Increased Health Service Utilization Research Articles

Psychometric properties of the Japanese version of the standardised assessment of personality abbreviated scale.

This study was undertaken to translate the Standardised Assessment of Personality - Abbreviated Scale (SAPAS) into Japanese and to evaluate its validity and reliability. SAPAS is one of the most rapid tools for assessing personality disorder (PD) and has excellent sensitivity and good specificity, whereas other PD assessment tools require such a significant investment of time that they are infeasible for large surveys or routine clinical practice. Customary assessment in clinical practice ideally incorporates screening for PD, as it is associated with a substantial public health burden, including premature mortality and increased health service utilization. Furthermore, PD's status as a key prognostic variable of mental disorders also drives PD screening. While SAPAS has been translated into several languages, there has been no Japanese version. Therefore, we translated SAPAS into Japanese (SAPAS-J) and evaluated its reliability and validity. Study 1 recruited undergraduates to reveal its test-retest reliability. Although its internal consistency was not high, since the intent of the original SAPAS was to assess the broad character of personality disorder with the fewest possible items, minimal correlations between items were reasonable. We tested two factorial models, the single-factor model and the higher-order-single-factor model, and the latter offered better fitting. This higher-order model contained a three-factor structure corresponding to clusters described in DSM-5. It measures general PD traits as a common higher-order latent variable comprising those factors. Correlations of SAPAS-J with the much longer PD screening questionnaire in Study 1 and depressive and anxiety symptoms in Study 2 from the general population support its validity. Although validation for the clinical use of SAPAS-J is limited, our research with non-clinical populations demonstrated sufficient validity to justify its use in the context of psychopathological analog research. Since PD is understood as a continuum, the severity of which is distributed dimensionally, the analog study recruiting from the general population and attempting to reveal psychopathological mechanisms of PD is meaningful.

SYSTEMATIC REVIEW OF REHABILITATION IN SKILLED NURSING FACILITIES FOR PERSONS LIVING WITH DEMENTIA

Abstract We conducted a systematic review of published literature though April 2023 to identify the experiences and outcomes of persons living with dementia (PLWD) undergoing post-acute care rehabilitation in skilled nursing facilities (SNF). A systematic search for studies published in English was carried out in eight databases including PubMed, Scopus, Google Scholar, Embase, PsycINFO, CINAHL, Cochrane Library, and Web of Science. Two reviewers independently screened articles and conducted a quality appraisal of selected studies. Forty-one articles met inclusion criteria. There was heterogeneity of study designs with most articles (n=33) being observational and cross-sectional, while randomized clinical trials (n=3) and qualitative studies (n=5) were less represented. Certain themes emerged from the results regarding patient outcomes and experiences. Measured outcomes demonstrated increased health service utilization, varied functional outcomes, and suboptimal patient care. Patient experiences included significant challenges with health care transitions, gaps in healthcare worker and caregiver knowledge & education, emphasis on alternate models of care, and importance of goal alignment. Overall, this systematic review provides a comprehensive understanding of the outcomes and experiences of post-acute care rehabilitation in SNFs for PLWD. The findings highlight the need for alternative care pathways, improved healthcare transitions, tailored rehabilitation approaches, enhanced dementia training for healthcare professionals, and person-centered goal setting. By addressing these critical aspects, future interventions can be developed to improve the delivery of post-acute care for PLWD and enhance their health outcomes.

Effectiveness and impact of community-based health insurance on health service utilization in northwest Ethiopia: a quasi-experimental evaluation.

Addressing the health challenges of lower socioeconomic groups in Ethiopia is still a huge problem. In that regard, the government piloted the community-based health insurance (CBHI) in 2011 in a few districts and subsequently scaled up. However, the effectiveness of the program on the utilization of health services and its impact was not well explored. Thus, we aimed to evaluate the effectiveness of CBHI toward health services' utilization and its impact in northwest Ethiopia. A quasi-experimental matched comparison group evaluation design with sequential explanatory mixed methods was employed. To evaluate the CBHI program, the effectiveness and impact dimensions from the Organization for Economic Cooperation and Development framework were used. A multistage sampling technique was used to select a total of 332 households enrolled in the CBHI program; 341 comparison households who did not enroll in the program were also randomly selected. A structured interviewer-administrated questionnaire was used to evaluate the effectiveness and impact of CBHI on health service utilization. The Propensity score matching model was employed for the estimation of the effect of the CBHI program on health service utilization. Challenges for program achievement toward health service utilization were explained through qualitative data and these were then analyzed thematically. The evaluation showed 1.3 visits per capita per year of health service utilization among CBHI members. Households enrolled in CBHI increased health service utilization by 6.9 percentage points (ATT = 0.069; 95% CI: 0.034, 0.114). There was an improvement in health service utilization after the introduction of CBHI, however, there are challenges: (i) shortage of human resources, (ii) out-of-stock of drugs and medical supplies, and (iii) long waiting times for service and reimbursement claims. These issues limit the success of the program toward health service utilization. The CBHI program contributed to health service utilization improvement among CBHI members. However, the utilization rate of health services among CBHI members is still less than the target stated for the program and also the WHO recommendation. Therefore, the findings of this evaluation can be used by program implementers, policy makers, and other stakeholders to overcome the identified challenges and to increase the success of the program.

Abstract 12446: Trajectories of Frailty and Cardiovascular Outcomes Among Medicare Beneficiaries, 2003-2015

Background: Frailty is associated with adverse cardiovascular outcomes independent of age and comorbidities, yet the independent role of frailty progression on health outcomes remains uncertain. Methods: In Medicare Fee-for-Service beneficiaries ≥ 65 years with continuous enrollment from 2003-2015, we calculated frailty progression or regression, using a continuous, validated Fried phenotype-based frailty index in years 1-5. We used linear mixed effects models and Cox proportional hazards models, adjusting for baseline frailty, to evaluate the influence of frailty trajectory on the risk of adverse health outcomes (death, HF, MI, ischemic stroke, MACE, and days at home [DAH] within the calendar year). Results: Among 26,414,887 individuals (mean age 75.4 ± 7.0 years, 57% female, 13% non-white race), 20.4% had frailty progression and 13.6% had frailty regression. Compared to frailty regressors, progressors had a greater risk of mortality (HR 1.59, 95% CI 1.58-1.59) and all cardiovascular outcomes. With increasing quartile of frailty progression and adjusting for baseline frailty, there was a graded risk in mortality (quartile 4 vs. 1, HR 2.21, 95% CI 2.21-2.23, p < 0.001) and all adverse cardiovascular outcomes (Figure). Compared to those in the lowest frailty progression quartile, those in the highest quartile had significantly fewer DAH (270.4 ± 112.3 vs. 308.6 ± 93.0, RR 0.88, 95% CI 0.87-0.88, p < 0.001). Conclusions: In this large, nationwide sample of older Medicare beneficiaries, the degree of frailty progression, independent of baseline frailty, was associated with increased risk of all-cause mortality, HF, MI, ischemic stroke, and MACE, and fewer DAH. Frailty progression therefore identifies patients at high risk for adverse outcomes and increased health services utilization.

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.

Why do consumers choose private over public health services? Reflective accounts of health providers in Vietnam

BackgroundIn Vietnam and many developing countries, private healthcare is increasingly being leveraged by governments to complement public services and increase health service access and utilisation. Extensive understanding of patterns of utilisation of private over public health services, and the rationale for such consumer decisions, is important to ensure and promote safe, affordable and patient-centred care in the two sectors. Few studies within the Southeast Asian Region have explored how private and public providers interact (via social networks, marketing, and direct contact) with consumers to affect their service choices. This study investigates providers’ views on social factors associated with the use of private over public health services in Vietnam.MethodA thematic analysis was undertaken of 30 semi-structured interviews with experienced health system stakeholders from the Vietnam national assembly, government ministries, private health associations, health economic association, as well as public and private hospitals and clinics.ResultsMultiple social factors were found to influence the choice of private over public services, including word-of-mouth, the patient-doctor relationship and relationships between healthcare providers, healthcare staff attitudes and behaviour, and marketing. While private providers maximise their use of these social factors, most public providers seem to ignore or show only limited interest in using marketing and other forms of social interaction to improve services to meet patients’ needs, especially those needs beyond strictly medical intervention. However, private providers faced their own particular challenges related to over-advertisement, over-servicing, excessive focus on patients’ demands rather than medical needs, as well as the significant technical requirements for quality and safety.ConclusionsThis study has important implications for policy and practice in Vietnam. First, public providers must embrace social interaction with consumers as an effective strategy to improve their service quality. Second, appropriate regulations of private providers are required to protect patients from unnecessary treatments, costs and potential harm. Finally, the insights from this study have direct relevance to many developing countries facing a similar challenge of appropriately managing the growth of the private health sector.

Satisfaction status and its associated factors on delivery service provided among women who gave birth at hawassa university comprehensive specialized hospital in southern Ethiopia 2022

Background: Despite the Ethiopian federal ministry of health implementing compassionate, respectful, and caring as one of the health sector transformation agendas to increase health service utilization, the level of maternal satisfaction with institutional delivery is still low and varies from region to region. In addition, no previous study was conducted in this study area. Therefore, the main objective of the study was to assess the level of women's satisfaction with institutional delivery services and associated factors among mothers who gave birth at Hawassa University's comprehensive specialized Hospital. Methods and Materials: Institutional based quantitative cross-sectional study was employed from April to May 2022 at Hawassa University's comprehensive specialized hospital. A total of 265 women who came to delivery service were included in the study and systematic sampling techniques was used to select study participant. A semi-structured questionnaire was used to collect data. The data was entered into EPI Data 3.1 version and transported to SPSS version 25 for data analysis. Binary and multi-regression were done for predictor variables associated at p-value <0.05 with the dependent variable. Result: A total of 265 mothers fully responded, making a response rate of 95.3%. This study found that 63% of study participants were satisfied and 37% of them were unsatisfied with the delivery and labor service. Participants' occupation, last pregnancy wanted, health conditions of the mother during and after delivery, media exposure to institutional delivery, total duration of labor, a surgical procedure done for women, the provider gives periodic updates on the progress of labor and explained what is being done and that to be expected were statistically associated with satisfaction status. Conclusion: The study showed that the overall satisfaction of the women with the delivery service provided by health care providers in the study area was relatively low. Therefore, all stakeholders should take immediate and appropriate action on those identified factors.

Understanding the Extent of Polypharmacy and its Association With Health Service Utilization Among Persons With Cancer and Multimorbidity: A Population-Based Retrospective Cohort Study in Ontario, Canada

Background: Cancer often co-occurs with other chronic conditions, which may result in polypharmacy. Polypharmacy is associated with adverse outcomes, including increased health service utilization. Objectives: This study examines the overall prevalence of polypharmacy (5 or more medications) among adults with cancer and multimorbidity, as well as the association of both minor polypharmacy (5-9 medications) and hyper-polypharmacy (10 or more medications) on high use of emergency room visits and hospitalizations, while controlling for age, sex, and type and stage of cancer. Methods: This retrospective longitudinal study used linked health administrative databases and included persons 18 years and older diagnosed with cancer between April 2010 and March 2013 in Ontario, Canada. Data on the number of health service utilizations at or above the 90th percentile (high users), was collected up to March 2014 and multivariate logistic regression was used to determine the impact of polypharmacy. Results: The prevalence of polypharmacy was 46% prior to cancer diagnosis, and 57% one year after diagnosis. Polypharmacy prior to and after cancer diagnosis increased with the level of multimorbidity, increasing age, but did not differ by sex. It was also highest in persons with lung cancer (52.4%) and those diagnosed with stage 4 cancer (51.3%). Minor polypharmacy increased the odds of being a high user of emergency rooms (1.16; 99% CI: 1.09-1.24) and hospitalizations (1.03; 0.98-1.09) and the odds of high use was greater with hyper-polypharmacy (1.41; 1.33-1.51) and (1.23; 1.17-1.29) respectively. Conclusion: Polypharmacy is highly prevalent and is associated with high health service utilization among adults with cancer and multimorbidity

Using Structural Equation Modelling in Routine Clinical Data on Diabetes and Depression: Observational Cohort Study.

Large data sets comprising routine clinical data are becoming increasingly available for use in health research. These data sets contain many clinical variables that might not lend themselves to use in research. Structural equation modelling (SEM) is a statistical technique that might allow for the creation of "research-friendly" clinical constructs from these routine clinical variables and therefore could be an appropriate analytic method to apply more widely to routine clinical data. SEM was applied to a large data set of routine clinical data developed in East London to model well-established clinical associations. Depression is common among patients with type 2 diabetes, and is associated with poor diabetic control, increased diabetic complications, increased health service utilization, and increased health care costs. Evidence from trial data suggests that integrating psychological treatment into diabetes care can improve health status and reduce costs. Attempting to model these known associations using SEM will test the utility of this technique in routine clinical data sets. Data were cleaned extensively prior to analysis. SEM was used to investigate associations between depression, diabetic control, diabetic care, mental health treatment, and Accident & Emergency (A&E) use in patients with type 2 diabetes. The creation of the latent variables and the direction of association between latent variables in the model was based upon established clinical knowledge. The results provided partial support for the application of SEM to routine clinical data. Overall, 19% (3106/16,353) of patients with type 2 diabetes had received a diagnosis of depression. In line with known clinical associations, depression was associated with worse diabetic control (β=.034, P<.001) and increased A&E use (β=.071, P<.001). However, contrary to expectation, worse diabetic control was associated with lower A&E use (β=-.055, P<.001) and receipt of mental health treatment did not impact upon diabetic control (P=.39). Receipt of diabetes care was associated with better diabetic control (β=-.072, P<.001), having depression (β=.018, P=.007), and receiving mental health treatment (β=.046, P<.001), which might suggest that comprehensive integrated care packages are being delivered in East London. Some established clinical associations were successfully modelled in a sample of patients with type 2 diabetes in a way that made clinical sense, providing partial evidence for the utility of SEM in routine clinical data. Several issues relating to data quality emerged. Data improvement would have likely enhanced the utility of SEM in this data set.

Population-level impact of a pulse oximetry remote monitoring programme on mortality and healthcare utilisation in the people with COVID-19 in England: a national analysis using a stepped wedge design

BackgroundTo identify the population-level impact of a national pulse oximetry remote monitoring programme for COVID-19 (COVID Oximetry @home (CO@h)) in England on mortality and health service use.MethodsWe conducted a retrospective...

Predictors of Multimorbidity Among Korean Older Adults: Longitudinal Secondary Data Analysis

Multimorbidity has become a global concern for an aging society. It has been reported to be associated with increased health service utilization, leading to poor health outcomes including quality of life. However, the incidence of multimorbidity and its related factors are poorly understood. The aim of this study was to determine the socioeconomic and health-related factors predicting the incidence of multimorbidity in Korean older adults using longitudinal secondary data from the Korean Longitudinal Study of Aging (KLoSA) dataset from 2008 to 2018. The KLoSA aimed to collect basic data to be used for developing socioeconomic policy for the aging society in Korea. The sample included 3,019 older adults aged 65 years and over who had 0-2 chronic diseases at baseline in 2008. Multimorbidity was measured with the incidence of co-existence of three or more chronic diseases using Cox’s proportional-hazards model. Among 3,019 respondents (female 57.6%, mean age 73.07±6.30 years), 586 (19.4%) incidents of multimorbidity were reported after 10 years of follow-up. Low participation in social activities, being overweight or obesity, more depressive symptoms, current or past drinkers, and lower life satisfaction were identified as significant predictors of multimorbidity among Korean older adults. This study identified high risk groups with overlapping senility and multimorbidity, who require more attention from health care providers in the course of chronic disease monitoring and management. This longitudinal approach will contribute to the development of preventive strategies to reduce the incidence of multimorbidity among older adults.

Geographic Remoteness Is Associated with Increased Blood Product Utilization and Higher Rates of Hospitalization and Deaths in Adults with Immune Thrombocytopenia

INTRODUCTIONImmune thrombocytopenia (ITP) is a hematological disease characterized by immune-mediated destruction of platelets. Prior to starting therapy for ITP it is critical to determine whether it is idiopathic or related to a secondary underlying condition as this informs treatment. There is significant use of blood products and components in patients with chronic ITP for management of thrombocytopenia and bleeding, including intravenous immune globulin (IVIg). Platelet transfusions are generally reserved for life-threatening bleeding or may be used in the preoperative setting in patients unresponsive to other therapies. The aims of this study are to identify gaps in process of care and to examine the impact of geographical remoteness on health service utilization and outcomes in adults with chronic ITP in Alberta.METHODSAdults who received rituximab, splenectomy, or thrombopoietin receptor agonists (TPO-RA) as second-line therapy for ITP during 2012-2019 in the province of Alberta, Canada were identified via the provincial special drug access database. Diagnostic workup including bone marrow biopsy results, abdominal imaging (ultrasound or CT scan), coagulation parameters, viral serologies for hepatitis, human immunodeficiency virus (HIV), serum protein electrophoresis (SPEP), and quantitative immunoglobulins were recorded and rates of completed tests were calculated. Utilization of IVIg, platelets, and packed red blood cells was assessed. Rates of hospitalization, mortality, and ITP-related deaths were calculated and compared according to geographic region.RESULTSOf the 204 patients identified for analysis 106 were female (52%). Most patients (123; 60%) lived within a major centre, whereas 21 (10%) lived over 250 km from a major centre. Review of diagnostic laboratory parameters revealed incomplete coagulation parameters in 117 patients (58%), and no coagulation parameters checked in 16%. Eighty-nine patients (44%) did not have quantitative immunoglobulins tested, and 57 (28%) did not have an SPEP performed. Fifty-three (26%) did not have any abdominal imaging performed to assess for splenomegaly or liver disease. Thirty-five (17%) did not have any viral serologies for hepatitis B, C, or HIV completed. Bone marrow aspirate and biopsy was performed in 110 patients (54%). Eighty-six (77%) of these biopsies yielded a normal result. Eight biopsies (7%) displayed a lymphoproliferative disorder or plasma cell disorder which was suspected or known prior to completing the test.There was significant geographic discrepancy in utilization of blood products and hospitalizations. During 527 patient years of follow up, 83 patients received a total of 343 doses of platelets. Eleven patients (13%) received platelet transfusions for inappropriate indications, and eight (9%) for unclear indications. One hundred twenty-seven patients received IVIg (mean 1290 g) with comparable usage across geographic regions. Compared to patients within 250 km from a major centre, those with geographic remoteness (>250 km from a major centre) utilized more platelets (mean 5.2 vs 1.2 doses; Figure 1) and packed red blood cells (mean 4.3 vs 1.2 units; Figure 2). Those with geographic remoteness also experienced a higher rate of ITP-related hospitalizations (mean 1.5 vs 1.1) and deaths (24% versus 9%). At a median follow-up of 3.42 years from ITP diagnosis, 27 patients (13%) were deceased. Fourteen of these deaths were ITP-related due to bleeding or infection (52%). There appears to be a gradient of rates of both all-cause and ITP-related deaths by distance from a major centre (Figures 3 and 4).DISCUSSIONThis study highlights gaps in quality of care in patients with chronic ITP in Alberta, Canada. A significant number of patients have an incomplete workup for ITP at the time of diagnosis with the most forgotten tests being coagulation studies, SPEP, quantitative immunoglobulins, viral serologies, and abdominal imaging. Additionally, we identified an unexpectedly high rate of bone marrow biopsies performed in our population. Most of these bone marrow examinations did not result in any change in management. Finally, this study identified that geographic remoteness is associated with increased health services utilization and ITP-related deaths. These data can be used to inform further quality improvement initiatives in chronic ITP and help address geographic inequities in healthcare outcomes. [Display omitted] DisclosuresSun: Bayer: Consultancy; Novo Nordisk: Consultancy; Pfizer: Consultancy; Shire: Consultancy; Octapharma: Consultancy, Research Funding.

Health service utilisation associated with chronic breathlessness: random population sample.

BackgroundMost health service utilisation studies are of people with specific diagnoses or demographic characteristics, and rarely of specific chronic symptoms. The aim of this study was to establish whether population-level health service utilisation increases in people with chronic breathlessness.MethodsA cross-sectional analysis was carried out of the South Australian Health Omnibus Survey 2017, a multi-stage, clustered area, systematic sampling survey of adults where questions are administered face-to-face in respondents’ homes. Self-report of health service utilisation in the previous 3 months (medical consultations, emergency department, hospital admission), chronic breathlessness (severity, duration, modified Medical Research Council (mMRC) breathlessness scale) and demographic data were used to predict self-reported health service utilisation.ResultsA total of 2898 people were included (49.0% male; median age 48.0 years (IQR 32.0–63.0); 64.1% educated beyond school; 55.4% in work; 73.5% had outpatient contact; 6.3% had a hospital admission in the previous 3 months). Chronic breathlessness (mMRC ≥1) was reported by 8.8% of respondents. In bivariable analyses, people with greater contact with health services were older, and a higher proportion were overweight/obese and had more severe chronic breathlessness. In multivariable analyses, chronic breathlessness and older age were positively associated with outpatient care and inpatient care, and people with chronic breathlessness were hospitalised for longer (incidence rate ratio 2.5; 95% CI 1.4–4.5).ConclusionThere is a significant association between worse chronic breathlessness and increased health service utilisation. There is a need for greater understanding of factors that initiate contact with health services.

200. The effect of a multidisciplinary spine clinic on treatment rates and lead times to care

<h3>BACKGROUND CONTEXT</h3> Back pain is a leading cause of years lived with disability and economic burden, exceeding more than $20 billion in health care costs not including indirect costs such as absence from work and caregiving. The multifactorial nature of back pain leads to treatment modalities administered by a variety of specialists which are often disjointed. Multiple studies have found that patients receiving delayed physical therapy for lower back pain had higher medical-related costs from increased health service utilization as well as a reduced improvement in pain severity compared to early management. Uncoordinated health care delivery can exacerbate the physical and economic toll of the chronic condition, thus improvements in interdisciplinary, shared decision-making may improve outcomes. <h3>PURPOSE</h3> To assess whether a multidisciplinary spine clinic (MSC), consisting of orthopedic surgery, neurosurgery, pain medicine, and physiatry, alters interventional and noninterventional planning and treatment compared to a traditional unidisciplinary spine clinic (USC) including only orthopedic surgery. <h3>STUDY DESIGN/SETTING</h3> We conducted a retrospective cohort study with patients initially presenting for spine care to orthopedic surgeons at both the outpatient unidisciplinary spine clinic and multidisciplinary spine clinic in the Bronx, NY. <h3>PATIENT SAMPLE</h3> We included adult patients of age 18 years or older initially presenting to orthopedic surgeons for spine care at our institution from July 1, 2018 to June 30, 2019. Eligible patients were identified through a health care surveillance software package (Clinical Looking Glass) and EMR review. <h3>OUTCOME MEASURES</h3> Time to treatment recommendation, time to treatment, and rates of treatment recommendations were assessed, including physical therapy, injections, and surgery. <h3>METHODS</h3> Treatment rates were compared between MSC and USC using Pearson's chi-squared test logistic regression. Time to treatment recommendation and time to treatment were compared using log-rank test and Cox proportional hazard regression. All analyses were repeated for the propensity score (PS) matched subsample. <h3>RESULTS</h3> This study included 1,764 patients, with 692 at MSC and 1,072 at USC. Patients in MSC were more likely to be recommended injection when compared to USC (8.5% vs 5.4%, p=0.01). When adjusted for confounders, the likelihood of injection recommendation remained greater in MSC than USC (odds ratio [OR]=2.22, 95% CI: (1.39, 3.53), p=0.001). MSC was also associated with a shorter time to receiving injection recommendation vs USC (median: 21 vs 32 days, log-rank: p<0.001; hazard ratio [HR]=1.90, 95% CI: (1.25, 2.90), p=0.003). MSC was associated with a higher likelihood of injection treatment (OR=2.27, 95% CI: (1.39, 3.73), p=0.001) and shorter lead time (HR=1.98, 95% CI: (1.27, 3.09), p=0.003). PS-matched analyses yielded similar conclusions. <h3>CONCLUSIONS</h3> Care delivered at a multidisciplinary spine clinic was associated with a higher likelihood of recommending injection and a shorter lead time to injection administration when compared to a traditional unidisciplinary spine surgery clinic. Multidisciplinary clinics may facilitate coordinated care amongst different specialties resulting in increased utilization of less invasive treatment modalities while also improving care efficiency. The multidisciplinary clinic model is an important advancement in care delivery and communication, which can be used as a powerful method of improving patient outcomes as treatment guidelines evolve. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

Association of frailty with health service utilisation and health care expenditure in sub-Saharan Africa: evidence from C\xf4te d\u2019Ivoire

BackgroundFrailty, a syndrome resulting in heightened risk of negative outcomes for older adults, is increasing across the globe. However, little is known about the health service impacts of frailty in low-income countries (LICs), and in particular, sub-Saharan Africa (SSA). This study explores the relationship between frailty and health service 1) utilisation and 2) expenditure within Côte d’Ivoire.MethodsParticipants aged 50 years and over participated in the Living Condition, Health and Resilience among the Elderly study. Frailty was assessed using a 30-item Frailty Index (FI). The association between frailty and self-reported health service utilisation was analysed for general practitioners (GPs), specialists, overnight hospitalisations, traditional practitioners and self-medication. Expenditure over the previous month included consulting, medications, hospitalisations and total expenditure.ResultsAmong participants [n = 860, mean age (SD) = 61.8 (9.7) years, 42.9% female], 60.0% were frail, 22.8% pre-frail and 17.2% robust. The mean (SD) FI was 0.28 (0.17). Increased health service utilisation was associated with frailty for GP attendance, traditional practitioners and self-medication but not specialists or overnight hospitalisation. Pre-frailty and frailty were associated with increased total health service expenditure, with frailty also associated with aggregate consulting costs and medications.ConclusionsAlthough frailty is associated with health service utilisation and expenditure in a variety of contexts, the study results suggest that such impacts may vary across the globe. The experience of frailty in LICs is likely to differ from that experienced elsewhere due to cultural traditions, attitudes to the health system, and accessibility, with more research needed.

Multivariate Association of Child Depression and Anxiety With Asthma Outcomes

Pediatric asthma is associated with increased health services utilization, missed school days and diminished quality of life. Children with asthma also report more frequent depressive and anxiety symptoms than non-asthmatic children, which may further worsen asthma outcomes. The current study investigated the relationship between depressive and anxiety symptoms and four asthma outcomes (asthma control, asthma severity, lung function, and asthma-related quality of life) in children (N = 205) with moderate-to-severe persistent asthma.

The Added Burden of Personality Disorder on Subsidized Australian Health Service Utilization Among Women With Mental State Disorder.

This study aimed to investigate health service utilization among women with mental state disorder only (MSD-PD), mental state disorder plus personality disorder (MSD+PD), and controls in a population-based sample. Women (n = 635) from the Geelong Osteoporosis Study completed mental health assessments and were categorized into groups (MSD-PD, MSD+PD, controls). General practitioner (mental and non-mental health encounters) and specialized mental health service utilization was ascertained from data linkage to the Medicare Benefits Schedule, Australia (01/09/2008-31/12/2012). Negative binomial and binary logistic regression models were employed to assess health service utilization differences between groups. Results indicated that women with MSD+PD had more encounters of non-mental health service utilization than women with MSD-PD and controls. Age significantly modified these relationships: women with MSD+PD and MSD-PD had more encounters of health service utilization at midlife and in the seventh decade of life. No significant differences were found in the frequency of general practitioner mental health service utilization or specialized mental health service utilization between groups. These data suggest that the presence of co-occurring PD is associated with increased health service utilization among women with other common mental health problems. Healthcare providers should be vigilant to the presence of PD when establishing management plans with patients presenting with common mental health problems.

Multivariate Association of Child Depression and Anxiety with Asthma Outcomes

Pediatric asthma is associated with increased health services utilization, missed school days, and diminished quality of life. Children with asthma also report more frequent depressive and anxiety symptoms than children without asthma, which may further worsen asthma outcomes. The current study investigated the relationship between depressive and anxiety symptoms and 4 asthma outcomes (asthma control, asthma severity, lung function, and asthma-related quality of life) in children (N= 205) with moderate to severe persistent asthma. The data were analyzed using a canonical correlation analysis, a multivariate framework that allows examination of all variables of interest in the same model. We found a statistically significant relationship between symptoms of depression and anxiety and asthma outcomes (1 - Λ= .372; P < .001). A large effect size suggests that 37.2% of variance is shared between depression and anxiety symptoms and 4 asthma outcomes (particularly asthma control and asthma-related quality of life) in the overall sample. Among girls (vs. boys), asthma control (measured by the Asthma Control Test) emerged as a stronger contributor to asthma outcomes compared with boys. These results suggest that psychiatric symptoms, especially anxiety, are associated with poor asthma-related quality of life, and more negative perception of asthma control in girls compared with boys (with no observed sex difference in physiological lung function). Clinicians should consider incorporating questions about psychiatric symptoms as part of routine asthma management, and focus patient educationon unique differences in which boys and girls perceivetheir asthma symptoms.

Financial Incentives, Efforts, and Performances in the Health Sector: Experimental Evidence from the Democratic Republic of Congo

Financial incentives for service providers are increasingly used in developing countries as a tool to maximize the effort and output of public providers. Using a field experiment in the Democratic Republic of Congo, we evaluate the impact of a fee-for-service mechanism aimed to increase health service utilization. We find that relative to fixed payments, the fee-for-service mechanism slightly decreased service utilization. We show that these detrimental effects of incentives do not result from a diminution in workers’ efforts, fraud, or switching away from nonincentivized actions. But workers’ intrinsic motivation decreased and their efforts were evidently misplaced, showing that incentivized workers are not always more productive because they may not understand how to perform.

Maternal Satisfaction and Factors Associated with Institutional Delivery Care in Central Ethiopia: a Mixed Study

BackgroundWomen satisfaction recognized as an important outcome of the maternal health care delivery system. Despite the Ethiopian federal ministry of health implemented compassionate, respectful, and caring as one of the health sector transformation agendas to increase health service utilization, the level of maternal satisfaction of institutional delivery is still low. This study aimed to assess maternal satisfaction and factors associated with institutional delivery care in central Ethiopia.MethodsCommunity-based cross-sectional study, which involved quantitative study supplemented with qualitative methods were employed. Mothers were proportionally allocated to each selected kebele according to the number of their size. Data were collected by a face-to-face interview using a standardized questionnaire to determine the level of maternal satisfaction with birth care. The result was presented using texts, percentages, and tables. Bivariate and multivariate logistic regressions were performed between dependent and independent variables at 95% confidence intervals and a P-value < 0.05 to show a significant association. In the qualitative part, data were transcribed carefully and analyzed thematically.ResultsThe overall a total of 451 respondents participated in this study making a response rate of 98%. The level of maternal satisfaction was 36.6% in this study. Spontaneous vaginal deliveries (SVD) (AOR: 7.33, CI: 2, 26.79), being attended by female sex health workers (AOR: 1.54, CI: 1.04, 2.28), receiving ambulance service to arrive at health facilities (AOR: 7.84, CI: 2, 61.63), utilizing of maternal waiting areas AOR: 1.72, CI: 1.09, 2.66), and respectful care (AOR=1.55, CI: 1.03, 2.34) were factors associated with maternal satisfaction. From qualitative study, three themes and ten categories have emerged.ConclusionMaternal satisfaction towards the delivery service was low. SVD, being attended by female sex health workers, ambulance service, cleaned delivery room, and respectful care were factors associated with maternal satisfaction. The health facilities in the study areas need to work on improving health facility cleanliness, health workers’ compassionate and respectful care, and providing ambulance service as a main means of transportation for laboring mothers.