Visit Data Research Articles

Seasonal Trends in Emergency Department Visits for Mental and Behavioral Health Conditions Among Children and Adolescents Aged 5-17 Years - United States, January 2018-June 2023.

Mental and behavioral health conditions among school-aged children, including substance use disorders and overall emotional well-being, are a public health concern in the United States. Timely data on seasonal patterns in child and adolescent conditions can guide optimal timing of prevention and intervention strategies. CDC examined emergency department (ED) visit data from the National Syndromic Surveillance Program for 25 distinct conditions during January 2018-June 2023 among U.S. children and adolescents aged 5-17 years, stratified by age group. Each year, during 2018-2023, among persons aged 10-14 and 15-17 years, the number and proportion of weekly ED visits for eight conditions increased in the fall school semester and remained elevated throughout the spring semester; ED visits were up to twice as high during school semesters compared with the summer period. Among children aged 5-9 years, the number and proportion of visits increased for five mental and behavioral health conditions. Seasonal increases in ED visits for some conditions among school-aged children warrant enhanced awareness about mental distress symptoms and the challenges and stressors in the school environment. Systemic changes that prioritize protective factors (e.g., physical activity; nutrition; sleep; social, community, or faith-based support; and inclusive school and community environments) and incorporate preparedness for increases in conditions during back-to-school planning might improve child and adolescent mental health.

Clinical characteristics of pathological confirmed prodromal dementia with Lewy bodies

IntroductionMisdiagnosis rate of Dementia with Lewy Bodies (DLB) remains high despite being second most common cause of neurodegenerative dementia. To date, understanding of clinical profile of pathologically confirmed prodromal DLB remains limited. The main objective of this study was to describe and compare it with pathologically confirmed Alzheimer's disease (AD). MethodsWe accessed the National Alzheimer's Coordinating Center database from 2005 to December 2022 data freeze and included 111 and 501 prodromal DLB and AD patients respectively. First visit data was analyzed. ResultsClinician-determined memory impairment is common in prodromal DLB (>70%) but associated with higher risk for AD diagnosis (OR 0.355, p = 0.0003). DLB had a higher proportion of non-amnestic mild cognitive impairment (MCI) diagnoses but statistically insignificance in differentiating the two. Inattention (OR 2.273, p = 0.0015), and neuropsychiatric features, such as visual hallucinations (OR 11.98, p < 0.0001), depressed mood (OR1.709, p = 0.0292), apathy (1.824, p = 0.0345), and night/REM sleep behaviors, are associated with DLB diagnosis. Hallucinations are infrequent (7–11%). Motor symptoms, particularly gait disorders (OR 4.570, p < 0.001), falls (OR3.939, p = 0.0003), tremors (OR2.237, p = 0.0154), slowness (OR3.573, p < 0.0001), and parkinsonism signs (OR2.443, p < 0.0001), are common. 32% showed no parkinsonism during initial presentation. Neuropsychological examination revealed less impaired memory and language but impaired executive function in DLB. ConclusionIn clinical practice, it is important to note that memory symptoms although being higher risk associated with AD diagnosis, are prominent in prodromal DLB. Psychosis is infrequent, and non-amnestic MCI is not necessarily associated with higher risk of DLB diagnosis. A careful clinical approach is key to improve the diagnosis of prodromal DLB.

Analyzing and Forecasting Pediatric Fever Clinic Visits in High Frequency Using Ensemble Time-Series Methods After the COVID-19 Pandemic in Hangzhou, China: Retrospective Study.

The COVID-19 pandemic has significantly altered the global health and medical landscape. In response to the outbreak, Chinese hospitals have established 24-hour fever clinics to serve patients with COVID-19. The emergence of these clinics and the impact of successive epidemics have led to a surge in visits, placing pressure on hospital resource allocation and scheduling. Therefore, accurate prediction of outpatient visits is essential for informed decision-making in hospital management. Hourly visits to fever clinics can be characterized as a long-sequence time series in high frequency, which also exhibits distinct patterns due to the particularity of pediatric treatment behavior in an epidemic context. This study aimed to build models to forecast fever clinic visit with outstanding prediction accuracy and robust generalization in forecast horizons. In addition, this study hopes to provide a research paradigm for time-series forecasting problems, which involves an exploratory analysis revealing data patterns before model development. An exploratory analysis, including graphical analysis, autocorrelation analysis, and seasonal-trend decomposition, was conducted to reveal the seasonality and structural patterns of the retrospective fever clinic visit data. The data were found to exhibit multiseasonality and nonlinearity. On the basis of these results, an ensemble of time-series analysis methods, including individual models and their combinations, was validated on the data set. Root mean square error and mean absolute error were used as accuracy metrics, with the cross-validation of rolling forecasting origin conducted across different forecast horizons. Hybrid models generally outperformed individual models across most forecast horizons. A novel model combination, the hybrid neural network autoregressive (NNAR)-seasonal and trend decomposition using Loess forecasting (STLF), was identified as the optimal model for our forecasting task, with the best performance in all accuracy metrics (root mean square error=20.1, mean absolute error=14.3) for the 15-days-ahead forecasts and an overall advantage for forecast horizons that were 1 to 30 days ahead. Although forecast accuracy tends to decline with an increasing forecast horizon, the hybrid NNAR-STLF model is applicable for short-, medium-, and long-term forecasts owing to its ability to fit multiseasonality (captured by the STLF component) and nonlinearity (captured by the NNAR component). The model identified in this study is also applicable to hospitals in other regions with similar epidemic outpatient configurations or forecasting tasks whose data conform to long-sequence time series in high frequency exhibiting multiseasonal and nonlinear patterns. However, as external variables and disruptive events were not accounted for, the model performance declined slightly following changes in the COVID-19 containment policy in China. Future work may seek to improve accuracy by incorporating external variables that characterize moving events or other factors as well as by adding data from different organizations to enhance algorithm generalization.

Predicting family physician physical activity electronic medical record inputs

ObjectiveTo compare characteristics of patients with and without physical activity noted in primary care electronic medical records. MethodsWe used pan-Canadian family physician electronic medical record data from the Canadian Primary Care Sentinel Surveillance Network (CPSSSN) to compare patient and provider characteristics on one visit per patient selected at random. Since patients were nested by providers, univariate statistics were explored then a multilevel model was constructed. ResultsThe dataset included 769,185 patients, of whom 14,828 (1.9%) had physical activity information documented. Male patients, aged 25–34.9, no comorbidities prior to the random visit date, moderate or elevated blood pressure risk categories prior to the random visit date, the least materially deprived quintile, and with median body mass index in the normal category prior to the random visit date had the most physical activity mentions. Of the 879 family physicians in the sample, just over half (56.1%) documented physical activity at least once across their patients. More female physicians and physicians who practised in academic sites documented physical activity. In a two-level logistic model to predict physical activity documented in the randomly selected visit: older than mean patient age, having fewer comorbidities, younger than mean family physician age, academic teaching sites, and electronic medical record systems were statistically significant covariates. ConclusionsThis work adds to existing literature by describing the frequency and the patient and family physician characteristics of physical activity documentation in the Canadian primary care context. Overall, patient physical activity was rarely documented in electronic medical records.

ANALYSIS OF DOMINANT RISK FACTORS FOR HYPERTENSIVE DISEASE

Background: Hypertension is a non-communicable disease with a high morbidity and mortality rate. This disease frequently triggers the iceberg phenomenon as numerous individuals remain unaware of the affliction. Aim: This study determines the most dominant risk factors for the incidence of hypertension. Methods: The quantitative study method used was conducted in September 2022. The study population utilized secondary data sourced from the Visit data at the Johar Baru Health Center in South Jakarta during 2021. The initial dataset consisted of 102,647 patients, out of which 13,946 had hypertension. Furthermore, data analysis involved employing the Chi-square test and Multiple Logistic Regression, with a significance level of 95%. Results: The Chi-Square test yielded significant results, indicating a relationship between risk factors for hypertension and seven out of the nine free variables examined. These variables included Body Mass Index (BMI) (p-value=0.000), excess salt consumption (p-value=0.000), underfeeding fruits and vegetables (p-value=.000), lack of physical activity (p-value=0.000), excess fat consumption (p-value=0.000), gender (p-value=0.000), and age (p-value=0.000), with a p-value of &lt;0.05. Meanwhile, smoking (p-value=0.516) and drinking alcohol (p-value=0.859) variables, with a p-value of &gt;0.05 had no relationship. Conclusion: The result showed that BMI was the most dominant risk factors for hypertension, with an OR of 1,610. Therefore, people with an abnormal BMI have a 1,610 times risk of developing hypertension.

Wastewater Surveillance Data as a Complement to Emergency Department Visit Data for Tracking Incidence of Influenza A and Respiratory Syncytial Virus - Wisconsin, August 2022-March 2023.

Wastewater surveillance has been used to assist public health authorities in tracking local transmission of SARS-CoV-2. The usefulness of wastewater surveillance to track community spread of other respiratory pathogens, including influenza virus and respiratory syncytial virus (RSV), is less clear. During the 2022-23 respiratory diseases season, concentrations of influenza A virus and RSV in wastewater samples in three major Wisconsin cities were compared with emergency department (ED) visits associated with these pathogens. In all three cities, higher concentrations of influenza A virus and RSV in wastewater were associated with higher numbers of associated ED visits (Kendall's tau range=0.50-0.63 for influenza-associated illness and 0.30-0.49 for RSV-associated illness). Detections of both influenza A virus and RSV in wastewater often preceded a rise in associated ED visits for each pathogen, and virus material remained detectable in wastewater for up to 3 months after pathogen-specific ED visits declined. These results demonstrate that wastewater surveillance has the potential to complement conventional methods of influenza and RSV surveillance, detecting viral signals earlier and for a longer duration than do clinical data. Continued use of wastewater surveillance as a supplement to established surveillance systems such as ED visits might improve local understanding and response to seasonal respiratory virus outbreaks.

School Attendance Following Receipt of Care From a School-Based Health Center

PurposeSchool-based health centers (SBHCs) may mitigate barriers to health care access and improve students' academic outcomes, but few studies test this hypothesis. We examined whether school attendance improved after students received care at an SBHC. MethodsWe conducted a secondary analysis of data from 17 SBHCs affiliated with a single large urban school district and demographic and attendance data from SBHC users (N = 14,030) and nonusers (N = 230,046) from August 2015–February 2020. We examined the percent of full school days present each month for three years before and after students' first SBHC visit and a proxy visit date for SBHC nonusers. Propensity weighted linear regression models tested whether visiting an SBHC was associated with a change in the attendance trajectory compared to a matched sample of SBHC nonusers. ResultsAmong SBHC users, attendance trajectories declined more steeply prior to their first SBHC visit than after the first visit (preslope −0.71%, postslope −0.05%), whereas SBHC nonusers had a similar attendance trajectory over the entire period (preslope −0.18%, postslope −0.17%), with difference-in-difference 0.65. Changes in trajectories were more pronounced for students with a mental health encounter. Prior to the first SBHC mental health visit, SBHC users displayed a marked decline in monthly attendance (preslope −1.02%). After the first mental health visit, attendance increased (postslope 1.44%), with difference-in-difference 2.33. DiscussionSBHC utilization was associated with improved school attendance over time, particularly for students with a mental health diagnosis. Investing in SBHCs may reduce school absenteeism and support student health.

Curating maternal, neonatal and child health (MNCH) datasets from a hospital’s catchment area in Nigeria between 2014 and 2019

In this Data Note, we present details regarding Maternal, Neonatal, and Child Health (MNCH) datasets sourced directly from patients' medical records. These datasets consist of 538 maternal, 720 neonatal, and 425 child records, all collected at St Luke’s General Hospital in Anua, Uyo, Nigeria, spanning from 2014 to 2019. Variables included in the datasets are: Maternal {patient number, date of visit, gender, age, class of patient, address, LGA, diagnose, symptom, prescription, blood pressure (mm Hg), temperature (degree centigrade), weight (Kg), latitude, longitude, elevation, (MSL), date record, GPS Accuracy (m)}; Neonatal {patient number, date of visit, gender, age, class of patient, address, LGA, symptom, health status, height (cm), weight (Kg), latitude, longitude, elevation (MSL), date record, GPS Accuracy (m)}; and Child Health {patient number, date of visit, gender, age, class of patient, address, LGA, diagnose, health history, temperature (degree centigrade), weight (Kg), latitude, longitude, elevation (MSL), date record, GPS accuracy (m)}. The purpose of sharing these datasets is to provide a resource for researchers interested in their potential reuse, whether for analysis, research, quality assurance, policy formulation, decision-making, patient safety, or other purposes. The datasets also include location information obtained through GPS (Global Positioning System) data from the study area, facilitating spatiotemporal analysis. We outline the methods used for curating the datasets, including the protocol for selecting and processing variables. To protect patient privacy, certain personal details such as names were replaced with unique patient numbers generated using Microsoft Excel. Furthermore, specific patient information, including addresses/locations, date of visit, latitude, longitude, elevation, and GPS accuracy, has been restricted for privacy reasons. Readers interested in accessing restricted data can make a formal request to the corresponding author (see data restriction statement). The curated datasets are available at the Open Science Framework.

TATA KELOLA REKAM MEDIS BERBASIS TEKNOLOGI INFORMASI DALAM MONITORING KUNJUNGAN PASIEN IGD DENGAN MENGGUNAKAN METODE AGILE

This study aims to simplify and expedite the processing of patient data, as well as the preparation of reports for officers. In addition, it aims to design an information system for emergency room patient visits to process patient data more quickly and effectively. This study employs a qualitative method with a descriptive approach. Data collection techniques include observation, interviews, and supplemented by literature study. The development method follows agile principles. The problems identified in this study are as follows: There is no information system for emergency patient visits, and the patient visit data for emergency departments are still being recorded using Microsoft Excel. With the implementation of this information system, officers can process patient data quickly and easily, as the computerized system is more organized and better integrated than before.

Longitudinal patterns of lifestyle risk behaviours among UK adults with established cardiovascular disease: a latent transition analysis.

People with cardiovascular disease (CVD) need to engage in healthy lifestyle behaviours. However, there is a gap in identifying longitudinal patterns of change in lifestyle behaviours among people with CVD. This study aimed to identify clustering of lifestyle risk behaviours and their 4 ± year changes among UK adults with CVD, and to determine the associated factors. We used the UK Biobank data collected at two time points (2006-2010/baseline data = T0 and 2014+/third visit data = T4). Six key lifestyle risk behaviours were assessed: smoking, high alcohol intake, poor fruit and vegetable consumption, physical inactivity, poor sleep balance (<7 or >8 h/night) and prolonged sitting. A random intercept latent transition analysis was performed to identify patterns of lifestyle risk behaviours at T0 and their changes from T0 to T4. We included 5,304 participants with CVD whose data on lifestyle risk behaviours were collected at two-time points. Alcohol intake and current smoking were 75.7% and 5.4% at baseline, respectively, and 67.4% and 3.0% at follow-up. Three latent classes emerged: Latent class (LC) 1-"high alcohol intake, poor sleep balance and poor fruit and vegetable intake", LC2-"high alcohol intake and poor fruit and vegetable intake", and LC3-"high alcohol intake". Most adults remained in the same LC over the 4 + years (range: 83.9%-100.0%). After 4 + years, 3.5% from LC3 and 10.4% from LC2 at baseline moved into LC1. The odds of transitioning to LC2 relative to staying in LC1 and LC3 were 2.22 and 4.13 times higher for males than for females, respectively. A single-year increase in participants' age was associated with a 1.16 times increase in the odds of moving to LC1 relative to staying in LC2. People with CVD did not show improvement in lifestyle risk behaviours, and interventions targeting multiple lifestyle risk behaviours are needed to improve CVD.

Is There an Association between Post-Traumatic Stress Disorder and the Incidence of Chronic Low Back Pain?

Preliminary research suggests post-traumatic stress disorder (PTSD) is a risk factor for chronic low back pain (CLBP). However, this literature displays some limitations. Therefore, this study aimed to investigate the association between PTSD and the 10-year cumulative incidence of CLBP in adults from Germany. The present retrospective cohort study included adults diagnosed with PTSD in 1 of 1284 general practices in Germany in 2005-2020 (index date). Individuals without PTSD were matched to those with PTSD (1:1) using a propensity score based on age, sex, index year, duration of follow-up, and the mean number of consultations during follow-up. In patients without PTSD, the index date was a randomly selected visit date. There were 60,664 patients included in the study. After adjusting for frequent comorbidities, there was a positive but non-significant association between PTSD and incident CLBP in the overall population (HR = 1.07, 95% CI = 0.99-1.15). Nonetheless, the relationship between PTSD and CLBP was statistically significant in the age group >60 years (HR = 1.24, 95% CI = 1.05-1.46). Conversely to previous research, PTSD was not associated with incident CLBP in this large German sample. Further longitudinal studies are warranted to corroborate these findings before drawing any firm conclusions.

Renal, cardiovascular, and respiratory outcomes associated with climate change

PurposeEnvironmental exposure such as declining air quality and increasing temperatures can exert detrimental effects on human health, including acute exacerbations of chronic diseases. We aim to investigate the association between these exposures and acute health outcomes in a rural Colorado community. MethodsMeteorological and adult emergency department (ED) visit data were retrospectively collected (2013–2017). Daily environmental exposure data included PM10, maximum daily temperature (MDT), and mean humidity and precipitation. Total daily counts of ED diagnoses for myocardial infarction, congestive heart failure, urolithiasis, and exacerbation of COPD and asthma, were calculated during the study period. Time series models using generalized estimating equations were fit for each disease and included all four environmental factors. ResultsBetween 2013 and 2017, asthma and COPD exacerbation accounted for 30.8% and 25.4% of all ED visits (n = 5113), respectively. We found that for every 5°C increase in MDT, the rate of urolithiasis visits increased by 13% (95% CI: 2%, 26%) and for every 10 μg/m3 increase in 3-day moving average PM10, the rate of urolithiasis visits increased by 7% (95% CI: 1%, 13%). The magnitude of association between 3-day moving average PM10 and rate of urolithiasis visits increased with increasing MDT. Associations between climate and other health outcomes were not statistically significant. ConclusionsThis retrospective study on ED visits is one of the first to investigate the impact of several environmental exposures on adverse health outcomes in a rural community. Research into mitigating the negative impacts of these environmental exposures on health outcomes is needed.

Long term clinical performance of 'open sandwich' and 'total-etch' Class II composite resin restorations showing proximal deterioration of glass-ionomer cement.

To compare clinical performance of resin composite posterior Class-II restorations placed with etch-and-rinse adhesive or open sandwich technique using glass-ionomer cement. Data on Class II restorations placed by one dentist between 1990 and 2016 were collected from patient files, including caries risk, tooth related variables, applied materials and dates of last check-up visit and restoration placement. Open sandwich restorations were placed before 2001, while after 2001, a total-etch technique using etch-and-rinse 3-step adhesive was used when placing a Class II composite restoration. For statistical analysis, Kaplan-Meier statistics and a multilevel Cox-Regression was conducted (p<0.05). Annual Failures Rates (AFR) were calculated. 675 Class II restorations were placed in 91 patients, 491 total-etch restorations (observation time 2-18y), and 184 open sandwich restorations (observation time 19-29y) showing AFRs at 15 years as 2.9% for total-etch and 9.7% for open sandwich restorations. Secondary caries as failure was equally distributed among the 2 groups and 27% of the failures in the open sandwich group were due to proximal deterioration of glass-ionomer cement. The Cox-regression showed a significant higher risk for failure for the open sandwich technique compared to total-etch class-II composite restorations (HR=2.9; p<0.001). Application of glass-ionomer cement using the open sandwich technique cannot be recommended for class-II restorations as being more complex and showing poorer clinical performance.

The impact of Medicaid expansion on mental health and substance use related inpatient visits.

Under the Affordable Care Act, many states expanded their Medicaid eligibility, allowing individuals living at or below 138% of the Federal Poverty Level to receive insurance coverage. As a result, forty states and the District of Columbia have expanded Medicaid to date. Although Medicaid expansion is expected to increase access to care in general, it is not evident if it has helped increase access to mental health and substance use-related healthcare, especially in inpatient settings. Therefore, this study examines the impact of Medicaid expansion on mental health and substance use- (MHSU) related inpatient visits and the variation in payer mix. This study utilizes state-level quarterly inpatient visit data from the Healthcare Cost and Utilization Project's Fast Stats Database from 2005 to 2019 and performs difference-in-differences regression analyses to compare MHSU-related inpatient visit data in expansion and non-expansion states for all visits and by payer. Analyses controlled for state-level socio-demographic and health policy variables. Findings indicate that Medicaid expansion did not significantly affect overall MHSU-related inpatient visits. However, Medicaid expansion was associated with 22.74% increase (P < 0.01; 95% CI: 17.76, 27.71) in the Medicaid share of MHSU-related inpatient visits, 18.31% reduction (P < 0.01; 95% CI: -22.54, -14.09) in the uninsured share of MHSU-related inpatient visits, and 4.42% reduction (P < 0.05; 95% CI: -7.83, -1.01) in the privately insured share of MHSU-related inpatient visits in expansion states compared with non-expansion states. Findings show that Medicaid expansion significantly affects the payer mix associated with MHSU-related inpatient visits while it has no significant impact on the overall MHSU-related inpatient visits.

Remission, response, retention and persistence to treatment with disease-modifying agents in patients with rheumatoid arthritis: a study of harmonised Swedish, Danish and Norwegian cohorts

ObjectivePrecision medicine in rheumatoid arthritis (RA) requires a good understanding of treatment outcomes and often collaborative efforts that call for data harmonisation. We aimed to describe how harmonisation across study...

Combining Register and Radiological Visits Data Allows to Reliably Identify Incident Wrist Fractures.

To evaluate how comprehensively wrist fractures can be tracked from the national medical registers, and to propose a method for complementing the register data using time stamps of wrist radiography visits recorded in the radiological image archive. For the Kuopio Osteoporosis Risk Factor and Prevention Study (OSTPRE) cohort of 14220 post-menopausal women, we analysed the data from the Care Register for Health Care, Register for Primary Health Care Visits, self-reports, radiological image archive PACS, and patient records to identify the wrist fractures occurred between 2011 and 2021. Using this gold standard of fractures, we validated the coverage of the registers and image archive and created algorithms to automatically identify fracture events from the registers and/or metadata of wrist radiography visits. We show that wrist fractures cannot be comprehensively identified based on national registers. To remedy this, our proposed method of combining register and image archive data can lift the coverage from 81% to 94% and reduce false discoveries from 6% to 2%. The proposed method offers a more reliable way of gathering fracture information. Comprehensive fracture identification is essential in many research settings, such as incidence statistics, prevention studies, and risk assessment models.

Desain Formulir Rekam Medis Di Bagian Pendaftaran Pada Kegiatan Khitanan Masal Al-Khitan Madinah Banjarmasin

In all health services it is mandatory to provide recording services medical records, as for the benefits of medical records, one of which is useful as written evidence of acts of service to a patient, too able to protect the legal interests of the patient concerned, hospitals and doctors and other health workers. Medical record is a file that contains notes and documents regarding patient identity, examination, treatment, actions, and services that have been given to patients. Al-Khitan Banjarmasin, which has been established since 2016, in every implementation of mass circumcision does not have a medical record form. The purpose of this study was to make a medical record form in the registration section of the Al-Khitan Medina Banjarmasin mass circumcision. This research method is a qualitative descriptive research. The subjects in this study consisted of the main informants who were registration officers of Al-Khitan Medina Banjarmasin, triangulation informants who were in charge of Al-Khitan Medina Banjarmasin, using observation and interview guide instruments. The data analysis technique is descriptive qualitative. The results of this study are the design of medical record forms that are made by taking into account the anatomical aspects, physical aspects and content aspects. The anatomical aspects of this design include the title of the form, the name of the circumcision house, Al-Khitan, Medina, Banjarmasin, the address of the circumcision house, no. medical record, introduction, basic information explaining the purpose of using the form in question, instructions containing clear instructions for fillers to write down patient data later. Physical aspects are made according to using black ink, white paper color, HVS paper material, A4 paper size, Aspects of the contents of the form are designed consisting of number, date of visit, history of illness, action, therapy/medicine, name and initials of the officer.

A mobile integrated health program for the management of undifferentiated acute complaints in older adults is safe and feasible.

Poor care access and lack of proper triage of medical complaints leads to inappropriate use of acute care resources. Mobile integrated health (MIH) programs may offer a solution by providing adaptable on-demand care. There is little information describing programs that manage undifferentiated complaints in the community. The objective of this study was to assess the safety and feasibility of an MIH program that responds to the community to manage medical complaints in older adults. This was a prospective observational study examining a pilot MIH program. Seven ambulatory clinics and their affiliated patients aged 65 and older were oriented to the program and invited to use its services. Visit and follow-up data for all patients who underwent an MIH visit were abstracted, along with 30-day follow-up information. All demographic data and outcomes were reported descriptively. In 21 months, 153 MIH visits were completed, involving 91 patients (mean age 81 years, 60.4% female). The most common chief complaints were generalized weakness (28.8%) and shortness of breath (18.9%). Electrocardiogram (57.5%) and point-of-care bloodwork (34.6%) were the most common diagnostic tests performed. Sixteen visits (10.4%) were followed by an emergency department (ED) visit within 72 h. In 11 encounters, the patient was referred to the ED; in five cases, the ED visit was unforeseen. Fifteen patients (9.8%) were admitted to the hospital after an MIH visit. There were two deaths within 30 days following an index visit. An MIH program designed to address the acute complaints of community-dwelling older adults was feasible and safe, with low rates of unforeseen emergency services utilizations. MIH programs have valuable diagnostic and therapeutic capabilities and may serve to help triage the acute medical needs of patients. Further study is required to validate the efficacy and cost-effectiveness of MIH programs.

The lifetime risk of developing type II diabetes in an urban community in Mumbai: findings from a ten-year retrospective cohort study

BackgroundIncidence and prevalence do not capture the risk of developing diabetes during a defined period and only limited evidence exists on the lifetime risk of diabetes based on longer and continuous follow-up studies in India. Lacunae in evidence on lifetime risk can be attributed primarily to the absence of comprehensive and reliable information on diabetes incidence, mortality rates and lack of longitudinal studies in India. In light of the scarcity of evidence in India, the objective of this study was to estimate the incidence of diabetes and its lifetime risk in an urban community of Mumbai.MethodsThe research study utilized data which is extracted from the electronic medical records of beneficiaries covered under the Contributory Health Service Scheme in Mumbai. The dataset included information on 1652 beneficiaries aged 40 years and above who were non-diabetic in 2011–2012, capturing their visit dates to medical center and corresponding laboratory test results over a span ten years from January, 2012- December, 2021. Survival analysis techniques are applied to estimate the incidence of diabetes. Subsequently, the remaining life years from the life table were utilized to estimate the lifetime risk of diabetes for each gender, stratified by age group.ResultsA total of 546 beneficiaries developed diabetes in ten years, yielding an unadjusted incidence rate of 5.3 cases per 1000 person-years (95% CI: 4.9- 5.8 cases/ 1000 person years). The age-adjusted lifetime risk of developing type II diabetes in this urban community is estimated to be 40.3%. Notably, males aged 40 years and above had 41.5% chances of developing diabetes in their lifetime as compared to females with a risk of 39.4%. Moreover, the remaining lifetime risk of diabetes decreased with advancing age, ranging from 26.4% among 40–44 years old to 4.2% among those age 70 years and above.ConclusionThe findings stress the significance of recognizing age specific lifetime risk and implementing early interventions to prevent or delay diabetes onset and to focus on diabetes management programs in India.

346. IMPACT OF VIRTUAL POST-OPERATIVE CARE ON ESOPHAGECTOMY PATIENTS DURING THE COVID-19 PANDEMIC

Abstract Background The SARS-CoV-2 pandemic has resulted in disruptions to oncology practices amongst healthcare institutions globally. To adapt, telehealth has been increasingly implemented into oncologic care, including that of esophageal cancer patients, which has been met with overall success. However, there remains a lack of evidence in the literature pertaining to the outcomes of virtual postoperative appointments for esophagectomy patients. Methods We conducted a retrospective cohort study to assess the clinical outcomes of esophageal cancer patients attending phone call follow-up (virtual) visits compared to standard in person care after esophagectomy. Demographic data, clinical and disease characteristics, and hospital visit data within 6 months of operation were collected. This included surgical clinic visits, endoscopies, and emergency room (ER) admissions. Results 168 esophagectomy patients underwent follow-up care between March 2020 to May 2022; 70 virtual and 98 in-person. Patients attending virtual appointments had significantly fewer ED admissions (−0.48, p = 0.005*, 95%CI [−0.80, −0.14]). Number of endoscopy visits (0.36, p = 0.110, 95%CI [−0.08, 0980]) and the number of clinic visits (0.42, p = 0.118, 95%CI [−0.11, 0.93]) were similar between the two cohorts. ER visits for virtual cohort included feeding tube complications (20.0%), dysphagia (20.0%), and abdominal pain (13.3%). For the in-person cohort, feeding tube complications (12.8%) and chest pain or cardiac features (9.3%) were the most common reasons. Conclusion The results of this study provide evidence for the increased use of telehealth following esophagectomy. The reduction in emergency admissions in the virtual cohort may be due to increased comfort with phone call appointments or increased fear of hospital visitation during the pandemic.