Utilization Of Hospital Services Research Articles

Hospital admissions among patients with Comorbid Substance Use disorders: a secondary analysis of predictors from the NavSTAR Trial

BackgroundIndividuals with substance use disorders (SUDs) frequently use acute hospital services. The Navigation Services to Avoid Rehospitalization (NavSTAR) trial found that a patient navigation intervention for hospitalized patients with comorbid SUDs reduced subsequent inpatient admissions compared to treatment-as-usual (TAU).MethodsThis secondary analysis extends previous findings from the NavSTAR trial by examining whether selected patient characteristics independently predicted hospital service utilization and moderated the effect of the NavSTAR intervention. Participants were 400 medical/surgical hospital patients with comorbid SUDs. We analyzed 30- and 90-day inpatient readmissions (one or more readmissions) and cumulative incidence of inpatient admissions through 12 months using multivariable logistic and negative binomial regression, respectively.ResultsConsistent with primary findings and controlling for patient factors, NavSTAR participants were less likely than TAU participants to be readmitted within 30 (P = 0.001) and 90 (P = 0.03) days and had fewer total readmissions over 12 months (P = 0.008). Hospitalization in the previous year (P < 0.001) was associated with cumulative readmissions over 12 months, whereas Medicaid insurance (P = 0.03) and index diagnoses of infection (P = 0.001) and injuries, poisonings, or procedural complications (P = 0.004) were associated with fewer readmissions. None of the selected covariates moderated the effect of the NavSTAR intervention.ConclusionsPrevious findings showed that patient navigation could reduce repeat hospital admissions among patients with comorbid SUDs. Several patient factors were independently associated with readmission. Future research should investigate risk factors for hospital readmission among patients with comorbid SUDs to optimize interventions.Trial RegistrationNIH ClinicalTrials.gov NCT02599818, Registered November 9, 2015 https://classic.clinicaltrials.gov/ct2/show/NCT02599818.

Evaluation of a community-based brief intervention service for youth in crisis with suicidal ideation or self-harm.

To evaluate the implementation of a mixed virtual and in-person brief intervention for young people, aged 12-25 years, presenting to a large urban mental health service in crisis with suicidal ideation and/or self-harm. A pragmatic, real-world evaluation was conducted on the Youth Brief Intervention Service between June 2021 (inception) and October 2022. Service users were offered four sessions over an approximate one-month period. Sessions focused on distress tolerance, safety plans and support systems. Implementation outcomes related to service uptake, retention, fidelity of the model and service user experience. Effectiveness outcomes were measured pre-post and included mental health-related hospital service utilization (primary outcome), functioning, mental health status, self-harm, suicidal ideation and quality of life. Of the 136 young people referred to the Youth Brief Intervention Service, 99 were accepted with 17 disengaging before the first session. Eighty percent of people who commenced, completed the package of care. Young persons' and parent/carers experience of service was high (97% and 88%, respectively). Mental health-related emergency department presentations and inpatient days decreased from 3 months pre-intake to 3 months post-intake (42 vs. 7 presentations, X2 = 25.3, p < .001; 11 vs. 0 inpatient days, X2 = 9.1, p = .01). There were significant improvements in mental health status, days engaging in self-harm, general health and functioning and quality of life. The Youth Brief Intervention Service is feasible, acceptable, subjectively beneficial and coincided with less mental health-related emergency department presentations and inpatient days, and improved mental health status and behaviour.

The impact of COVID-19 on healthcare booking and cancellation patterns: time series analysis of private healthcare service utilisation in Finland

BackgroundCOVID-19 has had wide-reaching effects on healthcare services beyond the direct treatment of the pandemic. Most current studies have reported changes in realised service usage, but the dynamics of how patients engage with healthcare services are less well understood. We analysed the effects of COVID-19 on healthcare bookings and cancellations for various service channels between January 2020 and July 2021.MethodsOur data includes 7.3 million bookings, 11.0 million available appointments, and 405.1 thousand cancellations by 900.6 thousand individual patients between the ages of 18 and 65 years. The data were collected from electronic health record data, including laboratory and imaging services as well as inpatient stays, between January 2017 and July 2021. The patients were Finnish private and occupational healthcare customers in the capital region of Finland. We fitted an autoregressive moving average (ARIMA) model on data between 2017 and 2019 to predict the expected numbers of bookings, available appointments, and cancellations, which were compared to observed time series data between 2020 and 2021.ResultsUtilisation of physical, in-person primary care physician appointments decreased by up to 50% during the first 18 months of the pandemic. At the same time, digital care channels experienced a rapid, multi-fold increase in service usage. Simultaneously, the number of bookings for laboratory and imaging services decreased by 50% below the pre-pandemic projections. The number of specialist and hospital service bookings remained at the predicted level during the study period. Cancellations for most health services increased sharply by up to three times the pre-COVID levels during the first weeks of the pandemic but returned to the pre-pandemic levels for the rest of the study period.ConclusionsThe reduction in in-person appointments and the increase in the utilisation of digital services was likely a contributing factor in the decrease of the utilisation of diagnostic and imaging services throughout the study period. Utilisation of specialist care and hospital services were not affected. Cancellations contributed to the changes in service utilisation only during the first weeks of the pandemic.

Rising Inpatient Utilization and Costs of Cannabis Hyperemesis Syndrome Hospitalizations in Massachusetts After Cannabis Legalization.

We described the demographics, inpatient utilization, and cost of services among patients hospitalized for putative cannabinoid hyperemesis syndrome (CHS) predating and postdating cannabis legalization in Massachusetts. As the recreational use of cannabis has been widely legalized nationally, the resulting shifts in clinical presentation, health care utilization, and estimated costs of CHS hospitalizations remain unclear in the postlegalization era. We performed a retrospective cohort study among patients admitted to a large urban hospital between 2012 and 2021, before and after the date of cannabis legalization in Massachusetts (Dec 15, 2016). We examined the demographic and clinical characteristics of patients admitted for putative CHS, the utilization of hospital services, and estimated inpatient costs pre and postlegalization. We identified a significant increase in putative CHS hospitalizations pre and post-cannabis legalization in Massachusetts (0.1% vs 0.02% of total admissions per time period, P < 0.05). Across 72 CHS hospitalizations, patient demographics were similar pre and postlegalization. Hospital resource utilization increased postlegalization, with increased length of stay (3 d vs 1 d, P < 0.005), and need for antiemetics ( P < 0.05). Multivariate linear regression confirmed that postlegalization admissions were independently associated with increased length of stay ( Β = 5.35, P < 0.05). The mean cost of hospitalization was significantly higher postlegalization ($18,714 vs $7460, P < 0.0005), even after adjusting for medical inflation ($18,714 vs $8520, P < 0.001) with intravenous fluid administration and endoscopy costs increased ( P < 0.05). On multivariate linear regression, hospitalization for putative CHS during postlegalization predicted increased costs ( Β = 10,131.25, P < 0.05). In the postlegalization era of cannabis in Massachusetts, we found increased putative CHS hospitalizations, with a concomitant increased length of hospital stay and total cost per hospitalization. As cannabis use increases, the recognition and costs of its deleterious effects are necessary to incorporate into future clinical practice strategies and health policy.

Impact of non-participation bias due to psychiatric illness on mortality and cardiovascular event estimates: a Danish longitudinal population study

ObjectivesThe impact of non-participation due to psychiatric illness on study outcomes in general population studies is insufficiently investigated. Here, we investigate the mental health bias in a population study and...

Abstract NS9: Nurse-Led Quality Improvement Initiative: Advancing Stroke Awareness in Communities Experiencing Racial and Ethnic Disparities

Background and Purpose: As a Joint Commission Comprehensive Stroke Center, the provision of community education is a priority goal of our program. The majority of our existing community education program takes place in locations where we receive requests to provide these sessions. Analysis of our Get With the Guidelines (GWTG) data reveals gaps in early arrival to the hospital and Emergency Medical Service (EMS) utilization among African American and Hispanic populations. Providing educational resources within these populations may help to close these gaps and foster trust in the healthcare system. The aim of this proposed nurse-led quality improvement project is to improve hospital arrival times of African American and Hispanic stroke patients living in zip codes where GWTG data have identified gaps, through provision of targeted community education. Methods: The top zip codes associated with our target outcomes for improvement will be identified using GWTG pre-data from 2022 and 2023. We will partner with our Community Outreach department. We will identify educational venues and stakeholders among African American and Hispanic populations in these zip codes. We will provide education tailored to our identified populations including early recognition of stroke signs and symptoms, activation of EMS, stroke risk factors, and opportunities for treatment. Post implementation, GWTG data will be reviewed for any changes. Results: Using GWTG data, arrival mode, last known well time, and symptom discovery time to Emergency Department arrival as it pertains to zip codes, race and ethnicity will be reviewed and analyzed. The target zip codes’ data will be compared pre- versus post-implementation of community education efforts. Discussion: Through community education and partnership with the Community Outreach department we hope to improve timeliness of arrival to hospital among disproportionately affected racial minorities in our community for early stroke evaluation and treatment consideration.

A State-Wide Initiative to Improve Health System Responses to People With Borderline Personality Disorder Symptoms in Crisis: A Retrospective Audit.

Gold Card SA is a four-session structured psychological intervention offered soon after an acute crisis presentation to people with symptoms characteristic of borderline personality disorder. This study describes individual and system-level outcomes from a large-scale health-care improvement initiative to implement Gold Card SA across South Australia. An uncontrolled pre-post study design was utilized examining service user (n = 332) patient-reported outcome measures and hospital service utilization records (6 months before and after Gold Card SA). Mixed-effects negative binomial regression analysis revealed a significant decrease in rates of service utilization across emergency department presentations (63%), mental health-related inpatient admissions (65%), and bed days (82%). Linear mixed-effect regression indicated large reductions in borderline symptoms and nonspecific psychological distress, and small to moderate improvements in psychosocial functioning. People presenting with or experiencing borderline personality disorder symptoms may benefit from a brief crisis intervention embedded within a stepped care model.

Analysis of the current status and influencing factors of cross-regional hospitalization services utilization by basic medical insurance participants in China - taking a central province as an example.

The geographically uneven distribution of healthcare resources has resulted in a dramatic increase of cross-regional hospitalization services in China. The over-use of cross-regional hospitalization services may hinder the utilization and improvement of local hospitalization services. It is of great practical significance to study the utilization of cross-regional hospitalization services and its influencing factors in order to effectively allocate medical resources and guide patients to seek medical treatment rationally. Therefore, this study aims to analyze the current situation and influencing factors of the utilization of cross-regional hospitalization services by patients insured by basic medical insurance in China. A total of 3,291 cross-provincial inpatients were randomly selected in a central province of China in 2020. The level of medical institutions, hospitalization expenses and actual reimbursement rate were selected as indicators of hospitalization service utilization. Exploratory factor analysis was used to assess the dimensionality of influencing factors and reduce the number of variables, and binomial logistic regression analysis and multiple linear regression analysis to explore the influencing factors of the utilization of cross-regional hospitalization services. The proportion of cross-provincial inpatients choosing tertiary hospitals was the highest with average hospitalization expenses of 24,662 yuan and an actual reimbursement rate of 51.0% on average. Patients insured by Urban Employees' Basic Medical Insurance (UEBMI) were more frequently (92.9% vs. 88.5%) to choose tertiary hospitals than those insured by Urban and Rural Residents' Basic Medical Insurance (URRBMI), and their average hospitalization expenses (30,727 yuan) and actual reimbursement rate (68.2%) were relatively higher (p < 0.001). The factor "income and security," "convenience of medical treatment" and "disease severity" had significant effects on inpatients' selection of medical institution level, hospitalization expenses and actual reimbursement rate, while the factor "demographic characteristics" only had significant effects on hospitalization expenses and actual reimbursement rate. Cross-provincial inpatients choose tertiary hospitals more frequently, and their financial burdens of medical treatment are heavy. A variety of factors jointly affect the utilization of cross-provincial hospitalization services for insured patients. It is necessary to narrow down the gap of medical treatment between UEBMI and URRBMI patients, and make full use of high-quality medical resources across regions.

Racial Differences in Inpatient Hospital Services Utilization and Expenditure between American Indian and Alaska Native and non‐Hispanic White Older Adults with Dementia

AbstractBackgroundWhile American Indian and Alaska Native (AI/AN) and non‐Hispanic white (White) adults are at high risks for dementia, little is known about hospital utilization and expenditures among AI/ANs and Whites with dementia. The goal of this study is to examine characteristics associated with inpatient hospital services utilization and expenditures among AI/AN and White older adults with dementia, to understand what factors contribute to differences in utilization and expenditures between the two populations.MethodWe analyzed data on demographic characteristics, health coverage, chronic disease status, hospital utilization and expenditures from the CMS 2019 Medicare Master Beneficiary Summary File for all AI/AN (n = 16,324) and a 5% random sample of White (n = 139,335) adults aged ≥65 who had dementia in 2019. To examine associations between patient characteristics with utilization and expenditures, we employed Poisson and negative binomial models for utilization measures (1+ hospitalizations and number of inpatient hospital days) and a two‐part model (a gamma distribution with a log‐link function) for expenditures, while stratifying by race.ResultAI/AN adults were younger than White adults; a larger percentage were dually enrolled in Medicaid, had diabetes and ESRD, and lived in a rural county (p&lt;0.01). Medicaid coverage is associated with higher inpatient hospital days and expenditures among AI/ANs (Incidence Rate Ratio (IRR) = 1.079; Marginal Effect (ME) = $3,313, p&lt;0.01) but is associated with lower days and expenditures among Whites (IRR = 0.874; ME = ‐$1,438, p&lt;0.01). The association between living in a rural county with expenditures followed a pattern similar to that of Medicaid coverage. Unadjusted mean hospital days and expenditures were 4.84 and $27,559 (AI/ANs) and 3.86 and $23,009 (Whites), respectively. When data for AI/ANs and Whites were combined, the average marginal expenditure for AI/ANs, compared to Whites was $4,550 in unadjusted model, but reduced to $2,772 when we adjusted for age, gender, comorbidities, and social determinants of health.ConclusionUnderstanding and addressing characteristics associated with racial differences in hospital use and expenditures among dementia patients may be helpful for health care resource planning and efficient use. In‐depth research is required to understand the contrasting differences in the impact of Medicaid on expenditures between AI/AN and White adults with dementia.

Feasibility of Constructing an Interactive Mapping Tool to Visualize Sickle Cell Disease Geographic Distribution and Medical Care Utilization in the United States

Introduction: It is recognized that many people living with sickle cell disease (SCD) face significant structural obstacles to establishing and maintaining long-term hematology care. For example, some people with SCD care may lose access as a result of a geographic move; others may lose access by aging out of the pediatric care setting. These scenarios could be addressed by providing resources in areas with addressable populations and unmet medical need. However, deploying SCD treatment resources is frustrated by the lack of an established tool that can estimate the number of people living with SCD or gaps in services available in a given geography. We hypothesized that we could build a tool using a combination of publicly available demographic data combined with hospital claims data. Methods: Using CDC estimations for SCD affecting 1 in 365 African American and 1 in 16,300 Hispanic births, we estimated SCD prevalence based on data from the 2021 US Census, segmented by age, race, and county. We added a distinction between rural and urban counties using classification from the Consumer Financial Protection Bureau (CFPB), which designates rural counties as “a county that is neither in a metropolitan statistical area nor in a micropolitan statistical area that is adjacent to a metropolitan statistical area.”. PowerBI was used to generate a heat map to visualize the data at a state and county level, with the ability to filter by patient age and urban vs. rural designation. Finally, using hospital claims data for SCD “with crisis” (i.e., claims referencing ICD10 codes: D5700; D5701; D5702; D57211; D57212; D57219; D57811; D57812; D57819) and SCD “without crisis” (i.e., claims referencing ICD10 codes: D571; D5720; D5740; D5742; D5744; D5780), Pearson correlation was used to determine if an association existed between our estimated SCD prevalence and SCD related hospital claims for claim years 2021, 2022 and partial 2023. Results: Our model estimates a total of 127,297 people living with SCD in the United States, with 97% (123,454) being Black and 3% (3,843) being Hispanic (Table 1). 88% (111,977) were predicted to be under age 65, and 28% (35,675) were predicted to be under age 19. The majority (95%, 120,875) lived in urban counties. Most rural counties with SCD patients are located in the South and Southeast US (Figure 1). There was a strong positive correlation between our predictions of SCD prevalence at the state level and SCD-related hospital claims (coefficient of 0.903217 [95%CI: 0.944-0.836], p&amp;lt;0.001). For claim years 2021, 2022 and 2023 (partial) there were 1.6 claims per 1 SCD patient across the United States. While there were 1.6 claims per patient in urban counties, there were 0.7 claims per 1 patient in rural counties, consistent with a relative lack of access to care in rural areas compared to urban areas. Conclusions: Although not a direct measurement, and possibly overestimating the number of people &amp;gt;age65 living with SCD, our estimate suggests that there may be several thousand more people living with SCD than what is generally believed (100,000 per US CDC). Our estimates are partially validated by our finding that hospital claims data correlate strongly with our estimates of SCD prevalence at the state level. Although only a relatively small population of people living with SCD reside in rural counties, lower utilization of hospital services, as measured by hospital claims data, suggest that rural populations may have an unmet medical need that is particularly striking. Although working with claims data and disease estimates based on census data introduces significant limitations, it is feasible that this type of analysis could help to direct resources to areas with greatest unmet medical need.

Effect of virtual mind-body fitness program on reduction in unplanned hospitalizations among patients undergoing active cancer treatments: A pragmatic randomized clinical trial.

473 Background: Despite the inclusion of mind-body approaches, such as yoga, meditation, exercise, and music therapy, into various clinical guidelines for managing cancer-related symptoms, there is no scalable approach to integrate these guidelines into oncology care delivery. This study aimed to evaluate the effectiveness of Integrative Medicine at Home (IM@Home), a virtual mind-body fitness program, on unplanned hospitalizations and urgent care visits among patients undergoing active cancer treatment. Methods: We conducted a pragmatic randomized clinical trial using a novel basket study design among patients with a diagnosis of breast, thoracic, gynecological, head/neck, or melanoma cancer who reported moderate or greater fatigue while receiving active cancer treatment. Eligible participants were randomized to IM@Home (choice of 20+ weekly virtual live mind-body and fitness classes) or enhanced usual care (EUC; standard of care plus access to 20+ pre-recorded online meditation resources) and were on the study for 12 weeks. Utilization of hospital services over the study period was collected from electronic medical records and compared between arms. Results: Among 200 patients (mean age 59.9 years) 181 (90.5%) were female, 155 (77.5%) white, 18 (9.0%) Black, 14 (7.0%) Asian, and 178 (89.0%) non-Hispanic. 73 (36.5%) patients had breast, 49 (24.5%) thoracic, 43 (21.5%) gynecological, 25 (12.5%) head/neck, and 10 (5.0%) melanoma cancer. 99 patients were randomized to IM@Home and 101 to EUC. During the study period, patients in the IM@Home group were less likely to be hospitalized (5 [5.1%] vs. 14 [13.9%], p=0.034) and spent fewer days in the hospital (5.4 vs. 9.4 days per patient, p=0.009). The proportion of patients with urgent care visits was similar between the study arms (9 [9.1%] IM@Home vs. 12 [11.9%] EUC, p=0.52), but the number of urgent care visits per patients was almost half in IM@Home vs. in the EUC arm (rate ratio=0.52, 95% confidence interval: 0.26, 0.98). Conclusions: Participation in the virtual IM@Home program reduced unplanned hospitalizations, number of hospitalization days, and urgent care visits among people with cancer undergoing active treatment. Future research with long term follow-up is needed to determine whether IM@Home may be a scalable solution for implementing evidence-based mind-body fitness programing to improve patient survival outcomes and reduce health care costs. Clinical trial information: NCT05053230 .

The effect of Covid-19 pandemic on healthcare utilization in public vs private centers in Iran: a multiple group interrupted time-series analysis

BackgroundThe outbreak of Coronavirus in late 2019 and its continuation in the following years has affected all human societies, government organizations, and health systems. Access to health services is an important issue during crises. The present study aimed to investigate the effect of the Covid-19 pandemic on the consumption of health services in the public sector compared to the private sector in Iran.MethodsThe research population consisted of all insured individuals covered by Iran Health Insurance Organization in Fars province, which amounts to approximately 2,700,000 people. The required information including the utilization of laboratory, radiology, medicine, and hospitalization services was extracted on a monthly basis from February 2019 to February 2021. The Multiple Group Interrupted Time Series Analysis (MGITSA) was used for data analysis along with STATA.15 software.ResultsAccording to the findings of MGITSA, in the short-term, the utilization of private laboratory, radiology, medication, and hospital admissions had decreased by approximately 18,066, 8210, 135,445, and 1086 times, respectively (P < 0.05). In the long-run, the use of laboratory and radiology services had increased by about 2312 and 514 times (P < 0.05), respectively. The comparison between the public and private sectors showed that in the short-term, the use of radiology services decreased by about 12,525, while the use of medication increased by about 91,471 times (P < 0.05). In the long-run, the use of laboratory services decreased by about 1514 times (P = 0.076) and no change was observed in the other services utilization (in public relative to private centers).ConclusionsUtilization of health services in the public versus private centers, except for medication and hospitalization, significantly decreased in the short-term. However the utilization of most services returned to the usual trend in the long-term. The reduction in access to health services could impose a significant burden of various diseases, at least in the short-term, and increase health costs in the coming years.

Ablation of atrial fibrillation in an ambulatory outpatient setting.

The safety of atrial fibrillation (AF) ablation in an ambulatory outpatient center has not previously been reported. The aim of this study is to report the feasibility and safety of AF ablation in an ambulatory setting. We identified all AF ablations performed at the Alaska Heart and Vascular Institute's ambulatory center since program initiation to current day using billing records. Procedural complications, postoperative utilization of hospital services, and emergency room (ER) utilization were captured by chart review. A total of 476 patients underwent pulmonary vein isolation in the ambulatory setting over a 6.3-year period. Patients' average age was 58 ± 9.3 years, body mass index was 32.9 kg/m2, and the CHA2DS2-VASc (congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, prior stroke or transient ischemic attack or thromboembolism, vascular disease, age 65-74 years, sex category) score was 1.7. For 85%, this was the first AF ablation, and 55% had paroxysmal AF. Cryoablation was used in 85%. A combined primary safety outcome capturing potentially unstable perioperative safety events occurred in 1.5% of patients, all of whom were stabilized prior to hospital transfer. A total of 1.5% of patients required same-day hospital services, with another 1.5% returning to the ER within 24 hours. A total of 96% of patients did not require hospital services within 24 hours of ablation. The 30-day ER utilization was 13.7%, similar to published data of same-day discharge of AF ablation done in the hospital setting. There were no emergent cardiac surgical interventions and no mortality events. Catheter ablation for AF in the ambulatory setting is both feasible and safe in this large single-center experience. More studies are needed to confirm this next frontier in catheter ablation for AF.

The real world experience of pediatric primary hyperoxaluria patients in the PEDSnet clinical research network.

The rarity of primary hyperoxaluria (PH) challenges our understanding of the disease. The purpose of our study was to describe the course of clinical care in a United States cohort of PH pediatric patients, highlighting health service utilization. We performed a retrospective cohort study of PH patients < 18years old in the PEDSnet clinical research network from 2009 to 2021. Outcomes queried included diagnostic imaging and testing related to known organ involvement of PH, surgical and medical interventions specific to PH-related renal disease, and select PH-related hospital service utilization. Outcomes were evaluated relative to cohort entrance date (CED), defined as date of first PH-related diagnostic code. Thirty-three patients were identified: 23 with PH type 1; 4 with PH type 2; 6 with PH type 3. Median age at CED was 5.0years (IQR 1.4, 9.3years) with the majority being non-Hispanic white (73%) males (70%). Median follow-up between CED and most recent encounter was 5.1years (IQR 1.2, 6.8). Nephrology and Urology were the most common specialties involved in care, with low utilization of other sub-specialties (12%-36%). Most patients (82%) had diagnostic imaging used to evaluate kidney stones; 11 (33%) had studies of extra-renal involvement. Stone surgery was performed in 15 (46%) patients. Four patients (12%) required dialysis, begun in all prior to CED; four patients required renal or renal/liver transplant. Conclusion: In this large cohort of U.S. PH children, patients required heavy health care utilization with room for improvement in involving multi-disciplinary specialists. What is Known: • Primary hyperoxaluria (PH) is rare with significant implications on patient health.Typical involvement includes the kidneys; however, extra-renal manifestations occur. • Most large population studies describe clinical manifestations and involve registries. What is New: • We report the clinical journey, particularly related to diagnostic studies, interventions, multispecialty involvement, and hospital utilization, of a large cohort of PH pediatric patients in the PEDSnet clinical research network. • There are missed opportunities, particularly in that of specialty care, that could help in the diagnosis, treatment, and even prevention of known clinical manifestations.

Child Birth Practices and Utilization of Antenatal Care (ANC) Services Among Migrant Tribal Women in Urban Areas of Gujarat.

Tribal women constitute a vulnerable population and migratory tribal women living in urban areas are among the most vulnerable and neglected sections. The current study was conducted among migratory tribal women living in the urban areas of Gujarat to understand their antenatal care (ANC) and child birth practices. This was a community-based mixed methods study, conducted during 2022, in four major cities of Gujarat. The sample size for the quantitative study consisted of 592 participants. Inclusion criteria for participants were tribal women migrants to urban areas; migration for employment; less than a year of residence in the urban area; married women; and working on construction-sites. The qualitative study included 20 tribal women selected from cities and a total of 24 grassroots workers and in-depth interviews were conducted. The participating women were in the age group of 16-43 years, with mean age being 26 years. Almost 67 (11%) women were pregnant at the time of the study. Around 51% of the women had FOUR antenatal care (ANC) visits during their previous pregnancy. Around 63 (18%) women had home births. Qualitative data revealed that their deep-rooted cultural practices and beliefs influenced their ANC patterns, child birth practices, and utilization of hospital services. Migrant tribal women are considered a vulnerable population in urban areas, as they do not have local documents.Further, they are bound by deep-rooted cultural beliefs. There is a need to use technology for developing tracking systems, in order to provide better maternity care to these women.

Improving Health and Addressing Social Determinants of Health Through Hospital Partnerships.

Hospitals and health systems are forming partnerships to develop an integrated social network of services that better address the needs of their surrounding communities and their social determinants of health (SDOH). There is little research on the association of these partnered services with hospital outcomes. This study examined the association between hospital social need partnerships and activities to improve hospital and community outcomes. A secondary cross-sectional design to analyze 2021 census data of nonfederal short-term acute care hospitals in the United States was utilized. Data were obtained from the American Hospital Association. Four multilevel logistic regression models were used to analyze data from 1005 hospitals. The authors found that hospital partnership type differed in association to social need outcomes. They found that hospitals with a partnership with health insurance providers were more likely to have better health outcomes. Hospitals partnered with health insurance providers, local organizations addressing housing insecurity, local businesses, or chambers of commerce were more likely to have decreased health care costs. Hospitals partnered with health care providers, health insurance providers, local organizations providing legal assistance, or law enforcement/safety forces were more likely to have decreased utilization of hospital services. However, hospitals partnered with other local or state government or social service organizations were less likely to indicate decreased utilization of services. Many hospitals and health systems across the United States are screening for SDOH and are advancing health care delivery and improving the community's overall health and well-being by identifying unmet social needs and partnering with the community to address them.

Home-Based Primary Care for Older Adults: Matched Case-Control Evaluation of Program’s Impact on Healthcare Utilization

Home-based Primary Care (HBPC) is an alternative model for homebound older adults. Healthcare utilization in HBPC was evaluated with a matched case-control design. Medical providers and social workers provided in-home visits. Enrolled patients were matched to controls on age, prior hospitalizations, and frailty risk. Difference-in-differences in utilization of primary care, specialty, and hospital services between 1-year pre- and 1-year post-enrollment were evaluated with hierarchical linear models. Analyses included 117 HBPC cases and 328 controls. HBPC cases had a significant increase in primary care visits compared to controls (7.8 ± 0.6; p &lt; .0001) but significantly decreased utilization of in-clinic primary care visits (−3.2 ± 0.6; p &lt; .0001). In-clinic specialty visits and hospital services did not differ between cases and controls (all p’s ≥ .75). Homebound patients accessed high-touch primary and social care, which is typically unachievable in clinic settings; however, additional work is needed to optimize services and target in-home care to impact healthcare utilization.

Does increasing physician volume in primary healthcare facilities under the hierarchical medical system help reduce hospital service utilisation in China? A fixed-effects analysis using province-level panel data

ObjectiveTo examine whether increases in physician volume in primary healthcare facilities are associated with reduced utilisation of hospital outpatient and inpatient services after China facilitated the establishment of the hierarchical...

How Might We Have Known? Using Administrative Data to Predict 30-Day Hospital Readmission in Clients Receiving Home Care Services from 2018 to 2021.

Reducing hospital readmissions can improve individual health outcomes and lower system-level costs. This study aimed to understand the characteristics of home care Personal Support clients who experienced a hospital admission (ie, hospital hold) and to identify factors that predict hospital readmission within 30 days of resuming home care Personal Support services. We conducted a retrospective cohort study using client administrative data from a home healthcare provider organization (2018-2021). The sample included clients (⩾18 years) who received publicly funded Personal Support services and experienced a hospital hold. Descriptive statistics and a binary logistic regression model analyzed the relationship between demographics, hospital service utilization, home care service utilization, and contextual factors on the outcome of 30-day hospital readmission. Approximately 17% (n = 662) of all clients with a hospital hold (n = 3992) were readmitted to hospital within 30 days. Compared with non-readmitted clients, those with greater home care Personal Support service intensity after the index hospital hold were less likely to experience a hospital 30-day readmission. In contrast, those with greater acuity, higher assessed care needs, more hospital holds overall, more extended hospital stays (⩾2 weeks), and lower social support had a higher likelihood of 30-day hospital readmission. The findings from this study provide a greater understanding of factors associated with home care clients' risk of hospital readmission within 30 days and can be used to inform targeted, evidence-based support to reduce home care clients' hospital readmissions.

Psychiatric co-morbidity of drug-resistant epilepsy in Veterans

ObjectivePsychiatric conditions are frequently co-morbid in epilepsy and studies examining Veterans with epilepsy suggest this population may present with unique psychiatric and clinical features Drug-resistant epilepsy (DRE) may confer a greater risk of psychiatric dysfunction; however, there is a paucity of literature documenting this. To expand our clinical understanding of Veterans with DRE, we assessed a comprehensive Veterans Health Administration (VHA)-wide sample, describing psychiatric conditions, medications, and healthcare utilization. MethodsPsychiatric and hospitalization data were collected on 52,579 Veterans enrolled in VHA healthcare between FY2014-2ndQtr.FY2020 from the VHA Corporate Data Warehouse administrative data. Data examined include psychiatric diagnosis, psychotropic medication use, and utilization of hospital services. ResultsAt least one psychiatric diagnosis was present in 70.2% of patients, while 49.8% had two or more diagnoses. Depression (51.7%), posttraumatic stress disorder (PTSD) (38.8%), and anxiety (38.0%) represented the most common psychiatric co-morbidities. Psychiatric medication use was present in 73.3%. Emergency room (ER) visits were highest in those with suicidality (mean 14.9 visits), followed by bipolar disorder (10.3), and schizophrenia (12.1). Psychiatric-related hospitalizations were highest for schizophrenia (mean 2.5 admissions) and bipolar disorder (2.3). Females had more psychiatric diagnoses (2.4 vs. 1.6, p < 0.001), psychiatric medications (3.4 vs. 2.3, p < 0.001), and ER utilization than males (6.9 vs. 5.5, p < 0.001). SignificanceA substantial psychiatric burden exists among Veterans with DRE. Compared to prior epilepsy literature, results suggest that Veterans with DRE evidence more prevalent psychiatric comorbidity, emergency care usage, and inpatient psychiatric admissions. Females were especially impacted, with greater rates of psychiatric conditions and treatment. Considering the relationship of psychiatric comorbidities in epilepsy with psychosocial functioning and quality of life, our findings highlight the need for screening and provision of services for those with DRE.