Number Of Inpatient Visits Research Articles

Predicting re-admission to hospital for diabetes treatment: a machine learning solution

Predictive analytics embrace an extensive range of techniques for identifying patterns within data to predict future outcomes and trends. The objective of this study is to design and implement a predictive analytics system that can be used to forecast the likelihood that a diabetic patient will be readmitted to the hospital. Using the Diabetes 130-US hospitals dataset we modelled the relationship between the patient re-admission (predictor) and the response variable using the Random Forest classifier. We obtained a maximum AUC of 0.684 and an F1 Score of 52.07%. Our study reveals that attributes such as number of inpatient visits, discharge disposition, admission type, and number of laboratory tests are strong predictors for the re-admission of patients. Findings from this study can help hospitals design suitable protocols to ensure that patients with a higher probability of re-admission are recovering well and possibly reduce the risk of future re-admission.

Prediction Model of Early Return to Hospital after Discharge Following Acute Ischemic Stroke.

Reducing hospital readmissions for stroke remains a significant challenge to improve outcomes and decrease healthcare costs. We analyzed 10,034 adult patients with ischemic stroke, presented within 24 hours of onset from a hospital-based stroke registry. The risk factors for early return to hospital after discharge were analyzed using multivariate logistic regression and classification and regression tree (CART) analyses. Among the study population, 277 (2.8%) had 3-day Emergency Department (ED) reattendance, 534 (5.3%) had 14-day readmission, and 932 (9.3%) had 30-day readmission. Multivariate logistic regression revealed that age, nasogastric tube feeding, indwelling urinary catheter, healthcare utilization behaviour, and stroke severity were major and common risk factors for an early return to the hospital after discharge. CART analysis identified nasogastric tube feeding and length of stay for 72-hour ED reattendance, Barthel Index (BI) score, total length of stay in the Year Preceding the index admission (YLOS), indwelling urinary catheter, and age for 14-day readmission, and nasogastric tube feeding, BI score, YLOS, and number of inpatient visits in the year preceding the index admission for 30-day readmission as important factors to classify the patients into subgroups. Although CART analysis did not improve the prediction of an early return to the hospital after stroke compared with logistic regression models, decision rules generated by CART can easily be interpreted and applied in clinical practice.

The Effectiveness of Medical and Surgical Treatment for Children With Refractory Epilepsy

Abstract INTRODUCTION Pediatric refractory epilepsy affects quality of life, clinical disability, and healthcare costs for patients and families. We aimed to show the impact of surgical treatment for pediatric epilepsy on healthcare utilization compared to medically treated pediatric epilepsy over 5 yr. METHODS The Pediatric Health Information System database was used to study hospitalized children with epilepsy using five published algorithms. Refractory epilepsy (RE) patients treated with either antiepileptic medications (AEDs) only or AEDs plus epilepsy surgery (ES) between 1/1/2008 and 12/31/2014 were included. Patients with a history of ES before 1/1/2008 or a vagus nerve stimulation implantation surgery were excluded. ICD-9-CM codes were used to identify ES. Healthcare utilization following the index date at 2- and 5-yr including inpatient, emergency department (ED), and all epilepsy-related visits were evaluated. The propensity scores (PS) method was used to match surgically and medically treated patients. Covariates associated with the probability of receiving surgical treatment were chosen in the logistic regression model for calculating PS. SAS 9.4 and Stata 14.0 were used for data management and statistical analysis. RESULTS A total of 2106 (17.1%) and 10186 (82.9%) were surgically and medically treated, respectively. A total of 4050 matched cases, 2025 per each treated group, were included. Overall survival rates of matched cases were 98.07% and 99.58% at 2-yr and 96.66% and 98.99% at 5-yr for medically and surgically treated patients, respectively. Within 5-yr follow-up, seizure-associated healthcare utilization was lower for the surgically treated group: number of inpatient visits were 3.9 vs 2.5 and ED visits were 3.2 vs 1.7 for medically and surgically treated patients, respectively. The number of AEDs at 1-yr follow-up was significantly lower for the surgically treated group (3.22 decreased to 2.59: surgical group, 3.24 decreased to 3.06: medical group). CONCLUSION We found a significant decrease in inpatient and ED visits and number of antiepileptic drug prescriptions, as well as higher survival rates, at 2- and 5-yr follow-up in the surgically treated group compared to the medically treated group for pediatric patients with refractory epilepsy. Pediatric epilepsy surgery can provide beneficial outcomes, favorable long-term effectiveness, and reduced healthcare utilization compared to medical management.

Effect of Physical Activity on Hospital Service Use and Expenditures of Patients with Coronary Heart Disease: Results from Dongfeng-Tongji Cohort Study in China.

The intervention of behaviors, including physical activity (PA), has become a strategy for many hospitals dealing with patients with chronic diseases. Given the limited evidence available about PA and healthcare use with chronic diseases, this study explored the association between different levels of PA and annual hospital service use and expenditure for inpatients with coronary heart disease (CHD) in China. We analyzed PA information from the first follow-up survey (2013) of the Dongfeng-Tongji cohort study of 1460 CHD inpatients. We examined factors such as PA exercise volume and years of PA and their associations with the number of inpatient visits, number of hospital days, and inpatient costs and total medical costs. We found that the number of hospital days and the number of inpatient visits were negatively associated with intensity of PA level. Similarly, total inpatient and outpatient costs declined when the PA exercise volume levels increased. Furthermore, there were also significant associations between the number of hospital days, inpatient costs or total medical costs and levels of PA years. This study provides the first empirical evidence about the effects of the intensity and years of PA on hospital service use and expenditure of CHD in China. It suggests that the patients' PA, especially the vigorous PA, should be promoted widely to the public and patients in order to relieve the financial burden of CHD.

SAT-439 Impact on Health Care Resources: A Comparison of Costs Following Treatment with Pegvisomant and Somatostatin Analogues Using Optum Claims Database

OBJECTIVES: To estimate the health care resource use (HCRU) and costs for patients diagnosed with acromegaly, following treatment with either pegvisomant, a growth hormone receptor antagonist (GHRA); or a somatostatin analogue (SSA). METHODS: De-identified data from Optum’s ClinformaticsTM Data Mart (CDM), a US claims database, were used to retrospectively identify patients with acromegaly from January 2011 - June 2018 who were treated with the GHRA or an SSA. Propensity score matching (PSM) was used to address the small sample size of acromegaly patients and to ensure a direct comparison between the two treatment groups. PSM was fitted using a logistic regression model that included age, gender, total cost and Charlson Comorbidity Index (CCMI) score at index¹. Follow up (FU), HCRU (including Emergency Room [ER] costs, outpatient and inpatient costs) were compared. Average differences in change from baseline costs between the GHRA and SSA from the matched groups are shown with p-values obtained from a t-test. All costs are average across visits. RESULTS: Following PSM 91 patients were treated with GHRA and 269 patients were treated with SSAs. Mean ER costs were higher in the SSA vs GHRA group ($63 vs -$19, p=0.5646). On average outpatient visits were higher in the SSA vs GHRA group (2.88 and 2.82 respectively, p=0.8583); associated costs were higher ($1181 and $789 respectively p=0.3832). Regarding office visits and associated costs, these were also higher in the SSA group (Visit: 0.77 vs 0.74 and Cost: $1 vs -$7). The number of inpatient visits was equal (average =0.03) for both groups, with slightly higher costs in the GHRA group ($131 vs $161, p=0.9644). The drug cost and overall total cost of SSAs vs GHRA were significantly different ($2630 vs $6933, p<0.0001; $3681 vs $7561, p<0.0004 respectively). In the matched group, 18.7% of GHRA and 26.0% of SSA patients had new diabetes as comorbidity at FU. DISCUSSION: This analysis suggests that patients treated with SSAs generally utilize slightly more healthcare resources. In particular, outpatient costs were higher in SSA group compared to GHRA. Looking at the matched CCMI at FU, the value was higher (with more comorbidities) for the SSA group (63%) compared to the GHRA group (57%), with a trend that higher rates of new diabetes comorbidities occur in the SSA group. CONCLUSIONS: Although the drug cost and total cost of treating with SSAs is less than that for GHRA, these data analyses show that patients treated with SSAs generally have an increased trend in patient visits, and hence healthcare utilization costs; this could be a consideration when making treatment choices. Reference: 1. Coding Algorithms for Defining Comorbidities in ICD-9-CM and ICD-10 Administrative Data. Quan H et al Medical Care Vol 43, Number 11, Nov 2005

Abstract P420: Chronic Pain in Adolescents and Adults With Congenital Heart Disease

Introduction: Chronic pain is a significant public health concern in the U.S., estimated to affect nearly 100 million people. While post-surgical pain associated with treatment of congenital heart disease (CHD) has been studied, the persistent prevalence of chronic pain among this growing population is unknown. Hypothesis: Our primary objective is to understand the burden of chronic pain among adolescents and adults with CHD in the Colorado Congenital Heart Defects Surveillance System (COCHD). Additionally, we will determine if chronic pain among individuals with CHD is associated with differing patterns of healthcare utilization and mental health diagnoses. Methods: We included 9,116 participants aged 11 to 64 years with a CHD lesion listed as a diagnostic code on an encounter occurring between January 1, 2011 to December 31, 2013. Chronic pain was defined as an encounter with ICD-9CM code (338.2-338.4) from a validated algorithm for identifying chronic pain in electronic medical record. Multivariable logistic regression was conducted to assess associations between chronic pain and the number of inpatient visits, cardiac procedures and mental health disorders, adjusted for CHD severity and age group. Results: Of the 9,116 participants identified with CHD between 2011-2013 in COCHD, 17.5% met the diagnostic criteria for chronic pain. Table 1 displays the differences in our cohort by chronic pain status. Chronic pain was associated with a 54% increase in the likelihood of a mental diagnosis (OR=1.54, 95%C.I.:1.43-1.66) and each increasing number of cardiac procedures that occurred during the 3 year study interval increased the likelihood of chronic pain by 25% (OR=1.25, 95%C.I.:1.21-1.30). Conclusion: Our study provides novel insight into the increasingly recognized public health issue of chronic pain within the growing population of adolescents and adults with CHD who have high lifetime healthcare utilization. Further studies will explore the complex relationship of mental illness, chronic pain and CHD.

Equity assessment of the distribution of CT and MRI scanners in China: a panel data analysis

BackgroundDistribution equity assessment of computed tomography (CT) and magnetic resonance imaging (MRI) scanners is an important dimension of access to health technology. However, limited studies on the subject have been done in China. This study aims to reveal the distribution status of CT and MRI scanners and assess their distribution equity of them in China.MethodsFive provinces with 66 cities from China were selected as the study sites. Descriptive analysis was used for the absolute number and number per million population of CT and MRI scanners in the study sites. Fixed effect model was used to examine the health service factors that were associated with the allocation of CT and MRI scanners. The Gini coefficient and concentration index was used to evaluate the distribution equity of CT and MRI scanners.ResultsThe absolute number and number per million population of CT and MRI scanners in five provinces were lower than those of Organization for Economic Co-operation and Development (OECD) countries, but annual growth rates were relatively higher from 2005 or 2006 to 2013. Population, GDP, number of hospitals, number of health professionals, number of hospital beds, number of outpatient visits, and number of inpatient visits all had a positive correlation with the allocation number of CT and MRI scanners. Moreover, the number of health professionals and the number of beds had a much closer correlation than other variables. All the Gini coefficients of CT and MRI had decreased overall. The concentration indices of CT and MRI were all positive and no more than 0.30.ConclusionsLarge gaps in the number of CT and MRI scanners per million population between China and OECD countries emerge, although the growth rate is higher in China. The distribution equity of CT and MRI scanners in China was relatively good from 2005 or 2006 to 2013. The overall distribution equity of CT and MRI scanners also improved during the period. However, consideration attention should be given to the area with large economic disparities.

Esomeprazole Formulary Exclusion: Impact on Total Health Care Services Use and Costs

Esomeprazole was excluded from the United Healthcare formulary for all commercial health plan members January 1, 2007. A retrospective analysis of the Ingenix LabRx database (September 1, 2005, through June 30, 2007) evaluated the effect of this exclusion on health care utilization and costs in a real–world setting. Total medical care services, including pharmacy claims, were examined for 6 months before and after the esomeprazole exclusion. Patients aged ≥ 18 years were included if they had continuous health plan enrollment (September 1, 2005, through June 30, 2007), ≥ 1 esomeprazole prescription during the index period (March 1 through August 31, 2006), and ≥ 2 esomeprazole prescriptions (with no switch to another proton pump inhibitor [PPI]) during the baseline period (sliding 6–month window from September 1 through August 31, 2006). During the 6–month post–exclusion period (January 1 through June 30, 2007), 19.5% of patients remained on esomeprazole, 43% switched to another PPI, and 37.5% had no prescription PPI claims. Compared with the previous 6 months, post–exclusion was associated with increased health care utilization, including a 4.2% increase in number of inpatient visits, and a 2.7% increase in other services (eg, laboratory testing, ambulatory procedures). Esomeprazole prescriptions decreased by 76.5%, whereas overall pharmacy claims for all drug classes (including gastrointestinal drugs) increased by 5.2%. Six–month prescription drug costs decreased by $177/patient (95% confidence interval [CI], $160–$194/patient), whereas costs for total medical services increased by $450/patient (95% CI, $259–$640/patient), resulting in a net increase of $273/patient (95% CI, $137–$408/patient). Total and gastrointestinal–related medical services costs were significantly higher for those switching to another PPI versus those continuing esomeprazole. Inpatient utilization contributed most (44.5%) to increased costs of nongastrointestinal comorbidities. This study provides real–world evidence that formulary exclusions can lead to unintended increases in overall health care utilization and costs that exceed anticipated pharmacy budget savings.

Impact of Universal Health Care Coverage on patient demand for health care services in Thailand

Fully implemented in Thailand in 2002, the Universal Health Care Coverage (UC) Program aimed to provide cheap access to health care services, for 30 baht (less than 1 U.S. dollar) per visit, to all uninsured Thais. In this paper, we studied the impact of the UC in Thailand on the demand for health care services using hospital level data. We found that the UC program was successful in increasing outpatient demand for health care, particularly the demand from the elderly and the poor. However, outpatient demand for health care dramatically increased during the first year of the program and faded away quickly in subsequent years. In contrast to outpatient demand, the number of inpatient visits and the number of days for which the inpatients were admitted at hospitals declined after the UC program was launched. In this paper, we offer our explanation of these phenomena, highlight problems associated with the UC program, and provide policy recommendations to improve the program.

PND52 HEALTH CARE RESOURCE UTILIZATION BEFORE AND AFTER INITIATION OF ARMODAFINIL TREATMENT FOR WAKEFULNESS

Once-daily armodafinil significantly improves wakefulness in patients with excessive sleepiness due to shift work disorder (SWD), treated obstructive sleep apnea (OSA), or narcolepsy. The objective of the current analysis was to examine resource utilization by patients who received armodafinil for these FDA-approved indications. Data were collected from the IMS LifeLink Database (December 2008 to March 2010) and contained longitudinal patient data from medical claims (diagnostic/therapeutic services), pharmacy claims (prescriptions), and eligibility files (demographics and enrollment). Patients were identified and healthcare utilization data were collected for 6 months before and up to 10 months after their first armodafinil pharmacy claim. Healthcare costs and visits before and after initiation of armodafinil were statistically analyzed using paired t-tests. 1,282 patients were included (4.5% SWD; 85.9% OSA; 20.4% narcolepsy). The mean monthly healthcare cost for patients prior to taking armodafinil was $1,562.99 (pharmacy $432.26; medical $1,130.73). After armodafinil initiation, overall monthly cost decreased to $1,438.11 (p=0.0588). Armodafinil significantly increased prescription costs by $138.53/month (p<0.0001) but decreased medical costs by $263.41/month (p<0.0001). Medical costs were decreased by $133.23 for physician costs (p<0.0001) and $75.62 for outpatient costs (p=0.0039). Emergency room costs were lower by $3.99/month (NS), and inpatient costs were lower by $7.51/month (NS). The number of inpatient visits were reduced by 0.21/year (p=0.0307), physician visits by 4.91/year (p<0.0001), and outpatient visits by 0.89/year (p<0.0001). After armodafinil treatment, reductions were seen in healthcare utilization and costs compared to the pre-armodafinil period. As expected, total prescription costs were greater following initiation of armodafinil therapy; however, lower total monthly costs were observed with armodafinil because use of medical resources decreased. This significant reduction in medical resource utilization appeared to be driven predominantly by fewer physician visits and lower outpatient costs. This research was sponsored by and conducted in collaboration with Cephalon, Inc., Frazer, PA.

Healthcare utilization changes in relation to treatment intensification with insulin aspart in patients with type 2 diabetes. Data from a large US managed-care organization

ABSTRACTObjective: Most patients with type 2 diabetes eventually require exogenous insulin therapy to achieve good glycemic control due to the progressive nature of the disease. Insulin aspart is a rapid-acting insulin analog developed for prandial use. This study aimed to illustrate the implications on healthcare costs of adding insulin aspart to basal therapy in a real-world setting.Methods: Patients with type 2 diabetes who intensified previous basal therapy with insulin aspart were identified from a large commercial US healthcare data source between April 2007 and September 2008. Patients were required to have received basal insulin treatment with or without concomitant oral antidiabetic (OAD) therapy for at least 90 days pre- and post-initiation of insulin aspart. Wilcoxon signed-rank test and McNemar's test were used for continuous and categorical variables, respectively, to analyze the difference of self-comparison between pre- and post insulin aspart add-on.Results: In total, 1,739 patients with an average age of 56 years were identified, of whom 55% were male. After initiation of insulin aspart, a significant improvement in glycemic control was observed (change in HbA1c: –0.5%, p=0.0013). Similarly, a reduction of 0.4% in HbA1c was observed for the subpopulation of 151 patients, who had both pre-and post-index HbA1c data (p=0.0085). Also, significantly fewer patients used OADs after insulin aspart initiation (56 vs. 64%, p< 0.0001). Overall and diabetes-related healthcare costs also significantly decreased by $2,283 and $2,028, respectively (p≤0.0001). Diabetes-related inpatient visits appear to be the main contributor to total cost (46%); however, after initiation of insulin aspart the number of inpatient visits decreased by 0.50 visits/patient/year (p< 0.05). This decrease was reflected in a large reduction in cost related to inpatient visits ($3,019/patient).Limitations: A regression to the mean effect may be associated with this pre-post comparison. The ability to make conclusions regarding cause and effect may be limited due to the retrospective design of this study.Conclusions: Patients with type 2 diabetes achieved better glycemic control and needed less OAD treatment after adding insulin aspart to previous basal therapy. Furthermore, patients experienced on average reduced healthcare utilization after initiation of insulin aspart, which resulted in significant cost savings.