Use Of Inpatient Services Research Articles

Clinical outcomes and outcome predictors of two-year assertive community treatment in Norway: an explorative prospective pre–post study

BackgroundAssertive Community Treatment (ACT) teams have become a part of mental health services for people with severe mental illness in many high-income countries. Studies in several countries have investigated the outcomes of ACT, and knowledge is also needed about outcomes of ACT teams in Norway. Our aims were to study clinical outcomes of ACT, how the outcomes were associated with characteristics of patients and treatment, and whether they differed across ACT teams.MethodsOur explorative, prospective, pre–post multicenter study involved 142 patients who received ACT for two years from the first 12 ACT teams established in urban and rural areas of Norway. There was no control group. The primary outcome was change in clinician-rated psychiatric symptoms. Secondary outcomes were clinician-rated change in functioning and engagement and change in community tenure compared with 2 years prior to ACT. We measured fidelity to the ACT model using the Tool for Measurement of Assertive Community Treatment. We performed linear mixed-effects modeling to analyze outcomes and their associations with characteristics of patients and treatment.ResultsAfter two years, psychiatric symptoms were significantly reduced with a small effect size. Negative symptoms, anxiety and depression, and agitation and mania had significant reductions, while positive symptoms had nonsignificant changes. Functioning, engagement, and community tenure all significantly increased with small effect sizes. Age, difficulty to engage, problematic use of alcohol, frequent previous use of inpatient services, total number of sessions, and team’s fidelity to the ACT model were associated with different groups of symptoms. Less improvement in functioning was associated with team fidelity and number of sessions. Change in engagement was not associated with any predictors. Increased community tenure was greater for younger patients and patients who were on community treatment orders at treatment start.ConclusionsACT for two years led to significant positive outcomes with small effect sizes for psychiatric symptoms, functioning, engagement, and community tenure. The outcomes were associated with some potential predictors, and some team-level variance emerged. Positive significant outcomes after two years indicate that larger improvements may be achieved from longer-term treatments by ACT teams.

Association of Daily Doses of Buprenorphine With Urgent Health Care Utilization

Higher buprenorphine doses may benefit the increasing number of individuals using fentanyl and other synthetic opioids, but there is little empirical evidence on the efficacy of such higher doses. To examine the association between higher buprenorphine doses (above 16 mg and 24 mg) and subsequent emergency department (ED) or inpatient service use among patients diagnosed with opioid use disorder. This cross-sectional study was a retrospective analysis of health data from Optum's deidentified Clinformatics Data Mart Database from 2016 to 2021 for commercially insured individuals aged 18 years or older diagnosed with opioid use disorder (OUD). Eligible participants initiated buprenorphine after at least 90 days of enrollment and were dispensed at least a 14-day supply of buprenorphine. Data were analyzed from September 2023 through February 2024. Maximum buprenorphine dose received by a patient for 14 or more days: more than 24 mg, more than 16 mg to 24 mg, more than 8 mg to 16 mg, or 1 mg to 8 mg. Days from initiation of the maximum buprenorphine dose to an ED or inpatient visit for a behavioral health diagnosis, controlling for patient demographics, comorbid conditions, time to reaching maximum dose, buprenorphine discontinuation, and pre-buprenorphine health care utilization. A total of 35 451 individuals with an OUD diagnosis who began buprenorphine treatment were identified (mean [SD] age, 46.2 [15.1] years; 20 983 male [59.2%]; 3326 Black [9.4%], 2411 Hispanic [6.8%], 26 712 White [75.3%]). The most common dose was more than 8 mg to 16 mg daily (14 802 patients [42.9%]), with 9669 patients (27.3%) in the 1 mg to 8 mg tier, 10 329 patients (29.1%) in the 8 mg to 16 mg tier, and 651 patients (1.8%) in the tier receiving more than 24 mg. Among all patients receiving buprenorphine, 12.5% experienced an ED or inpatient visit. Survival analysis shows patients receiving doses more than 24 mg and between 16 mg to 24 mg had longer times to ED or inpatient use than patients receiving from 8 mg to 16 mg (time ratio [TR], 1.11; 95% CI, 1.02 to 1.20) and more than 24 mg (TR, 1.37; 95% CI, 1.04 to 1.81). Findings for doses above 16 mg daily were consistent for observation windows as short as 365 days (more than 24 mg: TR, 1.48; 95% CI, 1.01-2.18; more than 16 mg to 24 mg: TR, 1.19; 95% CI, 1.06-1.32). These findings contribute to the sparse empirical research regarding potential benefits of higher-dose buprenorphine treatment of individuals with OUD. Clinicians should be aware of the potential effects of higher buprenorphine doses on health care utilization while policymakers work to ensure equitable access to individuals who could potentially benefit from higher doses.

Clinical Outcomes and Cost Implications of a Community Psychosocial Rehabilitation Service for Severe and Persistent Mental Illness in Nova Scotia, Canada.

Introduction: Individuals with severe and persistent mental illness (SPMI) present distinct challenges in mental healthcare due to the chronic and complex nature of their conditions. This study was conducted to assess the clinical efficacy and potential cost-effectiveness of a multidisciplinary community-based psychosocial rehabilitation team serving individuals with SPMI in Nova Scotia, Canada. Method: This study was conducted to evaluate the effects of a community-based psychosocial rehabilitation program on individuals with severe and persistent mental illness (SPMI) in Nova Scotia, Canada. This research focused on clinical outcomes and potential cost savings following a one-year intervention, offering critical insights into the benefits of community-based care for this population. A cohort of 137 clients accepted into the community rehabilitation service (Connections Dartmouth) between September 2016 and September 2020 was analyzed. Each participant received one year of community rehabilitation intervention. Using data from the Canadian Medical Service Insurance (MSI) billing system, this research compared the use of inpatient services and Emergency Department visits in the year prior to and the year following the intervention. The findings provide valuable evidence on the role of community rehabilitation in reducing healthcare utilization for individuals with SPMI. Results: The results demonstrated a statistically significant reduction in mean admission rates and length of inpatient admissions in the year following rehabilitation compared to the pre-rehabilitation year. A substantial percentage of patients experienced no inpatient admissions (88% vs. 60%) or Emergency Department visits (82% vs. 67%) in the post-rehabilitation year, compared to the pre-rehabilitation year. There was a significant reduction in inpatient days by 90%, translating into substantial cost savings. The findings highlight the potential economic benefits of community rehabilitation for people with SPMI. Conclusions: This uncontrolled study suggests that community rehabilitation is associated with positive clinical outcomes for individuals with SPMI in terms of reduced inpatient service use and associated costs. Further research, including controlled studies and cost-effectiveness studies, into the community psychosocial rehabilitation services in the Canadian setting is needed.

Inequalities in health care use among patients with arthritis in China: using Andersen’s Behavioral Model

BackgroundThis study sought to assess socioeconomic-related inequalities in health care use among arthritis patients in China and to analyze factors associated with this disparity.MethodsThis study used data from the 2018 China Health and Retirement Longitudinal Study. 3255 arthritis patients were included. The annual per capita household expenditure was used to divide individuals into five categories. We calculated actual, need-predicted, and need-standardized distributions of health care use by socioeconomic groups among people with arthritis. The concentration index (Cl) was used to assess inequalities in health service use. Influencing factors of inequalities were measured with the decomposition method.ResultsThe outpatient and inpatient service use rates among 3255 arthritis patients were 23.13% and 21.41%, respectively. The CIs for actual outpatient and inpatient services use were 0.0449 and 0.0985, respectively. The standardized CIs for both outpatient and inpatient services use increase (CI for outpatient services use = 0.0537; CI for inpatient services use = 0.1260), indicating the emergence of a significant pro-rich inequity. Annual per capita household expenditure was the chief positive contributor to inequity for both outpatient (104.45%) and inpatient services use (105.74%), followed by infrequently social interaction (22.60% for outpatient services use) and Urban Employee Basic Medical Insurance (UEBMI) (11.90% for inpatient services use). By contrast, UEBMI also provided a high negative contribution to outpatient services use (-15.99%).ConclusionsThere are significant pro-rich inequalities in outpatient and inpatient services use among patients with arthritis, which are exacerbated by widening economic gaps. Interventions to address inequalities should start by improving the economic situation of lower socioeconomic households.

Experience of health care utilization for inpatient and outpatient services among older adults in India

BackgroundPatient experiences have not been documented at all India level among older adults for inpatient and outpatient services. We provide all-India and sub national estimates on six domains of patient experience, namely: waiting time, respectful treatment, clarity of explanation provided, privacy during consultation, treated by provider of choice, and cleanliness of facility. MethodsUnit records of adults aged 45 years and above for their inpatient (n = 4330) or outpatient (n = 33,724) service use were assessed from the Longitudinal Ageing Survey of India (LASI), conducted in 2017-18. We identified patient experience as negative if the respondent rated it as either “Bad” or “Very Bad” on a five-point Likert scale. We computed proportion of negative experience by socio-economic status, geographic location, and type of healthcare facilities. We used binary logistic regression to estimate predictors of negative patient experience, and a three-level logistic regression model to partition the total geographic variation of patient experiences. FindingsMost individuals rated their experience in all six domains as “Good”. Negative experiences were higher among patients who used public facilities, specifically for waiting time and cleanliness of facility. Among inpatients, the higher-than-average negative experience was noted in the north and northwest, while among outpatients, it was higher in the northeast. The largest geographic variation in negative patient experience was attributable to the villages/CEBs for all domains in outpatient services and three domains of inpatient services, whereas states accounted for the other three inpatient domains. InterpretationMajority of older adults rated their experience of healthcare use positively, but less for public health facilities.

The impact of medical insurance and old-age security on the utilization of medical services by the older population with disabilities

ObjectiveIn this study, the impact of medical insurance and old-age security on the use of medical services by the older population with disabilities is analyzed. A reference for decision makers is provided to improve medical and old-age security policies and enhance the use of medical services by the older population.MethodsData were drawn from 3,737 older people with disabilities aged 65 years or above from the 2018 China Longitudinal Healthy Longevity Survey. A two-part model based on social ecological theory was used for both analysis and group prediction.ResultsIn terms of the use of outpatient medical services, old-age pension significantly increased the probability of outpatient visits for this population group (P < 0.05). Urban employee/resident medical insurance, the new rural cooperative medical insurance, and retirement pension significantly affected medical expenses. In terms of the use of inpatient medical services, the new rural cooperative medical insurance and retirement pension significantly influenced the choice of inpatient medical services; retirement pension increased inpatient medical expenditure (p < 0.01). The expected average probability of hospitalization, unconditional expected cost, and conditional expected cost for the older population with disabilities were 49.5%, RMB 6629.31, and RMB 3281.51, respectively. Both conditional and unconditional expected costs were significantly higher for older people with disabilities with the following attributes: male, married, no less than three chronic conditions, and unassisted daily care; costs were lower for older people with disabilities who are female, not married, had less than three chronic conditions, and had a spouse, child, or other caregiver.ConclusionMedical insurance and old-age security can significantly promote the utilization of medical services by the older population with disabilities. It is therefore recommended to focus on strengthening the support and health management of these people who are unattended to improve the effective use of health services and better meet their needs.

Transportation As A Determinant Of Health: Evaluating The Veterans Affairs Rideshare Program For Homeless Patients.

From 2020 to 2023, the Department of Veterans Affairs (VA) conducted a national pilot of a rideshare program to support homeless patients' transportation needs to obtain critical resources and attend medical appointments. This study linked Lyft rideshare data in 2022 to VA administrative data to examine characteristics and changes in service use among VA homeless service users. The results showed that VA homeless service users who used the VA Rideshare program were more likely to have psychiatric diagnoses and urgent care visits than those who did not use the program. When we controlled for past VA service use, use of the VA Rideshare program was associated with greater use of VA outpatient and inpatient services and fewer no-show medical appointments six months after the veterans' index date. VA Rideshare users had three to eight more program visits over the course of six months than non-Rideshare users. These findings indicate benefits associated with providing transportation assistance to vulnerable patients in a nationwide health system.

Association between preferred language and use of mental health services among home care recipients with schizophrenia spectrum and other psychotic disorders: A retrospective cohort study in Ontario, Canada, 2010 to 2015

Language is an important demographic factor that may impact patients’ interactions with the healthcare system. This may become more apparent for individuals with a mental illness. The objective of this study was to evaluate whether individual language was associated with the use of inpatient and outpatient psychiatric services among home care recipients with schizophrenia spectrum and other psychotic disorders. We conducted a population-based retrospective cohort study using health administrative data. The study population included all individuals aged 18–105 with schizophrenia spectrum and other psychotic disorders, identified via a validated algorithm, who were receiving home care in Ontario, Canada between January 1, 2010 and December 31, 2015. Home care data was used to identify patients’ primary language, categorized as Anglophone, Francophone, or Allophone. Mental health service use was evaluated over a one-year period following their first home care assessment in the study period and included the rate of outpatient psychiatrist visits and mental health-related emergency department (ED) visits and hospitalizations. Multivariable regression evaluated the association between primary language and mental health service use. The cohort consisted of 9,436 patients (85.8% Anglophones, 3.3% Francophones, 11.0% Allophones). Mental health service use was low among all linguistic groups during the one-year study period, with 53.4% with no outpatient psychiatrist visits and 83.3% and 83.0% with no mental health-related hospitalizations or ED visits, respectively. Francophones had a higher rate of mental health-related hospitalizations compared to Anglophones (adjusted relative risk = 1.36, 95% confidence interval 1.02–1.80), with no differences in hospitalization rates between Allophones and Anglophones. Language was not associated with the rate of outpatient psychiatrist visits or mental health-related ED visits. Mental health service use among homecare patients with schizophrenia spectrum and other psychotic disorders was low. While Francophones had a higher hospitalization rate than Anglophones, language was otherwise not associated with mental health service use.

Outcomes and Hospital Service Use Among Patients With COPD in a Nurse- and Allied Health–Led Clinic

Multidisciplinary disease management efforts enable the improvement in lung function among patients with chronic obstructive pulmonary disease (COPD), but there is little evidence of its association with risks of adverse health outcomes and health care service use. To examine the association between the use of a nurse- and allied health-led primary care clinic for respiratory patients, namely the Nurse and Allied Health Clinic-Respiratory Care (NAHC-Respiratory), and their risks of mortality and morbidity and health care service use. This territory-wide, population-based, propensity-matched, retrospective cohort study used data from the electronic health records of all patients who used public health care services in Hong Kong, China, from January 1, 2010, to December 31, 2019. All patients with COPD treated in public outpatient clinics between January 1, 2010, and December 31, 2014, were included. Patients who attended NAHC-Respiratory and usual care only were propensity score-matched at a 1:2 ratio. Data analyses were conducted between August 2023 and April 2024. Attendance at NAHC-Respiratory. All-cause and cause-specific mortality, incidence of COPD complications, and use of emergency department and inpatient services until the end of 2019 were compared between the NAHC-Respiratory and usual care participants using Cox proportional hazard regression, Poisson regression, and log-link gamma regression models after matching. This study included 9048 eligible patients after matching, including 3093 in the exposure group (2814 [91.0%] men; mean [SD] age, 69.8 [9.5] years) and 5955 in the reference group (5431 [91.2%] men; mean [SD] age, 69.5 [11.7] years). Compared with patients in the usual care-only group (reference), patients in the exposure group had lower risks of all-cause mortality (hazard ratio [HR], 0.84; 95% CI, 0.78-0.90) as well as pneumonia-caused (HR, 0.85; 95% CI, 0.74-0.97), respiratory-caused (HR, 0.86; 95% CI, 0.77-0.96), and cardiovascular-caused (HR, 0.74; 95% CI, 0.59-0.93) mortality. Exposure was associated with reduced rates of emergency department visits (incidence rate ratio [IRR], 0.92; 95% CI, 0.86-0.98) and hospitalization through emergency department (IRR, 0.89; 95% CI, 0.83-0.95). In this cohort study, the use of a nurse- and allied health-led clinic in primary care settings was associated with reduced risks of mortality and use of hospital services among patients with COPD. These findings emphasize the important role of health care workers other than physicians in disease management in the primary care setting. The NAHC-Respiratory model and service components can be used to help improve primary care programs to benefit more patients with COPD.

The longitudinal dispositions of people diagnosed with adjustment or severe stress disorders

BackgroundAdjustment and stress-related disorders are prevalent among psychiatric service users. Despite their prevalence, little is known about their prognosis. To reduce that gap, the present article documents the service use and diagnostic outcomes of people with adjustment or stress-related disorders presenting at Singapore’s largest psychiatric emergency department.MethodsAdministrative data from 2014 to 2021 was retrieved to follow a group of 683 service users whose first-ever psychiatric presentation in 2014 warranted a diagnosis of adjustment or stress-related disorder. People were grouped a priori depending on whether different diagnoses were recorded within 7 days, 9 months, after 9 months or not at all. Survival curves characterized conversion to other diagnoses and engagement with healthcare services. Service use outcomes include the number of hospitalizations, outpatient appointments, emergency department visits, and prescriptions.ResultsSixty-one percent (n = 417) never received another diagnosis over the 8-year period. This group used emergency services most and received the most pharmacotherapy shortly after their first visit. Of those who received another diagnosis, depression, personality disorders, and psychotic disorders were the most common. Those who received another diagnosis within 7 days (n = 70, 10%) received it on their first day of hospitalization (IQR 1–1), making the most use of inpatient services. The group who received another diagnosis within 9 months (n = 105, 15%) did so after 42 days (IQR 26–84) and had the highest relative number of deaths. Those who received another diagnosis after 9 months (n = 91, 13%) did so after 1,134 days (IQR 613–1,823) and had the longest period of engagement but made the least use of any psychiatric service, potentially suggesting a group whose early index diagnosis heralded vulnerability to future disorders.ConclusionsA large group of service users with acute stress or adjustment disorders will likely never be given another psychiatric diagnosis and appear to disengage following an initial period of high-intensity service use. The group that received a different diagnosis after the 9-month mark had prolonged contact with services but low intensity of service use and may represent a target for preventative intervention to help them improve their stress-managing skills and avoid developing other disorders.

Adolescent and Adult Transitions From Major Depressive Disorder to Bipolar Disorder

Bipolar disorder (BD) often first appears in adolescence after onset of major depressive disorder (MDD), but diagnosis and treatment are commonly delayed. This delay is a concern because untreated BD is associated with adverse long-term outcomes, a more recurrent disease course and difficult-to-treat illness, and suicide attempts and deaths. To examine the association of age at MDD onset with early transition to BD and the subsequent use of psychiatric inpatient services as a severity indicator. This retrospective cohort study analyzed comprehensive data sourced from the Stockholm MDD Cohort data from 1997 to 2018, which encompass both outpatient and inpatient care. Individuals with an initial MDD episode from January 1, 2010, to December 31, 2013, who transitioned to BD by December 31, 2018, were identified. Data were analyzed between September 5 and December 28, 2023. Post MDD assessments included a depression severity index, comorbidities, psychotherapy, psychotropic drugs, and electroconvulsive therapy. The main outcome was the transition from MDD to BD, dichotomized as occurring early (within 3 years of MDD onset) or late (3 years after MDD onset). Secondary outcomes encompassed the use of psychiatric inpatient services post transition and patterns of medication usage. A robust propensity score matching framework was used to estimate outcomes. The final balanced cohort included 228 individuals, with an equal distribution between adults (n = 114; mean [SD] age, 24.5 [6.3] years; 96 female [84.2%]; 20 experiencing an early transition to BD [17.5%]) and youths (n = 114; mean [SD] age, 15.3 [1.6] years; 93 female [81.6%]; 8 experiencing an early transition to BD [7.0%]). Youths were substantially less likely to transition early (odds ratio, 0.42; 95% CI, 0.20-0.88; P = .02), despite having more outpatient visits (mean [SD] visits per month, 1.21 [1.07] vs 0.97 [0.98] for adults; P = .01). Both groups experienced substantially reduced inpatient care following a BD diagnosis, concurring with a marked decline in antidepressant use without increased lithium use. These findings suggest that adolescents may experience delayed BD progression and that diagnosis substantially reduced inpatient care in all age groups, which coincided with a reduction in the use of antidepressants. These findings may inform pharmacologic strategies in patients with first-episode MDD at risk for BD.

Impact of Pseudomonas aeruginosa on resource utilization and costs in patients with exacerbated non-cystic fibrosis bronchiectasis

Aims Non‐cystic fibrosis bronchiectasis (NCFB) is a chronic progressive respiratory disorder occurring at a rate ranging from 4.2 to 278.1 cases per 100,000 persons, depending on age, in the United States. For many patients with NCFB, the presence of Pseudomonas aeruginosa (PA) makes treatment more complicated and typically has worse outcomes. Management of NCFB can be challenging, warranting a better understanding of the burden of illness for NCFB, treatments applied, healthcare resources used, and subsequent treatment costs. Comparing patients diagnosed with exacerbated NCFB, with or without PA on antibiotic utilization, treatments, and healthcare resources utilization and costs was the purpose of this study. Materials and methods This was a retrospective cohort study of commercial claims from IQVIA’s PharMetrics Plus database (January 1,2006–December 31, 2020). Study patients with a diagnosis of NCFB were stratified into two groups based on the presence or absence of PA, then followed to identify demographic characteristics, comorbid conditions, antibiotic treatment regimen prescribed, healthcare resources utilized, and costs of care. Results The results showed that patients with exacerbated NCFB who were PA+ had significantly more oral antibiotic fills per patient per year, more inpatient admissions with a longer length of stay, and more outpatient encounters than those who were PA−. For costs, PA+ patients also had significantly greater total healthcare costs per patient when compared to those who were PA−. Conclusion Exacerbated NCFB with PA+ was associated with increased antibiotic usage, greater resource utilization, and increased costs. The major contributor to the cost differences was the use of inpatient services. Treatment strategies aimed at reducing the need for inpatient treatment could lessen the disparities observed in patients with NCFB.

Healthcare utilization and its association with socioeconomic status in China: Evidence from the 2011-2018 China Health and Retirement Longitudinal Study.

Healthcare utilization often favors the higher-socioeconomic status (SES) and having chronic diseases may exacerbate this inequality. This study aims to examine the trends in health service use over time, the effect of SES on healthcare utilization, and the role of chronic diseases in this association. Data used in this study were from the China Health and Retirement Longitudinal Study (CHARLS) in 2011, 2013, 2015, and 2018, which is the first nationally representative survey of the middle-aged and older. The sample included people aged 45 years and older who responded to all the waves. A total of 10,922 adults were included in this study. Healthcare utilization was categorized into outpatient and inpatient service use and SES was measured by per-capita household expenditure. A multilevel zero-inflated negative binomial regression model was performed to analyze outpatient and inpatient service use, separately. The rates of outpatient service use in 2011, 2013, 2015, and 2018 were 19.11%, 21.45%, 20.12%, and 16.32%, respectively, while the rates of inpatient service use were 8.40%, 13.04%, 14.17%, and 18.79%, respectively. Compared to individuals in the lowest quintile of per-capita household expenditure, those in higher quintiles had higher odds of outpatient service use (Q2: odds ratio = 1.233, p < 0.0001; Q3: 1.416, p < 0.0001; Q4: 1.408, p < 0.0001; or Q5: 1.439, p < 0.0001) and higher rates of inpatient service use (Q2: incidence rate ratio = 1.273, p < 0.0001; Q3: 1.773, p < 0.0001; Q4: 2.071, p < 0.0001; or Q5: 1.992, p < 0.0001). Additionally, having morbidity generally increased healthcare utilization, but did not play a significant role in moderating the relationship between SES and healthcare utilization. Healthcare utilization rates were overall low in China, but relatively high for people in higher quintiles of per-capita household expenditure or those with morbidity, compared to their counterparts. Policy actions are required to provide more health education to the public, to further optimize health insurance schemes targeting outpatient services, especially for the low-SES, and to establish new health delivery models for NCD management in the primary health care setting.

Predictors of high intensity use of acute psychiatric inpatient services

ABSTRACT Objective High Intensity Users (HIUs) represent a small group of individuals accounting for a large proportion of inpatient resources. The paper aims to identify risk factors for becoming a High Intensity User of acute inpatient services and to understand the impact of different operationalisations of HIU. Method Participants were eligible admissions from 2016 to 2022 in an outer London NHS Trust. Retrospective case files were accessed to retrieve data. Regression models were used to identify predictors of HIU, operationalised using three binary and one continuous measure (3+ admissions in one year; 4+ in 5 years; 3+ ever; and percentage of adulthood in hospital). Results Being of Black ethnicity or younger when first admitted was associated with greater high intensity use, however defined. Risk of 3+ admissions in a year increased with age and was higher for those with personality disorders, previous admissions, those who had been placed in care during childhood, and those with historical cannabis use. Individuals whose first admission was due to a suicide attempt were at lower risk. Different operationalisations of HIU altered the factors that predicted risk. Discussion The study highlights the need for a consensus HIU definition to help progress the research and clinical efforts to support this group. Identifying and targeting support for those at greater risk for frequent readmission is needed to help reduce readmission and improve outcomes.

The impact of the COVID-19 pandemic on children and adolescent mental health in-patient service use in England: interrupted time-series analysis of national patient records.

During the initial phases of the COVID-19 pandemic, children and young people (CYP) faced significant restrictions. The virus and mitigation approaches significantly impacted how health services could function and be safely delivered. To investigate the impact of COVID-19 lockdowns on CYP psychiatric admission trends during lockdown 1 (started 23 Mar 2020) and lockdown 2 (started 5 Nov 2020) of the COVID-19 pandemic in England. Routinely collected, retrospective English administrative data regarding psychiatric hospital admissions, length of stay and patient demographic factors were analysed using an interrupted time series analysis (ITSA) to estimate the impact of COVID-19 lockdowns 1 and 2 on service use trends. We analysed data of 6250 CYP (up to 18 years of age) using ordinary least squares (OLS) regression analysis with Newey-West standard errors to handle autocorrelation and heteroscedasticity. Psychiatric hospital admissions for CYP significantly fell during lockdown 1, and then fell even further during lockdown 2. A greater proportion of admissions during lockdown were out of area or to independent sector units. During lockdown, the average age of CYP admitted was higher, and a greater proportion were female. There was also a significant increase in the proportion of looked-after children and CYP from the most socioeconomically deprived areas admitted during lockdown 2. During both lockdowns, fewer CYP had psychiatric admissions. The subsequent rise in admissions for more socioeconomically deprived CYP and looked-after children suggests that these CYP may have been disproportionately affected by the pandemic, or overlooked during earlier phases.

The impact of a novel musculoskeletal consult service in an inpatient rehabilitation facility: A descriptive analysis.

Musculoskeletal (MSK) pathologies significantly affect the rehabilitation course for patients admitted to an inpatient rehabilitation facility (IRF). The impact of a specialized inpatient MSK consult service has not been previously evaluated. To assess the demographics, pathologies, and impact on pain scores of patients who were evaluated by a specialized MSK consult service. Retrospective descriptive analysis of patients at an IRF who were evaluated by the MSK consult service. Academic IRF. 230 patients evaluated by the MSK consult service over 4.5 years. MSK consult service composed of sports medicine fellowship-trained physiatrists who use history, physical examination, point-of-care ultrasound, and specialized MSK knowledge to assess and address MSK barriers to functional improvement. Primary rehabilitation diagnosis, length of stay, discharge destination, reason for consult, MSK diagnosis, need for injection, change in Numerical Pain Rating Scale (NPRS) pain scores, change in Functional Independence Measures (FIM). A total of 230 consults met inclusion criteria for analysis. The most common symptoms were shoulder pain (47%), knee pain (30%), and hip/groin pain (10.4%). The MSK consult service made 82 different musculoskeletal and neuromuscular diagnoses. The most common primary rehabilitation diagnosis was stroke (28.3%). Injections were performed in 44.3% of consults, with an average reduction in NPRS pain score of 2.3 (SD 1.9) and a statistically significant reduction in average NPRS pain scores in patients who underwent injections compared to those who did not (p < .001). This study is the first to examine the use of an innovative inpatient MSK physiatry consult service in an IRF. This promising consult service can play a pivotal role in patient care by reducing functionally limiting MSK pain to allow for better toleration of therapies and to optimize functional gains.

Assessing the clinical and cost-effectiveness of inpatient mental health rehabilitation services provided by the NHS and independent sector (ACER): protocol

BackgroundMental health rehabilitation services provide specialist treatment to people with particularly severe and complex problems. In 2018, the Care Quality Commission reported that over half the 4,400 mental health inpatient rehabilitation beds in England were provided by the independent sector. They raised concerns that the length of stay and cost of independent sector care was double that of the NHS and that their services tended to be provided much further from people’s homes. However, there has been no research comparing the two sectors and we therefore do not know if these concerns are justified. The ACER Study (Assessing the Clinical and cost-Effectiveness of inpatient mental health Rehabilitation services provided by the NHS and independent sector) is a national programme of research in England, funded from 2021 to 2026, that aims to investigate differences in inpatient mental health rehabilitation provided by the NHS and independent sector in terms of: patient characteristics; service quality; patient, carer and staff experiences; clinical and cost effectiveness.MethodsACER comprises a:1) detailed survey of NHS and independent sector inpatient mental health rehabilitation services across England; 2) qualitative investigation of patient, family, staff and commissioners’ experiences of the two sectors; 3) cohort study comparing clinical outcomes in the two sectors over 18 months; 4) comprehensive national comparison of inpatient service use in the two sectors, using instrumental variable analysis of routinely collected healthcare data over 18 months; 5) health economic evaluation of the relative cost-effectiveness of the two sectors. In Components 3 and 4, our primary outcome is ‘successful rehabilitation’ defined as a) being discharged from the inpatient rehabilitation unit without readmission and b) inpatient service use over the 18 months.DiscussionThe ACER study will deliver the first empirical comparison of the clinical and cost-effectiveness of NHS and independent sector inpatient mental health rehabilitation services.Trial registrationISRCTN17381762 retrospectively registered.

Health care utilization after enrollment in an outpatient structured clinical program for children with medical complexity.

Although children with medical complexity (CMC) with high health resource utilization use outpatient structured clinical programs (SCP) to optimize their health, little is known about variation in trends of their health service use shortly after enrollment. We measured these trends and assessed the utility of patient characteristics to predict them. Retrospective analysis of 506 CMC newly enrolled in an outpatient, academic SCP. We measured outpatient and inpatient health service use for the first 6 months following enrollment. Using cluster analysis, we categorized CMC with similar trends by health service. We assessed patient demographic (e.g., age) and clinical [type and number of complex chronic conditions (CCC)] characteristics with the cluster categories. Most (90.3%) CMC enrolled had ≥1 CCCs; 53.8% had ≥3 CCCs. For all CMC, outpatient specialty visits, phone calls, and hospitalizations (not involving ICU) decreased significantly over the first 6 months after enrollment. For example, the hospitalization rate decreased from 9.7% to 4.5% in the 1st and 6th months, respectively, (P < 0.001). Cluster analysis revealed four categories of hospitalization trends, 6 months after enrollment: 72.9% of CMC had no hospital use; 16.0% had increased then decreased use; 8.3% had decreased use; and 2.8% had increased use. No patient and clinical characteristics clearly distinguished which hospitalization trend CMC experienced. Although the overall population of CMC experienced decreased outpatient and inpatient health services utilization over time, this decrease was not uniformly experienced. Fundamental patient demographic and clinical characteristics did not predict health service trends.

A Systematic Review and Meta-Analysis: Child and Adolescent Healthcare Utilization for Eating Disorders During the COVID-19 Pandemic

To conduct a meta-analysis documenting healthcare service utilization rates for pediatric (age<19 years) eating disorders during compared to before the COVID-19 pandemic. PsycINFO, MEDLINE, Embase, and Web of Science Core Collection were searched for studies published up to May 19, 2023. Studies with pediatric visits to primary care, inpatient, outpatient, and emergency department for eating disorders before and during the pandemic were included. This preregistered review (PROSPERO CRD42023413392) was reported using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Data were analyzed with random-effects meta-analyses. A total of 52 studies reporting >148,000 child and adolescent eating disorder-related visits to >300 health settings across 15 countries were included (mean age, 12.7 years; SD= 4.1 years; 87% girls). There was strong evidence of an increase in healthcare use for eating disorders during the pandemic (rate ratio [RR]= 1.54, 95% CI= 1.38-1.71). Moderator analysis revealed larger rate increases among girls (RR= 1.48, 95% CI= 1.28-1.71) compared to boys (RR= 1.24, 95% CI= 1.06-1.45) and for adolescents (age≥12 to 19 years) (RR= 1.53, 95% CI= 1.29-1.81) compared to children (RR= 0.87, 95% CI= 0.53-1.43). Moderator analysis demonstrated strong evidence of increased use of emergency department (RR= 1.70, 95% CI= 1.48-1.97), inpatient (RR= 1.56, 95% CI= 1.33-1.84), and outpatient (RR= 1.62, 95% CI= 1.35-1.95) services, as well as strong evidence of increased rates of anorexia nervosa (RR= 1.48, 95% CI= 1.24-1.75). Healthcare use for pediatric eating disorders increased substantially during the COVID-19 pandemic, particularly among girls and adolescents. It is important to continue to monitor whether changes in healthcare use associated with acute pediatric mental distress are sustained beyond the COVID-19 pandemic. Risk factors for eating disorders for youth during the COVID-19 pandemic; https://www.crd.york.ac.uk/; CRD42023413392. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented racial and/or ethnic groups in science. One or more of the authors of this paper self-identifies as living with a disability. We actively worked to promote sex and gender balance in our author group. We actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our author group. While citing references scientifically relevant for this work, we also actively worked to promote sex and gender balance in our reference list. While citing references scientifically relevant for this work, we also actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our reference list. The author list of this paper includes contributors from the location and/or community where the research was conducted who participated in the data collection, design, analysis, and/or interpretation of the work. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented sexual and/or gender groups in science.

Comparing the rate of inpatient admissions of prison residents with COVID-19 to the general population in England in 2020/2021 using Hospital Episode Statistics data

ObjectiveTo compare the rate of inpatient admissions of prison residents with COVID-19 to the general population and to consider differences in the use of inpatient and outpatient services by prison...