Reduce Health Care Resource Research Articles

EE187 Remdesivir Reduced Healthcare Resource Utilization in Patients Hospitalized With COVID-19 During the Omicron-Dominant Period

EE187 Remdesivir Reduced Healthcare Resource Utilization in Patients Hospitalized With COVID-19 During the Omicron-Dominant Period

Multi-center experience with outpatient total hip arthroplasty via a standard posterolateral approach.

This study sought to evaluate the safety, efficacy, and resource utilization of a pilot outpatient surgery program for total hip arthroplasty compared to traditional inpatient total hip arthroplasty performed via the posterolateral approach. A cohort of 68 patients from two sites were enrolled in a regional pilot project for outpatient total hip arthroplasty (THA) and matched 1:1 against a cohort of patients undergoing routine inpatient THA. Data was extracted retrospectively from patient and hospital charts including adverse events (AE), readmission within 90 days, emergency room (ER) visits, patient calls, patient-reported outcome measures, length of stay, and multiple surgical variables. The outpatient group had a mean hospital stay of 13 hours, whereas the inpatient group had a mean of 58 hours (p<0.001). Three outpatients and four inpatients experienced post-op complications. Three inpatients and one outpatient visited the ER within 8 weeks of surgery. No difference in pre-operative hemoglobin (p = 0.210), or surgical blood loss (p = 0.550) was found between study groups. There was no difference found between groups regarding Oxford-12 Hip Score improvement, nor satisfaction at six months, one and two years (p>0.125). This study demonstrates that outpatient THA using the posterolateral approach is as safe and effective as inpatient THA for overall healthy and carefully screened patients, based on the low rate of AEs observed and similar patient outcomes reported. Significantly reduced time in hospital demonstrates the reduced healthcare resources associated with outpatient THA.

Enhanced Recovery After Surgery in Immediate DIEP Flap Breast Reconstruction: Reducing Length of Stay and Opioid Use

Background: To improve patient outcomes amid reduced healthcare resources during the COVID-19 pandemic, a single Canadian cancer center implemented an Enhanced Recovery After Surgery (ERAS) protocol for autologous DIEP flap breast reconstruction. Methods: This retrospective cohort study included 100 consecutive patients undergoing microsurgical breast reconstruction with DIEP flaps using the ERAS protocol and 100 patients using a standard protocol. Primary outcomes were the hospital length of stay and opioid use. Secondary outcomes included postoperative complications, laxative and antiemetic consumption. Results: In this study, 80% of the patients had immediate reconstruction, while the remaining patients received either delayed immediate or delayed reconstruction. Patients in the ERAS group had shorter hospital stays (2.8 vs 4.5 days; P &lt; 0.001) and lower total opioid use (50.2 vs 136.3 mg; P &lt; 0.001). This reduction was also observed when breaking down opiates per day of hospitalization (30.2 vs 18.2 mg; P &lt; 0.001), and in the first 24 postoperatively hours (35.7 vs 67.6 mg; P &lt; 0.001). The control group had a higher incidence of postoperative complications, including seroma, partial and total flap necrosis, compared to the ERAS group. However, readmission rates were similar between the two groups. Conclusion: Implementing the ERAS protocol for DIEP flap breast reconstruction can significantly reduce hospital length of stay and postoperative opioid requirements without increasing the risk of adverse events. This pattern holds true for immediate reconstructions with DIEP flaps.

Reduced Healthcare Resource Utilization in TCR Αβ/CD19-Depleted Haploidentical Compared to Matched Related and Unrelated Donor Hematopoietic Cell Transplant in First 100 Days for Pediatric Hematologic Malignancies

Reduced Healthcare Resource Utilization in TCR Αβ/CD19-Depleted Haploidentical Compared to Matched Related and Unrelated Donor Hematopoietic Cell Transplant in First 100 Days for Pediatric Hematologic Malignancies

HOME-BASED REHABILITATION FOLLOWING ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION IN THE KURDISTAN REGION OF IRAQ: EPIDEMIOLOGY AND OUTCOMES

IntroductionOver the past 30 years multiple wars and embargos have reduced healthcare resources, infrastructure, and staff in Iraq. Subsequently, there are a lack of physiotherapists to provide rehabilitation after an anterior cruciate ligament reconstruction (ACLR). The implementation of home-based rehabilitation programmes may provide a potential solution to this problem. This study, set in in the Kurdistan region of Iraq, describes the epidemiology and outcomes of anterior cruciate ligament reconstruction (ACLR) followed by home-based rehabilitation alone.MethodsA cohort observational study of patients aged ≥ 16 years with an ACL rupture who underwent an ACLR under a single surgeon. This was performed arthroscopically using a hamstring autograft (2 portal technique). Patients completed a home-based rehabilitation programme of appropriate simplicity for the home setting. The programme consisted of stretching, range of motion and strengthening exercises based on criterion rehabilitation progressions. A full description of the programme is provided at: https://ngmvcharity.co.uk/.Demographics, mechanisms of injury, operative findings, and outcome data (Lysholm, Tegner Activity Scale (TAS), and revision rates) were collected from 2016 to 2021. Data were analysed using descriptive statistics.ResultsThe cohort consisted of 545 patients (547 knees), 99.6% were male with a mean age of 27.8 years (SD 6.18 years). The mean time from diagnosis to surgery was 40.6 months (SD 40.3). Despite data attrition Lysholm scores improved over the 15-month follow-up period, matched data showed the most improvement occurred within the first 2 months post-operatively. A peak score of 90 was observed at nine months. Post-operative TAS results showed an improvement in level of function but did not reach pre-injury levels by the final follow-up. At final follow-up, six (1.1%) patients required an ACLR revision.ConclusionPatients who completed a home-based rehabilitation programme in Kurdistan had low revision rates and improved Lysholm scores 15 months post-operatively. To optimise resources, further research should investigate the efficacy of home-based rehabilitation for trauma and elective surgery in low- to middle-income countries and the developed world.

Modified Brain Injury Guidelines for preinjury anticoagulation in traumatic brain injury: An opportunity to reduce health care resource utilization.

The Brain Injury Guidelines (BIG) stratify patients by traumatic brain injury (TBI) severity to provide management recommendations to reduce health care resource burden but mandates that patients on anticoagulation (AC) are allocated to the most severe tertile (BIG 3). We sought to analyze TBI patients on AC therapy using a modified BIG model to determine if this population can offer further opportunity for safe reductions in health care resource utilization. Patients 55 years or older on AC with traumatic intracranial hemorrhage (ICH) from two centers were retrospectively stratified into BIG 1 to 3 risk groups using modified BIG criteria excluding AC as a criterion. Intracranial hemorrhage progression, neurosurgical intervention (NSI), death, and worsened discharge status were compared. A total of 221 patients were included, with 23%, 29%, and 48% classified as BIG 1, BIG 2, and BIG 3, respectively. The BIG 3 cohort had a higher rate of AC reversal agents administered (66%) compared with the BIG 1 (40%) and BIG 2 (54%) cohorts ( p < 0.01), as well as ICH progression discovered on repeat head computed tomography (56% vs. 38% vs. 26%, respectively; p < 0.001). No patients in the BIG 1 and 2 cohorts required NSI. No patients in BIG 1 and 3% of patients in BIG 2 died secondary to the ICH. In the BIG 3 cohort, 16% of patients required NSI and 26% died. Brain Injury Guidelines 3 patients had 15 times the odds of mortality compared with BIG 1 patients ( p < 0.01). The AC population had higher rates of ICH progression than the BIG literature, but this did not lead to more NSI or mortality in the lower tertiles of our modified BIG protocol. If the modified BIG used the original tertile management on our population, then NS consultation may have been reduced by up to 52%. These modified criteria may be a safe opportunity for further health care resource and cost savings in the TBI population. Prognostic and Epidemiological; Level IV.

Patient Experience of Digitalized Follow-up of Antidepressant Treatment in Psychiatric Outpatient Care: Qualitative Analysis.

Nonadherence to pharmaceutical antidepressant treatment is common among patients with depression. Digitalized follow-up (ie, self-monitoring systems through mobile apps) has been suggested as an effective adjunct to conventional antidepressant treatment to increase medical adherence, improve symptoms of depression, and reduce health care resource use. The aim of this study was to determine patients' experience of digitalized follow-up using a mobile app as an adjunct to treatment concurrent with a new prescription, a change of antidepressant, or a dose increase. This was a qualitative, descriptive study. Patients at 2 psychiatric outpatient clinics were recruited at the time of changing antidepressant medication. After using a mobile app (either a commercial app or a public app) for 4-6 weeks with daily registrations of active data, such as medical intake and questions concerning general mental health status, individual semistructured interviews were conducted. Recorded data were transcribed and then analyzed using content analysis. In total, 13 patients completed the study. The mean age was 35 (range 20-67) years, 8 (61.5%) were female, and all reported high digital literacy. Overall, the emerging themes indicated that the patients found the digital app to be a valuable adjunct to antidepressant treatment but with potential for improvement. Both user adherence and medical adherence were positively affected by a daily reminder and the app's ease of use. User adherence was negatively affected by the severity of depression. The positive experience of visually presented data as graphs was a key finding, which was beneficial for self-awareness, the patient-physician relationship, and user adherence. Finally, the patients had mixed reactions to the app's content and requested tailored content. The patients identified several factors addressing both medical adherence and user adherence to a digital app when using it for digitalized follow-up concurrent with the critical time related to changes in antidepressant medication. The findings highlight the need for rigorous evidence-based empirical studies to generate sustainable research results.

Georgia community pharmacies and clinics: An evaluation of health outcomes and care access

BackgroundCare access remains a major social determinant of health. Safety net clinics may not be numerically sufficient to meet the health care demand for vulnerable populations. Community pharmacists remain a trusted health care provider and serve as first-line care access points. To date, Georgia care access points by safety net clinics and community pharmacies have not been compared. ObjectivesThis study sought to evaluate care access across Georgia. County health outcomes and health factor rankings were compared with mortality prevalence of respiratory disease, diabetes mellitus, kidney disease, and a composite of ambulatory care sensitive conditions emergency department (ER) utilization and hospital discharge. In addition, this study sought to determine whether care access points improve if community pharmacies were to provide primary care services. Design and Outcome MeasuresGeographic information systems mapping was used to locate safety net clinics and community pharmacies. Care access difference was analyzed using a 2-sample t test and health outcomes and rankings were evaluated using ordinary least square regression analysis. ResultsA significant difference in care access points was found between safety net clinics and community pharmacies across the state of Georgia (P < 0.05). Mortality prevalence for respiratory disease (P < 0.01), diabetes mellitus (P < 0.1), kidney disease (P < 0.05), ER utilization (P < 0.01), and hospital discharge (P < 0.01) was lower in counties in the top 50% than the bottom 50% health outcome ranking and health factor ranking. Approximately 95% of counties (n = 151) would experience more than a 50% increase in primary care access points by way of community pharmacies. ConclusionCommunity pharmacies are well positioned to address primary care disease states, reduce health care resource strain, and decrease preventable health care resource utilization. Leveraging pharmacists to provide primary care services can address care access issues and may improve care quality and reduce preventable hospitalizations and ER utilization in Georgia.

The impact of a point-of-care visual clinical decision support tool on admissions for cellulitis in the University of Maryland medical system.

Cellulitis is commonly diagnosed in emergency departments (EDs), yet roughly one third of ED patients admitted for presumed cellulitis have another, usually benign, condition instead (eg, stasis dermatitis). This suggests there is an opportunity to reduce health care resource use through improved diagnosis at the point of care. This study seeks to test whether a clinical decision support (CDS) tool interoperable with the electronic medical record (EMR) can reduce inappropriate hospital admissions and drive more appropriate and accurate care. This study was a trial of an EMR-interoperable, image-based CDS tool for evaluation of ED patients with suspected cellulitis. At the point of assigning a provisional diagnosis of cellulitis in the EMR, the clinician was randomly prompted to use the CDS. Based on the patient features entered into the CDS by the clinician, the CDS provided the clinician a list of likely diagnoses. The following were recorded: patient demographics, disposition and final diagnosis of patients, and whether antibiotics were prescribed. Logistic regression methods were used to determine the impact of CDS engagement on our primary outcome of admission for cellulitis, adjusted for patient factors. Antibiotic use was a secondary end point. From September 2019 to February 2020 (or 7 months), the CDS tool was deployed in the EMR at 4 major hospitals in the University of Maryland Medical System. There were 1269 encounters for cellulitis during the study period. The engagement with the CDS was low (24.1%, 95/394), but engagement was associated with an absolute reduction in admissions (7.1%, p=0.03). After adjusting for age greater than 65 years, female sex, non-White race, and private insurance, CDS engagement was associated with a significant reduction of admissions (adjusted OR=0.62, 95% confidence interval (CI): 0.40-0.97, p=0.04) and antibiotic use (Adjusted OR=0.63, 95% CI: 0.40-0.99, p=0.04). CDS engagement was associated with decreased admissions for cellulitis and decreased antibiotic use in this study, despite low levels of CDS engagement. Further research should examine the impact of CDS engagement in other practice environments and measure longer-term outcomes in patients discharged from the ED.

Reduced Healthcare Resource Utilization in Patients With Chronic Insomnia 24 Months After Treatment With Digital CBT-I: A Matched-Control Study

AbstractIntroductionThis analysis examined the impact of a digital therapeutic for treating chronic insomnia (currently marketed as Somryst®, at the time called Sleep Healthy Using The internet [SHUTi]) on healthcare resource use (HCRU) by comparing patients treated with the digital cognitive behavioral therapy for insomnia (dCBTi) to patients not treated with dCBTi, but with insomnia medications.MethodsA retrospective observational study using health claims data was conducted in two cohorts across the United States: patients who registered for dCBTi (cases) between June 1, 2016 and October 31, 2018 (index date) vs. patients who did not register for dCBTi but initiated a second prescription for an insomnia medication in the same time period (controls). Observation period was 16–24 months. No other inclusion/exclusion criteria were used. Control patients were matched using a nearest neighbor within-caliper matching without replacement approach. Incidence rates for HCRU encounter type were calculated using a negative binomial model for both cohorts. Costs were estimated by multiplying HCRU by published average costs for each medical resource.ResultsEvaluated were 248 cases (median age 56.5 years, 57.3% female, 52.4% treated with sleep-related medications) and 248 matched controls (median age 55.0 years, 56.0% female, 100.0% treated with sleep-related medications). Over the course of 24 months post-initiation, cases had significantly lower incidences of inpatient stays (55% lower, IRR: 0.45; 95% CI: 0.28–0.73; P=0.001), significantly fewer emergency department (ED) visits without inpatient admission (59% lower; IRR: 0.41; 95% CI: 0.27–0.63; P&lt;0.001), and significantly fewer hospital outpatient visits (36% lower; IRR: 0.64; 95% CI: 0.49–0.82; P&lt;0.001). There was also a trend for fewer ambulatory surgical center visits (23% lower; IRR: 0.77; 95% CI: 0.52–1.14; P=0.197) and fewer office visits (7% lower; IRR: 0.93; 95% CI: 0.81–1.07; P=0.302) with the use of SHUTi. Use of sleep medications was more than four times greater in controls vs. cases, with 9.6 (95% CI: 7.88–11.76) and 2.4 (95% CI: 1.91–2.95) prescriptions/patient, respectively (P&lt;0.001). All-cause per-patient HCRU costs were $8,202 lower over 24 months for cases vs. controls, driven primarily by a lower incidence of hospitalizations (-$4,996 per patient) and hospital outpatient visits (-$2,003 per patient).ConclusionsPatients with chronic insomnia who used a digital CBTi treatment had significant and durable real-world reductions in hospital inpatient stays, ED visits, hospital outpatient visits, and office visits compared to matched controls treated with medications.FundingPear Therapeutics (US), Inc.

Trajectory of Health-Related Quality of Life After Pediatric Epilepsy Surgery

Health-related quality of life (HRQOL) is regarded as a key outcome for evaluating treatment efficacy. However, it is uncertain how HRQOL evolves after epilepsy surgery compared with medical therapy, such as whether it continues to improve over time, improves and then remains stable, or deteriorates after a period of time. To assess trajectory of HRQOL over 2 years in children with drug-resistant epilepsy (DRE) treated with surgery compared with medical therapy. Prospective cohort study assessing HRQOL longitudinally over 2 years. Participants were children recruited from 8 epilepsy centers in Canada from 2014 to 2019 with suspected DRE aged 4 to 18 years who were evaluated for surgery. Data were analyzed from May 2014 to December 2021. Epilepsy surgery or medical therapy. HRQOL was measured using the Quality of Life in Childhood Epilepsy Questionnaire (QOLCE)-55. HRQOL and seizure frequency were assessed at baseline, 6-month, 1-year, and 2-year follow-ups. Clinical, parent, and family characteristics were assessed at baseline. A linear mixed model was used to evaluate HRQOL over time, adjusting for baseline clinical, parent, and family characteristics. There were 111 surgical and 154 medical patients (mean [SD] age at baseline was 11.0 [4.1] years; 118 [45%] were female). At baseline, HRQOL was similar among surgical and medical patients. HRQOL of surgical patients was 3.0 (95% CI, -0.7 to 6.8) points higher at 6-month, 4.9 (95% CI, 0.7 to 9.1) points higher at 1-year, and 5.1 (95% CI, 0.7 to 9.5) points higher at 2-year follow-ups compared with medical patients. Surgical patients experienced greater improvements in social functioning relative to medical patients, but not for cognitive, emotional, and physical functioning. At 2-year follow-up, 72% of surgical patients were seizure-free, compared with 33% of medical patients. Seizure-free patients reported higher HRQOL than those who were not. This study provided evidence on the association between epilepsy surgery and children's HRQOL, with improvement in HRQOL occurring within the first year and remaining stable 2 years after surgery. By demonstrating that surgery improved seizure freedom and HRQOL, which has downstream effects such as better educational attainment, reduced health care resource utilization, and health care cost, these findings suggest that the high costs of surgery are justified, and that improved access to epilepsy surgery is necessary.

Dementia and COVID-19 among Older African American Adults: A Scoping Review of Healthcare Access and Resources

African American/Black communities comprise 12.2% of the U.S. population, with a COVID-19 infection rate of more than 18% and marginal access to healthcare services. This scoping review synthesizes the emerging evidence on healthcare accessibility among older African American adult communities with dementia and COVID-19, as well as the resource requirements for this population during the pandemic. Searches of different databases for empirical studies and other sources on dementia and COVID-19 among older African American adults yielded 13 studies that met the following inclusion criteria: (a) focus on dementia and COVID-19, (b) sampled older African American adults, (c) investigated healthcare accessibility and resources, and (d) published between 2019 and 2022. Following the initial selection of the studies, eight were selected for relevance based on the Population, Concept, and Context (PCC) inclusion and exclusion criteria. Thematic analysis indicated that older African Americans with dementia and COVID-19 experienced longer delays in accessing timely healthcare, including transportation, intensive care units (ICUs), and mechanical ventilation. They also had reduced healthcare resources associated with a lack of health insurance, low financial resources, and an increased length of hospital stay, which further aggravated the negative effects of comorbid dementia and COVID-19 infections. Evidence showed that racial and age disparities affected older African American adults with dementia and COVID-19, resulting in lower healthcare access and marginal resources. This is consistent with historical and systemic inequities in meeting the healthcare needs of people of color in the United States, which was compounded for older African Americans during the COVID-19 pandemic.

SA7 Reduced Health Care Resource Utilisation and Costs Following a Switch From Multiple-Inhaler to Once-Daily Single-Inhaler Triple Therapy in COPD Patients in a Real-World Primary Care Setting in England

To investigate all-cause and chronic obstructive pulmonary disease (COPD)-related health care resource utilisation (HCRU) and direct medical costs in patients with COPD before and after switching from multiple-inhaler triple therapy (MITT) to once-daily single-inhaler triple therapy (SITT) fluticasone furoate/umeclidinium/vilanterol (FF/UMEC/VI).

EE364 Reduced Healthcare Resource Use in Patients With Chronic Insomnia After Treatment With a Digital Therapeutic With 2-Year Follow-Up

EE364 Reduced Healthcare Resource Use in Patients With Chronic Insomnia After Treatment With a Digital Therapeutic With 2-Year Follow-Up

S978 Impact of Inflammatory Bowel Disease on Outcomes of Patients Admitted With Pulmonary Embolism: A Nationwide Perspective

Introduction: Inflammatory Bowel Disease (IBD) patients have an established higher risk of Venous Thromboembolism, including Pulmonary Embolism (PE), secondary to chronic inflammatory state. However, Impact of IBD on the prognosis of admitted PE patients remains unstudied. Therefore, authors aim to investigate outcomes of hospitalized PE patients in the setting of IBD. Methods: Using International Classification of Diseases Tenth Revision (ICD-10) codes, the National Inpatient Sample database of the years 2016 to 2019 was searched for patients admitted with a primary diagnosis of PE, with and without a past medical history of IBD listed as secondary diagnosis. Univariate and Multivariate logistic regression analysis was performed to determine the risk of mortality and in-hospital complications in PE/IBD group compared to PE/non-IBD group. Baseline patients and facilities characteristics were incorporated into the analysis. Data was considered statistically significant if p-value was < 0.05. Results: Among 750,654 adults’ patients who were hospitalized in US with a primary diagnosis of PE from 2016 - 2019, 6,995 (1%) had a secondary diagnosis of IBD. Patients baseline characteristics are listed in Table. After running multivariate regression analysis, history of IBD was not associated with mortality difference in PE patients (aOR 0.80, p=0.245). In term of in-hospital outcomes (Figure), IBD/PE patients had an increased risk of cardiac arrythmias (aOR 1.18, p= 0.035) and sepsis (aOR 1.37, p=0.048), with no significant difference in risk of acute kidney injury (aOR 1.01, p=0.882), septic shock (aOR 1.28, p=0.516), acute coronary syndrome (aOR 0.83, p=0.337), acute respiratory failure (aOR 0.92, p=0.244) and in-hospital cardiac arrest (aOR 2.24, p=0.319). IBD/PE group had a prolonged length of stay (aMD 0.56 days, p=< 0.001) and increased cost of care (aMD 4093$, p=0.023) when compared to admitted PE patients who are IBD-free. Conclusion: Our study demonstrates that patients with PE have a slightly worse in-hospital outcomes in the setting of IBD, represented by increased risk of sepsis and cardiac arrythmias, and prolonged length of stay and healthcare resources utilizations. Further studies are needed to validate our findings, to prompt proper risk satisfaction and for IBD patients who are admitted with PE in a goal to reduce the incidence of the before mentioned outcomes and to reduce healthcare resources utilization in this group of patients.Figure 1.: Forest plot of outcomes in patient hospitalized for PE with history of IBD, compared to non-IBD Patients. Table 1. - Baseline characteristics of PE patients stratified based on diagnosis status of IBD VARIABLE OVERALL, PE %, No. WITHOUT IBD %, No. WITH IBD %, No. P value 100.0 (750,654) 99.0 (743659) 1.00 (6995) PATIENT’S CHARACTERISTICS AGE, MEAN YEARS 62.8 62.9 58.8 () < 0.001 FEMALE 51.9 (389589) 51.9 (385959) 55.1 (3854) < 0.001 RACIAL DISTRIBUTION < 0.001 WHITE 71.6 (537468) 71.5 (531716) 83.3 (5827) BLACK 18.9 (141874) 19.0 (141295) 11.2 (783) HISPANIC 5.83 (43763) 5.87 (43653) 2.73 (191) OTHERS 2.10 (15764) 2.10 (15617) 1.92 (134) INSURANCE TYPE < 0.001 MEDICAID 53.6 (402351) 53.7 (399345) 47.6 (3330) MEDICARE 12.3 (92330) 12.4 (92214) 10.8 (755) PRIVATE 29.8 (223695) 29.7 (220867) 39.2 (2742) UNINSURED 4.06 (30477) 4.09 (30416) 2.27 (159) CHARLSON COMORBIDITY INDEX SCORE < 0.001 1 23.3 (174902) 23.3 (173273) 24.1 (1686) 2 16.5 (123858) 16.5 (122704) 16.7 (1168) ≥3 29.3 (219942) 29.4 (218636) 22.5 (1574) MEDIAN ANNUAL INCOME, US$ < 0.001 1–43,999 28.5 (213936) 28.5 (211943) 22.0 (1539) 44,000–55,999 26.5 (198923) 26.5 (197070) 25.8 (1805) 56,000–73,999 24.8 (186162) 24.8 (184427) 26.8 (1875) ≥74,000 20.0 (150131) 20.0 (148732) 25.3 (1770) HOSPITAL CHARACTERISTICS HOSPITAL REGION < 0.001 NORTHEAST 18.0 (135118) 18.5 (137577) 20.8 (1455) MIDWEST 25.2 (189165) 25.1 (186658) 27.0 (1889) SOUTH 38.8 (291254) 38.8 (288540) 34.6 (2420) WEST 17.8 (133616) 17.8 (132371) 17.5 (1224) HOSPITAL BED SIZE 0.8425 SMALL 21.0 (157637) 21.0 (156168) 21.5 (1504) MEDIUM 29.6 (222194) 29.6 (220123) 29.8 (2085) LARGE 49.3 (370072) 49.3 (366624) 48.6 (3400) HOSPITAL LOCATION RURAL LOCATION 9.55 (71687) 9.57 (71168) 7.72 (540) < 0.001 URBAN LOCATION 22.7 (170398) 22.8 (169554) 18.6 (1301) TEACHING HOSPITAL 67.6 (507442) 6.76 (50271) 73.6 (5148) COMORBIDITIES HYPERTENSION 42.3 (317527) 42.3 (314568) 35.6 (2490) < 0.001 DIABETES MELLITUS 23.2 (174152) 23.3 (173273) 16.3 (1140) < 0.001 SMOKING HISTORY 38.7 (290503) 38.7 (287796) 39.6 (2770) 0.8226 HYPERLIPIDEMIA 35.9 (269485) 36.0 (267717) 27.8 (1945) < 0.001 OBESITY 25.4 (190666) 25.5 (189633) 19.8 (1385) < 0.001 CHRONIC KIDNEY DISEASE 12.7 (95333) 12.7 (94445) 10.2 (713) < 0.001 CORONARY ARTERY DISEASE 21 (157637) 17.5 (130140) 14.3 (1000) < 0.001 PERIPHERAL VASCULAR DISEASE 21.5 (161391) 2.16 (16063) 1.86 (130) 0.2200 CONGESTIVE HEART FAILURE 16.5 (123858) 16.5 (122704) 972 < 0.001 CHRONIC OBSTRUCTIVE LUNG DISEASE 18.3 (137370) 18.3 (136090) 17.1 (1196) 0.0053 CHRONIC LIVER DISEASE 4.68 (35131) 4.67 (34729) 6.65 (465) < 0.001 CORTICOSTEROID USE 4.13 (31002) 4.07 (30267) 11.8 (825) < 0.001 PE=Pulmonary Embolism, IBD=Inflammatory Bowel Disease.

Implementing pharmacists' medication safety recommendations is associated with reduced health care resource utilization and mortality in high-risk older Americans

BackgroundA medication safety review (MSR) is a novel, pharmacist-driven, technology-supported intervention that prioritizes adverse drug event risk mitigation. Previous research has shown that Medicare Part D beneficiaries who received MSRs in an enhanced medication therapy management (EMTM) model realized improvements in total Medicare spending, hospitalizations, emergency department (ED) visits, and mortality compared to control. However, it is unknown whether beneficiaries implemented pharmacists’ MSR recommendations. ObjectiveThe objective of the study was to evaluate whether MSR recommendation implementation is associated with improvements in these same outcomes for Part D beneficiaries enrolled in EMTM compared to a control group. MethodsThis retrospective, pre-post, cohort study evaluated outcomes for beneficiaries who were targeted for MSR services in 2018 and 2019. The “validated implementation MSR (viMSR)” cohort included those who received their first-ever MSR in 2018, received another MSR in 2019, and validated implementation of ≥1 recommendation in their 2018 MSR. The “failed to engage” (FTE) cohort included beneficiaries who were targeted for MSR services in both 2018 and 2019 but did not engage in an MSR at any point through the end of 2019. For both cohorts, we calculated the 2018-to-2019 change for each outcome and then determined whether year-over-year changes differed significantly between cohorts. For mortality, we relaxed the requirement for continuous enrollment in 2019, permitting us to compare the proportion of beneficiaries that died in each group in 2019. Analyses were adjusted for baseline multimorbidity. ResultsOf 4384 beneficiaries who completed MSRs, 602 (13.7%) implemented ≥1 recommendation. The viMSR cohort (N = 602) outperformed the FTE cohort (N = 7052) in total Medicare costs ($2162/y lower; P = 0.020), Part A Medicare costs ($1855/y; P = 0.024), hospitalizations (9.1 fewer admissions/100 beneficiaries/y, P = 0.020), ED visits (10.8 fewer visits/100 beneficiaries/y, P = 0.014), and mortality (3.8% fewer died in 2019; P < 0.001). ConclusionImplementing pharmacists’ recommendations in MSRs was associated with improved health care resource utilization and mortality for MSR-eligible beneficiaries.

Reduced Healthcare Resource Utilization in Patients with Opioid Use Disorder in the 12Months After Initiation of a Prescription Digital Therapeutic.

Background and AimsreSET-O, an FDA-authorized prescription digital therapeutic (PDT) delivering cognitive behavioral therapy and contingency management to patients with opioid u®se disorder (OUD), may help improve clinical outcomes. One-year differences in healthcare resource utilization (HCRU) and costs post-PDT initiation were evaluated.MethodsRetrospective analysis of healthcare claims data compared all-cause HCRU (across hospital facility encounters [sum of inpatient stays, treat-and-release emergency department [ED] visits, partial hospitalizations, and hospital outpatient department visits] and clinician services [procedure categories]) after PDT initiation (index) between reSET-O patients and controls. Overall and Medicaid-specific differences in HCRU, costs, and buprenorphine adherence were evaluated.FindingsCohorts included 901 reSET-O patients (median age 36 years, 62.4% female, 73.9% Medicaid) and 978 controls (median age 38 years, 51.1% female, 65.4% Medicaid). Compared to the control group, the reSET-O group experienced 12% fewer total unique hospital encounters (non-significant), driven by 28% fewer inpatient stays (IRR 0.72; 95% CI 0.55–0.96; P = 0.02), 56% fewer hospital readmissions [IRR 0.44; 95% CI 0.20–0.93; P = 0.033]), and 7% fewer ED visits (IRR 0.93; 95% CI 0.79–1.09; P = 0.386). Total clinician services increased by 1391 events versus controls. Differences were greater among the Medicaid patients. Adjustment for concomitant baseline substance use and mental health disorders resulted in similar HCRU incidence rate ratios. Changes in all-cause HCRU drove per-patient per-year cost differences of − $2791 versus controls (− $3832 versus Medicaid controls). Adjusted mean medication possession ratio was 0.848 (SE 0.0118) at 12 months for reSET-O patients, which was significantly higher than controls (0.761 [SE 0.0108]; P < 0.001).ConclusionsUse of reSET-O is associated with significant and durable real-world reductions in ED and inpatient (including readmissions) utilization, reduced net costs, and increased clinician services and buprenorphine adherence. Differences in costs versus controls were greatest among Medicaid patients.Infographic Supplementary InformationThe online version contains supplementary material available at 10.1007/s12325-022-02217-y.

Clinical Characteristics, Treatment Persistence, and Outcomes Among Patients With COPD Treated With Single- or Multiple-Inhaler Triple Therapy: A Retrospective Analysis in Spain

COPD is a leading cause of death and disability. COPD therapy goals include reducing exacerbations and improving symptom control. Single-inhaler triple therapy (SITT) or multiple-inhaler triple therapy (MITT) is indicated for patients with frequent exacerbations despite bronchodilator therapy. No available evidence compares SITT vsMITT in Spain in terms of treatment persistence, exacerbations, and other outcomes. Do COPD patients in Spain initiating SITT vsMITT have improved persistence, exacerbations, and health care resource utilization? This real-world, observational, retrospective cohort study analyzed electronic health records in the Spanish National Healthcare System BIG-PAC database to identify COPD patients aged≥ 40 years initiating SITT or MITT (using two or three inhalers) between June 1, 2018 and December 31, 2019. Comparative data on persistence (allowing up to 60days without prescription refill), exacerbation rates, and health care resource utilization and costs during 12-month follow-up were analyzed. Multivariate adjusted analyses were performed. Eligible patients (N= 4,625) initiating SITT (n= 1,011) or MITT (n= 3,614) had a mean age of 70.9 years; most were male (73.9%) with mainly moderate (62.0%) or severe (26.5%) airflow limitation. Between-cohort baseline characteristics were similar. At 12-month follow-up, SITT patients had higher persistence (hazard ratio [HR]= 1.37; 95%CI= 1.22-1.53; P< .001), reduced risk of exacerbations (HR= 0.68; 95%CI= 0.61-0.77; P= .001), and lower all-cause mortality risk (HR= 0.67; 95%CI= 0.63-0.71, P= .027), compared with MITT patients. SITT was associated with significantly reduced health care resource use (mean annual cost savings: €403 vsMITT). For both SITT and MITT, persistence was associated with improved exacerbation rates vsnonpersistence, and substantial adjusted mean annual cost savings (€2,115 and €2,700, respectively). Patients initiating SITT had a clinically relevant improvement in persistence leading to reductions in mortality, incidence of exacerbations, and health care resource use with consequent mean cost savings.

Interventions to address polypharmacy in older adults living with multimorbidity: Review of reviews.

To summarize evidence from published systematic reviews evaluating the effect of polypharmacy interventions on clinical and intermediate outcomes. It also summarizes the adverse events that may occur as a result of these interventions. A literature search was conducted using the electronic databases MEDLINE, Embase, CINAHL, Cochrane Central, and Cochrane Database of Systematic Reviews (PROSPERO registration number: CRD42018085767). The search yielded a total of 21,329 citations, of which 619 were reviewed as full text and 5 met the selection criteria. The polypharmacy interventions were found to produce statistically significant reductions in potentially inappropriate prescribing and improved medication adherence; however, the observed effects on clinical and intermediate outcomes were inconsistent. None of the included reviews reported any significant benefit of polypharmacy interventions for quality-of-life outcomes. Specific to health care utilization and cost, polypharmacy interventions reduced health care resource usage and expenditure. The reviews reported no differences in adverse drug events between polypharmacy interventions and usual care groups. The overall certainty of evidence was reported as low to very low across included reviews. Polypharmacy interventions are associated with reductions in potentially inappropriate prescribing and improvements in medication adherence. However, there is limited evidence of their effectiveness for clinical and intermediate outcomes.

EE304 IDegAsp Treatment Was Associated with Reduced Healthcare Resource Utilization in Adults with Type 2 Diabetes: A Real-World Study

To evaluate the impact of insulin degludec/insulin aspart (IDegAsp) treatment on healthcare resource utilization (HRU) in adults with type 2 diabetes (T2D).