Reduce Health Care Utilization Research Articles

Cost Savings and Reduced Health Care Utilization Associated with Participation in a Digital Diabetes Prevention Program in an Adult Workforce Population.

BackgroundThough in-person delivery of the Diabetes Prevention Program (DPP) has demonstrated medical cost savings, the economic impact of digital programs is not as well understood.ObjectiveThis study examines the impact of a digital DPP program on reducing all-cause health care costs and utilization among 2027 adult participants at 12 months.MethodsA longitudinal, observational analysis of health care claims data was conducted on a workforce population who participated in a digital diabetes prevention program. Differences in utilization and costs from the year prior to program delivery through 1 year after enrollment were calculated using medical claims data for digital DPP participants compared to a propensity matched cohort in a differences-in-differences model.ResultsAt 1 year, the digital DPP population had a reduction in all-cause health care spend of US$1169 per participant relative to the comparison group (P = 0.01), with US$699 of that savings coming from reduced inpatient spend (P = 0.001). Cost savings were driven by fewer hospital admissions and shorter length of stay (P < 0.001). No other significant results in cost differences were detected. There was a trend toward savings extending into the second year, but the savings did not reach statistical significance.ConclusionsThese results demonstrated significant short-term health care cost savings at 1 year associated with digital DPP program delivery.

The impact of dental care programs on healthcare system and societal outcomes: a scoping review

BackgroundDental diseases have detrimental effects on healthcare systems and societies at large. Providing access to dental care can arguably improve health outcomes, reduce healthcare utilization costs, and improve several societal outcomes.ObjectivesOur objective was to review the literature to assess the impacts of dental care programs on healthcare and societal outcomes. Specifically, to identify the nature of such programs, including the type of services delivered, who was targeted, where services were delivered, and how access to dental care was enabled. Also, what kind of societal and healthcare outcomes have been attempted to be addressed through these programs were identified.MethodsWe conducted a scoping review by searching four databases, MEDLINE, EMBASE, CINAHL, and Sociological s. Relevant articles published in English language from January 2000 to February 2022 were screened by four reviewers to determine eligibility for inclusion.ResultsThe search resulted in 29,468 original articles, of which 25 were included in the data synthesis. We found minimal evidence that answers our proposed research question. The majority of identified programs have demonstrated effectiveness in reducing medical and dental healthcare utilization (especially for non-preventive services) and avert more invasive treatments, and to a lesser degree, resulting in cost-savings. Moreover, some promising but limited evidence about program impacts on societal outcomes such as reducing homelessness and improving employability was reported.ConclusionDespite the well-known societal and economic consequences of dental problem, there is a paucity of studies that address the impacts of dental care programs from the societal and healthcare system perspectives.MeSH termsDelivery of Health Care, Dental Care, Outcome assessment, Patient acceptance of Health Care.

786. Effect of Nirmatrelvir/Ritonavir versus Placebo on COVID-19─Related Hospitalizations and Other Medical Visits

Abstract Background Nirmatrelvir coadministered with ritonavir (nirmatrelvir/r) is a COVID-19 treatment. This study evaluated nirmatrelvir/r in nonhospitalized, symptomatic adults with COVID-19 at high risk of progressing to severe disease. We report secondary efficacy endpoints associated with COVID-19─related medical visits, including hospitalization details and oxygen support, as of the primary completion data cutoff (Dec 11, 2021). Methods In this phase 2/3 double-blind, interventional study, adults with confirmed SARS-CoV-2 and symptom onset ≤ 5 days (d) were randomized 1:1 to receive nirmatrelvir/r 300 mg/100 mg or placebo (PBO) orally every 12 hours for 5 d. COVID-19─related medical visits were collected through Day 28. Oxygen support for COVID-19 and details of COVID-19─related hospitalization, including duration, intensive care unit (ICU) status, and mechanical ventilation, were assessed. Results Of the 2246 patients (pts) enrolled globally from Jul to Dec2021, 2085 (nirmatrelvir/r, n=1039; PBO, n=1046) started treatment and met criteria for the modified intent-to-treat population (mITT1; ≤ 5 d of symptom onset, did not/not expected to receive a mAb). Fewer overall COVID-19-related medical visits were reported with nirmatrelvir/r vs PBO (Table 1). In addition to fewer hospitalizations being reported with nirmatrelvir/r (n=8 [0.8%]) vs PBO (n=65 [6.2%]), pts receiving nirmatrelvir/r had fewer hospitalized d (Table 2), with mean durations of 9.6 (range, 5.0, 16.0) d with nirmatrelvir/r and 11.2 (range, 2.0, 57.0) d with PBO in hospitalized pts. No pts in the nirmatrelvir/r group and 9 pts (0.9%) in PBO group were admitted to the ICU. No pts in the nirmatrelvir/r group received mechanical ventilation vs 3 pts in the PBO group. Fewer other COVID-19─related nonhospital medical visits were reported with nirmatrelvir/r vs PBO (Table 3). In the full analysis set, fewer pts required oxygen therapy for COVID-19 with nirmatrelvir/r (n=9/1120 [0.8%]) vs PBO (n=54/1126 [4.8%]). Conclusion High-risk adults with symptomatic COVID-19 treated with nirmatrelvir/r within 5 d of symptom onset had fewer COVID-19─related medical visits and reduced healthcare utilization (no ICU visits, no mechanical ventilation, fewer days in hospital) vs pts receiving PBO. Clinical Trial: NCT04960202. Disclosures Jennifer Hammond, PhD, Pfizer Inc: Employee|Pfizer Inc: Stocks/Bonds Heidi Leister-Tebbe, BSN, Pfizer Inc: Employee|Pfizer Inc: Stocks/Bonds Annie Gardner, MPH, MSPT, Pfizer Inc: Employee|Pfizer Inc: Stocks/Bonds Paula Abreu, PhD, Pfizer Inc: Employee|Pfizer Inc: Stocks/Bonds Weihang Bao, PhD, Pfizer Inc: Employee|Pfizer Inc: Stocks/Bonds Wayne Wisemandle, MA, Pfizer Inc: Employee|Pfizer Inc: Stocks/Bonds Wajeeha Ansari, MPH, Pfizer Inc.: Stocks/Bonds Rienk Pypstra, MD, MBA, Pfizer Inc: Employee|Pfizer Inc: Stocks/Bonds James M Rusnak, MD, PhD, Pfizer Inc: Employee|Pfizer Inc: Stocks/Bonds.

Development and implementation of a nurse-based remote patient monitoring program for ambulatory disease management.

Numerous factors are intersecting in healthcare resulting in an increased focus on new tools and methods for managing care in patients' homes. Remote patient monitoring (RPM) is an option to provide care at home and maintain a connection between patients and providers to address ongoing medical issues. Mayo Clinic developed a nurse-led RPM program for disease and post-procedural management to improve patient experience, clinical outcomes, and reduce health care utilization by more directly engaging patients in their health care. Enrolled patients are sent a technology package that includes a digital tablet and peripheral devices for the collection of symptoms and vital signs. The data are transmitted from to a hub integrated within the electronic health record. Care team members coordinate patient needs, respond to vital sign alerts, and utilize the data to inform and provide individualized patient assessment, patient education, medication management, goal setting, and clinical care planning. Since its inception, the RPM program has supported nearly 22,000 patients across 17 programs. Patients who engaged in the COVID-19 RPM program experienced a significantly lower rate of 30-day, all-cause hospitalization (13.7% vs. 18.0%, P = 0.01), prolonged hospitalization >7 days (3.5% vs. 6.7%, P = 0.001), intensive care unit (ICU) admission (2.3% vs. 4.2%, P = 0.01), and mortality (0.5% vs. 1.7%, P = 0.01) when compared with those enrolled and unengaged with the technology. Patients with chronic conditions who were monitored with RPM upon hospital discharge were significantly less likely to experience 30-day readmissions (18.2% vs. 23.7%, P = 0.03) compared with those unmonitored. Ninety-five percent of patients strongly agreed or agreed they were likely to recommend RPM to a friend or family member. The Mayo Clinic RPM program has generated positive clinical outcomes and is satisfying for patients. As technology advances, there are greater opportunities to enhance this clinical care model and it should be extended and expanded to support patients across a broader spectrum of needs. This report can serve as a framework for health care organizations to implement and enhance their RPM programs in addition to identifying areas for further evolution and exploration in developing RPM programs of the future.

Socioeconomic Disparities Associated With Healthcare Utilization Among Adults With Rheumatoid Arthritis.

Rheumatoid arthritis (RA) is a chronic and debilitating disease associated with negative health outcomes and high healthcare utilization. Little is known about the role of demographic and socioeconomic factors associated with healthcare utilization in RA. The purpose of this study was to explore the relationships between demographic and socioeconomic characteristics, insurance status, general health perception, and healthcare utilization among adults with RA. In this cross-sectional analysis of data from 537 participants with a self-reported diagnosis of RA from the 2017-2020 National Health and Nutrition Examination Survey, multivariate logistic regression analyses were used to explore the relationships between demographic and socioeconomic factors, insurance status, general health perception, and healthcare utilization (i.e., whether an individual saw a provider, had a routine place to go for healthcare, and stayed overnight in the hospital). The mean age of participants was 57 years; 50% were female, 57.9% were non-Hispanic White, 17.9% were Black, and 15.2% were Mexican or other Hispanic. Individuals without health insurance were less likely than insured individuals with RA to have seen a provider, have a routine place to go for healthcare, and have stayed overnight in the hospital. Adults with RA who rated their health as very good or excellent were more likely to have a routine place for healthcare and less likely to stay overnight in the hospital than those who rated their health as fair or poor. Lack of health insurance significantly correlates with decreased healthcare utilization in adults with RA in the United States. Our findings underscore the need for more frequent assessment of insurance status in adults with RA to identify individuals at an increased risk for reduced healthcare utilization and who are more likely to experience poorly perceived general health.

Economic Evaluation of Contact Force Catheter Ablation for Persistent Atrial Fibrillation in the United States.

Atrial fibrillation (AF) is the most prevalent cardiac arrhythmia, and it increases the risk of stroke, heart failure, and other cardiac complications. Catheter ablation is well-established as a treatment for paroxysmal AF, and the recent PRECEPT (Prospective Review of the Safety and Effectiveness of the THERMOCOOL SMARTTOUCH SF Catheter Evaluated for Treating Symptomatic Persistent AF) clinical trial resulted in the catheter gaining approval for the treatment of persistent AF in the United States. To construct an economic simulation model, based on the results of the PRECEPT trial, to monetize the impact of radiofrequency catheter ablation (RFCA) compared with medical therapy (MT). Cost-offset and break-even analyses were performed to assess the economic impact of RFCA vs MT for adult persistent AF patients. Three perspectives were considered: commercial payers, Medicare, and self-insured employers. A cohort-level decision tree model was developed and validated in TreeAge Pro 2019. Sensitivity analyses were performed to determine the robustness of findings. For all 3 types of payer, RFCA had a higher initial cost compared with MT. However, reductions in health care utilization after ablation, driven by decreased cardiovascular hospitalizations, led to an annual cost offset of between $5037 and $8402 after the first year. Projecting this forward resulted in an estimated cost break-even after 5.9, 4.2, and 5.1 years for commercial payers, Medicare, and self-insured employers, respectively. In addition to providing clinical benefits, RFCA may be a valuable economic investment for U.S. payers, substantially reducing utilization after the first year.

Effects of an Alzheimer's and Dementia Care Co-management Program on Quality, Clinical Outcomes, and Utilization.

The quality of care provided to persons living with dementia (PLWD) and their care partners (CPs) is low, clinical outcomes are poor, and costs are high. Co-management of dementia care by Advance Practice Providers (APPs) has the potential to improve all of these metrics. The UCLA Alzheimer's and Dementia Care (ADC) Program is a health system-based co-management model of APP Specialists (DCSs) working with primary care and specialty physicians that is designed to meet dementia care needs. DCSs approach the PLWD and CP as a dyad, providing support, including community-based resources, to both; behavioral and medication management; and care coordination. The program has provided dementia care for over 3400 PLWD and has a current census of over 750 PLWD who are cared for by 4 nurse practitioner DCSs. Quality of care based on established dementia quality indicators assessed by medical record review was 92%. Based on an analysis of the first 1091 PLWD and their CPs, prior to entering our program, many caregivers were poorly informed about dementia caregiving and felt they were fighting this battle alone. One-third had high stress and more than 10 percent were depressed. By the end of a year in the program, confidence in handling problems and complications of Alzheimer's disease and dementia improved by 72 percent. CP strain (Modified Caregiver Strain Index), distress (Neuropsychological Inventory-Distress), and depression (PHQ-9) were reduced (all P<0.001). Moreover, the program reduced emergency department visits by 20%, days spent in the hospital by 26%, admissions to nursing homes for long-term care by 40%, (all P<0.05) and overall Medicare costs by $2404 per person/year. The ADC Program has been disseminated to 18 sites nationwide and more than 5000 PLWD and their CPs have received ADC care. Dementia co-management with APPs can improve quality and clinical outcomes and reduce health care utilization and costs. The ADC Program can be implemented in diverse health systems indicating the potential for widespread dissemination.

Evaluation of "Care Plus," A Multidisciplinary Program to Improve Population Health for Patients With High Utilization.

With rising health care costs, health systems have adopted alternative care models targeting high-need, high-cost patients to improve chronic disease management and population health. Intensive primary care teams may reduce health care utilization by tackling medical and psychosocial needs specific to this patient population. This study presents health care utilization trends from a high-intensity primary care program that employs a multidisciplinary team (including clinicians, psychologists, pharmacists, chaplaincy, and community health workers) and community partnerships. Using descriptive statistics and Poisson rates of differences, this study evaluates patient and utilization characteristics of those enrolled (n = 341) versus declined (n = 54) program participation from 2013 to 2020. Both enrolled and declined patients experienced significant reduction in emergency department and inpatient utilization, but differences between enrolled and declined patients were not statistically significant. Programs aimed at decreasing health care utilization for high-need, high-cost, medically complex patients may be best supported by interventions that simultaneously address social and behavioral health needs.

Was size of healthcare institution a factor affecting changes in healthcare utilisation during the COVID-19 pandemic in Korea? A retrospective study design analysing national healthcare big data

ObjectivesMany small-sized healthcare institutions play a critical role in communities by preventing infectious diseases. This study examines how they have been impacted by the global COVID-19 pandemic compared with large...

Pathways to reduced overnight hospitalizations in older adults: Evaluating 62 physical, behavioral, and psychosocial factors.

As our society ages and healthcare costs escalate, researchers and policymakers urgently seek potentially modifiable predictors of reduced healthcare utilization. We aimed to determine whether changes in 62 candidate predictors were associated with reduced frequency, and duration, of overnight hospitalizations. We used data from 11,374 participants in the Health and Retirement Study-a national sample of adults aged &gt;50 in the United States. Using generalized linear regression models with a lagged exposure-wide approach, we evaluated if changes in 62 predictors over four years (between t0;2006/2008 and t1;2010/2012) were associated with subsequent hospitalizations during the two years prior to t2 (2012-2014 (Cohort A) or 2014-2016 (Cohort B)). After robust covariate-adjustment, we observed that changes in some health behaviors (e.g., those engaging in frequent physical activity had 0.80 the rate of overnight hospital stays (95% CI [0.74, 0.87])), physical health conditions (e.g., those with cancer had 1.57 the rate of overnight hospital stays (95% CI [1.35, 1.82])), and psychosocial factors (e.g., those who helped friends/neighbors/relatives 100-199 hours/year had 0.73 the rate of overnight hospital stays (95% CI [0.63, 0.85])) were associated with subsequent hospitalizations. Findings for both the frequency, and duration, of hospitalizations were mostly similar. Changes in a number of diverse factors were associated with decreased frequency, and duration, of overnight hospitalizations. Notably, some psychosocial factors (e.g., informal helping) had effect sizes equivalent to or larger than some physical health conditions (e.g., diabetes) and health behaviors (e.g., smoking). These psychosocial factors are mostly modifiable and with further research could be novel intervention targets for reducing hospitalizations.

Reduced healthcare utilisation and improved patient experience: preliminary results from a county wide integrated care pilot in Viljandi, Estonia.

The International Journal of Integrated Care (IJIC) is an online, open-access, peer-reviewed scientific journal that publishes original articles in the field of integrated care on a continuous basis.IJIC has an Impact Factor of 2.913 (2021 JCR, received in June 2022)The IJIC 20th Anniversary Issue was published in 2021.

Dermatology urgent care model reduces costs and healthcare utilization for psychodermatology patients - a retrospective chart review.

Patients with psychiatric dermatoses may be high users of healthcare, especially emergency services. A dermatology urgent care model may reduce healthcare utilization in this population. To determine whether a dermatology urgent care model can reduce healthcare utilization among patients with psychiatric dermatoses. We conducted a retrospective chart review of patients seen in dermatology urgent care at Oregon Health and Science University between 2018 and 2020 with diagnoses of Morgellons disease and neurotic excoriations. Rates of diagnosis-related healthcare visits and emergency department visits were annualized before and during engagement with the dermatology department. Rates were compared using paired t-tests. We found an 88.0% reduction in annual rates of healthcare visits (P&lt;0.001) and 77.0% reduction in emergency room visits (P&lt;0.003). Results were unchanged when controlled for gender identity, diagnosis, and substance use. We could not account for healthcare use not included in electronic health record. Urgent care models in dermatology may reduce overuse of healthcare and emergency services among patients with psychiatric dermatoses.

Retrospective Efficacy and Cost-Containment Assessment of 10 kHz Spinal Cord Stimulation (SCS) in Non-Surgical Refractory Back Pain Patients.

Non-surgical refractory back pain (NSRBP) is persistent, severe back pain that is not considered surgically correctable. Published studies have demonstrated clinically important long-term improvement in pain and functional capacity when 10kHz spinal cord stimulation (SCS) is used to treat NSRBP. This study examines if real-world patients in interventional pain practice obtain the same outcomes, and have any reduction in health care utilization (HCU) following 10kHz SCS implant. We conducted a retrospective chart review of 105 patients from two clinical sites who underwent implantation of 10kHz SCS for NSRBP. The three most frequent diagnoses were lumbosacral radiculopathy, degenerative disc disease (DDD)/discogenic back pain and foraminal stenosis. The complete set of patient-level electronic data, including clinical outcomes, HCU, and at least 12 months (12M) follow-up were available in 90 subjects. The 90 analyzed patients were 63.9 years old (median 67) with an average of 10.2 years since back pain diagnosis. Reported pain on the Visual Analog Scale (VAS) decreased from 7.78±1.3 cm to 3.4±2.4 cm at 12M after SCS implant (p<0.001). Opioid usage (n = 65) decreased from 57.9±89.9 mg to 34.3±66.4 mg MSO4 equivalents (p = 0.004) at 12M. There were 46 patients on various doses of anticonvulsants, mostly gabapentin. The average dose decreased from 1847.91±973.6 mg at baseline to 1297.9±1184.6 mg at 12M after implant (p = 0.016). HCU was analyzed comparing the 12M before to the 12M after implant. Number of office visits decreased from 10.83±8.0 per year to 8.86±7.64 (p = 0.036), number of procedures to control chronic pain decreased from 2.2±1.9 to 0.6±1.2 (p<0.001). There was no significant change in number of imaging procedures, hospital admissions, or days spent in the hospital. 10kHz SCS warrants consideration as a therapeutic option for NSRBP patients and appears to provide a substantial reduction in HCU in the year following implant.

Addressing drivers of healthcare utilization for neonatal opioid withdrawal syndrome.

ObjectiveAim to reduce healthcare utilization (HU) for infants at risk of neonatal opioid withdrawal syndrome (NOWS) by 30% in 1 year and sustain for 2 years.Study designBaseline data from three Level I & II newborn nurseries from January 2016 to June 2018 informed PDSA cycles from August 2018 to December 2021. Shewhart process control charts evaluated length of stay (LOS), pharmacologic treatment (PT) rates, direct cost (DC), process, and balancing measures for special cause variation (SCV).ResultsTwo hundred and seventeen infants showed downward SCV in LOS (12.6 to 4.4 days), PT (53% to 17%) and DC ($12593.82 to $5219.17). Onset of the COVID-19 pandemic coincided with reversible SCV. DC varied by provider specialty.ConclusionTransition from MFNASS to ESC led to decrease in healthcare utilization for infants at risk of NOWS. QI methodology identified persistent drivers of variability, including the COVID-19 pandemic and provider specialty.

SUBOPTIMAL UPTAKE OF OUTPATIENT PULMONARY REHABILITATION FOLLOWING DISCHARGE FOR A COPD EXACERBATION: ONE HOSPITAL'S EXPERIENCE

SUBOPTIMAL UPTAKE OF OUTPATIENT PULMONARY REHABILITATION FOLLOWING DISCHARGE FOR A COPD EXACERBATION: ONE HOSPITAL'S EXPERIENCE

Catheter ablation using advanced porous tip contact force-sensing radiofrequency catheter: Impact on health care utilization among patients with persistent atrial fibrillation.

Catheter ablation (CA) is an effective treatment for patients with persistent atrial fibrillation (PsAF); however, little is known about its impact on health care utilization for patients with PsAF. The ThermoCool SmartTouch SF (STSF) catheter (Biosense Webster) incorporates an advanced porous tip and contact force-sensing technology. The purpose of this study was to determine health care utilization among patients with PsAF who underwent ablation with the STSF catheter. A retrospective cohort study using the Premier Healthcare Database identified patients with PsAF undergoing CA with the STSF catheter in inpatient and outpatient settings. The proportion of patients experiencing AF-related inpatient admissions, outpatient admissions, emergency department (ED) visits, electrical cardioversion, and a composite outcome in the 12 months pre- vs postablation were compared using the McNemar test. Subanalyses were performed on study outcomes by race/ethnicity. The final sample included 3077 patients (mean age 65.9 years; 31.7% female). Among patients with PsAF undergoing ablation with the STSF catheter, relative reductions in health care utilization in the 12 months post- vs preablation included 55.3% in AF-related inpatient admissions (P <.0001), 38.9% in outpatient admissions (P <.0001), 52.4% in ED visits (P <.0001), and 61.2% in electrical cardioversions (P <.0001). Composite outcomeutilization in the 12 months post- vs preablation declined by 40.2% (P <.0001) for the overall cohort, 40.0% for White patients (P <.0001), 52.2% for Black patients (P <.0001), and 50.1% for Asian patients (P = .032). Significant improvements in health care utilization were observed among PsAF patients who underwent ablation using the STSF catheter. Improvements were particularly marked in underrepresented racial and ethnic groups.

S788 Long-Term Use of Bile Acid Sequestrants to Improve Diarrhea and Abdominal Pain in IBD Patients With Ileoanal Pouch Anastomosis: A Tertiary Referral Center Experience

Introduction: Bile acid (BA) sequestrants are commonly used in IBD following ileocecal resection to treat bile acid malabsorption and associated abdominal pain and diarrhea. There is less experience with use of BA binders in IBD patients following colectomy and ileoanal pouch reconstruction. IBD ileoanal pouch patients frequently experience bouts of diarrhea and abdominal pain and have limited treatment options. We sought to characterize our institutional experience with BA sequestrants to treat abdominal pain and diarrhea in a large cohort of IBD ileoanal pouch patients with a focus on longterm therapy and improvement in patient reported outcomes. Methods: We analyzed a prospective, natural history registry of consented IBD patients followed at a tertiary center (2009-2022). Patients with ileoanal pouch reconstruction following colectomy were identified and individuals with > 2 years of follow up formed the study cohort. BA sequestrants included cholestyramine, colestipol and colesevelam. Patient reported outcomes of diarrhea and abdominal pain, recorded at the time of clinic encounters were organized, and mean scores before and after bile acid binder therapy were compared. Results: There were 132 ileoanal pouch patients with longterm followup (mean age 51.8 + 13.9 years; 42% F; 58% M). BA sequestrants were initiated in 93 individuals and 63 patients (68%) continued therapy for >2 years, forming the multiyear therapy group. Patterns of BA sequestrant use included 48% receiving one, 41% trialing two and 11% using all three agents. The most commonly prescribed were colesevelam (48 patients), cholestyramine (33 patients) and colestipol (22 patients) and switching between BA sequestrants was commonly due to insurance coverage. The mean number of stools per day improved following initiation of BA sequestrants (p< 0.001). Abdominal pain scores also improved with longterm BA sequestrant therapy (p=0.017). Patterns of healthcare utilization improved with longterm BA sequestrant therapy with a reduction in annual patterns of emergency room visits (p=0.007) and hospitalizations (p< 0.001). (Figure) Conclusion: A majority of IBD ileoanal pouch patients benefitted from BA sequestrant treatment, reducing number of bowel movements and abdominal pain over a >2 year period, with a parallel reduction in healthcare utilization. Formal trials of BA sequestrants in the longterm management of chronic ileoanal pouch symptoms in the IBD patient population are warranted.Figure 1.: Results before and after bile acid sequestrants.

Exploring cost and utilization outcomes of Huntsman at Home: Which patients benefit most from a novel oncology hospital at home program?

15 Background: We previously demonstrated that Huntsman at Home (HH), a novel oncology hospital at home program, was associated with reduced healthcare utilization and costs. HH was also linked to shorter hospital stays and fewer emergency room (ER) visits. In this study, we sought to understand the impact of HH in specific patient subgroups. Methods: We compared outcomes among 169 patients consecutively admitted to HH against 198 usual care patients. Five dichotomous subgroups were created based upon patient a) sex b) age c) area level median income d) Charlson Comorbidity Index (CCI), and e) current use of systemic therapy (ST). Outcomes included 30-day costs, unplanned hospitalizations (UH), length of hospital stays, and ER visits. HH and usual care were compared via inverse propensity weighted regression models. Treatment propensities were estimated via random forests based on age, race, stage, cancer site, presence of metastases, CCI, and area level median income.Results: The between group difference favoring HH achieved statistical significance (p &lt; 0.05) for at least two out of the four outcomes in each subgroup except for patients with higher comorbid illnesses. While HH participants did not always experience statistically better outcomes than usual care, none of the outcomes examined favored usual care for any subgroup. Sex. Female and male HH patients experienced fewer UH and lower costs than usual care. Male HH patients also had shorter hospital stays and fewer ED visits. Age. When stratifying age at 65 years, older HH patients experienced fewer days in the hospital and fewer UH. Younger HH patients had lower costs, and fewer UH and ED visits. Area level Income. All outcomes were better for high and low income HH patients compared to usual care except for ED visits among those with low income. CCI. Among those with a low CCI score, all four outcomes were better among HH patients. In contrast, differences between groups with higher comorbid illness did not achieve statistical significance for any outcome. Systemic Therapy. HH participants on ST experienced shorter hospital stays and fewer UH compared to usual care. Among those not on ST, HH patients experienced lower costs, and fewer UH and ED admissions. Conclusions: In this exploratory analysis, we found that the utilization and cost benefit associated with HH was robust, favoring better outcomes in each subgroup including lower 30-day costs, shorter hospital length of stay and fewer unplanned hospitalizations or ER visits. While medically complex patients may not receive similar benefit from HH as other subgroups, no outcomes favored patients managed by usual care. Taken together, this suggests that health care utilization and cost reductions associated with HH occur across multiple subgroups, but patients with high comorbidity may require additional intervention to realize lower utilization and costs.

Creating a proactive interdisciplinary approach to care: Embedding oncology care coordination within an oncology patient and family support program.

51 Background: The benefits of providing psycho-oncology services have been well documented in producing better effective team collaboration, patient outcomes, and reduced healthcare utilization. Cedars-Sinai Cancer spans five locations and serves over 11,000 patients a year. Their robust Patient and Family Support program (PFSP) includes psychiatry, palliative medicine, social work, nutrition, cancer rehabilitation, survivorship, and chaplaincy to envelop patients in multiple dimensions of support. A new oncology care coordination (CC) model embedded a social work (SW) and nurse (RN) CC within PFSP to identify and meet diverse unmet needs of patients through close interdisciplinary collaboration. Methods: Oncology CC was established within PFSP, containing an oncology SW CC and an oncology RN CC. Patients with higher acuity needs were identified through multiple avenues such as: health plan reporting and dashboards in the electronic medical record (EMR) providing alerts for patients with unmet needs. Preliminary data was captured on interdisciplinary collaboration and care coordination from a daily log kept by coordinators, as well as from the EMR. Results: Over 6 months (9/2021 to 2/2022), the PFSP CC team served 688 patients providing 1280 interventions. Of the 1280 interventions, 22% were coordination with other PFSP services; of which 54% was with SCM, 36% with Clinical SW, and 18% represented new referrals. 13% focused on outside services including medical devices, home health, and community resources. 6% comprised of post-discharge calls by the RN CC and 16% represented direct SW CC outreach. Care coordination such as appointment scheduling, assistance with prescriptions and communication with medical teams represented 9%, 1% and 11% of the interventions respectively. Conclusions: Results demonstrated for this subset of patients that the highest needs of oncology PFSP CC were SW and SCM, to address needs such as pain and symptom management, goals of care conversations and community resource linkage. Anecdotally, communication with primary oncology and other medical teams proved to be an essential role of the CC team, particularly to address inpatient to outpatient transitions of care. Discussion: CC team involvement is time-limited and appears to rely on the long-term relationship patients have with PFSP interdisciplinary team members for interventions to be long-lasting and effective. The CC team leveraged existing relationships that PFSP providers had established with primary oncology teams, allowing for timely care coordination. Future goals include: 1) developing an algorithm to better identify patients with higher acuity and unmet needs; 2) measuring impacts of CC services on care outcomes, health care utilization and reduced symptom burden; 3) expanding the CC team to serve more of the patient population.

The impact of substance use on health care utilization, treatment, and outcomes in patients with non-small cell lung cancer.

Mortality from non-small cell lung cancer (NSCLC) has improved with screening and novel treatments. The substance use epidemic has threatened health outcomes in a variety of diseases, but little is known about how it is associated with NSCLC outcomes. We performed a retrospective cohort study of 211 patients with NSCLC treated at a safety-net hospital. Sociodemographic data and clinical outcomes were extracted via review of electronic medical records. Patients were stratified based on substance use status. Comparative and multivariable analyses were performed to evaluate baseline characteristics and lung cancer outcomes including survival. Among 193 patients (91.5%) with information available on substance use, 24.9% reported substance use; specifically, alcohol, marijuana, and illicit substances. Patients with substance use were more likely to have increased health care utilization and poor social determinants of health, including safe housing, stable employment, and social support. There were no significant differences in treatment adherence. Only 6.3% of patients with substance use did not receive guideline concordant care (GCC) compared to 24.8% of patients without substance use; due to poor performance status, increased comorbidities, or loss to follow up. On univariable analysis, patients with substance use experienced inferior median overall survival (OS) if they had metastatic disease (0.40 vs. 1.03 years, P=0.01). However, in the multivariable analysis, substance use did not predict for survival. Independent predictors of mortality were sex (male HR, 1.67; 95% CI: 1.04-2.68; P=0.04), smoking status (current smoking HR, 2.63; 95% CI: 1.14-6.08; P=0.02), and stage (stage IV HR, 14.96; 95% CI: 6.28-35.63; P=0.008). Substance use is associated with poor social determinants of health and increased health care utilization. On multivariable analysis, substance use was not independently associated with OS once guideline-concordant care was used. Future studies should focus on improving our understanding of these associations, delineating potential mechanisms, and developing evidence-based strategies to reduce health care utilization and overcome challenges related to poor social determinants of health.