Reduce Emergency Department Visits Research Articles

The Association Between Telehealth Use During Buprenorphine Treatment for Opioid Use Disorder and Clinical Outcomes: A Retrospective Cohort Study.

Background: Patients with opioid use disorder (OUD) represent a high-risk population due to increased rates of adverse health outcomes and death. To evaluate whether telehealth utilization during OUD treatment compared with in-person encounters alone was associated with emergency department (ED) utilization, inpatient admissions, and mortality within three years of initiating buprenorphine. Methods: We conducted a retrospective cohort study within the Veterans Health Administration among Veterans treated for OUD between 2012 and -2022. The primary exposure was modality of care, characterized as telehealth encounters (with or without an in-person visit) compared with in-person visits only. Outcomes included an ED visit, inpatient admission, or mortality within three years of the index buprenorphine prescription. We measured the association between each type of treatment modality and outcomes through Cox proportional hazards regression modeling, adjusting for demographic and clinical covariates and confounders. Findings: Of the 57,021 Veterans diagnosed with OUD and who initiated buprenorphine, 38,072 Veterans met study eligibility criteria. The majority of Veterans were male, non-Hispanic White, 25-44 years of age, and lived in urban areas. Approximately 60% of this entire cohort experienced at least one ED visit, 40% experienced an inpatient admission, and 8% died during follow-up. Telehealth use compared with in-person visits only was associated with reduced ED visits (adjusted hazard ratio [aHR] 0.81; 95% confidence interval [CI] 0.77-0.85), inpatient admissions (aHR: 0.71; 95% CI: 0.67-0.76), and mortality (aHR: 0.80; 95% CI: 0.67-0.94). Conclusions: Telehealth may help overcome barriers to in-person care. During buprenorphine treatment for OUD, telehealth as a point of contact with providers and the health care system may reduce more adverse health outcomes, potentially through improving treatment retention. Qualitative studies may help shed light on the mechanisms through which telehealth directly impacts clinical outcomes.

The Impact of Emicizumab Prophylaxis on Hospitalizations and Emergency Department Visits Among Hemophilia A Patients Is Age Related.

Hemophilia A (HA) therapy poses a significant healthcare burden. In recent years, emicizumab has been approved for prophylaxis. The current study explores the impact of transitioning to emicizumab on emergency department (ED) visits and hospitalizations in pediatric and adult HA patients. Data of HA patients transitioned to emicizumab at the Israeli National Hemophilia Center was retrospectively analyzed. Demographic information, inhibitor status, treatment duration, number, and reasons of ED visits and hospitalizations were assessed. Overall, transitioning to emicizumab significantly reduced ED visits and hospitalizations. While children experienced a significant reduction in both ED visits and hospitalizations, adults showed no statistically significant change. Post-emicizumab initiation, main reasons for ED visits among children shifted from prophylactic treatment and central line-associated complications to injury-related incidents. This real-world analysis demonstrates a substantial decrease in ED visits and hospitalizations, following emicizumab prophylaxis in HA patients. However, this improvement was age dependent as it was observed only among children. Further prospective studies evaluating this aspect may shed light on these findings.

Risk Factors for Unplanned Emergency Department Visits in Patients with Nasopharyngeal Carcinoma During Radiotherapy.

Background/Objectives: Nasopharyngeal carcinoma (NPC) is commonly treated with radiotherapy (RT) or concurrent chemoradiotherapy (CCRT). However, unplanned emergency department (ED) visits during treatment can disrupt therapy and impact patient outcomes. This study aims to identify the risk factors associated with unplanned ED visits in patients with NPC receiving RT or CCRT. Methods: We retrospectively analyzed 2111 patients with NPC treated between 2001 and 2019 at Chang Gung Memorial Hospital. Patients were categorized based on whether they experienced an unplanned ED visit during or up to three months post-treatment. Demographic and clinical variables were compared using the Chi-squared test, and survival outcomes were assessed using Kaplan-Meier analysis. Results: Among the cohort, 573 patients (27.2%) experienced at least 1 unplanned ED visit. Risk factors for unplanned ED visits included older age (p < 0.001), hypertension (p < 0.001), higher Charlson Comorbidity Index (p = 0.001), and advanced clinical stage (T stage, p = 0.0046; N stage, p = 0.0034; M stage, p = 0.0008). No significant difference in ED visit rates was observed between RT alone and CCRT groups. Conclusions: Unplanned ED visits were common during NPC treatment, with risk factors primarily related to patient age, comorbidities, and disease stage. Identifying high-risk patients may enable interventions to reduce ED visits, improve survival outcomes, and alleviate healthcare costs.

Digital Youth and Family Engagement Program for Adolescents Who Receive Outpatient Mental Health Services: Qualitative Evaluation.

Incidents of depression, anxiety, and suicidal ideation among adolescents have increased in recent years. Mental health interventions tailored to adolescents and families need to consider mechanisms for increasing enrollment and sustaining program engagement. A telephone-based, health coach intervention for adolescents and families was implemented at a Southeastern US health system with the goals of improving psychiatric appointment attendance, medication adherence, reduction in emergency department visits, and assisting with crisis management ("Youth and Family Engagement" [YFE] program). This study aims to explore patients' and parents' perceptions of a mental health program and the factors that impact enrollment and sustained engagement. Semistructured interviews were conducted with adolescent patients (n=9, 56%), parents (n=11, 92%), and clinicians who placed patient referrals (n=6, 100%). Interviews were in English (participants: 19/26, 73%) or Spanish (parents: 7/11, 64%), depending upon participants' preference. Interviews explored perceptions of the YFE program, experiences working with health coaches, suggestions for program changes, and program goals. The data were analyzed using inductive coding methodologies, with thematic analysis used to organize emergent themes. Two qualitatively trained researchers, one bilingual in English and Spanish, facilitated all data collection and collaboratively performed data analysis. The YFE program's structure was often mentioned as promoting engagement, with telephone appointments and health coaches' ability to accommodate inflexible work or school schedules alleviating participation barriers. Skills learned from health coaches were frequently referenced, with adolescents generally citing internal processes, such as positive thinking and mindfulness. Parents discussed behaviors relative to their children, such as improvements with discipline, setting boundaries, and improved parent-child communication. Many participants discussed the importance of health coaches assisting families in navigating social systems, such as accessing resources (eg, housing) and navigating school processes (eg, individualized educational plans), with clinicians suggesting an increased emphasis on adolescents' nutrition and engagement in primary care. Spanish-speaking parents highlighted numerous advantages of working with bilingual health coaches, emphasizing both enhanced communication and cultural understanding. They specifically noted the coaches' ability to grasp their lived experiences and challenges as immigrants in the United States, which significantly enriched their participation in the program. Prioritizing convenient engagement for adolescents and families may be important for sustained program participation, as inflexible schedules and competing priorities pose barriers to traditional appointments. Future programs should carefully consider health coach-participant relationships, specifically cultural competency, providing services in native languages, and assisting families with wraparound care, as these may be crucial to sustained engagement.

A Readmission Risk Assessment Tool Is Not Predictive of 90-Day Readmission After Total Joint Arthroplasty at an Urban Tertiary Referral Hospital.

Readmission within 90 days of total joint arthroplasty (TJA) via an emergency department (ED) encounter represents a significant economic burden to the healthcare system. We aimed to determine the utility of a previously described readmission risk assessment tool (RRAT) in predicting readmission after presentation to the ED within 90 days of primary TJA. At a single academic tertiary referral medical center, a retrospective chart review was used to collect demographic data, surgery type, medical history, reason for presentation in the ED, and ED disposition for the 1,576 patients who underwent TJA between April 1, 2016, and December 31, 2018. The RRAT score of patients was calculated and compared between patients who were discharged home versus readmitted to inpatient care. We identified 244 patients (328 encounters) who presented to the ED within 90 days of primary TJA, resulting in a 3.1% readmission rate. No statistical difference was found between the RRAT scores of readmitted and discharged patients (p=0.24). The most common reason for presentation to the ED for discharged patients was surgical site pain compared to medical concerns (cardiac, hematological, and renal concerns) in the readmitted group. Although the RRAT score alone is not predictive of readmission within 90 days of TJA, the reason for presentation to the ED between discharged and readmitted patients does differ. These results present an opportunity for orthopedic surgery providers to discuss with other providers ways to optimize postoperative pain management and decrease readmissions. This study underscores the need for improved postoperative pain and chronic condition management to reduce ED visits and readmissions and highlights the necessity for larger, multi-center studies to better assess the RRAT score's predictive value.

Long term care-acute system integration and transformation: Innovations in models of care.

The article discusses innovations in integrating Long-Term Care (LTC) and acute systems, focusing on Humber River Health's (HRH) model. Older adults in LTC homes are vulnerable to avoidable Emergency Department (ED) visits due to frailty and medical complexity. HRH developed an integrated care model centred on LTC Remote Monitoring (RM) with LTC partners, leveraging nurse-led care models, digital tools, and virtual care hub to reduce avoidable ED transfers. Key components include the PREVIEW-ED© tool for early detection of clinical deterioration, LTC+ Hub and LTC++ Diagnostic Imaging and Transportation, supporting improved access to healthcare services. The program aligns with the Quintuple Aim, emphasizing patient and provider experiences, population health, cost reduction, and health equity. Results show significant reductions in ED visits, hospital lengths of stay, and associated costs, while enhancing resident and provider experiences. The LTC RM model is positioned as a scalable solution for system transformation in integrated care.

A Tale of 102,726 Messages: Characterizing the Modern Urologist's Portal Message Burden After Common Urologic Surgeries.

We aimed to characterize patient portal messaging use after urologic surgery to identify administrative burden and evaluate postoperative clinical associations. Epic was queried for all urologic surgeries performed at the Mayo Clinic enterprise between 2019 and 2022. Data from the highest volume procedures were extracted including patient-generated portal messages to their provider and emergency department (ED) visits within 6 months of surgery. Factors associated with portal users and message volume, as well as the impact of portal use on risk of subsequent ED visit, were evaluated. We analyzed data from 23,621 urologic procedures, which generated 102,726 patient portal messages within 6 months of surgery. We found that 55% of our cohort sent at least 1 message. Stratifying by subspecialty, endourologic surgeries generated the fewest number of messages per surgery (3.83; SD, 8.76), whereas female pelvic medicine and reconstructive surgeries yielded the most (6.05; SD, 10.92). Younger age, female sex, and White race were associated with increased portal utilization. Multivariable time-to-event analysis revealed a 33% reduction in the risk of ED presentation within 90 days after surgery for patients using the patient portal compared with those who did not. While only half of patients sent portal messages after surgery, active users showed a 33% reduction in ED visits, suggesting its potential to reduce health care utilization. Encouraging broader portal adoption can improve outcomes. However, the message burden for urologists necessitates solutions. Resource allocation should prioritize strategies to help urologists manage messages while preserving the established clinical benefits.

Data-driven insights to increase utilization of an oncology acute care clinic.

342 Background: Cancer patients often use the emergency department (ED) for acute symptoms. Because of the frequency of non-emergent acute care, many practices have created non-ED sites of care, such as Oncology Acute Care (OAC). OAC clinics can manage urgent conditions, and have been shown to reduce ED visits, however, patient and practice factors may lead to underuse of these clinics. We aimed to increase OAC utilization at our safety-net system. Methods: Parkland Health is the safety-net system for Dallas County, caring for a primarily uninsured (70.0% Medicaid/charity care), minority population (60.4% Hispanic, 24.2% Black). We established an OAC in 2017: patients can call a dedicated triage line staffed by English and Spanish-speaking nurses, who schedule OAC visits as appropriate. Subsequent quantitative and qualitative research found that OAC was underused, but that many patients were simply unaware of the OAC. In early 2023, a monthly 20-member multidisciplinary workgroup was formed, including many frontline staff. Findings and ideas for improvement were reviewed with our Patient and Family Advisory Council. Implementation strategies were aimed at raising staff/provider awareness, streamlining patient education, and developing relevant process measures. Results: By Q1 2024, nurse call volume rose to 235, from 110 calls in Q3 of 2023. Patients began to call sooner upon symptom onset (50% of symptoms were more than 3 days old, compared to 55%); 51% were scheduled to the OAC on the same day. Nurses managed 34% of calls through telehealth. Lack of OAC availability resulted in ED referral for 4% of calls. There was an early downward trend in potentially avoidable ED visits (15% of chemotherapy infusions with an ED visit in 30 days in Q4 2023, down to 12.5% in Q1 2024). Conclusions: A data-driven, delivery research collaboration has been established to reduce avoidable ED care among adults receiving chemotherapy. This collaborative has been marshalling existing resources to serve a patient population that faces many challenges in optimizing their care. By piloting these implementation strategies, we are improving patient symptom management, and have created a platform for ongoing delivery innovation.

Strategies to Reduce Frequent Emergency Department Use among Persons Experiencing Homelessness with Mental Health Conditions: a Scoping Review.

The USA has some of the highest utilization rates of the Emergency Department (ED) worldwide, leading to increased healthcare costs, constrained resources, and fragmented care. Many of the highest ED utilizers are persons experiencing homelessness (PEH) and those with mental health conditions, with even higher use by those with comorbid social challenges. This study reviewed the literature assessing interventional approaches in the ED to minimize the burden of ED utilization by PEH with associated mental health conditions. We first conducted an informal literature review of high ED utilizers and their most common presenting symptoms. We then conducted a scoping review of articles according to the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines; we used PubMed and Web of Science databases as well as Google Scholar. We screened the titles and abstracts of studies that evaluated programs that aimed to reduce ED usage by patients with mental illness who were also experiencing homelessness. Of the 1574 titles and abstracts screened, 49 full texts were examined for eligibility. Of those, 35 articles were excluded for a final count of 14 included studies. We found that the studies fell under two main interventional categories: housing support and care management. There were various approaches to reduce ED visits from PEH with mental illness around the world. Overall, these studies found varying degrees of success in reducing ED visits for both housing intervention and care management strategies. Comparison of these studies reveals that the success of related strategies like housing support often have different outcomes which can be attributed to the differences between the populations studied, previously available community resources, and other psychosocial factors affecting study participants. Overall, the most successful studies found that a tailored approach that addresses the unique needs of participants had the greatest impact on reducing ED visits and hospitalizations. Further research is needed to determine the best strategies for specific populations and how to promote health equity among PEH with associated mental health conditions.

Analyzing innovative policies and practices for palliative care in Portugal: a qualitative study

BackgroundCountries with formal policies for palliative care, and advanced and integrated practices in this field, such as Portugal, face challenges in achieving excellence in care, particularly in home-based assistance. Issues include care coordination among providers, confusion regarding the roles of each health care professional in the network, and a lack of monitoring and evaluation of actions. Our objective was to analyze the implementation of palliative care in primary health care in Portugal.MethodsWe conducted a qualitative, descriptive, and exploratory study in Portugal involving health care professionals with experience in palliative care. The data were collected through semistructured interviews and focus groups between March and October 2023. Eighteen health care professionals participated. We used the Alceste software for lexicographic analysis. The research was authorized by an Ethics Committee.ResultsFour classes were identified; classes 1 and 2, comprising 77% of the corpus, addressed the study objectives. Participants highlighted inequitable access, strategic development plans with unattainable short-term goals; and low literacy. They emphasized the importance of legislation, professional training initiatives for generalist palliative care at home, and early referral. Home-based challenges included professionals’ lack of exclusive dedication, absence of 24/7 coverage, and unavailability of capable family caregivers. The networks’ response to hospital admissions and patient transitions from hospital to home, with access to the specialized team, was also inadequate.ConclusionsHealth care professionals aim to increase patients’ time spent at home, reduce emergency department visits, and minimize hospitalizations by leveraging the resources of the national palliative care network. In addition to investments to sustain network implementation and legally guaranteed palliative care rights, the country must focus on measurable indicators for evaluating and monitoring actions, providing better guidance in the short, medium, and long term.

Impact of Referring High-Risk Patients to Intensive Outpatient Primary Care Services: A Propensity Score-Matched Analysis.

Many healthcare systems have implemented intensive outpatient primary care programs with the hopes of reducing healthcare costs. The Veterans Health Administration (VHA) piloted primary care intensive management (PIM) for patients at high risk for hospitalization or death, or "high-risk." We evaluated whether a referral model would decrease high-risk patient costs. Retrospective cohort study using a quasi-experimental design comparing 456 high-risk patients referred to PIM from October 2017 to September 2018 to 415 high-risk patients matched on propensity score. Veterans in the top 10th percentile of risk for 90-day hospitalization or death and recent hospitalization or emergency department (ED) visit. PIM consisted of interdisciplinary teams that performed comprehensive assessments, intensive case management, and care coordination services. Change in VHA and non-VHA outpatient utilization, inpatient admissions, and costs 12months pre- and post-index date. Of the 456 patients referred to PIM, 301 (66%) enrolled. High-risk patients referred to PIM had a marginal reduction in ED visits (- 0.7; [95% CI - 1.50 to 0.08]; p = 0.08) compared to propensity-matched high-risk patients; overall outpatient costs were similar. High-risk patients referred to PIM had similar number of medical/surgical hospitalizations (- 0.2; [95% CI, - 0.6 to 0.16]; p = 0.2), significant increases in length of stay (6.36; [CI, - 0.01 to 12.72]; p = 0.05), and higher inpatient costs ($22,628, [CI, $3587 to $41,669]; p = 0.02) than those not referred to PIM. VHA intensive outpatient primary care was associated with higher costs. Referral to intensive case management programs targets the most complex patients and may lead to increased utilization and costs, particularly in an integrated healthcare setting with robust patient-centered medical homes. PIM 2.0: Patient Aligned Care Team (PACT) Intensive Management (PIM) Project (PIM2). NCT04521816. https://clinicaltrials.gov/study/NCT04521816.

Primary Care Quality Improvement Through Patient-Centered Medical Homes and the Impact on Emergency Department Utilization for Children With Autism and Mental Health Disorders.

To address health care spending growth, coordinated care, and patient-centered primary care, most states in the United States have adopted value-based care coordination programs such as patient-centered medical homes (PCMHs). The objective of this study was to understand the relationship between having access to PCMHs and emergency department (ED) utilization for high cost/need children with autism and children with mental health disorders (MHDs). This cross-sectional study included 87 723 children between ages 3 and 17 years in the 2016-2018 National Survey for Children's Health. Multivariate-adjusted logistic regression analyses were used to assess the association between ED and PCMH utilization for children with autism, with MHDs without autism, and others without autism or MHDs. Marginal predictions were used to examine whether PCMH utilization was moderated by health conditions. The results showed that children with a PCMH had a 16% reduction in the odds to visit the ED (adjusted odds ratio [aOR] = 0.84; confidence interval [CI], 0.77-0.92; P < .001). When compared with the reference group of children without autism and without MHDs, children with MHDs but without autism had 93% higher odds to visit the ED (aOR = 1.93; CI, 1.75-2.13; P < .001) and children with autism had 35% higher odds to visit the ED (aOR = 1.35; CI, 1.04-1.75; P = .023). Marginal effects results suggested that PCMHs reduced the odds of ED visits the most for children with MHDs without autism and reduced the predicted ED visits from 30.1% to 23.7% (P < .001). Primary care quality improvement through access to a PCMH reduced ED visits for children, but the effect varied by autism and MHD conditions. Future PCMH efforts should continue to support children with autism and address unmet needs for children with MHDs with a focus on needed care coordination, family-centered care, and referrals.

Shift in emergency department utilization by frequent attendees with sickle cell disease during the COVID-19 pandemic: Amulticentre cohort study.

While the coronavirus disease-2019 (COVID-19) might have increased acute episodes in people living with sickle cell disease (SCD), it may also have changed their reliance on emergency department (ED) services. We assessed the impact of the COVID-19 pandemic and lockdowns on ED visits in adult SCD people followed in five French reference centres, with a special focus on 'high users' (≥10 visits in 2019). We analysed the rate of ED visits from 1 January 2015 to 31 December 2021, using a self-controlled case series. Among 1530 people (17 829 ED visits), we observed a significant reduction in ED visits during and after lockdowns, but the effect vanished over time. Compared to pre-pandemic, incidence rate ratios for ED visits were 0.59 [95% CI 0.52-0.67] for the first lockdown, 0.66 [95% CI 0.58-0.75] for the second and 0.85 [95% CI 0.73-0.99] for the third. High users (4% of people but 33.7% of visits) mainly drove the reductions after the first lockdown. COVID-19 lockdowns were associated with reduced ED visits. While most people returned to their baseline utilization by April 2021, high users had a lasting decrease in ED visits. Understanding the factors driving the drop in ED utilization among high users might inform clinical practice and health policy.

Practice Transformation in the Transforming Clinical Practice Initiative and Emergency Department Use.

To provide insight on how ambulatory care practices can reduce emergency department (ED) visits, we studied changes in Medicare ED visits for primary and specialty care practices in the Transforming Clinical Practice Initiative. We compared practices that transformed more vs less during the 6-year period ending in 2021 (3,773 practices). Using data from a practice transformation assessment tool completed at multiple intervals, we found improvement in the transformation score was associated with reduced ED visits by 6% and 4% for primary and specialty care practices, respectively, 3 to 4 years after first assessment. Transformation in 5 of 8 domains contributed to reduced ED visits.

Association between stringency of lockdown measures and emergency department visits during the COVID-19 pandemic: A Dutch multicentre study.

The COVID-19 outbreak disrupted regular health care, including the Emergency Department (ED), and resulted in insufficient ICU capacity. Lockdown measures were taken to prevent disease spread and hospital overcrowding. Little is known about the relationship of stringency of lockdown measures on ED utilization. This study aimed to compare the frequency and characteristics of ED visits during the COVID-19 outbreak in 2020 to 2019, and their relation to stringency of lockdown measures. A retrospective multicentre study among five Dutch hospitals was performed. The primary outcome was the absolute number of ED visits (year 2018 and 2019 compared to 2020). Secondary outcomes were age, sex, triage category, way of transportation, referral, disposition, and treating medical specialty. The relation between stringency of lockdown measures, measured with the Oxford Stringency Index (OSI) and number and characteristics of ED visits was analysed. The total number of ED visits in the five hospitals in 2019 was 165,894, whereas the total number of visits in 2020 was 135,762, which was a decrease of 18.2% (range per hospital: 10.5%-30.7%). The reduction in ED visits was greater during periods of high stringency lockdown measures, as indicated by OSI. The number of ED visits in the Netherlands has significantly dropped during the first year of the COVID-19 pandemic, with a clear association between decreasing ED visits and increasing lockdown measures. The OSI could be used as an indicator in the management of ED visits during a future pandemic.

Risk Factors for Emergency Department Visits and Readmissions for Postpartum Hypertension [ID 2683548

INTRODUCTION: Postpartum hypertension is a source of significant maternal morbidity and mortality. We aim to evaluate risk factors for postpartum emergency department (ED) visits and readmissions for hypertensive complications. METHODS: This was a retrospective cohort study of all birthing patients with peripartum hypertension at a single tertiary care center over a 5-year period (2017–2022). Maternal baseline and intrapartum characteristics were chart abstracted. Primary outcome of interest was postpartum ED visit or readmission (EDR) due to hypertensive complications. Patients who had EDR within 42 days of delivery were compared to those who underwent routine outpatient surveillance. This is IRB #14-001098. RESULTS: Of 16,162 patients who gave birth during the study period, 2,403 (14.9%) patients met the definition of peripartum hypertension. 218 (9.1%) presented to the ED or were readmitted for hypertension. Risk factors for EDR were as follows: maternal age greater than 40 years (22.9% versus 15.3%; P=.003), cesarean delivery (42.7% versus 35.8%; P=.044), chronic hypertension (37.2% versus 31.6%; P=.029), severe preeclampsia (32.6% versus 15.6%), p50% elevated blood pressures within the 24 hours prior to discharge (16.5% versus 11.9%; P=.046). CONCLUSION: Maternal age over 40, chronic hypertension, severe preeclampsia, prescription of antihypertensives on discharge, and elevated blood pressures leading up to discharge are associated with postpartum ED visits or readmissions for hypertension. Attention should be paid to these high-risk groups to reduce ED visits and readmissions.

A Comparison of Emergency Room Visits and Hospital Admissions Between People with Prediabetes and Diabetes.

The purpose of this study was to characterize risk factors and groups at risk among people with diabetes and prediabetes for increased hospital utilization. Electronic health records for all people who visited the emergency department (ED) and had type II diabetes mellitus (PWD) or prediabetes (PWPD) were collected. ED use, hospital admissions, demographics, and clinical characteristics were compared between the groups. Multivariable logistic regression was used to compare the odds of ED high utilization (HU) (3+ visits per year) and hospital admissions between PWD and PWPD with interactions for socioeconomic status, race, marital status, and total comorbidities. PWD had higher mean ED visits per year compared with PWPD (1.5 vs. 1.2) and were more likely to be admitted (57.3% vs. 34.9%). PWD had higher odds of ED HU (2.1 [1.6, 2.7]) and hospital admissions (1.9 [1.6, 2.1]). Among PWD, Black, not married, and those with more than one comorbidity had the highest odds of ED HU. Among PWPD, those of low SES, Black, and divorced had the higher odds of ED HU. Hospital admissions were a risk for PWD and PWPD with increasing comorbidities. Early recognition and identification of prediabetes and clear criteria for diagnosis could reduce ED visits and hospital admissions.

Developing an interprofessional decision support tool for diabetic foot ulcers management in primary care within the family medicine group model: a Delphi study in Canada

BackgroundPrimary care professionals encounter difficulties coordinating the continuum of care between primary care providers and second-line specialists and adhere to practice guidelines pertaining to diabetic foot ulcers management. Family medicine groups are providing primary care services aimed to improve access, interdisciplinary care, coordination and quality of health services, and reduce emergency department visits. Most professionals working in family medicine groups are primary care physicians and registered nurses. The aim of this study was to develop and validate an interprofessional decision support tool to guide the management of diabetic foot ulcers for primary care professionals working within the family medicine group model.MethodsA one-page decision tool developed by the research team was validated by an expert panel using a three-round Delphi protocol held between December 2019 and August 2021. The tool includes 43 individual actions and a care pathway from initial presentation to secondary prevention. Data collection was realized with both paper and electronic questionnaires, and answers were compiled in an electronic spreadsheet. Data was analyzed with use of descriptive statistics, and consensus for each item was defined as ≥ 80% agreement.ResultsExperts from 12 pre-identified professions of the diabetic foot ulcer interdisciplinary care team were included, 39 participants out of the 59 invited to first round (66.1%), 34 out of 39 for second (87.2%) and 22 out of 34 for third (64.7%) rounds. All items included in the final version of the decision support tool reached consensus and were deemed clear, relevant and feasible. One or more professionals were identified to be responsible for every action to be taken.ConclusionsThis study provided a comprehensive decision support tool to guide primary care professionals in the management of diabetic foot ulcers. Implementation and evaluation in the clinical setting will need to be undertaken in the future.

Emergency department visits by nursing home residents. A retrospective Italian study of administrative databases from 2015 to 2019

BackgroundVisits to Emergency Departments (ED) can be traumatic for Nursing Home (NH) residents. In Italy, the rate of ED visits by NH residents was recently calculated as 3.3%. The reduction of inappropriate ED visits represents a priority for National Healthcare Systems worldwide. Nevertheless, research on factors associated with ED visits is still under-studied in the Italian setting. This study has two main aims: (i) to describe the baseline characteristics of NH residents visiting ED at regional level; (ii) to assess the characteristics, trends, and factors associated with these visits.MethodsA retrospective study of administrative data for five years was performed in the Piedmont Region. Data from 24,208 NH residents were analysed. Data were obtained by merging two ministerial databases of residential care and ED use. Sociodemographic and clinical characteristics of the residents, trends, and rates of ED visits were collected. A Generalized Linear Model (GLM) regression was used to evaluate the factors associated with ED visits.ResultsIn 5 years, 12,672 residents made 24,609 ED visits. Aspecific symptoms (45%), dyspnea (17%) and trauma (16%) were the most frequent problems reported at ED. 51% of these visits were coded as non-critical, and 58% were discharged to the NH. The regression analysis showed an increased risk of ED visits for men (OR = 1.61, 95% CI 1.51–1.70) and for residents with a stay in NH longer than 400 days (OR = 2.19, 95% CI 2.08–2.31).ConclusionsOur study indicates that more than half of NH residents’ ED visits could potentially be prevented by treating residents in NH. Investments in the creation of a structured and effective network within primary care services, promoting the use of health technology and palliative care approaches, could reduce ED visits and help clinicians manage residents on-site and remotely.

Hospital usage for oral and dental conditions in Hawaii: A cross-sectional study using the 2021 Hawaii statewide hospital data.

To investigate the frequency of emergency department (ED) usage primarily for oral/dental conditions in Hawaii and to examine social-demographic factors associated with the identified ED visits. This was a cross-sectional study of the 2021 Hawaii Statewide Hospital data. We identified records indicating ED usage and a primary diagnosis of non-traumatic dental conditions (NTDC) and other oral dental conditions (OODC). Descriptive analyses of ED visits for NTDC and OODC were performed to identify vulnerable individuals based on age, sex, race/ethnicity, primary source of payment, county of residence, and total charges per hospital record. A multivariable negative binomial regression model included age, sex, and county of residence was used to obtain adjusted rate ratios (aRR) and 95% confidence intervals (CI) of ED visits for NTDC. Among hospital records with diagnoses for oral or dental conditions (n = 12,336), 97% indicated ED, of which half had an NTDC diagnosis, and the remaining half had an OODC diagnosis. Distinct differences in the characteristics of ED visits were observed between NTDC and OODC. The median total charges per record indicating ED for NTDC and OODC were $1439 and $2439, respectively. A higher rate of ED visits for NTDC was found for those aged 21-44 (aRR [95%CI] = 3.02 [2.41, 3.80], reference: 0-9 years) and those living in a less populous county (Hawaii: 1.73 [1.43, 2.07]; Kauai: 1.78 [1.45, 2.19], reference: Honolulu). Continued effort to improve dental health is required to reduce ED visits for oral and dental conditions among Hawaii residents, especially for vulnerable individuals.