Visit Characteristics Research Articles

Patient compliance for metabolic evaluation and medical treatment (CoMET) in calcium-oxalate stone patients: prospective study by EULIS eCORE study group.

In this study, we aimed to identify the compliance rates of calcium-oxalate stone patients for metabolic evaluation, diet and medical treatment and also determine the factors that are associated with poor compliance rates. This study was conducted by the EULIS eCORE working group prospectively. In the initial visit, demographic and stone-related characteristics were recorded. Patients were suggested metabolic evaluation, dietary advices and medical treatment. Follow-up visit was performed after 3months and compliance rates were recorded. Logistic regression analysis was performed to determine factors associated with poor compliance to metabolic evaluation, diet and medical treatment. Data of 346 patients from nine centers were analyzed. Compliance rates were 71.7%, 65.3%, and 63.7% for metabolic evaluation, diet, and medical treatment, respectively. In multivariate analysis, level of education (p = 0.003), history of emergency department visit (p = 0.04), number of stone surgeries (p = 0.03), patient care in dedicated stone clinic (p = 0.03), and history of shock wave lithotripsy (p = 0.005) were detected as independent predictors of compliance to metabolic analysis. Level of education (p < 0.001) and history of emergency department visit (p = 0.01) were detected as independent predictors of patient compliance to diet. Number of stone episodes (p = 0.03), family history of stones (p = 0.02), and polypharmacy (p < 0.001) were detected as independent predictors of patient compliance to medical treatment. Patient compliance to metabolic evaluation, diet, and medical therapy is important for successful management of urolithiasis. Dietary advices and medications should be personalized by taking in to account the factors associated with poor compliance.

How do patients and care partners describe diagnostic uncertainty in an emergency department or urgent care setting?

Little is known about how patients perceive diagnostic uncertainty. We sought to understand how patients and care partners perceive uncertainty in an emergency or urgent care setting, where making a final diagnosis is often not possible. We administered a survey to a nationally representative panel on patient-reported diagnostic excellence in an emergency department or urgent care setting. The survey included items specific to perceived diagnostic excellence, visit characteristics, and demographics. We analyzed responses to two open-ended questions among those who reported uncertainty in the explanation they were given. Themes were identified using an inductive approach, and compared by whether respondents agreed or disagreed the explanation they were given was true. Of the 1,116 respondents, 106 (10 %) reported that the care team was not certain in the explanation of their health problem. Five themes were identified in the open-ended responses: poor communication (73 %), uncertainty made transparent (10 %), incorrect information provided (9 %), inadequate testing equipment (4 %), and unable to determine (4 %). Of the respondents who reported uncertainty, 21 % (n=22/106) reported the explanation of their problem given was not true. The findings of this analysis suggest that the majority of patients and their care partners do not equate uncertainty with a wrong explanation of their health problem, and that poor communication was the most commonly cited reason for perceived uncertainty.

80 Family Caregiver Emotional and Communication Needs in Canadian Paediatric Emergency Departments

Abstract Background Paediatric emergency departments (EDs) have been identified as inherently stressful for families, making it challenging to understand and meet families’ global needs, beyond urgent medical care. There is a paucity of research describing how effectively the emotional and communication needs of family caregivers are met during ED visits. Objectives To describe the extent to which family caregivers’ emotional and communication needs were met during paediatric ED visits and relate these findings to visit and demographic characteristics. Design/Methods Electronic surveys with medical record review were deployed at ten Canadian paediatric EDs from October 2018 – March 2020. A convenience sample of families with children &amp;lt;18 years presenting to a paediatric ED were enrolled, for one week every three months, for one year per site. Caregivers completed one survey in the ED and a follow-up survey, up to seven days post-visit. Results This study recruited 2005 caregivers who were mostly identified as mothers (74.3%, 1462/1969); mean age was 37.8 years (SD 7.7). 71.7% (1081/1507) of caregivers felt their emotional needs were met. Staff physicians (35.6% [535/1502]), bedside nurses (24.2% [364/1502]), residents/medical students (13.8% [207/1502]) and triage nurses (12.4% [186/1502]) were identified as providing the best emotional support to caregivers. 86.4% (1293/1496) identified communication with the doctor as good/very good and 83.4% (1249/1498) with their child’s nurse. Caregiver involvement in their child’s care was reported as good/very good 85.6% (1271/1485) of the time. 81.8% (1074/1313) of caregivers felt comfortable in caring for their child at home at the time of discharge. Greater triage acuity, being the father (vs. mother), lower caregiver anxiety, respect for the child’s privacy, caregiver involvement in their child’s care, satisfactory updates, and having questions adequately addressed positively impacted caregiver emotional needs. Caregivers feeling less scared during an ED visit, lower caregiver anxiety, caregiver involvement in their child’s care, satisfactory updates, and having questions adequately addressed increased caregiver comfort in caring for their child’s illness at home. Conclusion Approximately 30% of caregivers presenting to paediatric EDs have unmet emotional needs, over 15% have unmet communication needs, and 15% felt inadequately involved in their child’s care, challenging healthcare providers to do better. Family caregiver involvement in care and good communication from ED staff are key elements in improving overall patient experience and satisfaction.

52 An Evaluation of Satisfaction with Emergency Department Care in Children and Adolescents with Mental Health Concerns

Abstract Background Increasingly, the emergency department (ED) is a vital safety net for children and adolescents with mental health concerns seeking crisis care. Evaluating patient and parent/caregiver experience and satisfaction with care is essential to improve the quality of mental health services provided. Objectives The primary objective was to evaluate total satisfaction with the delivery of ED mental health care in two paediatric EDs in Alberta, Canada (Stollery Children's Hospital and Alberta Children's Hospital). Secondary objectives included exploring aspects of ED mental health care (staff interpersonal skills, confidentiality/privacy, and patient-reported outcomes of care) associations with general satisfaction, patient and ED visit characteristic associations with total satisfaction score, and care experience themes. Design/Methods We enrolled patients &amp;lt;18 years of age presenting with a mental health concern—e.g., anxiety, disruptive behaviour, self-harm, depression, situational crisis—over a 12-month period (February 1, 2020—January 31, 2021). Satisfaction data were collected using the Service Satisfaction Scale, which includes quantitative and qualitative data on aspects of ED mental health care. ED visit (length of stay, mental health and psychiatry consultations, hospital admission) and patient (discharge diagnoses, age, sex) data were collected. We evaluated associations of general satisfaction with ED mental health care using Pearson’s correlation coefficient tests, and associations between total satisfaction score with patient and ED visit characteristics using multivariable regression analyses. Inductive thematic analysis of qualitative feedback identified satisfaction and patient experience themes. Results 646 participants were enrolled with most being Caucasian (71.2%; 460/646) and female (56.3%; 364/646); the median age was 13 years (IQR, 11-15 years). The most common discharge diagnosis was anxiety or stress-related disorders (39.5%; 245/620). Parents/caregivers and adolescents were most satisfied with confidentiality and respect in the ED and least satisfied with how the ED services helped reduce symptoms and/or problems. Greater satisfaction was reported for parents/caregivers whose child received care at Alberta Children’s Hospital (p=0.003). General satisfaction was strongly associated with the perceived amount of help received in the ED (r=0.85). ED visit characteristics associated with total satisfaction score included an evaluation by a mental health team member (p=0.004) and psychiatrist consultation (p=0.05). Written comments demonstrated satisfaction with ED provider attitudes and interpersonal skills and dissatisfaction with access to mental health and addictions care, wait time, and COVID-19. Conclusion The results reflect the need to improve the satisfaction with ED mental health care delivery, with a particular focus on enhancing access to care by appropriate mental health providers.

Influence of Body Mass Index on the Evaluation and Management of Pediatric Abdominal Pain in the Emergency Department.

Introduction: Childhood obesity is a serious concern in the United States, with over one third of the pediatric population classified as obese. Abdominal pain is one of the most common chief complaints among pediatric emergency department (ED) visits. We hypothesized that overweight and obese children being evaluated in the ED for abdominal pain would have higher resource utilization than their normal and underweight peers. Methods: This was a retrospective review of pediatric patients <18years who presented with abdominal pain to the ED of a tertiary care center from January 1, 2014-September 3, 2020. Patients were excluded if they did not have both a height and weight recorded. We categorized patients as underweight (body mass index [BMI] <5th percentile); normal weight (BMI 5th to <85th percentile), overweight (BMI 85th to <95th percentile); or obese (BMI ≥95th percentile). Descriptive statistics were used to examine the study population. We used chi-square tests to examine the differences in patient characteristics between normal/underweight patients and overweight/obese patients. The Kruskal-Wallis test was completed for examining differences in the medians. We used multivariable logistic regression to examine visit characteristics associated with overweight/obese patients, including ED interventions, testing, and length of stay (LOS). Results: Of the 184 subjects included in the analysis, nine (4.9%) were underweight, 108 (58.7%) were normal weight, 21 (11.4%) were overweight, and 46 (25.0%) were obese. Patients with a BMI of ≥85th percentile were older (median 15 vs 13years, P = 0.01). They were otherwise similar in demographics. There was no significant difference between normal/underweight and overweight/obese subjects in disposition (37% vs 43% discharge, P = 0.38), 72-hour return (7% vs 6%, P = 0.82), ED LOS (median 4.42 vs 3.95 hours, P = 0.195), or inpatient LOS (median 42.0 vs 34.2 hours, P = 0.06). There were no statistically significant differences in total number of ED tests or interventions received by overweight/obese patients compared to normal/underweight patients, and each subject received a median of six tests (interquartile range [IQR] 4-7) and two interventions (IQR 1-3). Conclusion: Among pediatric patients presenting to the ED with abdominal pain, we found that patient characteristics and ED resource utilization (including testing, intervention, disposition, and LOS) did not differ significantly across BMI categories.

The Perpetual Pivot: Understanding Care Partner Experiences in Ontario Long-Term Care Homes during the COVID-19 Pandemic.

Long-term care homes (LTCHs) were impacted during the COVID-19 pandemic. With their ever-changing conditions and restrictions, care partners' roles in LTCHs changed drastically. In this cross-sectional study, an electronic survey was used to examine the experiences of care part-ners who were caring for one or more adults in an Ontario LTCH during the pandemic. The survey was circulated through social media (convenience sample) which produced a convenience sample of 81 caregiver participants. Visit characteristics and a comparison in the quality of care in LTCHs was analyzed before the pandemic as well as during the most restrictive times. Visitation lengths and frequencies, other sources of communication such as phone and video calls, and various types of care provided by caregivers such as personal grooming and personal care all decreased significantly during the pandemic. Care partners also reported that the health of their care recipients decreased significantly during restrictive visitation times. Through thematic analysis, we identified three themes: restrictions and changing LTCH conditions created (1) social isolation and an erosion of connection, (2) a communication breakdown, and (3) a lack of person-centered care. Findings from this research can promote the health and wellbeing of residents and care partners within LTCHs.

Bridging the Divide: Unintended Consequences of the Shift to Home-Based Telemedicine

ObjectiveTo evaluate the impact on healthcare access of the change in telemedicine delivery from a clinic-based model, in which patients connect with their healthcare provider from local telemedicine clinics, to a home-based model, in which patients independently connect from their homes. Study DesignIn this retrospective analysis, we compared relative uptake in telemedicine services in Period 1 (01/01/2019 – 03/15/2020, pre-pandemic, clinic-based model) versus Period 2 (03/16/2020 – 06/30/2022, home-based model) within a tertiary pediatric hospital system. Using multivariable logistic regression, we investigated the influence of telemedicine delivery model on patient sociodemographic characteristics of completed telemedicine visits. ResultsWe analyzed 400,539 patients with 1,406,961 completed outpatient encounters (52% White, 35% Black), of which 62,920 (4.5%) were telemedicine. In the clinic-based model (Period 1), underserved populations had greater likelihoods of accessing telemedicine: Hispanic ethnicity (odds ratio (OR)=1.41, p=0.028) vs reference group non-Hispanic, Medicaid (OR=2.62, p<0.001) vs private insurance, and low-income neighborhood (OR=3.40, p<0.001) vs medium-income. In aggregate, telemedicine utilization rapidly increased from Period 1 (1.5 encounters/day) to Period 2 (107.9 encounters/day). However, underserved populations saw less relative increase (Medicaid [OR=0.28, p<0.001], Hispanic [OR=0.53, p<0.001], low-income [OR=0.23, p<0.001]). ConclusionsWe observe that the clinic-based model offers more equitable access, while the home-based model offers more absolute access, suggesting that a hybrid model that offers both home-based and clinic-based services may result in more absolute and equitable access to telemedicine.

Racial Inequities in Police Transport for Patients to the Emergency Department: A Multicenter Analysis

Police involvement in patient transport to emergency medical care has increased over time, yet studies assessing racial inequities in transport are limited. This study evaluated the relationship between race and police transport to the emergency department for adult patients. This cross-sectional study evaluated adult (aged ≥18 years) visits at 13 different emergency departments across two regional hospital systems in the Southeastern and Northeastern U.S. from 2015 to 2022. Data were extracted from electronic health records. This analysis evaluated the association between race and transport by police transport using generalized linear multivariable mixed model with a binary logistic link for presence of police transport. Data were nested by patient and adjusted for site, demographics, and diagnostic visit characteristics. Of 4,291,809 adult emergency department visits, 25,901 (0.6%) involved transport by police. Of the 25,901 visits in police-involved encounters, 10,513 (40.6%) patients were Black, and 9,827 (37.9%) were White. The adjusted model showed that Black patients were at higher odds of transport by police than White patients (AOR=1.64; 95% CI=1.57-1.72). Male sex, younger age (18-35 years), history of behavioral health diagnosis, and emergency department psychiatric or substance use disorders were independently associated with increased odds of police transport. This analysis revealed racial inequities in police-involved transport to emergency medical care, highlighting an urgent need to evaluate drivers of inequities and the ways in which police transport influences clinical outcomes.

Stability of Suicide Risk Prediction Models During Changes in Health Care Delivery.

The authors aimed to use health records data to examine how the accuracy of statistical models predicting self-harm or suicide changed between 2015 and 2019, as health systems implemented suicide prevention programs. Data from four large health systems were used to identify specialty mental health visits by patients ages ≥11 years, assess 311 potential predictors of self-harm (including demographic characteristics, historical risk factors, and index visit characteristics), and ascertain fatal or nonfatal self-harm events over 90 days after each visit. New prediction models were developed with logistic regression with LASSO (least absolute shrinkage and selection operator) in random samples of visits (65%) from each calendar year and were validated in the remaining portion of the sample (35%). A model developed for visits from 2009 to mid-2015 showed similar classification performance and calibration accuracy in a new sample of about 13.1 million visits from late 2015 to 2019. Area under the receiver operating characteristic curve (AUC) ranged from 0.840 to 0.849 in the new sample, compared with 0.851 in the original sample. New models developed for each year for 2015-2019 had classification performance (AUC range 0.790-0.853), sensitivity, and positive predictive value similar to those of the previously developed model. Models selected similar predictors from 2015 to 2019, except for more frequent selection of depression questionnaire data in later years, when questionnaires were more frequently recorded. A self-harm prediction model developed with 2009-2015 visit data performed similarly when applied to 2015-2019 visits. New models did not yield superior performance or identify different predictors.

Changes in low-acuity patient volume in an emergency department after launching a walk-in clinic.

Unscheduled low-acuity care options are on the rise and are often expected to reduce emergency department (ED) visits. We opened an ED-staffed walk-in clinic (WIC) as an alternative care location for low-acuity patients at a time when ED visits exceeded facility capacity and the impending flu season was anticipated to increase visits further, and we assessed whether low-acuity ED patient visits decreased after opening the WIC. In this retrospective cohort study, we compared patient and clinical visit characteristics of the ED and WIC patients and conducted interrupted time-series analyses to quantify the impact of the WIC on low-acuity ED patient visit volume and the trend. There were 27,211 low-acuity ED visits (22.7% of total ED visits), and 7,058 patients seen in the WIC from February 26, 2018, to November 17, 2019. Low-acuity patient visits in the ED reduced significantly immediately after the WIC opened (P=0.01). In the subsequent months, however, patient volume trended back to pre-WIC volumes such that there was no significant impact at 6, 9, or 12 months (P=0.07). Had WIC patients been seen in the main ED, low-acuity volume would have been 27% of the total volume rather than the 22.7% that was observed. The WIC did not result in a sustained reduction in low-acuity patients in the main ED. However, it enabled emergency staff to see low-acuity patients in a lower resource setting during times when ED capacity was limited.

Predicting emergency department visits and hospitalizations for patients with heart failure in home healthcare using a time series risk model.

Little is known about proactive risk assessment concerning emergency department (ED) visits and hospitalizations in patients with heart failure (HF) who receive home healthcare (HHC) services. This study developed a time series risk model for predicting ED visits and hospitalizations in patients with HF using longitudinal electronic health record data. We also explored which data sources yield the best-performing models over various time windows. We used data collected from 9362 patients from a large HHC agency. We iteratively developed risk models using both structured (eg, standard assessment tools, vital signs, visit characteristics) and unstructured data (eg, clinical notes). Seven specific sets of variables included: (1) the Outcome and Assessment Information Set, (2) vital signs, (3) visit characteristics, (4) rule-based natural language processing-derived variables, (5) term frequency-inverse document frequency variables, (6) Bio-Clinical Bidirectional Encoder Representations from Transformers variables, and (7) topic modeling. Risk models were developed for 18 time windows (1-15, 30, 45, and 60days) before an ED visit or hospitalization. Risk prediction performances were compared using recall, precision, accuracy, F1, and area under the receiver operating curve (AUC). The best-performing model was built using a combination of all 7 sets of variables and the time window of 4days before an ED visit or hospitalization (AUC = 0.89 and F1 = 0.69). This prediction model suggests that HHC clinicians can identify patients with HF at risk for visiting the ED or hospitalization within 4days before the event, allowing for earlier targeted interventions.

Patient, Provider, and Practice Characteristics Predicting Use of Diagnostic Imaging in Primary Care: Cross-Sectional Data From the National Ambulatory Medical Care Survey

ObjectiveTo determine imaging utilization rates in outpatient primary care visits and factors influencing likelihood of imaging use. MethodsWe used 2013 to 2018 National Ambulatory Medical Care Survey cross-sectional data. All visits to primary care clinics during the study period were included in the sample. Descriptive statistics on visit characteristics including imaging utilization were calculated. Logistic regression analyses evaluated the influence of a variety of patient-, provider-, and practice-level variables on the odds of obtaining diagnostic imaging, further subdivided by modality (radiographs, CT, MRI, and ultrasound). The data’s survey weighting was accounted for to produce valid national-level estimates of imaging use for US office-based primary care visits. ResultsUsing survey weights, approximately 2.8 billion patient visits were included. Diagnostic imaging was ordered at 12.5% of visits with radiographs the most common (4.3%) and MRI the least common (0.8%). Imaging utilization was similar or greater among minority patients compared with White, non-Hispanic patients. Physician assistants used imaging at higher rates than physicians, in particular CT at 6.5% of visits compared with 0.7% for doctors of medicine and doctors of osteopathic medicine (odds ratio 5.67, 95% confidence interval 4.07-7.88). ConclusionDisparities in rates of imaging utilization for minorities seen in other health care settings were not present in this sample of primary care visits, supporting that access to primary care is a path to promote health equity. Higher rates of imaging utilization among advanced-level practitioners highlight an opportunity to evaluate imaging appropriateness and promote equitable, high-value imaging among all practitioners.

Utilization, Delivery, and Outcomes of Dance/Movement Therapy for Pediatric Oncology Patients and their Caregivers: A Retrospective Chart Review.

Children with cancer and their caregivers face physical and psychosocial challenges during and after treatment. Dance/movement therapy (DMT) has been used to improve well-being, promote healthy coping, and mitigate the impact of illness, but limited knowledge exists regarding DMT utilization, delivery, and outcomes in pediatric oncology. This retrospective study aimed to identify reasons for referral to DMT, DMT visit characteristics, key DMT techniques and processes, and clinician-reported outcomes. We examined the electronic medical records of 100 randomly selected pediatric patients (resulting in 1160 visits) who received DMT services between 2011 and 2021. Sociodemographic, clinical, and visit characteristics, referral reasons, and clinician-reported outcomes were reported as frequency and proportions. Qualitative thematic analysis was used to identify key DMT techniques and processes. Among 100 patients (63% female, aged 0-27 years), 77.9% were referred for psychological distress and 19.6% for pain. Two distinct DMT approaches were used during visits: a traditional DMT approach (77%) and a multisensory DMT approach (23%). The most common visit length was 15-25 min (41.6%), followed by sessions of 30-45 min (22.5%) and ≤10 min (18.1%). A total of 61.9% of DMT visits were inpatient and 38.1% outpatient. Of all visits, 8.8% were new and 91.2% were follow-ups. Caregivers were engaged in treatment in 43.7% of visits, and 5.5% of visits focused entirely on the work with the caregiver. DMT intervention focused on self-expression, emotional self-regulation, coping strategies, socialization, and caregiver-child interaction. Clinician-reported outcomes included enhanced coping with hospital experience (58%), improved pain management (27%), improved self-regulation (21%), and increased physical activation (13.2%). The results suggest DMT as a supportive intervention for psychological distress and pain management in pediatric oncology patients and provide insights into DMT practices and outcomes to guide intervention development and future research.

Paper 45: Which Osteochondritis Dissecans Subjects Will Heal Non-Operatively? An Application of Machine Learning Methods to the ROCK Cohort

Paper 45: Which Osteochondritis Dissecans Subjects Will Heal Non-Operatively? An Application of Machine Learning Methods to the ROCK Cohort

Patient and Visit Characteristics Associated With Otolaryngology Telemedicine Care.

Clinicians are increasingly adopting telemedicine in an effort to expand patient access and efficiently deliver care. The degree of health disparities among patients receiving otolaryngologic telemedical care is unclear. We performed a retrospective cross-sectional study to explore disparities in telemedicine delivery. We evaluated otolaryngology clinical visits from January 2019 to November 2022. We obtained patient demographics and visit characteristics (e.g., subspecialty, telemedicine vs in-person). Our primary outcome was demographic characteristics of otolaryngology patients who received telemedicine vs in-person care during the study timeframe. A total of 231,384 otolaryngology clinical visits were reviewed, of which 26,895 (11.6%) were telemedicine visits. Rhinology (36.5%) and facial plastics (28.4%) subspecialties performed the most telemedicine visits. On multivariate analysis, individuals who identified as Asian, non-English speaking, and with Medicare insurance were statistically significantly less likely to use telemedicine than in-person services. Our findings suggest that expanding telemedicine care may not improve access for all populations, and socioeconomic factors are important considerations to ensure patients are receiving equally accessible care. Futures studies are warranted to understand how these disparities may impact health outcomes and patient satisfaction with care.

Tourists’ Motivation in Wetland Destinations: Gornje Podunavlje Special Nature Reserve Case Study (Mura-Drava-Danube Transboundary Biosphere Reserve)

The main objectives of this research were twofold: firstly, to evaluate tourists’ perception of Gornje Podunavlje Special Nature Reserve, one of the four significant protected areas within the Serbian part of Mura-Drava-Danube Biosphere Reserve, and secondly, to identify the motivations behind tourists’ visits to wetlands and their overall satisfaction with the visits. In addition, this study was also focused on the relationships between aforementioned constructs and tourists’ socio-demographic characteristics and visit characteristics. Finally, this study attempts to address the relationships between tourists’ motives for their visit, their image perception and satisfaction. The research findings showed that each of the three remaining factors had significant relationships with Satisfaction and experience. The research was conducted in the form of the survey in the period between May 2020 and April 2022 on the sample of 216 visitors. The research findings showed that each of three remaining factors had significant relationships with Satisfaction and experience. Relationships are also found between identified improvement requirements, Motivation for spending time particularly in wetlands, and perceived biodiversity image. Finally, there are significant relationships between duration of the visit with Satisfaction and experience and Motivation for spending time in nature and future behavior. Practical implications of the research results might be beneficial for managers of wetland destinations, in order to improve the offer in line with tourists’ preferences.

Impact of the COVID-19 pandemic on medical-seeking behavior in older adults by comparing the presenting complaints of the emergency department visits

BackgroundThe outbreak of the coronavirus disease 2019 (COVID-19) has caused a catastrophic event worldwide. Since then, people’s way of living has changed in terms of personal behavior, social interaction, and medical-seeking behavior, including change of the emergency department (ED) visiting patterns. The objective of this study was to analyze the impact of the COVID-19 pandemic on the ED visiting patterns of the older people to explore its variable expression with the intention of ameliorating an effective and suitable response to public health emergencies.MethodsThis was a retrospective study conducted in three hospitals of the Cathay Health System in Taiwan. Patients aged ≥ 65 years who presented to the ED between January 21, 2020, and April 30, 2020 (pandemic stage), and between January 21, 2019, and April 30, 2019 (pre-pandemic stage) were enrolled in the study. Basic demographics, including visit characteristics, disposition, and chief complaints of the patients visiting the ED between these two periods of time, were compared and analyzed.ResultsA total of 16,655 older people were included in this study. A 20.91% reduction in ED older adult patient visits was noted during the pandemic period. During the pandemic, there was a decrease in ambulance use among elderly patients visiting the ED, with the proportion decreasing from 16.90 to 16.58%. Chief complaints of fever, upper respiratory infections, psychological and social problems increased, with incidence risk ratios (IRRs) of 1.12, 1.23, 1.25, and 5.2, respectively. Meanwhile, the incidence of both non-life-threatening and life-threatening complaints decreased, with IRRs of 0.72 and 0.83, respectively.ConclusionHealth education regarding life-threatening symptom signs among older adult patients and avocation of the proper timing to seek medical attention via ambulance were crucial issues during the pandemic.

Characterization of visits to the emergency room by patients with colorectal cancer in the year prior to their diagnosis: A retrospective study.

e15609 Background: Colorectal cancer (CRC) is one of the leading causes of cancer death globally, with more than 0.9 million deaths annually. Despite screening programs, many of the CRC patients (pts) are diagnosed at an advanced stage, resulting in an overall 5-year survival rate of only about 60%. Enhancing the detection of CRC in pts referred to the Emergency Room (ER) could potentially improve early detection and survival outcomes. While the prevalence of initial cancer diagnoses obtained through ER admission is documented, the proportion of individuals diagnosed with CRC who visited the ER during the year proceeding their diagnosis remains unknown. This study aimed to examine the percentage of CRC pts treated at Rabin Medical Center (RMC) who visited the ER in the year prior to diagnosis and to characterize these visits. Methods: A retrospective cohort study was conducted to identify pts diagnosed and treated at RMC for histologically confirmed CRC between 2012-2022 and to characterize their ER visits in the year prior to diagnosis. Each visit was recorded by date and the number of months before diagnosis. ER visits initiated for a recent diagnosis of CRC, i.e., occurring one month before diagnosis, were excluded. Demographic and clinical information (age at ER visit, gender, stage at diagnosis, number of visits, and interval between the first visit and diagnosis) was collected and analyzed. Results: Of the 2,240 pts treated for CRC at RMC between 2012-2022, 476 (21.2%) visited an ER, at RMC (13.3%) or elsewhere (7.9%), in the year prior to diagnosis. The median age at the first visit was 72 years (range: 25-96) and 55.7% were males. Pts were diagnosed with localized, locally advanced, and metastatic disease in 134 (45.0%), 70 (23.5%), and 63 (21.1%) cases, respectively, while stage was not yet established in 31 (10.4%). Quantitative and temporal characteristics of the ER visits are presented (Table 1). Pts had on average 1.6 visits (range: 1-11) in the year prior to diagnosis; 113 (37.9%) had 2 or more visits during that year. The median interval between the first ER visit and the CRC diagnosis was 4 months (range: 2-12); an interval of 5 months or longer was observed in 127 (42.6%) pts. Conclusions: To our knowledge, this is the first report on ER visits of CRC pts in the year prior to their diagnosis. The high percentage of pts visiting the ER highlights the importance of developing screening tools at the ER level to improve early detection and survival outcomes. This is further emphasized by prevalence of repeat ER visits and long interval between the first ER visit and the CRC diagnosis in many cases. [Table: see text]

Trends and characteristics of potentially preventable emergency department visits among patients with cancer in the US.

e13643 Background: An initial step to reducing emergency department (ED) visits among patients with cancer is to identify the characteristics of patients visiting the ED and examine which of those visits could be prevented. The objective of this study was to explore nationwide trends and characteristics of ED visits and examine factors associated with potentially preventable ED visits and unplanned hospitalizations among patients with cancer in the US. Methods: This cross-sectional study used data on ED visits from the National Hospital Ambulatory Medical Care Survey from January 1, 2012, to December 31, 2019; US Cancer Statistics reports were used to estimate new cancer cases each year. Frequencies and trends of ED visits by adult patients (aged ≥18 years) with cancer were calculated. The primary outcome was potentially preventable ED visits (using the Centers for Medicare &amp; Medicaid Services definition), and secondary outcomes were hospitalizations and the immediacy of the ED visits. Multivariable logistic regression analyses were performed to examine the associations of patient, hospital, and temporal factors with potentially preventable ED use and ED use resulting in hospitalization. Results: Among 854911106 ED visits, 35510014 (4.2%) were made by patients with cancer (mean [SD] age, 66.2 [16.2] years); of those, 55.2% of visits were among women, 73.2% were among non-Hispanic White individuals, 89.8% were among patients living in a private residence, and 54.3% were among Medicare enrollees. A total of 18 316 373 ED visits (51.6%) were identified as potentially preventable, and 5 770 571 visits (21.3%) were classified as high acuity. From 2012 to 2019, potentially preventable ED visits increased from 1 851 692 to 3 214 276. Pain (36.9%) was the most common reason for potentially preventable ED visits. The number of patients who visited an ED because of pain increased from 1 192 197 in 2012 to 2 405 849 in 2019 (a 101.8% increase). Overall, 28.9% of ED visits resulted in unplanned hospitalizations, which did not change significantly over time (from 32.2% in 2012 to 26.6% in 2019; P = .78 for trend). Factors such as residence in a nursing home (odds ratio, 1.73; 95% CI, 1.25-2.41) were positively associated with having a potentially preventable ED visit, and factors such as the presence of more than 1 comorbidity (odds ratio, 1.82; 95% CI, 1.43-2.32) were positively associated with having an unplanned hospitalization. Conclusions: In this study, 51.6% of ED visits among patients with cancer were identified as potentially preventable, and the absolute number of potentially preventable ED visits increased substantially between 2012 and 2019. These findings highlight the need for cancer care programs to implement evidence-based interventions to better manage cancer treatment complications, such as uncontrolled pain, in outpatient and ambulatory settings.

Association Between Capitated Payments and Preventive Care Among U.S. Adults

There is increasing interest in using capitation rather than fee for service to promote primary care and population health. The goal of this study was to examine the association between practice reimbursement mix (majority fee for service versus majority capitation versus other) and receipt of common preventive screening examinations and health counseling from 2012 to 2018. Using the National Ambulatory Medical Care Survey, a retrospective cross-sectional study of 24,864 visits with primary care clinicians among patients aged 18-75 years without a cancer diagnosis was conducted. The main dependent measures were age- and sex-appropriate receipt of breast cancer screening, osteoporosis screening, cervical cancer screening, chlamydia testing, colon cancer screening, diabetes screening, and hyperlipidemia screening as well as 3 health counseling items. Multivariable logistic regression was performed to assess the association between reimbursement mix and receipt of preventive care, adjusted for patient, visit, and practice characteristics. Majority capitation reimbursement was associated with a greater likelihood of receiving breast cancer screening (AOR=2.11, 95% CI=1.16, 3.84, p=0.014) and osteoporosis screening (AOR=4.34, 95% CI=1.74, 10.8, p=0.0017) than majority fee-for-service or other reimbursement mixes. Reimbursement mix was not associated with the likelihood of receiving 9 other preventive care or health counseling services. Larger amounts of capitation reimbursement may improve some but not all aspects of preventive care compared with fee for service.