Increase In Emergency Department Visits Research Articles

Relationship between patient-perceived quality of primary care and self-reported hospital utilisation in China: A cross-sectional study

Background Reducing avoidable hospital admissions is a global healthcare priority, with optimal primary care recognised as pivotal for achieving this objective. However, in developing systems like China, where primary care is evolving without compulsory gatekeeping, the relationship between patient-perceived primary care quality and hospital utilisation remains underexplored. Objectives This study aimed to explore the association between patient-perceived primary care quality and self-reported hospital utilisation in China. Methods Data were collected from 16 primary care settings. Patient-perceived quality of primary care was measured using the Assessment Survey of Primary Care scale across six domains (first-contact care, continuity, comprehensiveness, accessibility, coordination, and patient-centredness). Hospital utilisation included patient self-reported outpatient visits, hospital admissions, and emergency department (ED) visits in the last six months. Logistic regression analyses were examined associations between self-reported hospital utilisation and perceived primary care quality adjusted for potential confounders. Results Of 1,185 patients recruited, 398 (33.6%) reported hospital utilisation. Logistic regression analyses showed that higher total scores for patient-perceived quality of primary care were associated with decreased odds of hospital utilisation (adjusted odds ratio(AOR): 0.417, 95% confidence interval (CI): 0.308–0.565), outpatient visits (AOR: 0.394, 95% CI: 0.275–0.566) and hospital admissions (AOR: 0.496, 95% CI: 0.276–0.891). However, continuity of care was positively associated with ED visits (AOR: 2.252, 95% CI: 1.051–4.825). Conclusion Enhanced patient-perceived quality of primary care in China is associated with a reduction in self-reported overall hospital utilisation, including outpatient visits and hospital admissions. However, better continuity of care may be associated with increased ED visits. Further research is warranted for precise insights and validation of these findings.

Impact of ambient temperature on respiratory disease: a case-crossover study in Seoul.

Respiratory diseases contribute to global morbidity and mortality, and temperature is a significant factor. We investigated the association between ambient temperature and emergency department (ED) visits for various respiratory diseases in Seoul, South Korea. Using data from the National Emergency Department Information System (2008-2017), we analysed 1,616,644 ED visits for respiratory diseases, categorised according to the Korean Standard Classification of Diseases 7th revision codes (J00-J99). Using a time-stratified case-crossover design and a distributed lag nonlinear model, we investigated the effect of temperature exposure on ED visits for respiratory diseases, calculating the relative risk (RR) for the maximum risk temperature (MaxRT) of both cold and hot extremes compared to the minimum risk temperature (MinRT). Cold temperatures (MaxRT: -9.0°C) resulted in a 2.68-fold increase (RR = 2.68, 95% CI = 2.26-3.14) in ED visits for total respiratory diseases, while hot temperatures (MaxRT: 29.4°C) led to a 1.26-fold increase (RR = 1.26, 95% CI = 1.11-1.42) compared to the MinRT (24.8°C). Cold temperatures increased the risk of most respiratory diseases, except interstitial lung disease, whereas hot temperatures increased ED visits for acute upper respiratory infections and influenza. Cold temperatures increased ED visits for all age groups, especially those aged 18-64 (RR = 3.54, 95% CI = 2.90-4.33), while hot temperatures significantly affected those < 18 (RR = 1.45, 95% CI = 1.27-1.66). The risk levels were similar in both males and females, regardless of hot and cold temperatures. Our findings underscore the significant impact of both cold and heat exposure on ED visits for respiratory diseases, with varying intensities and risk profiles across different population groups.

The Effect of Marijuana on Postoperative Spine Patients' Emergency Department Visits, Readmission Rates, and Opioid Consumption.

To compare postoperative opioid consumption with patients who tested negative for tetrahydrocannabinol (THC) preoperatively with those who were THC-positive and patients who were positive for THC and any other drug and to compare 90-day rates of postoperative emergency department (ED) visits and 90-day readmission rates, using morphine milligram equivalents (MMEs), for those three patient populations. Three patient groups were confirmed with preoperative urine drug screens. Chart reviews were conducted to determine whether there was an ED visit or hospital readmission 90 days from the index procedure. MMEs were calculated for all patients. There were a total of 252 patients in the THC-negative control group, 54 in the THC-positive group, and 47 in the THC-and-opioid-positive group. The 90-day ED visit and 90-day readmission rates were not statistically significant among the groups. Both the multidrug and THC-only-positive patients showed a higher 90-day MME compared with the control patients. Our study demonstrates that THC used may increase opioid consumption. The THC patients to be cautious toward are the multidrug user. Although not statistically significant, multidrug patients were noted for a trend toward increased ED visits and readmissions.

Limited English Proficiency can Negatively Impact Disease/Treatment in Children With Cancer Compared to Those Who are English Proficient-an Institutional Study

BackgroundIn 2013, 25.5 million people in the United States self-identified as having limited English proficiency (LEP). LEP in adults has been associated with longer hospital stays, increased adverse events, increased emergency room visits, and decreased understanding of medications prescribed. This study aims to define the relationship between LEP and outcomes in a pediatric oncologic population. MethodsWe performed a matched case-control study utilizing data from our institutional cancer database (children </ = 18, 2012-2021). LEP families were matched by disease and stage with English proficient (EP) families. Descriptive, univariate, and bivariate analysis were performed. ResultsTwenty-four LEP children were identified and matched with 77 EP children. LEP children represented 11 languages, with the most common being Spanish (42%). Statistical regression demonstrated a clinically significant trend for LEP children to have an increased mean number of unexpected hospital admissions (p = 0.04), increased number of clinic cancellations (n = 0.003), and increased emergency department visits (p = 0.05). LEP children were more likely to have Medicaid than commercial insurance (p < 0.001). There was no difference in 2-year event free or overall survival. ConclusionIn our study cohort, LEP families are at risk for more negative treatment experiences than EP families. Further studies are needed to delineate specific causes and interventions. Type of StudyRetrospective comparative cohort study. Level of EvidenceLevel III.

Abstract 12939: Friend or Foe: Increased Access to Care via Patient Portals

Background: Patient portals are secure online websites that grant patients access to their medical record. Portal use is associated with improved chronic disease management. Whether the use of patient portals is associated with cardiac outcomes is less well known and deserves further study. We examined the association of patient portal use with cardiac events among a large cohort of patients with CVD. We expected to find differences in portal use by sociodemographic info. We hypothesized that portal use would be negatively associated with cardiac events. Methods: De-identified data for adult patients meeting inclusion criteria were obtained between January 2018 and October 2021. The association of portal use with demographic factors was assessed using t-test and/or chi squared. Our primary outcomes were emergency department (ED) visit or all-cause readmission. We used a Cox model adjusting for demographic and clinical covariates at an alpha of 0.05. Results: The Table summarizes our findings. There was a significant difference in portal use by sex, race, ethnicity, English proficiency, and marital status. The Figure shows the adjusted findings that portal use was associated with higher hazards of ED visits and all-cause readmission at one year. Conclusions: Our data demonstrate that sociodemographic factors are associated with online patient portal use at a single institution. Contrary to our hypothesis, we found that portal use portends increased ED visits and hospitalization (lower event-free survival). These data suggest that patient portal access and closer clinician scrutiny may lead to increased health services utilization.

Agreement between youth and caregiver report of pain and functioning in pediatric sickle cell disease: PedsQL sickle cell disease module.

Pain is a primary symptom of sickle cell disease (SCD) and is often severe and chronic. To treat SCD-related pain, proper assessment of SCD pain among youth, including the degree of concordance or agreement between youth and caregiver reports of pain, is essential but has not yet been adequately evaluated. In this study, 525 youth with SCD and their parents were evaluated as part of the Sickle Cell Clinical Research and Intervention Program (SCCRIP) to examine pain rating concordance and predictors of concordance. Youth and parents completed the Pediatric Quality of Life Inventory Sickle Cell Disease module (PedsQL-SCD) to measure pain, pain interference, and pain-related constructs. Disease, clinical, and demographic variables were obtained from the SCCRIP database. Intraclass correlations demonstrated moderate-to-poor consistency between youth and caregiver reports of pain and pain interference (ICCs range from 0.17 to 0.54). Analysis of covariance and regression models found that patient age, frequency of hospitalizations and emergency department (ED) visits, economic hardship, and fetal hemoglobin levels were significantly associated with varying pain-rating agreement levels among parent proxy and child self-report pain. Concordance of pain assessments among youth with SCD and their caregivers using the PedsQL-SCD Module was moderate at best, corroborating prior research. Youth factors predicting discordance among pain-related factors included increased ED visits, older age, and female sex. Collectively, these results bolster the use of integrated pain assessments to reduce parent-child discrepancies, thereby improving the adequacy of SCD-related pain assessment and treatment.

Short-term exposure to various ambient air pollutants and emergency department visits for cause-stable ischemic heart disease: a time-series study in Shanghai, China

Studying the impact of local meteorological conditions and air pollution on cardiovascular disease is crucial for reducing the burden of cardiovascular disease. However, there have been few studies on the acute effects of various air pollutants on stable ischemic heart disease (SIHD), and the effects of these factors are not well defined and require further investigation. We performed a time-series study aimed at exploring the association between short-term exposure to various air pollutants and emergency department (ED) visits for SIHD during 2013–2020 in Baoshan District Renhe Hospital of Shanghai, China. The associations between air pollution (NO2, PM2.5, PM10, SO2 O3-8 h and CO) and ED visits were analyzed using quasi-Poisson regression. Subgroup and sensitivity analyses were conducted. From 2013 to 2020, a total of 18,241 ED visits for SIHD were recorded. Elevated PM2.5, PM10, NO2, SO2 and CO were significantly associated with increased ED visits for SIHD at lag (0, 5), lag 0, lag (0-4, 01-03), lag (0-3, 5, 01-03) and lag (3-5). When the concentration of O3-8 h was lower than the threshold recommended by the WHO, exposure to O3-8 h was associated with a slightly decreased risk of SIHD. Moreover, the relationship between different types of air pollution and the frequency of ED visits exhibited variations based on gender, age, and seasonality. This study suggests that short-term exposure to PM2.5, PM10, NO2, SO2 and CO might induce SIHD, especially in old females. Air pollution control measures should be encouraged to prevent the occurrence and development of SIHD.

Neighborhood Deprivation and Association With Medical Complications, Emergency Department Use, and Readmissions in Shoulder Arthroplasty Patients

Background: Social determinants of health are prognostic indicators for patients undergoing orthopedic procedures. Purpose: Using the area deprivation index (ADI), a validated, weighted index of material deprivation and poverty (a 0%-to-100% scale, with higher percentages indicating greater disadvantage), we sought to evaluate whether there are associations in shoulder arthroplasty patients between higher ADI and rates of (1) medical complications, (2) emergency department (ED) utilizations, (3) readmissions, and (4) costs. Methods: We queried the PearlDiver nationwide database for patients who had undergone primary shoulder arthroplasty from 2010 to 2020. Patients from regions associated with high ADI (95%+) were 1:1 propensity matched to a comparison group by age, sex, and Elixhauser Comorbidity Index. This yielded 49,440 patients in total. Outcomes included 90-day complications, ED utilizations, readmissions, and costs. Logistic regression models computed odds ratios (ORs) of ADI on the dependent variables. P values of &lt; .05 were significant. Results: Patients from high ADI regions showed higher rates and odds of complications than those in the comparison group (10.84% vs 9.45%; OR: 1.10), including acute kidney injuries (1.73% vs 1.38%; OR: 1.23), urinary tract infections (3.19% vs 2.80%; OR: 1.13), and respiratory failures (0.49% vs 0.33%; OR: 1.44), but not increased ED visits (2.66% vs 2.71%; OR: 0.99) or readmissions (3.07% vs 2.96%; OR: 1.03). Patients from high ADI regions incurred higher costs on day of surgery ($8251 vs $7337) and at 90 days ($10,999 vs $9752). Conclusions: This 10-year retrospective database study found that patients from high ADI regions undergoing primary shoulder arthroplasty had increased rates of all 90-day medical complications, suggesting that measures of social determinants of health could inform health care policy and improve post-discharge care in these patients.

Substance Use Disorders, Mental Illness, and Health Care Utilization Among Adults With Recent Criminal Legal Involvement.

Individuals involved with the criminal legal system have higher rates of mental illness, addiction, and health care utilization. The authors examined whether substance use disorders and mental illness alone or in combination drive health care utilization among those with recent criminal legal involvement. This cross-sectional analysis used nationally representative data from U.S. adults with past-year criminal legal involvement (N=9,039) recorded in the National Survey on Drug Use and Health (2015-2019). Using adjusted negative binomial regression models, the authors estimated relative risks for health care utilization. Primary independent variable categories included neither substance use disorder nor mental illness, substance use disorder only, mental illness only, and both conditions. Health care utilization included emergency department (ED) visits and nights spent in inpatient care. Relative to neither mental illness nor substance use disorder, mental illness alone was associated with significantly increased acute health care services use: for ED visits, incidence risk ratio (IRR)=1.43 (95% CI=1.18-1.75) and for inpatient stays, IRR=2.14 (95% CI=1.47-3.11). Having both conditions was associated with increased ED visits (IRR=1.62, 95% CI=1.38-1.91) and inpatient stays (IRR=4.16, 95% CI=2.98-5.82). Substance use disorder alone was associated only with higher risk for ED visits compared with neither condition (IRR=1.23, 95% CI=1.01-1.50). Mental illness with or without co-occurring substance use disorder is a strong driver of acute health care utilization after interaction with the criminal legal system. Interventions tailored to the unique needs of individuals with mental illness or substance use disorder are needed for those with recent criminal legal involvement.

The effect of Iran's health sector evolution plan on hospitals performance indicators: an interrupted time series analysis.

The Health Sector Evolution Plan (HSEP) was set up in Iran's health system to respond to some of the main problems in hospitals and other health sectors. We aimed to compare the effect of the HSEP on teaching hospital performance before and after the implementation of the HSEP through the interrupted time series (ITS) analysis. With a cross-sectional design, data collection was performed in 17 teaching hospitals affiliated with the Kermanshah University of Medical Sciences (KUMS). We used the existing data on three indicators of hospitalization rate (per 10,000 population), Emergency Department Visits (EDVs) (per 10,000 population), and in-hospital mortality (per 10,000 population). The monthly data from 2009 to 2019 was analyzed by the ITS method 60 months before and 61 months after the HSEP. We found a non-statistically significant decrease in the monthly trend of hospitalization rate relative to the period before the HSEP implementation (-0.084 per 10,000 population [95%CI: -0.269, 0.101](. There was a statistically significant increase in the monthly trend of EDVs rate compared to before the HSEP implementation (1.07 per 10,000 population [95%CI: 0.14, 2.01]). Also, a significant decrease in the monthly trend of in-hospital mortality compared to before the HSEP implementation [-0.003 per 10,000 population (95%CI: -0.006, -0.001)] was observed. Our study demonstrated a significant increasing and decreasing trend for EDVs and in-hospital mortality following the HSEP implementation, respectively. Regarding the increase in hospitalization rate and EDVs after the implementation of HESP, it seems that there is a need to increase investment in healthcare and improve healthcare infrastructure, human resources-related indicators, and the quality of healthcare.

Pollen and asthma morbidity in Atlanta: A 26-year time-series study

BackgroundCompared to many environmental risk factors, the relationship between pollen and asthma is understudied, including how associations may differ by pollen type and between subgroups, and how associations may be changing over time. ObjectivesWe evaluated the association between ambient pollen concentrations and emergency department (ED) visits for asthma and wheeze in Atlanta, Georgia during 1993–2018. We estimated overall associations for 13 individual pollen taxa, as well as associations by decade, race, age (5–17, 18–64, 65+), and insurance status (Medicaid vs non-Medicaid). MethodsSpeciated pollen data were acquired from Atlanta Allergy & Asthma, a nationally certified pollen counting station. ED visit data were obtained from individual hospitals and from the Georgia Hospital Association. We performed time-series analyses using quasi-Poisson distributed lag models, with primary analyses assessing 3-day (lag 0–2 days) pollen levels. Models controlled for day of week, holidays, air temperature, month, year, and month-by-year interactions. ResultsFrom 1993 to 2018, there were 686,259 ED visits for asthma and wheeze in the dataset, and the number of ED visits increased over time. We observed positive associations of asthma and wheeze ED visits with nine of the 13 pollen taxa: trees (maple, birch, pine, oak, willow, sycamore, and mulberry), two weeds (nettle and pigweed), and grasses. Rate ratios indicated 1–8% increases in asthma and wheeze ED visits per standard deviation increases in pollen. In general, we observed stronger associations in the earliest period (1993–2000), in younger people, and in Black patients; however, results varied by pollen taxa. ConclusionsSome, but not all, types of pollen are associated with increased ED visits for asthma/wheeze. Associations are generally higher in Black and younger patients and appear to have decreased over time.

Effect of Chronic Disease Home Telehealth Monitoring in the Veterans Health Administration on Healthcare Utilization and Mortality.

The high prevalence of chronic diseases, including congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD), and diabetes mellitus (DM), accounts for a large burden of cost and poor health outcomes in US hospitals, and home telehealth (HT) monitoring has been proposed to improve outcomes. To measure the association between HT initiation and 12-month inpatient hospitalizations, emergency department (ED) visits, and mortality in veterans with CHF, COPD, or DM. Comparative effectiveness matched cohort study. Veterans aged 65years and older treated for CHF, COPD, or DM. We matched veterans initiating HT with veterans with similar demographics who did not use HT (1:3). Our outcome measures included a 12-month risk of inpatient hospitalization, ED visits, and all-cause mortality. A total of 139,790 veterans with CHF, 65,966 with COPD, and 192,633 with DM were included in this study. In the year after HT initiation, the risk of hospitalization was not different in those with CHF (adjusted odds ratio [aOR] 1.01, 95% confidence interval [95%CI] 0.98-1.05) or DM (aOR 1.00, 95%CI 0.97-1.03), but it was higher in those with COPD (aOR 1.15, 95%CI 1.09-1.21). The risk of ED visits was higher among HT users with CHF (aOR 1.09, 95%CI 1.05-1.13), COPD (1.24, 95%CI 1.18-1.31), and DM (aOR 1.03, 95%CI 1.00-1.06). All-cause 12-month mortality was lower in those initiating HT monitoring with CHF (aOR 0.70, 95%CI 0.67-0.73) and DM (aOR 0.79, 95%CI 0.75-0.83), but higher in COPD (aOR 1.08, 95%CI 1.00-1.16). The initiation of HT was associated with increased ED visits, no change in hospitalizations, and lower all-cause mortality in patients with CHF or DM, while those with COPD had both higher healthcare utilization and all-cause mortality.

USING A REGISTRY TO DRIVE OUTCOMES: A REDUCTION IN OPIOID PRESCRIPTION SIZE AFTER TOTAL JOINT ARTHROPLASTY CAN BE SAFELY PERFORMED WITHOUT AN INCREASE IN COMPLICATIONS

Excessive opioid prescriptions after total joint arthroplasty (TJA) increase risks for adverse opioid related events, chronic opioid use, and increase the availability of opioids for unlawful diversion. Thus, decreasing postoperative prescriptions may improve quality after TJA. Concerns exist that a decrease in opioids prescribed may increase complications such as readmissions, emergency department (ED) visits or worsened patient reported outcomes (PROs). The purpose of this quality improvement study was to explore whether a reduction in opioids prescribed after TJA resulted in increased complications.Methods: Data originated from a statewide arthroplasty database (MARCQI). The database collects over 96% of all TJA performed in the state of Michigan, USA. Data was prospectively abstracted and included OMEs prescribed at discharge, readmissions, ED visits within 30 days and PROs. Data was collected one year before and after the creation of an opioid prescribing protocol that had decreased prescriptions by approximately 50% in opioid naive and tolerant patients. Trends were monitored using Shewhart control charts.84,998 TJA over two-years were included. All groups showed a reduction in opioids prescribed. Importantly, no increased complications occurred concomitant to this reduction. No increases in ED visits or readmissions, and no decreases in KOOSJR/HOOSJR/PROMIS10 scores were noted in any of the groups.Using large data sets and registries can drive performance and improve quality. The MARCQI Postoperative opioid prescription recommendations and performance measures decreased total oral morphine equivalents prescribed over a large and diverse population by approximately 50% without decreasing PROs or increasing ED visits or hospital readmissions. A reduction in opioids prescribed after TJA can be accomplished safely and without an increase in complications across a large population.

An Increase in Same Day Discharge After Total Joint Arthroplasty During the COVID-19 Pandemic Does Not Influence Patient Outcomes: a Retrospective Cohort Analysis.

The COVID-19 pandemic caused major transitions in total joint arthroplasty (TJA), notably with the increased utilization of same-day discharge (SDD) pathways. This study assessed the effect of accelerated discharge pathways following the resumption of elective cases during the COVID-19 pandemic on SDD rates, adverse events, and characteristics associated with successful SDD following total hip (THA) and total knee arthroplasty (TKA). This retrospective study split patients into cohorts; TJA prior to COVID-19 (pre-COVID, July 2019-December 2019) and TJA following resumption of elective surgery (post-COVID, July 2020-December 2020). Patient characteristics such as age, sex, body mass index (BMI), ASA score and pertinent comorbidities were analyzed, and length-of-stay (LOS), 30-day emergency department (ED) visit rates, readmissions and reoperations were compared. 1333 patients met inclusion criteria that were divided into pre-COVID (692) and post-COVID (641) cohorts. The pre-COVID group had a median age of 69 years (IQR 63-76) and the post-COVID group had a median age of 68 years (IQR 61-75) (P=0.024). SDD increased from 0.1% to 28.9% (P<0.001) and LOS decreased from 1.3 days to 0.89 days (P<0.001). There was no change in 30-day ED visits, readmissions, or reoperations (P=0.817, P=0.470, P=0.643 respectively). There was no difference in ED visits, readmissions, or reoperations in SDD patients. The odds of SDD were associated with age (P<0.001, OR=0.94), BMI (P=0.006, OR=0.95), male sex (P<0.001, OR=1.83), and history of tobacco use (P<0.001, OR=1.87). At our institution, the COVID-19 pandemic accelerated utilization of SDD pathways without increasing ED visits, readmissions or reoperations.

Epidemiological features of traumatic brain injuries from a first-level trauma care national medical center in Georgia.

Traumatic brain injuries is a significant public health issue in both developed and developing countries. In Georgia, traumatic brain injuries remains one of the leading causes of mortality and disability. Traumatic brain injuries affect families, communities and societies in Georgia and have far-reaching human, social and economic costs, manifested in increased emergency department visits, hospitalizations, disability and deaths.The aim of this study is to retrospectively analyze the epidemiological features of Traumatic Brain Injuries on the example of Medical Centre in Georgia which provides a first level trauma care for patients in the country. Retrospective observational study was conducted from August 1 to October 31, 2018. The study included patients who were admitted with a Traumatic Brain Injuries diagnosis and S00-S09.0 codes (ICD 10). SPSS 20 was used for statistical analysis. A total of 96 TBI-related hospitalizations were studied. 56.3% (n=54) of hospitalized patients were males. The average age of patients was 40.7 years. Furthermore, patients aged 25-44 years were more represented in the number of TBI-related hospitalizations (39.6%). 95.8% of all Traumatic brain injuries hospitalizations were as a result of unintentional injuries. Unintentional falls were shown to be the predominant mechanism of injury accounting for over half of TBI-related hospitalizations (56.2%). The second most common mechanism of injury is the road traffic injury, mostly occurring among males (63.9%). This study offers an insight into understanding the epidemiological features of Traumatic Brain Injuries on the example of the National Medical Center from Georgia.

A Reduction in Opioid Prescription Size After Total Joint Arthroplasty Can be Safely Performed Without an Increase in Complications

BackgroundExcessive opioid prescriptions after total joint arthroplasty (TJA) increase risks for adverse opioid-related events, chronic opioid use, and unlawful opioid diversion. Decreasing postoperative prescriptions may improve quality after TJA. Concerns exist that a decrease in opioids prescribed may increase complications, such as readmissions, emergency department (ED) visits, or worsened patient-reported outcomes (PROs). The purpose of this study was to explore whether a reduction in opioids prescribed after TJA resulted in increased complications. MethodsData originated from a statewide database prospectively abstracted, including oral morphine equivalents prescribed at discharge, readmissions, ED visits, and PROs. Data were collected from 84,998 TJA occurring 1 year before and after the creation of an opioid-prescribing protocol that had decreased prescriptions by approximately 50%. Trends were monitored using Shewhart control charts. Regression models were used to determine statistically significant changes over time. ResultsAll groups showed a reduction in opioids prescribed by almost 50% without an increase in emergency room visits or readmissions and without a detrimental effect on PROs. Compared to baseline data before opioid reduction, opioid-naive total knee arthroplasty had significant improvements in all outcomes (P = .03, P = .02, P < .001, P < .001). Opioid-tolerant total knee arthroplasty and total hip arthroplasty had no worsened outcomes and significant improvement in (Knee Injury and Osteoarthritis Outcome score for Joint Replacement P = .03) and (Hip Disability and Osteoarthritis Outcome Score for Joint Replacement P = .03). Opioid-naive total hip arthroplasty had significant improvements in Hip Disability and Osteoarthritis Outcome Score Joint Replacement (P = .003) and Patient Reported Outcomes Measurement Information System (P = .001). ConclusionsPostoperative opioid prescription recommendations from a statewide registry decreased prescribing by approximately 50% without decreasing PROs or increasing ED visits or readmissions. A reduction in opioids prescribed after TJA can be accomplished safely and without increased complications.

Emergency Department Visits During Pregnancy.

Pregnant women often seek care in an emergency department (ED). We sought to describe the frequency, characteristics, and factors associated with increased ED visits during pregnancy. We conducted a retrospective cohort study using administrative health data of all pregnancies resulting in a live birth at 20 or more weeks of gestation in Alberta, Canada, from 2011 to 2017. The primary outcome was the occurrence of any ED visit during pregnancy. The secondary outcomes were ED visit characteristics and discharge disposition. We calculated rate ratios (RRs) and 95% confidence intervals (CIs) for associations between sociodemographic and clinical factors and increased ED visits during pregnancy using random-effect negative binomial regression adjusting for multiple pregnancies per person during the study period. We included 255,929 pregnancies from 193,965 women. Of all the pregnancy episodes followed, 37.3% (95% CI 37.1 to 37.5) had at least 1 ED visit, resulting in a total of 226,811 ED visits and an overall ED visit rate of 94.0 visits per 100 pregnancies (95% CI 93.6 to 94.3). Most visits were nonobstetric (46.4%) and resulted in ED discharge (85.3%). Increased ED visits were associated with living in remote (RR 6.9; 95 %CI 6.7 to 7.1) or rural (RR 3.4; 95% CI 3.4 to 3.5) areas, younger age (RR 1.9; 95% CI 1.8 to 2.0), intensive prenatal care (RR 1.5; 95% CI 1.5 to 1.5), major/moderate health conditions (RR 1.6; 95% CI 1.6 to 1.6), mental health conditions (RR 1.6; 95% CI 1.5 to 1.6), and high antepartum risk score (RR 1.1; 95% CI 1.1 to 1.1). Approximately 1 in 3 women in our sample visited the ED during pregnancy. A higher number of visits occurred in those with rural/remote residence, younger maternal age, and concomitant health conditions.

Stent Omission in Pre-stented Patients Undergoing Ureteroscopy Decreases Unplanned Health Care Utilization.

Despite AUA guidelines providing criteria for ureteral stent omission after ureteroscopy for nephrolithiasis, stenting rates in practice remain high. Because pre-stenting may be associated with improved patient outcomes, we assessed the impact of stent omission vs placement in pre-stented and non-pre-stented patients undergoing ureteroscopy on postoperative health care utilization in Michigan. Using the MUSIC (Michigan Urological Surgery Improvement Collaborative) registry (2016-2019), we identified pre-stented and non-pre-stented patients with low comorbidity undergoing single-stage ureteroscopy for ≤1.5 cm stones with no intraoperative complications. We assessed variation in stent omission for practices/urologists with ≥5 cases. Using multivariable logistic regression, we evaluated whether stent placement in pre-stented patients was associated with emergency department visits and hospitalizations within 30 days of ureteroscopy. We identified 6,266 ureteroscopies from 33 practices and 209 urologists, of which 2,244 (35.8%) were pre-stented. Pre-stented cases had higher rates of stent omission vs non-pre-stented cases (47.3% vs 26.3%). Among the 17 urology practices with ≥5 cases, stent omission rates in pre-stented patients varied widely (0%-77.8%). Among the 156 urologists with ≥5 cases, stent omission rates in pre-stented patients varied substantially (0%-100%); 34/152 (22.4%) never performed stent omission. Adjusting for risk factors, stent placement in pre-stented patients was associated with increased emergency department visits (OR 2.24, 95% CI:1.42-3.55) and hospitalizations (OR 2.19, 95% CI:1.12-4.26). Pre-stented patients undergoing stent omission after ureteroscopy have lower unplanned health care utilization. Stent omission is underutilized in these patients, making them an ideal group for quality improvement efforts to avoid routine stent placement after ureteroscopy.

Identifying Risk Factors for Hospitalization with Behavioral Health Disorders and Concurrent Temperature-Related Illness in New York State.

Extreme temperature events are linked to increased emergency department visits, hospitalizations, and mortality for individuals with behavioral health disorders (BHD). This study aims to characterize risk factors for concurrent temperature-related illness among BHD hospitalizations in New York State. Using data from the NYS Statewide and Planning Research and Cooperative System between 2005-2019, multivariate log binomial regression models were used in a population of BHD hospitalizations to estimate risk ratios (RR) for a concurrent heat-related (HRI) or cold-related illness (CRI). Dementia (RR 1.65; 95% CI:1.49, 1.83) and schizophrenia (RR 1.38; 95% CI:1.19, 1.60) were associated with an increased risk for HRI among BHD hospitalizations, while alcohol dependence (RR 2.10; 95% CI:1.99, 2.22), dementia (RR 1.52; 95% CI:1.44, 1.60), schizophrenia (RR 1.41; 95% CI:1.31, 1.52), and non-dependent drug/alcohol use (RR 1.20; 95% CI:1.15, 1.26) were associated with an increased risk of CRI among BHD hospitalizations. Risk factors for concurrent HRI among BHD hospitalizations include increasing age, male gender, non-Hispanic Black race, and medium hospital size. Risk factors for concurrent CRI among BHD hospitalizations include increasing age, male gender, non-Hispanic Black race, insurance payor, the presence of respiratory disease, and rural hospital location. This study adds to the literature by identifying dementia, schizophrenia, substance-use disorders, including alcohol dependence and non-dependent substance-use, and other sociodemographic factors as risk factors for a concurrent CRI in BHD hospitalizations.

Age-related Impact of the CDC's 2016 Guideline for Prescribing Opioids for Chronic Pain on Opioid Prescribing Levels and Health Outcomes among the Patients with Sickle Cell Disease

INTRODUCTON: The Guideline for Prescribing Opioids for Chronic Pain instituted by the Centers for Disease Control and Prevention (CDC) in 2016 has been found to be effective in decreasing opioid use. However, this decrease has included patient groups that fall outside of the intended scope of the guideline such as patients with sickle cell disease (SCD) who already experience difficulty accessing needed pain management. The aim of this study was to evaluate the effect of CDC's 2016 Opioid Guideline on opioid prescribing level and health outcomes among patients with SCD. Because patients with SCD may experience different symptoms and complications as they age, the consequences were assessed by age group. METHODS: This retrospective cohort study employed an interrupted time series analysis using the IBM® MarketScan® Commercial Database from 1/1/2011 to 12/31/2019. The study population included individuals ≥1 years old who had ≥3 SCD diagnosis codes within 5 years and had no cancer diagnosis. Monthly-measured opioid prescribing levels included: opioid prescription rate, mean daily morphine milligram equivalents (MME) per prescription, and mean number of days supplied per prescription. Health outcomes included: monthly rates of vaso-occlusive crisis (VOC)-related emergency department (ED) visits and hospitalizations, and monthly rates of healthcare facility visits related to opioid use disorder (OUD), depression, and anxiety. Segmented regressions (breakpoint: March 2016) were conducted for all outcomes to compare trends before and after the guideline release. RESULTS: The study included 14,979 SCD patients (1-65 years old, mean [SD] age = 25.9 [16.9], 56.9% female). After the guideline release, compared to the pre-guideline period, 1) children (1-12 years; N=3,916 [26.4%]) experienced significant decreases in the opioid prescription rate (-0.09 prescription/100 person-month, p=0.001), mean daily MME per prescription (-1.02 MME/month, p=0.001) and the number of days supplied per prescription (-0.02 days/month, p=0.009), but a significant increase in the VOC-related hospitalization rate (+0.11 hospitalizations/100 person-month, p=0.021); 2) adolescents (13-18 years; N=1,782 [11.9%]) experienced significant decreases in the mean daily MME per prescription (-8.48 MME/month, p=0.012) and the number of days supplied (-0.03 days/month, p=0.003), but an increase in the VOC-related hospitalization rate (+0.21 hospitalizations/100 person-month, p=0.003); 3) young adults (19-27 years; N=2,599 [17.4%]) experienced a significant decrease in the number of days supply (-0.04 days/month, P<0.001), and no significant change in the VOC-related outcomes; 4) adults 28-45 years (N=4,293 [28.7%]) experienced significant decreases in opioid prescription rate (-0.48 prescription/100 person-month, p<0.001), mean daily MME per prescription (-21.19 MME/month, p<0.001), and the number of days supplied (-0.06 days/month, p<0.001), but significant increases in VOC-related ED visit rate (+0.13 visits/month, p<0.001) and hospitalization rate (+0.30 hospitalizations/100 person-month, p<0.001); and 5) adults 46-65 years (N=2,344 [15.6%]) experienced significant decreases in the opioid prescription rate (-0.55 prescription/100 person-month, p<0.001), mean daily MME per prescription (-3.68 MME/month, p<0.001), the number of days supplied (-0.03 days/month, p=0.003), and VOC-related ED visit rate (-0.1 visits/100 person-months, p=0.023). OUD-related healthcare facility visits did not differ in either pediatric (1-18 years) or adult (19-65 years) patients before vs. after the guideline release. Depression-related visits increased significantly (+0.09 visits/100 person-months, p=0.002) among adult patients while anxiety-related visits decreased significantly (-0.05 visits/100 person-months, p=0.023) among the same population post-guideline compared to the pre-guideline periods. CONCLUSIONS: The CDC guideline release was associated with a decrease in opioid prescribing levels across all age groups even though the guideline was intended only for the adult population. Overall, pain-related health outcomes were negatively impacted by the guideline: older age groups with increased ED visits and younger age groups with increased hospitalizations, while there were no decreases in the rate of OUD. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal