Trends In Health Care Utilization Research Articles

Trends in Health-Care Utilization at the End of Life Among Patients With Hematologic Malignancies in a Middle-Income Country: Challenges and Opportunities in Brazil.

Patients with hematologic malignancies (HMs) often receive poor-quality end-of-life care. This study aimed to identify trends in end-of-life care among patients with HM in Brazil. We conducted a retrospective cohort study (2015-2018) of patients who died with HM, using electronic medical records linked to health insurance databank, to evaluate outcomes consistent with health-care resource utilization at the end of life. Among 111 patients with HM, in the last 30 days of life, we found high rates of emergency department visits (67%, n = 75), intensive care unit admissions (56%, n = 62), acute renal replacement therapy (10%, n = 11), blood transfusions (45%, n = 50), and medical imaging utilization (59%, n = 66). Patients received an average of 13 days of inpatient care and the majority of them died in the hospital (53%, n = 58). We also found that almost 40% of patients (38%, n = 42) used chemotherapy in the last 14 days of life. These patients were more likely to be male (64% vs 22%; P < .001), to receive blood transfusions (57% vs 38%; P = .05), and to die in the hospital (76% vs 39%; P = .009) than patients who did not use chemotherapy in the last 14 days of life. This study suggests that patients with HM have high rates of health-care utilization at the end of life in Brazil. Patients who used chemotherapy in the last 14 days of life were more likely to receive blood transfusions and to die in the hospital.

Emergency Department Visits for Inflammatory Bowel Disease Patients Are Increasing at a Steady Rate

Introduction: Inflammatory bowel disease (IBD) is a chronic condition & often leads to significant utilization of healthcare resources, including emergency department (ED) visits. With the increasing use of biologic therapy over the past decade, one may expect to see a decrease or plateau of the rate of ED visits for IBD. We evaluated whether the rate of ED visits for IBD have changed overtime. Methods: Using claims data from the Healthcare Cost and Utilization Project, we identified a cohort of patients who presented to the ED w/ a primary diagnosis code of either Crohn's disease (CD) or ulcerative colitis (UC), from 2006-2014. We calculated rates of presentation to the ED for CD and UC separately. We also conducted a time series trend analysis to estimate if the rate of change in ED presentation was statistically significant over time. Results: For CD, the total # of ED visits increased each year, from 63000 visits in 2006 to 93277 in 2014, w/ a corresponding increase in the rate of ED visit from 19.76 per 100000, to 29.25 per 100000 (see figure 1). Although the rate increased each year, the rate of change overtime remained steady & wasn't statistically significant (P value 0.87). For CD, the disposition from the ED did vary overtime, w/ an increase in discharges & a slowing of the rate w/ regard to admissions (figure 2), although the trends between the two lines weren't significant, (P value 0.2). For UC, the total # & rate of ED visits were less than that which we saw for CD. For UC, the total # of ED visits increased from 27846 in 2006, to 44670 in 2014, w/ a corresponding increase in the rate of ED visits from 8.7 per 100000, to 14.0 per 100000 (see figure 1). For UC, although the rate of ED visit increased each year, the rate of increase remained stable overtime & wasn't statistically significant (P value 0.98). The rates of discharge from the ED vs admission to the hospital (figure 3), & the rates of the 2 dispositions overtime weren't statistically significant (P value 0.5). The difference between the rate of increase between CD & UC wasn't statistically significant (P value 0.88) Conclusion: The rate of ED visits for CD & UC appears to be increasing overtime, although the rate of increase appears to be steady--neither increasing or decreasing. Further studies evaluating trends in health care utilization are necessary to design initiatives to improve patient care & try to decrease the use of potentially unnecessary hospital based resources.714_A Figure 1. Rate of ED visits in patients with CD & UC714_B Figure 2. Disposition in ED in CD patients714_C Figure 3. Disposition from ED in UC patients

Trends in healthcare utilization and costs associated with pneumonia in the United States during 2008\u20132014

BackgroundPneumonia is the leading cause of morbidity and mortality worldwide. Pneumococcal conjugate vaccines have reduced the burden of pneumonia, but data on the current burden of pneumonia and its impact on the healthcare system are needed to inform the development and use of new vaccines and other preventive measures.MethodsWe retrospectively analyzed the frequency of pneumonia in the US during 2008–2014 using data from the MarketScan® Commercial Claims and Encounters database. Frequencies of healthcare utilization related to the index pneumonia episode were calculated using the annual number of enrolled person-years (PY) as the denominator and the number of individuals with pneumonia as the numerator. Pneumonia-associated costs were calculated as mean payment per episode during the 2 years from 2013 to 2014.ResultsThe overall annual healthcare utilization rate for pneumonia was 15.1 per 1000 PY and decreased slightly from 2008 to 2014 (from 15.4 to 13.5 per 1000 PY). Most pneumonia-related healthcare utilization was due to office/outpatient visits (10.3 per 1000 PY; 68.3%). Emergency department/urgent care visits (2.5 per 1000 PY; 16.9%) and hospitalizations (2.2 per 1000 PY; 14.8%) contributed less. Pneumonia-related healthcare utilization was highest in children < 5 years (rate per 1000 PY = 29.7 for < 1 year, 47.9 for 1 year, and 39.5 for 2–4 years) and adults > 65 years (45.0 per 1000 PY). The mean cost per pneumonia episode (95% confidence interval) was US$429.1 ($424.8–$433.4) for office/outpatient visits, $1126.9 ($1119.5–$1134.3) for emergency department/urgent care visits, and $10,962.5 ($10,822.8–$11,102.2) for hospitalization.ConclusionsThe burden of pneumonia on the US healthcare system remains substantial. The results presented here can help guide new vaccination strategies and other preventive interventions for reducing the remaining burden of pneumonia.

Acute Otitis Media and Associated Complications in United States Emergency Departments.

Complications due to acute otitis media (AOM), while rare, are associated with significant morbidity and are not well characterized from an epidemiological perspective. We analyze the pattern of presentation and emergency department (ED) utilization in patients with AOM and associated complications. Retrospective analysis of the Nationwide Emergency Department Sample (NEDS) from 2009 to 2011. Emergency Department. Patients who presented with a primary diagnosis of AOM or acute mastoiditis. Diagnostic. NEDS was queried for patient encounters with a diagnosis of AOM or acute mastoiditis based on ICD-9 codes. Complications of severe infection, including petrositis, Gradenigo's syndrome, facial paresis, labyrinthitis, meningitis, intracranial abscess, venous sinus thrombosis, and cerebrospinal fluid leak, were assessed. Weighted estimates for demographics, types of complications, socioeconomic status, and trends over time were extracted. A weighted total of 5,811,127 ED visits were identified. The majority of patients were less than 18 years old (79.9%) with an average age of 10.1 years. Most were discharged (99.4%). There were 15,243 (0.26%) patients who presented with a complication. The most common complications were acute mastoiditis (0.16%), labyrinthitis (0.06%), and facial paresis (0.03%). Compared with patients with uncomplicated AOM, patients with complicated AOM were older (37 vs. 10-yr old), insured by Medicare (18% vs. 2.1%), and more likely to be admitted (43.6% vs. 0.4%) (p < 0.0001, for all comparisons). ED visits related to AOM or mastoiditis are common and complications are rare. An in-depth analysis on a national level is useful for assessing healthcare utilization trends.

Trends in healthcare utilization and costs associated with acute otitis media in the United States during 2008\u20132014

BackgroundAcute otitis media (AOM) is the most common cause of pediatric medical visits and antibiotic prescriptions worldwide, but its current impact on the US healthcare system is not clear. The aim of this study was to investigate changes in the incidence of AOM from 2008, just before 13-valent pneumococcal conjugate vaccine was introduced, to 2014 using US insurance records in the Truven MarketScan® database. The study also examined the costs associated with index AOM events during the two most recent years for which data were available (2013–2014).MethodsAOM cases in the MarketScan database during 2008–2014 were identified using ICD9 diagnosis codes 381.xx and 382.xx. Incidence rates of healthcare utilization related to the index AOM episode were calculated using the annual number of enrolled person-years as the denominator and the number of individuals with AOM as the numerator. AOM-associated costs were calculated as the mean payment per episode during the 2 years from 2013 to 2014.ResultsThe overall annual rate of AOM-related healthcare utilization was 60.5 per 1000 person-years and changed little from 2008 to 2014 (range, 58.4–62.6). Most of this was due to office/outpatient visits (55.7 [range, 52.0–58.8] per 1000 person-years). Emergency department/urgent care visits (4.7 [range 3.7–6.3] per 1000 person-years) and hospitalization (0.0 [range, 0.0–0.1] per 1000 person-years) contributed little. The rate of AOM-related healthcare utilization per 1000 person-years was highest in the youngest children and declined with age (474.3 for < 1 year, 503.9 for 1 year, 316.3 for 2–4 years, 94.9 for 5–17 years, 33.1 for 18–49 years, 28.6 for 50–64 years, 23.7 for 65–74 years, 20.2 for 75–84 years, and 16.1 for ≥85 years). The mean cost per AOM episode in 2013–2014 (95% confidence interval) was $199.0 (198.4–199.6) for office or outpatient visits, $329.6 (328.2–331.0) for emergency department/urgent care visits, and $1592.9 (1422.0–1763.8) for hospitalization.ConclusionsIn the US, AOM-associated healthcare utilization and costs remain substantial. More effective preventive measures such as new vaccines are needed to reduce the burden of AOM.

SAT-041 - Trends in healthcare utilization in the United States and Europe associated with patient with acute hepatic porphyria with recurrent attacks in EXPLORE: A prospective, multinational natural history study of patients with acute hepatic porphyria

SAT-041 - Trends in healthcare utilization in the United States and Europe associated with patient with acute hepatic porphyria with recurrent attacks in EXPLORE: A prospective, multinational natural history study of patients with acute hepatic porphyria

A register-based case-control study of health care utilization and costs in binge-eating disorder

ObjectiveCapturing trends in healthcare utilization may help to improve efficiencies in the detection and diagnosis of illness, to plan service delivery, and to forecast future health expenditures. For binge-eating disorder (BED), issues include lengthy delays in detection and diagnosis, missed opportunities for recognition and treatment, and morbidity. The study objective was to compare healthcare utilization and expenditure in people with and without BED. MethodsA case-control design and nationwide registers were used. All individuals diagnosed with BED at eating disorder clinics in Sweden between 2005 and 2009 were included (N = 319, 97% female, M age = 22 years). Ten controls (N = 3190) were matched to each case on age-, sex-, and location of birth. Inpatient, hospital-based outpatient, and prescription medication utilization and expenditure were analyzed up to eight years before and four years after the index date (i.e., date of diagnosis of the BED case). ResultsCases had significantly higher inpatient, hospital-based outpatient, and prescription medication utilization and expenditure compared with controls many years prior to and after diagnosis of BED. Utilization and expenditure for controls was relatively stable over time, but for cases followed an inverted U-shape and peaked at the index year. Care for somatic conditions normalized after the index year, but care for psychiatric conditions remained significantly higher. ConclusionIndividuals with BED had substantially higher healthcare utilization and costs in the years prior to and after diagnosis of BED. Since previous research shows a delay in diagnosis, findings indicate clear opportunities for earlier detection and clinical management. Training of providers in detection, diagnosis, and management may help curtail morbidity. A reduction in healthcare utilization was observed after BED diagnosis. This suggests that earlier diagnosis and treatment could improve long-term health outcomes and reduce the economic burden associated with BED.

Trend of health care utilization of cleft lip and/or palate in Korea during 2007-2016.

ObjectiveThis study is performed to investigate the trend of health care (HC) utilization among cleft lip and/or palate (CL/P) during 2007–2016 by using data from the Korean National Health Insurance Service (KNHIS).MethodsThe KNHIS data were reorganized to count a specific patient only once for a specific year. Cleft type (cleft lip [CL], cleft palate [CP], and cleft lip and palate [CLP]), sex, and age at HC utilization were investigated. The study period was divided into the first half (2007–2011) and the last half (2012–2016). The utilization number and rate per 1,000 population were calculated for the total population and for new-born patients. Independent t-test and one-way analysis of variance were used for statistical analyses.ResultsThe total CL/P population (n = 48,707) comprised 19.2% CLP, 35.5% CL, and 45.3% CP (CLP < CL < CP; p < 0.001). Their HC utilization rate increased from 0.066 in 2007 to 0.118 in 2016. The new-born patient population (n = 7,617) comprised 18.6% CLP, 30.4% CL, and 51.0% CP (CLP < CL < CP; p < 0.001). Their HC utilization rate increased from 1.12 in 2007 to 1.74 in 2016. An examination of the utilization number and rate among new-born patients revealed CP exhibited a female-dominant pattern (all p < 0.01), while CL and CLP exhibited a male-dominant pattern (all p < 0.01). However, utilization number showed no difference by sex and cleft type between 2007–2011 and 2012–2016.ConclusionsThese results might serve as a guideline for HC utilization among patients with CL/P.

Exploring Characteristics and Health Care Utilization Trends Among Individuals Who Fall in the Health Insurance Assistance Gap in a Medicaid Nonexpansion State.

States that did not expand Medicaid under the Affordable Care Act (ACA) in the United States have seen a growth in the number of individuals who fall in the assistance gap, defined as having incomes above the Medicaid eligibility limit (≥44% of the federal poverty level) but below the lower limit (<100%) to be eligible for tax credits for premium subsidies or cost-sharing reductions in the marketplace. The purpose of this article is to present findings from a secondary data analysis examining the characteristics of those who fell in the assistance gap ( n = 166) in Missouri, a Medicaid nonexpansion state, by comparing them with those who did not fall in the assistance gap ( n = 157). Participants completed online demographic questionnaires and self-reported measures of health and insurance status, health literacy, numeracy, and health insurance literacy. A select group completed a 1-year follow-up survey about health insurance enrollment and health care utilization. Compared with the nonassistance gap group, individuals in the assistance gap were more likely to have lower levels of education, have at least one chronic condition, be uninsured at baseline, and be seeking health care coverage for additional dependents. Individuals in the assistance gap had significantly lower annual incomes and higher annual premiums when compared with the nonassistance gap group and were less likely to be insured through the marketplace or other private insurance at the 1-year follow-up. Findings provide several practice and policy implications for expanding health insurance coverage, reducing costs, and improving access to care for underserved populations.

Primary Biliary Cholangitis (PBC) Is Associated With Significant Mortality and Health Care Utilization (HCU) in Medicare Population

Introduction: PBC can lead to morbidity, mortality, and HCU. We assessed recent trends in HCU and mortality for PBC patients enrolled in Medicare program. Methods: We used 5% random samples of Medicare beneficiaries (2005-2015) for inpatient/outpatient services. PBC included ICD-9 code of 571.6 as both primary and secondary diagnoses. We assessed HCU [episodes of care, length of inpatient stay (LoS), total charges/payments) and short-term mortality. Independent predictors of outcomes were evaluated in multiple generalized linear or logistic regression models. Results: Out of 2.8 million Medicare claims, 6,375 were for PBC. Proportion of Medicare-PBC increased from 21.0 (2005-2008) to 25.6 (2014) per 100,000 (p=0.001). Demographics of PBC cohort remained the same for the study period: age 69.8±9.9, 17% male, 88% white, 19% enrolled due to disability (all p>0.10). Total outpatient claims were 11,140 for 5,284 unique patients. The number outpatient claims per patient per year ranged from 1.9 to 2.2 (p=0.31), total per patient per year charges ranged from $3,065 (2005) to $5,773 (2014) (p < 0.05) and the average total per-patient-per-year (PPPY) payments ranged from $641 (2008) to $967 (2014) in 2016 U.S. dollars (p=0.10) with patients-paid share ranging from 15% to 19% (p=0.59). Independent predictors of higher outpatient spending included ascites, hepatic encephalopathy, portal hypertension, hepatocellular carcinoma and Charlson score (CCS)>1 (betas from $325 to $744 per condition; p < 0.01). One-year mortality in PBC remained stable over time (9% to 14%, p=0.11). Independent predictors of one-year mortality included older age, male gender, black or Hispanic race, ascites, hepatic encephalopathy and higher CCS (p < 0.05). Inpatient claims were 2,802 for 1,928 unique patients (#claims per patient 1.36 to 1.57, p=0.88). Average total inpatient charges increased from $60,411 (2005) to $73,662 (2014) (p=0.01), while PPPY payments ranged from $18,322 to $28,107 (p=0.48) with patients-paid share ranging from 9% to 13% (p=0.48). Independent predictors of higher inpatient spending were younger age, disability, and hepatic de-compensation (beta from $8,663 to $14,010 per condition, p < 0.04). Ascites, hepatic encephalopathy, higher CCS and longer inpatient stay were also associated with higher inpatient mortality in PBC (p < 0.03). Conclusion: PBC is an important liver disease associated with mortality and HCU. The prevalence and HCU of PBC in Medicare population is increasing.

Trends in health care utilization for asthma exacerbations among diverse populations with asthma in the United States

Trends in health care utilization for asthma exacerbations among diverse populations with asthma in the United States

Temporal trends in healthcare utilization following primary melanoma diagnosis among Medicare beneficiaries

Little is known about the impact of primary melanoma diagnosis on healthcare utilization and changes in utilization over time. To evaluate population-based temporal trends in healthcare utilization following primary melanoma diagnosis. We conducted a before-and-after multiple time series study of Medicare beneficiaries aged ≥ 66 years with primary melanoma diagnoses between 2000 and 2009 using the Surveillance, Epidemiology, and End Results Medicare database. Primary exposure was time from primary melanoma diagnosis at 3-6 months and 6-24 months postdiagnosis. Covariates included tumour-, patient- and geographical-level characteristics and healthcare utilization in the 6 months before diagnosis. Poisson regression was used to estimate population-based risk-adjusted utilization rates for skin biopsies, benign skin excisions, internal medicine office visits and dermatology office visits. The study population included 56 254 patients with first diagnoses of primary melanoma. Most patients were ≥ 75 years old (56·8%), male (62·1%), and had in situ melanoma (42·4%) or localized invasive melanoma (45·9%). From 2000 to 2009, risk-adjusted skin biopsy rates 24 months postdiagnosis increased from 358·3 to 541·3 per 1000 person-years (P < 0·001), and dermatology visits increased from 989·0 to 1535·6 per 1000 person-years (P < 0·001). Benign excisions and internal medicine visits remained stable. In 2000, risk-adjusted skin biopsy rates 6 months postdiagnosis increased by 208·5 relative to the 6 months before diagnosis (148·7 vs. 357·2) compared with an observed absolute increase of 272·5 (290·9 vs. 563·1) in 2009. Trends in dermatology visits were similar. Utilization of skin biopsies and dermatology office visits following primary melanoma diagnosis has increased substantially over time. These results may inform optimization of care delivery for melanoma within the Medicare population.

Healthcare utilization in older patients using personal emergency response systems: an analysis of electronic health records and medical alert data

BackgroundPersonal Emergency Response Systems (PERS) are traditionally used as fall alert systems for older adults, a population that contributes an overwhelming proportion of healthcare costs in the United States. Previous studies focused mainly on qualitative evaluations of PERS without a longitudinal quantitative evaluation of healthcare utilization in users. To address this gap and better understand the needs of older patients on PERS, we analyzed longitudinal healthcare utilization trends in patients using PERS through the home care management service of a large healthcare organization.MethodsRetrospective, longitudinal analyses of healthcare and PERS utilization records of older patients over a 5-years period from 2011–2015. The primary outcome was to characterize the healthcare utilization of PERS patients. This outcome was assessed by 30-, 90-, and 180-day readmission rates, frequency of principal admitting diagnoses, and prevalence of conditions leading to potentially avoidable admissions based on Centers for Medicare and Medicaid Services classification criteria.ResultsThe overall 30-day readmission rate was 14.2%, 90-days readmission rate was 34.4%, and 180-days readmission rate was 42.2%. While 30-day readmission rates did not increase significantly (p = 0.16) over the study period, 90-days (p = 0.03) and 180-days (p = 0.04) readmission rates did increase significantly. The top 5 most frequent principal diagnoses for inpatient admissions included congestive heart failure (5.7%), chronic obstructive pulmonary disease (4.6%), dysrhythmias (4.3%), septicemia (4.1%), and pneumonia (4.1%). Additionally, 21% of all admissions were due to conditions leading to potentially avoidable admissions in either institutional or non-institutional settings (16% in institutional settings only).ConclusionsChronic medical conditions account for the majority of healthcare utilization in older patients using PERS. Results suggest that PERS data combined with electronic medical records data can provide useful insights that can be used to improve health outcomes in older patients.

MP95-05 INCREASING UTILIZATION OF CARE FOR URINARY STONE DISEASE IN OLDER ADULTS

You have accessJournal of UrologyStone Disease: Epidemiology & Evaluation II1 Apr 2017MP95-05 INCREASING UTILIZATION OF CARE FOR URINARY STONE DISEASE IN OLDER ADULTS Kevin T. Hobbs, Brad Hammill, Daniel Wollin, Glenn M. Preminger, Michael E. Lipkin, Kenneth E. Schmader, and Charles D. Scales, Jr. Kevin T. HobbsKevin T. Hobbs More articles by this author , Brad HammillBrad Hammill More articles by this author , Daniel WollinDaniel Wollin More articles by this author , Glenn M. PremingerGlenn M. Preminger More articles by this author , Michael E. LipkinMichael E. Lipkin More articles by this author , Kenneth E. SchmaderKenneth E. Schmader More articles by this author , and Charles D. Scales, Jr.Charles D. Scales, Jr. More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.3007AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Urinary stone disease (USD) has long been considered a condition afflicting those of working age. As the US population ages, however, it is unclear what impact changing population dynamics may have on care utilization. The objective of our research was to examine trends in health care utilization for USD in the United States by age, with a particular emphasis on older adults. METHODS We used data from the Nationwide Inpatient Sample (NIS) and the Nationwide Emergency Department Sample (NEDS) to estimate trends for inpatient and emergency department care utilization from 2006 to 2013. Older adults were defined as individuals aged at least 65 years. Encounters for USD were identified using diagnostic codes and established algorithms. We calculated annual number of ED visits and hospitalizations for stones by age group. Linear regression was used to assess changes in utilization over time. RESULTS An estimated 1.77 million ED visits and 1 million inpatient discharges for USD occurred during the study period for older adults (≥65 years). ED visits with principal diagnosis of USD increased 66% (p <.001) for ages 65-84 and 72% (p <.001) for ages 85+, whereas younger adults (ages 18-64 years) only increased 19% (p <.001) (Figure). Similar trends were observed for inpatient discharges, with an increase of 15% (p = .0014) for ages 65-84 and 34% (p = .0049) for ages 85+. Inpatient discharges for younger adults decreased during the study period. In sensitivity analyses examining any diagnosis of USD, similar increases in utilization by older adults were noted. CONCLUSIONS Health care utilization for USD is growing rapidly among older adults, and faster than any other age group. Further research is required to determine the extent to which this trend reflects changing population dynamics, changing risk of stones among older individuals, or both. Regardless of the underlying causes, it will be imperative to develop approaches for medical and surgical stone care for these older and often frail adults. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e1288 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Kevin T. Hobbs More articles by this author Brad Hammill More articles by this author Daniel Wollin More articles by this author Glenn M. Preminger More articles by this author Michael E. Lipkin More articles by this author Kenneth E. Schmader More articles by this author Charles D. Scales, Jr. More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Psychiatric Comorbidities Are Associated with Increased Cost of Care and Healthcare Utilization in Multiple Myeloma (MM) Patients

Background: Cost of cancer care is projected to reach $173 billion by 2020, a 39% increase from 2010. Several factors including psychiatric (psych) comorbidities contribute to this increase. Within the oncology setting, 29-38% of the patients (pts) are reported to have mood disorders and 15% have major depression. Depression alone is associated with increased healthcare utilization in pts with breast, colon, lung and prostate cancers. A 2015 report noted that the presence of at least one psychiatric comorbidity in 300 Leukemia pts was associated with an extra $55,000 per pt in just one year. Similarly, in pts treated with systemic steroids, the incidence of neuropsychiatric disorders can be as high as 75%. However, no such data is available for MM, where more than 90% of pts are treated with steroids, likely increasing risk for mood problems and impacting treatment cost. As such, the aim of our study was to analyze the SEER-Medicare database for healthcare utilization trends and acute cost of care (cost incurred during 6 months after MM diagnosis) in MM pts with or without psych comorbidities.Methods: Pts diagnosed with MM between 1991-2010 with continuous Medicare coverage (1 year prior to diagnosis-date of death/end of 2012) were included. Pts were categorized as: MM with any psych disorder (MM+P), MM with depression (MM+D) and MM only. Presence of ³1 inpatient (ipt) or ³2 outpatient (opt) ICD9 diagnosis codes were used to assign pts to the psych categories. Within MM+P and MM+D groups were subdivided by presence of psych or depression diagnosis prior to MM (MM+P PRE or MM+D PRE). Medicare claims adjusted for inflation (2013) within the first 6 months (mth)/total MM care were summed by drug and total charges. Univariate and multivariate logistic regression models (adjusted for age, year, sex, race, and the Charlson Comorbidity Index; CCI) were performed to determine associations with ipt, opt, and any emergency department (ED) charges after MM diagnosis. Associations between psych conditions prior to MM diagnosis and costs of care after MM diagnosis were assessed using univariate and multivariate proportional odds models.Results: The study population included 36,007 eligible MM pts with a median follow-up of 1.8 years. 15168 (42%) pts had a psych condition at any time (MM+P), while 9355 (26%) were diagnosed prior to MM diagnosis (MM+P PRE). Depression was present in 8421 pts (23%), 4546 (13%) of those occurring prior to MM diagnosis. In comparison to MM pts, MM+P and MM+D pts tended to be female, White, and had a higher CCI (all p<0.001). When compared to MM pts, those with MM+P PRE and MM+D PRE had significantly higher incidence of MM-related complications (hypercalcemia, renal dysfunction, anemia, fractures and dialysis) at the time of or after MM diagnosis and also required increased overall care (all p<0.001). Both, MM+P and MM+D had higher odds of ipt visits (OR 1.48 and 1.41, resp., p<0.001), ED care (OR 1.48 and 1.37, resp., p<0.001) and opt visits (OR 1.25 and 1.22, resp., p<0.001) as compared to MM only pts. Cost of care analysis showed that MM+P and MM+D pts had a significantly higher cost of opt (OR 1.36 and 1.39, resp., p<0.001), ipt (OR 1.49 and 1.54, resp., p<0.001) and total care (OR 1.52 and 1.55, resp., p<0.001) as compared to MM only pts during first 6 mth after MM diagnosis (Figure 1). Total costs of care for MM+P and MM+D were also higher than MM only but the differences were less significant. Cost of care differences existed within first 6 mth of MM diagnosis by pt race as well with MM+P among Hispanic and Asian pts being more strongly associated with higher costs than Whites and African-Americans (AA) (p<0.001). MM+D had similar trends but not significant after adjustment for multiple comparisons.Conclusion: Psych comorbidities are associated with significant increase in healthcare utilization and cost of care in MM pts and may contribute to higher MM-related complications. More research is needed to study whether a multidisciplinary approach to identify and manage MM pts with psych conditions may help mitigate these trends. [Display omitted] DisclosuresAilawadhi:Pharmacyclics: Consultancy; Novartis: Consultancy; Amgen Inc: Consultancy; Takeda Oncology: Consultancy.

National Utilization and Forecasting of Ototopical Antibiotics: Medicaid Data Versus "Dr. Google".

To forecast national Medicaid prescription volumes for common ototopical antibiotics, and correlate prescription volumes with internet user search interest using Google Trends (GT). National United States Medicaid prescription and GT user search database analysis. Quarterly national Medicaid summary drug utilization data and weekly GT search engine data for ciprofloxacin-dexamethasone (CD), ofloxacin (OF), and Cortisporin (CS) ototopicals were obtained from January 2008 to July 2014. Time series analysis was used to assess prescription seasonality, Holt-Winter's method for forecasting quarterly prescription volumes, and Pearson correlations to compare GT and Medicaid data. Medicaid prescription volumes demonstrated sinusoidal seasonality for OF (r = 0.91), CS (r = 0.71), and CD (r = 0.62) with annual peaks in July, August, and September. In 2017, OF was forecasted to be the most widely prescribed ototopical, followed by CD. CS was the least prescribed, and volumes were forecasted to decrease 9.0% by 2017 from 2014. GT user search interest demonstrated analogous sinusoidal seasonality and significant correlations with Medicaid data prescriptions for CD (r = 0.38, p = 0.046), OF (r = 0.74, p < 0.001), CS (r = 0.49, p = 0.008). We found that OF, CD, and CS ototopicals have sinusoidal seasonal variation with Medicaid prescription volume peaks occurring in the summer. After 2012, OF was the most commonly prescribed ototopical, and this trend was forecasted to continue. CS use was forecasted to decrease. Google user search interest in these ototopical agents demonstrated analogous seasonal variation. Analyses of GT for interest in ototopical antibiotics may be useful for health care providers and administrators as a complementary method for assessing healthcare utilization trends.

The ACA and Trends in Healthcare Utilization and Loss Ratios: An Index-Based Approach

Using the U.S. Health insurance industry data, we create indices for healthcare utilization and loss ratios by insured sub-populations for 2006-2014 and link to the introduction of the ACA by setting 2010 as base year. The indices may be used to inform public policy and for general benchmarking. In general, index trends in utilization (and not in loss ratios) show no sharp changes of direction with the introduction of the ACA, but show continuation of trends already in place. Still, the trend patterns often differ substantially, depending upon the sub-population and/or utilization/loss measure under examination.

The Effect of Antiretroviral Treatment on Health Care Utilization in Rural South Africa: A Population-Based Cohort Study.

BackgroundThe effect of the rapid scale-up of vertical antiretroviral treatment (ART) programs for HIV in sub-Saharan Africa on the overall health system is under intense debate. Some have argued that these programs have reduced access for people suffering from diseases unrelated to HIV because ART programs have drained human and physical resources from other parts of the health system; others have claimed that the investments through ART programs have strengthened the general health system and the population health impacts of ART have freed up health care capacity for the treatment of diseases that are not related to HIV. To establish the population-level impact of ART programs on health care utilization in the public-sector health system, we compared trends in health care utilization among HIV-infected people receiving and not receiving ART with HIV-uninfected people during a period of rapid ART scale-up.Methods and FindingsWe used data from the Wellcome Trust Africa Centre for Population Health, which annually elicited information on health care utilization from all surveillance participants over the period 2009–2012 (N = 32,319). We determined trends in hospitalization, and public-sector and private-sector primary health care (PHC) clinic visits for HIV-infected and -uninfected people over a time period of rapid ART scale-up (2009–2012) in this community. We regressed health care utilization on HIV status and ART status in different calendar years, controlling for sex, age, and area of residence. The proportion of people who reported to have visited a public-sector primary health care (PHC) clinic in the last 6 months increased significantly over the period 2009–2012, for both HIV-infected people (from 59% to 67%; p<0.001), and HIV-uninfected people (from 41% to 47%; p<0.001). In contrast, the proportion of HIV-infected people visiting a private-sector PHC clinic declined from 22% to 12% (p<0.001) and hospitalization rates declined from 128 to 82 per 1000 PY (p<0.001). For HIV-uninfected people, the proportion visiting a private-sector PHC clinic declined from 16% to 9%, and hospitalization rates declined from 78 to 44 per 1000 PY (p<0.001). After controlling for potential confounding factors, all trends remained of similar magnitude and significance.ConclusionsOur results indicate that the ART scale-up in this high HIV prevalence community has shifted health care utilization from hospitals and private-sector primary care to public-sector primary care. Remarkably, this shift is observed for both HIV-infected and -uninfected populations, supporting and extending hypotheses of ‘therapeutic citizenship’ whereby HIV-infected patients receiving ART facilitate primary care access for family and community members. One explanation of our findings is that ART has improved the capacity or quality of primary care in this community and, as a consequence, increasingly met overall health care needs at the primary care level rather than at the secondary level. Future research needs to confirm this causal interpretation of our findings using qualitative work to understand causal mechanisms or quasi-experimental quantitative studies to increase the strength of causal inference.

Trends in health care utilization and costs attributable to hepatocellular carcinoma, 2002-2009: a population-based cohort study.

The incidence of hepatocellular carcinoma (hcc) and the complexity of its diagnosis and treatment are increasing. We estimated trends in net health care utilization, costs of care attributable to hcc in Ontario, and rate ratios of resource use at various stages of care. This population-based retrospective cohort study identified hcc patients and non-cancer control subjects, and health care resource utilization between 2002 and 2009. Generalized estimating equations were then used to estimate net health care utilization (hcc patients vs. the matched control subjects) and net costs of care attributable to hcc. Generalized linear models were used to analyze rate ratios of resource use. We identified 2832 hcc patients and 2808 matched control subjects. In comparison with the control subjects, hcc patients generally used a greater number of health care services. Overall, the mean net cost of care per 30 patient-days (2013 Canadian dollars) attributable to outpatient visits and hospitalizations was highest in the pre-diagnosis (1 year before diagnosis), initial (1st year after diagnosis), and end-of-life (last 6 months before death, short-term survivors) phases. Mean net homecare costs were highest in the end-of-life phase (long-term survivors). In the end-of-life phase (short-term survivors), mean net costs attributable to outpatient visits and total services significantly increased to $14,220 from $1,547 and to $33,121 from $14,450 (2008-2009 and 2002-2003 respectively). In hcc, our study found increasing resource use and net costs of care, particularly in the end-of-life phase among short-term survivors. Our findings offer a basis for resource allocation decisions in the area of cancer prevention and control.

Health care utilization trends in ductal carcinoma in situ admissions.

e18053Background: Ductal carcinoma in situ (DCIS) is a neoplasm confined to breast ducts. The incidence of DCIS has increased since 1970s with acceptance of screening mammography. The treatment of ...