Outpatient Volume Research Articles

Safety and Cost-Effectiveness of Outpatient Surgery in Acute Burn Care.

Outpatient burn surgery is increasingly used in acute burn care. Reports of its safety and efficacy are limited. This study aims to evaluate the safety and cost reduction associated with outpatient burn surgery and to describe our center's experience. This was a single-center, retrospective cohort study of consecutive patients who underwent outpatient burn surgery requiring split-thickness skin graft or dermal regenerative template from January 2010 to December 2018. Patient demographics, comorbidities, burn etiologies, operative data, and postoperative care were reviewed. The primary outcome is complications involving major graft loss requiring reoperation. One hundred and sixty-five patients and 173 procedures met the inclusion criteria. The average age was 44 years and 60.6% (100/165) were male. Annual outpatient procedure volume increased 48% from 23 to 34 cases over the 9-year period. The median (interquartile range) grafted percentage total body surface area was 1.0 (1.0)%. Rate of major graft loss requiring reoperation was 5.2% (9/172) and the most common site was the lower extremity (8/9, 88.9%). Age, sex, comorbidities, total body surface area, and procedure types were not significantly associated with postoperative complication rates. The outpatient burn surgery model was estimated to save CA$8170 per patient from inpatient costs. Demonstration of the safety and cost savings associated with outpatient acute burn surgery is compelling for further utilization. Our experience found the adoption of improved dressing care, appropriate patient selection, increased patient education, adequate pain control, and regimented outpatient multidisciplinary care to be fundamental for effective outpatient surgical burn care.

Impact of the COVID-19 pandemic on cardiology services at a tertiary cardiac centre in a low- and middle-income country in Asia

Abstract Background The COVID-19 pandemic resulted in reduced numbers of patients presenting with and undergoing procedures for cardiac conditions worldwide. This impact, specifically looking at the changes in patient visits, admissions and procedure volumes, has not been recorded thus far, in terms of a South Asian LMIC setting. Purpose We aimed to assess the impact of the pandemic on emergency room (ER) visits, cardiology admissions, out-patient and in-patient procedures at a LMIC tertiary cardiac centre. Methods Data on ER visits, specific in-patient and out-patient procedures (echocardiography, exercise stress tests, electrocardiography [ECG]) were collected via hospital electronic records from January to December 2020, and compared with corresponding data for the same months in 2019. The difference or deficits were expressed as a percentage (%Δ). Data for each quarter were compared using paired t-test. A p value <0.05 was considered significant. Results There were significantly reduced numbers of out-patient visits (Δ −31.2%; p=0.007), ER visits (%Δ −59.5%; p=0.0), in-patient admissions (Δ −33.1%; p=0.005), total out-patient procedures (%Δ −31.9%; p=0.008) and catheterization volumes (%Δ-29.7%; p=0.001) in 2020, as compared with 2019 (Table 1 & Figure 1). Among out-patient procedures, adult trans-thoracic echo, ECG and stress tests showed greatest deficits in April 2020. No trans-oesophageal echocardiograms were performed in April to July 2020. The greatest deficits were observed in April 2020, as compared with 2019 (out-patient visits: Δ-92.7%; out-patient procedures: %Δ-94.5%; in-patient admissions: %Δ-85.9%; catheterization procedures: %Δ-85.2%), except for ER visits, where the greatest deficit was seen in June 2020: %Δ-90.7%). Numbers continued to remain extremely low in May 2020, coinciding with the nation-wide lockdown measures. Out-patient visits, procedures and in-patient admissions have gradually increased since July 2020. However, the greatest impact seems to have been on ER visits, continued to remain low, with significantly reduced volumes in both 2nd and 3rd quarters of 2020. The lowest deficits in outpatient visits (Δ-4.9%), ER visits (Δ-31.9%) and out-patient procedures (Δ-0.9%) were seen in December 2020, while for in-patient admissions (Δ-7.9%) and catheterization procedures (Δ-6.5%) this was in October 2020. Conclusion There was a significant reduction of out-patient and in-patient cardiology services volumes in 2020, with the greatest reduction in April and May, coinciding with a general “lockdown”. ER visits were the most greatly affected. Trends show a steady increase in out-patient and catheterization procedures, beginning from July, but have not yet reached pre-COVID volumes, even by the end of 2020. These findings indicate that, the pandemic has resulted in significantly fewer ER visits; however, patients still present as outpatients, both for procedures and catheterization. Funding Acknowledgement Type of funding sources: None. Table 1Figure 1

Editorial Commentary.

No AccessUrology PracticeBusiness of Urology1 Nov 2021Editorial Commentaryis a letter which has replyReply by AuthorsThis article comments on the following:Use of Lean Methodologies in Outpatient Urology Clinic Alec S. Koo Alec S. KooAlec S. Koo Skyline Urology, Torrance, California More articles by this author View All Author Informationhttps://doi.org/10.1097/UPJ.0000000000000256.01AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "Editorial Commentary." Urology Practice, 8(6), pp. 655–656 © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsRelated articlesUrology PracticeAug 20, 2021, 12:00:00 AMReply by AuthorsUrology PracticeAug 25, 2021, 12:00:00 AMUse of Lean Methodologies in Outpatient Urology Clinic Volume 8Issue 6November 2021Page: 655-656 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Alec S. Koo Skyline Urology, Torrance, California More articles by this author Expand All Advertisement Loading ...

Impact of the COVID-19 Pandemic on Outpatient Service in Primary Healthcare Institutions: An Inspiration From Yinchuan of China.

The coronavirus disease 2019 (COVID-19) pandemic has posed a great challenge to the healthcare system. This study evaluated the impact of the pandemic on the utilization of primary healthcare (PHC). The outpatient data from 158 PHC institutions in Yinchuan from May 1, 2017 to April 30, 2020 were used. The difference in difference (DID) model was used to analyze the difference in the number of outpatient visits per day, total outpatient expenditure per day, and outpatient expenditure per visit between December 2019 and February 2020 compared with the same periods in two previous years. The autoregressive integrated moving average (ARIMA) modelling was used to investigate the association between the outpatient volume and the number of the last week's new COVID-19 cases in Yinchuan, Ningxia, and China. From December 2019 to February 2020, the decline in the number of outpatient visits per day (DID: -367.21 times, P=.004) was larger than that in two previous years, and a similar trend can be seen in the outpatient expenditure per day. However, the rise in the outpatient expenditure per visit (DID: 19.06 thousand yuan, P=.003) was larger than that in two previous years. In 2020, the outpatient visits for most types of diseases decreased from week 3 and rebounded after week 5. The decline and rebound of outpatient visits in the population aged 45 years and older were steeper than in those younger. The outpatient volume was negatively associated with the number of the last week's new COVID-19 cases. This study indicated a significant impact of the pandemic on PHC service utilization. Since PHC service is the foundation of the healthcare system in most developing countries, measures should be taken to make PHC help cope with the crisis and relieve the burden of hospital care.

Effects of Vertical Integration Reform on Primary Healthcare Institutions in China: Evidence From a Longitudinal Study.

Integrated care is a global trend in international healthcare reform, particularly for piloting vertical integration involving hospitals and primary healthcare institutions (PHIs). However, evidence regarding the impact of vertical integration on primary healthcare has been mixed and limited. Our study aims to evaluate the empirical effects of vertical integration reform on PHIs in China, and examines variations across integration intensity (tight integration vs. loose collaboration). This study used a longitudinal design. The time-varying difference-in-difference (DID) method with a fixed-effect model for panel data was adopted. A total of 370 PHIs in the eastern, central, and western areas of China from 2009 to 2018 were covered. Outcome measures included the indicators at three dimensions regarding inpatient and outpatient service volume, patient flow between PHIs and hospitals and quality of chronic disease care (hypertension and diabetes). Significant increases in absolute (the number) and relative (the ratio between PHIs and hospitals) volume of inpatient admissions have been found after reform under tight integration, peaking at 183% and 15.0% respectively, in the third reform year. The quality of hypertension and diabetes care (by indicators of control rate of blood pressure and blood glucose) showed significant improvements under both types of vertical integration after reform. It was much more distinct for the PHIs under tight integration, which had the most significant increase of 34.0% and 22.8% under tight integration for the control rate of hypertension and diabetes compared to the peak of 21.2% and 22.1% respectively under loose collaboration. Our findings suggest that vertical integration (especially tight integration) in China significantly contributed to strengthening primary healthcare in terms of inpatient services and quality of hypertension and diabetes care, providing empirical evidence to other countries on integrating primary healthcare-based health systems.

Recovery of outpatient imaging utilization during the first wave of the COVID-19 pandemic

ObjectiveDuring the COVID-19 pandemic, Radiology practices experienced marked reductions in outpatient imaging volumes. Our purpose was to evaluate the timing, rate, and degree of recovery of outpatient imaging during the first wave of the pandemic. We also sought to ascertain the relationship of outpatient imaging recovery to the incidence of COVID-19 cases. MethodsRetrospective study of outpatient imaging volumes in a large healthcare system was performed from January 1, 2019-August 25, 2020. Dataset was split to compare Pre-COVID (weeks 1–9), Peak-COVID (weeks 10–15) and Recovery-COVID (weeks 16–34) periods. Chi-square and Independent-samples t-tests compared weekly outpatient imaging volumes in 2020 and 2019. Regression analyses assessed the rate of decline and recovery in Peak-COVID and Recovery-COVID periods, respectively. ResultsTotal outpatient imaging volume in 2020 (weeks 1–34) was 327,738 exams, compared to 440,314 in 2019. The 2020 mean weekly imaging volumes were significantly decreased in Peak-COVID (p = 0.0148) and Recovery-COVID (p = 0.0003) periods. Mean weekly decline rate was −2580 exams/week and recovery rate was +617 exams/week. The 2020 Post-COVID (weeks 10–34) period had an average decrease of 36.5% (4813.4/13,178.6) imaging exams/week and total estimated decrease of 120,335 exams. Significant inverse correlation (−0.8338, p < 0.0001) was seen between positive-tested COVID-19 cases and imaging utilization with 1-week lag during Post-COVID (weeks 10–34) period. ConclusionRecovery of outpatient imaging volume during the first wave of COVID-19 pandemic showed a gradual return to pre-pandemic levels over the course of 3–4 months. The rate of imaging utilization was inversely associated with new positive-tested COVID-19 cases with a 1-week lag.

Emergency department utilization by gynecologic cancer patients during the COVID-19 pandemic: unintended improvements in the selective use of emergency care?

Objectives:To evaluate the effects of the COVID-19 pandemic on emergency department (ED) utilization by gynecologic oncology patients in a large academic cancer center.Methods:Institutional data were captured from the EMR for the first 4 months of the US COVID-19 pandemic (March-June 2020) and compared to a historical control (March-June 2019). Data were collected from three major hospitals within an urban academic health system. Patients were identified as those with a gynecologic cancer diagnosis and active treatment (chemotherapy and/or radiation) within the prior 180 days of ED encounter, with an outpatient oncology visit within the last 90 days. Data including number and location of emergency department visits, admission outcomes, primary ICD-10 emergency department diagnosis, payer type, and patient demographics were collected. Descriptive statistics were performed.Results:Gynecologic oncology patients were significantly less likely to present to the ED for care during the first 4 months of COVID-19 (n=91) when compared to a historical control (n=144), p<0.01. Patients presenting during COVID were more likely to be admitted (43/91 vs 47/144, p<0.01), and to be kept for observation (18/43 vs 8/47, p=0.01). Of patients who were admitted, those presenting during COVID were significantly more likely to require an ICU stay during admission (12/43 vs 5/47, p=0.04). Six patients admitted during COVID (14%) died during their admission, while 3 patients (6%) died in the control group. There were no differences with respect to race, payor type, diagnosis, length of stay, or need for procedures when comparing patients admitted during COVID versus the control group. Four patients were COVID 19 positive during admission, which contributed to 1 patient death. Utilization of the health system's outpatient oncology urgent care center remained unchanged during COVID-19 (n=19 vs. n=15, p=0.43).Conclusions:Fewer gynecologic cancer patients presented to the ED during the COVID-19 pandemic, and those presenting had increased rates of indicated and complex care requirements. The concurrent stability in the outpatient urgent care center volume highlights a potential role for more stringent patient triaging to improve healthcare utilization in this vulnerable population going forward.

All India Ophthalmological Society Financial Impact Survey on ophthalmology practice in India during COVID-19.

Purpose:A survey was conducted by the All India Ophthalmological Society (AIOS) to document the initial coronavirus disease 2019 (COVID-19)-related financial impact on ophthalmology practice in India. It also assessed various measures taken by ophthalmologists and the possible role of AIOS in mitigating the economic crisis.Methods:An online questionnaire-based cross-sectional survey was conducted among its registered members from July to August 2020. The prevalidated questionnaire contained 25 items related to the impact of COVID-19 on patient volume, the extent of financial distress faced by the ophthalmologists, and various proactive measures taken by them. All valid responses were tabulated and analyzed.Results:Out of 1,026 respondents, more than 90% ophthalmologists faced a 25% or more reduction in outpatient and surgical volume. Nearly 59% reported that they can suffer from serious financial distress in near future due to COVID-19 pandemic-related losses. Those who are young (P < 0.0005), salaried (P < 0.0005), and practicing in private sector (P < 0.0005) and Tier 1 cities (P < 0.0005) are reported to be more vulnerable to become financially unstable. The major concerns were revenue losses (70%), preexisting debts (39%), and increased operating costs (27%). The majority (90%) believed that AIOS can help in alleviating the distress. There was also hesitancy regarding the adoption of teleophthalmology and home-based care.Conclusion:COVID-19 has significantly affected the financial sustainability of ophthalmologists practicing in India. Identification of vulnerable groups and timely advocacy efforts by AIOS can help in mitigating this financial crisis.

Pandemic Use of Telehealth by Oncology at a Rural Academic Medical Center.

Introduction: The COVID-19 pandemic resulted in an exponential increase in telehealth. In response to the pandemic, Dartmouth-Hitchcock Health (D-HH) and its Norris Cotton Cancer Center (NCCC) closed non-essential in-person services on March 17, 2020 and began reopening on April 27, 2020. We examined outpatient telehealth utilization at D-HH and NCCC in the peri-pandemic period and compared utilization to the Academic Medical Center (AMC) overall and to other service lines. Methods: Weekly outpatient volumes, percentage telehealth, percentage video versus audio-only, and percentage of new patients were examined for D-HH, for the AMC, and for selected AMC-based service lines from January 1 to October 31, 2020. Results: Compared with the AMC overall and with five other primarily non-surgical specialties, oncology was lower in the (1) proportion of outpatient visits performed via telehealth (example week 7/12/20: oncology = 11%; AMC = 21%; mean of 5 other specialties = 38%) and (2) percentage of telehealth involving video versus audio-only (7/12/20: oncology = 19%; AMC = 58%; mean of 5 others = 60%). Oncology more closely resembled the surgical specialty of orthopedics (7/12/20: 2% telehealth; 10% of telehealth involved video). Oncology also demonstrated (1) a high proportion of outpatient visits involving procedures (oncology = 22%; orthopedics = 12%) and (2) no difference between telehealth and in-person visits in terms of the percentage involving new patients. Conclusions: During the peri-pandemic period, our oncology service demonstrated a lower than average incorporation of telehealth overall into their outpatient practice and a lower proportion of telehealth performed by video. Further understanding these results and the drivers behind them will be integral for redesigning outpatient oncology care with optimal integration of telehealth.

Candidacy for ambulatory outpatient shoulder arthroplasty: a retrospective review

BackgroundOutpatient shoulder arthroplasty performed in an ambulatory surgery center has been shown to be a safe and cost-effective practice in appropriately selected patients. The decision to proceed with outpatient shoulder arthroplasty is based on a multitude of factors, including the patient's overall medical status, insurance type, social factors, and complexity of shoulder pathology. Currently, there is a paucity of literature that exists identifying the main drivers in determining in which setting, outpatient or inpatient, shoulder arthroplasty is performed. MethodsA retrospective chart review of 1017 patients who underwent total shoulder arthroplasty (TSA) or reverse total shoulder arthroplasty at a single institution between January 2014 and February 2020 was performed. Each patient was screened for medical candidacy using a previously described evidenced-based patient selection algorithm based on age and cardiopulmonary risk factors. Clinical documentation and billing records were reviewed to determine the setting in which the shoulder arthroplasty was performed and the primary factors for determining inpatient shoulder arthroplasty. ResultsOverall 837 (82.3%) arthroplasties were performed inpatient, with at least a 23-hour hospital stay, and 180 (17.7%) were performed outpatient at a free-standing ambulatory orthopedic surgery center. The patient selection algorithm identified 522 (51.3%) patients as medical candidates for outpatient surgery. Poor candidacy based on medical risk stratification (495; 59.1%) and government insurance payors (231; 27.6%) were the most common reasons for a procedure to be performed in an inpatient setting. Among those deemed appropriate outpatient candidates but who had surgery in an inpatient setting, insurance status (231; 67.5%) was the most common reason, whereas additional medical or social concerns represented a smaller proportion (40; 11.7%). Eliminating shoulder arthroplasty as an inpatient-only code would have effectively transitioned 231 patients, 22.7% of the entire cohort, from an inpatient setting to an outpatient setting. ConclusionsMedical stratification and insurance status both contribute significantly toward the decision to perform shoulder arthroplasty outpatient. Should policy change occur that eliminates shoulder arthroplasty from the Centers for Medicare and Medicaid Services inpatient-only distinction, a significant increase in outpatient shoulder arthroplasty volume would be expected. In the absence of insurance requirements, our data suggest that 40.4% of patients could safely undergo shoulder arthroplasty in an outpatient setting. Level of EvidenceLevel III, retrospective comparative study.

Impact of COVID-19 Lockdown on Oral Oncology-related Outpatient Volume at Indian Dental Institutions

This study aimed to evaluate the impact of the lockdown on oral oncology-related out-patient volume at Indian dental institutions. The total number of newly diagnosed cases of oral submucous fibrosis, oral leukoplakia, oral lichen planus, and oral cancers, recorded at two dental institutional settings before lockdown (January-March 2020) and after lockdown (June-August 2020), were included retrospectively and compared. The study included a total of 797 cases at both institutions. At Institution-I, a total of 312 cases were recorded before the lockdown, and 63 cases were recorded after the lockdown. At Institution-II, a total of 311 cases were reported before lockdown, and 111 cases were recorded after lockdown. Comparisons between the pre-lockdown and post-lockdown data yielded a significant change in the proportions of oral sub-mucous fibrosis, oral leukoplakia, oral lichen planus, and oral cancers at both institutions (Chi-square test; p < 0.001). Following the lockdown, a substantial reduction was observed in the proportion of oral submucous fibrosis (OSMF) cases at both institutions, and the proportion of oral cancers increased at both institutions. There was a significant difference between the proportions of cases reported before lockdown at both institutions (p < 0.001). However, after-lockdown, no such differences were noted (p = 0.69); the absence of significance could most likely be due to the low sample size or low-power during the post-lockdown period. The oral potentially malignant disorders (OPMD) and oral cancer (OC) patient volumes reduced substantially following lockdown. During the post-lockdown period, the proportion of oral cancers increased, whereas the proportion of OSMF cases decreased. Results indicate that OPMD and oral cancer patients were impacted differently by the lockdown. This study provides insight into the impact of lockdown and highlights the importance of reestablishing oral oncology-related patient care. A vital discussion is also provided on useful compensatory strategies that may reduce delays during the ongoing crisis. How to cite this article: Panta P, Reddy P, Misra SR, et al. Impact of COVID-19 Lockdown on Oral Oncology-related Outpatient Volume at Indian Dental Institutions. J Contemp Dent Pract 2021;22(5):501-505.

The impact of the coronavirus disease 2019 pandemic on gastroenterologists in Southeast Asia: A mixed-methods study.

The coronavirus disease 2019 pandemic has impacted gastroenterology practices worldwide; however, its protracted effects within Southeast Asia were unknown. The primary aim of the study was to determine the impact of the pandemic on clinical demands including burnout among gastroenterologists within the region. The secondary aim was to identify risk factors for burnout and determine regional stressors. This was a mixed-methods study. Gastroenterologists were surveyed electronically between September 1 and December 7, 2020, via gastroenterology and endoscopy societies of Brunei, Indonesia, Malaysia, Philippines, Singapore, and Thailand. Quantitative and qualitative data were collected. The 22-item Maslach Burnout Inventory-Human Services Survey (MBI-HSS) was used to detect burnout. Quantitative data were non-parametric; non-parametric methods were used for statistical comparisons. Logistic regression was used to determine risk factors for burnout. Content analysis method was used to analyze qualitative data. Ethical approval was obtained. A total of 73.0% reported that they were still significantly affected by the pandemic. Of these, 40.5% reported increased workload and 59.5% decreased workload. Statistically significant differences in weekly working hours, endoscopy, and inpatient volumes were present. No differences were observed in outpatient volumes, likely because of telemedicine. Burnout was common; however, 50.1% of gastroenterologists were unaware of or did not have access to mental health support. This, as well as depression, being a trainee, and public sector work, increased burnout risk significantly. The effects of the pandemic are multifaceted, and burnout is common among Southeast Asian gastroenterologists. Safeguards for mental health are suboptimal, and improvements are urgently needed.

Patient volume and quality of primary care in Ethiopia: findings from the routine health information system and the 2014 Service Provision Assessment survey

BackgroundSeveral studies have reported inadequate levels of quality of care in the Ethiopian health system. Facility characteristics associated with better quality remain unclear. Understanding associations between patient volumes and quality of care could help organize service delivery and potentially improve patient outcomes.MethodsUsing data from the routine health management information system (HMIS) and the 2014 Ethiopian Service Provision Assessment survey + we assessed associations between daily total outpatient volumes and quality of services. Quality of care at the facility level was estimated as the average of five measures of provider knowledge (clinical vignettes on malaria and tuberculosis) and competence (observations of family planning, antenatal care and sick child care consultations). We used linear regression models adjusted for several facility-level confounders and region fixed effects with log-transformed patient volume fitted as a linear spline. We repeated analyses for the association between volume of antenatal care visits and quality.ResultsOur analysis included 424 facilities including 270 health centers, 45 primary hospitals and 109 general hospitals in Ethiopia. Quality was low across all facilities ranging from only 18 to 56% with a mean score of 38%. Outpatient volume varied from less than one patient per day to 581. We found a small but statistically significant association between volume and quality which appeared non-linear, with an inverted U-shape. Among facilities seeing less than 90.6 outpatients per day, quality increased with greater patient volumes. Among facilities seeing 90.6 or more outpatients per day, quality decreased with greater patient volumes. We found a similar association between volume and quality of antenatal care visits.ConclusionsHealth care utilization and quality must be improved throughout the health system in Ethiopia. Our results are suggestive of a potential U-shape association between volume and quality of primary care services. Understanding the links between volume of patients and quality of care may provide insights for organizing service delivery in Ethiopia and similar contexts.

A Telemonitoring Intervention for Cirrhotic Ascites Management Is Cost-Saving.

BackgroundPatients with cirrhosis and ascites experience frequent hospital admissions, leading to poor quality of life and high healthcare costs. Monitoring weight is a component of ascites care and telemonitoring may improve outcomes and costs.GoalsWe aimed to evaluate the cost and outcomes of current care compared to a telemonitoring system for ascites.StudyWe developed a decision-analytic model that examined 100 simulated patients over a 6-month horizon. We compared usual care to a new telemonitoring program, which we estimate costs $50,000/6 months.ResultsThe cost of standard of care for 100 patients with cirrhotic ascites over a 6-month period is $167,500 more expensive than telemonitoring. By varying parameter probabilities by ± 10% and outcome costs by ± 20%, we found that standard of care remains more expensive than care with a telemonitoring intervention by $9400 to $340,200 per 6-month period. Standard of care leads to 9 more admissions (range 4 to 12) than a telemonitoring intervention, while telemonitoring leads to 9 more outpatient visits (range 6 to 9) and 28 additional outpatient large volume paracenteses (LVPs) (range 17 to 28). With more and less expensive telemonitoring interventions, standard of care remained more expensive. With 50% adherence to the intervention, standard of care was $89,848 more expensive.ConclusionsIn almost all probability and cost scenarios, a telemonitoring intervention is cost-saving for the management of cirrhotic ascites. Using hospital admissions as a surrogate for quality of care, patient outcomes are improved primarily though more proactive medical intervention and more LVPs.Supplementary InformationThe online version contains supplementary material available at 10.1007/s10620-021-07013-2.

Impact of China\u2019s zero mark-up drug policy on drug cost of NCDs\u2019 outpatients: an interrupted time series analysis

BackgroundChina proposed the Zero Markup Drug Policy (ZMDP), which popularized in tertiary hospitals across the country in 2017, to control drug expenditures’ rapid growth further and reduce the public’s medical burden. This study aims to evaluate the impact of ZMDP on the drug cost of chronic disease outpatients in the tertiary hospital in Chongqing.MethodsWe collected and described the drug-cost data for outpatients with chronic diseases in a Chongqing’s tertiary hospital from 2015 to 2019. The instantaneous and long-term changes of the outpatient volume and average drug cost after the ZMDP were evaluated using interrupted time series (ITS). We also analyzed the policy’s impact under the stratification of gender, age, and basic medical insurance types.ResultsA total of 350,848 outpatients were collected from January 2015 to February 2019. After the ZMDP, the outpatient volume for diabetes, hypertension, and coronary heart disease (CHD) all showed a downward trend, with a decrease of 53.04 (P = 0.012), 142.19 (P < 0.01) and 12.16 (P < 0.001) per month. Simultaneously, the average drug cost decreased by 4.44 yuan (P = 0.029), 5.87 yuan (P < 0.001) and 10.23 yuan (P = 0.036) per month, respectively. By gender, the average drug cost of diabetes in males had the most considerable instantaneous change, reducing by 51.21 yuan (P = 0.017); the decline of CHD in women is the most obvious, with an average monthly decrease of 12.51 yuan (P < 0.001). By age, the instantaneous change of CHD was the greatest for those older than 65 years old, with a decrease of 102.61 yuan (P = 0.030). CHD in 46–65 years old showed the most significant reduction, with an average monthly decline of 11.70 yuan (P < 0.01). BMIUE’s hypertension had the most considerable instantaneous change, which decreased 59.63 yuan (P = 0.010). BMIUE’s CHD showed the most apparent downward trend, with an average monthly decrease of 10.02 yuan (P = 0.010).ConclusionThe ITS analysis is an effective method of health policy evaluation. The implementation of the ZMDP can reduce the drug cost for chronic disease outpatients in the tertiary hospital and their economic burden. Follow-up policies still require targeted price adjustments in the health service system to adjust the drug cost-effectively.

Abstract No. 442 The role of telemedicine in the maintenance of interventional radiology outpatient evaluation and management volume during the COVID-19 global pandemic

To assess the impact of COVID-19 on the overall volume of IR outpatient-based evaluation and management encounters (E&M) and to demonstrate the role of telehealth in offsetting the loss of volume caused by COVID-19

Update from the American Urological Association's Residents and fellows committee.

The American Urological Association’s (AUA) Residents and Fellows committee, since its inception in 2002, represents the voice of trainee members of the AUA. Over the past few years, the committee has been investigating issues surrounding parental leave among US residents. Through the help of the AUA our committee developed a survey [1]. We found that 1 in 4 residents have children and 80% of those residents had a child during residency. We also found that 78% of residents took <2 weeks off after the birth of their child. Currently, there is no national American Board of Urology (ABU) policy for trainees [2, 3]. Our committee has had the opportunity to interface with the ABU to express concerns surrounding the lack of parental leave policy for trainees. Over the past year, the ABU has worked with the numerous stakeholders to develop a standardised parental leave policy that will be put into place this July. Residents will be allowed to take 6 weeks of parental leave without affecting vacation or sick leave and without an extension of training. Additionally, residents will be allowed an additional 2–4 weeks of leave depending on their year of training. This policy effectively will provide 8–10 weeks of parental leave. Our committee has offered full support for ABU’s pending policy and appreciation for their acknowledgement of parental leave as an issue critical to trainees. Most recently, over the past year our committee also worked to support residents during the COVID-19 pandemic. Urology residents were faced with uncertainty on a daily basis during the pandemic with decreased inpatient, outpatient, and surgical volumes [4]. Additionally, didactics were disrupted and residents were redeployed to COVID units. Collaborative efforts for urology resident education emerged across the country. One of the first initiatives was the UCSF Urology COViD (Urology Collaborative Online Virtual Didactics) lecture series [5]. Similarly, residents from the New York Section of the AUA created the Educational Multi-institutional Program for Instructing Residents (EMPIRE) lecture series [6]. These lectures provided critical didactic education that was suddenly absent from residency training. Topics spanned the breadth of urology and experts across the country volunteered to be presenters. The virtual educational series did more than just replace missing didactics, they presented a novel opportunity for a more interconnected national resident education program. These virtual education series derived their success from several factors. First, they met a widespread demand for easily accessible educational opportunities during the pandemic. Second, using teleconference platforms, the lectures maintained a sense of interactivity through live question and answer sessions and audience surveys. Alternatively, recordings of these sessions provided flexibility for learning. Third, by addressing a wide variety of topics, learners could tailor their experience around their interests. And finally, informal ‘mentoring sessions’ with each speaker before the lectures provided timely insights and career advice for residents and students. The creation of a digital library of urology lectures and the collaboration necessary to rise to these challenging times will likely have long-lasting effects. The challenge of the COVID-19 pandemic created an opportunity for an entirely interconnected urology resident cohort. Will urology residents be inspired to pursue fellowship after increased exposure to subspecialists? Could this serve as the foundation to create a national resident mentorship program? Despite the challenges of the COVID-19 pandemic the work of the AUA Residents and Fellows Committee has continued and our constituency is more connected than ever. The authors have no relevant interests to disclose.

Abstract No. 89 Development and deployment of a comprehensive telemedicine program allows for restoration of outpatient clinic volumes and continuing patient access during the COVID-19 pandemic

Purpose: To evaluate the effect of telemedicine initiatives on restoring and maintaining access to an interventional radiology clinic at an academic medical center during the COVID-19 pandemic Materials and Methods: Institutional billing and administrative data were retrospectively reviewed over a 52-week period, from September 2019 to August 2020. Phase 1 (29 weeks) represented pre-pandemic, normal operations. Phase 2 was the period when telephone encounters were available (11 weeks), with Phase 3 representing the period when both telephone and video encounters were available (12 weeks). The final day of in-person clinic visits was March 23, 2020. Telephone visits were initially used to maintain clinic access for patients. After a period of development and testing, video consultation was available after 76 days. Guidelines and requirements related to the provision of telemedicine services, as outlined at institutional, state and national levels, were adhered to over the study period. Visit type and basic patient demographic information was recorded. Results: There were 6,522 clinic visits over the study period. In the pre-pandemic period (Phase 1), telephone encounters represented 2.4% of monthly clinic encounters (range 0.4 – 3.7%), with a total of 104 telephone visits completed in this time. In phases 2 and 3, the monthly telephone encounters ranged from 242 to 466, representing 70% - 86% of all clinic encounters. There were 420 video visits completed in Phase 3, representing between 25.4% - 32% of monthly clinic encounters. Of these video encounters, 35.2% were performed at satellite centers, with the remainder performed by providers on the main campus. Telemedicine services were provided to residents of 41 states and the District of Columbia;however, provision of services was contingent on the patient’s physical location at the time of the encounter, based on billing and licensing requirements. Out-of-state residents represented 15% and 27.2% of video and telephone encounters, respectively. With the availability of both telephone and video visits in Phase 3, clinic encounters in June, July and August were at 98.7%, 104% and 87.7% of average monthly pre-pandemic volume, respectively. However, despite restoration of clinic encounters in phase three to 96.4% of pre-pandemic levels, billing for Evaluation and Management lagged behind, reaching 38.9% of pre-pandemic levels in the same period. Conclusions: Despite a precipitous fall in clinic volume in the earliest days of the pandemic, roll-out of telemedicine services allowed for restoration of clinic volumes to near pre-pandemic levels.

The impact of COVID-19 pandemic on colorectal cancer patients: a single-center retrospective study

BackgroundSince December 2019, China has experienced a public health emergency from the coronavirus disease, which has become a pandemic and is impacting the care of cancer patients worldwide. This study evaluated the impact of the pandemic on colorectal cancer (CRC) patients at our center and aimed to share the lessons we learned with clinics currently experiencing this impact.MethodsWe retrospectively collected data on CRC patients admitted between January 1, 2020 and May 3, 2020; the control group comprised patients admitted between January 1, 2019 and May 3, 2019.ResultsDuring the pandemic, outpatient volumes decreased significantly, especially those of nonlocal and elderly patients, whereas the number of patients who received chemotherapy and surgery remained the same. During the pandemic, 710 CRC patients underwent curative resection. The proportion of patients who received laparoscopic surgeries was 49.4%, significantly higher than the 39.5% during the same period in 2019. The proportion of major complication during the pandemic was not significantly different from that of the control group. The mean hospital stay was significantly longer than that of the control group.ConclusionsCRC patients confirmed to be infection-free can receive routine treatment. Using online medical counseling and appropriate identification, treatment and follow-up can be effectively maintained. Adjuvant and palliative chemotherapy should not be discontinued. Endoscopic polypectomy, elective, palliative, and multidisciplinary surgeries can be postponed, while curative surgery should proceed as usual. For elderly CRC patients, endoscopic surgery and neoadjuvant radiotherapy are recommended.

Medical Data Feature Learning Based on Probability and Depth Learning Mining: Model Development and Validation.

BackgroundBig data technology provides unlimited potential for efficient storage, processing, querying, and analysis of medical data. Technologies such as deep learning and machine learning simulate human thinking, assist physicians in diagnosis and treatment, provide personalized health care services, and promote the use of intelligent processes in health care applications.ObjectiveThe aim of this paper was to analyze health care data and develop an intelligent application to predict the number of hospital outpatient visits for mass health impact and analyze the characteristics of health care big data. Designing a corresponding data feature learning model will help patients receive more effective treatment and will enable rational use of medical resources.MethodsA cascaded depth model was successfully implemented by constructing a cascaded depth learning framework and by studying and analyzing the specific feature transformation, feature selection, and classifier algorithm used in the framework. To develop a medical data feature learning model based on probabilistic and deep learning mining, we mined information from medical big data and developed an intelligent application that studies the differences in medical data for disease risk assessment and enables feature learning of the related multimodal data. Thus, we propose a cascaded data feature learning model.ResultsThe depth model created in this paper is more suitable for forecasting daily outpatient volumes than weekly or monthly volumes. We believe that there are two reasons for this: on the one hand, the training data set in the daily outpatient volume forecast model is larger, so the training parameters of the model more closely fit the actual data relationship. On the other hand, the weekly and monthly outpatient volume is the cumulative daily outpatient volume; therefore, errors caused by the prediction will gradually accumulate, and the greater the interval, the lower the prediction accuracy.ConclusionsSeveral data feature learning models are proposed to extract the relationships between outpatient volume data and obtain the precise predictive value of the outpatient volume, which is very helpful for the rational allocation of medical resources and the promotion of intelligent medical treatment.