Reduce Emergency Department Visits Research Articles

Evaluation of COPD Chronic Care Management Collaborative to Reduce Emergency Department and Hospital Revisits Across U.S. Hospitals.

Chronic obstructive pulmonary disease (COPD) is the third-leading cause of early readmissions. The Centers for Medicare and Medicaid instituted a financial penalty for excessive COPD readmissions galvanizing hospitals to implement effective strategies to reduce readmissions. We evaluated a 6-month COPD Chronic Care Management Collaborative to support hospitals to reduce preventable COPD-related revisits. Sites were recruited among nearly 300 Vizient, Inc., members. The Collaborative used performance improvement initiatives to assist with implementation of effective strategies. Participants submitted performance data for 2 outcome measures: emergency department (ED) and hospital revisits. Forty-seven members enrolled (Part I+II: n=33; Part I: n=3; Part II: n=11) of which 23 submitted data (n=23/47). The majority (n=19/23, 83%) reduced rates of COPD-related ED and/or hospital revisits. Among all 23 sites, the change in ED visits went from 11.05% to 10.87%; among 7 sites with reductions in ED visits, the reduction was 12.7% to 9%. Among all 23 sites, there were not reductions in hospital readmissions (18.53% to 18.64%); among 7 sites with reductions, the readmission rate went from 20.1% to 15.6%. The mean reach across 17 hospitals reporting reach for their most successful measure at baseline was 35.2% (SD=26.7%) and for the other 6, reporting reach at follow-up was 73.8%% (SD=18.3%); of note, only 3 sites submitted both baseline and follow-up data. The Collaborative successfully supported the majority of sites in reducing COPD-related ED and/or hospital revisits using subject matter experts and coaching strategies to support hospitals' implementation of COPD quality improvement interventions.

Analysis of an Alternative Model of Definitive Care For Low-Acuity Emergency Calls: A Natural Experiment.

Emergency medical services (EMS) diversion strategies attempt to limit the impact of low-acuity care on emergency department (ED) crowding, but evidence supporting these strategies is scarce. This study aims to measure the effect of a treat-in-place and alternative destination program on ED transports and EMS utilization. We used a natural experiment study design to measure effects of a pilot prehospital diversion program on ED transport, number of EMS vehicles dispatched, and EMS time on task for low-acuity emergency calls in a midsized urban setting characterized by a high prevalence of health disparities, concentrated poverty, and limited access to primary care between October 2018 and January 2020. We also used direct variable cost to estimate the return on investment attributable to avoided ED visits. Of 3725 calls that met eligibility criteria, the program responded to 1084 (29.1%), with 56.7% of those resulting in an ED visit, compared with 64.6% of the 492 control calls that were eligible but were dispatched when program services were unavailable. Of 1084 calls receiving response, 213 (19.6%) were enrolled in the program, and 8.5% of those were transported by EMS to the ED. Adjusted results show EMS time on task was 23.4 min less for enrolled calls vs. controls. The program can achieve a positive return on investment by enrolling 2.9 patients/day. A prehospital diversion program reduced ED visits and EMS transport times. Improved targeting of patients for enrollment would further increase the intervention's efficacy and cost savings.

Analysis of COVID-19 pandemic impact on the presenting complaints of the emergency department visits.

The impact of coronavirus disease 2019 (COVID-19) on economic and medical systems is significant, especially in the emergency department (ED). The patterns of ED visits have also changed significantly and may play a crucial role in rearranging medical resources to the most needed departments during the pandemic.This was a retrospective study conducted in hospitals of the Cathay Health System. All patients presented to the EDs between January 21, 2020 to April 30, 2020 (pandemic stage) and January 21, 2019 to April 30, 2019 (before the pandemic stage). Basic demographics, including visit characteristics, disposition, and chief complaints, of the patients visiting the ED between these 2 periods of time will be compared and analyzed.A total of 71,739 patients were included in the study. A reduction in ED visits was noted in 15.1% (32,950 ED visits) during the pandemic stage. ED visiting patients with the chief complaints of upper respiratory infection and social problems increased by 14.23% and 1.86%, respectively, during the pandemic period. Critical chief complaints such as cardiac arrest, chest pain and altered mental status decreased to less than the ED visits difference (−15.1%) between the pandemic and prepandemic stages, for 0%, −7.67%, and −13.8% respectively.Rearrangement of the ED pediatric staff to the COVID-19 special units and recruiting more social workers to the ED should be performed to respond to the COVID-19 pandemic.

COVID-19 Pandemic Impact on Emergency Department Visits and Quality of Service: A Comparative Cross-Sectional Study in a Tertiary Centre

Background: The COVID-19 pandemic has contributed to a devastating impact on emergency departments worldwide, resulting in a global crisis with various health consequences. We aimed to evaluate this impact on an emergency department (ED) visit of critical conditions such as Acute Coronary Syndrome (ACS), Cerebrovascular accident (CVA), Sepsis and Febrile neutropenia (FN), and to assess the quality of the ED after new adaptive measures were applied.
 Methods: This is a comparative cross-sectional study to assess the number of patients who presented to the ED of King Abdullah Medical city with the specified diagnosis. We collected data via the E-medical records. We compared the data over three periods pre-lockdown, lockdown and post lockdown in years 2019-2021. For quality measurement, Adaa (Ministry of Health's program) was used to calculate the percentage of patients who stayed 4 hours or less in the ED.
 Results: The total number of ED visits in the specified periods of study was 8387. The total numbers of patients for 2019, 2020, and 2020 respectively were 2011 (, ACS 70.4%, CVA 16.3%, sepsis and FN 13.3%.), 2733 (ACS 73.1%, CVA 9.9%, sepsis and FN 17.0%), and 3643 (ACS 64.0%, CVA 19.4%, sepsis and FN 16.7). The average percentage of patients who stayed 4 hours or less in the ED was 60% and 57.5% for 2020 and 2021, respectively.
 Conclusion: Although we expected reductions in ED visits during COVID-19 periods, we found that visits were rising through the years 2019-2021.

The association between involuntary alcohol treatment and subsequent emergency department visits and hospitalizations: a Bayesian analysis of treated patients and matched controls.

Many nations have provisions for involuntary treatment of alcohol dependence where the person is at serious risk of harm to themselves. To date, there has been little thorough evaluation of its effectiveness. This study aimed to determine if there were differences between involuntary and voluntary treatment for alcohol dependence on subsequent emergency and hospital care. A retrospective cohort design using linked routinely collected administrative data on health-care utilization. Hospital and community-based alcohol treatment, New South Wales, Australia. A total of 231 patients who were involuntarily treated for alcohol dependence and 231 matched controls who received treatment as usual within the period May 2012 to April 2018. Involuntary treatment comprised a 28-day mandated hospital admission which included supervised withdrawal, comprehensive assessment, rehabilitation and support followed by voluntary aftercare support for up to 6months. Treatment as usual comprised three not mutually exclusive forms of intensive voluntary alcohol treatment: withdrawal management, rehabilitation and pharmacotherapies for alcohol dependence. Outcome measures: changes in the number of emergency department (ED) visits and number of unplanned hospital admissions 12 months before and 12 months after completion of index treatment. Both groups showed a reduction in ED visits (incidence rate ratio (IRR) = 0.56, 95% credible intervals (CrI) = 0.39-0.78) and unplanned hospital admissions (IRR = 0.49, 95% CrI = 0.37-0.65). There was no statistically significant difference between the two groups (IRR = 0.77, 95% CrI = 0.58-1.03 for ED visits and IRR = 0.79, 95% CrI = 0.62-1.01 for hospital admissions). The Bayes factors were 0.925 and 0.936 for ED visits and unplanned hospital admissions, respectively, interpreted as weak evidence in support of the null hypothesis of no difference between the interventions. Involuntary treatment of alcohol dependence was associated with reduced health service utilization in the year following treatment, and the outcomes did not differ from those of a matched control group.

526. Implementation of Use of Monoclonal Antibody Therapy in a Large Academic Center for the Outpatient Treatment of Covid-19: Impact on 30 Day Hospitalization Rates, ED Visits and Death

BackgroundMonoclonal Antibody Therapy (MAbs) has been shown to reduce rates of ED visits and hospitalizations in patients at risk for severe Covid-19 infection in clinical trials. Since November, three Mabs received emergency use authorization: Bamlanivimab (Bam), Bamlanivimab/Etesevimab (Bam/Ete) and Casirivimab/Imdevimab (Casi/imdevi). We describe here the real-world effectiveness of implementing early MAb therapy in the outpatient setting for individuals with Covid-19 at high risk of progression. MethodsWe examined the records of 808 UCLA Health patients with a confirmed positive SARS-CoV2 PCR test who were either referred for outpatient Mab therapy or received Mab treatment in the emergency department (ED) between December 10, 2020, and May 3, 2021. The primary outcome of our analysis was the combined 30-day incidence of emergency department visits, hospitalizations, or death following the date of referral. SARS-CoV2 isolates of hospitalized patients who had received Mabs were sequenced to determine the presence of variants.ResultsOf 808 patients, 383 were referred for treatment but did not receive treatment, 109 received Mabs in the ED and 316 patients were treated in an outpatient setting. Composite 30-day mortality, ED visits and hospital admissions were significantly reduced in the combination therapy group (Bam/Ete or Cas/Imd) compared with monotherapy (Bam alone) or no treatment groups (aHR 0.16, 95% CI .038, .67). Significant factors associated with the composite outcome included: history of lung disease (HR 4.46, 95% CI 2.89-6.90), cardiovascular disease (HR 1.87, 95% CI 1.12-3.12), kidney disease (HR 2.04, 95% CI 1.27-3.25), and immunocompromised state (HR 3.24, 95% CI 1.02-10.26) as well as high social vulnerability index (HR 1.87, 95% CI 1.13-3.10). Over one-third of hospitalized patients who had received Mabs were confirmed to have the California variant (B.1.427/29) (Figure 1). Figure 1. Covid-19 MAB Treatment Failure LineagesConclusionOur data show that in a real-world setting, combination monoclonal antibody therapy, not monotherapy, significantly reduced ED visits and hospital admissions, likely due to the presence of the California variants. High socioeconomic vulnerability and certain medical conditions increased risk of treatment failure.Disclosures Omai Garner, PhD, D(ABMM), Beckman Coulter (Scientific Research Study Investigator)

The care ecosystem: Outcomes from an integrated healthcare system

AbstractBackgroundThe Care Ecosystem (CE) is a model of dementia care consisting of a multidisciplinary team of nursing, care team navigators (CTNs), and social workers designed to support persons with dementia (PWD) and their caregivers. Developed and tested at the UCSF Memory and Aging Center, the CE has been shown to improve PWD quality of life, reduce emergency department visits, and decrease caregiver depression/burden compared to usual care. We present CE data from a high volume neurology clinic within an integrated healthcare system.MethodA total of 435 patient‐caregiver dyads were enrolled in the CE over a 2.5 year period. Data relating to demographics, dementia severity, caregiver burden, and healthcare utilization were collected at baseline and after one year (n=116). Experience surveys were completed by dyads at 6 and 12 months (n=200). A retrospective review of data captured by RedCap and the electronic medical record was performed.ResultThere was worsening of dementia disease severity (DSRS) and functional impairment (FAQ) over a one year period (figure 1a/b). Both immediate/anticipated caregiver needs (figure 2) and safety concerns (figure 3) decreased over time. For safety, there were particular sizable reduction of caregiver safety concerns for driving (65%), falls (52%), problems getting lost (57%), weight and appetite changes (63%), and medication safety concern (61%) for the PWD. There was a reduction in the number of PWD using >10 medications with the CE (figure 4). The number of ED visits decreased over time whereas hospitalizations increased over the one year (figure 5a/5b). There was a reduction in caregiver depression, difficulty, and burden (6a/b/c). Dyads rated CTNs favorably ranging from 88‐92% of the time.ConclusionOur results suggest that the CE is feasible and effective in an integrated healthcare system setting. Despite worsening of disease state in the PWD, caregiver burden and distress decreased over the one year assessment period, suggesting a favorable impact on caregiver quality of life. PWD and caregivers rated the CTN experience positively. Although these preliminary results favor the CE, further studies are necessary to better understand the impact of the CE on healthcare utilization in integrated healthcare systems.

Pre- and post-home visit behaviors after using after-hours house call (AHHC) medical services: a questionnaire-based survey in Tokyo, Japan

BackgroundAfter-hours house call (AHHC) medical services have been implemented in Japan to reduce ambulance use, as well as overcrowding at the emergency department (ED). Examining the pre-and post-home visit behaviors of those using AHHC medical services will provide insights into the usefulness of these services and help develop strategies to reduce ED visits and ambulance use further.MethodsThis questionnaire-based study used data from anonymized medical records and internet-based questionnaires completed by patients who used AHHC medical services in Tokyo, Japan, between January 1 and December 31, 2019. The questionnaire comprised two questions: (1) What action would the patient have taken in the absence of AHHC services and (2) what action was taken within 3 days following the use of the AHHC services. In addition, following home consultations, AHHC doctors classified the patient’s illness severity as mild (treatable with over-the-counter medications), moderate (requires hospital or clinic visit), or severe (requires ambulance transportation).ResultsOf the 15,787 patients who used AHHC medical services during the study period, 2128 completed the questionnaire (13.5% response rate). Individuals aged ≤15 years and 16–64 years were the most common users of AHHC services (≤15 years, 71.4%; 16–64 years, 26.8%). Before using the AHHC service, 46.4% of the total respondents reported that they would have visited an ED had AHHC services not been available (≤15 years, 47.8%; 16–64 years, 42.8%; ≥65 years, 43.6%). The proportion of patients originally planning to call an ambulance was higher among those in the older age groups (≤15 years, 1.1%; 16–64 years, 6.0%; ≥65 years, 20.5%). After using the AHHC services, most patients (68.1%) did not visit a hospital within 3 days; however, the proportion of patients who visited an ED and called an ambulance within 3 days increased with the severity of illness.ConclusionsIncreasing AHHC medical services awareness among older adults and patients assessed as having severe illnesses regularly availing of AHHC services may help reduce ED visits and ambulance use.

Resilience-based Integrated IBD Care Is Associated With Reductions in Health Care Use and Opioids

Integrated inflammatory bowel disease (IBD) care is effective but not routinely implemented. Validated methods that simultaneously address mind and body targets such as resilience may improve access and outcomes. We describe the development and implementation of the GRITT method and its impact on resilience, health care utilization (HCU), and opioid use in IBD. Consecutive patients from an academic IBD center were evaluated for low resilience on the basis of provider referral. Low resilience patients were invited to participate in the GRITT program. Primary outcome was % reduction in HCU. Secondary outcomes were change in resilience and corticosteroid and opioid use. Patients were allocated into 2 groups for analysis: GRITT participants (GP) and non-participants (NP). Clinical data and HCU in the year before enrollment were collected at baseline and 12 months. One-way repeated measures multivariate analysis of covariance evaluated group× time interactions for the primary outcome. Effect size was calculated for changes in resilience over time. Of 456 screened IBD patients 394 were eligible, 184 GP and 210 NP. GP had greater reduction in HCU than NP: 71% reduction in emergency department visits, 94% reduction in unplanned hospitalizations. There was 49% reduction in opioid use and 73% reduction in corticosteroid use in GP. Resilience increased by 27.3 points (59%), yielding a large effect size (d= 2.4). Mind-body care that focuses on building resilience in the context of IBD care may be a novel approach to reduce unplanned HCU and opioid use, but large, multicenter, randomized controlled trials are needed.

Emergency department use and hospital admission in children following ambulatory surgery: a retrospective population-based cohort study

IntroductionPaediatric ambulatory surgery (same day surgery and planned same day discharge) is more frequently being performed more in Canada and around the world; however, after surgery children may return to...

Implementation of a Discharge Continuity Patient Initiative to Reduce Emergency Department Visits after Bariatric Surgery

Implementation of a Discharge Continuity Patient Initiative to Reduce Emergency Department Visits after Bariatric Surgery

Evaluation of the core 5 social determinants of health screening tool.

This study evaluated the effects of a social determinants of health (SDH) screening tool and service referral on emergency department (ED) use among patients at a Federally Qualified Health Center primary care clinic. Quasi-experimental. Three-hundred and eleven English-speaking patients 18 years and older. The Core 5 SDH screening tool consists of five yes/no items assessing food, housing, utilities, transportation, and safety needs. The number of ED visits 3months before and after the intervention were collected from electronic health records. The research team administered the Core 5 SDH screening tool and if desired, referred patients with an identified need for SDH services. Approximately 43% of patients reported a SDH need with food insecurity most prevalent (62.2%). The number of ED visits was significantly lower 3months post-intervention compared to 3months before for the 125 participants who wanted and received the SDH service referral (IRR=0.64, 95% CI=0.41, 0.99) and for the 35 participants who reported receiving some/all of the needed services at the 2-week follow-up (IRR=0.36, 95% CI=0.17, 0.76). Addressing patients' SDH needs may reduce ED visits, lower healthcare costs, and ultimately, improve health.

Analysis of reasons for Emergency Department (ED) visits and subsequent hospital admissions in patients with solid malignancies: A retrospective study from a cancer center in rural Maine.

241 Background: Reducing ED visits in patients with cancer is cost saving and is particularly relevant during the COVID pandemic. We aim to identify patterns of ED visits among various cancer patients and reduce preventable ED visits and hospital admissions. Methods: We analyzed the number of ED visits and hospital admissions that occurred in patients with breast, lung, and Gastrointestinal (GI) cancers between July12019 and October31 2020 including demographics, stage, treatment type preceding the month of ED visit, reason, time of the day, day of the week the visit occurred. Results: 308 patients had 519 ED visits, 111 breast cancer patients had 184, 102 lung cancer patients had 186 and 95 GI cancer patients had 149 ED visits. 38% had > 1 visit. 51%, (37% breast, 60% Lung and 58 % GI cancer) had stage 4 disease at the time of visit. There were no visits in the month of May 2020. 275 (53%) visits required hospital admissions, 60% of ED visits in lung cancer, 54% in GI and 46 % in breast cancer patients required hospitalization. Most common reason for ED visits in breast cancer patients was fall/injury (20%), with median age of 71 years, none were cancer/ chemotherapy induced. Among lung and GI cancer patients respiratory (24%) and GI related (24%) symptoms were the most common reasons respectively, majority were cancer/chemotherapy related. Most common symptoms requiring hospital admissions were respiratory 21%, GI 18%, cardiac 12%. 11% and 9% of ED visits were due to fall/injury and cancer related pain, of these 3.6% and 9% resulted in hospital admissions respectively. Lung and GI cancer patients were more likely to be referred to the ED from the oncologist office (23%) than breast cancer patients (11%). Conclusions: Reasons for ED visits vary by tumor types and some may be preventable. Fall/injury in breast cancer patients and cancer related pain in lung and GI cancer patients were frequent reasons for preventable ED visits. In lung and GI cancer patients, cancer/chemotherapy related respiratory, GI symptoms are felt to be less avoidable since they may be related to disease progression or presenting symptoms. We have initiated several strategies such as ‘’systematic physical therapy assessment’’ of our breast cancer patients over age 70 to reduce ED visits due to fall/injury. We are developing strategies to involve palliative care early to reduce the number of ED visits related to cancer related pain We now have “call us first campaign” to assess and intervene before going to ED since most visits occurred during working hours.[Table: see text]

Reducing Emergency Department Visits and Opioid-Related Deaths in Maryland

The state of Maryland has consistently ranked among the top states by opioid-involved overdose deaths. Emergency rooms in Maryland have been overrun with patients struggling with opioid use disorder (OUD). While hospitals are heavily burdened, it has become clear that they serve as a critical entry point for OUD prevention programs. Despite this, when section 19-310 of the Maryland Heroin and Opioid Prevention Effort (HOPE) and Treatment Act of 2017 passed, it included vague language requiring hospitals to create their own discharge protocols for such patients rather than putting into place statewide mandates. We propose two alternative solutions. First, the Maryland General Assembly can amend the HOPE and Treatment Act of 2017 to mandate that peer recovery services be made available during inpatient care, within the emergency department, and post-discharge for patients presenting with OUD. Second, we recommend the addition of a subtitle to describe how to establish and operate mobile clinic treatment programs. The former amendment would offer a prompt solution that could reduce opioid-related hospitalizations and deaths in the state. It will also help reach underrepresented populations who are the least likely to access peer recovery support and other health services in response to OUD.

Changes in Emergency Department Visits, Diagnostic Groups, and 28-Day Mortality Associated With the COVID-19 Pandemic: A Territory-Wide, Retrospective, Cohort Study

Study objectiveWe aimed to evaluate and characterize the scale and relationships of emergency department (ED) visits and excess mortality associated with the early phase of the COVID-19 pandemic in the territory of Hong Kong.MethodsWe conducted a territory-wide, retrospective cohort study to compare ED visits and the related impact of the COVID-19 pandemic on mortality. All ED visits at 18 public acute hospitals in Hong Kong between January 1 and August 31 of 2019 (n=1,426,259) and 2020 (n=1,035,562) were included. The primary outcome was all-cause mortality in the 28 days following an ED visit. The secondary outcomes were weekly number of ED visits and diagnosis-specific mortality.ResultsED visits decreased by 27.4%, from 1,426,259 in 2019 to 1,035,562 in 2020. Overall period mortality increased from 28,686 (2.0%) in 2019 to 29,737 (2.9%) in 2020. The adjusted odds ratio for 28-day, all-cause mortality in the pandemic period of 2020 relative to 2019 was 1.26 (95% confidence interval 1.24 to 1.28). Both sexes, age more than 45 years, all triage categories, all social classes, all ED visit periods, epilepsy (odds ratio 1.58, 95% confidence interval 1.20 to 2.07), lower respiratory tract infection, and airway disease had higher adjusted ORs for all-cause mortality.ConclusionA significant reduction in ED visits in the first 8 months of the COVID-19 pandemic was associated with an increase in deaths certified in the ED. The government must make provisions to encourage patients with alarming symptoms, mental health conditions, and comorbidities to seek timely emergency care, regardless of the pandemic.

The Impact of the Affordable Care Act Insurance Expansions on Opioid‐Related Emergency Department Visits

Research ObjectiveAmid rising opioid‐related deaths and hospital use, the 2010 Patient Protection and Affordable Care Act (ACA) was signed into law, with the central coverage provisions implemented in 2014. Because lack of health insurance is a barrier to opioid use disorder treatment, and because opioid use disorder treatment can prevent opioid‐related emergency department (ED) visits, we explore the impact of ACA Medicaid expansion and ACA marketplace insurance expansions on opioid‐related ED visits.Study DesignWe use ZIP Code‐level ED utilization data from the 2010–2018 Healthcare Cost and Utilization Project (HCUP) State Inpatient Databases (SID) and State Emergency Department Databases (SEDD) for 29 states, while also accounting for the implementation of relevant state‐level policies using information from sources such as the Kaiser Family Foundation and the Prescription Drug Abuse Policy System. We control for area‐level sociodemographic information using from sources such as the Bureau of Labor Statistics and the Census. We use a difference‐in‐differences (DD) estimation strategy as well as a within‐state dose–response, difference‐in‐differences‐in‐differences (DDD) model based on pre‐ACA uninsurance levels to estimate impacts of the ACA in each of the five years following the 2014 insurance expansions.Population StudiedWe use data on ED visits among nonelderly adults from 2010–2018 for 17 states that adopted Medicaid expansion on January 1, 2014 (Arizona, California, Connecticut, Hawaii, Illinois, Iowa, Kentucky, Maryland, Massachusetts, Minnesota, Nevada, New Jersey, New York, North Dakota, Ohio, Rhode Island, and Vermont) and 12 states that did not implement Medicaid expansion during the study period (Florida, Georgia, Kansas, Maine, Missouri, Nebraska, North Carolina, South Carolina, South Dakota, Tennessee, Utah, and Wisconsin).Principal FindingsWe find that ACA coverage expansions reduced opioid‐related ED visits, but the effect varies over time. Relative to non‐expansion states, opioid‐related ED visit rates in expansion states remain the same or decrease slightly in the first three years after Medicaid expansion (2014–2016). A more marked decline emerges in the fourth and fifth years (2017–2018) after Medicaid expansion. Both DD and DDD results show strong evidence that the impact of ACA insurance expansions on opioid‐related ED visits grew over time.ConclusionsWe find that ACA insurance expansions reduced opioid‐related ED visit rates, with an effect that grows over time. As time from ACA implementation increases, aggregate effects of lower out‐of‐pocket prices, improved access to care, and supply responses would most likely produce reductions in opioid‐related ED visits, which we find in the fourth and fifth year after ACA implementation. These dynamics help explain why studies examining shorter post‐ACA periods or that were unable to estimate time‐varying impacts did not detect significant impacts of coverage expansions on opioid‐related ED visits.Implications for Policy or PracticeThere are likely to be lags between the time when an individual with substance use disorder (or at risk of developing the disorder) gains coverage, the time when the individual accesses treatment, and consequent reductions in ED visits. Our findings suggest that there are similarly important dynamics in the impact of insurance expansion on opioid‐related ED visits.

MP54-20 APPLICATION OF ARTIFICIAL INTELLIGENCE TO IMPROVE PATIENT SELECTION FOR THE KAISER PERMANENTE HEALTHY STONE POPULATION MANAGEMENT PROGRAM

You have accessJournal of UrologyStone Disease: Epidemiology & Evaluation II (MP54)1 Sep 2021MP54-20 APPLICATION OF ARTIFICIAL INTELLIGENCE TO IMPROVE PATIENT SELECTION FOR THE KAISER PERMANENTE HEALTHY STONE POPULATION MANAGEMENT PROGRAM Reza Goharderakhshan, Nikhil Crain, Drew Clausen, Dennis Walsh, Gary Chien, and Ronald Loo Reza GoharderakhshanReza Goharderakhshan More articles by this author , Nikhil CrainNikhil Crain More articles by this author , Drew ClausenDrew Clausen More articles by this author , Dennis WalshDennis Walsh More articles by this author , Gary ChienGary Chien More articles by this author , and Ronald LooRonald Loo More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002084.20AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The Healthy Stone (HS) program follows the AUA kidney stone medical management guidelines with the goals of reducing both stone recurrence and additional treatments in high risk patients. We previously presented on the predictive accuracy of a machine learning algorithm to assess the risk of stone recurrence. This algorithm was used to risk stratify eligible patients diagnosed with a kidney stone who participated in the HS program vs. those who did not. We examined the impact of our Healthy Stone program for each risk category over a three year follow up period. METHODS: The predictive algorithm was retrospectively applied to two groups of patients who remained within the Kaiser Permanente health plan with three year follow up data. The treatment group (N=537) included patients enrolled in the HS program. The control group (N=1984) included patients diagnosed with kidney stones in the same period as the treatment group who did not enroll in the HS program. The kidney stone recurrence risk was computed for all patients. They were then stratified into four risk groups (lowest, low, moderate, high). The volume of kidney stone related surgical procedures and Emergency Department (ED) encounters was examined for both groups. RESULTS: The AI algorithm identified 242 (45%) high risk patients in the treatment group, and 397(20%) high risk patients in the control group. In the high-risk group, there was a reduction in ED visits (36%) (Figure 1) and surgical procedures (44%) (Figure 2) for patients managed by the HS program over those not enrolled in the program. In the lower risk groups, the impact of the HS program on ED visits and surgeries was less significant. CONCLUSIONS: Our study demonstrates a significant reduction in recurrent stone treatment encounters for high-risk patients who were enrolled in the Healthy Stone program vs. those who were not. Using an AI algorithm may augment our clinical decision making for patients who are most likely to benefit from a prevention program and therefore improve resource utilization. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e957-e957 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Reza Goharderakhshan More articles by this author Nikhil Crain More articles by this author Drew Clausen More articles by this author Dennis Walsh More articles by this author Gary Chien More articles by this author Ronald Loo More articles by this author Expand All Advertisement Loading ...

Bridge Clinic Cuts Emergency Department Use in Patients With OUD

Bridge Clinic Cuts Emergency Department Use in Patients With OUD

P–407 Early pregnancy in the Emergency Department; presentation, management, outcome and the effect of COVID–19

Study questionHas the COVID–19 pandemic and public health guidance impacted referrals, outcome and management of early pregnancy in the emergency room?Summary answerCOVID–19 changed the way in which women sought guidance and accessed services in early pregnancy.What is known alreadySpontaneous miscarriage is the most common complication of pregnancy1. Experiencing an early pregnancy loss is often an unexpected and difficult time that can be physically traumatising2. A previous study looking at the experience of a miscarriage from both the female and male point of view identified that long waiting times surrounded by other pregnant women in the Emergency Department (ED) was particularly difficult part of the experience2. The COVID–19 pandemic had a significant impact on both hospital and community services. Public health advice also changed the way women accessed healthcare.Study design, size, durationRetrospective audit was performed over two six-month periods – July to December 2019 and March to August 2020. Two groups of data were collected; women who contacted the ED with concerns related to early pregnancy (under thirteen weeks gestation) and those who attended the ED with the same complaints. Information was cross referenced to see how many women contacted the ED prior to arrival and what, if any advice was given.Participants/materials, setting, methodsAll women under thirteen weeks gestation with a complaint of bleeding per vaginum (PV) or pain related to early pregnancy who presented to the ED in a large tertiary maternity unit were included in the audit. All women meeting the same criteria who contacted the ED by telephone were also included.Main results and the role of chanceOver the twelve months of data collection, 1274 women had their first visit to the ED. There were 270 further visits within the early pregnancy period recorded for the same cohort of women. Additionally, 1452 phone calls were recorded. There was a 38% (n = 293) decrease in women attending the emergency room in early pregnancy in 2020 during the first wave of COVID–19. There was a 16% (n = 110) increase in women contacting the ED for advice in early pregnancy in the same period in 2020. Women were more like likely to have been referred to the ED by their General Practitioner (GP) (OR 0.62, 95%CI 0.48–0.80) and to have phoned in advance of arrival (OR 1.55, 95%CI 1.17–2.04) in 2020. They were also more likely to have already had a previous ultrasound scan in the current pregnancy (OR 0.64, 95%CI 0.48–0.93). There was a significantly shorter waiting time for an appointment in the early pregnancy clinic in 2020 compared with 2019 (3.5 days versus 2.4 days, p = 0.002). There was no change in the number of women admitted (OR 1.19, 95%CI 0.81–1.74).Limitations, reasons for cautionSingle centre audit. Pregnancies only followed to booking visit/dating scan and outcome noted at that stage.Wider implications of the findings: The COVID–19 pandemic highlighted the need for more education around early pregnancy. Easily accessible information about local early pregnancy services gives women autonomy. Phone triage allowing referral of women to appropriate services, reduces ED visits. Standard training in early pregnancy ultrasound could reduce follow up referrals and admission rates.Trial registration numberNot applicable

Medication selection, health services outcomes, and cost trajectories for Medicaid beneficiaries with infantile spasms

ObjectiveThere are three recommended first-line treatments for infantile spasms, adrenocorticotropic hormone (ACTH), oral corticosteroids, and vigabatrin, though non-standard treatments such as topiramate are sometimes selected. Is it uncertain how treatment selection influences health services outcomes. MethodsWe conducted a retrospective cohort study of Medicaid beneficiaries newly diagnosed with infantile spasms from 2009–2010. We included infants with a new diagnosis of infantile spasms between age 2–9 months who filled ACTH (reference), prednisolone, vigabatrin, or topiramate prescriptions. Multivariable Cox proportional hazards regression compared time to first emergency department (ED) visit or hospitalization across treatment groups during 2 years of follow-up. Monthly costs for each treatment were examined in 6-month intervals and compared in a multivariable generalized linear model. ResultsAmong 256 children with infantile spasms, 116 received ACTH, 62 prednisolone, 15 vigabatrin, and 63 topiramate. The rate of ED visit or hospitalization per person-year did not differ significantly for prednisolone (0.9 [95 % CI 0.7–1.2]; adjusted hazard ratio [aHR] 0.84, 95 % CI 0.57–1.24), vigabatrin (0.8 [95 % CI 0.4–1.5]; aHR 0.91, 95% CI 0.45–1.84), or topiramate (1.7 [95 % CI 1.3–2.3]; aHR 1.15, 95 % CI 0.80–1.65), when compared to ACTH (1.1 [95 % CI 0.9–1.3]). The median payment for ACTH was $96,406 (interquartile range 70,742–138,476) during the first 6 months. The adjusted mean total payment in the first 6 months was 73% lower for prednisolone (95% CI −82, −61), 69% lower for vigabatrin (95% CI −84, −40), and 73% lower for topiramate (95% CI −82, −59). However, in subsequent 6-month intervals, costs associated with ACTH were not significantly different compared to other treatments. SignificanceCompared to other treatments for infantile spasms, use of ACTH was associated with greater cost in the first 6 months of treatment, but not with reduced ED visits or hospitalizations. The cost effectiveness of ACTH depends on its relative clinical efficacy, and merits additional research.