Unnecessary Resource Utilization Research Articles

Improvement in Kidney Function after Discontinuation of Fenofibrate in Outpatient Nephrology Consultation for Chronic Kidney Disease

Background: It has been noted in observational and interventional studies that individuals exposed to fenofibrate can exhibit a rise in serum creatinine (sCr) concentration. However, it is not known to what extent this phenomenon impacts kidney function in patients who are referred to a nephrology clinic for consultation for chronic kidney disease (CKD). Methods: We conducted a prospective observational study of patients referred to our nephrology clinic for a new evaluation of a rise in sCr or worsening CKD and who were on fenofibrate therapy. We examined the effect of discontinuation of fenofibrate on kidney function, change in sCr, and estimated glomerular filtration (eGFR) at 3, 6, and 12 months. Results: A total of 22 patients (59% women, 86% White, 59% with type 2 diabetes, and 18% with peripheral arterial disease) were captured over 2.5 years. Median sCr at the time of fenofibrate discontinuation was 1.9 (1.1–3.3) mg/dL and eGFR, 32 (17–57) mL/min; proteinuria was absent in 17 (77%). Upon discontinuation of fenofibrate, median sCr decreased to 1.5 (0.9–2.4), 1.4 (1.0–2.5), and 1.4 (1.0–2.3) mg/dL at 3, 6, and 12 months, respectively (p < 0.05); whereas median eGFR increased to 44 (27–71), 45 (23–71), and 42 (21–71) mL/min, respectively (p < 0.05). A ≥30% rise in eGFR was observed in 59% of the patients at 3 months, and it persisted in 45% and 50% of patients at 6 and 12 months, respectively. Conclusion: Discontinuation of fenofibrate in patients referred for CKD evaluation can result in sustained reduction in sCr in about half of the patients and for up to 1 year. There is a need to raise awareness among primary practitioners about this phenomenon. Recognition of fenofibrate as a cause of rise in sCr could reduce unnecessary nephrology consultation and resource utilization.

Abstract 13373: Cost-Effectiveness of Population-Based Atrial Fibrillation Screening Using Wearable Devices

Introduction: Screening of atrial fibrillation (AF) using contemporary wrist-worn wearable devices may prevent strokes, but false positive diagnoses could also lead to unnecessary bleeding and utilization of healthcare resources. Aim: To assess the cost-effectiveness of contemporary AF screening strategies and identify optimal conditions for the deployment of such strategies. Methods: We developed a microsimulation model to evaluate 8 distinct AF screening strategies, including 6 strategies utilizing wrist-worn wearable devices and 2 strategies utilizing traditional modalities ( Figure ). Within a simulated cohort of 30 million individuals with an age, sex, and comorbidity profile matching the US population aged ≥65 years (i.e., with a guideline-based screening indication), we assessed cost-effectiveness from the healthcare system perspective using incremental cost-effectiveness ratios (ICERs) at a willingness-to-pay of $100,000 per quality-adjusted life-year (QALY). We used scenario analyses to identify conditions under which the cost-effectiveness of screening may be optimized. Results: In the base case analysis, 7/8 strategies were effective (87.5%, range of QALYs gained 14-862 per 100,000 people). All 6 contemporary screening strategies were effective (range of QALYs gained 226-957 per 100,000 people). The most cost-effective strategy was wearable photoplethysmography, followed conditionally by wearable electrocardiogram with patch monitor confirmation (ICER $57,882/QALY, Figure). The cost-effectiveness of screening was consistent across multiple scenarios, including across strata of sex and targeting the US population aged ≥50 years. Conclusions: AF screening utilizing wrist-worn wearable devices appears cost-effective, and merits prioritization by potential payers.

Optimization of a Thermal Flow Meter for Failure Management of the Shunt in Pediatric Hydrocephalus Patients.

Hydrocephalus patients suffer from an abnormal buildup of cerebrospinal fluid (CSF) in their ventricles, and there is currently no known way to cure hydrocephalus. The most prevalent treatment for managing hydrocephalus is to implant a ventriculoperitoneal shunt, which diverts excess CSF out of the brain. However, shunts are prone to failure, resulting in vague symptoms. Our patient survey results found that the lack of specificity of symptoms complicates the management of hydrocephalus in the pediatric population. The consequences include persistent mental burden on caretakers and a significant amount of unnecessary utilization of emergency healthcare resources due to the false-positive judgement of shunt failure. In order to reliably monitor shunt failures for hydrocephalus patients and their caretakers, we propose an optimized design of the thermal flow meter for precise measurements of the CSF flow rate in the shunt. The design is an implantable device which slides onto the shunt and utilizes sinusoidal heating and temperature measurements to improve the signal-to-noise ratio of flow-rate measurements by orders of magnitude.Clinical Relevance- An implantable flow meter would be transformative to allow hydrocephalus patients to monitor their shunt function at home, resulting in reduced hospital visits, reduced exposure to radiation typically required to rule out shunt failure, and reduced caretaker anxiety.

Strategic Topological Formation for Wireless Control Systems.

The excessive use of nodes and communication links in a wireless control system (WCS) causes unnecessary utilization of resources. In this article, a strategic topological formation is studied for a WCS, where a previously proposed topology consisting of a plant system, a controller system, and an intermediate network system is further developed. More specifically, this article presents a modeling framework and a design procedure for the topology that results in the utilization of a reduced number of nodes and communication links. It also discusses several conditions for the connectivity of the nodes under different topological scenarios. This article uses a four-tank process system as an application example to demonstrate the strategic topological formation of its WCS.

Development and feasibility of a Configurable Assessment Messaging Platform for Interventions (CAMPI).

Short message service (SMS) is a widely accepted telecommunications approach used to support health informatics, including behavioral interventions, data collection, and patient-provider communication. However, SMS delivery platforms are not standardized and platforms are typically commercial "off-the-shelf" or developed "in-house." As a consequence of platform variability, implementing SMS-based interventions may be challenging for both providers and patients. Off-the-shelf SMS delivery platforms may require minimal development or technical resources from providers, but users are often limited in their functionality. Conversely, platforms that are developed in-house are often specified for individual projects, requiring specialized development and technical expertise. Patients are on the receiving end of programming and technical specification challenges; message delays or lagged data affect quality of SMS communications. To date, little work has been done to develop a generalizable SMS platform that can be scaled across health initiatives. We propose the Configurable Assessment Messaging Platform for Interventions (CAMPI) to mitigate challenges associated with SMS intervention implementation (e.g., programming, data collection, message delivery). CAMPI aims to optimize health data captured from a multitude of sources and enhance patient-provider communication through a technology that is simple and familiar to patients. Using representative examples from three behavioral intervention case studies implemented among diverse populations (pregnant women, young sexual minority men, and parents with young children), we describe CAMPI capabilities and feasibility. As a generalizable SMS platform, CAMPI can be scaled to meet the priorities of various health initiatives, while reducing unnecessary resource utilization and burden on providers and patients. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Improving care for patients with atrial fibrillation through the use of a personal electrocardiogram.

ABSTRACTBackground:Atrial fibrillation (AF) is the most common arrhythmia affecting more than six million people in the United States. The economic burden is estimated to be >$6 billion annually with catastrophic events dramatically increasing expenditure. When patients experience symptoms, they commonly present to an acute care facility; this can be costly and anxiety provoking.Local problem:Same-day access issues prohibit patients from communicating directly with their cardiology provider, forcing them to use resources and increasing psychological burden.Methods:A convenience sample, made up of 43 patients, was given a KardiaMobile device. Eligible patients had ≥2 AF-related emergency department (ED) or urgent care (UC) visits over 12 months, needed rate control with medication titration, or were monitored for AF reoccurrence after reestablishing sinus rhythm.Interventions:Patients emailed recordings daily and when experiencing symptoms. The recordings were reviewed by a nurse practitioner (NP); abnormal readings were followed by a phone call, telehealth, or in-person visit.Results:An independently designed survey was conducted online; almost all respondents (97%) found value in the project and the device. Virtually all respondents (97%) felt that the program improved access. A majority (86%) reported decreased anxiety. Had the respondents not been in the program, 34% indicated that they would have presented to an ED and 25% would have presented to an UC, realizing a cost savings of $81,950 in reduced ED visits alone.Conclusion:A personal electrocardiogram, with NP oversight, to manage AF is cost-effective and reduces unnecessary resource utilization. It is patient centered, improves access, and empowers patients to manage their symptoms.

Trauma patients in the pediatric ICU: rational use of a limited resource.

Traumatic injuries are a leading cause of pediatric mortality; pediatric ICUs (PICUs) are an important but potentially limited resource associated with high costs. In an era of rising healthcare costs, appropriate resource utilization is important. Here, we examine evidence-based guidelines supporting the management of pediatric traumatic injury outside of the PICU. Historical management of solid organ injury and traumatic brain injury was focused on operative management. However, over the past four decades, management of solid organ injury has shifted from invasive management to nonsurgical management with a growing body of evidence supporting the safety and efficacy of this trend. The management of traumatic brain injury (TBI) has had a similar evolution to that of solid organ injury with regard to nonoperative management and management outside the critical care setting. The use of evidence-based guidelines to support expectant management in the setting of pediatric trauma has the potential to reduce unnecessary resource utilization of the PICU. In this review, we present findings that support nonoperative management and management of pediatric trauma outside of the PICU setting. In resource-poor areas, this approach may facilitate care for pediatric trauma patients. The implications are also important in resource-rich settings because of the unintended risks associated with PICU.

Emergency Department Utilization After Administration of Peripheral Nerve Blocks for Upper Extremity Surgery.

The purpose of this study was to determine the impact of upper extremity peripheral nerve blocks on emergency department (ED) utilization after hand and upper extremity surgery. We reviewed all outpatient upper extremity surgeries performed in a single Midwestern state between January 2009 and June 2019 using the Indiana Network for Patient Care. These encounters were used to develop a database of patient demographics, comorbidities, concurrent procedures, and postoperative ED visit utilization data. We performed univariate, bivariate, and multivariate logistic regression analyses. Among 108 451 outpatient surgical patients, 9079 (8.4%) received blocks. Within 1 week of surgery, a greater proportion of patients who received peripheral nerve blocks (1.4%) presented to the ED than patients who did not (0.9%) (P < .001). The greatest risk was in the first 2 postoperative days (relative risk, 1.78; P < .001). Pain was the principal reason for ED utilization in the block cohort (53.6%) compared with those who did not undergo a block (35.1%) (P < .001). When controlling for comorbidities and demographics, only peripheral nerve blocks (adjusted odds ratio [OR], 1.71; P = 0.007) and preprocedural opioid use (adjusted OR, 1.43; P = .020) conferred an independently increased risk of ED utilization within the first 2 postoperative days. Peripheral nerve blocks used for upper extremity surgery are associated with a higher risk of unplanned ED utilization, most likely related to rebound pain. Through proper patient education and pain management, we can minimize this unnecessary resource utilization.

The Changing Landscape of Uncomplicated Gram-Negative Bacteremia: A Narrative Review to Guide Inpatient Management.

Gram-negative bacteremia secondary to focal infection such as skin and soft-tissue infection, pneumonia, pyelonephritis, or urinary tract infection is commonly encountered in hospital care. Current practice guidelines lack sufficient detail to inform evidence-based practices. Specifically, antimicrobial duration, criteria to transition from intravenous to oral step-down therapy, choice of oral antimicrobials, and reassessment of follow-up blood cultures are not addressed. The presence of bacteremia is often used as a justification for a prolonged course of antimicrobial therapy regardless of infection source or clinical response. Antimicrobials are lifesaving but not benign. Prolonged antimicrobial exposure is associated with adverse effects, increased rates of Clostridioides difficile infection, antimicrobial resistance, and longer hospital length of stay. Emerging evidence supports shorter overall duration of antimicrobial treatment and earlier transition to oral agents among patients with uncomplicated Enterobacteriaceae bacteremia who have achieved adequate source control and demonstrated clinical stability and improvement. After appropriate initial treatment with an intravenous antimicrobial, transition to highly bioavailable oral agents should be considered for total treatment duration of 7 days. Routine follow-up blood cultures are not cost-effective and may result in unnecessary healthcare resource utilization and inappropriate use of antimicrobials. Clinicians should incorporate these principles into the management of gram-negative bacteremia in the hospital.

Adoption of a Perioperative Surgical Home for Adolescent Idiopathic Scoliosis Surgery Decreases Postoperative Opioid Usage

Purpose Posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS) has wide treatment variation resulting in unnecessary resource utilization. Significant pain following this procedure is common and opioid medications are the foundation of postoperative pain management. Opioid usage and difficulties with pain can impact mobilization, gastric motility, discharge readiness, and patient satisfaction. The Perioperative Surgical Home (PSH) model of care is one method to decrease variability and eliminate waste through standardization of care. The purpose of this study is to report the impact of implementation a PSH for AIS (PSH-AIS) …

A Novel Approach for a Novel Pathogen: Using a Home Assessment Team to Evaluate Patients for COVID-19.

Thousands of people in the United States have required testing for SARS-CoV-2. Evaluation for a special pathogen is resource intensive. We report an innovative approach to home assessment that, in collaboration with public health, enables safe evaluation and specimen collection outside the healthcare setting, avoiding unnecessary exposures and resource utilization.

Hospital readmissions after pulmonary resection: post-discharge nursing telephone assessment identifies high risk patients.

BackgroundWe previously reported that post-discharge nursing telephone assessments identified a frequent number of patient complaints. Our aim was to determine if telephone assessments can identify patients at risk for emergency room (ER) visits or hospital readmissions.MethodsA single-institution, retrospective review was performed on all patients undergoing pulmonary resection over a 12-month period. Standardized nursing telephone calls were conducted and records were reviewed to determine postoperative issues. ER visits and readmissions within 30 and 90 days were recorded.ResultsIn total, 521 patients underwent pulmonary resection and 245 (47%) were reached for telephone assessment. ER visits within 30/90 days were 8.1% (n=42) and 12.1% (n=63). Readmissions within 30/90 days were 3.1% (n=16) and 6% (n=31). For those reached by telephone assessment, patients with major issue demonstrated increased 30-day ER visits: 22.6% (n=7) vs. 8.0% (n=17), P=0.019. For all patients, those with 90-day ER visit and/or readmission were more likely to have pulmonary complications during initial admission (43.8% vs. 21.2%, P<0.001). Among patients who were reached by telephone, independent predictors of ER visit or readmission within 30 days were: major issue identified on telephone assessment (P=0.007), discharge with chest tube (<0.001), and reintubation postoperatively (P=0.047).ConclusionsStandardized nursing telephone assessments were able to identify a high-risk population more likely to need ER visit or readmission. However, telephone assessments did not decrease ER visits or readmissions. Improved post-discharge protocols are needed for these high-risk patients in order to ensure patient safety, optimize patient experience, and limit unnecessary resource utilization.

Second opinions, multiple physician appointments, and overlapping prescriptions in the paediatric population: A systematic literature review.

Doctor shopping, double doctoring, and overlapping prescriptions are often used as synonyms for multiple physician appointments in the same disease episode. Such behaviours translate into poor patient satisfaction and patient-doctor communication as well as abuse or misuse of drugs, increasing health care costs and resulting in negative health consequences. This systematic review of the literature was conducted to identify factors that drive doctor-shopping behaviour in children's caregivers. The search was conducted in PubMed and grey literature and was based on the following search terms: included doctor or physician shopping, drug seeking, double doctoring, children, and combinations of those. Overall, 500 records were identified, of which 11 were selected for qualitative synthesis. Data extracted considered definitions of doctor shopping, co-morbidities, and target population characteristics. Definitions of doctor shopping were inconsistent. The frequency of doctor shopping was high for acute illnesses and ranged from 53% in children with a fever in Hong Kong to 18% at an emergency department in Canada. The incidence of this phenomenon was low when taking into account addictive drugs and was rated at 0.02% to 0.3% in the full paediatric population. This phenomenon was more prevalent in children younger than 1 year, in children with attention-deficit hyperactivity disorder (ADHD) and co-morbid psychiatric conditions, and in those whose caregivers themselves had psychiatric conditions. It was more frequent in cases with an acute disease (eg, fever, gastroenteritis, and urinary tract infection) than a chronic disease (eg, asthma). The knowledge about doctor shopping by children's caregivers is limited, despite that this is a frequent behaviour. There is a need for further research covering a broader range of diseases. The causes and consequences of doctor shopping should be sought as well to investigate its relation to health care regulations and possibility to reduce unnecessary medical resource utilization.

Dynamic Event-triggered Control for Heterogeneous Leader-following Consensus of Multi-agent Systems Based on Input-to-state Stability

By utilizing dynamic event-triggered control strategy, this paper deals with consensus problem of a class of heterogeneous leader-following multi-agent systems(MASs) consisting of a high-dimensional leader system but low-dimensional following systems. A kind of observer-based consensus controllers is put forward with a dynamic event-triggered function consisting of the measurement error and a threshold based on the neighbors discrete states to reduce unnecessary utilization of limited communication and computation resources. Meanwhile, a dynamic variable is used to generate the event-triggered law using Input-to-State Stability(ISS) criteria. Based on this criteria, the proposed control strategy ensures stability of MASs, which fully reflects of the relationship between the external control inputs of the following systems and the internal states of the leader system and fully considered the influence of disturbances or noises on the MASs. Furthermore, the Zeno behavior for triggering time sequence is excluded. At last, a numerical simulation is provided to demonstrate the feasibility and effectiveness of the theoretical results.

Event-Triggered Consensus Control for Multi-Agent Systems Against False Data-Injection Attacks.

In this article, the event-triggered security consensus problem is studied for time-varying multiagent systems (MASs) against false data-injection attacks (FDIAs) and parameter uncertainties over a given finite horizon. In the process of information transmission, the malicious attacker tries to inject false signals to destroy consensus by compromising the integrity of measurements and control signals. The randomly occurring stealthy FDIAs on sensors and actuators are modeled by the Bernoulli processes. In order to reduce the unnecessary utilization of communication resources, an event-triggered control mechanism with state-dependent threshold is adopted to update the control input signal. The main objective of this article is to design a controller such that, under randomly occurring FDIAs and admissible parameter uncertainties, the MASs achieve consensus. By utilizing stochastic analysis method, two sufficient criteria are derived to ensure that the prescribed H∞ consensus performance can be achieved. Then, the desired controller gains are derived by solving recursive linear matrix inequalities. Simulation results are presented to illustrate the effectiveness and applicability of the proposed control method.

Patient Navigation in Cancer: The Business Case to Support Clinical Needs.

Patient navigation (PN) is an increasingly recognized element of high-quality, patient-centered cancer care, yet PN in many cancer programs is absent or limited, often because of concerns of extra cost without tangible financial benefits. Five real-world examples of PN programs are used to demonstrate that in the pure fee-for-service and the alternative payment model worlds of reimbursement, strong cases can be made to support the benefits of PN. In three large programs, PN resulted in increased patient retention and increased physician loyalty within the cancer programs, leading to increased revenue. In addition, in two programs, PN was associated with a reduction in unnecessary resource utilization, such as emergency department visits and hospitalizations. PN also reduces burdens on oncology providers, potentially reducing burnout, errors, and costly staff turnover. PN has resulted in improved patient outcomes and patient satisfaction and has important financial benefits for cancer programs in the fee-for-service and the alternative payment model worlds, lending support for more robust staffing of PN programs.

Development and clinical implementation of eclipse scripting-based automated patient-specific collision avoidance software.

PurposeIncreased use of Linac‐based stereotactic radiosurgery (SRS), which requires highly noncoplanar gantry trajectories, necessitates the development of efficient and accurate methods of collision detection during the treatment planning process. This work outlines the development and clinical implementation of a patient‐specific computed tomography (CT) contour‐based solution that utilizes Eclipse Scripting to ensure maximum integration with clinical workflow.MethodsThe collision detection application uses triangle mesh structures of the gantry and couch, in addition to the body contour of the patient taken during CT simulation, to virtually simulate patient treatments. Collision detection is performed using Binary Tree Hierarchy detection methods. Algorithm accuracy was first validated for simple cuboidal geometry using a calibration phantom and then extended to an anthropomorphic phantom simulation by comparing the measured minimum distance between structures to the predicted minimum distance for all allowable orientations. The collision space was tested at couch angles every 15° from 90 to 270 with the gantry incremented by 5° through the maximum trajectory. Receiver operating characteristic curve analysis was used to assess algorithm sensitivity and accuracy for predicting collision events. Following extensive validation, the application was implemented clinically for all SRS patients.ResultsThe application was able to predict minimum distances between structures to within 3 cm. A safety margin of 1.5 cm was sufficient to achieve 100% sensitivity for all test cases. Accuracy obtained was 94.2% with the 5 cm clinical safety margin with 100% true positive collision detection. A total of 88 noncoplanar SRS patients have been currently tested using the application with one collision detected and no undetected collisions occurring. The average time for collision testing per patient was 2 min 58 s.ConclusionsA collision detection application utilizing patient CT contours was developed and successfully clinically implemented. This application allows collisions to be detected early during the planning process, avoiding patient delays and unnecessary resource utilization if detected during delivery.

An Overview on Biofuels and Their Advantages and Disadvantages

Blazing of fossil energy resources generally changes the global climate. Speeding up of global temperate nowadays is an important aspect. Emission of greenhouse gases mainly from blazing of fossil energy resources is one of the most important sources. So, to carry the significant energy and to reduce air pollution, biofuels might be a substitute energy sources. The unnecessary utilization of fossil energy resources or fuels results deficient in the storage in underground earth then people naturally have to depend on biofuels. Consequently increasing demand for the manufacture of biofuels will put a huge burden on agriculture and food prices. Biofuels generally attributed as liquid fuels which are made from the biomass. This consists of mostly wood, vegetable oils, forestry products, agricultural crops, agricultural residues or municipal garbage, residues of domestic animal wastes and aquatic plants. In this review, we summarized the different types of biofuels including biodiesel and their comparative study, production and uses from an ecological perspective.

Posterior lumbar fusions at physician-owned hospitals – is it time to reconsider the restrictions of the Affordable Care Act?

Background ContextCaused by perceptions regarding unnecessary healthcare resource utilization, high costs of care, and financial incentives towards “cherry-picking” cases in physician owned hospitals, the Affordable Care Act (ACA) of 2010 imposed restrictions on existing physician-owned hospitals from expanding. Despite an increasing number of individuals requiring access to spine surgical care, no study has evaluated the surgical safety and costs of elective posterior lumbar fusions (PLFs) being performed in physician-owned vs. non-physician-owned hospitals. PurposeWe assessed differences in 90-day costs and outcomes between patients undergoing elective 1- to 3-level PLFs at physician-owned hospitals vs. nonphysician-owned hospitals. Study DesignRetrospective cohort study of 2007 to 2014 100% Medicare claims database. Patient SampleThe 2007 to 2014 Medicare 100% Standard Analytical Files (SAF100) was queried using International Classification of Diseases 9th Edition (ICD-9) procedure code for patients undergoing elective 1- to 3-level PLFs (81.07, 81.08, and 81.62). The Medicare Hospital Compare database was used to identify provider codes for physician-owned hospitals. These provider codes were cross-referenced to identify records of patients receiving elective PLFs at these hospitals from the SAF100 database. Outcome MeasuresNinety day complications, readmissions, emergency department (ED) visits, charges, and costs. MethodsMultivariate logistic and linear regression analyses were used to assess significant differences in 90-day complications, readmissions, charges and costs between the two groups. ResultsA total of 6,679 (2.9%) patients received an elective PLF at a physician-owned hospital (N=39; 2.2%) whereas 225,090 (97.1%) received surgery at nonphysician-owned hospital (N=1,774; 97.8%). After controlling for age, gender, region, hospital factors (socio-economic status area, urban vs. rural location and volume) and Elixhauser co-morbidity index, undergoing surgery at physician-owned hospital was associated with lower odds of thromboembolic complications (OR 0.66 [95% CI 0.53–0.82]; p<.001), urinary tract infections (OR 0.87 [95% CI 0.79–0.95]; p=.002) and renal complications (OR 0.52 [95% CI 0.43–0.63]; p<.001) within 90-days following the surgery. Patients undergoing PLFs at physician-owned hospitals vs. nonphysician-owned hospitals also had lower risk-adjusted inpatient charges (−$10,218), inpatient costs (−$2,302), 90-day charges (−$9,780) and 90-day costs (−$2,324). No significant differences were noted between physician-owned and nonphysician-owned hospitals with regards to 90-day wound complications (OR 1.08 [95% CI 0.94–1.22]; p=.279), pulmonary complications (OR 1.06 [95% CI 0.97–1.17]; p=.187), cardiac complications (OR 0.92 [95% CI 0.83–1.01]; p=.089), septic complications (OR 0.77 [95% CI 0.56–1.01]; p=.073), all-cause ED visits (OR 0.96 [95% CI 0.89–1.04]; p=.311), revision surgery (OR 1.09 [95% CI 0.72–1.59]; p=.653) and readmissions (OR 0.98 [95% CI 0.89–1.08]; p=.680). ConclusionOur results suggest that patients undergoing elective 1- to 3-level PLFs at physician-owned hospitals do not experience a greater number of complications and/or readmissions while having lower risk-adjusted charges and costs over the 90-day episode of care. The findings call on the need for revaluation/reconsideration of the ACAs restriction on the expansion of these physician-owned hospitals.

The Effect of Psychiatric Diagnosis and Psychotropic Medication on Outcomes Following Total Hip and Total Knee Arthroplasty

BackgroundNearly 20% of the US adult population lives with mental illness, and less than 50% of these receive treatment. Preoperative mental health may affect postoperative outcomes in patients undergoing total joint arthroplasty (TJA), yet is rarely addressed; poor outcomes increase the cost of care and burden on the healthcare system. This study examines the influence of patients with psychiatric diagnosis (PD) and taking psychotropic medication (PM) on emergency room visits, readmissions, and discharge disposition following TJA. MethodsSingle institution retrospective analysis of a consecutive series of 3020 primary TJA performed between January 2017 and June 2018. Chi-squared, t-tests, and analysis of variance were used to quantify differences between groups. ResultsNine hundred seventy-six (32.3%) patients had a PD, most had depression (10.1%), anxiety (8.6%), or both (8.4%); 808 (26.8%) patients were on PM. Patients with PD were more likely to experience emergency room visits (6.3% vs 10.0%, P = .034) and skilled nursing facility discharge (11.6% vs 17.9%, P = .005). Patients taking PM were more likely to experience skilled nursing facility discharge (12.4 vs 17.1, P = .047); those taking >2 PM had the highest rate (21.6%). ConclusionPatients with PD on or off PM may experience increased healthcare utilization in the postoperative period. Increased patient education and support may reduce these discrepancies. PD is not a deterrent for TJA, but targeted interventions should be developed to provide additional support where needed and avoid unnecessary utilization of resources.