Physician Office Visits Research Articles

Comorbid depression and anxiety and their association with health care resource utilization among individuals with type 1 diabetes in the United States.

Type 1 diabetes mellitus (T1DM) is a prevalent chronic endocrine disorder and accounts for 5%-10% of all diabetes cases worldwide. T1DM can have a substantial impact on health care utilization. Although it is well known that individuals with diabetes are at a greater risk of mental health disorders, specific evidence addressing the health care burden of comorbid depression/anxiety in people affected by T1DM is lacking. To assess health care resource utilization (HCRU) among adults with T1DM and comorbid depression or anxiety. We identified individuals aged 18 to 64 with a T1DM diagnosis from January 1, 2017, to December 31, 2021, using a 25% random sample of the IQVIA PharMetrics Plus for Academics database. The index date was the date of the first medical claim with a T1DM diagnosis. Eligibility required continuous medical and prescription coverage for 12 months before (baseline) and after (follow-up) the index date. Comorbid depression/anxiety and baseline characteristics were assessed during the baseline period. The following 2 mutually exclusive groups were created: individuals with T1DM and comorbid depression/anxiety, and those with only T1DM. To balance baseline demographic and clinical characteristics between the groups, we implemented 1:1 propensity-score matching. We assessed all-cause, diabetes-related, and major adverse cardiovascular event-related HCRU during the follow-up period. Logistic (binary) and negative binomial (count) regression models examined the association between comorbid depression/anxiety and HCRU across types of health care settings. Out of 6,491 eligible individuals with T1DM, 1,168 (18%) had either depression or anxiety. In the matched cohort of 2,314 individuals, those with T1DM and comorbid depression/anxiety had significantly higher odds of all-cause emergency department visits (odds ratio = 1.67; 95% CI = 1.39-2.00) and higher rates of physician office visits (incidence rate ratio = 1.37; 95% CI = 1.27-1.47) and other outpatient encounters (incidence rate ratio = 1.23; 95% CI = 1.13-1.34) than those with only T1DM. Findings were similar for diabetes-related and major adverse cardiovascular event-related HCRU. Comorbid depression/anxiety among individuals with T1DM results in significantly higher HCRU than T1DM alone. The findings underscore the importance of effective management of comorbid depression/anxiety in the T1DM population.

Cost-Effectiveness of Bivalent Respiratory Syncytial Virus PrefusionF (RSVpreF) Vaccine During Pregnancy for Prevention of Respiratory Syncytial Virus Among Infants in Argentina.

Lower respiratory tract illness (LRTI) caused by respiratory syncytial virus (RSV) is common among young children in Argentina. Use of the currently available prophylactic agent is limited to children aged ≤ 2years with selected high-risk conditions, and thus the majority of infants remain unprotected. We estimated the value-based price (VBP) of a novel RSVpreF vaccine for use among pregnant people for prevention of RSV-LRTI among infants during the first year of life. Clinical outcomes and economic costs of RSV-LRTI during infancy and expected impact of RSVpreF vaccination during pregnancy were projected using a population-based Markov-type cohort model. Model results-estimated on the basis of gestational age at birth, disease/fatality rates, and mother's vaccination status-include total numbers of RSV-LRTI cases, RSV-LRTI-related deaths, and associated costs. Base case analyses (RSVpreF vs. no vaccine) were conducted from the healthcare system perspective. Probabilistic sensitivity analyses (PSA; 1000 replications) were also conducted. Willingness-to-pay (WTP) was $10,636 per quality-adjusted life-year (QALY; i.e., 1 × 2021 gross domestic product [GDP] per capita) in base case analyses and PSA. Costs are reported in USD, estimated on the basis of the June 22, 2023 exchange rate. Use of RSVpreF among 342,110 pregnant persons provided protection to 330,079 infants at birth. In total, RSVpreF prevented 3915 RSV hospitalizations, 6399 RSV cases requiring emergency department care, 6182 RSV cases requiring a physician office visit, and 67 disease-related deaths. Direct costs were projected to be reduced by $5.0million. With 2061 QALYs gained and vaccine administration cost of $1.4million, the VBP of RSVpreF was estimated to be $74.46 per dose. In PSA, mean VBP was $75.02 (95% confidence interval 54.24-97.30). RSVpreF among pregnant persons would significantly reduce the clinical and economic burden of RSV-LRTI among infants in Argentina and would be considered a cost-effective intervention up to a price of approximately $75.

Changes in Utilization and Expenditures Among Commercially Insured U.S. Adults With Diabetes During the COVID-19 Pandemic: Preliminary Findings

IntroductionPeople with diabetes were among the populations that experienced the most profound impacts during the COVID-19 pandemic. We estimated changes in healthcare utilization and expenditures for commercially insured adults aged 18-64 years with diabetes during the pandemic. MethodsMedical claims data were from IQVIA PharMetrics Plus. Linear regressions were used to estimate the changes in utilization (per 1,000 individuals) for inpatient stays, emergency room (ER) visits, physician office visits, and ambulatory surgery center (ASC) procedures. Changes in expenditures, in total and out-of-pocket, were estimated using generalized linear models. Expenditures were adjusted to 2021 U.S. dollars using the Consumer Price Index. ResultsUtilization was reduced significantly for all service types during the pandemic. While the largest reduction occurred between 03/2020-05/2020, the decrease persisted throughout 2021. During 03/2020-05/2020, ASC procedures were reduced by 4.7 visits per 1,000 individuals. The reduction ranged between 0.7 and 1.3 visits per 1,000 individuals subsequently. Expenditures declined for all service types during 03/2020-05/2020. However, after May 2020, the reduction remained statistically significant only for physician office visits for all months, with varying changes in expenditures for other service types. ConclusionHealthcare utilization and expenditures reduced among commercially insured adults with diabetes during the COVID-19 pandemic.

Healthcare resource utilization of patients with warm autoimmune hemolytic anemia initiating first line therapy of oral corticosteroids with or without rituximab.

This retrospective cohort study described real-world treatment patterns and healthcare resource utilization (HCRU) of patients with warm autoimmune hemolytic anemia (wAIHA) initiating treatment with first-line (1L) oral corticosteroids (OCS) + rituximab (R) compared to 1L OCS. Patients with a wAIHA diagnosis code (D59.11) between 8/2020-3/2022 were identified using US pharmacy and medical claims databases. Patients initiating 1L OCS ± R were identified (date of initiation = 'index date') with a 1-year pre-index period and a variable (minimum 1-year) follow-up period. The final sample comprised 77 1L OCS + R patients and 400 1L OCS patients (~ 60% female, mean age > 64 years). Over the 1-year follow-up, HCRU was higher in the OCS + R cohort with higher mean number of physician office visits (22.9 and 14.4; p < 0.01), including hematology/oncology office visits, and higher utilization of rescue therapy (59.7% and 33.3%; p < 0.01), driven by higher use of injectable corticosteroids. Patients in OCS + R and OCS groups completed 1L therapy after a similar mean duration of 103.5 and 134.6 days, respectively (p = 0.24). In the majority of patients, second-line (2L) therapy was initiated at a similar timepoint: 66.2% OCS + R and 72.0% OCS cohorts (p = 0.31) initiated 2L in a mean of 218.3 and 203.2 days (p = 0.76) after the end of 1L treatment, respectively. The addition of rituximab in 1L did not extend the remission period, with most patients in both cohorts initiating 2L therapy within less than 1 year of completing 1L treatment. 1L OCS + R patients also had substantial HCRU burden. More effective novel therapies are needed to address the high unmet need in wAIHA.

Association between adherence with oral anticancer medications and short-term health care resource utilization: A 2010-2018 claims-based analysis.

There is limited evidence on the effect of adherence to oral anticancer medications on health care resource utilization (HRU) among patients with cancer. To determine the association between adherence to oral anticancer medication and subsequent HRU. A retrospective cohort study was conducted using Optum Clinformatics® Data Mart commercial claims database. Patients who initiated an oral anticancer medication between 2010 and 2017 were included. Proportion of days covered was used to calculate medication adherence in the first 6 months after oral anticancer medication initiation. All-cause HRU in the following 6 months was assessed. Multivariable negative binomial regressions were used to determine the association between oral anticancer medication adherence and HRU, after controlling for confounders. Of 37,938 patients, 51.9% were adherent to oral anticancer medications. Adherence with oral anticancer medication was significantly associated with more frequent physician office and outpatient visits for several cancer types with the strongest association among those with liver cancer (adjusted incidence rate ratio [aIRR] = 1.34; 95% CI = 1.18-1.52 and aIRR = 1.32; 95% CI = 1.13-1.55, respectively). Oral anticancer medication adherence was associated with more emergency department visits only among patients with lung cancer (aIRR = 1.22; 95% CI = 1.01-1.48). Oral anticancer medication adherence was significantly associated with a higher rate of inpatient hospitalizations and longer stays among patients with liver cancer (aIRRs were 1.45 [95% CI = 1.02-2.05] and 2.15 [95% CI = 1.21-3.81], respectively), whereas hospitalizations were fewer and length of stay was shorter among patients with colorectal cancer who were adherent with oral anticancer medication (aIRRs were 0.77 [95% CI = 0.68-0.86] and 0.77 [95% CI = -0.66 to 0.90], respectively). Other measures did not reveal statistically significant differences in HRU among adherent and nonadherent patients for the cancer types included in the study. HRU following the initial phase of oral anticancer medication therapy was generally similar among adherent and nonadherent patients. We observed a slightly higher rate of office and outpatient visits among adherent patients, which may reflect ongoing monitoring among patients continuing oral anticancer medication. Further studies are needed to determine how oral anticancer medication adherence may affect HRU over a longer time period.

Prevalence and Cost of Routine Preoperative Care for Low-Risk Cataract Surgery a Decade after Choosing Wisely

ObjectiveExamine the frequency and cost of procedural clearance tests and exams in preparation for low-risk cataract surgery among members of a commercial healthcare organization in the US. Determine what characteristics most strongly predict receipt of preoperative care and the probability that preoperative care impacts post-surgical adverse events. DesignRetrospective health care claims analysis and medical records review from a large, blended-health organization headquartered in Western Pennsylvania, USA. ParticipantsMembers aged ≥65 years who were continuously enrolled 6 months before and after having cataract surgery from 2018 through 2021 and had approved surgery claim(s). MethodsPreoperative exams or tests occurring in the 30 days prior to surgery were identified via procedural and diagnosis codes on claims of eligible members (e.g., CPT codes for blood panels and preprocedural ICD-10 CM codes). Prevalence and cost were directly estimated from claims; variables predictive of preoperative care receipt and adverse events were tested using mixed effects modeling. Main Outcome MeasuresTotal costs, prevalence, and strength of association as indicated by odds ratios. ResultsUp to 42% of members having cataract surgery had a physician office visit for surgical clearance, and up to 23% of members had testing performed either in isolation or along with clearance visit(s). The combined costs for the preoperative visits and tests were $4.3M (approximately $107-114 per impacted member). There was little difference in member characteristics between those receiving and not receiving either preoperative testing or exams. Mixed effects models showed that the most impactful determinants of preoperative care were the surgical facility and member’s care teams; for preoperative testing, facilities were a stronger predictor than care teams. Adverse events were rare and unassociated with receipt of preoperative testing, exams, or a combination of the two. ConclusionsRates of routine preoperative testing before cataract surgery have not declined despite intervening guidance from the Choosing Wisely campaign to reduce this utilization. Additionally, preoperative evaluations, many likely unnecessary, were very common. Further attention to and reconsideration of current policies and practice for preoperative care may be warranted, especially at the facility level.

Tiered Physician Network Plans and Patient Choices of Specialist Physicians

Tiered physician network (TPN) health plans sort physicians into tiers based on their cost and quality, and patients pay lower copays for visits with physicians in the lower-cost and better-quality tiers. When the plans are first introduced, they lead patients to seek care from higher-value physicians. To examine whether TPNs are associated with patient choice of physician when the plans have been in place for 8 to 12 years and whether there are inequities in patient out-of-pocket costs associated with inequities in access to physicians in lower-copay tiers. This cross-sectional study comprising 46 645 physicians and 585 399 patients in TPNs, including 54 683 patients who had a new patient visit with a physician in a TPN, used health insurance claims data from a large employer purchaser from July 1, 2014, to June 30, 2019. Statistical analysis was performed from November 2020 to August 2023. Evaluation and management visit with a physician in a TPN. Main outcomes were new patient market share per physician-carrier-zip code-year, distance from centroid of patient zip code to centroid of zip code of nearest low- or medium-copay physician, and mean TPN physician office visit copay per patient. A regression discontinuity design was used to estimate the association of a physician's tier ranking, and a difference-in-differences analysis was used to estimate the association of copayment differences across tiers with market share among new patients. Equity in access was measured by comparing travel distance to the nearest physician in a low-copay or medium-copay tier and mean copayments across patient incomes. The main analysis sample included 46 645 physician-carrier-zip code-year observations, 9506 (20.4%) of which were in the low-copay tier, 31 798 (68.2%) in the medium-copay tier, and 5341 (11.5%) in the high-copay tier. The 54 683 new patients in the sample had a mean (SD) age of 46.4 (16.7) years and included 33 542 women (61.3%). There was no association of having a worse tier ranking (0.045 percentage points [95% CI, -0.058 to 0.148 percentage points]) or of copayment differences between tiers (0.001 percentage points [95% CI, -0.002 to 0.004 percentage points]) with physician market share among new patients. The patients with the lowest income paid slightly lower mean (SD) copayments for office visits to a TPN physician than the patients with high income ($48.08 [$16.42] vs $51.59 [$16.79], a 6.8% difference). In this cross-sectional study of TPN health plans, there was no association between physician tier ranking and physician market share among any group of patients. These findings suggest there are limitations in TPNs' steering of patients toward high-value physicians. These plans were not associated with exacerbated health inequity in this setting.

Health-Care Resource Utilization and Treatment Patterns in Men with Erectile Dysfunction and Benign Prostatic Hyperplasia-Associated Lower Urinary Tract Symptoms in the United States: A Retrospective Database Study.

To compare health-care resource utilization (HCRU) outcomes in patients with erectile dysfunction (ED) and benign prostatic hyperplasia-associated lower urinary tract symptoms (BPH-LUTS) treated with tadalafil or non-phosphodiesterase-5 inhibitor (PDE5i), adherence to and persistence with tadalafil by dose in the United States (US). This was a noninterventional, real-world evidence study of men (aged ≥45 years) with ED and BPH-LUTS treated with tadalafil or non-PDE5i. The IQVIA US PharMetrics Plus claims database was used. Outcomes included all-cause and disease-specific HCRU over a 12-month follow-up. Persistence with and adherence to tadalafil were evaluated stratified by dose (10 or 20 mg as needed; 2.5 or 5 mg as once daily [OD]). The final sample comprised 11,351 tadalafil and 48,722 non-PDE5i patients. For all-cause and disease-specific HCRU, including prescription fills, physician office visits, emergency room visits, laboratory tests, radiology examinations, outpatient surgical services, ancillary services, hospitalizations, mean number of utilizations, and proportions of patients with one or more utilizations, were lower for tadalafil compared with non-PDE5i patients. For all-cause HCRU, proportions of patients with one or more emergency room visits (18.6% vs 21.7%, p<0.0001) and outpatient surgical visits (63.0% vs 68.8%, p<0.0001) were significantly lower for tadalafil compared with non-PDE5i patients. For disease-specific HCRU, the proportion with one or more disease-specific physician office visits (55.1% vs 91.4%), laboratory tests (34.8% vs 58.2%), outpatient surgery (24.3% vs 38.9%), or outpatient ancillary services (18.0% vs 29.8%) were significantly lower for tadalafil compared with non-PDE5i patients (all comparisons, p<0.0001). Mean persistence days (179.8 vs 61.2), proportion persistence (35.8% vs 6.5%), and mean adherence (0.5 vs 0.2) were higher for tadalafil OD doses than as-needed tadalafil doses. Patients on tadalafil demonstrated less HCRU and higher persistence and adherence (OD versus as-needed tadalafil) than non-PDE5i patients, which demonstrates its benefit in the management of ED and BPH-LUTS in the US.

Costs and Resource Utilization of People with Stable Heart Failure and Insomnia: Evidence from a Randomized Trial of Cognitive Behavioral Therapy for Insomnia

ABSTRACT Objectives Nearly half of patients with chronic heart failure (HF) report insomnia symptoms. The purpose of this study was to examine the impact of CBT-I versus HF self-management on healthcare costs and resource utilization among patients with stable chronic HF who participated in a clinical trial of the effects of CBT-I compared to HF self-management education (attention control) over 1 year. Methods We measured resource utilization as self-reported (medical record review) physician office visits, emergency department visits, and inpatient admissions at 3-month intervals for 1 year after enrollment. Costs were estimated by applying price weights to visits and adding self-reported out-of-pocket and indirect costs. Univariate comparisons were made of resource utilization and costs between CBT-I and the HF self-management group. A generalized linear model (GLM) was used to model costs, controlling for covariates. Results The sample included 150 patients [79 CBT-I; 71 self-management (M age = 62 + 13 years)]. The CBT-I group had 4.2 inpatient hospitalizations vs 4.6 for the self-management group (p = .40). There were 13.1 outpatient visits, in the CBT-I compared with 15.4 outpatient visits (p-value range 0.39–0.81) for the self-management group. Total costs were not significantly different in univariate or ($7,813 CBT-I vs. $7,538 self-management), p = .96) or multivariable analyses. Conclusions Among patients with both HF and insomnia, CBT-I and HF self-management were associated with similar resource utilization and total costs. Additional research is needed to estimate the value of CBT-I relative to usual care and other treatments for insomnia in patients with HF.

Ruxolitinib for myelofibrosis in elderly non-transplant patients: healthcare resource utilization and costs

AimThis study evaluated real-world healthcare resource utilization (HCRU), direct costs, and overall survival (OS) of patients who were Medicare beneficiaries and were newly diagnosed with myelofibrosis (MF) who filled ≥1 prescription of ruxolitinib versus those who did not.Patients and MethodsThis was a study of the US Medicare fee-for-service database. Beneficiaries were aged ≥65 years with an MF diagnosis (index) between January 1, 2012 − December 31, 2017. Data were summarized descriptively. OS was estimated using Kaplan-Meier analysis.ResultsPatients with ≥1 prescription fill of ruxolitinib (n = 2,787) had lower mean rates (per patient per month [PPPM]) versus patients who did not fill a prescription for ruxolitinib (n = 7,262) for hospitalizations (0.16 vs 0.32), length of inpatient stay (0.16 vs 2.44 days), emergency department visits (0.10 vs 0.14), physician office visits (4.68 vs 6.25), skilled nursing facility stays (0.02 vs 0.12), home health/durable medical equipment services (0.32 vs 0.47), and hospice visits (0.30 vs 1.70). Monthly medical costs were numerically lower in patients who had ≥1 fill of ruxolitinib versus those who did not fill a prescription for ruxolitinib ($6,553 vs $12,929), largely driven by inpatient costs ($3,428 vs $6,689). Pharmacy costs were $10,065 and $987 in patients who filled versus did not fill ≥1 prescription for ruxolitinib, respectively; total PPPM all-cause healthcare costs were $16,618 and $13,916, respectively. The median OS was 37.5 and 18.7 months for the cohorts of patients who filled versus did not fill ≥1 prescription for ruxolitinib, respectively (hazard ratio = 0.63, 95% CI = 0.59 − 0.67).ConclusionsRuxolitinib is associated with reduced HCRU and direct costs of medical care in addition to increased survival, suggesting it to be a cost-effective advance for patients with MF.

Abstract 751: Disparities in physician office visit wait time among US cancer survivors

Abstract Background: Disparities are well-documented in the time spent seeking medical care in the US. Studies have found that minority populations are likely to have longer wait times securing healthcare access and higher total time spent at clinic visits. However, this relationship has not been previously examined among the cancer survivor population, which constitutes about 17 million people in the US. Methods: Study data were derived from the 2018 National Health Interview Survey, a nationally representative survey of US adults. Study sample was restricted to cancer survivors (n=2,940; N=23,310,174). The primary outcome of this study was reports of prolonged wait times during doctor office visits. Weighted multivariable logistic regression were used to estimate adjusted associations between prolonged wait times during doctor office visits and sociodemographic and behavioral characteristics of cancer survivors. All analyses were conducted using STATA version 14.2. Results: Respondents who identified as Black/African American were almost 3 times more likely than their White counterparts to report prolonged wait times during doctor office visits (aOR 2.65, 95% CI; 1.296, 5.419). Similarly, respondents who identified as Hispanic were almost 3 times more likely than non-Hispanic respondents to report prolonged wait times during doctor office visits (aOR 2.604, 95% CI; 1.347, 5.035). Respondents in the $50,000 - $74,999 income bracket were less likely to report prolonged wait times during doctor office visits than respondents who earned less than $35,000 (aOR: 0.50, 95% CI, 0.276, 0.916). Conclusion: Black/African American and Hispanic cancer survivors had increased odds of reporting prolonged wait times during doctor office visits. Disparities in cancer health and survivorship are well documented among racial minorities. Addressing disparities in healthcare experiences and access will be crucial in dispelling existing cancer health disparities. Citation Format: Onyema Chido-Amajuoyi, Ikenna Nnamani, Owhofasa Agbedia. Disparities in physician office visit wait time among US cancer survivors [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 751.

Documentation and Treatment of Obesity in Primary Care Physician Office Visits: The Role of the Patient-Physician Relationship.

An ongoing patient-physician relationship may increase the likelihood of acknowledging obesity and providing a treatment plan. The purpose of the study was to investigate if continuity of care was associated with recording of obesity and receipt of a weight-loss treatment plan. We analyzed data from the 2016 and 2018 National Ambulatory Medical Care Survey. Only adult patients with measured body mass index of ≥ 30 were included. Our primary measures were acknowledgment of obesity, treatment of obesity, continuity of care, and obesity-associated comorbid conditions. Among patients who were objectively obese, only 30.6% had an acknowledgment of the patient's body composition in the visit. In adjusted analyses, continuity of care was not significantly related to recording of obesity but did significantly increase the likelihood of treatment for obesity. Continuity of care was only significantly related to obesity treatment when defined as a visit with the patient's established primary care physician. The effect was not seen with continuity with the practice. There are many missed opportunities for prevention of obesity-related disease. Continuity of care with a primary care physician was associated with benefits in treatment likelihood, but greater emphasis on managing obesity in a primary care visit seems warranted.

Economic Burden of Asthma in Northwest Iran.

The economic burden of asthma is a major public health concern. This study estimates the economic burden of asthma in Northwest of Iran. A longitudinal study was conducted between 2017 and 2018 in Tabriz (Iran) using the Persian version of the Work Productivity and Activity Impairment (WPAI) questionnaire. Direct and indirect costs associated with asthma were estimated based on the societal perspective, prevalence-based approach, and bottom-up method. Annual indirect costs were estimated using the human capital (HC) method. The structural equation model was used to evaluate the relationship between costs, sex, and asthma severity. A total of 621 patients with asthma were enrolled in the study. Significant differences were found between female and male patients for the mean cost of radiology (P=0.006), laboratory (P=0.028), and diagnostic (P=0.017) tests at baseline, and for laboratory (P=0.012), and diagnostic (P=0.027) tests at one-year follow-up. The more severe asthma, the more significant the costs for annual physician office visits (P=0.040) and medications (P=0.013). As asthma severity increased, significantly higher expenditures were observed in women for days lost from work at baseline (P=0.009) and one-year follow-up (P=0.001), and in men for productivity loss at work due to impairment at baseline (P=0.045). A significant association between indirect costs and the cost of impairment-related lost productivity at work (β=3.29, P<0.001), and between severe asthma and indirect costs (β=32.36, P<0.001) was observed. High costs are incurred by Iranian asthma patients, especially because of impairment-related productivity loss at work associated with asthma exacerbation.

The Skin Antiseptic agents at Vaginal dElivery (SAVE) trial: study protocol for a randomized controlled trial

BackgroundCleansing of the vulva and perineum is recommended during preparation for vaginal delivery, and special attention is paid to cleansing before episiotomy because episiotomy is known to increase the risk of perineal wound infection and/or dehiscence. However, the optimal method of perineal cleansing has not been established, including the choice of antiseptic agent. To address this issue, we designed a randomized controlled trial to examine whether skin preparation with chlorhexidine-alcohol is superior to povidone-iodine for the prevention of perineal wound infection after vaginal delivery.MethodsIn this multicenter randomized controlled trial, term pregnant women who plan to deliver vaginally after episiotomy will be enrolled. The participants will be randomly assigned to use antiseptic agents for perineal cleansing (povidone-iodine or chlorhexidine-alcohol). The primary outcome is superficial or deep perineal wound infection within 30 days after vaginal delivery. The secondary outcomes are the length of hospital stay, physician office visits, or hospital readmission for infection-related complications, endometritis, skin irritations, and allergic reactions.DiscussionThis study will be the first randomized controlled trial aiming to determine the optimal antiseptic agent for the prevention of perineal wound infections after vaginal delivery.Trial registrationClinicalTrials.gov NCT05122169. First submitted date on 8 November 2021. First posted date on 16 November 2021

Characteristics of U.S. older adult medicare beneficiaries receiving the influenza vaccination at retail pharmacies

BackgroundPharmacy-provided influenza vaccination services have become more prevalent among the older adult population. However, little is known about the characteristics of older adults associated with receiving the influenza vaccination at retail pharmacies and how these associated characteristics have changed. ObjectiveTo examine characteristics of older adults associated with use of retail pharmacy-provided influenza vaccination services and how the characteristics changed between 2009 and 2015. MethodsThe study used a retrospective, cross-sectional design with data from the 2009 and 2015 Medicare Current Beneficiary Survey. Older adults aged 65 and older who completed a community questionnaire and received the influenza vaccination during the previous winter were identified. Andersen's Behavioral Model of Health Services Use was the conceptual framework for inclusion of the population characteristics. A multivariable log-binomial regression was performed to estimate the association between the population characteristics and use of pharmacy-provided vaccination service, and the relative change in associations between 2009 and 2015. Survey weights were applied in all analyses. ResultsThe results showed older adults who were non-Hispanic black (compared to non-Hispanic white), who did not have secondary private insurance (compared to those who had), who did not have physician office visit (compared to those who had) and who lived in non-metro area (compared to those who lived in metro area) had become more likely to use pharmacy-provided influenza vaccination services in 2015 than in 2009. ConclusionsPharmacy-provided influenza vaccination services appear to reduce access barriers for racially and socioeconomically disadvantaged older adults. Findings could help inform not only the retail pharmacies that provide vaccination services to better outreach to potential target populations but also policy makers about the disadvantaged populations that would benefit from the vaccination services provided by retail pharmacies.

Disparities in Physician Office Visit Wait Time Among Cancer Survivors in the USA.

Disparities in Physician Office Visit Wait Time Among Cancer Survivors in the USA.

Effective hospital readmission prediction models using machine-learned features

Background:Hospital readmissions are one of the costliest challenges facing healthcare systems, but conventional models fail to predict readmissions well. Many existing models use exclusively manually-engineered features, which are labor intensive and dataset-specific. Our objective was to develop and evaluate models to predict hospital readmissions using derived features that are automatically generated from longitudinal data using machine learning techniques.Methods:We studied patients discharged from acute care facilities in 2015 and 2016 in Alberta, Canada, excluding those who were hospitalized to give birth or for a psychiatric condition. We used population-level linked administrative hospital data from 2011 to 2017 to train prediction models using both manually derived features and features generated automatically from observational data. The target value of interest was 30-day all-cause hospital readmissions, with the success of prediction measured using the area under the curve (AUC) statistic.Results:Data from 428,669 patients (62% female, 38% male, 27% 65 years or older) were used for training and evaluating models: 24,974 (5.83%) were readmitted within 30 days of discharge for any reason. Patients were more likely to be readmitted if they utilized hospital care more, had more physician office visits, had more prescriptions, had a chronic condition, or were 65 years old or older. The LACE readmission prediction model had an AUC of 0.66 ± 0.0064 while the machine learning model’s test set AUC was 0.83 ± 0.0045, based on learning a gradient boosting machine on a combination of machine-learned and manually-derived features.Conclusion:Applying a machine learning model to the computer-generated and manual features improved prediction accuracy over the LACE model and a model that used only manually-derived features. Our model can be used to identify high-risk patients, for whom targeted interventions may potentially prevent readmissions.

Socioeconomic and demographic determinants of radiation treatment and outcomes in glioblastoma patients.

Poor outcomes in glioblastoma patients, despite advancing treatment paradigms, indicate a need to determine non-physiologic prognostic indicators of patient outcome. The impact of specific socioeconomic and demographic patient factors on outcomes is unclear. We sought to identify socioeconomic and demographic patient characteristics associated with patient survival and tumor progression, and to characterize treatment options and healthcare utilization. A cohort of 169 patients with pathologically confirmed glioblastomas treated at our institution was retrospectively reviewed. Multivariable cox proportional hazards analysis for overall survival (OS) and cumulative incidence of progression was performed. Differences in treatment regimen, patient characteristics, and neuro-oncology office use between different age and depressive disorder history patient subgroups were calculated two-sample t-tests, Fisher's exact tests, or linear regression analysis. The median age of all patients at the time of initiation of radiation therapy was 60.5 years. The median OS of the cohort was 13.1 months. Multivariable analysis identified age (Hazard Ratio 1.02, 95% CI 1.00-1.04) and total resection (Hazard Ratio 0.52, 95% CI 0.33-0.82) as significant predictors of OS. Increased number of radiation fractions (Hazard Ratio 0.90, 95% CI 0.82-0.98), depressive disorder history (Hazard Ratio 0.59, 95% CI 0.37-0.95), and total resection (Hazard Ratio 0.52, 95% CI 0.31-0.88) were associated with decreased incidence of progression. Notably, patients with depressive disorder history were observed to have more neuro-oncology physician office visits over time (median 12 vs. 16 visits, p = 0.0121). Patients older than 60 years and those with Medicare (vs. private) insurance were less likely to receive as many radiation fractions (p = 0.0014) or receive temozolomide concurrently with radiation (Odds Ratio 0.46, p = 0.0139). Older glioblastoma patients were less likely to receive as diverse of a treatment regimen as their younger counterparts, which may be partially driven by insurance type. Patients with depressive disorder history exhibited reduced incidence of progression, which may be due to more frequent health care contact during neuro-oncology physician office visits.

Abstract 10200: Costs and Resource Utilization of People With Stable Heart Failure and Insomnia: Evidence From a Randomized Trial

Introduction: Nearly half of patients with chronic heart failure (HF) report insomnia symptoms. Cognitive behavioral therapy for insomnia (CBT-I) is efficacious for treating insomnia in the presence of comorbid conditions. This study estimated healthcare costs and resource utilization for people with stable chronic HF and insomnia using data from an NIH-funded clinical trial comparing CBT-I with an HF self-management Methods: Using data from the HeartSleep Study, we examined resource utilization one year following randomization. Resource utilization was measured as self-reported physician office visits, emergency department visits, and inpatient admissions, collected at each follow-up. Costs were estimated by applying price weights to visits, and adding self-reported out of pocket expenses and indirect costs. Univariate comparisons were made of resource utilization and costs between CBT-I and attention control groups. A generalized linear model (GLM) was used to model costs, controlling for covariates. Results: There were no significant differences in demographic characteristics between patients who received CBT-I (N=79) and those who received HF self-management (attention control) (N=71). During the first year following randomization, participants receiving CBT-I had 4.2 inpatient hospitalizations compared to 4.6 for the attention control group (p = 0.40). Participants receiving CBT-I also had 13.1 outpatient visits on average, while control participants had 15.4 outpatient visits. Relatively few emergency department visits were required by either CBT-I or attention-control participants. Overall, total costs were slightly higher for participants who received CBT-I ($7,813 vs. $7,538, p = 0.96). In the multivariable analysis participants who received CBT-I had $630 in higher costs, but this was not statistically different from the attention control group. Conclusions: Among patients with both HF and insomnia, CBT-I and HF self-management had similar resource utilization and total costs. Additional research is needed to estimate the value of CBT-I relative to other treatments for insomnia in patients with HF.

A deep tensor-based approach for automatic depression recognition from speech utterances.

Depression is one of the significant mental health issues affecting all age groups globally. While it has been widely recognized to be one of the major disease burdens in populations, complexities in definitive diagnosis present a major challenge. Usually, trained psychologists utilize conventional methods including individualized interview assessment and manually administered PHQ-8 scoring. However, heterogeneity in symptomatic presentations, which span somatic to affective complaints, impart substantial subjectivity in its diagnosis. Diagnostic accuracy is further compounded by the cross-sectional nature of sporadic assessment methods during physician-office visits, especially since depressive symptoms/severity may evolve over time. With widespread acceptance of smart wearable devices and smartphones, passive monitoring of depression traits using behavioral signals such as speech presents a unique opportunity as companion diagnostics to assist the trained clinicians in objective assessment over time. Therefore, we propose a framework for automated depression classification leveraging alterations in speech patterns in the well documented and extensively studied DAIC-WOZ depression dataset. This novel tensor-based approach requires a substantially simpler implementation architecture and extracts discriminative features for depression recognition with high f1 score and accuracy. We posit that such algorithms, which use significantly less compute load would allow effective onboard deployment in wearables for improve diagnostics accuracy and real-time monitoring of depressive disorders.