipalities representing 3.2 million people. ApproachSampling was conducted at 26 wastewater treatment plants and facilities across the province. The project quantified SARS-CoV-2 genomic material in wastewater to reveal population-level trends of COVID-19 cases. This inclusive and comprehensive strategy captures everyone who contributes to wastewater, including those not clinically diagnosed. Researchers collected wastewater samples in municipalities three times a week. Additional sentinel monitoring was undertaken in neighbourhoods, hospitals, long-term care facilities, worksites, shelters, and schools. Results were shared on the public COVID Data Tracker website (https://covid-tracker.chi-csm.ca/). Data was additionally linked with hospital outcomes, workforce absenteeism and outbreak information. ResultsWastewater-based surveillance (WBS) for SARS-CoV-2 genomic RNA associates very strongly with clinically diagnosed cases and health resource utilization, providing a ≥6-day leading indicator. WBS can effectively be performed across a range of geographic scales (from cities to individual facilities), ensuring actionable data that is relevant to end-users. We have published how outbreaks across a range of high-risk facilities can be monitored and predicted with WBS and can also be used to model COVID-19-associated workforce absenteeism. Emails and website interactions suggested widespread citizen engagement using data for evidence-based decisions. ConclusionWBS is a valuable tool for identifying potential outbreaks and tailoring response measures at the policy level and by individual citizens. We've created customizable real-time data-sharing tools catering to both the public (enhanced data transparency) and government (actionable insights).

Medical students in distress: a mixed methods approach to understanding the impact of debt on well-being

BackgroundNearly three in four U.S. medical students graduate with debt in six-figure dollar amounts which impairs students emotionally and academically and impacts their career choices and lives long after graduation. Schools have yet to develop systems-level solutions to address the impact of debt on students’ well-being. The objectives of this study were to identify students at highest risk for debt-related stress, define the impact on medical students’ well-being, and to identify opportunities for intervention.MethodsThis was a mixed methods, cross-sectional study that used quantitative survey analysis and human-centered design (HCD). We performed a secondary analysis on a national multi-institutional survey on medical student wellbeing, including univariate and multivariate logistic regression, a comparison of logistic regression models with interaction terms, and analysis of free text responses. We also conducted semi-structured interviews with a sample of medical student respondents and non-student stakeholders to develop insights and design opportunities.ResultsIndependent risk factors for high debt-related stress included pre-clinical year (OR 1.75), underrepresented minority (OR 1.40), debt $20–100 K (OR 4.85), debt >$100K (OR 13.22), private school (OR 1.45), West Coast region (OR 1.57), and consideration of a leave of absence for wellbeing (OR 1.48). Mental health resource utilization (p = 0.968) and counselors (p = 0.640) were not protective factors against debt-related stress. HCD analysis produced 6 key insights providing additional context to the quantitative findings, and associated opportunities for intervention.ConclusionsWe used an innovative combination of quantitative survey analysis and in-depth HCD exploration to develop a multi-dimensional understanding of debt-related stress among medical students. This approach allowed us to identify significant risk factors impacting medical students experiencing debt-related stress, while providing context through stakeholder voices to identify opportunities for system-level solutions.

An Inventory of Rare Disease Registries in the Canadian Landscape

What Was the Question? There is a lack of centralized information about rare disease registries (RDRs) in Canada. To address this, we created an inventory of RDRs in Canada and international RDRs that include patients living in Canada. What Did We Do? Information about RDRs was identified through a search of published literature, grey literature, consultations with members of the rare disease community, and a survey with the registry holders. What Did We Find? We identified 148 RDRs, of which 66 are RDRs in Canada and 82 international RDRs. In total, 21% of RDRs in Canada and 11% of international RDRs capture rare cancer(s). About a half of RDRs in Canada (53%) and international RDRs (46%) collaborate with other national or international registries or networks. Most RDRs in Canada (73%) and international RDRs (86%) identify patients for RDR enrollment through health care provider referrals. Electronic medical records (68%), clinician-reported data (68%), and medical chart abstraction (60%) are the most common sources of data for RDRs in Canada compared to international RDRs, for which patient (79%) and caregiver (61%) surveys are most common. Most RDRs in Canada collect clinical data (95%), laboratory and diagnostic data (85%), health outcomes data (83%), and treatment data (78%), and less commonly patient-generated data (55%) and caregiver data (15%). What Does This Mean? The information in the inventory will help guide future initiatives for improving the RDR landscape in Canada. Most RDRs in Canada source data from electronic health records, clinician-reported data, and medical charts. Fewer RDRs in Canada implement patient and caregiver surveys. RDRs in Canada include information relevant to decision-makers as most collect clinical data, health outcomes data, and treatment data, and about half collect health resource utilization data. This inventory will support future initiatives to assess the suitability of RDRs for generating decision-grade real-world evidence.

The effect of an innovative payment method on inpatient volume and bed resources and their regional distribution: the case of a central province in China

BackgroundSince 2020, China has piloted an innovative payment method known as the Diagnosis-Intervention Packet (DIP). This study aimed to assess the impact of the DIP on inpatient volume and bed allocation and their regional distribution. This study investigated whether the DIP affects the efficiency of regional health resource utilization and contributes to disparities in health equity among regions.MethodsWe collected data from a central province in China from 2019 to 2022. The treatment group included 508 hospitals in the pilot area (Region A, where the DIP was implemented in 2021), whereas the control group consisted of 3,728 hospitals from non-pilot areas within the same province. We employed the difference-in-differences method to analyze inpatient volume and bed resources. Additionally, we conducted a stratified analysis to examine whether the effects of DIP implementation varied across urban and rural areas or hospitals of different levels.ResultsCompared with the non-pilot regions, Region A experienced a statistically significant reduction in inpatient volume of 14.3% (95% CI 0.061–0.224) and a notable decrease of 9.1% in actual available bed days (95% CI 0.041–0.141) after DIP implementation. The study revealed no evidence of patient consultations shifting from inpatient to outpatient services due to the reduction in hospital admissions in Region A after DIP implementation. Stratified analysis revealed that inpatient volume decreased by 12.4% (95% CI 0.006–0.243) in the urban areas and 14.7% in the rural areas of Region A (95% CI 0.051–0.243). At the hospital level, primary hospitals experienced the greatest impact, with a 19.0% (95% CI 0.093–0.287) decline in inpatient volume. Furthermore, primary and tertiary hospitals experienced significant reductions of 11.0% (95% CI 0.052–0.169) and 8.2% (95% CI 0.002–0.161), respectively, in actual available bed days.ConclusionsDespite efforts to curb excessive medical service expansion in the region following DIP implementation, large hospitals continue to attract a large number of patients from primary hospitals. This weakening of primary hospitals and the subsequent influx of patients to urban areas may further limit rural patients’ access to medical services. The implementation of the DIP may raise concerns about its impact on health care equality and accessibility, particularly for underserved rural populations.

Recurrence risk prediction models for hepatocellular carcinoma after liver transplantation.

Liver transplantation (LT) is an effective method for curing hepatocellular carcinoma (HCC). However postoperative tumor recurrence can lead to higher mortality rates. To select suitable candidates for LT, the Milan Criteria (MC) were first proposed based on tumor morphological characteristics. For those patients who meet the MC, the MC can effectively reduce the postoperative tumor recurrence rate and improve the prognosis of patients undergoing LT. It has always been internationally recognized as the gold standard for selecting candidates for LT, marking a milestone in the history of LT for HCC. However, its strict conditions exclude some HCC patients who could benefit from LT. Therefore, comprehension consideration criteria, including serum biomarkers, tumor histology, and other factor, have been continuously proposed in addition to tumor morphology. This article summaries the prediction model for HCC recurrence after LT from five aspects: tumor morphology, serum markers, histopathology, cellular inflammatory factors and downstaging treatment before transplantation. The aim is to assist clinicians in accurately assessing HCC status, selecting appropriate liver transplant candidates, maximize graft and patients' survival, and optimizing the utilization of social health resources.

Rising incidence, health resource utilization and costs of Polycystic Ovary Syndrome in the United Kingdom.

Trends in incidence of Polycystic Ovary Syndrome (PCOS) and effects on health resource utilization are unclear. To describe trends in prevalence and incidence of PCOS in the United Kingdom. To establish healthcare resource use and associated costs. Data were extracted from the Clinical Practice Research Datalink Aurum and Hospital Episode Statistics databases. Point prevalence and incidence were calculated (2004-2020). Patients with PCOS were matched to controls (1:1) by age, body mass index and primary care practice. Primary care contacts were assigned an average cost and prescription items assigned a net ingredient cost. Inpatient admissions and outpatient consultations were processed into Healthcare Resource Groups and costed to the National Tariff. PCOS incidence increased from 1.22 per 1000 person years in 2004 to 1.77 (2012) and 2.20 (2019). Point prevalence increased from 1.02% (2004) to 2.2% (2012) and 3.5% (2020), and was highest in Asians. Mean contacts per person year (ppy) for patients with PCOS versus controls were 0.48 vs 0.29 for inpatients (p<0.001), 3.81 vs 2.15 for outpatients (p<0.001) and 6.43 vs 4.68 (p<0.001) for primary care. Mean healthcare costs (ppy) were £837 vs £493 (p<0.001) for inpatients, £444 vs £253 (p<0.001) for outpatients, £157 vs £112 for primary care and £109 vs £83 (p<0.001) for primary care prescriptions. Total health care contacts ppy were 10.72 vs 7.11 (p<0.001) and total associated costs £1,546 vs £940 (p<0.001). The incidence of PCOS has risen significantly. Health resource utilization and costs of PCOS are significantly greater than controls.

Population health outcomes of blood-based screening for colorectal cancer in comparison to current screening modalities: insights from a discrete-event simulation model incorporating longitudinal adherence

Aim Insufficient adherence to colorectal cancer (CRC) screening impedes individual and population health benefits, with about one-third of individuals non-adherent to available screening options. The impact of poor adherence is inadequately considered in most health economics models, limiting the evaluation of real-world population-level screening outcomes. This study introduces the CAN-SCREEN (Colorectal cANcer SCReening Economics and adherENce) model, utilizing real-world adherence scenarios to assess the effectiveness of a blood-based test (BBT) compared to existing strategies. Materials and methods The CAN-SCREEN model evaluates various CRC screening strategies per 1,000 screened individuals for ages 45–75. Adherence is modeled in two ways: (1) full adherence and (2) longitudinally declining adherence. BBT performance is based on recent pivotal trial data while existing strategies are informed using literature. The full adherence model is calibrated using previously published Cancer Intervention and Surveillance Modeling Network (CISNET) models. Outcomes, including life-years gained (LYG), CRC cases averted, CRC deaths averted, and colonoscopies, are compared to no screening. Results Longitudinal adherence modeling reveals differences in the relative ordering of health outcomes and resource utilization, as measured by the number of colonoscopies performed per 1,000, between screening modalities. BBT outperforms the fecal immunochemical test (FIT) and the multitarget stool DNA (mtsDNA) test with more CRC deaths averted (13) compared to FIT and mtsDNA (7, 11), more CRC cases averted (27 vs. 16, 22) and higher LYG (214 vs. 157, 199). BBT yields fewer CRC deaths averted compared to colonoscopy (13, 15) but requires fewer colonoscopies (1,053 vs. 1,928). Limitations Due to limited data, the CAN-SCREEN model with longitudinal adherence leverages evidence-informed assumptions for the natural history and real-world longitudinal adherence to screening. Conclusions The CAN-SCREEN model demonstrates that amongst non-invasive CRC screening strategies, those with higher adherence yield more favorable health outcomes as measured by CRC deaths averted, CRC cases averted, and LYG.

Health Resource Utilization and Cost Impact of Integrative Medicine Services for Newly Diagnosed Chronic Pain Patients.

Background: Integrative medicine (IM) is the healing-oriented practice of medicine that emphasizes the relationship between practitioner and patient. It considers the whole person, their environment, lifestyle, and social and cultural factors. It is evidence based and makes use of all appropriate therapies, conventional and complimentary. Objective: To evaluate the impact of IM services on health outcomes and care costs of chronic pain management patients compared with standard care. Methods: This article uses University of New Mexico hospital billing data from 10/2016 to 09/2019 to identify patients with nervous system or musculoskeletal pain. A total of 1,304 patients were matched using propensity scores into IM services (treatment: 652) and standard care (control: 652) cohorts for difference-in-differences analysis. The patients were matched based on age, sex, race, zip code, insurance type, ICD-10s, prescriptions, health care events, and medical claim costs. Results: Patients who used IM services had better health outcomes and lower costs at 3-month, 6-month, and 12-month follow-up. At the 12-month follow-up, the IM group showed a 19% decrease in utilization of inpatient care, a 37% decrease in Emergency Department utilization, and an 11.3% reduction in claim costs compared with the control group. Conclusion: Patients who utilize IM services as part of chronic pain management have overall lower health care costs and better health outcomes. Unfortunately, in the health system studied, less than 3% of patients utilize these services. Promotion of and education about IM services should be aimed at both patients and their providers.

High-Quality Hospital Status on Health Care Costs for Pediatric Congenital Heart Disease Care for U.S. Military Beneficiaries.

Congenital heart disease (CHD) is the most common and resource demanding birth defect managed in the United States, with approximately 40,000 children undergoing CHD surgery year. Researchers have compared high-volume to low-volume hospitals and found significant hospital-level variation in major complications, health resource utilization, and health care costs after CHD surgery. Using nationwide representative claim data from the United States Military Health System from 2016 to 2020, TRICARE beneficiaries diagnosed with CHD were tabulated based on ICD-10 codes (International Classification of Diseases, 10th revision). We examined the relationships between total costs and total hospitalizations costs post 1-year CHD diagnosis and presence or absence of High-Quality Hospital (HQH) designation. We applied both the naive generalized linear model (GLM) to control for the observed patient and hospital characteristics and the 2-stage least squares (2SLS) model to account for the unobserved confounding factors. This study was approved by University of Maryland, College Park Institutional Review Board (IRB) (Approval Number: 1576246-2). A relationship between HQH designation and total CHD related costs was not seen across 2SLS model specifications (marginal effect; -$41,579; 95% CI, -$83,429 to $271). For patients diagnosed with a moderate-complex or single ventricle CHD, the association of HQH status was a statistically significant reduction in total costs (marginal effect; -$84,395; 95% CI, -$140,560 to -$28,229) and hospitalization costs (marginal effect; -$73,958; 95% CI, -$121,878 to -$26,039). It is very imperative for clinicians and patient support advocates to urge policymakers to deliberate the establishment of a quality designation authority for CHD management. These efforts will not only help to identify and standardize quality care metrics but to improve long-term health, effectiveness, and equity in the management of CHD. Furthermore, these efforts can be used to navigate patients to proven HQH, thereby improving care and reducing associated treatment costs for CHD patients.

An observational study to understand burden and cost of care in adults diagnosed with refractory chronic cough (RCC) or unexplained chronic cough (UCC)

BackgroundRefractory and unexplained chronic cough (RCC and UCC) necessitate frequent referral for specialist evaluations, but data on healthcare resource utilisation and costs are lacking.MethodsThis observational study enrolled adults with RCC or UCC attending a specialist cough clinic and included a control cohort, both from North West England, matched 1:5 for age, gender and smoking history. Primary and secondary care data were obtained for the 5 years prior to and 2 years post initial clinic visit (index). The primary endpoint was the total 5-year healthcare cost to the UK NHS pre-RCC or UCC diagnosis compared to the control cohort.ResultsMean age at index for the 200 RCC or UCC consented patients was 62.2 ± 11.4 years; 71% were female, and 68% had never smoked. Mean duration of symptoms pre-diagnosis was 8.0 ± 9.4 years. Mean cough severity score was 63.7 ± 23.2 mm at index on a Visual Analog Scale, and Leicester Cough Questionnaire total score was 10.9 ± 4.1. GP data were available for 80 patients and mean total cost over the 5 years pre-diagnosis (index date) was 3.0-fold higher (95% CI 2.3, 3.9) than in the control cohort (p < 0.001). Most excess costs were related to visits and procedures carried out in secondary care. RCC- or UCC-associated costs decreased post-diagnosis, but remained higher than those of controls.ConclusionDiagnosis of RCC or UCC requires significant health resource utilisation in the 5 years prior to a specialist clinic diagnosis. Resource utilisation was less after diagnosis, but remained higher than in a matched control cohort.

Automatic delineation of rational service areas and health professional shortage areas in GIS based on human movements and health resources

AbstractHow people travel to receive health services is essential for understanding healthcare shortages. The rational service areas (RSAs) are defined to represent local healthcare markets and used as the basic units to evaluate whether people have access to health resources. Therefore, finding an appropriate way to develop RSAs is important for understanding the utilization of health resources and supporting accurate resource allocation to the health professional shortage areas (HPSAs). Existing RSAs are usually developed based on the local knowledge of public health needs and are created through time‐intensive manual work by health service officials. In this research, a travel data‐driven and spatially constrained community detection method based on human mobility flow is proposed to automate the process of establishing the statewide RSAs and further identifying HPSAs based on healthcare criteria in a geographic information system (GIS) software. The proposed method considers the difference between rural and urban populations by assigning different parameters and delineates RSAs with the goal of reducing health resource inequalities faced by rural areas. Using the data in the State of Wisconsin, our experiment shows that the proposed RSA delineation method outperforms other baselines including the traditional Dartmouth method in the aspects of RSA compactness, region size balances, and health shortage scores. Furthermore, the whole process of delineating RSAs and identifying HPSAs is automated using Python toolboxes in ArcGIS to support future analyses and practices in a timely and repeatable manner.

Exploring the influence of weather variability and climate change on health outcomes in people living with dementia: A scoping review protocol.

Environmental factors resulting from climate change and air pollution are risk factors for many chronic conditions including dementia. Although research has shown the impacts of air pollution in terms of cognitive status, less is known about the association between climate change and specific health-related outcomes of older people living with dementia. In response, we outline a scoping review protocol to systematically review the published literature regarding the evidence of climate change, including temperature and weather variability, on health-related quality of life, morbidity, mobility, falls, the utilization of health resources, and mortality among older adults living with dementia. This scoping review will be guided by the framework proposed by Arksey and O'Malley. Electronic search (Medline, Embase, PsycINFO, CINAHL, Scopus, Web of Science) using relevant subject headings and synonyms for two concepts (older people with dementia, weather/ climate change). No publication date or other restrictions will be applied to the search strategy. No language restriction will be applied in order to understand the impact of non-English studies in the literature. Eligible studies must include older adults (65+years) with dementia living in the community and investigate the impacts of climate change and/or weather on their health-related quality of life, morbidity, mobility, falls, use of health resources and mortality. Two independent reviewers will screen abstracts and select those for a full-text review, perform these reviews, select articles for retention, and extract data from them in a standardized manner. This data will then be synthesized and interpreted. OSF registration: DOI: 10.17605/OSF.IO/YRFM8.

Prioritising the Mental Health of Psychiatric Trainees across Europe

This first special issue of the International Journal of Psychiatric Trainees (previously named European Journal of Psychiatric Trainees) features four articles based on posters presented at the 31st Forum of the European Federation of Psychiatric Trainees in Zurich. Focusing on mental health challenges faced by psychiatric trainees across Europe – including key themes such as burnout, depression, and the impact of patient suicide – this special issue highlights the need for systematic support programs, improved awareness and utilisation of mental health resources, and structural changes in medical education. By considering these matters, the Journal supports discussion and action towards improving the mental health of psychiatric trainees worldwide.