Reduction In Emergency Room Visits Research Articles

Increasing tree cover and high-albedo surfaces reduces heat-related ER visits in Los Angeles, CA

There is an urgent need for strategies to reduce the negative impacts of a warming climate on human health. Cooling urban neighborhoods by planting trees and vegetation and increasing albedo of roofs, pavements, and walls can mitigate urban heat. We used synoptic climatology to examine how different tree cover and albedo scenarios would affect heat-related morbidity in Los Angeles, CA, USA, as measured by emergency room (ER) visits. We classified daily meteorological data for historical summer heat events into discrete air mass types. We analyzed those classifications against historical ER visit data to determine both heat-related and excess morbidity. We used the Weather Research and Forecasting model to examine the impacts of varied tree cover and albedo scenarios on meteorological outcomes and used these results with standardized morbidity data algorithms to estimate potential reductions in ER visits. We tested three urban modification scenarios of low, medium, and high increases of tree cover and albedo and compared these against baseline conditions. We found that avoiding 25% to 50% of ER visits during heat events would be a common outcome if the urban environment had more tree cover and higher albedo, with the greatest benefits occurring under heat events that are moderate and those that are particularly hot and dry. We conducted these analyses at the county level and compared results to a heat-vulnerable, working-class Los Angeles community with a high concentration of people of color, and found that reductions in the rate of ER visits would be even greater at the community level compared to the county.

INNOVATING HOME HEALTH DELIVERY TO IMPROVE VETERANS’ ACCESS TO CARE AND CARE COORDINATION

Abstract Nearly 350,000 Veterans receive home health services through the Veterans Health Administration (VA) annually. Historically, VA has purchased most home health services from contract agencies in the community. VA leaders have expressed growing concerns about Veterans’ access to home health, especially in rural areas. Coordinating care between VA and contract agencies is an ongoing challenge. To address these challenges, the VA Midwest Health Care Network (VISN 23) developed the VA Home Health (VAHH) pilot program. The program launched at the Iowa City VA and is currently operating at 4 sites in Iowa and South Dakota. Through VAHH, local VA Medical Centers hire home health staff directly (nurses, aides, physical and occupational therapists), rather than purchase these services through contract agencies. In this presentation, we describe program development, challenges, and early evaluation findings. In fiscal year (FY) 2022, 200 Veterans received VAHH. So far in FY2023, over 700 Veterans have been served. Pre/post comparisons involving Veterans receiving VAHH show modest reductions in emergency room visits (727 vs. 664 visits) and inpatient admissions (227 vs. 192 admissions). Overall hospital lengths of stay have reduced more dramatically (2132 vs. 1390 total days). VAHH staff note close communication with Veterans’ primary care teams, and Veterans describe being highly satisfied with the program. Interest in VAHH is growing nationally, particularly as access to home health in many regions is limited. Early lessons from the VAHH pilot program could inform VA decisions about home health delivery and assist other sites in improving care for Veterans.

Evaluation of the Effects of Fasting During the Holy Month of Ramadan on Patients with Epileptic Attacks Who Visited the Emergency Room

Background: Epilepsy is one of the most common disorders of the central nervous system. Many factors affect the occurrence and severity of epileptic attacks (EAs). Food is one of the most challenging of the factors. Fasting during Ramadan is one of the important requirements in Islam, and it has always been challenging for epileptic patients. This study evaluated the number of EA cases admitted to the emergency room (ER) during Ramadan. Methods: This prospective and cross-sectional study evaluated all ER visits by EA patients during the months of Shaaban, Ramadan, and Shawwal (all were convulsions). In this study, the mean average ER visit frequency was compared in the three months. The differences between the mean averages of EA visits were significant (P<0.05). Results: Of the 156 cases, half were male and half were female. The frequency of EAs was 68, 35, and 53 for the months of Shaaban, Ramadan, and Shawwal, respectively. It was found that there was about 40% reduction in ER visits during the month of Ramadan, mainly due to the discontinuation of antiepileptic drugs. Conclusion: During the Holy month of Ramadan, the number of visits to the ER due to EA (convulsions) decreased. Two mechanisms are involved in the reduced number of epileptic occurrences and their control: First, the consumption of a high-fat diet and bigger protein portions, and, second, reduced food consumption. Other possible factors are reduced travel during Ramadan, better administration of drugs, and the peaceful mind attributed to this month.

A Practice-Proven Adaptive Case Management Approach for Innovative Health Care Services (Health Circuit): Cluster Randomized Clinical Pilot and Descriptive Observational Study.

Digital health tools may facilitate the continuity of care. Enhancement of digital aid is imperative to prevent information gaps or redundancies, as well as to facilitate support of flexible care plans. The study presents Health Circuit, an adaptive case management approach that empowers health care professionals and patients to implement personalized evidence-based interventions, thanks to dynamic communication channels and patient-centered service workflows; analyze the health care impact; and determine its usability and acceptability among health care professionals and patients. From September 2019 to March 2020, the health impact, usability (measured with the system usability scale; SUS), and acceptability (measured with the net promoter score; NPS) of an initial prototype of Health Circuit were tested in a cluster randomized clinical pilot (n=100) in patients with high risk for hospitalization (study 1). From July 2020 to July 2021, a premarket pilot study of usability (with the SUS) and acceptability (with the NPS) was conducted among 104 high-risk patients undergoing prehabilitation before major surgery (study 2). In study 1, Health Circuit resulted in a reduction of emergency room visits (4/7, 13% vs 7/16, 44%), enhanced patients' empowerment (P<.001) and showed good acceptability and usability scores (NPS: 31; SUS: 54/100). In study 2, the NPS was 40 and the SUS was 85/100. The acceptance rate was also high (mean score of 8.4/10). Health Circuit showed potential for health care value generation and good acceptability and usability despite being a prototype system, prompting the need for testing a completed system in real-world scenarios. ClinicalTrials.gov NCT04056663; https://clinicaltrials.gov/ct2/show/NCT04056663.

0550 Positive Airway Pressure for Obstructive Sleep Apnea in Diastolic Heart Failure Patients Reduces Healthcare Resource Utilization

Abstract Introduction Although diastolic heart failure (HFpEF) patients frequently have comorbid obstructive sleep apnea (OSA), which has been associated with poor prognosis, the impact of positive airway pressure (PAP) therapy remains unclear. This retrospective study sought to investigate the association between 1 year adherence to PAP therapy and healthcare resource utilization (HCRU) in patients with newly diagnosed OSA and comorbid HFpEF. Methods A national sample of administrative claims data linked to objective PAP therapy usage was used for this analysis. Eligible patients either had two healthcare encounters or one hospitalization with a diastolic heart failure ICD-10 diagnosis code the year prior to being diagnosed with OSA and initiated on PAP therapy. HCRU was measured as a composite outcome of hospitalizations and emergency room (ER) visits. Propensity score matching was used to create well-balanced groups with differing PAP adherence levels to assess the association with 1 year HCRU outcomes. Risk-adjusted models were used to generate the number needed to treat (NNT) that referred to the number of patients that need to become adherent to PAP from non-adherent to avoid 1 visit. Results 4,237 patients with OSA and comorbid HFpEF were included. With propensity score matching, 963 PAP adherent and 963 non-adherent patients remained. After 1 year of PAP therapy, adherent patients had fewer visits than non-adherent patients (1.16 visits per subject vs. 1.75, p &amp;lt; 0.001), driven by a 57% reduction in hospitalizations and a 36% reduction in ER visits for adherent patients. Total HCRU costs were lower in adherent patients than in non-adherent patients ($12,732 vs. $15,610, p&amp;lt; 0.01). Converting 1 patient from non-adherent to adherent would avoid 1.25 visits (either ER visit or hospitalization), with an NNT of 0.8. Conclusion HFpEF patients with OSA that are adherent to PAP therapy for 1 year have fewer hospitalizations and ER visits than patients that are not adherent. More importantly, HCRU costs were lower in adherent patients, highlighting the clinical and economic benefits of treating OSA with PAP therapy in HFpEF patients. Support (if any) Funding Source: ResMed

0549 Positive Airway Pressure for Obstructive Sleep Apnea in Systolic Heart Failure Patients Reduces Healthcare Resource Utilization

Abstract Introduction The prevalence of obstructive sleep apnea (OSA) is high in patients with systolic heart failure (HFrEF) and has been associated with poor prognosis in this patient population. The impact of positive airway pressure (PAP) therapy in patients with OSA and HFrEF remains unclear. This retrospective study sought to investigate the association between 1-year adherence to PAP therapy and healthcare resource utilization (HCRU) in patients with newly diagnosed OSA and comorbid HFrEF. Methods A national sample of administrative claims data linked to objective PAP therapy usage was used for this analysis. Included patients either had two healthcare encounters or one hospitalization with a systolic heart failure ICD-10 diagnosis code the year prior to being diagnosed with OSA and initiated on PAP therapy. HCRU was measured as a composite outcome of hospitalizations, and emergency room (ER) visits. Propensity score matching was used to create well-balanced groups with differing PAP adherence levels to assess the association with 1-year HCRU outcomes. Risk-adjusted models were used to generate the number needed to treat (NNT) that referred to the number of patients that need to become adherent to PAP from non-adherent to avoid 1 visit. Results We identified 3,182 patients with OSA and comorbid HFrEF, and after propensity score matching, 738 patients remained in each group (adherent vs. non-adherent). After 1 year of PAP therapy, adherent patients had fewer visits than non-adherent patients (0.92 vs. 1.15 visits per subject, p = 0.006), which was driven by a 24% reduction in ER visits for adherent patients. Composite hospitalization and ER visit costs were lower in adherent versus non-adherent patients ($3,500 vs. $5,879, p=0.03). The NNT for the entire cohort to avoid one visit was 1.5 patients. Conclusion HFrEF patients with comorbid OSA who were adherent to PAP therapy for 1 year have fewer composite hospitalizations and ER visits than patients that were not adherent. These results highlight the clinical and economic benefits of treating OSA in HFrEF patients. Support (if any) Funding Source: ResMed

Understanding the impact of the COVID‑19 pandemic on healthcare services for adults during three waves of COVID‑19 infections: A South African private sector experience.

Since the onset of the COVID‑19 pandemic, healthcare resources have been repurposed to focus on COVID‑19. Resource reallocation and restrictions to movement that affected general access to care may have inadvertently resulted in undue disruptions in the continuum of care for patients requiring non-COVID‑19 healthcare services. To describe the change in pattern of health service use in the South African (SA) private sector. We conducted a retrospective study of a nationwide cohort of privately insured individuals. An analysis of claims data was performed for non-COVID‑19 related healthcare services provided from April 2020 to December 2020 (year 1 of COVID‑19) and April 2021 to December 2021 (year 2 of COVID‑19) relative to the same period in 2019 prior to the COVID‑19 pandemic in SA. Over and above plotting the monthly trends, we tested for statistical significance of the changes using a Wilcoxon test given the non-normality of all the outcomes. Between April and December 2020, relative to the same period in 2021, and also relative to the same period in 2019, we found a 31.9% (p<0.01) and a 16.6% (p<0.01) reduction in emergency room visits, respectively; a 35.9% (p<0.01) and 20.5% (p<0.01) reduction in medical hospital admissions; a 27.4% (p=0.01) and 13.0% (p=0.03) reduction in surgical hospital admissions; a 14.5% (p<0.01) and 4.1% (p=0.16) reduction in face-to-face general practitioner consultations for chronic members; a 24.9% (p=0.06) and 5.2% (p=0.54) reduction in mammography for female members; a 23.4% (p=0.03) and 10.8% (p=0.09) reduction in Pap smear screenings for female members; a 16.5% (p=0.08) and 12.1% (p=0.27) reduction in colorectal cancer registrations and an 18.2% (p=0.08) and 8.9% (p=0.07) decrease in all oncology diagnoses. Uptake of telehealth services throughout the healthcare delivery system increased by 5 708% in 2020 compared with 2019, and 36.1% for 2021 compared with 2020. A significant reduction in emergency room visits, hospital admissions and utilisation of primary care services was observedsince the start of the pandemic. Further research is required to understand if there are long-term consequences of delayed care. An increase in the use of digital consultations was observed. Research on their acceptability and effectiveness may open new modalities of care, which may have cost- and time-saving benefits.

Ambulatory Pulmonary Artery Pressure Monitoring Reduces Costs and Improves Outcomes in Symptomatic Heart Failure: A Single-Centre Canadian Experience

BackgroundPulmonary artery pressure (PAP) monitoring reduces heart failure (HF) hospitalizations (HFHs) and improves quality of life in New York Heart Association (NYHA) class III HF. We evaluated the impact of PAP monitoring on outcomes and health spending in a Canadian ambulatory HF cohort. MethodsTwenty NYHA III HF patients underwent wireless PAP implantation at Foothills Medical Centre, Calgary, Alberta. Baseline, and 3-, 6-, 9-, and 12-month assessments of laboratory parameters, hemodynamics, 6-minute walk text and Kansas City Cardiomyopathy Questionnaire scores were collected. Healthcare costs 1 year pre- and post-implantation were collected from administrative databases. ResultsMean age was 70.6 years; 45% were female. Results were as follows: an 88% reduction in emergency room visits (P = 0.0009); an 87% reduction in HFHs (P < 0.0003); a 29% reduction in heart function clinic visits (P = 0.033), and a 178% increase in nurse calls (P < 0.0002). Questionnaire and 6-minute walk test scores at baseline vs last follow-up were 45.4 vs 48.4 (P = 0.48) and 364.4 vs 402.8 m (P = 0.58), respectively. Mean PAP at baseline vs follow-up was 31.5 vs 24.8 mm Hg (P = 0.005). NYHA class improved by at least one class in 85% of patients. Mean measurable HF-related spending preimplantation was CAD$29,814 per patient per year and postimplantation was CAD$25,642 per patient per year (including device cost). ConclusionsPAP monitoring demonstrated reductions in HFHs, and emergency room and heart function clinic visits, with improvements in NYHA class. Although further economic evaluation is needed, these results support the use of PAP monitoring as an effective and cost-neutral tool in HF management in appropriately selected patients in a publicly funded healthcare system.

Are restrictions in sales hours of alcohol associated with fewer emergency room visits in Lithuania? An interrupted time-series analysis.

On 1 January 2018, an amendment to the alcohol control law was introduced in Lithuania which, among other changes, reduced trading hours for alcoholic beverages by 4 h for weekdays and Saturdays, and by 9 h for Sundays. The objective of the current study was to quantify the potential association of this law with the numbers and types of emergency room (ER) visits in Lithuania, in general and specifically for Sundays, for all ER visits, for injury-related ER visits and specifically for alcohol poisoning as a 100% alcohol-attributable cause. Sex-stratified time-series analysis-based models for the period 2016-2019 were used to test for associations and for potential alternative explanations (e.g., the increase in minimum legal drinking age, which occurred at the same time). Overall, while the reduction in sales hours for both sexes was associated with slight increases in all types and in injury-related ER visits on a weekly basis, the association with ER visits for alcohol poisoning was in the opposite direction for men in all models. Specifically, among men, it was associated with an approximate decrease of 20% of alcohol poisoning-related ER visits on Sundays and an approximate decrease of 12% of alcohol poisoning-related ER visits for all seven weekdays. As predicted, restrictions on availability were associated with marked reductions in ER visits for alcohol poisoning in men. However, contrary to expectations, there were no overall reductions in overall ER visits, nor reductions in injury-related ER visits.

Feasibility of Electronic Patient-Reported Outcome (ePRO) Measurement Using PRO-CTCAE® Questionnaire to Improve Quality of Life Assessment and Healthcare Resources Management in Patients with Lymphoma Receiving Intravenous Chemotherapy

Introduction Different validated questionnaires to assess quality of life (QoL) exist and are used in clinical trials for patients with hematological malignancies. The use of Patient-Reported Outcome Measurement (PROM) in daily clinical practice is scarce. "E-Res Salud” is a value-based healthcare program implemented in a public hospitals network in Spain that aims to give voice to patients and collect individual and aggregate data to improve process management and patient journey. The hypothesis of this prospective single-center study was that the implementation of an electronic PROM (ePROM) program in patients with lymphoma receiving intravenous (iv) chemotherapy in the outpatient setting may improve self-perception of health and allow a better use of resources. The primary objective was to compare the adverse events (AEs) profile reported by physicians in the electronic medical record (EMR) and those reported by patients through a validated questionnaire (PRO-CTCAE®). Secondary objectives were to describe the evolution of symptoms reported along the treatment period and to analyze the impact of a PROM program in the reduction of visits to Emergency Room (ER) and unscheduled hospitalizations. Methods Patients with diagnosis of non-Hodgkin lymphoma (NHL) in the need of iv. therapy between 1st January 2019 and 31st December 2021 were included in the study. "E-Res Salud” was launched in January 2020. Patients included in 2019 and those rejecting participation were considered the control arm. All participating patients were registered in the hospital patient portal. PRO-CTCAE® was electronically sent through the app at 3 points (after 1st, 3rd, and 6th month of therapy). Those reporting symptoms of low intensity were to receive recommendations automatically through the app. Those reporting symptoms of high intensity were to receive a teleconsultation call by the specialized nurse. Differences in proportions were compared with chi-square test. Survival was estimated with Kaplan Meier method. A Sankey diagram was built to depict flows of severity of symptoms. Two-sided test and p-values <0.05 were considered statistically significant. Analysis were performed with SPSS-Statistics.v.23. Results Among the 201 patients included in the study, 76 patients (37.8%) reported outcomes in the ePROM program. Despite patients were not randomized, baseline characteristics were balanced (Table 1). Most frequently AEs reported by physicians in the EMR were hematological (73%), gastrointestinal (62%) and psychological (38%). In contrast, the most frequently patient-reported adverse events were cutaneous (47%), gastrointestinal (44%) and oral (26%), according to PRO-CTCAE® categories (p<0.01). A Sankey diagram showed symptoms’ flow during the first six months of treatment. After the first course of chemotherapy, 46% of patients reported symptoms of high frequency, intensity or impact in their QoL. At third month the proportion of patients reporting high intensity symptoms was significantly higher (67% vs. 46%; p<0.05). No differences were found between the third and sixth month. Differences were also statistically significant between first and sixth month (p<0.01). Finally, those who were adherent to the program had fewer number of visits to ER (19.2% vs. 55.2%; p<0.01) and required fewer unscheduled hospital admissions (15.8% vs. 37.6%; p<0.01). When analyzing outcomes of patients with symptoms of high intensity, the intervention of a specialized nurse reduced the proportion of patients who finally visited the ER vs. those who didn't report any or low intensity symptoms (18.8% vs. 53.8%; p<0.01). Overall survival among patients visiting ER was significantly shorter than among those who did not (stratified hazard ratio, 2.26; 95% confidence interval [CI], 1.11 to 4.63; p=0.025). Conclusion Better understanding of patient-reported symptoms could aid physicians to develop an individualized treatment plan. The use of ePROM and secondarily identifying those patients who report symptoms of high intensity may be translated into a better self-perception of health and QoL. The reduction of ER visits should be a key target for hematologists as it may impact in survival. Further follow-up and larger sample size will allow us to increase data granularity of the level of detail considered in this model and will lead to a decision-making process by integrating patients voice into healthcare decision. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Abstract 11028: Positive Airway Pressure Therapy for Obstructive Sleep Apnea in Heart Failure Patients With Preserved Ejection Fraction - Implications for Healthcare Resource Utilization

Introduction: Heart failure patients with preserved ejection fraction (HFpEF) frequently have co-morbid obstructive sleep apnea (OSA), although the impact of OSA treatment remains unclear in this patient population. We assessed the association between adherence to positive airway pressure (PAP) therapy and healthcare resource utilization in patients with OSA and HFpEF. Methods: Administrative insurance claims data linked with objective PAP therapy usage data from patients with OSA and HFpEF were used to measure the association of PAP adherence and healthcare resource utilization, defined by hospitalizations and emergency room (ER) visits. US Medicare defines PAP compliance as use for at least 4 hours/night for 70% of nights in a consecutive 30-day period over 90 days. PAP adherent patients met this criteria for all 4 90-day periods, while PAP non-adherent patients did not meet this criteria for any 90-day period over one year. Propensity score methods were used to create well matched groups with differing PAP adherence levels. Results: The study cohort consisted of 4,237 eligible patients (54.0% female, mean age 64.1 years), of whom 40% were considered adherent to PAP therapy (30% intermediate-adherent, 30% non-adherent). After propensity score matching on prior year covariates, during the year after PAP prescription, PAP adherent patients had fewer hospital visits than non-adherent patients, with a 57% reduction in hospitalizations and a 36% reduction in ER visits for PAP adherent patients (Table 1a). These results remained consistent with inverse probability weighting, and furthermore showed a significant difference in hospitalizations between intermediate-adherent and non-adherent patients, but no significant difference in ER visits (Table 1b). Conclusions: Treating OSA with PAP therapy in patients with HFpEF is associated with a reduction in hospitalizations and ER visits. Adherence to PAP therapy is required to realize these clinical benefits.

Abstract 13554: Effect of Positive Airway Pressure Therapy for Obstructive Sleep Apnea in Heart Failure Patients With Reduced Ejection Fraction - Implications for Healthcare Resource Utilization

Introduction: Obstructive sleep apnea (OSA) is common in heart failure, although the impact of OSA treatment remains unclear. We assessed the association between adherence to positive airway pressure (PAP) therapy and healthcare resource utilization in patients with OSA and heart failure with reduced ejection fraction (HFrEF). Methods: Administrative insurance claims data linked with objective PAP therapy usage data from patients with OSA and HFrEF were used to measure the association of PAP adherence and a composite clinical outcome of hospitalization and emergency room (ER) visits. US Medicare defines PAP compliance as usage of the device for at least 4 hours/night for 70% of nights in a consecutive 30-day period over 90 days. PAP adherent patients met these criteria for all 4 90-day periods, while PAP non-adherent patients did not meet these criteria for any 90-day period over one year. Propensity score methods were used to create well matched groups with differing PAP adherence levels. Results: The study cohort consisted of 3,182 eligible patients (69.9% male, mean age 59.7 years) of whom 39% were considered adherent to PAP therapy (29% intermediate-adherent, 31% non-adherent). In the year after PAP prescription, after propensity score matching, PAP adherent patients had fewer hospital visits than non-adherent patients, driven by a 24% reduction in ER visits for adherent patients (Table 1a). These results remained consistent with inverse probability weighting and furthermore showed there were no statistically significant differences between intermediate-adherent and non-adherent patients for any outcome (Table 1b). Conclusions: Treating OSA with PAP therapy in patients with HFrEF is associated with a reduction in the composite outcome of hospitalization and ER visits, driven primarily by a reduction in ER visits. Consistent adherence to PAP therapy is required to realize these benefits.

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.

Reductions in NO2 and emergency room visits associated with California's goods movement policies: A quasi-experimental study

IntroductionThis study examines whether the “Emission Reduction Plan for Ports and Goods Movement” in California reduced air pollution exposures and emergency room visits among California Medicaid enrollees with asthma and/or chronic obstructive pulmonary disease. MethodWe created a retrospective cohort of 5608 Medicaid enrollees from ten counties in California with data from 2004 to 2010. We grouped the patients into two groups: those living within 500 m of goods movement corridors (ports and truck-permitted freeways), and control areas (away from the busy truck or car permitted highways). We created annual air pollution surfaces for nitrogen dioxide and assigned them to enrollees’ home addresses. We used a quasi-experimental design with a difference-in-differences method to examine changes before and after the policy for cohort beneficiaries in the two groups. ResultsThe reductions in nitrogen dioxide exposures and emergency room visits were greater for enrollees in goods movement corridors than those in control areas in post-policy years. We found that the goods movement actions were associated with 14.8% (95% CI, −24.0% to −4.4%; P = 0.006) and 11.8% (95% CI, −21.2% to −1.2%; P = 0.030) greater reduction in emergency room visits for the beneficiaries with asthma and chronic obstructive pulmonary disease, respectively, in the third year after California's emission reduction plan. ConclusionThese findings indicate remarkable health benefits via reduced emergency room visits from the significantly improved air quality due to public policy interventions for disadvantaged and susceptible populations.

A Housing First evaluation project for homeless Veterans in Canada: Quantitative findings

LAY SUMMARY This study sought to evaluate a Housing First program for Veterans experiencing homelessness. Housing First is an approach made up of many different aspects of care including peer support and greater access to care resources within the home. These aspects of care are offered in order to address underlying issues and maintain housing stability. The program was implemented across four cities in Canada including London, Toronto, Calgary, and Victoria. To assess the program, interviews with Veterans were conducted at time of enrollment, 3, 9, and 15 months. The Veterans in this study demonstrated a significant reduction in homelessness. As well, a significant reduction in emergency room visits was reported. Other health care interactions and quality-of-life scores remained stable. These findings could, therefore, lead to potential future cost savings in the health care sector. This study demonstrates why this approach to housing for Veterans can be a highly effective and useful way to ensure housing stability.

Where Are We Headed? Diagnosing Abnormal Head Shapes Through Virtual Care Visits.

Since the beginning of the coronavirus disease 2019 pandemic in early March, there has been a push to expand virtual patient care visits instead of in-person clinic visits. Studies have found that telemedicine can provide efficient triaging, reduction in emergency room visits, and conservation of health care resources and personnel. Although virtual patient care has been implicated in providing similar outcomes to traditional face-to-face care in patients affected with coronavirus disease 2019, there are a lack of studies on the effectiveness of virtual care visits (VCVs) for patients with craniosynostosis or deformational plagiocephaly. This study aims to develop an understanding of whether physicians can accurately diagnose pediatric patients with craniosynostosis or deformational plagiocephaly via VCVs, and whether they can determine if affected patients will benefit from helmet correction or if surgical treatment is required. An Institutional Review Board-approved retrospective chart analysis over a 4-month period (March 1, 2020 to June 30, 2020) was performed analyzing all pediatric patients (<18 years old) who underwent virtual care calls for diagnosis and treatment of abnormal head shape. Patients were referred to UT Physicians Pediatric Surgery clinic for evaluation by a member of the Texas Cleft-Craniofacial Team (2 surgeons or 1 physician's assistant). Variables such as patient demographics, diagnosis, and need for confirmation were pulled and recorded from Allscripts Electronic Medical Records software. Thirty-five patients were identified who fit our search criteria. Out of these patients, eleven (31.43%) cases were diagnosed with craniosynostosis, twenty-two (62.86%) cases were diagnosed with deformational plagiocephaly, and 2 (5.71%) cases were diagnosed as being normocephalic. Median age at virtual care evaluation was 14.10 months (Interquartile Range [IQR] 5.729, 27.542) for patients diagnosed with craniosynostosis and 6.51 months (IQR 4.669, 7.068) for patients diagnosed with deformational plagiocephaly. All eleven (100%) patients diagnosed with craniosynostosis were referred for a confirmatory computed tomography scan before undergoing surgical intervention and saw an alleviation in head shape postoperatively. Eighteen (81.82%) of patients diagnosed with deformational plagiocephaly were recommended to undergo conservative treatment and the remaining 4 (18.18%) were recommended for helmet therapy. Two cases were unable to be diagnosed virtually. These patients needed a follow-up visit in person to establish a diagnosis and plan of treatment. Virtual care visits are increasing in frequency and this includes consultations for abnormal head shapes. Our experience demonstrates that the majority of patients can be evaluated safely in this modality, with only 5.71% requiring additional imaging or in-person visits to confirm the diagnosis. Our study underscores the feasibility of virtually diagnosing and recommending a plan for treatment in pediatric patients with abnormal head shapes. This information can be implemented to further our knowledge on the accuracy of diagnosis and treatment options for patients with craniosynostosis and deformational plagiocephaly. Further analyses are needed to quantify the financial and patient-reported outcomes of VCVs for these patients.

Evaluation of an intervention to reduce child injury in Bedouin communities in Southern Israel

BackgroundChild injury is particularly prevalent in low socioeconomic populations and minorities. In Israel, Bedouin children exhibit high rates of injuries and death. A multifaceted community intervention to reduce injury in...

Treatment navigation to reduce emergency room (ER) visits in cancer patients.

199 Background: The practice of conventional oncology has undoubtedly changed in the last 15 years, becoming more efficient, but also more complex and expensive. This complex care needs significant coordination. In the last 2 years in half of the continuing development of our care coordination working in the "Navigation Treatment" domain, the impact on reducing ER visits was, in media, 75%. Methods: In 2015 IOV developed a patient-centered Navigation System based on Kanban (board and visual signals-KNS) for managing the treatment plan of our patients that was successful. In 2016 with support of an educational grant from QTP-ASCO, we extended this system to manage pain to others cancers and treatment-related symptoms, education, resource referral or Coordination of multi-disciplinary care. This study addresses only decreased ER visits between Dec 15 and May 20 by all patients monitored by Nurses navigators. We measured the proportional reduction of ER visits related to pain to the total ER visits in three successive periods: development of the NKS (dec15-jul16), pilot phase (aug16-oct17), and as an adopted best practice (oct17-until today). The KNS comprises a set of standardized procedures and successive checks for patients in treatment based on three procedures: (a) standardized treatments prescriptions to pain and symptoms controls; (b) standardized follow up in 24 and 48 hours, 1, 2 and 4 weeks; and (c) manage side effects of opioids or other emerging problem (constipation, confusion, mucositis, diarrhea, fever, etc.). Any patient initiating opioid use is included in the KNS until opioid is discontinued. Once pain is adequately controlled, the frequency of checks become wider up to once a month if no toxicity is identified. Any new condition (will restart the 24-48 hours loop. The KNS is managed by oncology nurses using phone or video calls, messaging, and appointments; Mon-Sun from 6 AM to 8 PM. Results: The KNS managed a median of 204 (table*) patients per month during the last 32 months (Oct 17 to May 20). Patients with pain, symptoms, or side effects that were effectively managed by the team avoided an unwanted visit to the ER, in media by 75%. Pain represents 20% of ER visits generally; in pilot phase 15% of ER visits, and actually 4% of ER visits, an 80% reduction in pain-related ER visits. ER visits represent patients with uncontrolled pain and not effectively managed by the KNS. Conclusions: The development of a system to deliver more effective care patients resulted in a 75% reduction of ER visits and adequate pain control in our practice.

Navigating care to reduce emergency room (ER) visits in cancer patients using opioids.

e18265 Background: Pain is the most frequent and one of the most important cancer related symptom with significant impact in quality of life. It is also the most frequent reason (27% of visits) for a patient to go to an ER and 53% can be prevented with adequate care (Panattoni, JCO 35, 2017 suppl; abstr 6505). Methods: In 2015 IOV developed a patient centered Navigation System based on Kanban (board and visual signals - KNS) for managing treatment plan of our patients that was very successful. In 2016 with support of an educational grant from QTP-ASCO we extended this system to manage pain and other cancer or treatment related symptoms. This study addresses only pain management and ER visits between dec16 and dec18 for a total of 187 patients using opioids. We measured the proportional reduction of ER visits related to pain to the total ER visits in three successive periods: development of the NKS (dec15-jul16), pilot phase (aug16-oct17) and as an adopted best practice (oct17-dec18). The pain KNS comprises a set of standardized procedures and successive checks for patients using opioids based on three procedures: (a) standardized prescription and use of analgesics using WHO’s Pain Ladder; (b) standardized follow up in 24 and 48 hours, 1, 2 and 4 weeks; and (c) manage side effects of opioids or other emerging problem (constipation, confusion, etc). Any patient initiating opioid use is included in the KNS until opioid is discontinued. Once pain is adequately controlled, the frequency of checks become wider up to once a month if no toxicity is identified. Any new condition will restart the 24-48 hours loop. The KNS is managed by oncology nurses using phone or video calls, messaging, and appointments; Mon-Sat from 6AM to 10PM. Results: The KNS managed a median of 132 patients per month during 29 months (aug16 to dec18). Pain represented 20% of ER visits (33.65 UCL and 6.7 LCL); in pilot phase 15% of ER visits (27.34 UCL and 3.70 LCL); and now 4% of ER visits ( 8.46 UCL and 0 LCL), an 80% reduction in pain related ER visits. ER visits represents patients with uncontrolled pain and not effectively managed by the KNS. Conclusions: The development of a simple visual system to manage cancer patients with pain resulted in 80% reduction of ER visits and adequate pain control in our practice.

A Remote Patient Monitoring Intervention for Patients With Chronic Obstructive Pulmonary Disease and Chronic Heart Failure: Pre-Post Economic Analysis of the Smart Program.

BackgroundExacerbation of chronic obstructive pulmonary disease (COPD) and chronic heart failure (CHF) are associated with high health care costs owing to increased emergency room (ER) visits and hospitalizations. Remote patient monitoring (RPM) interventions aim to improve the monitoring of symptoms to detect early deterioration and provide self-management strategies. As a result, RPM aims to reduce health resource utilization. To date, studies have inconsistently reported the benefits of RPM in chronic illnesses. The Smart Program is an RPM intervention that aims to provide clinical benefit to patients and economic benefit to health care payers.ObjectiveThis study aims to economically evaluate the potential benefits of the Smart Program in terms of hospitalizations and ER visits and, thus, associated health care costs from the perspective of the public health care system.MethodsSeventy-four patients diagnosed with COPD or CHF from one hospital site were included in this one-group, pre-post study. The study involved a secondary data analysis of deidentified data collected during the study period – from 3 months before program initiation (baseline), during the program, to 3 months after program completion (follow-up). Descriptive analysis was conducted for the study population characteristics at baseline, the clinical frailty score at baseline and 3-month follow-up, client satisfaction at 3-month follow-up, and number and costs of ER visits and hospitalizations throughout the study period. Furthermore, the cost of the Smart Program over a 3-month period was calculated from the perspective of the potential implementer.ResultsThe baseline characteristics of the study population (N=74) showed that the majority of patients had COPD (50/74, 68%), were female (42/74, 57%), and had an average age of 72 (SD 12) years. Using the Wilcoxon signed-rank test, the number of ER visits and hospitalizations, including their associated costs, were significantly reduced between baseline and 3-month follow-up (P<.001). The intervention showed a potential 68% and 35% reduction in ER visits and hospitalizations, respectively, between the 3-month pre- and 3-month postintervention period. The average cost of ER visits reduced from Can $243 at baseline to Can $67 during the 3-month follow-up, and reduced from Can $3842 to Can $1399 for hospitalizations.ConclusionsIn this study, the number and cost of ER visits and hospitalizations appeared to be markedly reduced for patients with COPD or CHF when comparing data before and after the Smart Program implementation. Recognizing the limitations of the one-group, pre-post study design, RPM requires an upfront investment, but it has the potential to reduce health care costs to the system over time. This study represents another piece of evidence to support the potential value of RPM among patients with COPD or CHF.