Number Of Ambulatory Care Visits Research Articles

Predicting hospitalisations related to ambulatory care sensitive conditions with machine learning for population health planning: derivation and validation cohort study

ObjectiveTo predict older adults’ risk of avoidable hospitalisation related to ambulatory care sensitive conditions (ACSC) using machine learning applied to administrative health data of Ontario, Canada.Design, setting and participantsA retrospective...

How Can One Strengthen a Tiered Healthcare System through Health System Reform? Lessons Learnt from Beijing, China.

How one can reshape the current healthcare sector into a tiered healthcare system with clarified division of functions between primary care facilities and hospitals, and improve the utilization of primary care, is a worldwide problem, especially for the low and middle-income countries (LMICs). This paper aimed to evaluate the impact of the Beijing Reform on healthcare-seeking behavior and tried to explain the mechanism of the change of patient flow. In this before and after study, we evaluated the changes of outpatient visits and inpatient visits among different levels of health facilities. Using the monitored and statistical data of 373 healthcare institutions 1-year before and 1-year after the Beijing Reform, interrupted time series analysis was applied to evaluate the impact of the reform on healthcare-seeking behavior. Semi-structured interviews were used to further explore the mechanisms of the changes. One year after the reform, the flow of outpatients changed from tertiary hospitals to community health centers with an 11.90% decrease of outpatients in tertiary hospitals compared to a 15.01% increase in primary healthcare facilities. The number of ambulatory care visits in primary healthcare (PHC) showed a significant upward trend (P < 0.10), and the reform had a significant impact on the average number of ambulatory care visits per institution in Beijing’s tertiary hospitals (p < 0.10). We concluded that the Beijing Reform has attracted a substantial number of ambulatory care visits from hospitals to primary healthcare facilities in the short-term. Comprehensive reform policies were necessary to align incentives among relative stakeholders, which was a critical lesson for other provinces in China and other LMICs.

Assessment of Antibiotic Prescribing for Influenza in the US Outpatient Care Setting

This retrospective research aimed to study the prescribing trends of antibiotics for influenza and adherence to the guidelines issued by the Infectious Diseases Society of America (IDSA) by utilizing the National Ambulatory Medical Survey (NAMCS) 2016 database. This was based on a sample of visits to non-federally employed officebased physicians who are engaged in direct patient care at community health centers. Patient sex, race, as well as the source of payment, and the provider type were among the demographic variables studied for adherence to the guidelines. The total number of ambulatory care visits were 1,753. Of those, 63.6% of patients were prescribed, inappropriate agents. General and Family Practice physicians were the most frequented providers (32.9%), followed by Nurse Practitioners (21.9%), and Pediatricians (17.1%). Family practice physicians and nurse practitioners appeared to prescribe more inappropriately as compared to the other specialties (X2 =0.001). White and black patients were prescribed more inappropriately as compared to other races (X2 =0.032). Antibiotic resistance is a public health problem of increasing magnitude, and finding effective solutions to address this problem is critical. Antibiotic resistance is also an economic healthcare burden. Adherence to guidelines minimizes antibiotic resistance and promotes patients and public health.

Association Between Work Absence and Health Services Utilization and Costs Among Employed Individuals With Arthritis.

To evaluate whether work absence is associated with increased health services utilization and health care costs among employed individuals with arthritis. This was a retrospective cross-sectional study using pooled data from the 2011 to 2015 Medical Expenditure Panel Survey (MEPS). Employed individuals with arthritis were identified using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9) codes and Clinical Classification code. Generalized linear models were used to analyze utilization and costs outcomes. Individuals with arthritis who reported work absences had greater odds of having a hospitalization event (odds ratio [OR]: 9.198, P < 0.001), higher number of ambulatory care visits (β = 0.549, P < 0.001), and had higher total health care costs (β = 0.40, P < 0.001) and arthritis-related costs (β = 0.035, P < 0.0002) compared with individuals without work absences. Among employed individuals with arthritis, self-reported work absence is associated with significantly higher health care utilization and health care costs.

P.144 Health care utilization by patients seen at a tertiary headache clinic

Background: Multidisciplinary treatment programs benefit headache patients. No evidence exists as to whether they change resource use. A historical prospective cohort study was performed to compare the frequency of ambulatory care and emergency department visits for the purposes of headache by patients seen at the Calgary Headache Assessment and Management Program (CHAMP) in the three years before, and after, their first appointment. Methods: Administrative data from Alberta Health was used. All patients seen by a physician at CHAMP from 2003-2013 were included. Sample characteristics were described and the Wilcoxan signed rank sum test was used to compare the number of ambulatory care and emergency department visits in the three years before and after each patient’s first physician appointment at CHAMP. Follow-up visits at CHAMP were excluded from analyses. Results: The median number of ambulatory care visits over three years changed from 4 to 2 (p&lt;0.001). The median number of emergency department visits was zero before and after assessment at CHAMP. The mean number of emergency department visits changed from 1.5 to 1.2 (p&lt;0.0001). Conclusions: Enrollment in a multidisciplinary headache program reduces the number of ambulatory care visits and emergency department visits for purposes of headache.

Effects of Visiting Nursing Services in Long-term Care Insurance on Utilization of Health Care

Purpose: This is a comparative study using secondary data from the Korean national long term care (LTC) insurance. Methods: Visiting nursing (VN) service users (n=666) and non-users (n=4,375) were extracted and compared in terms of medical expenditures, length of hospitalization, and annual number of ambulatory care visits to investigate effects of VN services in LTC. Results: Total health care expenditures were compared between the two groups and it was found that VN service users spent about $ 1700 than non-users for their medical costs between 2009 and 2011. The average length of in-hospital stay for VN service users was 19.4 days shorter than that of non-users. However, using VN services did not significantly influence the annual number of ambulatory care visits. Conclusion: The study has found that VN services are effective ways of providing community-based LTC services. We recommend LTC policy makers to further utilize VN services to deliver cost effective health care services.

Challenging Cough Cases: A Protocolized Approach

Program Description: Chronic cough is an increasingly important public health concern, accounts for a large number of ambulatory care visits, and often involves a protracted clinical course. Otolaryngologists play a critical role in the care of these patients because of our interdisciplinary approach to the aerodigestive tract and our mastery of many procedures used to evaluate and treat related conditions. This miniseminar will present challenging cases with panel discussion and audience participation to emphasize evidence-based practice and the “state-of-the-art” for patients with chronic cough. Controversial areas will include prioritization, the use of evidence-based protocols, and the importance of early diagnosis in value-based health care. Educational Objectives: (1) Describe evidence-based treatment guidelines in the evaluation and treatment of chronic cough. (2) Use the spectrum of common and uncommon causes of chronic cough with an appreciation of the underlying physiology. (3) Evaluate these complex patients, perform objective testing when indicated, and prescribe appropriate pharmacotherapy for patients with chronic cough.

Measuring fragmentation of ambulatory care in a tripartite healthcare system

BackgroundHong Kong has a tripartite healthcare system, where western medicine provided in both public and private sectors coexist with Chinese medicine practice. The purpose of this study is to measure fragmentation of ambulatory care experienced by the non-institutionalized population aged 15 and over in such a tripartite system, thus shed light on the ongoing primary care reform.MethodsThis is a cross-sectional secondary data analysis using the Thematic Household Survey, which was conducted by the Hong Kong Census and Statistics Department during November 2009 to February 2010 to collect territory-wide health-related information. Among 18,226 individuals with two or more ambulatory visits during the past 12 months before interview, we grouped each visit into one of the three care segments—public western, private western and Chinese medicine. Two individual-level measures were used to quantify longitudinal fragmentation of care across segments over the one-year period: Most Frequent Provider Continuity Index (MFPC) and Fragmentation of Care Index (FCI). Both are analyzed for distribution and subgroup comparison. A Tobit model was used to further examine the determinants of fragmentation.ResultsMore than a quarter of individuals sought care in two or all three segments, with an average MFPC of 65% and FCI of 0.528. Being older, female, married, unemployed, uninsured, or born in mainland China, with lower education, lower income, higher number of chronic conditions or poorer health were found to have experienced higher fragmentation of care. We also found that, fragmentation of care increased with the total number of ambulatory care visits and it varied significantly depending on what segment the individual chose to visit most frequently—those chose private western clinics had lower FCI, compared with those chose public western or Chinese medicine as the most frequently visited segment.ConclusionsEven measured at healthcare segment level, people in Hong Kong experienced modest fragmentation of care. Individuals’ health beliefs—as a result of the persistent habitual tendency and latitude incentivized by the system—may be behind the fragmented care we saw. Efforts are needed to alter health beliefs, targeting subgroups of vulnerable population, and create environments that promote better coordinated primary care.

Direct-to-Consumer and Physician Promotion of Tegaserod Correlated With Physician Visits, Diagnoses, and Prescriptions

Direct-to-consumer advertisement (DTCA) and physician promotion of drugs can influence patient and physician behaviors. We sought to determine the relationship between promotion of tegaserod and the number of office visits for abdominal pain, constipation, and bloating; diagnoses of irritable bowel syndrome (IBS); and tegaserod prescriptions. We used an Integrated Promotional Services database to estimate tegaserod DTCA and promotion expenditures; the National Ambulatory/Hospital Medical Care Surveys (1997-2005) to estimate the number of ambulatory care visits for abdominal pain, constipation, and bloating and diagnoses of IBS; and IMS Health's National Prescription Audit Plus (Fairfield, CT) to estimate the number of prescriptions. We constructed segmented and multivariate regression models to analyze the data. In the 3 months immediately following the start of tegaserod DTCA, there was a significant increase in physician visits (by 1 million; 95% confidence interval [CI], 0.5-1.6 million) and IBS diagnoses (by 397,025; 95% CI, 3909-790,141). Subsequently, the trend of visits and IBS diagnoses was reduced. In multivariate analyses that examined the overall relationship of promotion with visits, diagnoses, and prescriptions, only the relationship between physician promotion and tegaserod prescribing was significant; every $1 million spent on physician promotion resulted in an additional 4108 prescriptions (95% CI, 2526-5691). The initial DTCA of tegaserod was associated with a significant, immediate increase in physician visits and IBS diagnoses. This trend reversed and, in multivariate models, neither DTCA nor physician promotion correlated with visits or diagnoses. Physician promotion (although not DTCA) correlated with tegaserod prescription volume.

Best practice modeling initiative in an infection control program

BACKGROUND: Proper staffing of infection control departments has long been a topic of interest. The most complete report on the subject, the Study on the Efficacy of Nosocomial Infection Control, was published in 1985. A survey of university's health system members was undertaken in 2000 to obtain benchmarking information for staff. In order to participate in a best practice modeling initiative in the organization, a survey of U.S. News and World Report's Best Hospitals was performed. The first component of the process was to gather comparative data as described here. The next step will be to perform additional research on practices for the best performing institutions, i.e., evaluation of surveillance practices, educational activities, etc. METHODS: A survey tool was developed to obtain general demographic and staffing information. An infection control professional (ICP) at each institution was contacted to obtain most of the information. Additional information was obtained from standard references. RESULTS: Results from 13 institutions (93%) were obtained. Full-time equivalent (FTE) ratios based on the following parameters were compared for the institutions: number of occupied beds (median=137 occupied beds per FTE; range=53-360), number of intensive care unit beds (median=17 beds per FTE; range=10-32), number of admissions or discharges (median=6,503 admissions per FTE; range=2559-14,659), number of ambulatory care visits (median=134,661 visits per FTE; range=31,883-361,928), and number of personnel (median=1,437 staff per FTE; range=683-3023). CONCLUSIONS: Many institutions are using benchmarking comparison data to make decisions regarding staff reductions. This survey provides preliminary data for determining the best practice in staffing for infection control departments. More information may be needed to evaluate other factors which affect the ICP's workload.

The contribution of primary care systems to health outcomes within Organization for Economic Cooperation and Development (OECD) countries, 1970-1998.

To assess the contribution of primary care systems to a variety of health outcomes in 18 wealthy Organization for Economic Cooperation and Development (OECD) countries over three decades. Data were primarily derived from OECD Health Data 2001 and from published literature. The unit of analysis is each of 18 wealthy OECD countries from 1970 to 1998 (total n = 504). Pooled, cross-sectional, time-series analysis of secondary data using fixed effects regression. Secondary analysis of public-use datasets. Primary care system characteristics were assessed using a common set of indicators derived from secondary datasets, published literature, technical documents, and consultation with in-country experts. The strength of a country's primary care system was negatively associated with (a) all-cause mortality, (b) all-cause premature mortality, and (c) cause-specific premature mortality from asthma and bronchitis, emphysema and pneumonia, cardiovascular disease, and heart disease (p<0.05 in fixed effects, multivariate regression analyses). This relationship was significant, albeit reduced in magnitude, even while controlling for macro-level (GDP per capita, total physicians per one thousand population, percent of elderly) and micro-level (average number of ambulatory care visits, per capita income, alcohol and tobacco consumption) determinants of population health. (1) Strong primary care system and practice characteristics such as geographic regulation, longitudinality, coordination, and community orientation were associated with improved population health. (2) Despite health reform efforts, few OECD countries have improved essential features of their primary care systems as assessed by the scale used here. (3) The proposed scale can also be used to monitor health reform efforts intended to improve primary care.

Use and costs of ambulatory care services among Medicare enrollees with schizophrenia.

The objective of this study was to identify predictors of the use and cost of ambulatory care services among Medicare recipients with schizophrenia. The design was a cross-sectional analysis of Medicare claims in 1991. The study subjects were a 5 percent random sample of all persons in the United States who had at least one Medicare service claim in 1991 and who were diagnosed as having schizophrenia in any care setting. Outcome measures included use and cost of any ambulatory care service, individual therapy, psychiatric somatotherapy, group therapy, or family therapy. For nearly 25 percent of the total sample of 12,440, no claims were filed for ambulatory care services in 1991. The mean+/-SD number of ambulatory care visits during the year was 7.9+/-21. The most frequently used type of therapy was individual therapy (5+/-14 visits). The mean+/-SD yearly cost of care for persons who received ambulatory care services was $470+/-$1,028. Among persons under 65 years of age, Caucasians were about 1.5 times as likely as African Americans to have received an ambulatory care service and 1.3 times as likely to have received individual therapy. Persons who were 65 or older were less likely to have received any service. Among service recipients, costs of care were lower for African Americans and for older people. The use of Medicare-funded ambulatory care services by persons with schizophrenia varied by race and age. Further investigation is required to determine whether subgroups of individuals who do not have additional insurance coverage or access to services are receiving substandard care.

A survey of infection control professional staffing patterns at University HealthSystem Consortium institutions

Proper staffing of infection control departments has long been a topic of interest. The most complete report on the subject, the Study on the Efficacy of Nosocomial Infection Control, was published in 1985. To provide current benchmarking comparison data for expected staff reductions at the University of Michigan Health System, a survey of University HealthSystem Consortium members was performed. A survey tool was developed to obtain general demographic, staffing, and case-mix information. An infection control professional at each institution was contacted to obtain most of the information. Additional information was obtained from standard references. Responses were obtained from 45 University HealthSystem Consortium members (67%). Full-time equivalent ratios were based on the following parameters and compared for the institutions: number of occupied beds (according to occupancy rate, median 137 occupied beds/full-time equivalent), number of intensive care unit beds (median 28 beds/full-time equivalent), number of admissions or discharges (median 6686 admissions/full-time equivalent), number of ambulatory care visits (median 104,426 visits/full-time equivalent), and case-mix index (median 1.75). Many institutions are using benchmarking comparison data to make decisions regarding staff reductions. This survey provides preliminary data for determining the "best practice" in staffing for infection control departments. More information may be needed to evaluate other factors that affect infection control professionals' workload.

Health services use and mortality among older primary care patients with alcoholism.

To describe the prevalence of alcoholism in an older primary care population and to compare rates of health services use and mortality among those with and those without evidence of alcoholism. Baseline screening for alcoholism using the CAGE questionnaire and longitudinal assessment of health services use and mortality using an electronic medical record system. An academic primary care group practice at an urban ambulatory care clinic. A total of 3954 patients aged 60 and older who completed the CAGE alcoholism screening questionnaire during routine office visits. Comorbidity, preventive health services use, hospital episodes and length of stay, emergency room visits, ambulatory care visits, total outpatient charges, and mortality. The prevalence of current evidence of alcoholism, as defined by a CAGE score > or = 2 and alcohol use in the previous 12 months, was 10.6%. Patients with evidence of alcoholism were younger (66.2 vs 68.3 years), had fewer years of education (8.4 vs 9.1), were more likely to be male (65.8 vs 27.2%), black (71.2 vs 62.6%), smokers (40.4 vs 26.3%), and malnourished (32.5 vs 26.3%). Patients with alcoholism were more likely to have a diagnosis of obstructive lung disease (22.9 vs 18.3%), injuries (14.2 vs 8.3%), and gout (6.7 vs 2.9%) and less likely to have a diagnosis of hypertension (56.9 vs 61.8%), arthritis (23.3 vs 29.3%), and diabetes (15.9 vs 23.3%). Among those with evidence of alcoholism, 41.6% had a diagnosis of alcoholism in their outpatient medical record. Rates of completion of preventive health services did not differ between the two groups, and there was no difference in the number of ambulatory care visits, emergency room visits, or total outpatient charges. Patients with evidence of alcoholism were more likely to be hospitalized (21.5 vs 16.9%) and more likely to die within 2 years (10.6% vs 6.3%). One of 10 older patients in this primary care practice had current evidence of alcoholism, fewer than half of whom had documentation of alcohol abuse in their medical records. These patients were more likely to be hospitalized and more likely to die but did not consume a greater amount of outpatient resources. Further research is needed to determine if interventions to reduce alcohol use would also reduce excess hospitalizations and mortality among these older patients.