Probability Of Hospital Admission Research Articles

Improved Utilization of Serial Testing Without Increased Admissions after Implementation of High-Sensitivity Troponin I: a Controlled Retrospective Cohort Study.

Guidelines recommend high-sensitivity cardiac troponin (hs-cTn) for diagnosis of myocardial infarction. Use of hs-cTn is increasing across the U.S., but questions remain regarding clinical and operational impact. Prior studies have had methodologic limitations and yielded conflicting results. To evaluate the impact of transitioning from conventional cardiac troponin (cTn) to hs-cTn on test and resource utilization, operational efficiency, and patient safety. Retrospective cohort study in two New York City hospitals during the months before and after transition from conventional cTn to hs-cTn at Hospital 1. Hospital 2 served as a control. Consecutive emergency department (ED) patients with at least one cTn test resulted. Multifaceted hs-cTn intervention bundle, including a 0/2-h diagnostic algorithm for non-ST-elevation myocardial infarction, an educational bundle, enhancements to the electronic medical record, and nursing interventions to facilitate timed sample collection. Primary outcomes included serial cTn test utilization, probability of hospital admission, ED length of stay (LOS), and among discharged patients, probability of ED revisit within 72h resulting in hospital admission. Multivariable regression models adjusted for age, sex, temporal trends, and interhospital differences. The intervention was associated with increased use of serial cTn testing (adjusted risk difference: 48 percentage points, 95% CI: 45-50, P < 0.001) and ED LOS (adjusted geometric mean difference: 50min, 95% CI: 50-51, P < 0.001). There was no significant association between the intervention and probability of admission (adjusted relative risk [aRR]: 0.99, 95% CI: 0.89-1.1, P = 0.81) or probability of ED revisit within 72h resulting in admission (aRR: 1.1, 95% CI: 0.44-2.9, P = 0.81). Implementation of a hs-cTn intervention bundle was associated with an improvement in serial cTn testing, a neutral effect on probability of hospital admission, and a modest increase in ED LOS.

Vaccine effectiveness against referral to hospital after SARS-CoV-2 infection in St. Petersburg, Russia, during the Delta variant surge: a test-negative case-control study

BackgroundThe results of a randomised trial showed the safety and efficacy of Gam-COVID-Vac against COVID-19. However, compared to other vaccines used across the globe, the real-world data on the effectiveness of Gam-COVID-Vac, especially against the disease caused by the Delta variant of concern, was limited. We aimed to assess the effectiveness of vaccination mainly conducted with Gam-COVID-Vac in St. Petersburg, Russia.MethodsWe designed a case-control study to assess the vaccine effectiveness (VE) against referral to hospital. Self-reported vaccination status was collected for individuals with confirmed SARS-CoV-2 infection who were referred for initial low-dose computed tomography (LDCT) triage in two outpatient centres in July 3–August 9, 2021, in St. Petersburg, Russia. We used logistic regression models to estimate the adjusted (for age, sex, and triage centre) VE for complete (14 days or more after the second dose) vaccination. We estimated the VE against referral for hospital admission, COVID-19-related lung injury assessed with LDCT, and decline in oxygen saturation.ResultsIn the final analysis, 13,893 patients were included, 1291 (9.3%) patients met our criteria for complete vaccination status, and 495 (3.6%) were referred to hospital. In the primary analysis, the adjusted VE against referral to hospital was 81% (95% confidence interval: 68–88) for complete vaccination. The VE against referral to hospital was more pronounced in women (84%, 95% CI: 66–92) compared to men (76%, 95% CI: 51–88). Vaccine protective effect increased with increasing lung injury categories, from 54% (95% CI: 48–60) against any sign of lung injury to 76% (95% CI: 59–86) against more than 50% lung involvement. A sharp increase was observed in the probability of hospital admission with age for non-vaccinated patients in relation to an almost flat relationship for the completely vaccinated group.ConclusionsCOVID-19 vaccination was effective against referral to hospital in patients with symptomatic SARS-CoV-2 infection in St. Petersburg, Russia. This protection is probably mediated through VE against lung injury associated with COVID-19.

Impact of Comorbidities on Hospitalization for Injuries in Riders of Electric Bikes and Powered Scooters: A Retrospective Cross-Sectional Study.

Background and Objectives: Injuries associated with electric bikes (E-bikes) and powered scooters (P-scooters) have increased yearly worldwide. We aimed to evaluate the impact of pre-existing comorbidities on the probability of hospitalization for injuries in riders of E-bikes and P-scooters. Materials and Methods: A retrospective cross-sectional study design was used. The cohort included patients referred to the emergency department (ED) of a tertiary medical center in 2014–2020 for injuries sustained while riding an E-bike or P-scooter. Data were collected from the medical files on demographics, clinical characteristics including pre-existing comorbidities and permanent use of medications, and injury characteristics. Findings were compared between patients referred for hospitalization from the ED and patients discharged home. Results: Of the 1234 patients who met the inclusion criteria, 202 (16.4%) had a prior medical condition and 167 (13.5%) were taking medication on a permanent basis. A significant relationship was found between hospitalization and having a medical condition (𝜒2(1) = 9.20, p = 0.002) or taking medication on a permanent basis (𝜒2(1) = 6.24, p = 0.01). Hospitalization for injuries was more likely in patients with a comorbidity (27.8%) than those without a comorbidity (15.5%), and in patients who were on permanent drug therapy (22.2%) than in patients who were not (12.9%). Surprisingly, anticoagulant intake specifically had no effect on the probability of hospital admission. Conclusions: Patients with comorbidities have a higher incidence of hospitalization for E-bike- and P-scooter-associated injuries. Therefore, physicians may take into account comorbidities for the effective management of this patient group’s injuries.

When disaster strikes in the ring: a 20-year study of head and neck injuries secondary to boxing

The purpose of this study was to explore the patterns of head and neck injuries secondary to boxing. We conducted a 20-year retrospective cross-sectional study using the National Electronic Injury Submission System (NEISS). We derived the predictor variables from both patient and injury characteristics. The principal outcome variable was the probability of hospital admission from the ED. We used bivariate analysis to determine if an association existed between two variables of interest. We created a multiple logistic regression model to model the probability of admission using all significant univariate predictors. The final sample consisted of 1,919 patients. Children were most likely to injure their heads (p < 0.01). Young adults were also most likely to injure their heads (p < 0.05). Adults were most likely to injure their faces (p < 0.01). Children were most likely to incur facial contusions (p < 0.01) and internal organ injuries (p < 0.01). Young adults were most likely to suffer concussions (p < 0.01). Adults were most likely to suffer lacerations (p < 0.01). Certain age groups were more/less likely to injure a particular anatomical site and more/less likely to incur a particular type of injury. Relative to young adults, seniors had an increased odd of admission. Head injuries had an increased odds of admission relative to mouth injuries. Fractures and internal organ injuries proved to be the most dangerous injuries.

Poisoning among the elderly

ObjectivesPoisonings continue to be an important public health problem. Herein, we analyzed the epidemiology of poisonings in elderly individuals. MethodsRetrospective cohort study conducted between 2011 and 2019 in a university hospital. We analyzed demographic variables, type of poison involved, suicidal or accidental nature of the poisoning, and the probability of admission, or death to the hospital. ResultsA total of 880 (6.1%) of the 14,300 poisonings treated in the same period occurred in people over 65 years of age. The most numerous group were individuals between 65–69 years-old (39%), followed by the group of 70–75 years-old (20%), being men 57%. In 88% of the cases a single poison participated, being by frequency alcohol (51.6%), drugs (29.5%), and household or industrial products (12.8%). Alcohol intoxication predominated in men up to 75 years of age, and above this age drug or suicidal intoxication predominated, mainly in women. A total of 145 (16%) subjects were hospitalized, the drugs most frequently implicated being digoxin and benzodiazepines. The probability of hospital admission was associated with intoxication by metformin, digoxin, lithium or with the age of the patient (OR per year = 1.03; 95% CI: 1.0–1.06). A total of 19 patients died (2.16%), mainly due to suicidal caustic ingestion (OR = 5.7: 95% CI: 1.4–23.6) or by drugs, directly related to metformin (OR = 10.1; 95% CI: 2.4–42.4). ConclusionsThe prevalence of poisoning in the elderly is not negligible, and physicians should have a high index of suspicion in a complex situation.

Intoxicaciones en la tercera edad

ObjectivesPoisonings continue to be an important public health problem. Herein, we analyzed the epidemiology of poisonings in elderly individuals. MethodsRetrospective cohort study conducted between 2011 and 2019 in a university hospital. We analyzed demographic variables, type of poison involved, suicidal or accidental nature of the poisoning, and the probability of admission, or death to the hospital. ResultsA total of 880 (6.1%) of the 14,300 poisonings treated in the same period occurred in people over 65 years of age. The most numerous group were individuals between 65-69 years-old (39%), followed by the group of 70-75 years-old (20%), being men 57%. In 88% of the cases a single poison participated, being by frequency alcohol (51.6%), drugs (29.5%), and household or industrial products (12.8%). Alcohol intoxication predominated in men up to 75 years of age, and above this age drug or suicidal intoxication predominated, mainly in women. A total of 145 (16%) subjects were hospitalized, the drugs most frequently implicated being digoxin and benzodiazepines. The probability of hospital admission was associated with intoxication by metformin, digoxin, lithium or with the age of the patient (OR per year = 1.03; 95% CI: 1.0-1.06). A total of 19 patients died (2.16%), mainly due to suicidal caustic ingestion (OR = 5.7: 95% CI: 1.4-23.6) or by drugs, directly related to metformin (OR = 10.1; 95% CI: 2.4-42.4). ConclusionsThe prevalence of poisoning in the elderly is not negligible, and physicians should have a high index of suspicion in a complex situation.

Commercial valved spacers versus home-made spacers for delivering bronchodilator therapy in pediatric acute asthma: a cost-effectiveness analysis

Objective Although valved spacers are the preferred method for administering metered-dose inhaler bronchodilators such as albuterol in pediatric acute asthma, their high cost and their lack of availability have limited their use, especially in low- and middle-income countries (LMICs). Because of this, it is a common practice to use home-made spacers, although a formal analysis evaluating their cost-effectiveness is lacking. Therefore, the objective of this study was to analyze the cost-effectiveness of home-made spacers compared to commercial valved spacers for delivering bronchodilator therapy in pediatric acute asthma. Methods A decision-analysis model was used to estimate health outcomes and costs of a simulated cohort of pediatric patients treated for acute asthma. Effectiveness parameters were obtained from a systematic review of the literature. Cost data were obtained from hospital bills and from the national manual of drug prices in Colombia. The study was carried out from the perspective of the national healthcare system in Colombia, a middle-income country (MIC). The main outcome of the model was avoidance of hospital admission. Results Base-case analysis showed that compared to commercial valved spacers, administering bronchodilators with home-made spacers results in lower overall treatment costs (US$126.75 vs. US$128.59 average cost per patient) without a significant difference in the probability of hospitalization avoided (0.8500 vs. 0.8500). Conclusions The present study shows that in Colombia, an MIC, compared with commercial valved spacers, the use of home-made spacers for administering bronchodilator therapy is more cost-effective because it yields a similar probability of hospital admission at lower overall treatment costs.

Are Motorized Scooters Associated With More Severe Craniomaxillofacial Injuries?

The purpose of the present study was to compare the severity of craniomaxillofacial injuries between accidents involving motorized and nonmotorized standup scooters. This is a 20-year cross-sectional study of the National Electronic Injury Surveillance System. Injuries from powered and unpowered standup scooters were included in this study if they involved the head, face, eyeball, mouth, or ear. Study predictors were obtained from both patient and injury characteristics. The study outcome was the probability of hospital admission from the emergency department. A multiple logistic regression model was created to model the probability of admission using all significant univariate predictors. A total of 11,916 records were included in the present study, of which 9.5% involved motorized scooters. The proportion of motorized injuries more than tripled from 2014 (5.8%) to 2018 (22.1%). Motorized injuries occurred more often in older individuals (24.0 vs 8.5years; P<.01). A greater proportion of motorized injuries involved the head (55.0 vs 36.9%; P<.01) and resulted in concussion (11.5 vs 5.6%; P<.01), fractures (6.7 vs 2.0%; P<.01), and other nonspecified internal organ injuries (31.1 vs 19.6%; P<.01). Motorized scooter injuries had more than triple the admission rate compared to nonmotorized injuries (13.9 vs 3.7%; P<.01). After controlling for potential confounders, injuries from motorized scooters still had double the odds of hospital admission (odds ratio, 2.03; P<.01). Motorized standup scooters appear to cause more severe injuries than conventional nonmotorized scooters. The recent growth of rentable electric scooters may pose a future public health concern. Ride-sharing companies should ensure that customers are capable of safely and responsibly operating these vehicles.

Association of daily copayments with use of hospital care among medicare advantage enrollees

BackgroundWhile the traditional Medicare program imposes a deductible for hospital admissions, many Medicare Advantage plans have instituted per-diem copayments for hospital care. Little evidence exists about the effects of changes in cost-sharing for hospital care among the elderly. Changing inpatient benefits from a deductible to a per diem may benefit enrollees with shorter lengths of stay, but adversely affect the out-of-pocket burden for hospitalized enrollees with longer lengths of stay.MethodsWe used a quasi-experimental difference-in-differences study to compare longitudinal changes in proportion hospitalized, inpatient admissions and days per 100 enrollees, and hospital length of stay between enrollees in MA plans that changed inpatient benefit from deductible at admission to per diem, intervention plans, and enrollees in matched control plans – similar plans that maintained inpatient deductibles. The study population included 423,634 unique beneficiaries enrolled in 23 intervention plans and 36 matched control plans in the 2007–2010 period.ResultsThe imposition of per-diem copayments were associated with adjusted declines of 1.3 admissions/100 enrollees (95% CI − 1.8 to − 0.9), 6.9 inpatient days/100 enrollees (95% CI − 10.1 to − 3.8) and 0.7 percentage points in the probability of hospital admission (95% CI − 1.0 to − 0.4), with no significant change in adjusted length of stay in intervention plans relative to control plans. For persons with 2 or more hospitalizations in the year prior to the cost-sharing change, adjusted declines were 3.5 admissions/100 (95% CI − 8.4 to 1.4), 31.1 days/100 (95% CI − 75.2 to 13.0) and 2.2 percentage points in the probability of hospitalization (95% CI − 3.8 to − 0.6) in intervention plans relative to control plans.ConclusionsInstituting per-diem copayments was associated with reductions in number of admissions and hospital stays, but not length of stay once admitted. Effects of inpatient cost-sharing changes were magnified for persons with greater baseline use of hospital care.

Advantage of inhaled corticosteroids as additional therapy to systemic corticosteroids for pediatric acute asthma exacerbations: a cost-effectiveness analysis

Objective: Although the efficacy of systemic corticosteroids (SCs) in acute asthma exacerbations is well established, the fact that many children still require admission to hospital and that SCs have a slow onset of action are cause of concern. For this reason, the use of inhaled corticosteroids (ICS) as a therapy added to SCs has been explored, with no clarity about its cost-effectiveness. The aim of the present study was to evaluate the cost-effectiveness of ICS in addition to SCs (ICS + SCs) compared to standard therapy with SCs for treating pediatric asthma exacerbations.Methods: A decision-analysis model was developed to estimate the cost-effectiveness of SCs compared to ICS + SCs for treating pediatric patients with acute asthma exacerbations. Effectiveness parameters were obtained from a systematic review of the literature. Cost data obtained from hospital bills and from the national manual of drug prices. The study was carried out from the perspective of the national healthcare system in Colombia. The main outcome of the model was avoidance of hospital admission.Results: For the base-case analysis, the model showed that compared to SCs, therapy with ICS + SCs was associated with lower total costs (US$88.76 vs.US$97.71 average cost per patient) and a lower probability of hospital admission (0.9060 vs. 0.9000), thus showing dominance.Conclusions: This study shows that compared with standard therapy with SCs, ICS + SCs for treating pediatric patients with acute asthma exacerbations is the preferred strategy because it was associated with a lower probability of hospital admission, at lower total treatment costs.

A community pharmacist home visit project for high utilizers under a universal health system: A preliminary assessment

Due to the increasing prevalence of multimorbidity, the percentage of heavy users of health care services increased rapidly. To contain inappropriate outpatient visits and improve better medication management of high utilizers, the National Health Insurance Administration in Taiwan launched a community pharmacist home visit (CPHV) project for high utilizers in 2010. We employed a natural experimental design to evaluate the preliminary effects of the CPHV project. The intervention group consisted of patients enrolled in the CPHV project during 2010 and 2013. Patients in the comparison group were non-enrollees selected via a propensity score matching technique. A difference-in-differences analysis was conducted by using multilevel models to examine the effects of the project. The average number of physician visits decreased from 130.0 to 98.9 visits (23.8%) among the CPHV project enrollees, while the average number decreased from 99.5 to 89.5 visits (10.1%) among the non-enrollees, with a net effect of a 21.0-visit reduction. The CPHV project also led to modest reductions in the number of medication items used per day, the probability of hospital admission and yearly healthcare expenses. The CPHV project seems promising for decreasing health care utilization and costs of the patients with high-needs.

Impact of thiopurines on the natural history and surgical outcome of ulcerative colitis: a cohort study

ObjectiveThiopurines are used as maintenance therapy in ulcerative colitis (UC), but whether these drugs influence the natural history of the disease is unknown. We aimed to assess the effect of...

Expanding Home-Based Primary Care to American Indian Reservations and Other Rural Communities: An Observational Study.

Home-based primary care (HBPC) is a comprehensive, interdisciplinary program to meet the medical needs of community-dwelling populations needing long-term care (LTC). The U.S. Department of Veterans Affairs (VA) expanded its HBPC program to underserved rural communities, including American Indian reservations, providing a "natural laboratory" to study change in access to VA LTC benefits and utilization outcomes for rural populations that typically face challenges in accessing LTC medical support. Pretest-Posttest quasi-experimental approach with interrupted time-series design using linked VA, Medicare, and Indian Health Service (IHS) records. American Indian reservations and non-Indian communities in rural HBPC catchment areas. 376 veterans (88 IHS beneficiaries, 288 non-IHS beneficiaries) with a HBPC length of stay of 12months or longer. Baseline demographic and health characteristics, activities of daily living (ADL), previous VA enrollment, and hospital admissions and emergency department (ED) visits as a function of time, accounting for IHS beneficiary and functional statuses. For HBPC users, VA enrollment increased by 22%. At baseline, 30% of IHS and non-IHS beneficiaries had 2 or more ADLs impairments; IHS populations were younger (P<.001) and had more diagnosed chronic diseases (P=.007). Overall, hospital admissions decreased by 0.10 (95% confidence interval (CI)=-0.14 to -0.05) and ED visits decreased by 0.13 (95% CI=-0.19 to -0.07) in the 90days after HBPC admission (Ps<.001) and these decreases were maintained over 1year follow-up. Before HBPC, probability of hospital admission was 12% lower for IHS than non-IHS beneficiaries (P=.02). Introducing HBPC to rural areas increased access to LTC and enrollment for healthcare benefits, with equitable outcomes in IHS and non-IHS populations.

P731 The impact of thiopurine drugs on the natural history and surgical outcome of ulcerative colitis: A cohort study

Thiopurines are used as maintenance therapy in ulcerative colitis, but whether these drugs influence the natural history of the disease is unknown. We aimed to assess the effect of thiopurines in terms of colectomy, hospital admission, progression in disease extent and anti-TNF therapy within 10 years. Patients diagnosed with ulcerative colitis within the Örebro University Hospital catchment area, during 1963–2010 (n = 1007), who initiated thiopurines (n = 253) were included. To overcome the risk of confounding by indication, we used a novel approach and compared patients who stopped treatment within 12 months because of an adverse reaction (n = 76) with patients who continued therapy or discontinued due to other reasons (n = 177). Long-term outcomes were assessed by Cox-regression analyses with adjustments for confounding factors including sex, age, hospital admission at diagnosis, disease extent, and previous medication at first thiopurine exposure. No significant difference in baseline characteristics was observed between the two groups. The cumulative probability of colectomy within 10 years was 19.5% in tolerant patients compared with 29.0% in intolerant, (adjusted HR: 0.43; 95% confidence interval (CI) 0.24 to 0.79; Figure 1). The probability of hospital admission was 34.0 % in tolerant vs. 56.2% in intolerant patients (adjusted HR: 0.38; 95% CI 0.25 to 0.59). The risk for progression in disease extent was 20.4% in tolerant patients compared with 48.8% in intolerant, (adjusted HR: 0.44; 95% CI 0.20 to 0.99). Within 10 years, 16.1% of tolerant and 27.5% of intolerant patients received anti-TNF therapy, (adjusted HR: 0.43; 95% CI 0.24 to 0.79). Figure 1 Based on the novel approach of comparing patients tolerant and intolerant to thiopurines, we, for the first time, reveal that thiopurines have a profound beneficial impact of the natural history and long-term colectomy rates of ulcerative colitis.

Rate Control With Beta-blockers Versus Calcium Channel Blockers in the Emergency Setting: Predictors of Medication Class Choice and Associated Hospitalization.

Rate control is an important component of the management of patients with atrial fibrillation (AF). Previous studies of emergency department (ED) rate control have been limited by relatively small sample sizes. We examined the use of beta-blockers (BBs) versus nondihydropyridine calcium channel blockers (CCBs) in ED patients from 24 sites and the associated hospital admission rates. In this preplanned substudy, we examined chart data on AF patients who visited one of 24 hospital EDs in Ontario, Canada, between April 2008 and March 2009. We describe the proportion of patients who received either a BB or a CCB, had a heart rate<110 beats/min 2 hours later, and had any complications. We used hierarchical logistic regression modeling to determine the predictors of BB versus CCB use and to assess the between-hospital variation in use of BBs versus CCBs. Solely in patients who had no rhythm control attempts, we examined the difference in the probability of hospital admission after propensity score matching patients by medication class. Of the 1,639 patients who received either a BB (n=429) or a CCB (n=1,210), 70.9% of the patients who received a BB had successful rate control versus 66.1% for a CCB. Complications were rare (2.4%), and the large majority were hypotension (2.0%). In adjusted analyses, predictors of receiving a BB (compared to a CCB) included already being on a BB, being sent in from a doctor's office, or being seen at a teaching hospital. In contrast, patients with evidence of heart failure, prior use of a CCB, a higher presenting heart rate, or a successful pharmacologic cardioversion (vs. no attempt) or who were seen at the highest AF volume EDs were significantly less likely to receive a BB, compared to a CCB. Systematic between-hospital differences accounted for 8% of the variation in BB versus CCB use. Hospital characteristics accounted for the large majority of that variation: after accounting for patient characteristics the between-hospital variation decreased by a relative 2.8%. By further adjusting for hospital characteristics, it decreased by a relative 74.7%. Among propensity score-matched patients with no rhythm control attempts, more CCB patients were admitted (51.6%) compared to BB patients (40.0%; difference of 11.6%; 95% confidence interval= 7.9%-16.2%). In this study of 24 EDs, CCBs were used more frequently for rate control than BBs, and complications were rare and easily managed using both agents. Variation between hospitals in BB versus CCB use was predominantly due to hospital characteristics such as teaching status and AF volumes, rather than different case mix. Among patients who did not receive attempts at rhythm control, use of a BB for rate control was associated with a lower rate of hospitalization.

HEALTHCARE RESOURCES UTILIZATION AND TEMPORARY DISABILITY IN POPULATION AGED 50-64 ACCORDING TO THE EPIDEMIOLOGICAL ESSE-RF STUDY

Aim . To analyze health care resource utilization and temporary disability in people of pre-retirement age in the Russian population. Material and methods . The analysis was carried out on the basis of the ESSE-RF study materials (13 regions of the RF). Standard epidemiological survey methods and evaluation criteria were used. The analysis included results of a survey of the ESSE-RF study participants about health care resource utilization and temporary disability (TD) during 12 months before the survey. The following characteristics were ascertained: a number and reasons of outpatient visits for medical assistance, hospital admissions (including duration of in-hospital treatment), emergency calls and temporary disability (a number of days and cases), their mean number per one study participant, mean number of cases and days of TD per 100 working participants, associations with social-demographic parameters, risk factors, chronic non-communicable diseases, stress and anxiety levels by the Hospital Anxiety and Depression Scale (HADS). Results . A total of 8334 people aged 50-64 years were examined: men – 2784 (33%) and women – 5550 (67%). A share of the hospitalized (at least one time) was 11% in the age group of 50-54 years, 12% – in the age group of 55-59 years and by the age of 60-64 this indicator increased to 15%. 20% of the participants at least one time were admitted to hospital and/or called an ambulance. A share of people who had utilized health care resources at least one time was increasing with age. Unemployed people were hospitalized more frequently than employed ones. Number of chronic non-communicable diseases correlated with the probability of hospitalization and/or emergency call. Categories 2 and 3 of disability, presence of diabetes mellitus, ischemic heart disease and hypertension were statistically significantly associated with the probability of hospitalization and/or emergency call. Smoking did not increase the probability of hospitalization and/or emergency call in comparison with absence of this risk factor, at that, people who had given up smoking were 1.3 times more likely to be hospitalized than non-smokers. People with low and moderate alcohol consumption were hospitalized and called an ambulance significantly less often than those who abstained from alcohol. Clinically significant anxiety increased the probability of hospital admission and/or emergency call as compared to people without this factor by the HADS. Subclinical and clinically significant anxiety, mean and high levels of stress were associated with the probability of hospitalization and/or emergency call. Number of TD days turned out to be rather low - 0.3 day per 1 working man and 0.4 day - per 1 working woman, this index did not significantly differ with age. Conclusion . So, pre-retirement age (50-64 years) is characterized by increase in health care resource utilization due to health state worsening. At the same time significant share of people of this age (40%) did not seek medical help. These 40% of pre-retirement age people can be possible reserve for health state improvement by means of their active involvement in preventive activity of primary health care system (the study had been conducted before the preventive medical examination program starting).

Clinical metrics in emergency medicine: the shock index and the probability of hospital admission and inpatient mortality

Study objectivesThe shock index (SI), defined as the ratio of HR to systolic BP, has been studied as an alternative prognostic tool to traditional vital signs in specific disease states...

Medication-related emergency department visits in pediatrics: a prospective observational study.

There are few data on the rate and characterization of medication-related visits (MRVs) to the emergency department (ED) in pediatric patients. We sought to evaluate the frequency, severity, preventability, and classification of MRVs to the ED in pediatric patients. We performed a prospective observational study of pediatric patients presenting to the ED over a 12-month period. A medication-related ED visit was identified by using pharmacist assessment, emergency physician assessment, and an independent adjudication committee. In this study, 2028 patients were enrolled (mean age, 6.1 ± 5.0 years; girls, 47.4%). An MRV was found in 163 patients (8.0%; 95% confidence interval [CI]: 7.0%-9.3%) of which 106 (65.0%; 95% CI: 57.2%-72.3%) were deemed preventable. Severity was classified as mild in 14 cases (8.6%; 95% CI: 4.8%-14.0%), moderate in 140 cases (85.9%; 95% CI: 79.6%-90.8%), and severe in 9 cases (5.5%; 95% CI: 2.6%-10.2%). The most common events were related to adverse drug reactions 26.4% (95% CI: 19.8%-33.8%), subtherapeutic dosage 19.0% (95% CI: 13.3%-25.9%), and nonadherence 17.2% (95% CI: 11.7%-23.9%). The probability of hospital admission was significantly higher among patients with an MRV compared with those without an MRV (odds ratio, 6.5; 95% CI: 4.3-9.6) and, if admitted, the median (interquartile range) length of stay was longer (3.0 [5.0] days vs 1.5 [2.5] days, P = .02). A medication-related cause was found in ∼1 of every 12 ED visits by pediatric patients, of which two-thirds were deemed preventable. Pediatric patients who present to the ED with an MRV are more likely to be admitted to hospital and when admitted have a longer length of stay.

Equity in the Utilization of Healthcare Services in India: Evidence From National Sample Survey

Background: The pursuit of equity in health and healthcare has been the key feature of health policy in India. However, despite the policy significance, the volume of literature available on this issue is scarce. Therefore, this paper is an attempt to examine the horizontal inequities in healthcare utilization, consisting of outpatient and inpatient care in 15 major states and north-eastern region of India. Methods: Cross-sectional data were taken from the National Sample Survey Organization (NSSO) 60th round (2004), the survey on ‘morbidity and healthcare’. While outpatient care was assessed using the probability of outpatient visit 15 days prior to the survey date, the indicators of inpatient care utilization were based on the following variables: the probability of hospital admission and length of stay in hospital over a 12-month period. All these measures of healthcare utilization were standardized for need differences and controlled for socio-economic factors. Need standardized concentration indices were used to measure interstate and intrastate income-related inequities in healthcare utilization. Results: Absolute inequalities were found between states in the proportion of the population reporting a visit to an outpatient provider, in the range of 4.42% to 21.72%. Similarly, inpatient care varied from 1% to 10%. The magnitude of inequity for both outpatient and inpatient care was pro-rich across rural and urban areas of India and in majority of the states. In fact, in majority of the states, the horizontal inequity across types of curative care was noticeably higher within the rural population than in the urban population. The analysis demonstrated that high per capita government health spending was significantly associated with low inequity in utilization of inpatient care. Conclusion: The study concludes that it would be necessary to address the prevailing inequities in healthcare by substantially scaling up the public spending on health, and achieving effective universal coverage of healthcare in India.

Equity in the utilization of healthcare services in India: evidence from National Sample Survey

The pursuit of equity in health and healthcare has been the key feature of health policy in India. However, despite the policy significance, the volume of literature available on this issue is scarce. Therefore, this paper is an attempt to examine the horizontal inequities in healthcare utilization, consisting of outpatient and inpatient care in 15 major states and north-eastern region of India. Cross-sectional data were taken from the National Sample Survey Organization (NSSO) 60th round (2004), the survey on 'morbidity and healthcare'. While outpatient care was assessed using the probability of outpatient visit 15 days prior to the survey date, the indicators of inpatient care utilization were based on the following variables: the probability of hospital admission and length of stay in hospital over a 12-month period. All these measures of healthcare utilization were standardized for need differences and controlled for socio-economic factors. Need standardized concentration indices were used to measure interstate and intrastate income-related inequities in healthcare utilization. Absolute inequalities were found between states in the proportion of the population reporting a visit to an outpatient provider, in the range of 4.42% to 21.72%. Similarly, inpatient care varied from 1% to 10%. The magnitude of inequity for both outpatient and inpatient care was pro-rich across rural and urban areas of India and in majority of the states. In fact, in majority of the states, the horizontal inequity across types of curative care was noticeably higher within the rural population than in the urban population. The analysis demonstrated that high per capita government health spending was significantly associated with low inequity in utilization of inpatient care. The study concludes that it would be necessary to address the prevailing inequities in healthcare by substantially scaling up the public spending on health, and achieving effective universal coverage of healthcare in India.