High-cost Settings Research Articles

An integrated low-cost automatic pipetting used in nucleic acid detection PCR instrument and clinical detection

PurposeThis paper aims to introduce a custom-designed integrated nucleic acid detection polymerase chain reaction (PCR) instrument for clinical detection applications.Design/methodology/approachThe PCR instrument can make rapid, sensitive, low-cost and quantitative molecular diagnosis compared with the current routine test flow from the pipette, series reagent to RT-PCR by manual manipulation. By integrating the multichannel automatic pipetting module, heat amplification module and real-time fluorescence detection module for the first time, the custom-designed integrated nucleic acid detection PCR instrument can achieve sample collection, subpackage, mixing, extracting, measuring and result presentation.FindingsThe multichannel automatic pipetting module was assembled with an accuracy of 0.4% (2 microliters) for accuracy measurement. Besides, the accuracy and sensitivity of nucleic acid using integrated low-cost nucleic acid detection PCR instruments were checked with COV-2019 virus (staining method) and African swine fever virus (probe method) under different concentrations.Practical implicationsBecause of its high cost, complex system and bulky laboratory settings, including sample subpackage, mixing, extracting, measuring and finally result in presentation, the current nucleic acid detection system is not suitable for field operation and disease diagnosis in remote areas. The group independently designed and assembled an integrated low-cost multichannel nucleic acid detection PCR instrument, including a multichannel automatic pipetting module, a heat amplification module and a real-time fluorescence detection module.Originality/valueThe above equipment showed better reliability compared with commercial qPCR. These results can lay the foundation for functional, fast and low-cost PCR equipment for trace measurements.

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).

The Influence of Anti-LGBTQIA+ Legislation on Graduate Medical Education

The Influence of Anti-LGBTQIA+ Legislation on Graduate Medical Education

396 Characterizing inpatient hospitalizations for hidradenitis suppurativa and assessing the impact of outpatient dermatology care on hospitalizations

Introduction: Hidradenitis suppurativa (HS) is associated with a significant disease burden. The use of high-cost settings care are common among HS patients. Objective: To explore factors that may influence hospital admissions and readmissions among HS patients. Methods: Using ICD-9/10 codes (705.83 and L73.2), we extracted the medical records of adult HS patients who visited the Henry Ford Health System (HFHS) ED between 2010 and 2020. Results: Of the 100 HS patients, 52 (52%) were admitted to an inpatient service. Hypertension (OR:2.55,95% CI:1.11-5.83, p value=0.027), diabetes mellitus (OR:2.42, 95%CI:1.05-5.61, p value =0.039), cellulitis (OR: 19.28, 95%CI:4.23-87.96 p<0.001), sepsis (OR:10.25, 95%CI:1.34-89.24, p value=0.025), and depression (OR:3.32, 95%CI:1.10-10.04, p value =0.002) were significant predictors of admission. Chronic kidney disease (OR:3.05, 95% CI:1.00-9.23,p value=0.049), congestive heart failure (OR:4.06, 95%CI:1.19-13.80, p value =0.025), coronary artery disease (OR:15.20, 95%CI:2.80-82.65, p value=0.002), chronic obstructive pulmonary disease (OR:8.94, 95%: 1.51-52.86, p value =0.003), cellulitis (OR:4.62, 95%CI:1.66-12.88, p=0.003), sepsis (OR:3.75, 95%CI:1.02-13.82,p value =0.047), and depression (OR:4.50, 95%CI:1.54-13.18, p value=0.006) were positively associated with readmission. Those who received outpatient dermatology care had a lower risk of being admitted (n=87, 28.7% vs n=13,100%, p <0.001) and readmitted (n=10, 11.5% vs n=5, 38.5%, p value =0.0108). Discussion: In this study, we demonstrate that certain comorbidities, that are common among HS patients, are significant determinants of admission to an inpatient service. Furthermore, the increase access to outpatient dermatology care significantly reduces the likelihood of HS patients being admitted and readmitted. Conclusion: The findings of this study illuminate the pivotal role of dermatologists in improving patients’ health outcomes while minimizing the avoidable use of high-cost settings care.

Proportional-assist ventilation with load-adjustable gain factors for mechanical ventilation: a cost-utility analysis.

Background:Mechanical ventilation is an important component of patient critical care, but it adds expense to an already high-cost setting. This study evaluates the cost-utility of 2 modes of ventilation: proportional-assist ventilation with load-adjustable gain factors (PAV+ mode) versus pressure-support ventilation (PSV).Methods:We adapted a published Markov model to the Canadian hospital-payer perspective with a 1-year time horizon. The patient population modelled includes all patients receiving invasive mechanical ventilation who have completed the acute phase of ventilatory support and have entered the recovery phase. Clinical and cost inputs were informed by a structured literature review, with the comparative effectiveness of PAV+ mode estimated via pragmatic meta-analysis. Primary outcomes of interest were costs, quality-adjusted life years (QALYs) and the (incremental) cost per QALY for patients receiving mechanical ventilation. Results were reported in 2017 Canadian dollars. We conducted probabilistic and scenario analyses to assess model uncertainty.Results:Over 1 year, PSV had costs of $50 951 and accrued 0.25 QALYs. Use of PAV+ mode was associated with care costs of $43 309 and 0.29 QALYs. Compared to PSV, PAV+ mode was considered likely to be cost-effective, having lower costs (−$7642) and increased QALYs (+0.04) after 1 year. In cost-effectiveness acceptability analysis, 100% of simulations would be cost-effective at a willingness-to-pay threshold of $50 000 per QALY gained.Interpretation:Use of PAV+ mode is expected to benefit patient care in the intensive care unit (ICU) and be a cost-effective alternative to PSV in the Canadian setting. Canadian hospital payers may therefore consider how best to optimally deliver mechanical ventilation in the ICU as they expand ICU capacity.

Establishing a Patient-Centered Virtual Care Model Across the Continuum of Care

Introduction:The once-in-a-generation COVID-19 pandemic accelerated the pace at which virtual care (VC) was advanced to triage, evaluate, and care for patients. An early adopter of VC delivery, Mayo Clinic had provided video visits and other remote care options for more than 5 years, yet the need for VC during the pandemic surpassed our available capacity for telehealth care.Methods:To continue providing high-quality care while preventing exposure of patients and staff to high-risk environments, staff from Primary Care and Express Care (minor acute services) collaborated to expand the outpatient VC service to triage patients with acute or chronic symptoms and to address concerns that could be managed remotely. We aimed to maximize the treatment options available outside of high-cost settings and also aimed to accelerate development of longer-term solutions for improving care coordination and continuous population management.Results:Patient use of virtual visits showed an unprecedented increase after changes were implemented that expanded the existing virtual visit menu, facilitated patient self-triage and direct scheduling, streamlined physical connections for virtual appointments, and incorporated additional language (medical interpreter) support. The combination of patient convenience, ease of scheduling, and added safety for providers and patients, in conjunction with other telehealth options, resulted in a better overall patient experience.Conclusion:Any organization that is considering deploying a sustainable program of VC must put patient needs and safety at the center. Organizations should seize opportunities to agilely adjust and advance any emergency-response solutions to serve a longer-term purpose.

Development and Evaluation of an Integrated Outpatient Infusion Care Model for the Treatment of Pediatric Headache

BackgroundCare for pediatric patients with headache often occurs in high-cost settings such as emergency departments (EDs) and inpatient settings. Outpatient infusion centers have the potential to reduce care costs for pediatric headache management. MethodsIn this quality improvement study, we describe our experience in creating the capacity to support an integrated outpatient pediatric headache infusion care model through an infusion center. We compare costs of receiving headache treatment in this model with those in the emergency and inpatient settings. Because dihydroergotamine (DHE) is a costly infusion, encounters at which DHE was administered were analyzed separately. We track the number of ED visits and inpatient admissions for headache using run charts. As a balancing measure, we compare treatment efficacy between the infusion care model and the inpatient setting. ResultsThe mean percentage increase in cost of receiving headache treatment in the inpatient setting with DHE was 61% (confidence interval [CI]: 30-99%), and that without DHE was 582% (CI: 299-1068%) compared with receiving equivalent treatments in the infusion center. The mean percentage increase in cost of receiving headache treatment in the ED was 30% (CI: −15 to 100%) compared with equivalent treatment in the infusion center. After the intervention, ED visits and inpatient admissions for headache decreased. The mean change in head pain was similar across care settings. ConclusionsOur findings demonstrate that developing an integrated ambulatory care model with infusion capacity for refractory pediatric headache is feasible, and our early outcomes suggest this may have a favorable impact on the overall value of care for this population.

Seasonal burden of National Emergency Department visits due to hidradenitis suppurativa

Seasonal burden of National Emergency Department visits due to hidradenitis suppurativa

Direct-To-Consumer Telemedicine Visits For Acute Respiratory Infections Linked To More Downstream Visits.

Use of direct-to-consumer telemedicine-on-demand virtual care for minor medical issues-is growing rapidly. Although it may yield immediate savings by diverting health care from higher-cost settings, these savings could be countered if direct-to-consumer telemedicine increases follow-up care and, therefore, episode costs. Comparing downstream care utilization data from a large, commercial payer for the period 2016-19, we found that patients with initial visits for acute respiratory infection were more likely to obtain follow-up care within seven days after direct-to-consumer telemedicine visits (10.3percent) than after in-person visits (5.9percent). In both settings approximately 90percent of patients did not obtain additional care. The telemedicine cohort had fewer (0.5percent versus 0.6percent) emergency department visits-a small but statistically significant difference-but more subsequent office, urgent care, and telemedicine visits. Our findings suggest that potential savings from shifting initial care to a direct-to-consumer telemedicine setting should be balanced against the potential for higher spending on downstream care.

The clinical and radiographic evaluation of Allium sativum oil (garlic oil) in comparison with mineral trioxide aggregate in primary molar pulpotomy.

Background:Mineral trioxide aggregate (MTA) is known as a common biomaterial for pulpotomy of primary molars, with limitation including high cost, difficult handling, and long setting time. This study was conducted to compare the clinical and radiographic success rate of Allium sativum oil and MTA in pulpotomy of primary molar teeth.Materials and Methods:This randomized, controlled, clinical trial was performed on a group of children with at least two symptom-free primary molars requiring pulpotomy. A total of 90 teeth were randomly assigned into two groups: After pulp amputation and hemostasis, Group I received MTA as medication in the pulp chamber and Group II received Allium sativum oil over the pulp stumps. Pulp chamber was then filled with reinforced ZOE paste (zinc oxide eugenol) and teeth were restored using stainless steel crowns. The follow-up scheme of 6, 12, and 18 months was set, and teeth evaluation was conducted by a calibrated pediatric dentist based on the modified criteria proposed by Zurn and Seale. The results were analyzed using the generalized estimating equation analysis with the P = 0.05 as the level of significance.Results:The clinical success rate was 100% in both groups after all follow-ups. The radiographic success rate was, however, 91.1% after 6.75. 6% after 12 and 18 months in Group II while it was 95.6% after 6, 91.1% after 12 and 18 months in Group I in those follow-up points. The difference between the two groups was not statistically significant.Conclusion:According to the results, Allium sativum oil has a high clinical and radiographic success rate comparable to those of MTA.

Empty Beds in Nursing Homes Filled by Younger Individuals Following ACA Medicaid Eligibility Expansion

National decline in nursing home occupancy rates coupled with expansion of Medicaid insurance eligibility under the Affordable Care Act (ACA) potentially create an opportunity for younger, low-income individuals to enter nursing homes following a hospitalization. Changes in the population of individuals using nursing homes could result in downstream consequences on facility payor mix, case severity index, and ultimately patient outcomes. This study measures the effect of ACA Medicaid eligibility expansion on the patient population using nursing homes, accounting for the nursing homes’ occupancy rate. Data were obtained from the publicly available national dataset, LTCfocus (2009-2016). Difference in differences estimation with time and state fixed effects was utilized to examine the effect of ACA Medicaid eligibility expansion on two outcomes, 1) average age in years of residents as of April 1 and 2) the proportion of individuals covered by Medicaid insurance at the facility level. Results show facilities with pre-ACA occupancy rates between 40% and 50% demonstrated the largest decrease in average age by year three, 1.32 years [95% CI: -2.257, -0.385]. Facilities with a pre-ACA occupancy rate of 60-70% demonstrated the largest increase in the proportion of individuals covered by Medicaid in year one, a 5.5 percentage point increase [95% CI: 0.009, 0.102]. In summary, Medicaid expansion under the ACA resulted in an increase in younger individuals and individuals covered by Medicaid using nursing homes, varying across pre-ACA occupancy rates. It remains to be studied if increased utilization of this high cost setting provides superior patient outcomes for these populations.

Strategies to minimize preventable morbidity and mortality resulting from pandemics like COVID-19.

Strategies to minimize preventable morbidity and mortality resulting from pandemics like COVID-19.

Methodological considerations in clinical outcomes assessment of pharmacy-based minor ailments management: A systematic review.

BackgroundThe accessibility of services within community pharmacies provides an ideal opportunity to manage minor ailments, yet over £1.1 billion is spent by the National Health Service (NHS) in the United Kingdom (UK) in managing minor ailments in high cost settings. There is a need to review the evidence base around clinical effectiveness of pharmacy-based management of minor ailments since the absence of such may lead to under-utilisation of pharmacy services and non-implementation of available pharmacy service models. This study aimed to systematically review the methodological approaches used to assess clinical outcomes of pharmacy-based management of minor ailments in the research literature.MethodsA systematic review was conducted to identify relevant literature using the following databases: Medline, EMBASE, CINAHL, IPA, CRD, CDSR, and Google Scholar from publication year 2000 onwards. Studies were included if they evaluated clinical outcomes of pharmacy-based management of any minor ailments, with or without a comparator setting such as Emergency Departments (EDs) or general practices. Screening and selection of titles, abstracts and full texts followed by data extraction and quality assessment (QA) was conducted. Paired researchers, from the team, reviewed papers using a protocol based on the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P). QA was undertaken using the Critical Appraisal Skills Programme (CASP). Reporting was conducted in accordance with PRISMA checklist and statements.ResultsA total of 19 studies were included. The majority of studies were observational, conducted in community pharmacies, and did not use a comparator participant group nor a comparator setting. Interventions included counselling, medicines supply and provision of advice on the management of minor ailments. One study used the randomised controlled trial (RCT) design with majority of the study utilising observational design. A range of clinical outcomes including symptom severity, pattern, resolution, and quality of life were reported. Methods used for the assessment of clinical outcomes were, overall, poorly reported. This included a lack of information on the development and validation of the data collection tools and the timing of baseline and follow-up data collection. Adverse clinical outcomes data were collected by only seven studies.ConclusionsCurrently, there are methodological limitations in the studies that have sought to assess clinical outcomes of pharmacy-based management of minor ailments. Such lack of high quality evidence may contribute to failings to shift care from high cost settings, such as EDs and general practices. Generation of high quality evidence is likely to influence public choices when seeking care for minor ailments. There is scope for development of a core outcomes set specific to minor ailments management and development of a validated methodology for measuring such outcomes in a research study.

Consensus methodology to determine minor ailments appropriate to be directed for management within community pharmacy.

National Health Service (NHS) 111, a medical helpline for urgent care used within the England and Scotland, receives significant numbers of patient calls yearly for a range of clinical conditions. Some are considered high acuity and mainly directed to urgent and emergency care. Low acuity conditions are also directed to these costly, overburdened services. Community pharmacy is a recognised setting for effective low acuity condition management and could offer an alternative. To design and evaluate a new NHS111 pathway re-directing patients with low acuity conditions to community pharmacy. Two consensus development stakeholder workshops were undertaken. A "low acuity" condition was defined as one that can be clinically assessed by a community pharmacist and requires a treatment and/or advice available within a community pharmacy. Retrospective NHS111 patient data (February-August 2016) from the North East of England and access to the NHS Pathways clinical decision support software were available to stakeholders. The NHS111 data demonstrated the volume of patient calls for these conditions that could have been redirected to community pharmacy. Stakeholders reached consensus that 64 low acuity conditions could be safely redirected to community pharmacy via NHS111. This represented approximately 35,000 patients (11.5% of total) being shifted away from the higher cost settings in the North East region alone during February-August 2016. The stakeholder group discussions provided rationale behind their classifications of conditions to ensure patient safety, the care experience and added value. The resulting definitive list of low acuity conditions that could be directed to community pharmacy via NHS111 could result in a shift of workload from urgent and emergency care settings. Future work needs to evaluate the cost, clinical outcomes, patient satisfaction of a community pharmacy referral service that has the potential to improve integration of community pharmacy in the wider NHS.

No Patient Left Behind: Patient-Centered Healthcare Reform

No Patient Left Behind: Patient-Centered Healthcare Reform

Managing Minor Ailments; The Public's Preferences for Attributes of Community Pharmacies. A Discrete Choice Experiment.

BackgroundDemand for health services continues to rise. Greater use of community pharmacy services instead of medical services for minor ailments could help relieve pressure on healthcare providers in high-cost settings. Community pharmacies are recognised sources of treatment and advice for people wishing to manage these ailments. However, increasing the public’s use of pharmacy services may depend on attributes of pharmacies and their staff. This study aimed to determine the general public’s relative preferences for community pharmacy attributes using a discrete choice experiment (DCE).MethodA UK-wide DCE survey of the general public was conducted using face-to-face computer-assisted personal interviews. Attributes and levels for the DCE were informed by a literature review and a cohort study of community pharmacy customers. The context for the experiment was a minor ailment scenario describing flu-like symptoms. The DCE choice sets described two hypothetical community pharmacy services; respondents were asked to choose which (if either) of the two pharmacies they would prefer to help them manage symptoms. Data from 1,049 interviews were analysed using an error components logit model. Willingness to pay (WTP), a monetary measure of benefit, was estimated for the different attribute levels.ResultsWhen seeking help or treatment for flu-like symptoms, respondents most valued a pharmacy service that would improve their understanding and management of symptoms (WTP = £6.28), provided by staff who are trained (WTP (pharmacist) = £2.63: WTP(trained assistant) = £3.22), friendly and approachable (WTP = £3.38). Waiting time, pharmacy location and availability of parking also contributed to respondents’ preferences. WTP for a service comprising the best possible combination of attributes and levels was calculated as £55.43.ConclusionAttributes of a community pharmacy and its staff may influence people’s decisions about which pharmacy they would visit to access treatment and advice for minor ailments. In line with the public’s preferences, offering community pharmacy services that help people to better understand and manage symptoms, are provided promptly by trained staff who are friendly and approachable, and in a local setting with easy access to parking, has the potential to increase uptake amongst those seeking help to manage minor ailments. In this way it may be possible to shift demand away from high-cost health services and make more efficient use of scarce public resources.

Influence of self-care advice on patient satisfaction and healthcare utilization.

The aim of this study is to explore the influence of nurse-led self-care advice on healthcare utilization and patients' satisfaction with telephone nursing. Many consultations in high-cost settings are for conditions that are manageable through self-care and callers with greater satisfaction with the nurse interaction are nearly four times more likely to engage in self-care. Cross-sectional study. Questionnaires were sent out to 500 randomly selected callers to the Swedish Healthcare Direct in Northern Sweden during March 2014. Callers were asked about their satisfaction with the consultation, their intended actions prior to consultation, the recommendation given by the nurse and the action undertaken after the call. Young callers and persons recommended watchful waiting or recurrence if no improvements were significantly less satisfied with their care. When calling on their own behalf, both men and women rated the severity of their symptoms equally and were advised to self-care to the same extent. Self-care advice had a constricting influence on self-reported healthcare utilization, with 66·1% of cases resulting in a lower level of care than first intended. Feeling reassured after the call was the aspect of nursing care that influenced satisfaction the most. Receiving self-care advice rather than referral to a general practitioner influences patient satisfaction negatively. Feeling reassured after consultation is strongly related to satisfaction, which in turn has been found to increase the likelihood of engaging in self-care behaviour.

Increased utilization of emergency department and inpatient care by patients with hidradenitis suppurativa

Hidradenitis suppurativa (HS) is a chronic cutaneous disease with acutely painful flares. In a prior study of all-cause utilization, patients with HS had higher utilization of emergency department (ED) and inpatient care. We sought to assess utilization of medical care specifically related to HS, especially high-cost settings. The MarketScan medical claims database was examined for participants with either HS or psoriasis based on International Classification of Diseases, Ninth Revision codes, during the study period, January 2008 to December 2012. This was a cohort cost-identification study with analyses of utilization measures and direct costs. The proportion of the HS cohort hospitalized was 5.1% and was higher than the psoriasis cohort (1.6%) (P < .0001). The proportion of patients who used the ED was also higher in the HS cohort (7.4% vs 2.6%, P < .0001). When compared with a subset of patients with severe psoriasis, the proportions of patients with HS who used the ED (7.4% vs 4.2%, P < .0001) or inpatient care (5.1% vs 2.5%, P < .0001) remained elevated. The study sample may not be generalizable to other patient populations and may represent those with more severe disease. Pharmaceutical costs were not included and confounding factors such as race, socioeconomic status, and insurance type were not investigated. Patients with HS had increased utilization of high-cost settings, such as the ED and inpatient care, compared with patients with psoriasis, another chronic inflammatory disease. Both patients and providers should be aware of this finding and further work is needed to incorporate assessment of patient outcomes.

Estimating the burden of minor ailment consultations in general practices and emergency departments through retrospective review of routine data in North East Scotland.

Background.Minor ailment attendances in general practices and emergency departments (EDs) place significant burden on health care resources.Objectives.To estimate the prevalence and type of minor ailment consultations for adults in general practice and ED that could be managed in a community pharmacy.Methods.Retrospective review of routine data from general practices (n = 2) and one ED in North East Scotland. Two independent consensus panels assessed each consultation summary to determine whether it represented a minor ailment. Outcomes included prevalence of consultations for minor ailments in general practice and ED and frequency of different minor ailment type that could be managed in community pharmacies.Results.In total, of the 494 general practice and 550 ED consultations assessed, 13.2% [95% confidence interval (CI): 18.6–25.9%] and 5.3% (95% CI: 4.0–8.0%), respectively, were categorized as minor ailments suitable for management in community pharmacies. Consensus among panel members was moderate for general practice consultations, but fair to poor for ED consultations. Agreement between uni- and multi-disciplinary panels was good. Applied to national data, these estimates would equate to ~18 million general practice and 6500000 ED consultations that could be redirected to community pharmacy, equating to ~£1.1 billion in resources.Conclusion.Minor ailment consultations still present a major burden on higher cost settings. Effective strategies are needed to raise awareness among patients and health professionals regarding conditions that can be managed effectively in pharmacies and to change patient health-seeking behaviour for such conditions.

Health Care Utilization Patterns and Costs for Patients With Hidradenitis Suppurativa

Hidradenitis suppurativa (HS) is a chronic cutaneous disease with acutely painful flares that require appropriate and timely treatment. To assess how individuals with HS utilize medical care, especially emergency department (ED) care, a high-cost setting, and to describe the health care costs for this group. Cohort cost-identification study of 150 493 individuals with claims from the MarketScan medical claims database. Patients with claims for HS and psoriasis (16 736 and 110 266, respectively) and a control group with neither condition (23 491) during the study period, January 2008 to December 2010, were included. An HS cohort was formed from all the patients who had 2 or more claims for HS (International Classification of Diseases, Ninth Revision [ICD-9] code 705.83) during the 3-year period. A psoriasis cohort was used as a comparison group, since it is another chronic inflammatory condition with prominent skin findings. This group included randomly selected patients who had 2 or more claims for psoriasis (ICD-9 code 696.1) during the 3-year period. A second control group included randomly selected patients who had no claims for either condition during the 3-year period. From these cohorts only patients that were continuously enrolled for the 3-year period were included. Health care utilization measures including inpatient length of stay, emergency department and outpatient visits, and number of days supplied of prescription medication were investigated. Cost variables were also investigated and included inpatient, outpatient, emergency department, prescription drug, and total all-cause health care expenditures, which were adjusted for inflation and reported in 2010 US dollars. The largest component of the total 3-year cost for the HS group was inpatient cost (37.4%). In contrast, for the psoriasis group this was drug costs (46.5%) and for the control group, inpatient costs (40.9%). The proportion of people who were hospitalized in the HS cohort (15.8%) was higher than the psoriasis (10.8%) or control (8.6%) groups (P < .001). The proportion of patients who used the ED over the 3-year period was higher in the HS cohort (27.1%) than the psoriasis (17.4%) or control groups (17.2%) (P < .001). Similarly, the mean (SD) 3-year ED cost for the HS group was $2002 ($6632) and was higher than both comparison groups (P < .001). After adjustment for age, sex, and comorbidities, ED utilization remained higher in the HS group compared with the control (P < .001) and psoriasis (P = .02) cohorts. Hidradenitis suppurativa affects a younger, predominantly female population of patients. High-cost settings, such as ED and inpatient care, are used more frequently for patients with HS. Both patients and clinicians should be aware of this finding, and further research is needed to investigate the impact of health care utilization on patient outcomes.